Just to give her a chance

Yesterday, I had just brought a patient into the hospital and was making light conversation with a couple of the nurses and one of the nurses, Mary, had asked if I had worked on Saturday. I replied that I hadn’t. She related that she had gotten several emergency patients in a row; one in particular was a teenager that was in ventricular tachycardia. Unusual, but obviously possible. I commented about a particular transport I had more than a few years ago, a young lady with an underlying congenital heart problem of dextrocardia. Again, unusual but possible. As I was driving home from work later that evening, I relived that call in my mind. It made it a bit hard to continue driving.

I had just brought an emergency patient into St. Joe’s West and was preceded by another crew who had transported a 19 year old in respiratory distress. Upon arriving at the emergency room, I was informed by my dispatcher that I would be transporting a critical patient from the emergency room to Children’s Hospital Emergency Room. Stat.

After I finished transferring my current patient’s care over to the staff, I went to the ER doc and nurse to receive my reports and orders for my critical patient. A 19 year old female had collapsed, in respiratory distress, while playing soccer, if my memory serves. She then went into respiratory arrest and bradycardia and was transported by a fellow crew. All of her treatments over the years and all of her primary doctors and surgeons were at Children’s. That was where she needed to be.

Her main medical history was dextrocardia. Dextrocardia comes in two forms. The first form presents with the heart on the opposite side of the chest, usually with no other side effects except that medical professionals have to reverse the ECG leads when obtaining an ECG. The second form is a bit more radical with all visceral organs reversed. My patient had the first form but with an added twist. As it was described to me by her parents, she was also born with her heart pumping blood in the opposite direction, from the left side of the heart to the right. She had undergone more than a dozen surgeries as a child to correct this, but ultimately she still had a heart that was effectively running in reverse, usually causing her to be chronically fatigued.

I went into the trauma room to observe my patient and to see what exactly I was dealing with. A pretty-as-a-flower young lady was laying on the gurney, sedated. I remember her parents being in the room, looking very worried. She was intubated and on a ventilator, and her heart was being paced by a transcutaneous pacemaker (the hospital version of our LifePak ECG Monitor/Defibrillator). She had several medications running, including a sedative (probably Propofol) and Levophed (a vasopressor medication that encourages the heart to be more active and pump more forcefully so as to increase blood pressure). I was also made aware that the staff had been slowly increasing the gain (milliamps) on the pacemaker to maintain heart capture. Plain and simple, this kid’s heart was failing. This transport wasn’t going to be an easy one.

I made all my preparations. Got all my medications switched over to our medication pumps, obtained my ventilator settings and prepared the ventilator. We moved our patient to our stretcher and switched to our ventilator. I synchronized our pacemaker with the hospital’s and made the switch. So far, so good. 

“Fly like the wind” was the order from the doc and from me to my partner. Mom was accompanying us, secured in the passenger seat. 

We hadn’t even made it all the way to I-94 before I was already increasing the gain on the pacemaker to keep her heart going. I kept Mom informed of what was happening, but to be assured that I wouldn’t give her daughter and her anything less than my very best. 

By the time we were sprinting past St. John’s, the gain was maxxed out and I had already increased the Levophed to its maximum limit. My mind was racing, trying to think of anything else I could possibly do to help this beautiful kid with a whole life ahead of her. She made up my mind for me. She arrested. Too far to turn back to St. John’s, we narrowed our sights on Children’s and told my partner to pick it up, speed limiter be damned. I honestly don’t think my partner was ever doing less than 80 mph once we entered on to the freeway. 

I started my CPR compressions and ventilations, and started dumping Epinephrine and Atropine into the IV. I remember telling her to keep going, even yelling at her to not give up. Anything to give her a chance. We rolled into Children’s ER and immediately into the Trauma Room to the awaiting trauma team. I stayed and helped until the last, CPR or ventilating or administering medications, whatever was needed. An hour and a half later, we finally stopped.

Afterwards, I went to the quiet room where her mother and father had been waiting to express my condolences. I finally broke down and cried. I had finally left everything on the table that day. Her parents were so grateful for what I did for their daughter and hugged me, trying to console me when I should have been the one consoling them. 

It was a quiet trip back to the service area. I was truly exhausted, physically and mentally.

I went to the funeral home a few days later to pay my respects. It’s not something I usually do, but I do occasionally. I’ve found over the years that it helps lessen the burden on the soul and keeps my perspective in check. I found that, regardless of this young lady’s heart problem, she defied the odds, living life like a normal kid should, with an abundance of energy and optimism. She had many friends and family and it appeared to me that she never let something like a broken heart stop her from living every day to the fullest.

As I finished my drive home yesterday, thinking about all of this and through blurry eyes, “The Fire Down Below” by Bob Seger came on the radio. Coincidence? Probably, but maybe not. I realized that that young lady approached her life with a fire and a spirit that kept her going years after what many thought was possible. When she arrested, I felt like I claimed that fire, if only for a little while, so I could do what I needed to do. She deserved nothing less. I needed to give her nothing less than my best. I realize now that I also did it for myself. So I could go back the next day and the next day and every day. Just to give someone else that chance. 

Okay, that’s enough for now. I’m an emotional wreck right now. God bless and Bring it!

Mikey

Old Glory Speaks to Me

I am Old Glory,

The Stars and Stripes,

The Star-Spangled Banner,

And The Red, White and Blue.

My Union is a constellation

For each of these United States,

My stripes for each of those

Bold colonies who declared unequivocally

Free and independent of a tyrannical king.

Old Glory Red is for valor

For those who fought and died,

For those who still fight,

Remember them all.

Red is the blood spilt by soldiers and sailors.

Oh, the sacrifices they have made

So that we may live,

So that we are free.

Red is the courage of our citizens,

To stand and defend the defenseless,

To accomplish the impossible,

To sacrifice all for our beliefs,

To follow The American Dream.

Red is the lifeblood,

The heart,

The love,

The very essence of these United States:

It’s citizens.

Nowhere else will you find such people.

White is the light,

Blinding to all who wish to be free.

The fire that Liberty holds aloft,

Guiding others to our shores.

The New Colossus at the golden door,

The Shining City upon a Hill.

White is the purity,

Of justice,

Of freedom.

It is the Spirit of America.

It is the ideal that justice prevails,

It is our treasured freedoms,

The bedrock on which this great nation rests.

White is the spirit of it’s citizens,

The religious freedoms that we hold dear,

Free to pray and to worship,

The free voices with which we utter without fear.

White is the melody of a song,

It inspires like no other,

A chorus of angels,

To inspire and strengthen us.

Old Glory Blue is to be true,

Of loyalty our fighting men and women,

Understand and declare:

“No one left behind”.

Blue is the embodiment of strength,

Of perseverance and commitment,

Of character and belief.

When all hope seems lost,

It’s what an American strives to be.

Blue is our skies and our waters,

Pure and good.

Breathe deep and drink deep,

It sustains us when nothing else exists.

Blue is excellence,

For which we strive,

We toil and we hunger,

We serve with distinction.

Be proud and blessed,

I am you and yours.

I am your neighbor and your friend;

I know no colors but these.

I encourage the fallen to stand,

I protect the innocent and the defenseless,

I show the path to those lost;

I bring faith to those in need.

I am justice when injustices exist,

Be assured that liberty prevails.

I am the strength of hard work,

You know its rewards.

I am the spirit that drives you,

To exceed all expectations.

I am the optimist,

There is always a way.

I am humility and charity,

Giving our last to others that need.

I persist against our enemies,

When you are down and almost out,

With hope and melody,

I encourage you to fight to your last breath.

You see a banner,

Struck in freedom and liberty,

Sewn with hope and faith and love,

Hung with pride and spirit.

I see a people,

Determined and strong,

Charitable and free,

Proud and thankful.

I am Old Glory!

--------------------------

Michael Clinton Ulrich

11/23/2012

On my mind in my light reading

"Whoever you are--you who are alone with my words in this moment, with nothing but the honesty to help you understand--the choice is still open to be a human being, but the price is to start from scratch, to stand naked in the face of reality and, reversing a costly historical error, to declare: 'I am, therefore I'll think.'

"Accept the irrevocable fact that your life depends upon your mind. Admit that the whole of your struggle, your doubts, your fakes, your evasions, was a desperate quest for escape from the responsibility of a volitional consciousness--a quest for automatic knowledge, for instinctive action, for intuitive certainty--and while you called it a longing for the state of an angel, what you were seeking was the state of an animal. Accept, as your moral ideal, the task of becoming a man.

Do not say that you're afraid to trust your mind because you know so little. Are you safer in surrendering to mystics and discarding the little that you know? Live and act within the limit of your knowledge and keep expanding it to the limit of your life. Redeem your mind from the hockshops of authority. Accept the fact that you are not omniscient, but playing a zombie will not give you omniscience--that your mind is fallible, but becoming mindless will not make you infallible--that an error made on your own in safer than ten truths accepted on faith, because the first leaves you the means to correct it, but the second destroys your capacity to distinguish truth from error. In place of your dream of an omniscient automaton, accept the fact that any knowledge man acquires is acquired by his own will and effort, and that THAT is his distinction in the universe, THAT is his nature, his morality, his glory." --Ayn Rand, Atlas Shrugged.

Three Years

09 March 2012

I’m not quite sure what I wish to say or how I’m going to say it. I guess I’ll just let my fingers type and my mind wander. Let’s see where this goes.

On my way home from work tonight, I started thinking about tomorrow. Specifically tomorrow, three years ago. 

During the 24 hours that made up March 10, 2009, I experienced a far greater range of emotions than any one person should be allowed to suffer: breathless, exhaustion, pain, despair, sleepy, ache, numb, blessed, scared, strength, realization, shock, starved, relief, awed, fear, thankful, sorry, amazed, angry, inspired, humbled. 

I’m still not quite sure how to classify that day. I really think that I had hit rock bottom a few months previous. Losing my job and, subsequently, my house provided a spectacular view from what I thought was the very bottom. I realize that the bottom can be, and is, several rungs below that. The view is spectacularly inspiring. Looking up because you can’t look down any more was inspiring to me once I realized that I was done feeling sorry for myself. It’s thought-provoking even. And I had a lot of time for inspired thought-provoking in the days and weeks and months ahead.

As I was driving tonight, I subconsciously realized that I remember the stark details vividly. I had worked the previous 24 hours feeling completely exhausted, feeling as if I was a COPD patient with exertional dyspnea, the type of patient that I had treated many times in my many years in EMS. I could only walk a few steps before I needed to catch my breath and gather my strength. I persevered that day, this day three years ago. 

I saw myself, exhausted from a long day and night of work, even more exhausted as I arrived at my doctor’s office to figure out what was going on. I remember looking at my chest x-ray, wondering why the hell my left side of my chest was as white as the wind-driven snow. I remember the conversation with my doctor, how I decided that, because I had just driven thirty miles to my doctor’s office, I could drive the last eight miles to Mt. Clemens Regional Emergency Center. Almost breathless, I slogged into the ER to be triaged, exhausted. Sleepy.

Looking back in recollection, maybe if I had looked into a mirror at the doctor’s office, I might have accepted his offer of an ambulance ride to the ER. Apparently, according to the triage nurse and the other nurses and techs and doctors, I was pretty ghostly looking. Pale. White. A wheelchair appeared and I was promptly ushered into the trauma room. My pulse ox reads a measly 84%. Oxygen, IV’s, labs, 12 lead ECG, more x-rays and a CT of my chest. Shock. A collapsed lung and a large unknown mass in the middle of my chest. What was going on? Despair. Pain.

Mom and Dad show up at the ER. Nicole arrives to take charge. I think I’m so tired and numb but I’m thankful that I can trust her to try and make sense of the inexplicable. I still have a little strength left. We always made a good team. From the first day of EMT class, a long time ago. Big brother, little sister.

The ER doc shows up at the bedside. They want to tell me privately but I don’t have anything to hide from anyone. Tell me what I don’t want to hear. They don’t know what the mass is yet, but I have an ICU bed with my name written all over it. It feels weird, being on the other side of the veil. A patient, rather than the caregiver. Kinda scary, but oddly relieving too. Truly believing that each person helping me now is doing so because they want to, rather than because they’re being paid to do so. It’s what we do. Delusional? Maybe. But I still believed it. But I might have been starved too. I honestly don’t remember eating that day. My stomach aches.

Word gets out. Mikey is in the ER. Seems like wildfire as the word spreads. Everybody knows Mikey. I’m starting to realize the full unadulterated importance of friendship and family. I am in awe as the visitors arrive. You show up, a couple at a time, a few, a group, a multitude. When all is said and done eight days later, several dozen visitors each day. I think they relaxed the rules just a teeny bit while I was a guest in the ICU. It was a party. Somebody just forgot to bring the beer. Rob might’ve tried smuggling some in if I would’ve asked. Now, that’s a partner! Who would believe that someone gave me a blow up sex doll while I was in the ICU? You can’t make this stuff up! 

My date with the ICU begins. I remember taking quite a few patients out of the ICU. This is the first time I saw one wheeled in from the ER. 2 South. I’m relieved for the small fact that I might be able to sleep eventually. I get my marching orders from my nurse. Stay in bed and rest. And keep the oxygen on. As tired as I am, sleep is beyond me. I can’t even follow simple instructions.

As it gets dark and the day grows older, Kimmy becomes my protector, the watchful eye. She’s working down in the ER on the graveyard shift. She comes to visit me in the ICU when she can, making sure I’m ok. Most people can point to an older and wiser mentor who you learned life’s lessons from while you’re learning to love the job you were destined to do. I have to be different. My mentor is younger and much prettier than I. I’d like to think we’re both pretty smart and we’re both much wiser together as partners. Four years. At least three years. It seems like much longer, but in truth probably much shorter. Do you have a partner that you can run a code with and not say a word? I do.

March 10, 2009 will be the day that changed my life forever. For the better and worse. It was the day that I felt my absolute worst. Every day since has been my best. Some days are better than others but these days are always best days. Over the past three years I’ve read more about cancer and Hodgkin’s disease than anyone should be allowed to learn. I find it oddly troubling that the American Cancer Society would need a slogan, but it’s a good one: “The official sponsor of birthdays”. Because every birthday forever after is one that might not have been. I was lucky. My brother David was extremely lucky. Several friends were lucky. Several other friends weren’t so lucky. Celebrate and live life like it was your last day. I’d say it’s a pretty good rule to follow.

It’s humbling to truly realize how many lives one single life touches, whether in the course of a day or a lifetime. Loves, girlfriends and girl friends, partners, co-workers, bosses, students, FTO-lings, supervisors, EMT’s, paramedics, nurses, doctors, techs, firefighters, police officers, classmates, acquaintances, all my “nieces” and “nephews” that know Uncle Mikey, and my families, real and adopted. Friends, all.

I just want to say…

May God bless you all. He’s blessed me. Thank you!

Lighthouses

Does everyone know the current Keebler commercial? The one with the two girls just getting home from school and there's only one cookie left and the big sister finally relents and gives her little sister (with her puppy dog eyes) the last cookie? The head Keebler dude makes a dash for it and replaces the last cookie with another one and scoots outta sight before the big sister knows what happened. And everything is right with the world once again. I hope I'm not the only one that think it's a pretty cool commercial.

I love a good story where the underdog defies the odds, the losers become winners or even something as simple as a cookie commercial displays the good nature that I believe exists in all of us.

The stories are out there. Sometimes even Hollywood gets it right. Rudy and his lifelong quest of Blue and Gold. Remember the Titans moves beyond racism to triumph. Hoosiers is a modern day David versus Goliath. Or the story of lending a hand and giving a stranger the one thing he desires most (a family) in The Blind Side. Movies like Rudy, Remember the Titans, Hoosiers or The Blind Side show us the heroism that exists in all of us, even in someone that isn't heroic. That the best role models aren't heroic or geniuses at all, but real people that have real problems. That the strongest, the smartest, the most beautiful or the most charismatic is, in reality, just a Hollywood fairy tale. But, even then, sometimes it seems as if Hollywood does get it right, if only occasionally.

The real heroes are regular Joes and Janes. Their lives are flawed. Their characters are not-so-pretty and average. Their circumstances are dismal. Their problems are real. But their spirits live and soar. Their passions are real and contagious. Their stories inspire us and make us believe. Their inspirations give us hope and fuel our own dreams. They are slices from the American Dream, the indomitable spirit that exists in each of us.

Is it ultimately a product of our American civilization, our amazing country in which we are so privileged to reside, the ideals that we believe in and strive to achieve that inspire these regular Joes and Janes to dream farther than we can see and to believe that the impossible is indeed possible? Would a person in an oppressive society allow themselves these same dreams and beliefs as easily as the same person in a society that values freedom as a way of life as we do? Would they be encouraged to follow those dreams as easily as they could in a society such as we are privileged to be a part of? Would they even be aware that such opportunities even exist?

Honestly, I'd hate for those questions to be merely rhetorical. I'd hate that what I just asked be true. The American spirit is, in truth, the Human Spirit, personified. That spirit is what makes each individual human unique, but also the same. It's what separates us from the other members of the animal kingdom. The sad reality is that unless you were or are one of the fortunate few to be born in these United States of America, then much of what we take for granted isn't even a glimmer of a thought in the mind's eye.

Can we fully appreciate these gifts that we take for granted? Sometimes I feel as if we don't appreciate these gifts, these freedoms, that we do enjoy. Do we remember; do we appreciate what those before us endured? Americans wept, argued, sweated, fought, bled, killed and died so that we could enjoy the freedoms that we enjoy today. Each American generation has known adversity, privilege, wealth, poverty, sorrow and happiness. As much as I do believe that America and its ideals are a microcosm for the entire human race, for humanity; it remains a beacon for that same humanity as well. When the rest of humanity seems as if in a fog, it looks to the light that shine bright upon our shores, guiding the lost to liberty, to freedom.

These stories of adversity: our Hoosiers, our Titans, our Rudy Reuttigers and our Michael Ohers are our lights and our inspirations. They show the rest of us, the rest of humanity, what we can do when faced with adversity, how we can overcome that adversity, and how we can prosper and triumph in spite of that adversity.