The Devil's Hour

4 AM is the Devil’s Hour. I’m convinced.

Nothing good happens at 4 am. If you get woken up for a call at 3 am, it’s just a really late night. Often times, you’re still up. If you get a call at 5 am, it’s just a really early morning. That’s close to when I wake up for work anyway. No problem. But 4 am… of our 24 hour shift, it is the absolute worst hour. Here’s why:

When we get woken up at the station for a call, we have 60 seconds from the time of the call to get our uniform on, grab any gear, run down the stairs, through the parking lot, and get on the radio in our ambulances. This means during the night, you go from complete shut down to adrenaline fueled driving with screaming sirens in 1 MINUTE.

Often times, this isn’t that hard as we’re used to it, but at 4 am, good grief. Somehow, right at 4, I am always at the deepest part of my REM cycle sleep and thus it is the hardest to pull out of. It’s the type of awakening that leaves you confused and with a headache at first. Of course, at this point you’re also hungry and have to pee. Badly. But there’s no time for that.

Next is the type of calls we get at 4 am. They are always one of two types of calls. Absolute BS, or Horrible Trauma. For some reason, there’s seems to be no in between.

Absolute BS: When awoken at such an hour, it’s always for “Toe Pain” (Yes, these are actual reasons people call 911). I had a buddy once get a call for a woman who had a nightmare. It’s often chronic pain problems like back pain. When I ask, “Ma’am, how long have you had this back pain?”, they often answer “3 days”. SO WHY DID YOU WAIT TIL 4AM TODAY TO CALL?? Whatever the complaint is, foot pain, anxiety, being cold (we gave her a blanket), or a combative crack whore threatening to slit my throat (did not give her a blanket), it is almost never reason to call 911. It’s basically adding insult to injury for us.

Horrible Trauma: The other half of the time, it’s for some absolutely crazy call. Guns shots, brutal beatings, or multi casualty incidents. My partner and I once ran a traffic collision call on the 405 south. We came around the bend in the freeway to find two wrecked cars, one completely engulfed in flame, and a woman on the ground with a broken back. It was a chaotic scene of screams and wreckage. We got the call at exactly 4 am. The worst call my partner ever ran was a head on suicide collision on PCH, where one party had to be airlifted out and the suicidal driver burned to death. 4 am. My partner still has flashbacks at times and remembers the horrible smell of charred flesh.

Now, I am not suggesting that the devil himself has the rights to one hour of our night. It’s just an expression. But if he did, by God, it would be 4 am.

Am I Going To Die?

I’ve had a Patient ask me so many times “Am I going to die?” Do they really think an EMT or Paramedic would ever respond, “Yes. You’re going to die”. Of course not, yet they keep asking.

What possible scenario could exist where the emergency responder would reply with anything other than “No, you’re not going to die.” What are we going to say? “Yeah, sorry about this, but you’ve only got a few moments left to live. You better make some phone calls.” There is not a single scenario where they would ever say “Yes.”

This question is ridiculous for two reasons.

1. If you are asking if you’re going to live, you are TALKING and thus are conscious and relatively okay. The very fact that you are able to form this morbid thought and then articulate it means your brain and vital organs are functioning adequately and you are in good shape. The ones who are actually in danger of biting it are those who are unconscious, and thus do not speak.

2. If you are asking this absurd question to me, an EMT, it means you or someone has already activated the 911 system and you are getting help as we speak. You’d only be in danger when you’re conscious if you were in the middle of nowhere or alone and could circle the drain over a long period of time. Your 127 HOURS survival scenario.

So in short, if you’re talking (not unconscious or altered) and you’re talking to me (someone who is currently taking you to an emergency room) you are FINE.

This rule also applies to “Am I going to be okay?”. Of course you are. And even if you somehow weren’t, would I really say, “Naw, you’re Effed.” ?

The reality is, people just want the comfort of hearing us say “You’re going to be alright”. And I get that. But when you call 911 for nausea/vomiting, get over yourself. You’re fine.

So in short, if you are ever having a medical emergency, CALM DOWN. It’s the best thing for you and for us.

Shock To The Heart

Ever seen someone get shocked while still conscious? Neither had I.

I recently ran a call on a 30-year-old woman who was having chest pain. She was Indian and there was a language barrier. We tried getting the story from the husband, but he was little help. Her vitals were good and we couldn’t figure out why she was in such distress. Her clinic “doctor” had diagnosed her with anxiety the night before, so perhaps this was emotional.

We got her into the ambulance and put her on an EKG heart monitor, at which point we realized she had an outrageously high pulse rate of 200 beats per minute. The firefighter on scene had taken a horribly inaccurate pulse. This was the highest pulse rate I’ve ever seen on a patient. Her heart was beating out of her chest and the monitor just showed scribbled lines. We all kicked into high gear.

On this day I was driving the rig and the medic in the back was unable to get an IV line on her to give her drugs to slow her dangerously high heart rate down. It was at this point that I heard him say,

“I can’t get a line, so… really push it”.

It my entire time as an EMT, I have NEVER had a medic tell me to drive faster. But the reality was, we couldn’t slow her heart in the field and any minute her heart could give up and stop.

If you think you’ve got road rage, try driving an ambulance during rush hour. Every lane is blocked; people are idiots on the road and get in your way. I hauled with screaming sirens, opposing traffic and swerving around cars. I kept hearing “we’re almost at the hospital. Just hang on”. This poor woman was about to go into cardiac arrest.

For some reason, this was more nerve-racking than someone who is already in full arrest. A full arrest patient is already technically dead, and you’re trying to bring them back, but when someone is on the verge, or circling the drain, it’s all on you. It takes a lot to get my adrenaline going these days, but this certainly did it.

Once we got her to the hospital, the doctors immediately tried giving her drugs, but they didn’t slow her heart. They only had one last resort left. They had to shock her heart to restart it. The trouble was, she was still conscious. I’ve only seen this done on people who are unconscious.

Everyone stood back and the doctor told her, “Ma’am, you’re going to feel a shock.” 

Yeah,.. I’ll say. As the charging sound rang, I didn’t know what kind of reaction to expect. What followed almost made me burst out laughing in the room. I know, terrible, right? The woman reacted like a confused drunk who has a huge hiccup. Her upper body jumped, and she wearily faded back with a priceless look of confusion on her face. And boom, her heart restarted itself back to a healthy rate of 104 bpm.

Turns out the woman was having a heart attack, and shocking her saved her life. Still, I’d never want to be awake for that.

Combative Patients

I get paid to fight people. It’s one of the perks of the job. Not because I like hurting people, but rather it’s excellent practice for if you are in a situation where you need to.

Many patients, after having a seizure or a diabetic coma (these are many of our calls) become altered and combative. They don’t know what’s going on and in their confusion, they think this group of men is trying to kill them. Thus, their instincts respond with full fight-for-your-life adrenaline and they fight us, sometimes viciously.

This is the reason why I fight old women. It’s for their care….I promise.

My favorite combative patient was a man in his twenties who had a seizure. My partner and I got the common call in South Central and as soon as we rolled up, a fire fighter came out the door and yelled to us “Get the restraints!!” This is when we knew it was going to be a good call.

We entered into a bedroom where this 6-foot 200lb beast of a man was thrashing on the bed with 6 Firefighters trying to hold him down as sweat poured down their faces. My partner, a small scrappy Italian with braces, immediately RAN INTO THE ROOM AND JUMPED ON THE GUY’S BACK AND ROAD HIM LIKE A BULL. I swear I remember him giving a Howard Dean “YAAHHH!!!” before he jumped.

I would have laughed, had I not been in the middle of serious wrestling mach. I jumped in and went to work on trying to restrain the man’s flailing arms. It was near impossible. He was rolling, flipping, spiting and screaming. He tried to bite me multiple times and I almost had to put an elbow to his face.

I used joint manipulation to control him without hurting him. Meanwhile, my partner, still in full Rodeo mode, put soft restraints around his wrists.  All 8 of us were working in total chaos.

It was a blast.

We hit him with a sedative. It didn’t work. A normal patient with full adrenaline is difficult to control, but this guy was a Bear. After 10 minutes of wrestling, we got him strapped down on a backboard so we could move him safely to the ambulance. The police never showed up.

The Fire Medic and I jumped in the back and although the Patient was strapped down, I used my entire body weight just to hold his hands down from ripping the Medic apart, who was trying to place and IV. The guy jerked so violently, his IV ripped out and blood started spraying everywhere.

Remember, all this madness is happening in the back of a speeding ambulance veering through traffic. So we in the back were getting thrown around as sirens and the patient screamed. Total chaos. By this point, the medic and I were drenched in sweat and laughing.

I realized then, I love my job.

My Saddest Call

To date, my saddest call I’ve ever ran was watching someone lose the love of their life to death in front of their eyes.

I was in a hospital in Inglewood, and a patient a co-worker of mine brought in was in full arrest (heart stopped, not breathing) as a result of a heart attack. I hopped in and started doing chest compressions.

This man was a police officer in his early sixties. Emotionally, the hardest part of the job is not the patient, but the family and loved ones who are breaking down while you’re trying to save their loved one. In this case, the police officer’s wife was in the room while I worked on him. As I furiously pumped this man’s heart, trying to keep him alive and get it to start again, she was bawling. She cried out to God and repeatedly asked Jesus aloud to save her husband. She spoke to her unconscious husband, begging him to not leave her. It was the saddest thing I think I’ve ever witnessed, but I had work to do.

I think there’s something different about chest compressions. Physically touching, you are connected in a way to someone as they’re dying. You feel them as their life passes from them, but at the same time it’s such a violent act. You are using all your strength to keep someone alive. Him being a married police officer, I felt an even greater connection to him than I do when we’re working on say a gangbanger. I pumped and pumped, almost breaking this guy’s ribs as his wife watched, completely powerless to stop death from taking the love of her life.

Despite everything, he slipped into death. It’s very rare you can bring someone back. The doctors told me to stop. I relented. We called it. She lost it.

The nurse gave her a chair to sit in. As I took off my gloves and left the room, I stood in the hallway watching this woman. I had a front row seat to the worst moment of her life. This job gives you a view to a side of life few people ever see. It teaches you what’s really important. I don’t know how long they were married. I don’t know what her name was. But I do know she must have loved him with fierce conviction. Her life had just changed forever, and I was there to see it.

It’s the only time I’ve ever gotten choked up on the job.

Despite her praying, and crying out to Jesus, he did not answer her. People die. It’s what happens. I do not believe God ignored her cries. I believe his heart broke as much as hers.

This was my first week on the job.

My Craziest Call: GSW

People often ask me, as an EMT, what was my craziest call? As of now, it is my first Gun Shot Wound (GSW). My partner and I awoke at 2am to a GSW call in Inglewood. We threw our uniform on, kicked on the lights and sirens, and hauled to the call. We arrived to a chaotic seen of flashing red and blue police lights, caution tape, bystanders, and fire department rigs. The body, a male in his early twenties (could have been a teen) was lying on the front lawn of a home. I looked him over but couldn’t see a gunshot wound, but I did see blood pouring out onto the lawn. This meant the gunshot was to the back of the head.

We rolled him over to check the trauma on his backside. As we did, blood shot out the back of his head, almost spraying my partner. I checked for ID, but he had nothing on him other than pepper spray. With the utmost urgency, we put him on a backboard (gunshots can cause spinal trauma) and put him on the gurney while trying to stop the bleeding.

As soon as we got him into the back of the ambulance, he went into full cardiac arrest, meaning his heart stopped beating and he stopped breathing. At this point he is considered clinically dead. We take off for UCLA. With these calls you have to go to a trauma center, and this part of Inglewood is the furthest you can be from a trauma center in West LA. With a long way to go, I started doing chest compressions as the fire department paramedic but a bag valve mask over the patient and forced air into his lungs.

As I was pumping this guy’s heart, it caused the blood from the back of his head to go spewing out and for blood to start pooling on the floor of the ambulance. We threw down towels as to not slip on the blood. Doing CPR is much more rigorous that it would seem and after five minutes, you’re sweating. I looked through the window, and we were only at the 405 and the 10. There was not much hope.

Finally we made it to the UCLA ER. We pulled him out the back and I continued to do compressions while stuffing towels under his head to curb the bleeding all the way to the trauma room. In my field, having a full arrest is rare and so is a gunshot wound, but having both at the same time is near unheard of. We got him into the trauma room, threw him on the bed and a team of 12 trauma ER doctors went to work. They pumped epinephrine into his system, and he regained his heartbeat and started breathing. The guy made it. It was a good night,… except for cleaning the ambulance.