Near (But Not So Dear) To My Heart

So I recently had my yearly physical for work. Over the age of forty you get a chest x-ray every two years as well as all the rest of the battery of tests and bloodwork they do. Well I was due for an x-ray as it turns out. Okay, no problem. Quick and simple and done. I actually got my blood work results emailed to me before we had even competed the physical and left the building. And my cholesterol was down thirty points from last year. Woo hoo!

So, I was a bit surprised when I found a voice mail on my phone a couple days later saying the doctor wanted to talk to me about my test results. Usually they just nag me about the cholesterol and all the rest is good. Well it was about quarter to five on a Friday when I called them back. The nurse put the doc on the line and she told me that the chest ray showed a mass in the hilar region of my right lung.

Yeah.

That's what I thought.

She said I needed to follow up with my personal doc and that they recommend a CT scan asap. Hmm...ya think?

 

Of course it is now five oclock on a Friday and I cant do anything about it. I emailed my doc just to get a jumpstart on the process and he actually responded on Sunday with an email that said he already scheduled me a CT on Tuesday. Right on. Way to go.

Went for the CT. Also quick and easy and painless. And then the waiting began.

I had just picked up my kids from school the next day and was driving away when my phone rang. I saw it was Kaiser and pulled into a parking lot, gave the kids the shush signal, and answered the phone. The news was not fun. He told me the scan confirmed a 3" mass in my chest. Not in my lungs fortunately but in the mediastinum.

He said I needed a biopsy (again asap) and that he had made the referral and they would contact me hopefully by weeks end. If they didn't call by Monday I was supposed to call him back. I adjusted that to Friday. No way was I waiting through the weekend.

Fortunately they called on Friday (late on Friday) and had me scheduled for the following Friday. It took an interminable five days to get the results late Wednesday afternoon. The good news was it did not appear to be cancerous, won't know for sure until it is analyzed after removal.

Which brings us to removal:

I need a thymectomy (the tumor grew out of the thymus) which could be minimally invasive but has a whole host of potential complications that can't be seen until they are in the midst of the procedure.

 

For example if the tumor has adhered to anything like my lung or pericardium or phrenic nerve they mav have to remove a small section of whatever it adhered to. In the case of the phrenic nerve that would mean permanently paralyzing the right side of my diaphragm. I was assured this was okay because the left side will still work just fine. Also the tumor is large and has to come out intact which means having a big enough hole to take it out of. This means possibly rib spreaders or taking a piece of rib out or worst of all a sternotomy (splitting my sternum and wiring it back together after). Really hoping it doesn't go that route.

So stay tuned folks. Same tumor time. Same tumor channel.

The Duke Boys Ride Again!....Almost

"E-51 respond to a report of a traffic accident at Oak and Mercator. PD also en route."

We jumped on the rig and headed to the residential neighborhood intersection we'd been given. We expected to see a minor accident between a couple of suburban commuters coming home from work. But what we found in the middle of the street at the end of a long set of skid marks was.........
The General Lee.

Yep. A perfect recreation of the famed General Lee from the Dukes of Hazzard. Apparently this guy had spent the last 3 years restoring it and a half hour ago finished rebuilding the transmission. So, he and his buddy decide to take it for a test run. Somewhere in this test run he and his buddy (in a separate car) wound up colliding. And 5 minutes into owning a bad-ass replica piece of television nostalgia it looked a little closer to this:

 

Well folks, that's how it is sometimes in Hazzard County, when even the best of intentions and the purest deeds don't always turn out the way you planned 'em to. Life is funny that way. Isn't it?

Both Ends Of The Spectrum or All Dogs Go To Heaven?

This day started off a little differently for my quiet little district. We responded to an auto accident pretty close to the station and not expecting much. When we pulled up to the scene we saw that the accident involved a moving van and a small passenger car with significant front end damage and the elderly driver still in the driver's seat. I went to the driver while the rest of my crew checked on the guy with the moving van.

My patient was 90 years old, seatbelted and with his air bags deployed. He claimed no injuries but did say his right arm was a little numb. This was a bit odd because the impact was to the front right side of the car and there was no passenger intrusion and really nothing for him to hit his arm on at all. So I was thinking it might be medical. He had no other deficits, passed the stroke test, didn't need spinal immobilization...but still couldn't move his right arm.

He had a small dog with him in the passenger seat who must have been thrown into or under the dash. He lay dazed on the seat with a bloody nose and some irregular breathing.

 

The truck crew decided to take the dog out of the car and over to the side of the road. They put his leash on him and a firefighter stayed with him on the sidewalk. Our ambulance was delayed and taking a long time so we tried to get the patient out of the car as well but he was having difficulty with the car being so low, his numb arm, and a little hip pain so we decided to leave him there until the ambulance arrived, ten minutes later.

It was at this time that the dog's concussion wore off. Suddenly the firefighter yelled, "Hey!" "Hey somebody get something. He's biting me and he's gonna get out of this leash." The dog was awake and alert and unhappy now. This big firefighter was holding the dog's leash from the very tip and trying to steer clear of this little angry weiner dog. It was actually pretty funny.

 

They wound up wrapping the dog in a tarp and putting him in the back of a cop car. We got the patient sent off to the hospital and a family member picked up the dog. I'd be interested to know what happened to both of them but we didn't see the ambulance crew again that day.

The next bit of weirdness came when we had to respond to another district for an injury in the Walmart parking lot. That always promises to be interesting. The last time I went there it was for a tennis racket fight (http://myworkinglifeinthefd.blogspot.com/2013/05/tennis-anyone-or-people-of-walmart.html). En route we got the update that it was for a woman struck by a shopping cart. "Gentlemen! Call your lawyers!"

 

When we arrived we found the woman in the parking lot next to about 6 carts pushed together. She was with security and a store employee filling out a report. I asked what happened and she said the carts rolled over her foot and bumped her knee. Okaaaayyyy.
"Did you get knocked down or hit your head or anything?"
"No."
So I examined her knee which showed no signs of injury whatsoever and asked if she wanted an ambulance. She answered no without hesitation. As we gathered our gear to go and fill out her AMA paperwork she started getting worked up with the report writing employee ( who did exactly the right thing and just smiled and agreed with everything she said). The "patient" was going off on how dangerous these carts were and that isn't the right "protocol for this" (?), and that she could have been "terminally injured". We got her to sign the release and got the hell out of there without another word. Until we got in the rig of course and all began quoting, "She could have been terminally injured."

We got to end our day with a welfare check on a woman who hadn't been seen in three weeks or more. When we arrived the cops were already there and led us to the back yard. All the doors and windows were locked but there was a set of double doors with clear glass insets leading from the back yard to the kitchen. It smelled bad already and my firefighter pointed out flies around the eave vent. This was a baaaad sign.

When we got to the door in the backyard we could see a dog lying dead on the kitchen floor and feces all over the place. We went to grab forcible entry tools of the rig and to get masks on. If you ever see firefighters return to the engine just to put on a mask, I guarantee it's not going to be pleasant. We forced the back door open and everyone took a deep breath and headed into the house. There were a few yips from another small dog in the house somewhere but then silence. We made our way to a back bedroom trying only to breathe through our mouths and even then only as little as possible. We found her in the bedroom with obvious signs of death I won't go into. Suffice it to say we didn't have to confirm it with our monitor. We turned and left.

Someone would have to go look for that other dog I guess but we weren't about to go crawling around in there to do it right then. We turned the scene over to the cops and got back on the rig. And, of course, being the gallows humor firemen that we are, we commented that it had been a bad day for dogs in our district. To which I added, "Yep. Now, that woman was 'terminally injured."

We pretty much do it all, but no, we don't do that.

We responded out of district for an elderly-ish male who had fallen. On arrival we found out the fall was two days ago but the pain has worsened and he wants to be seen in the hospital. Apparently, when it happened the FD responded but he refused transport to the hospital. I went through all of my assessments and he did seem to be in some pain, mostly in his hips. He had no obvious signs of a hip fracture or dislocation and his pelvis felt stable, but it did hurt him when I pressed on it. He was sitting in a rolling desk chair and we offered to just move him outside to the gurney on the chair to save having to have him get up and back down twice. We couldn't fit the gurney into the cluttered house and as it was we had to pick the chair up and carry it up a couple stairs. He agreed and understood there would be a couple of bumps and a little pain along the way, especially when we had to pick him up out of the chair and onto the gurney. My guess is he may have a small, type A fracture, but only x-rays will tell.

As we were moving the chair up the little steps into the living room, I saw a flash from one of the relatives phone go off. It was aimed at the ground and I assumed it was accidental. My firefighter, though, told me when we got outside that she was filming us the whole time. Another relative was complaining the whole time and asking why the fire department had taken him the first time when he fell. My captain had to politely go through the routine explanations of how we are the fire department and don't transport and that decision is usually made by the ambulance crew and additionally that if the patient is alert, oriented, and competent we can not force them to go against their will. That is called kidnapping. She wasn't too thrilled with that answer. She then presented us with a small stack of legal documents she wanted us to witness.

 

Again, we had to explain that that is not something we can or would do. It is far out of our scope of practice. I think it was about that time the filming began.

So, it will be interesting to see if anything comes of this. We relayed the whole thing to our BC and to the guys at the station we were covering to give them a heads up. They checked the log book and discovered that the original fall had actually been four days ago and a different crew had run that call.

I'm used to the fact that when we are working outside, especially at a fire that there are likely to be a dozen cell phones filming us, but I wasn't expecting it inside somebody's house on a medical call. I guess between, security cams, nanny cams, cell phones, and drones I can just assume that I always on candid camera.

Smile.

Just Wait Here A Minute...Or Thirty

We responded to an auto accident just down the street from the station. It was on a one lane road right at the only intersection for a couple of blocks. With the siren cranked up and the lights flashing the cars ahead of me actually pulled to the right for once.

There was still barely room to squeak by. As I got to the scene I saw two vehicles with moderate damage and one patient lying on the sidewalk and being supported by a bystander.
My only real option to protect the scene and ourselves was to "take the lane" and block the road.

I felt bad for the people who pulled over and did what they were supposed to just to have me turn in front of them and block the only lane in their direction. There were only a few cars back there and I assumed that PD would turn them around and then close the road. That apparently didn't happen.

We dealt with patient care, spread absorbent down to catch the leaking fluids (from the cars, not the patients), disconnected battery cables, swept up glass and spare parts (again from vehicles not patients) and waited for the tow trucks. I was putting tools away on the traffic side of the engine when I noticed that the few cars had turned into twenty or more and were stretched all the way down the block and around the bend. The flatbeds were arriving to remove the cars and there was really no where for the cars to go but I still hustled back to the front of the engine to get away from the stares and questioning looks.

All in all these cars sat behind my engine on a residential street for about 35 minutes without even an option to bail out or turn around. Sorry about that folks. Cost of doing business I guess.

Magnificent Failures

My fire academy instructor held a drill in which each team was given a task to do and then given conflicting orders to see how they would handle it. For the record, when it happened to my team I pointed out the conflict of orders to the instructor and asked which he wanted us to handle. He just yelled at us and sent us on our way. We, along with most of the other crews were able to handle all the tasks assigned if not in their original order. After the drill, he deemed us all "magnificent failures". We accomplished all the objectives just as we had been trained and were successful in all operations. But the failure to acknowledge the conflicting orders was the goal of the drill (hence why he ignored me when I pointed that out). We had a fire not too long ago where that term popped into my head again.

My district is pretty quiet and we don't get a lot of fires. The closest two stations are so close that they are pretty much right on top of us when we respond and if we don't get out of the station quick enough we could get beat into our own district. On this day I happened to have an overtime captain and my firefighter was off on a trade so I was the only regular crew member.

The tones went off at o'dark thirty, somewhere between midnight and two a.m. When I heard the address I knew just where it was and it was a house fire in my district! I located the hydrant on the map, jumped into my gear, and hopped into the engine. I was dressed, with my radio in my pocket and ready to fire up the rig and drive out when the captain climbed into his seat. I looked back to confirm the firefighter was ready to go only to find out that he wasn't there. I waited a few seconds staring at the door to the station expecting him to come running through it any second, all the while mentally ticking away the time we were wasting. He didn't show.

I jumped out of the rig and ran back into the station. As I turned the corner to the dorms I saw that his door was open and the light was on. Oh thank god, he must have gone through the other door to the apparatus bay. Just to be sure I called his name and continued down the hall. I peered into his room and there he was, sound asleep in his bed with the lights on and the dispatch radio giving a follow up to responding rigs.

 

I called his name again from the doorway saying we had to go. Nothing. Are you kidding me? I marched into his room, grabbed him by the leg and shook him. Not surprisingly, I scared the living hell out of him. He snapped awake with me yelling, "Get up! We got a fire!"

I went back to the rig, fired it up and waited for him to hurriedly get dressed and on board. I took off for the address and as I rounded the corner before the final turn I saw no other rigs in sight. We might be first in after all. I made the turn and saw Engine 50 pulling up in front of the house. There was definitely at least a room and contents fire going on. Had I known that we were second in I would have come from the other end of the block and brought these guys a water supply. So now I pulled past E50 and parked on the opposite side of the street where I thought I was out of the way and started to bottle up to go to work. Of course, since things were going so well, I happened to park right where the engine coming from the other direction with the water supply needed to go and had to get back in and reposition the rig to get out of their way. Meanwhile the rest of the assignment was arriving and going to work.

E50 had a quick knock down on what turned out to be a single room and contents fire. Not much of a fire, but it still should have been ours. We wound up on a hoseline outside hosing down the fence and smoldering wood pile on the Delta side of the house. Not very interesting. The overtime captain was content because it meant he didn't have to do the report and the firefighter was mortified and very apologetic.

We finished soaking down the wood pile and went inside to check out the damage as the truck crew was clearing the roof. Just as I stepped in the front door I heard a big crash outside. I came back outside to see the ladder that was put up from the driveway to the roof lying on the ground next to the firefighter who had been climbing down it. I guess he tried to come down without someone footing the ladder for him and it shot out from beneath him. He was surprisingly unhurt if embarrassed.

 

So, the fire went out, all tasks completed, and no injuries to the public or the fire crews but quite a few errors were made. So, magnificent failures indeed.

Class Interrupted

I was taking a surf rescue class in the SF Bay Area and much of the class took place by the Golden Gate Bridge which made for a beautiful place to train. It also lent itself to a unique real world training opportunity.

It was the morning session of the third day of class and I was in the group doing small boat ops pretty near the base of the North Tower of the bridge. The other group was doing some rescue swimming in the cove closer to shore. I was piloting one of the boats and doing some victim retrieval drills when I heard a loud whistle and saw the other instructor (who was running the swim ops) standing on the pier and raising his fist in the air, the signal for "come to me". Our instructor headed over that way in his boat and I decided to follow along behind to see what was up. As I got closer I could only hear a bit of their conversation but what I caught was something about the South Tower, in the water, and a lot of pointing. I knew immediately what must have happened and as the instructor turned his boat around, I came along side and confirmed it. Someone had just jumped from the bridge near the South Tower and we were en-route to start the search.

We called the other boat to us and the three boats went flying out towards the bridge as fast as we could go. The first thing we saw was smoke on the water (yet no fire in the sky). I learned later that when someone jumps, the CHP or bridge personnel will go out to the person's last known location and drop a flare to mark the position and give us an idea of the tides. In this case the tide was still going out and so the flare was moving out to sea.

Just as our three boats coordinated what our search pattern would be (starting close to the bridge and working our way out to sea) a PD boat and CG boat came racing out of the harbor and further out past the flare. They began their search pattern from the outside working back in toward our boats. After less than probably five minutes of searching we saw the CG and PD boats take off, racing back to the harbor. Shortly after that we got the news over the radio that they had recovered the body and were heading back in.

Out boats met up and returned to the cove and joined the rest of the class that had been doing the rescue swimming. We filled them in on what happened and how it went while the Coast Guard crew carried the Stokes basket with the body-bagged victim onto the dock to await the coroner.

We had eaten up some class time, obviously, in that pursuit. So we got a quick review of what the swimmers had been practicing and then broke for lunch. The body remained on the dock for most of our lunch period and then we were back in the water working on the skills that could maybe someday help us rescue someone like that.