By Eugenia Klopsis
The New York Sun
Copyright 2006 The New York Sun, One SL, LLC
All Rights Reserved
Technically, I was on vacation during last week’s heat wave, spending the week at my mother’s place on the shore with my husband and year-old son. That ended when the phone rang and it was Bronson, who sounded frantic as he said he needed the day off to accompany his wife, Rachel, to the doctor for an amniocentesis. No one would work for him, so he called me.
Loyal partner that I am, I drove in for the day — the hottest of the year — and have been regretting it ever since.
I called him on my cell phone, just to bother him. “Here I am, sweltering,” I said. There’s nothing wrong with the pregnancy, but a paramedic student and a nurse naturally want to take every possible precaution.
He said he couldn’t talk, that they were about to have the amnio. I clicked off, sighed, and stared out the windshield at people plodding across the street, sipping iced coffees from plastic cups. I was working with a new EMT with very little experience and who didn’t know the area, so on top of it all I was stuck driving, which is not one of my favorite things.
To make matters worse, we were cooped up in the ambulance cab in the weak air conditioning, not talking. To keep the air conditioning going, we had to keep the engine running, and passers-by shot us dirty looks as our diesel fumes spilled out over the already sizzling street corner. What they didn’t realize is that the back of an ambulance can get as hot as 140 degrees if not cooled, and so in order to tend to patients back there we have to keep the engine running.
As I figured would happen, we got a call for an unconscious on the street. During regular weather, whenever I get a call like this I think of the local drunks, who often pass out after having had one too many. Because it was a heat wave, I suspected someone had genuinely collapsed. As I turned onto a residential street in Bay Ridge, a woman waved us down.
We pulled up to a two-family house and saw an elderly white male — skinny, well-dressed — lying face down on the sidewalk. My partner wanted to start an in-depth physical exam right there in the heat, but I remembered mother telling me, “The sidewalk was so hot you could fry an egg!”
“Let’s get him inside the bus,” I said.
The patient was unconscious and unresponsive, but apparently not injured. I checked his forehead. He was hot to the touch but bone-dry, not sweating. During heat exhaustion, victims sweat profusely; heatstroke comes when there’s no more sweat left, not enough liquid in the body to sweat anything out. A loss of fluid volume, and the accompanying electrolytes, can lead to shock unless fluids are given intravenously. I told my partner to get the stretcher as I radioed for an ETA for medics, who would administer the fluids. The dispatcher responded that they were about eight minutes out. “Damn,” I said as we loaded the patient onto the stretcher and get him inside the ambulance. I cranked the air conditioning, took a quick blood pressure (very low), gave him high-concentration oxygen, and applied ice packs to his groin, armpits, and neck. I was ready to roll to the hospital and give the dispatcher notification that the ER should be ready with fluids when all of a sudden the medics turned the corner and screeched to a halt. They jumped into our ambulance and did an EKG that showed a rapid heartbeat of 136 beats a minute and a dangerous rhythm.This man’s heart was trying to pump a diminishing supply of blood through his arteries to perfuse his vital organs: the heart and brain. This can go on for only a short while before his blood volume simply becomes too low, and he moves from being in shock to being dead.
The medics started an IV, spiked a liter bag of normal saline, and gave him dextrose and thiamine, in case there was a diabetic emergency going on. I thought about how Bronson would love to be on this call, since he’s a paramedic student. I instinctively started to call him, but remembered the amnio.
We arrived at Maimonides’s ER, where the doctors placed an ice sheet — an ice pack that’s as big as a bed - under the patient. His temperature was an unbelievable 108 degrees. A fever this high can cause brain damage.
Done with my paperwork and ready to leave the air-conditioned hospital and face the outside heat, I text-messaged Bronson that he just missed a fantastic call. He let me know that everything went well with the amnio and that they were going home.
“Thank God for Western medicine,” I replied. “And give Rachel my love.”
Ms. Klopsis is an emergency medical technician on an ambulance in Brooklyn. This column details her observations and experiences. Some names and identifying details have been changed to protect the privacy of patients.