Becoming a street nurse had never occurred to me prior to my moving to Louisville, and, in fact, I had never heard of a street nurse. However, it was to become my life for the next five years. When I moved to Louisville, I was scanning the classifieds and came upon an advertisement for Critical Care RN’s willing to work EMS as Senior Medical Officers. Wow! That sounded like a pretty heady thing. I was later to learn that only Seattle and Louisville used nurses on the streets. We also had the highest “save” statistics. The interview was not without some major concerns on my part. It wasn’t so much what I might have to deal with on the streets at night, even though that fear was considerable, but, rather, my concern about a lifelong problem, which I didn’t even know had a name until I read a book called The Accidental Tourist. Then it had a name: Geographical Dyslexia. In a nutshell, it means you can’t find your way out of a phone booth. It is a malady that runs in our family. I was grateful to find that I had something with a name, and that it was not mere stupidity on my part. However, I could see that it might cause problems in a new town where immediacy would be a factor with directional sense imperative. This weakness was a constant vexation for me throughout my time at EMS. Only occasionally did it cause a major problem, which I will reveal at a later time in this series.
Each new nurse was initially paired with a more seasoned nurse who had been on the street for at least six months. After that time, she would be cut loose, and paired up with a paramedic or EMT. I was both excited and terrified. I would use the word near-panicked, but I wouldn’t want you to think of me as anything of the sort. At any rate, the first six months were the most difficult, and there were times when I questioned myself as to what in the world I was doing out on the streets at night in the worst section of town, where no one ever seemed to sleep, and violence was the norm. I might add that I chose the worst section of town for the reason that the streets were numbered and laid out in blocks. The East End, although safe and not dangerous, had streets that curved every which way and changed names in the middle of a block. I knew that I could not function in a section like that even with my street map, which I carried religiously.
One of my first runs was with a nurse I was paired with by the name of Deet. I was somewhat intimidated by the fact that she was so sure of herself. The system in Louisville was very new. A doctor, “The Red Baron,” was our director. What a frightening man. He wore a constant scowl, and walked with a fierceness that made him unapproachable. He was a redhead no taller than about 5’4″, and reminded us of a bulldog. There was gossip that he slept with a LFD scanner at his side so he could dress in full regalia and make runs in conjunction with the fire department. I guess he could be called a fire engine chaser, as there was naught he could do at the scene, unless LFD turned up a victim. Lord only knows when he slept. He was an odd one to be sure. His authority was never questioned, although he, himself, was not a firefighter. He, in fact, was the director of Emergency Services at Louisville General Hospital, and our boss, as well. It was said that he held nurses in high regard, (though you couldn’t prove it by me). Thus, when he became the first director of the newly formed EMS service, he put out a call for street nurses. He wrote “standing orders” which we memorized, thus omitting our having to call in for orders, as the Paramedics were required to do. This greatly decreased our “down time”. That is not to say that we couldn’t call in for orders if something baffling occurred. General Hospital was a “catch all” for the uninsured, the unkempt, and un-housed. It was also our major trauma center.
One of my first experiences that almost made me rethink my decision to be a street nurse was when Deet and I were sent to a “man down” run. It was to a construction area underground. It was an early morning run, and I remember the sun had not been up long. As we approached the scene, Deet made the decision that we would not take all of our equipment, as it was probably a guy who had just gotten injured on the job. Healthy, young men were most often construction workers. The man had not been reported to Tick as unconscious. Well, I had my first lesson in not trying to predict what we would find. Almost all runs are “unknowns”. An auto accident can be a heart attack victim, and a man down can be anything from a drunk sleeping it off, to a dead man. This run turned out to be the latter. It was the worst possible scenario for us, as we were underground, couldn’t radio out due to the overhead concrete, and Deet was with a rank novice…me. The patient was obviously dead. Deet started doing one-man CPR as I headed back up the stairs for the heart monitor/defibrillator, the oxygen, and the jump kit. My heart was racing. I had Deet’s “hand-held”, and as soon as I cleared the building, I radioed in for Tick to send us a backup ambulance, code three. I felt that there wasn’t a chance that the guy could possibly make it, as he had been down ten minutes, at least, from the time the call went out, but when I reached Deet, with the equipment, she was continuing CPR. All of a sudden, I heard retching. I looked over and saw Deet’s mouth catch the full eruption. It is not commonly known that cardiac victims vomit, but let me assure you that most of them do. This one did. We didn’t have a facemask or a pocket mask with us, an oversight that I never made again. With the help of the others, we got him loaded up and out into the ambulance. Deet and I stayed in the back of the unit working him, as the EMT drove code 3 to General Hospital. I picked up the mike and radioed in what we had, and advised them that we needed room four for a 10-81. My stomach was lurching at the sight of what had happened to my partner. We got to General, unloaded, room four’d our victim, and let them take over. I walked out of four with Deet, who went to the sink and drank a bottle of that yellow mouthwash stuff, and then promptly vomited into the sink. It was all I could do not to toss my cookies, too.
Good God, I thought to myself. If this is what we have to do, I’m getting out. Once it was over and we were in the ambulance heading away from General, the patient having been pronounced, I bluntly asked her if she were nuts. She said…”When I go home, I have to sleep. I do what I do to keep from laying awake thinking what I should have done.” That set a pattern of belief that I followed my entire time there. You do what you have to do. You do your best. If the patient dies, it will not be from your lack of trying.
Our radio came back alive with Tick’s even voice…Med 33.
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