Thursday, December 29, 2011

Fire Showing: Triple load

Here's a link to my friend Jeremy's (at I.F.D.) blog, Fire Showing, with some excellent tips for companies that use the triple load.

Fire Showing: Triple load: Couple quick videos on how to stretch and reload the triple load. Everyone who uses these loads should know this and know how long they are...

Friday, December 16, 2011

The Worst Call I've Ever Had To Work

One year ago (as of this writing), on December 16, 2010, I was on duty, working on the ladder truck. My kids (from my first marriage) were living with me, and had been for about two months (long legal battle story, not going into it here). I received a phone call from my wife telling me there was smoke-like dust all over the basement and that my son (who was 14 yrs old at the time) was acting rather bizzare, and asked if I could possibly come home. I told my captain I had a family emergency and needed to go home, and as I was extra that day, it was no problem.

When I got home, my son was as high as a kite. He was also extremely angry at everyone, and taking it out on me. I'm a big man, and have big shoulders & thick skin, so I wasn't bothered per se by that. What was bothering me was that I had only just realized that my son has a drug problem. I see it at work all the time, but never expected to see it at home. Now what do do about it?

That afternoon and evening was a constant battle between he and I. At one point he kicked the kitchen table at his stepmother and took a swing at me. That is a big no-no in my mind. I stepped into his punch and bear hugged him, collapsing onto the floor and pinning him (not unlike what we sometimes do at work with combative patients). After several minutes, he settled down. I grounded him from everything except church, school, meals, homework, and showers.

He went to bed about 10:30. Ten minutes later he said he was thirsty and got a bottle of water from the fridge. No problem, I figured. I'd rather he keep hydrated. I kept hearing things falling off his bed, so I went to check. He was acting very lethargic at this point, but was still awake and talking. Immediately I was hit with an overwhelming odor of nail polish remover - I found two empty bottles that he’d huffed. After opening the window in his room, I climbed the ladder to his loft bed and found an assortment of pills, a lighter, and a razor blade. After securing these items on a table well out of his reach, I helped him down. I grabbed a pair of shoes and a coat for him and decided to take him to the ER. I figured he was quite high, but I hadn’t yet realized the gravity of the situation.

I helped him walk about seven or eight feet, and then he collapsed. I helped him to the floor, and asked him what he had taken. He looked at me, smiled, and said, “Enough.” At that point I called 9-1-1. After giving the address, call back # and nature, I identified myself to Lee's Summit FD 9-1-1 and told them that I am a CJC medic, and asked if I had to answer all the pre-arrival questions or could I keep assessing/treating my son, and they calmly said to call back if there were any changes. The next few minutes were some of the longest few minutes in my life.
Initially, he was easily rousable with a light shake. He’d open his eyes and holler “What?” at first, then after a moment or two of this, he stayed unconscious. I’d initially put him into the recovery position, thinking if he puked, it’d be easier to maintain his airway. After he became totally unconscious, his breathing became totally erratic. Over the next minute or so I witnessed him have strange, irratic breathing patterns, like ataxic breathing, & I could no longer find a radial pulse. I rolled him onto his back and before I realized it I had done the head-tilt/chin-lift and also cut his shirt off. He still had a carotid pulse and was getting somewhat decent chest rise, and wasn’t yet cyanotic.
One thing I did was I kept looking for the guys on my crew, calling out their names, angerly and sarcasticly asking if they got lost in the 50ft from the street to my door. Then I’d realize I had left shift and was in my own house and that LSFD was on the way.
LSPD & LSFD arrived in what was actually short order (under four minutes from the time I dialed 9-1-1), but it FELT like for ever. Two cops and the ambulance crew stormed in and about ten seconds later the pumper's crew came in with the rest of the stuff. I recognized two of them from working together at part time jobs and from various fire schools I've attended with them - Jim V. and Craig A., but at that time I couldn't have told anyone what their names were. I saw them come in, and just said, "Man, I'm glad you two are here."
They quickly dropped a nasal airway, had the monitor on him, got a line started and gave narcan. At that point it was still unclear exactly what he took or why. They recommended to me that they take him to Children’s Mercy Hospital, which was fine with me. They quickly loaded him on a back board and took him to the cot and unit, then took off with their lights and siren going. The cops that were there searched his room and found a suicide note and several empty prescription bottles. They radio’d and relayed the info to the medics on the ambulance.
(A little background, my son and daughter lived with my ex-wife until Oct 2010. Bitter divorce, not going into it here.)
When he first moved up in October, I monitored him daily to see that he was taking his prescription meds properly, and he was. So I trusted that he still was. Apparently he had other ideas. He’d been hoarding his pills for some time. He was on amitriptyline 10mg for preventing migraines, naproxen 500mg PRN for when he got a migraine, and unbeknownst to me, was also on phenergan 25mg PRN for nausea (he hid them from me, and his mother neglected to inform me of such). For his pill popping finale that evening, he took approximately: 900 mg of amitriptyline, 625 mg phenergan, 20,000 mg of naproxen (yes, that’s 20g, quite a lot more than one is supposed to take), and 29,250 mg of aspirin (ditto the naproxen comment). The naproxen, aspirin, and phenergan all potentiate (increase the effects of) the amitriptyline.
When we were done with the cops (who were totally supportive of us and very helpful) we drove to CMH. When we got there, as we were checking in with security, well, he must have been told to call the back when we got there, because we were met with two chaplains before we were done getting our ID stickers. They took us straight to a family grief room. That’s when I started preparing my daughter for the bad news my wife (an RN) and I were already expecting. Fortunately, it wasn’t what I thought it was going to be. He was still alive!
They had him on a vent. They used RSI on him as soon as he arrived, which was almost an hour earlier. The RSI meds had worn off, but he wasn’t fighting the vent at all. They brought us back to him where I also saw he had a Foley, an NG tube, and was having 12 leads done q 15min. His QRS was .180 which is way beyond normal. His blood pressure bottomed out, and they had three IVs going, wide open. They were also giving him Sodium Bicarb like it was going out of style. They were done in the ER, and they were ready to move him to the PICU after we got to see him.
Once upstairs, the waiting began. As a parent, I was allowed unlimited access, so I kept going back and then coming out to brief my family. My brother showed up (he lives in across town from me) and that was very helpful to have him there. Then they said I could bring family members back one at a time. I brought my daughter (she was 15 at the time) back first. She said it reminded her of when her cousin died in an ICU a few yrs ago. I told her to take a good look, as this is what drugs can do to you. (I now knew both of my kids had been popping pills, and I WANTED her to be totally scared, which I believe she was.) She had become nearly inconsolable when she saw me readying him for CPR if needed, and when she saw the medics do their thing she got worse. She calmed down en route to the hospital, but now was upset again. I know some folks would rather shield their kids from seeing this, especially as this was her own brother. However, I wanted her to completely understand that he may yet die. I think she got the point.
I also brought my brother and my wife back. I could only bring one at a time because of rules (yeah, who needs dumb ol’ rules anyway). But it worked out fine. The staff there was in full-on hustle mode. There was a doctor and no less than three nurses in there. I learned a new meaning to “Intensive Care”.  The staff there was great. Any time I had a question, they would answer it, despite being busy. Sometimes they called in someone else to either answer the question or to take over a job while they answered my question.
About 5am, the kids’ mother arrived. I am pleased to report that things went well and we all were seemingly on the same team for the duration of his hospitalization. We all held a vigil there until about 10pm, when we finally left for home to get a little shut eye. My ex stayed at the Ronald McDonald House, which is right around the corner from the hospital.
Then the news gets worse. About 3am on Saturday morning, my wife and I suddenly awoke. She said she had a very vivid dream that where she had found him in the garage on Thursday afternoon (before I got home), there was also a rope and duct tape. We ran down to the garage where she’d found him, and sure enough, there was rope and duct tape there. We looked up and saw where he had popped ceiling insulation out in an attempt to find a place to secure a rope. He was going to hang himself, but she interrupted him. When I got home shortly after she interrupted him, he was quite angry, I think because he was planning on killing himself while I was at work. I took pictures of it all to show the hospital staff (specifically the mental health folks).
We went back to the hospital after we got a few more hours of sleep and spoke to the nurses and docs about what we found. They took notes and I’m sure passed them along to whomever they needed to pass them on to. We were there all day and well into the night.
At one point a nurse walked up to me and said she saw me the night before, still in a fire uniform, and said it looked like her husbands, and asked if I worked at CJC? When I told her yes, she said Aaron P. is her husband. She and I talked for a while, and she assured me that everything that could be done for him was being done. It was a waiting game.
Waiting games suck.
He was in a coma for almost 72hrs. They’d gotten his blood pressure under control, gotten his QRS narrowed to .090 (which is within normal limits), and he was even starting to breathe on his own with the ventilator there for support only. It was Monday morning before he would stay awake and he was extubated. His sister and his aunt had put up posters in his room. His first words were a complaint that none of them were of Megan Fox! By Monday afternoon he was transferred upstairs to a behavioral health observation room. Tuesday afternoon he was transferred to Research Psych. There, they put him on two new meds, neither of which is a tricyclic-antidepressant.
While he was still in the PICU, his mother and her attorney filed some sort of thing with the court where she was asking for emergency custody. We'd just finished a very long legal fight, and how the kids moved up with Amy and I on October 23rd. They’d been with me for two months. Then this crap happened. Amy and I talked about it, prayed about it, and ultimately decided that we are not going to fight it. We knew the kids didn’t want to live here, and I’ve even seen in my daughter’s writings that she is thinking about harming herself. Now my son overdosed. I know that their being here against their will is a major reason for such drastic actions, however, I am smart enough to know that it is not the ONLY factor. His attempt was the night before he was to visit his mother. It is my sincere wish and prayer that as he continues to receive therapy, the mental health professionals help him learn to deal with what ever  problems he has in a less drastic manner.
The strange thing about it is that I am totally at peace with letting them go back to their mother’s. I am NOT saying that I am shying away from raising them. Not at all. I want nothing more than to be a positive influence on my children, and for them to be healthy and happy and to make the most of themselves. The only thing we can figure is that God knew he was going to try this, and down there he may not have been found in time, and there aren’t the resources down there as there are up here. He would have to have been life flighted to Cardinal Glennon’s in St. Louis (another EXCELLENT pediatric hospital), and may have died because of the distances involved. I don’t know. What I do know is it wasn’t his time yet, God has plans for him yet, and on Christmas Day I got to give my son presents, instead of a funeral. I thank God every single day for that!
So now it has been a year. I have been on quite an emotional roller coaster since this incident. I am, however, very pleased to report that my children are doing well, and that my son has fallen in love with playing guitar. My brother gave him one for his birthday this year, and WOW! He has taken quite a liking to it. He has also sold his ATV and bought a truck, and is working on it nearly every day to get it customized to his liking for when he turns 16. I am very proud of both my children, and love them dearly.

Thanks for reading this. God bless.

Ken