An enigma, wrapped up in a puzzle, wrapped up in a conundrum

I ran w/MedicJon ("Hazbulance") Sun. and we ran a doozy of a call (as you can surely tell by the title of this post).
We got a call for an Unconscious at a nearby hotel. We get there and find a lady who is semi-conscious, laying on the bathroom floor in a pool of her own urine. The type of semi-consciousness we witnessed would not be inconsistent w/someone who had low blood sugar or was postictal, or maybe had ODed on Opiates. There was Insulin and liquid Methadone in the hotel room. Her blood sugar was normal so we pretty much put our stock in the Opiates.
We dragged her out of the bathroom and loaded her up on our cot. She was with it enough to swat at us w/her arms, but not w/any accuracy. She was also, for all intents and purposes, non-communicative.
Once in the back of the unit, I started an IV, and this chick had crap for veins. This further pushed us down the Opiates trail. I got one in (Supah-stah!), but I had to float it, and leave the catheter part of the way out. It was tenuous at best, and on top of that, I had to hold her arm straight for it to work. She fought the IV a bit, to be expected. I held her arm while Jon pushed 1mg of Narcan. I kept the IV flowing, but not too much longer after that. As we're waiting for the Narcan to take effect, her respiratory effort was getting less and less. I said something to that effect, and asked how long we should wait for it to work. Before we could really decide, she was nearly apneic, so Jon laid the head of the cot down and we called for the Engine Co. to come back-things like this never happen before we release them, dontchaknow.
Well, of course her jaw was clenched, and her two front snaggle teeth securely clamped down over her bottom lip. So, Jon wrenched an OP airway in her and started bagging while I went for an EJ. She had a pretty one, until I went for it... then it magically disappeared. Doh! By this time, we've pulled a driver off the Engine and are headed to the ER. Calls like this make you grateful for a short transport time.
Jon gave her another mg of Narcan IM (that never did anything either), then he and I switched seats so he could make a couple more attempts at a patent IV, but no luck. I was not getting really good compliance bagging, but it was the best we could do. We showed up at the ER w/a respiratory arrest, no line, no tube. Fan-freakin'-tastic.
We transfer her over to their stretcher, and I tell our Asst. OMD that they'll probably have to put in a central line. He kinda pooh-pooh's that, but I ended up being right. Took 'em 3 tries, too. I felt like even more of a rock star, then. =) They also got her intubated. 'Round about the time they'd blown both femoral line attempts and they were poking her subclavian area, she up and went into VTach... then VFib. I hate it when that happens!
Jon and I stood by/assisted while they worked her for a good 40-60 mins. (I'm guess-timating) I mostly felt in the way, but Jon was doing some damn fine compressions with one hand. His turn to be the rock star!
The staff threw everything in the book at this lady, and nothing was happening. We were all ready to throw in the towel when she suddenly developed a perfusing rhythm again. The Primary RN was trying to figure out what rhythm to chart and Jon said "UFB". Can I get an Amen?
Well, we never did figure out what her underlying problem was. She had a bad case of metabolic acidosis, but more so than a witnessed, agressively-worked arrest would cause. She was on her 3rd amp of Bicarb, but had a serum Bicarb of 10, Ph of 7. They were talking about starting a Bicarb drip by the time we finished all our paperwork and were ready to head out. Her other labs were remarkably unremarkable, esp. for a person who had died.
We left the ER and immediately got punched for seizures way down on the Interstate, so we ran down there, picked up the postictal patient, and ran him in. When we dropped him off, I asked the Primary RN how our lady was doing, and her words were "She's hanging on by a thread." The RT told me her lungs were full since all told, she'd gotten like 3L of NSS, and the woman barely weighed over 100lbs. Whoops!
Real interesting call. Plus, we had fun. A good day in all!

Why I Volunteer

Recent posts from DTXMATT12 and MedicChris have inspired me to tell my own story. It's long and complicated, but I will try and keep it as condensed as possible.
My mom is an RN. I've always had an interest in medicine. I had the "Visible Man" puzzle/model, I took apart my "Stretch Armstrong" doll, I watched "Emergency!" and I played "Operation". There was a theme early on!
In High School, I took a Sports Medicine class, and it was hands-down my favorite elective ever. The teacher taught us CPR (I've been certified ever since, 20+ years), and encouraged us to do ride-alongs w/EMS. This was the first time I expressed interest in being an EMT. Later on in High School, I got rather sidetracked with a misspent youth, and didn't get back around to the interest for another 10 years.
In my early 20's, I developed a life-threatening Thyroid condition. Between that experience and my best friend dying some years later, I decided it was finally time to pursue my interest. I just happened to live within walking distance of the station where I've now been assigned for 10 years, so I went down one Friday evening and signed-up. My whole life changed.
Due to scheduling, I didn't actually start EMT class till I'd been a member of the VFD for 3 months. In that time, I got my other courses out of the way, and became an Ambulance Driver (really-that's all I was at the time).
Once I got into EMT class, I moved away from the county where I volunteer, and haven't lived there since. I was working full-time in the Publishing industry and traveling 70 miles round-trip two nights a week to class. I was definitely serious about it! I remember when I took my exam, a Medic named Tim that I admired very much was the Examiner at my Trauma station. When I went a smidge over 10 minutes and failed, I was outside the Academy crying. He saw me. I almost died. But, he was kind, told me to stop crying, go back and re-test, and that I'd pass. I did just those things.
For the next 4 years, I ran as an EMT-B w/the VFD and kept my Publishing career going. Then I decided to become a Medic. I started classes at GWU, and that experience also changed my life.
I went through the pilot program for EMT-Intermediate in our state. Believe me, the fact that it was a pilot program was obvious. It was a big CF. We had 8 different textbooks, a number of instructors pretty close to 20, and every one of them contradicted each-other. It was so much harder than it had to be! Between the difficulty, the time commitment, and my tendency to be a perfectionist, I thought I was going to have a nervous breakdown. But, I prevailed again. Out of 5 people in the class from my Dept., I was one of only 2 who passed the National Registry the first time.
Becoming a Medic (in VA, I and P are no different, which is why I call myself a Medic and not a Paramedic) changed me in a more profound way. I decided to give up my successful career in Publishing and work in Healthcare full-time. I accepted a job at a brand-new, free-standing, full-service ER. I still work there today. I credit the job for outrageous amount of clinical experience and knowledge it gave me every single shift for getting me through my Internship as a Medic quicker than anyone else from our class. I also credit my Preceptor, Leon-what an amazing person! He's been a Medic over 20 years, and is the most laid-back guy. He helped counter my borderline OCD, thankfully.
The family atmosphere that DTXMATT12 and MedicChris speak of was not a reality for me until about the time I became a Medic. I developed a few friendships in the Dept., and along the way I even fell in love with my partner (now my spouse). But those family-like bonds were not something I truly understood until I was finished with my Internship and had to rely very heavily on the Engine Co. at our station. The I/O on the Engine became like a father to me. He was on my first ever duty crew, as was the DPO, who I also became close with. There was one guy who was the younger brother of another who I'd befriended in the past, and I got to know him well, too. It was just me, my current spouse, and those three guys most days. The week after I finished my Internship, I was on my own-Leon was sent elsewhere. I was so vulnerable that I quickly forged those bonds that mostly eluded me in the past.
Becoming a Medic also helped me understand other Medics better. Class is like a Rite of Passage, and finishing is like entering into an exclusive club. You speak the same language, and have shared experiences that really, no one else can totally understand. EMS in general is pretty unique, as I'm sure Fire Fighting is (although I don't know that for sure-not my cup of tea).
Why am I not a member of a paid FD? Well, I have a lot of physical shortcomings when it comes to the street. I'm better off in an environment where I'm not as physically taxed, and don't have to work 24-hour shifts. I'm the first to admit I can't hack it out there on a full-time basis. I don't know how anyone could do that til they retire. I'm not even 40 yet and the thought of a 24 makes me want to go take a nap. So, I'm a wussy. But, I know my shortcomings, and in EMS, there is no room for ego. I'd just be a burden to myself, my colleagues and my patients, and that's the last thing I ever want to do.
I love my job, I love my volunteer work and the extended family that goes with it. I never regret taking a 50% pay cut to change careers, even when the bills come. I know I'm doing something important, and I'm proud of myself. I've got confidence I never had until I started this journey.
Here's to another 10 years w/the VFD-with it will come Life Membership, and no more working BINGO! =)