The career archive of a NYC paramedic

Tag: paramedic calls

The Long Distance Girlfriend Experience

The ads on late-night television imply that for about $5 a minute you can speak with an eager nymphomaniac clad in sexy lingerie and writhing about on the satin sheets of her king-size bed. “They’re definitely over 18!” many of the adverts proclaim. The callers probably assume the woman they’re sharing sexual secrets with is doing so from the private comfort of her own home. How romantic (or hardcore) would it be to hold an intimate conversation in a cubicle next to 30 other cubicles?

The phone sex industry exploded in the 1980s with the emergence of 1-900 phone lines. 1-900 phone numbers charged exorbitantly higher rates than regular phone numbers, usually by the minute, and seemed tailor-made for carnal interplay, or psychic readings. Despite the best efforts of puritan government agencies and the later development of technology that delivered porn to your phone, sex chat lines continue to endure to this day. There is a lucrative appeal, apparently, to engage in naughty talk with an anonymous stranger. It provides an outlet for men to engage in a soft-porn fantasy: the long-distance girlfriend experience.

One day I was shipped out to work with someone in downtown Brooklyn and I ended up having one of those “nymphomaniacs” as a patient. It was where my innocent eyes were opened to the elicit world of landline love.

We were sent to an office building in the business district. When the doors opened up on the 6th floor, it looked much like the typical office settings I assume most people work in, though there were some notable differences. The cubicles were larger than any of the cubicles I’d seen elsewhere and the dividers seemed to be covered in a thick soundproofing material. Large billboards near the ceiling, holding messages about bonuses and incentives, had images of shiny, red-painted lips talking into phone receivers held by hands that had shiny, red-painted fingernails.

None of the employees resembled the woman in the pictures hanging overhead. No one wore lip gloss and any manicures were subdued. The uniform of the day appeared to be sweatpants and unmatched leisurewear. There wasn’t a teddy to be found, though there were plenty of hiking boots and flannel shirts. Aside from the relaxed dress code, another thing that let us know we weren’t in the standard American workplace included the two large and very intimidating security guards at the entrance.

A friendly woman greeted us immediately and told us she’d take us to the patient. The woman wore a lanyard around her neck attached to two pieces of official-looking ID proclaiming her name to be “Bambi”, quotation marks included. A quick glance at the other lanyard IDs revealed that a name ending in “i” was likely a prerequisite for employment. We were surrounded by a number of Rikki’s, Tammi’s, Freddi’s, and Toni’s.

As we walked down the path towards the patient we listened in on snippets of raunchy phone interactions. The women vocally expressing their enthusiasm for deviant sex acts did so while filing their non-red nails, thumbing through magazines, and various other multi-tasks. One woman’s attention was intensely directed towards a birdhouse she was building out of popsicle sticks, while at the same time feigning believable interest in bondage. Her face lit up when we admired her handiwork as we walked by.

The whole time we were walking, we were followed by a young man, dressed in a suit and tie, holding something. When we reached our patient, whose lanyard gave her name as “Candi”, quotation marks included, the man propped a prosthetic leg against the wall of the cubicle. He gave a polite nod and left.

“My leg!” shouted “Candi” with delight. “Thank you so much!” She was a fairly large, middle-aged woman with a haircut that resembled a crew cut. It looked as if a tremendous effort was being expended to breathe.

“Bambi” told us that when “Candi” started complaining of difficulty breathing they moved her into a bigger cubicle that had a window, which they opened so she could get some air. “Bambi” proudly told us that “Candi” was their most consistent Gold Star employee and hoped we’d give her Gold Star treatment. Going by the billboards near the ceiling, it meant that she was receiving the highest bonuses.

My partner asked what we were both thinking, “What gets someone a ‘Gold Star’?”

“Call me and you’ll find out,” “Candi” said through labored breaths but with a wink and a sly smile.

“Candi” was sweaty and very pale. Our visual medical impression told us something serious was going on. We got to work quickly putting her on oxygen and assessing her vital signs. When we asked her about her medical history she dumped the contents of her large handbag onto the desk. She dug around through the pile that included her wallet, some keys, a lighter, a pack of cigarettes, a few candy wrappers, and a very large rubbery dildo, to hand us her medication bottles. They indicated she had hypertension, diabetes, high cholesterol, and a thyroid condition. She also told us she had renal failure and was under the care of a cardiologist. For someone who was only 45, she had an extensive medical history.

She opened up her flannel work-shirt so we could put on the little pasties for our monitor and we listened to her lungs, which were clear. When I mentioned this to our patient, whose other ID said her name was Mary Robles, she gave a somewhat resigned expression. “Then it’s my heart,” she said.

She pantomimed the cardiac monitor paddles from the days of old, imitating the recoil of being shocked by a jolt of electricity, as her thumbs pressed imaginary buttons. She’d obviously been through this before, apparently with machinery using 1970s technology. When I told her we used sticky pads now, not the old-school paddles, she nodded sadly, knowing as we all did, that the pads did not hold the same dramatic effect.

Our modern cardiac monitor indicated that her heart was beating erratically and very fast. At the time we didn’t carry any drugs that would fix it. As Mary/”Candi” understood, a dramatic jolt of electricity was the only thing we could do. But we did have some drugs that would help our patient with the pain of the procedure. We just had to call our MD to get approval.

“Bambi” waved over to the phone on the desk and told me I could use it to make the call. She went over to help “Candi” put her stuff back into her purse without telling me about the numerous assortment of buttons on the phone. It was hard to stifle a laugh as we watched her try to wrestle that dildo back into the overflowing purse. My partner turned his head as he attempted the easier job of starting an IV. Making the phone call turned out to be far more challenging.

For the youngsters who have never used a landline I’ve provided this video:

I had some difficulty figuring out how to get an outside line with their phone. I couldn’t find a button that produced a dial tone so I started randomly hitting each one. It seemed that each button I tried gave me access to the phone calls being made from the cubicles around me. Each call I inadvertently eavesdropped on was long past any foreplay discussion and some involved heavy moaning. It was rather eye-opening conversation and when “Bambi” noticed my reactions as I quickly hit other buttons, she stepped in to assist me.

Laughing, she explained that we were in a “Quality Control Cubicle” and a regular assignment at this office was listening in on phone calls. “If the customers only knew…” she said.

With her assistance I was able to get in touch with our telemetry doctor who gave us permission to use Valium to sedate Ms. Robles. He and I both expressed some concern over the procedure we were going to do, given the overall precarious health of the patient, but the MD admitted there was no other option. The patient, herself, wasn’t the least bit worried, however.

“Bring it on, I’m ready!” she said, loud enough for the MD to hear.

“Looks like everything will be fine,” he told me.

Cardioversion is a heart-stopping experience, quite literally for the patient, but also for paramedic caregivers as well. After you sedate the patient and charge up the machine, there’s usually a bit of apprehension before hitting the button that will deliver a few joules of electricity through the benign-looking pads we use now, instead of the familiar paddles seen on screens large and small. Interrupting the abnormal electrical activity going on in someone’s heart carries the risk of stopping it permanently. It has never happened for me yet, at least in someone who was sitting and talking to me, but there’s a first time for everything.

In the case of Mary Robles, sending those 100 joules of electricity to her heart did nothing but cause her to utter a loud, prolonged, moaning-type of yell, which fit in quite well with her current surroundings. I’m sure the soundproofing material of those cubicle walls did nothing to block the sound to her fellow moaners nearby. Except Mary/”Candi” wasn’t faking it, this time.

Her heart went right back to the very fast, erratic, and inefficient way it had been beating before. This meant we would be pushing that button again, this time with a slightly higher dose of electricity.

Our patient was unfazed. “Fire away!” she said after we shot her up with another round of Valium.

We were far more nervous than Ms. Robles when we pushed the button a second time. Once again, we delivered the jolt which brought forth another yelling type of moan. It was also followed with a relieved kind of “Whew!”

We all carefully watched the monitor with anticipation. Thankfully the jumbled electrical patterns organized themselves into a regular rhythm. Our patient knew what this meant even before we told her and she raised her arms and yelled a triumphant, “YES!”

She told us she felt much better and her vital signs reflected it as well. As she grabbed her prosthetic leg she told me that losing her leg made her better at her job. I gave a confused look and she just smiled. I still wonder what that meant.

As we headed to the hospital, she told me that many of the employees there were customers of hers. I asked her how she knew but she just gave me another wink and a smile.

Advertising Billboard

Warning: there’s some profanity ahead. You can’t write about Liz without vulgarity being part of the dialog.

It had been a cold and stressful morning for Liz Moreno. An aggressive and violent woman, she had done far more ‘ass-kicking’ than usual that day. She had a black eye and several bruises. Her right arm was also severely painful. She tried to deaden the pain with alcohol, more alcohol than her usual allotment, but it had not done anything significant to help. If Liz felt the need to smack someone else today that disrespected or inconvenienced her, she would be at a disadvantage. Normally she was very quick to utilize the city’s ambulance resources but today she had some errands to do before she would spend more of her valuable time in a hospital. She also decided to turn over a new leaf by getting involved with a new religious philosophy.

Liz had never been one to embrace any religion or spiritually. Religion was for suckers she’d often say. With all it’s talk of being kind and good, it was just a way to keep people in their place. Turning the other cheek was for the weak and those who didn’t know how to fight. But her last stint in prison had taught her that churches and temples were good for more than just a free meal or a place to sleep. She had learned many things from another woman there, one who had fashioned her crucifix into a shank. Religious articles were less likely to be taken away. If they did, you could sue, claiming religious persecution, she had told her. Liz couldn’t believe she hadn’t known about this before. So much time had been wasted being unaffiliated.

She went to a second-hand store with a crucifix in mind. She was hoping to fashion a far more superior weapon than the one her mentor in prison had shown her. But the secondhand shop was low on religious articles. It seemed people didn’t like to part with their weapon making materials. The trip had not been wasted, however. She was able to find a Buddha figure and it was made out of a nice heavy concrete type of stone. As she fished around in her bra for the cash necessary to make the purchase, the cashier remarked that her arm didn’t look too good and suggested that she get it checked out. Liz suggested she mind her own fucking business and paid for her new religious representative. But after walking out the store and trying to hold her heavy new acquisition with her damaged limb she had a change of heart and asked the woman to call 911 for her.

“Look! I found God!” she laughed as she got into the ambulance. The crew who was familiar with the perpetually angry woman were a bit leery of this rare display of joy and the newfound love for heavy concrete objects in the hands of a perpetually angry woman. They splinted up her arm and took her to the hospital where she repeatedly told everyone with glee that she had “found God, his name is Buddha.”

Sometime after getting out of the hospital and enjoying her new prescription pain medications, an ambulance was again called for her when she was found unresponsive and barely breathing. “Where’s my Buddha?” she quickly asked when she awoke from her opioid reversal, via Narcan (naloxone). Her new spiritually had already become ingrained into her psyche.

The ambulance people had destroyed her high and she felt justified for lashing out at them. Even thought she always berated them for various perceived infractions this one was very different. She didn’t want to hear anything about ‘barely breathing’. Her prescription was LEGAL. They couldn’t do anything about it. Sure she had taken far more than the bottle instructed but it wasn’t the point. A doctor had given her these medications. She hadn’t gotten high off of something purchased from a man named Angel on the corner of Decatur and Wyckoff. She had done nothing wrong and didn’t deserve to be punished for it with Narcan.

As she argued with the crew she was comforted in knowing she now had two weapons-her concrete Buddha and her nifty new cast. “Look,” she showed the paramedics. “It’s like I got concrete stone on my arm too!”

“Nice little advertising billboard, you’ve got there,” said the paramedic.

What was he talking about? She looked to where he was looking. It took some contortions but she could tell something was written on her brand new cast. She studied it with her head bent at an uncomfortable angle.

“BLOW JOBS 75 CENTS – broken arm sale.”

It had been written in large lettering with a thick black marker. And the words faced outwards, like advertising, just as the man had said. You could practically see it from three blocks away. “What? The fuck? Man!” she screamed. Her cast had been on her arm less than 24 hours and someone had already vandalized it.

“When you’re passed out on Oxy worse things can happen,” said the medic, trying to console an inconsolable Liz.

“Shut the fuck up!” she told him. She was going to raise up her concrete Buddha as a warning but she couldn’t grab it in time. The crew had taken it away, out of her reach.

“You’ll get it back at the hospital,” they told her.

Didn’t they know it was a religious article? She was allowed to hold it. Her prison mentor had told her all about it.

“You know, there are some who say that Buddhism isn’t a religion. There’s no deity. It’s really more of a spiritual philosophy. I don’t know if it fits the same parameters,” one of the medics told her.

“What was she saying? What’s a parameter? Can I still sue if they take away a spiritual philosophy figure made out of heavy stone? They must just be fucking with me. If only I had my Buddha, I’d show them,” she thought. But there were other things to worry about. Who had defaced her cast? Who was she last with? That person was going to feel the full, literal weight of her spiritual philosopher.

Liz spent a few hours at the hospital, mostly being lectured about the right way to take pain medication. When she asked for more they gave her Tylenol. Tylenol! Didn’t they know that’s not the same?

The same paramedic crew found Liz a few days later. Someone had called for her when they saw her bleeding and laying on a street corner. Those paramedics thought they were going to her hit with the Narcan again, she laughed, but the joke was on them. She was just drunk. A battered and bruised Liz made her way to the ambulance anyway. At least at the hospital she could get some rest.

The crew had never seen Liz so battle-worn and that was saying something. She looked tired and had cuts and abrasions everywhere. Another tooth was gone from the already sparse lineup and one of her eyes was swollen. They asked her what happened. She showed them her cast. The “BLOW JOBS 75 CENTS- broken arm sale” had been mildly scribbled over with a blue ball point pen. You couldn’t even see that it had been crossed out unless you looked closely.

“I’ve never beat up so many people in my entire life,” she told them. “I got all kinds of mens coming over day and night with their one dollar bills, asking me for change. Fuck them! Who charges 75 cents for a blow job? I do a blow job I want a bag of tar or some blow! You keep your fucking dollar bills to yourself. Fucking assholes. They be throwing quarters at me! Quarters! You believe that? Buddha cracked a couple of skulls, I tell you. That thing is heavy but it do the job. Last thing they worry about now is their pee-pee.”

Buddha too, had gone through some physical changes. A few chips and scratches seemed to under line the story Liz told of her recent encounters. With all the violent karma she had been dishing out lately, Liz’s new religion hadn’t provided her with much peace.

And Somewhere Along the Way, She Was Shot

This is one of those “worst” jobs.

Trying to find the address the dispatcher sent us to had us searching a desolate, poorly illuminated street. Most of the industrial buildings appeared to have been abandoned but the presence of new gates and security cameras indicated some of them probably were not. It was difficult to locate a number on most of these buildings even using our fancy vehicular spotlight. We asked the dispatcher to verify the address and try the callback for a better location. Our “Unconscious” in bed person didn’t seem to live here, no one did. The area had at least ten more years to go before the first loft apartments would start gentrifying the neighborhood.

Finally a man appeared, seemingly out of nowhere. He was thin, about 50ish, and his stubble was mostly grey. He had become very annoyed by the 911 people calling back over and over again to ask about a location that he felt should have been obvious to find. We told him we would follow him.

He led us down a short alley to the padlocked side entrance of one of the buildings that was, actually, abandoned. There was no way we would have found this patient without a guide. The entire area seemed eerily bleak and unusually quiet. Yet despite our unease, we still followed the strange man for some reason.

The man showed us a large hole in the wall that had once been a window and pointed to where the patient was. We shined our two flashlights into the darkness. A large figure lay on what could hardly be considered a “bed”. It had possibly once been a mattress but now it had completely become one with whatever the floor was.

“Is this the only way in?” we asked. The man nodded. We looked at each other with a smile as we shined our flashlights around the entire space contained behind the ‘window’. Many rodents scattered. The area was filled with garbage, so much garbage. There were extra piles of garbage on top of the floor which was covered in garbage. We had more than a few safety concerns. We looked at the ceiling to see if it would hold for the duration of time we would possibly be in there for. It’s not like we know anything about building construction but I thought it would hold. There weren’t any other people around, except for the inconvenienced man and the individual on the other side of the room.

My partner nodded over to the person on the ‘mattress’. “What’s going on with that one over there?” he asked.

“I can’t wake her up!” he said. The man went on to explain that he had found the woman, who he was familiar with and called “Flo”, on what he called his bed. He wasn’t really sure what her real name was. They had had “relations” and then afterwards they shared some drugs and took a nap. Now he wanted her to leave. This was his hangout and she was only a visitor, in his telling of it. He tried rousing her but she never responded.

One after another, we athletically hopped up to sit on the open window ledge. We swung our legs around to the other side of the opening and shined our lights below us before hopping down. Every step we took was done carefully as we made our way over to the woman. The floor was littered with drug paraphernalia and the air smelled of death and every kind of rot imaginable.

The woman was completely naked. She was initially on her side and when we turned her over we discovered that she was pregnant. My partner and I exchanged the first of many knowing glances toward each other, glances that we could easily interpret despite the darkness of this filthy area.

Her pupils were pinpoint and her breathing was slow and irregular. “How much did she have?” I asked her companion.

The man had no idea. It turned out that when he said they had ‘shared’ drugs what he really meant was that he had shared her drugs with himself. Whatever she had taken, she had taken it before he found her. It became clear he had had “relations” with the woman while she was in this unconscious state. I was even more disgusted.

We asked him where her clothes were and he said he didn’t know. He had found her like that and taken it as an invitation. He had found a needle in her foot and without knowing what was in it, used what was left on himself. There was nothing unusual about any of this, in his world. He had no idea how long ago that was because, as he told us, he doesn’t wear a watch. He was just a free spirit.

We hit the woman with some naloxone (Narcan) and gave her oxygen in the hope it would reverse whatever chemicals she had shot into her foot. But even though her breathing got a little better it did nothing to change her unconscious status. We started ventilating her with our BVM (bag-valve-mask) and called for EMT back up to assist us.

“I’m not really into working her up in this hell hole,” my partner said to me. The man became somewhat confused and visibly insulted. What hell hole? This spacious warehouse loft that smells of death? Why, in a decade or so hipsters will be paying thousands of dollars for this place that he now lives in for free.

But we opened the drug bag to see what we could accomplish until the BLS got there to help us get her out. We needed multiple little pads of alcohol to swab her arms clean while searching for a vein to stick, which was a monumental endeavor since most of them had been destroyed from years of injecting chemicals into them with unsterilized needles. I’m going to pat ourselves on the back for the success in getting this difficult IV in the darkness, illuminated only by shaky flashlights that don’t have the LED capability they have now, in modern times.

My low lumens flashlight is the EMS version of I walked 5 miles to school in the snow.

While running the flashlight up and down her limbs in search of a usable vein we noted an injury to her upper left shoulder. It looked like a bullet hole. The man knew nothing about it and was as surprised as we were.

We heard the sirens of our back up and we sent the man out to show them how to find us. In the meantime we gave “Flo” more naloxone, to no avail. This certainly wasn’t just an overdose. Whatever she had taken had also been injected into the arm of our guide and it didn’t seem to be affecting him as profoundly, although she certainly could have taken significantly more.

As our EMTs made their way through the ‘window’ we yelled across the abandoned room for them to be careful, as if they couldn’t see for themselves the danger inside. I loved them for having brought a hospital sheet with them, as so many don’t. It would be a tremendous help in moving her since she had no clothes to grab on to. The crew moved right to the top of my most favorite EMT list when they noted our nice clean IV with admiration.

“Where’s her rapist?” I asked.

“Oh, I don’t know. He pointed to where you guys were and he took off and left,” one of them told us. He looked at the patient. “Wait, is she pregnant?”

“Yes, and it looks like she’s been shot as well,” said my partner. This was like one of the ‘mega-codes’ we train on at the academy, except they usually just stick to either trauma OR medical, not both at the same time.

As we balanced ourselves on top of piles of garbage we managed to get our patient onto a carrying device so we could get her out. We then slowly made our way over to the hole in the wall, stepping over crack pipes and needles, every kind of trash, and the long dead corpses of rodents who did not survive. We luckily made it without falling. We then carefully passed our patient through the hole in the wall onto an awaiting stretcher.

I was never so grateful to make it to the clean, controlled environment of our ambulance. We could finally make a better assessment of our patient. But taking a good look at our patient made me incredibly sad. This woman’s body told the story of a hard and rough life. What kind of messed up circumstances had this woman lived under, what stories could she tell? She was a tall woman who looked to be in her forties, although that was purely a guess. She had scars everywhere. There were track marks where I never thought there would be track marks. She was missing most of her teeth and her nails were either really long or gone altogether.

Her gunshot wound had a clear entrance and exit wound but did not seem to be causing any significant bleeding. We would probably be going to a trauma center even though the gunshot was the least of her issues at the moment. Her vital signs remained fairly stable. Since we didn’t know the onset of the symptoms, of what appeared to be a stroke, going to a ‘stroke center’ would not have been useful. There is a definite timeline that stroke procedures require and we had no way of knowing when everything started.

We intubated her and hooked her up to our monitor. She seemed to be slightly responsive to painful stimuli, which was a good step in the right direction.

“Umm, guys,” said one of the EMT’s tugging at my shirt. “I think the baby might be coming.” He was noting what appeared to be water breakage on a particular area of the sheet covering her.

I’m sure we all looked similarly terrified. An OB kit was pulled from the cabinet and more sheets were utilized, just in case.

What kind of notification would we be giving?

We tried to give the basics to prepare the trauma center without being too long winded. If we told the whole story we would be at the hospital by the time we were finished. We tried to downplay the gunshot but that’s all you have to hear for it to make it to the top of the interest hierarchy. We were also requesting that an incubator be standing by.

It was mayhem inside the hospital. Thanks to our notification dozens of trauma related people were standing by along with others not sure why they had been summoned for a gunshot notification. I guess when you hear that a patient has a gunshot wound all the other information gets drowned out. You could tell they were gearing up to get mad about something. And nobody listens to the whole synopsis.

There were so many people throwing out questions at us from all directions. We tried very hard to tell our patient’s story in one cohesive storyline but it kept getting interrupted by questions we had no answers to. Didn’t you give naloxone? Why isn’t she breathing on her own? How many months along was she? How long ago did the gunshot happen? Where are the police? What kind of medical history does she have? What did she take? Did you give the naloxone? Why did you take off all her clothes? Does she take any medications? What’s that smell? Is this her first pregnancy? Did the father come along? Is there any weakness on a particular side? Did she say anything? What kind of gun was it? She’s obviously on something, why didn’t you give naloxone?…

This seemed to be a hospital far too comfortable with having everything taken care of beforehand. Had they never gotten a patient before that didn’t arrive with a complete medical history? They continued with their demands for answers we didn’t have and they never stopped bringing up naloxone, as if we hadn’t already given her our entire protocols worth. I was starting to get annoyed at all of them in their nice clean environment. They didn’t have to step over crackpipes and rotting fast food to get to their patient. They didn’t have to contort their body into a small width of space between the captains chair and the back of the stretcher in order to insert a tube down the patient’s throat. They didn’t have to hold their breath for minutes at a time to deal with the overwhelming stench of different things dying and decaying at different rates around them . I doubt they could have gotten an IV the way we had. Was anyone even noting the stroke that we had given as the first priority of our notification?

The EMTs and I were feeling a little overwhelmed when my partner used his charm and wit to put some perspective into the hoard of questioners and complainers.

“Look,” he yelled, surrounded by the angry faces of a crowd demanding answers. “She was found in a garbage dump. The only person with her told us that he fucked her and then stole her needle and ran off somewhere. That’s all the information we were given, now it’s all the information you have. And somewhere along the way the woman was shot.”

We brought another trauma patient to that hospital a few hours later. It was somewhat insulting and also somewhat useful that no one seemed to remember us at all. It was a different nurse doing triage and she apologized for a delay in finding us a stretcher. “You’re not going to believe this but some EMS crew brought in this lady who having a stroke, and she was shot too. AND she had a baby in the ER! Can you believe it? They delivered a baby in the ER!”

“That IS crazy!” I replied.

“They were going out of their minds around here when I came in. And the OB floor took their time sending down an obstetrician so an ER doctor had to do it. They were lucky it wasn’t a C-section.”

I found out that is extremely rare for comatose women to give birth unassisted but our patient had, for the most part. No one had to tell her to push and no one had to do an epidural. She delivered a small, underweight baby girl who had a long road ahead of medical treatments.

The incompetent EMS people who brought her in had not provided any of the necessary information, such as the number of pregnancies she had previously, when her due date was, where she was getting her prenatal care, none of it.

“I guess you had to ask the patient herself, then,” I surmised.

“How could we do that?” she looked at me like I was crazy. “The woman was unconscious. She couldn’t tell us anything.”

A Foul Mouthed Nun

Before I went to a Catholic high school I knew very little about nuns except for the stereotypical things: they wear habits, they pray all day, and they like to beat up little kids who don’t do their homework. I had many Catholic friends growing up and I never heard any of them dispute these accepted norms. My dad was a former Catholic who had left his religion for various ideological reasons but still felt they would provide an excellent education which is how I ended up at an all-girls high school taught by many nuns, most of whom didn’t wear habits and didn’t beat us up for not doing homework (the stern look worked much better anyway). But yet it wasn’t until I had a nun as a patient that I learned there were also nuns into weight-lifting and some of them even cursed like sailors.

Sister Theresa Agnes had been visiting NYC with another sister from a parish upstate where they were both stationed, if that’s the correct term. The two women looked as if they could be actual sisters, with similar features and mannerisms. They had been running around all morning going to the more obscure city landmarks that most tourists don’t see. They were particularly interested in the borough of Brooklyn.

We found her in an old church in, what was then, a ‘bad’ neighborhood in Brooklyn. We had driven past this beautiful structure many times and it had often seemed almost abandoned. It was not illuminated at night like many of the other churches and we had never seen much activity, but, of course, we worked at night. Some of the windows had been broken, the openings protected with makeshift coverings that remained in place for years. But it was still a magnificent building that looked as if it were transported from another, much older, country. When we went inside it confirmed my long-held belief that beautiful architecture cannot be fully appreciated from only the outside.

Our patient was found in a large room with a high ceiling and several huge paintings which seemed very old. It had carved wood walls and furniture. The room smelled pleasantly of wood cleaner and old incense. Sister Theresa and the other nun were holding hands with two priests and they were all praying. When we walked in Sister Theresa perked up noticeably. “Look,” she told them. “They sent us two women! Girl power!”

We were told that Sister Theresa Agnes had passed out not once, but twice. The first time she briefly passed out it was blamed on the heat of the day and a change in schedule and scenery. She remained slightly dizzy and became easily short of breath. The second time she was out slightly longer and it had occurred after walking up a short flight of stairs.

The 58-year-old seemed tired and she looked pale from across the room. She asked one of the priests if she could have some more water and he took a glass that had been near her and went to fill it. Like my high school teachers, neither of the nuns was wearing habits and they both had on running shoes. We talked about how the women had spent their day and asked how long Sister Theresa had been experiencing dizziness and fatigue. Upon much consideration and reflection, she admitted it had probably been going on for a few weeks.

“That would explain how you were able to beat me at tennis,” said the other nun. “She’s very competitive when it comes to sport,” she told us.

“Well I’m glad I’ll have a legitimate excuse now,” said our smiling patient.

When we seemed to have a difficult time counting her pulse, Sister Theresa noted that her heart rate was usually slow because she was a runner.

“Runner, yeah, sure,” said the other sister, rolling her eyes. “She’s a triathlete. She does marathons. She’s a cyclist, swimmer, rock climber, and she lifts weights.”

“It brings me closer to God and I feel better when I’m active,” she told us.

But her heart rate was really slow. It was remarkable that she was sitting up and having this conversation with us. We put her on our monitor and found her to be experiencing a third-degree heart block. It’s an electrical arrhythmia usually cured with a pacemaker. It was probably only because of her excellent physical conditioning that she had been able to tolerate so little oxygen circulating in her system for so long. A third-degree heart block is considered to be extremely rare in healthy, physically active individuals making our patient an interesting anomaly. (We found out later that she had once contracted Lyme disease from her many sojourns outdoors and it had put her at risk).

We gave her an IV and tried our first line of treatment which we knew would probably not work. The drug we gave her, Atropine, works at a higher area of the heart than the area causing her electrical disruption. What she ended up needing was trans-cutaneous pacing (TCP).

TCP works much like an internal pacemaker by sending electrical currents that override the heart’s faulty pathways. It’s done through pads on the patient’s chest. To tolerate the constant influx of small electrical jolts we called our telemetry physician in order to give her narcotics. We would be giving her Valium, which works as an amnesiac. It wouldn’t exactly stop the pain but would make her forget it was happening.

We had everything set up and warned our patient of what was going to be happening. She assured us it would be OK. We started up our pacing and she suddenly started cursing like some sort of sailor. A polite sort of sailor.

“FANGDAMMER!” she yelled. This unique word hadn’t yet been added to the lexicon of expletives uttered to me by the public. It was quickly followed by “Poo On A Stick!”, “Crappity!”, “Schinittycrapes”, and “Dookerzonks” (I apologize if I’ve utilized incorrect spelling here. I’m going phonetically because my internet dictionary has been of limited use.) She denied being in pain but she continued to spew words like “Craditoollies” and “Snogerites”. It was an interesting phenomenon brought on by the sedation drug.

Rather than be outraged by all this foul language coming from a bonafide representative of a religious order, I wrote many of them down for future use. I figured that these were secret code curse words, backed up by the wrath of God. My enemies had no idea what they had coming to them.

The unorthodox street talk continued as we moved her to the ambulance. One of the priests helped us with our bags and seemed embarrassed by the constant flow of profanity coming from his colleague. We assured him that we had heard it all before, even though we hadn’t, actually. We have to maintain a professional demeanor so we told him that we understood it was just the Valium talking.

When we got to the hospital she thanked us and apologized for her “rancid potty-mouth”. She also said she had been blessed by our care, which was one of the nicest things anyone has ever said to us. She was quickly evaluated and it appeared she would be getting her own pacemaker that day. She looked forward to getting back on her feet again soon so she could continue to explore our big city. We said goodbye and thanked her for the new words we would be spewing back at terrible drivers with lesser vocabularies. We had all been blessed that day.

Here is a link if you’d like to learn more about third-degree heart block: https://my.clevelandclinic.org/health/diseases/17056-heart-block

The Polygamist

Along with smoking and poor diet there are other factors that can endanger one’s health and longevity. Although not cardiac in nature, one man’s poor lifestyle choices led him to call 911 for chest pain on several occasions. His heart problems began when he complicated his life by sharing a 700 square foot apartment with the three girlfriends he was juggling. “I’m a man who loves too much,” he would say. “I can’t help it. No one woman could handle all that I have to give. My heart is just too big.”

“He’s having a heart attack,” said one of the girlfriends as we arrived. She said it with no great urgency, just matter-of-fact, and directed us behind her. We entered an apartment whose decorating scheme centered around large storage container boxes doubling as furniture. In addition to the containers being used as tables and stools, one held a small toddler who would be pushed around the apartment by 5 or 6 other small children while we were there, all happily oblivious to the events going around them. The place was already chaotic and we hadn’t even met all the wives yet.

We found our 42 year old male sitting in a chair flanked by the other two women in his life. They were each holding an arm and stroking his hair. He was hyperventilating and clutching his considerable belly. A plethora of prescription bottles were found on a bright red plastic storage container that doubled as an end table.

“Please,” he said looking back and forth to each woman with a pained expression on his face. “Please get me a cold wet rag for my forehead.” The two ladies looked at each other for a few moments before one of them reluctantly got up. She must have known doing so would cause her to lose her spot. When she got up the woman who had answered the door took over the left arm position which clearly annoyed the woman getting the wet rag.

As we cleared some space for our equipment a chubby little arm attached to a curious little girl stretched out with a lollypop for me. As I declined, I told our patient, Miguel, how cute I thought his daughter was and how we shared a proclivity for sweets.

“Oh she’s not his.” said one of the girlfriends. “Only three of these are his, two with me and one with her,” pointing to the other older girlfriend.

“And another on the way,” said the youngest one, proudly patting her belly.

As we extended our congratulations we noticed the other two women looked at each other and rolled their eyes in displeasure. The younger woman saw this and smiled even more. There was definitely and underlying dynamic going on here.

“I got other children too,” said Miguel. “They just don’t live with me.”

This man had quite an extensive love life, obviously. What kind of charm did he hold? He definitely wouldn’t be considered attractive in the conventional sense. He was overweight and missing a front tooth in a set of broken yellow teeth. Hygiene didn’t seem to be an priority, including the food clinging to an oddly shaped handlebar moustache. How did this man have three women fighting over him?

And what of these women? What was in this for them? Were things that grim in the dating world? I felt that they could probably do better. They were more than moderately attractive with pretty faces. It seemed that Miguel had a ‘type’ in that all three of the ‘wives’ looked as if they could be sisters, or at least related.They were on the tall side, taller than Miguel, heavy-set and had long curly hair. Two of the women were probably in their late 30’s. The younger one was in her early 20’s.

As I attached our cardiac monitor to Miguel and took some vital signs my partner approached one of the older women and asked if they could assist by providing some basic information. The other older woman shoved her out of the way and said “Ask me. I’ve been with him 11 years. I know him better!”

The first one then shoved her way back over and said “Well I’ve been with him NINE years! So you should ask me!” Perhaps she was just bad at math or maybe the seniority rules worked differently over here. The two argued briefly over who should be giving out his information, each insisting that they were more knowledgeable, based on their many years clutching his arm and providing wet rags. Another tangent they went off on centered on how slow the other was in obtaining the damp rags and not holding the arm supportively enough. My partner looked over at me with the same pained expression Miguel had when we walked though the door. The younger one walked over with an ID or Medicaid card and attempted to hand it to my partner. One of the other ladies took it out of her hands and threw it on the ground.

“Stay out of this!” she told the newest wife. She shrugged and walked away, resuming her seat on a futon.

“Good luck,” she told my partner.

“I get heart attacks all the time.” Miguel said to me. He handed me his latest discharge paper from the local hospital. It was dated only a few days earlier.

“ACUTE ANXIETY” was the diagnosis. The paper showed he was prescribed another anti-anxiety drug with instructions to “reduce stress.”

“It feels the same now as it did then?” I asked. He nodded. “What was going on when this came on?”

“They was fighting.” he said casually.

“Ahhh…” I said.

“Oh that’s nothing,” he said. “They always fighting. Every day. This is nothing new.” Then he took off the oxygen mask we had given him and said very loudly towards the women, “But I love all my wives EQUALLY!”

The woman kind rolled their eyes a little but the nine year veteran looked at the younger one and said “That’s right! We are all EQUAL”

The youngest just patted her belly and nodded with a sly expression that made me think that she had a slight advantage over the other two.

I went through the medications that were next to the lamp on the storage container table and noted they were all for anxiety and acid reflux.

“Oh yeah,” Miguel said. “I get a lot of anxiety. And acid from anxiety. I had it a long time. I get disability for it.

“So you don’t work.” said my partner, not as a question but as a statement. “And you’re home all day. Here. With the wives. And they’re home all day too. With you. And each other. And you’re all just together. Here.”

Miguel nodded. The wife with 11 years pointed out that she and the 9 year wife don’t work either. “We are here all the time to take care of him,” she said. “He’s a very sick man. He needs help. That’s our job. But she works. She’s out working a lot of the time.” she said pointing to the youngest with contempt.

“Hell yeah!” said the youngest wife. “And be here with you all day? How do you think we pay for this place? And your QVC habit?”

The tension had just gone up a few notches. “Take me to the other room,” said the 11 year wife to the 9 year wife, “before I get arrested for slapping down a pregnant woman.”

“You do like the QVC.” the nine year wife told her as she walked away.

With the exam wrapped up all signs pointed to another anxiety attack, with some possible GI issues as well.

“So I don’t have to go?” asked Miguel.

“Oh no,” yelled my partner from the other side of the room. “There’s no way we are leaving you here.”

Miguel’s symptoms seemed to decrease considerably when we left the apartment. I found it strange that none of the women offered to accompany him but I learned later that a previous crew had made this a rule and it seemed to work out better for all involved to not have anyone go instead of having a huge fight over who would stay with the children and who would go to the hospital.

We returned to the same apartment a few months later on Valentines Day. The three wives had gotten into a brawl over the gifts Miguel had chosen for them. As another testament to his high desirability he had made sure it was the thought that counted, rather than the price of the gifts. The three women had each gotten some kind of NYC tourist trinket, the kind sold by street vendors. A clock highlighting the Statue of Liberty lay broken on the floor. Miguel’s love for NYC, or perhaps just NYC souvenir items, was an unsaid point of consternation, I felt. There was also a difference of opinion on the amount paid for each item with the consensus being that the little replica NYC taxicab cost more than the clock and the “I Love NY” t-shirt, which was 2 sizes too small for any of them. An argument ensued regarding the t-shirt with the recipient implying it was meant for one of the others as a hint that she was getting too large. It seemed lost on her that all three of them would have been considered too large by that reasoning. It was the same woman who had been confused about whether 9 or 11 was a longer duration of time.

Despite some scratches and disheveled hair none of the women wanted to go the hospital. Miguel did though. He practically ran to the ambulance. We suggested that his toxic home life may be to blame for his numerous hospitalizations and he acknowledged that it did. But he simply said “There’s nothing I can do about it. I am a lover. I cannot choose who I am.”

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