By Eugenia Klopsis
The New York Sun
Copyright 2007 The New York Sun, One SL, LLC
All Rights Reserved
Editoral note: Klopsis is an emergency medical technician on an ambulance in Brooklyn, New York. This column details her observations and experiences. Some names and identifying details have been changed to protect the privacy of patients.
We’re leaning against the hood of our ambulance, sun-worshipping, when the call comes in for a CVA-C, a critical stroke.
“Critical” means that the patient should be given drugs that, if administered less than two hours after the stroke, may reduce the damage to the point where the patient may fully recover.
We hop into the ambulance and fly to a six-story apartment building, but the inside door is locked. The bells are not listed by apartment number but by three-digit codes that correspond to a directory of names tacked to the wall. We radio dispatch for the patient’s name, and the dispatcher spells out something long and Eastern European-sounding, with too many consonants.
Bronson writes it out on a scrap of paper. “So much for Americanizing,” he mutters.
“Where are those Ellis Island desk clerks when you need them?” I say. Looking at the directory, I find three of the same name.
Bronson presses all three buzzers, but no one answers. Someone exits the building, so we walk in. “So much for security codes,” he says.
When the elevator opens, a woman rushes out saying, in a heavy accent, “I called.” As the elevator is hauling us up to the fifth floor, she says: “I think my husband had a stroke. I found him unconscious on the couch.”
“Why do you think it’s a stroke?” Bronson asks.
“I was a nurse in Russia.” She says he has high blood pressure, but that he takes no medication for it.
“When did you last see him normal?”
“An hour ago.”
This falls within the two-hour time limit, so we move quickly.
Inside the apartment, a family member is holding the man upright on the couch so that he doesn’t slump. He weighs about 250 pounds, so this is not easy. He’s got deep, rapid, snoring respirations, which are a sign of a brain injury - a brain bleed. He also has neurological posturing, flexing his arms inward, also a sign of a brain injury. “Hemorrhagic stroke,” Bronson concludes, and we radio for medics. The snoring respirations mean his airway is not secure. He needs to be intubated. Medics report back a five minute ETA.
We put the man on the floor and try to get a plastic device into his mouth to keep his airway open, but he’s clenching his teeth. We bag him with supplemental oxygen. The medics arrive and call telemetry for permission to give narcotics to get him to unclench his teeth. After a successful intubation, we’re off to a nearby stroke center with a notification, advising the staff that we’re five minutes out.
Five minutes later, we wheel the patient into the ER. But instead of a swarm of doctors and nurses engulfing us and taking over, there’s only one triage nurse sitting at her desk. “How do you know it’s a hemorrhagic stroke?” she asks accusingly.
We explain what we found: rapid respirations, posturing, clenched teeth.
She doesn’t seem impressed. “Go to the critical area,” she says.
But even there, no doctors are rushing in. We explain what we’ve got to the nurse on duty. “Okay, we’ll take care of it,” she says noncommittally.
We go back to the main area to write up our paperwork, piecing together all of our latex gloves on which we’ve jotted down the patient’s name, vitals, and findings in ballpoint pen. We’ve got six gloves - white, blue, and purple - so many flaccid hands waving to us on the countertop, each holding its own piece of the patient’s history.
The medics are on the phone with telemetry reporting their narcotics usage when we hear over the loudspeaker, “Cancel stroke team to the critical room.”
Bronson blinks at me. “What the-?”
I go to the critical room. “It’s not a stroke?” I ask.
The nurse is blase: “It’s not a stroke.”
I blink. “Ya coulda fooled me,” I say and go back outside to tell the medics. They can’t believe their ears, and they laugh, then shrug in resignation. “We did our job,” they say, through thick skins gotten by exactly this kind of treatment. “We know we did the right thing for our patient.”
Then we hear over the loudspeaker, “Stroke team to the critical room, stat.”
I whip out a spare glove and start taking notes. A passing supervisor is too interested. “What are you writing down?” she asks.
I click my pen and shove the glove into my pocket. “None of your beeswax.”