By Crystal Wallin, NREMT-P, CCEMT-P, Gundersen Tri-State Ambulance

It’s mid-morning and when the call comes in. Our crew today is made up of three of us; the usual dual medic crew of myself and my partner is increased by the presence of a flight nurse. The local flight service owned by our parent company has its flight team members do ride time with our ground service once a year in addition to time spent in ICU, NICU, OR etc.

It is my first shift back after a diagnosis of multiple sclerosis back in late summer and I am giddy driving to work that morning. I worked for years as a night time dispatcher before paramedic school, and for much of my early career as a street medic, I worked a straight night time power truck. In the years that followed, I worked a combination of night shifts and 24 hour shifts. Now as an ER nurse, I work 3pm to 3am and love it. But this snowy cold morning of my first shift back in uniform finds me on a day shift. It is a testament to my love of the job that catapulted me out of my warm bed and into the hot shower at the first nagging of my cell phone alarm.

Something about that uniform feels like putting on my most authentic self. I am not sure how long it will be before I identify as a nurse no matter the fact that I love my current employment in a small town ER, but that gold patch on my arm feels good after my medical leave.

So after greeting my partner, meeting our rider whose long career in nursing impresses both of us, we complete our truck check and kits, narcotics check, I am logged into all programs without incident. Radio clipped on my hip and Boston strap with the familiar weight of the mic just below my left clavicle, I am sure my ear to ear grin looked exactly like any rookie’s face.

And the familiar tones sound a few hours later for this call, “deedle-eedle-eedle-eedle, 303, you’re needed for a call in Midsize Town for a 20-something female who fell in her shower”. We put ourselves en route, set off down the road, winding our way around cars and mindful of the wet snow. I’m driving as my partner is charting his last patient. As often happens, we go back and forth about the nature of the call, what might’ve caused the incident, who does what once on scene. Every paramedic does things a little differently and every regular crew develops a rhythm. I’ve not been part of any crew rhythm in a few months and I want to be mindful of my partner’s preferences. He’s a newer medic but an incredibly intelligent one. I am glad to be with him on this shift as I find my place on the street after being used to the pace and metronome of the ER.

We arrive on scene in not too short order, and I back the truck into the driveway. Fire is on scene, and left us the driveway. Backing remains a muscle memory skill and I engage the emergency brake, notify dispatch while my partner updates the mileage on the tablet’s Navigator screen. These things I do as if it was only yesterday, and that too feels good. My boot hits the running board and my hand is automatically turning on the radio at my hip. We enter the house, the three of us, finding ourselves immediately inside a living room. Six eyes are gravely fixed on us; a beautiful bulldog, a toddler of perhaps two years of age, and a small human of about 4 years. The 4 year old calmly points us back to the hallway. Just outside a bathroom door, a fireman looks up.

“Hey guys – hey, long time no see! So, this is <Jane Doe> and she was taking a shower, felt light headed, we’re just about to get some vitals here” and as I step into the doorway I see the second fireman with his monitor in front of my patient. He looks up, and the proximity causes us to decide I can relieve him in the small space.

I hunker down, elbows on knees and heels of my dripping boots off the floor. I survey my patient. Her eyes are tightly shut, she’s gripping the towel wrapped around her with one hand and holding the other to her brows. She’s tachypnic, there are some puddles on the floor but her face is dried and no diaphoresis noted. Her color is good. Her eyelids are fluttering. It takes all of a solid minute on the clock but she finally opens her eyes and focuses on my face, my quiet questions. She slows her breathing to hear what I’m calmly asking and I’m able to get those baseline vitals. I find out she uses a cane to walk, a cane which the small human happily hands to the firemen when the request is relayed out and down the hall. She had an injury awhile back, years ago, and a nagging reminder which necessitates the usage of the cane. Today she woke up feeling nauseous and as the morning has gone on, everything she had in her GI system has left by both exits available. After about four hours of this, she thought she’d take a shower. During her shower she felt light headed, went to sit down on the side of the tub and slid onto her bottom on the floor. Her vitals now check out great. She confides that she also has problems with anxiety and some panic issues since she’s become a single mom. We go over a few other medical history things and that tachypnea is gone, now. She indicates a neat pile of folded, clean clothes by the sink, and I hand them to her. I get a second set of vitals after she is clothed, and she wants to stand. The cane is on one side and with me on the other, she easily stands. Repeat vitals show no deviation from the baseline we’ve established. We stand there a minute, chatting like two ladies do about the small humans in the living room and how it’s hard to be sick when you’re the mama in charge. She’s visibly calmer now. We walk slowly together to the living room.

Both small people are watching through the blinds as my partner finishes shoveling her walk. Her driveway is already done, and the flight nurse is petting the pretty bulldog. I tell fire they’re ok to clear, exchange “good to see you, good to be back, thank you, be safe out there, hope you don’t have to see us again” pleasantries – and they’re gone.

The patient and I sit on the couch. She’d called a family member prior to our arrival and we decide we will wait for him. I ask her what I can get for her while we wait, and she looks at me in surprise. “It’s been a long time since someone asked me that”. She tells me of Gatorade in the fridge and where her meds are for anxiety, etc. Vitals are unchanged. I bring her the Gatorade and give her the mom line “just sip it now, I know you know that” and she smiles easily, her shoulders are now relaxed and she puts the anxiety meds within arm’s reach. The relative comes and they work out that my patient will stay home with some of the family member’s help; he will stay and watch the small humans so she can get a little rest.

My partner goes to the truck to get the computer for my patient to sign the release while I go over a few things with her. She needs to rest, try to keep some fluids down but if anything changes, she needs to think about being seen. She continues to say she has been feeling much better, that’s why she wanted to shower. She ruefully grins at me, saying “I should’ve known I was weak from the morning, though” and we finish the list of things to be aware of, and when it really is time to be seen. The small person who retrieved the cane told me proudly he learned to call 911 just yesterday, so when mom plopped on her bottom he knew just what to do! I look at my patient beaming at him, color in her cheeks and hair drying in slight curls around her face, and tell her “great job, mom. You’re doing a wonderful job”. Her chin tucks and she’s shy, but she needs to hear that. In this small apartment where the detritus of small folks fills the floor in spots, a wriggly bulldog’s under bite is the closest thing to help with the kids she’s got on an average day. I imagine it can get a little overwhelming even when you’re not sick.

A few minutes later, kids high fived, bulldog petted nearly to death, walkway and driveway shoveled, goodbyes said, refusal of transport signature obtained and promises to call if anything changes, I shake the family member’s hand and we make our way to the truck.

 I walk absently to the driver’s door, lost in thought of the days when my own kids were little and I was a newly single mom. I catch movement and look through the cab to the opposite window. My partner is gesticulating at me, pointing to me and then the passenger seat. I mime typing and point at him. He shakes his head, then at the driver’s seat. We exchange places and as we buckle, I say, “all done with your report huh?” and he replies “yep!” I laugh, “that was pretty good, a whole conversation in gestures” and flight nurse buckled in back, he pulls out of the driveway. I update Navigator, he tells MedComm we are clear with a signed refusal, and we make our way out of the little tidy neighborhood of duplexes. Radio up, we head back toward the four lane as the fat snowflakes continue to fall rapidly.

That rhythm of street medicine is always just there, a memory away. Predicated by a desire to help others, rooted in strong protocols and talented partners, but fed oh so well by that human to human connection.

There’s nothing like it. The patch is golden and the reward is infinite.

“303, en route”.