Sunday, July 19, 2009

anger and defeat

I was working my PT transport job last week when I got to experience my first "vent pt" at the job.

We will call her Carrie (of course its not her real name) She is 24, only a few months younger than myself. She was involved in a terrible car accident a couple years ago, maybe even just a year ago. It caused several problems for her including brain damage, paralysis, contractures, and respiratory failure. She is on a vent normally 8 hours a day, at night through her trach. She is very alert and oriented, and tries to communicate by talking, but more effectively communicates using a board with letters andpointing them to spell things out.

She was scheduled to go for an eye exam to determine if she needs glasses. She had had a previous appointment with this doctor a few weeks prior but never got examined due to another crew from my PT job getting lost on the way their and being late so the doctor refused to see her.

Upon walking into Carrie's room to introduce myself, you can imagine my surprise to find her on her vent in the middle of the day. She stated she was not feeling well today. When asked if she still wanted to go to her appointment she was very adament that she needed to go since the fiasco with her last appointment.

I went searching for my partner (who also happens to be the boss man) to let him know she was on a vent. I found him outside with a bettery charger hooked up under the hood of our ambulance...I began telling him what was going on and he just gave me the FML look. He then proceeds to tell me that we were on the BLS truck today, with no meds and no vent, that the other crew (who was an ALS crew as well) has the ALS truck because they had a vent pt today as well. After some scrambling he found the back up vent and got some extra oxygen from the facility and get the truck running. I checked that we would indeed have enough oxygen to get there, stay there and return and that my portable suction was in working order and well as the onboard, all was well.

I then got a crash course on the vent. (Two things should be noted here: 1) This was my 3rd shift here and I had yet to be introduced to our regular vent and 2) this was not our regular vent but a new vent we were thinking about switching to, so even my boss didnt know all the operations of it.) Thank goodness for RTs. She so kindly helped me set the appropriate setting for the pt and helped in my crash course of vent operation. By this point we were going to be about 15 min late for the pt appointment and she was getting upset because she didnt want to make the trip and not get seen again. I personally saw to it that the doctors office be called and the situation be explained about not knowing she was on a vent and agreed that as long as were were not going to be more than 30 min late he would still evaluate her. I reassured the pt and we were ready to go.

The transport to the doctor's office itself was pretty uneventful. Carrie was in a good spirit even though she wasn't feeling the greatest, even demanding to know why her husband wasn't wearing his wedding band, which he doesn't wear at work where he came straight from to go to her appointment with her. All of her VS were great. Her husband rode in the ambulance with us. I had everything set up and running smoothly. We got the doctor's office, unloaded the pt and went inside. We were standing in the waiting room when I heard the familiar gurgle of a trach needing suctioned. Carrie agreed that she would like to be suctioned. I walked to the head of the cot where my portable was set up and ready to go, I hooked up her inline suction and turned the power switch to on and nothing suction, no lights on portable, absolutely nothing. I asked the receptionist if we had a few minutes to go out to the truck to suction Carrie's trach and the doctor came out and said that would be absolutely fine, so back outside we went and back into the truck. I set up and hooked up the onboard suction, turned it on and began suctioning the trach using the inline catheter. I got one good sweep done, and went to a second to make sure we got it all, it still sounded kinda crappy and when I went for the second sweep I noticed it didnt seem to be suctioning. so I thought it was clogged, switched to a hard tip catheter, tried it on my glove, there was absolutely no suction. It then dawned on me there was no air coming out of the vents in the pt compartment either. When I questiopned my boss it dawned on both of us that the prior battery issues may be causeing a problem now.

While I began explinging to Carrie and her husband the predictament, my Bossman Partner went inside to talk to the doc. The doc was very unerstanding, and said he would try to get the appropriate approvals to do an exam at the facility Carrie was staying in.

Carrie was a whole other story. I explained the problem with the pt compartment not working and that the doctor was going to reschedule. She was downright angry. I can understand her anger, I would be angry too. All she kept talking about though was the fact that we had a dvd player in the back of our unit and a GPS unit to tell us how to get places yet we can't keep our trucks in working condition. That is all I heard from her the entire trip back to her facility. Meanwhile I was more concerned with her well-being, which remained very stable.

I was kind of at a loss for what else to say to her, so I just let her be angry and rant. I took as much of the blame as she would let me. And then she looks at me and says "Just let me die." And the only thing I could say to her was "Not today Carrie, not today." And her husband is still sitting right there beside her with this look of tiredness and defeat....

No comments: