Oct 23, 2009

Just Not Myself - Reacting to Error

Yesterday was a nightmare...I never saw it coming. (some prophet, huh?) This post is from the point of view of the guy I turned into while driving to work yesterday. It's gonna sound different because I wasn't myself yesterday. I'm glad crap like doesn't happen every day.

I arrived at work 20 minutes early - that's weird. I'm never early. Wait - let's back up...

I woke up at 4:15am and couldn't go back to sleep. There I was wide awake...what the heck? After 45 minutes of staring at the ceiling I got up, made coffee and logged in to Facebook.

(fast forward)
When I surveyed the parking lot, I noticed my shiny new rig idling and the mechanic outside talking on the phone...Crap! This is not good! Darin (the Sup de jour) gave me the bad news.
Time for an oil change.

Well, it could be worse. Oil changes are quick, Glen can do them in less than an hour - so maybe we'd only be in a back up rig for a short time. I can deal with that : )

Clocked in, coffee in hand, we were told to line up for H1N1 vaccinations. I seriously thought about bailing on it - I haven't had the flu since I played with pterodactlys in the sandbox....but I caved in. (I hate peer pressure)

After milling around for 30 minutes and not getting close to the front of the line, dispatch told us we had an interfacility call...crap! Darin tossed us the keys to the POS back up and told us yesterday's crew moved all our gear over last night...should be good to go....honest.

My partner rolled his eyes in disgust...the seat-belt light glowed dimly, while the engine quietly slept. Crap!! Someone left the battery switch on. Darin told us to have the mechanic (still talking on the phone) to give it a jump. We advised dispatch of the problem, they called the hospital and delivered the news of our delay. 15 minutes later we're under way...late.

We're not used to running late. We usually arrive early, the paperwork isn't ready, the patient isn't ready and no one's called report to the receiving facility. We can bank on 20 minutes of boredom. Sometimes I do 'hot laps' around the hallways, praying for random patients or irritating the nurses with bad humor. The nurse behind the desk was on the phone getting her butt chewed out by the doc who was doing the procedure on our patient. She promised him we were loading him and about to leave. She gave us a quick report, tossed us the paperwork and asked us to hurry as politely as she could.

I did everything on the way - the 5 minute transport was just long enough to get a couple sets of vitals, an EKG, a quick history and ask the patient what was going on. He was very helpful, and even mentioned that the urologist who was doing the procedure called him on his cell phone and bitched him out this morning for not being there earlier. They set up the transfer for last night, because the procedure was slated for early morning, but they rescheduled the transfer. The irate doc called the staff and the patient and threatened to cancel the procedure. Just amazing, I love people who act that way.

After that transport we hoped to go back to the barn and switch out of our pre-Cambrian meat wagon. No such luck. We went to the west side instead to cover another rig's area. The brilliant idea to do a rig check hit my partner. We found the portable and main oxygen tanks bone- dry....Nice. A call to dispatch and we on our merry way back to the barn. We changed out the empty tanks and moved our gear into our normal rig. Our shiny new one had a couple of gallons of new oil waiting to be broken in.

My partner is a good guy. Sometimes his thorough-osity irritates me. (Don't ask if that's a real word) His inspection of the portable o2 tank on the gurney? Stone cold dead. Crap!

It was just the beginning.

We found 12 pillows stuffed under the bench seat. I'm not sure how the guys on the other shift party, but apparently the feathers fly when they get excited. We had (as usual) one backboard - without straps. The garbage can in back was bloated bag of refuse, spilling it's vile contents on the floor. We found no de-fib pads in the monitor and no idea what our predecessors planned to do if they had a code. There was a key broken off in the door of the main o2 compartment. This is becoming legendary. Braun, in their infinite wisdom switched to a spring loaded lock cylinder last year. All the new rigs come with an exciting new "feature". If you don't jam the key all the way into the lock and properly depress the spring mechanism, the key snaps off when you turn it. We've broken off about a dozen keys on our rig alone. Finger pointing is at an all-time high.

Our second patient was...'interesting' We were told by dispatch she lived on the 3rd floor of an apartment complex that had no elevators - only an outside stairwell. They were sending another unit with us to help carry her up the stairs. On scene we were warned by the nurse that she was demanding, controlling, pushy, refused to have male nurses in her room and 'fired' some of the female nurses during her short stay. Our informant added this gem to the rap sheet; "she was no stranger to narcotics". YAY!

I broke out a bottle of Rico Suave aftershave, lit a few candles and sauntered into her room - determined to win her over. It worked...she feel in love with us. We had a fairly decent trip with one irritating exception. She had a beautiful vase of flowers (lillies) that we brought along. In carrying them I somehow got orange pollen all over the front of my uniform shirt. It remained there the rest of the shift. About a dozen people were kind enough to ask what happened. I rolled my eyes in disgust.

Coming out of the hospital with the patient, I shook my head in unbelief. Some nucklehead from AMR parked his rig 4 feet behind ours. How the heck were we supposed to load our patient. Don't their gurneys need the same loading space ours do? The EMT shot me a look and asked if he should back up. I said, "I don't know, what do you think?"

Our next transport was a bariatric. Thankfully, it only required us to swap out gurneys. We grabbed the 'wide load' bed and put it in the rig. My partner's obsession with oxygen bottles continued and (drum roll, please).....the tank was empty. The gurney had no pillow and no blanket. A microscopic exam of the mattress revealed every bacteria known to man. Who knows if it had been cleaned in the last month. Our frustration went into high gear. We cursed the lazy worthless slobs we worked with who couldn't manage to do a single friggin' thing right. Dropping off our (very nice) bariatric patient at dialysis, we maneuvered the wide gurney into the room. A nurse poked her head into the room and sheepishly asked if we wanted help. I said, (a bit sarcastically) "I don't know, what do you think?"

(Warning - rant ahead)
OK...we have a bariatric patient. That means they're around 300 lbs, minimum. A lot are 400 - 500 lbs. Some are over 650 lbs. Why does a nurse think for one minute we're going to refuse lifting help? Get your butt in the room and help us! It's a constant source of irritation for us... people who can't or won't do heavy lifting. We pretty much stopped asking for lifting help at the dialysis unit a long time ago. All we every got was attitudes and excuses. A lot of hospital floors are the same way. People disappear every time a large patient shows up. We come to their floor and like cockroaches when you turn the lights on, people scurry for a hiding place.

We have a few EMT's working for us who request an extra unit to assist in lifting when the patient weighs 175 lbs. Two people who can't lift a patient that weighs 175?? No, I'm not kidding....it's becoming a lot more common. Why are these people even doing healthcare? EMS isn't for everyone. Maybe you like the lights or the drama. Maybe it's driving fast. None of that matters. The job involves lifting and carrying people who are disabled. Some are very big. If you need help every time because you can't or won't lift someone, you're a liability. There are other jobs that don't require heavy lifting. Perhaps you'd be better suited in one of them.
(End of rant)

Coming out to our rig, we noticed a shuttle van parked behind us. Yes, we were parked in the shuttle loading area. I'm sorry, but I think ambulances qualify as shuttles, even if we don't have a wheelchair lift. The shuttle was parked exactly 5 feet off our rear bumper. As we approached with our gurney, a woman materialized out of thin air. She introduced herself as the supervisor who was training the new shuttle driver. She sweetly apologized for his park job. Her smile gave away something of what really happened. (at least in my bewildered mind)

(10 minutes earlier) She explained to the newbie, "The ambulance needs exactly six feet of space to unload their gurney. They are not a shuttle van and thus they have no right to park where they did. Do you understand? Good, as you park the van, I want you to leave exactly five feet of space between our vehicle and theirs."

I waited for my partner to go back inside and get the signature he forgot. Sheesh! The shuttle van prepares to leave. I can't believe what I'm watching in the mirror. The van has at least 50 feet of room to back up before they leave. Instead, the driver cuts the wheel away from the curb and creeps forward in his attempt to merge. He crawls within a couple inches of my rear bumper...I can't watch, I close my eyes and brace for impact.
He clears my bumper without hitting me. I'm simply amazed. Stupidity reigns in the heart of men...I just want to go home.

I call dispatch and remind them I need my flu vaccine. They send us to the barn, I snort the vaccine up both nostrils and quickly leave as the stuff drips down the back of my throat...yum.

We get a call to the homeless shelter for a dude with a massively swollen arm. Been like that for a month. Had a DVT a month ago...looks like he still has it. He tells the fire guys his story, they relay it to us. We begin the drive...6 blocks to the hospital. Vitals are good, sats are great. On the way the guy decides to add a few more pieces to the puzzle...diabetic, CVA, heart problems...yada yada. We check his sugar - almost 500...thanks a lot for sharing, pal. I can just hear them now...why didn't you start an IV?? Why didn't you blah blah blah?? 30 seconds to arrival.

Call the ball...

We did our best to tell the story we had so far. But the dude kept changing it. He told us he was taking insulin, but told the nurse he wasn't. Then he told them he wasn't taking his coumadin or any of his medications. He tossed us under the bus. My partner rolled his eyes with disgust once again. I told him don't worry - he's gonna change the story again when the doc sees him and make the nurses look like idiots. If he sees someone else like a specialist, the story changes again. Guys like him make a career out of telling everyone a different story so we all look like morons.

On the way out the door the nurse asked us if we checked out his breath sounds. "Wow, I've never heard such junky sounds in my life, what did you guys hear?" My EMT informed her that our stethoscope was missing an earpiece and a bloody eardrum awaited anyone who used it. I went in a different direction. I thought the lifters in the engine needed adjustment based on the loud tapping sound I kept hearing in the background. I don't know, maybe we should have started him on Levaquin.

The end of shift was fast approaching. Just when I thought the nightmare was over, we had one more problem. Some dingleberry parked a back-up rig in our spot. We have numbers for our rigs stenciled on the ground in front of the parking spaces. It's management's way of bringing it down to the 3rd grade level of personal accountability most of us operate at. But apparently it's too complicated for some. I fetched the keys, once again trying to fix a problem created by lazy mope. To my dismay, the back-up rig (a different one from this morning's fiasco) wouldn't stay running. It turned over, but when I let go of the ignition key, it died. Maybe I could back it up, holding the ignition key on and grind the starter to a burnt lump of metal! Crap!

I went inside & broke the happy news to the supervisor. He rolled his eyes in disgust. 15 minutes later the offending unit was extricated from it's wrongful location and I backed my rig in. Thank God for the end of this day. I didn't pray for a single patient. I did feel like strangling half the people I work with. I prayed that God would never again let me suffer through a shift like this.

I asked God what happened today. The answer is this: I gave a co-worker some advice the day before about reacting to the situations around us. Today I was given an opportunity to walk out my words of advice. It wasn't easy. The advice came from a man I respect greatly; Bill Johnson. He said (paraphrasing) "If you react to error, you won't arrive at truth, but another error. As long as error is your starting point, you're going to end up going in the wrong direction. We are not designed to react to error - but to respond to truth."

I spent an entire day reacting to the errors of other people. It frustrated me to no end. I could have chosen, as I often do, to seek God's truth in every situation and respond to it. Today I chose to react instead of respond. I hope I never make that mistake again.

1 comment:

  1. Thanks Dave for sharing the events and (hopefully),lessons learned.And hopefully most days are not like that,although I have a feeling it's a pretty stressful job. But because God has placed you there...He has already equipped you with all the tools you need . So many times at the end of the day I reflect on 'what could I have done differently'? And sometimes life just happens so fast that I don't take the time to ask Him for His counsel. But He is so faithful...and patient; He gracefully and gently reminds us that it's okay...we will get it...eventually.We don't need to beat ourselves up...just know that there will be another opportunity in some way,shape or form,to learn...and that is the comforting truth