I love my wife and all, but Jesus Hercules Christ...

[bendtheski]

Wife and I just got back from a 3600 mile NW road trip. The night before we left she’s doing her usual last-minute full house-douching and plans to be up till after midnight, so I went to sleep. A little after midnight she comes to bed exhausted, but tells me she doesn’t feel right, and asks me to help her to the bathroom. I’m immediately concerned.

I get her situated and return to bed, but stay awake a little longer because this is pretty unusual. A few minutes later, I hear what I think is her blowing her nose, but it just keeps going. I decide I should investigate.

I find her unconscious still on the toilet. The nose blowing is actually agonal breathing. I’m a 9-1-1 dispatcher, I know what agonal breathing sounds like, and can hear it in my head as I type this.

Instinct (and maybe training) kick it. I grab her shoulders and shake her, shouting her name over and over for what seemed like an eternity. After a minute or so, she starts to groan and regain consciousness. I half carry her to the bed and fire up her concentrator to 3.5 liters. After about 15 minutes, she tells me she feels ok, but doesn’t remember anything after going into the bathroom.

I came back to work yesterday, and was describing the event to a co-worker who happens to be an EMT. She described it as positional asphyxia, something I’ve only heard a couple of time in my 15 years in 9-1-1. For a couple of weeks now I’ve been carrying around how close I just came to losing my wife. I remember in the moment thinking WTF happens if I can’t revive her? for about a second before acting and then adrenaline took over.

My wife is a former victim’s advocate, and told me about a conversation she had with our coroner regarding finding people deceased on the toilet. Apparently it’s pretty common with unattended deaths (along with being found nekid). Of course for all we know, she might have come to on her own and been just fine.

I was still an asshole on at least one occasion during the trip, but am extremely grateful there wasn’t a different outcome. Coincidentally my wife’s dad passed somewhat unexpectedly 4 days into the trip, so I had a chance to be a supportive husband which I feel I mostly am. Anyway, we made it 3600 miles in 10 days without killing each other. I guess I love my wife.


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[zion zig zag]

^^^there’s a lot to unpack in that and I’d encourage you to see a doc. I’m curious why you didn’t go to the ER that night? Most people don’t come back from true agonal respirations without cpr. Snoring from a hunched airway seems more likely.

If it was positional asphyxiation, what caused it? Most likely she had a vasovagel episode on the toilet, but could she have had a seizure? What caused her to need help to the toilet? Good luck man, go tell her doc that story


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[old goat]

Bend--I hope you never have to go through something like that again.

2 years ago my wife wasn't feeling well. She had full on GI's, pulse 130's, BP in the 50's and 60s, O2 sat in the 80's. I had to argue with her for quite a while to let me call 911 and I was going to do it anyway when she relented. Pretty soon the house was full of (unmasked) EMT's and firefighters, most of them standing around doing nothing. Seven people I believe. In the hospital she had patches of pneumonia both lungs. With fluids and antibiotics she got better quickly. Multiple covid tests were negative. They called it atypical pneumonia (doctor note for we don't know what the fuck it was). I think is was aspiration pneumonia, but not sure. I'm pretty sure if I hadn't gotten her to the hospital she would have died.

She has had two other health crises since--all prevaccine. In all three cases I was not allowed to accompany her because covid, which I think significantly impaired her care as she isn't very good at relaying what is going on. If I had to do it again they would have had to call security to throw me out. Sure, doctors can call me on the phone but it's not nearly the same. I still don't think they've gotten to the bottom of what's going on with her but it's hard to convince her to pursue it when she's feeling ok and she doesn't like me getting involved with her health. (Maybe because many years ago, 6 weeks after getting back from NOLA, I misdiagnosed her Hepatitis A as simple fatigue.)

Re dying on the toilet--a surgeon who kept working way way too long died in the clinic on the pot with his pants around his ankles getting CPR. I made sure to retire before that was me.

[zion zig zag]

Pretty soon the house was full of (unmasked) EMT's and firefighters, most of them standing around doing nothing. Seven people I believe.

Oh wow, it’s too bad they sent so many people to save your wife’s life. I guess the alternative is they only send two people to each call, and then when it went from a breathing problem to a full arrest in the 4 minutes it took them to get there, those two people can be totally overwhelmed and have large gaps in patient care while they carry gear and gurneys. That sounds better.

[~mikey b]

that’s not agonal breathing

[Mustonen]

Well it isn’t good breathing, and that’s scary. Glad she’s ok.

And it’s frustrating and scary to have a million people standing around doing nothing in full pandemic panic while your wife is in critical condition.

Jesus Christ you guys are pricks.

[zion zig zag]

Well it isn’t good breathing, and that’s scary. Glad she’s ok.

And it’s frustrating and scary to have a million people standing around doing nothing in full pandemic panic while your wife is in critical condition.

Jesus Christ you guys are pricks.

In this case OG is being a prick. He is a medical professional and should be advocating for better patient outcomes, not worse. This shit isn’t arbitrary, we don’t show up over staffed because they were bored of sitting in the recliner. We show up with resources because the public is notoriously bad at giving a good picture of what is really happening.

So when you have Cletus calling in to say that his wife doesn’t feel good, and you send one ambulance with two people on an Alpha response sick person, and then they show up and the old lady is in full arrest, her chances at ROSC are very poor. So dispatchers are trained to ask relevant questions, in this case, they determined that Og’s wife had difficulty breathing, and that historically is a problem that needs lots of hands. So you get a full response. And then when the call needs chest compressions, an IV with meds, managed airway and a patient carried down four flights of stairs in snowy conditions, you have that help without waiting for 5 more people to show up. Thank goodness that wasn’t the case here, so when two guys take vitals and talk calmly to her while the others stand around, be glad that’s the case.

Now back to OG. The fire chief determines that more staffing is needed because the rigs are out of service on calls too often and leaves the city uncovered. He goes to city council to explain the problem and they propose a budget increase. Of course, this means that they have to raise taxes by $9 a year to cover three more staff members and that calls for a truth in taxation hearing. Now you have OG at the pulpit on Tuesday night ranting and raving about how they are over staffed, “he’s seen it, by God!” And since he’s a retired doc, people listen, because he’s an authority on the matter.

It’s the second time he’s relayed that story, it wasn’t even relevant here, but he feels the need to spout it. A hundred dollar bill says he was the type of doc that would complain when they were one person short of a full crew on a difficult surgery because he knows how quickly things can go bad and its all hands on deck. And that is in a perfectly controlled, hospital environment, with unlimited back up and equipment. So yeah, he needs to be an advocate and quit with the disparaging of the system because of his very small exposure to one incident.

[Mustonen]

Well, sure. I don’t know and honestly don’t give a shit. I think they should send all the people they can to help my elderly wife, but if there’s a global pandemic afoot maybe they can hang out outside so they don’t unwittingly kill her that way.

OG is similar to many surgeons and other doctors I’ve known throughout my life (kind of the family biz). There is a demeanor that grates and I’m probably overly sensitive to it, but you’re doing a lot of projecting here.

[Meadow Skipper]

OG is similar to many surgeons and other doctors I’ve known throughout my life (kind of the family biz). There is a demeanor that grates and I’m probably overly sensitive to it, but you’re doing a lot of projecting here.

I agree with all this. It’s pretty stressful to have your loved one suddenly seriously ill, and I totally get the impression that there are way too many people around for a seemingly simple deal and I get that it’s a whole fuck of a lot better to be over-staffed when responding to a high priority incident where the responders aren’t sure what’s going on.

All that said, when I was an EMT patroller, physicians were generally the most difficult patients or partners to the patients, because they seemed to figure they were the docs and should be running the accident scene, even if they were neurologists or pediatricians. It often took a while for the pre-hospital care folks to get things rolling the way it should be.

This one time I had a physician patient up high on the mountain, that I rightfully assessed as having a possibly fractured pelvis, that refused to let me move him. Finally I asked him how he planned to get down. He thought about it, and finally relented. Also, a few mcg of fentanyl IN seemed to assist the decision process.

[skiJ]

Oh wow, it’s too bad they sent so many people to save your wife’s life. I guess the alternative is they only send two people to each call, and then when it went from a breathing problem to a full arrest in the 4 minutes it took them to get there, those two people can be totally overwhelmed and have large gaps in patient care while they carry gear and gurneys. That sounds better.

In this case OG is being a prick. He is a medical professional and should be advocating for better patient outcomes, not worse. This shit isn’t arbitrary, we don’t show up over staffed because they were bored of sitting in the recliner. We show up with resources because the public is notoriously bad at giving a good picture of what is really happening.

So when you have Cletus calling in to say that his wife doesn’t feel good, and you send one ambulance with two people on an Alpha response sick person, and then they show up and the old lady is in full arrest, her chances at ROSC are very poor. So dispatchers are trained to ask relevant questions, in this case, they determined that Og’s wife had difficulty breathing, and that historically is a problem that needs lots of hands. So you get a full response. And then when the call needs chest compressions, an IV with meds, managed airway and a patient carried down four flights of stairs in snowy conditions, you have that help without waiting for 5 more people to show up. Thank goodness that wasn’t the case here, so when two guys take vitals and talk calmly to her while the others stand around, be glad that’s the case.

Now back to OG. The fire chief determines that more staffing is needed because the rigs are out of service on calls too often and leaves the city uncovered. He goes to city council to explain the problem and they propose a budget increase. Of course, this means that they have to raise taxes by $9 a year to cover three more staff members and that calls for a truth in taxation hearing. Now you have OG at the pulpit on Tuesday night ranting and raving about how they are over staffed, “he’s seen it, by God!” And since he’s a retired doc, people listen, because he’s an authority on the matter.

It’s the second time he’s relayed that story, it wasn’t even relevant here, but he feels the need to spout it. A hundred dollar bill says he was the type of doc that would complain when they were one person short of a full crew on a difficult surgery because he knows how quickly things can go bad and its all hands on deck. And that is in a perfectly controlled, hospital environment, with unlimited back up and equipment. So yeah, he needs to be an advocate and quit with the disparaging of the system because of his very small exposure to one incident.

zzz -

If you read comments like these from a third party, do you see any warning signs ? ??

goat certainly doesn't need me defending him, and you have certainly made some hysterical claims and lept to some sensational conclusions...


goat has more than forty years Experience - that's worth a lot ;
his posts are mostly thoughtful, sometimes candid ,,, and
he certainly deserves better than the rants above ;

remember 2020 ?
covid was largely an unknown, deadly disease - especially for old-er people --

it's nice that there were Seven people available and willing to respond when goat's wife was in distress
( and to my reading(,) what was done was not 'life saving' / it was well-handled as emergency care - That's great. and from thirty years and forty years and sixty years experience, there did not need to be Seven responders inside goats home ! )

your rant about EMS ,,, budgeting and administration makes me worry you may be experiencing ' Burn Out' ( been there ) and your ,,, claims about goat's professionalism are Unprofessional

( downshift - and
Please get yourself some help, zzz )


the covid craziness continues -

sadly. tj

[riser4]

I read OG's post to mean he was mostly frustrated that folks weren't wearing masks. That they weren't doing anything while potentially infecting everyone has got to be a concern, yes? Unnecessary exposure. If they are there in case something goes wrong as part of the protocol, fine. Butt put on a mask and or stand outside/away from people.

[zion zig zag]

you’re doing a lot of projecting here.

Fair enough.

[zion zig zag]

I read OG's post to mean he was mostly frustrated that folks weren't wearing masks. That they weren't doing anything while potentially infecting everyone has got to be a concern, yes? Unnecessary exposure. If they are there in case something goes wrong as part of the protocol, fine. Butt put on a mask and or stand outside/away from people.

I think you’re right. On my first read I misinterpreted that as a sidebar, when in fact it was the main complaint. Apologies to OG as that was/is a valid concern, we need to do better. Obviously, this touched a nerve, sorry for the rant.

Edit: SkiJ thanks for the concern but I’m good.

[old goat]

I agree with all this. It’s pretty stressful to have your loved one suddenly seriously ill, and I totally get the impression that there are way too many people around for a seemingly simple deal and I get that it’s a whole fuck of a lot better to be over-staffed when responding to a high priority incident where the responders aren’t sure what’s going on.

All that said, when I was an EMT patroller, physicians were generally the most difficult patients or partners to the patients, because they seemed to figure they were the docs and should be running the accident scene, even if they were neurologists or pediatricians. It often took a while for the pre-hospital care folks to get things rolling the way it should be.

.

Actually I didn't say a word after briefly explaining what was going on. I never said a word about them not wearing masks. I stood out of the way and let the EMT's do their work. I didn't complain that I coudn't go into the ER with her, athough I should have. Nor did I give any directions to the ski patrollers who got me down the mountain when I broke my back. Same with the patrollers who took care of me when I dislocated my shoulder and the nurse in the patrol shack who relocated it. Nor did I complain about my care at any time while I was in the hospital for my back or my heart. I just did what I was told--ecept for refusing one blood gas draw. When I was skiing with my ex-patrol son and a friend and the friend blew out his knee I let my son handle it, because I know EMT's are trained to handle things at the scene and I am not. I have never once tried to assist patrol on the scene of an injury, even when it looked like something more than the usual hurt knee, even when they were doing CPR. I'm a good patient and I know my place. I saved being a prick for the OR and hospital when I was the doctor and not the patient or patient's family.

I did discuss my wife's case with a neighbor who is an Paramedic firefighter and he agreed with me no need for so many to be in the house, especially unmasked. I have participated in enough codes in the hospital to know that while too few is a problem, so is too many. But the reason I was concerned about so many was the lack of masks, a couple months into the epidemic, when there was every reason to believe my wife had covid. I was wearing a mask.. I was bothered by the cavalier attitude of medical professionals who should have known better. And I emphasize that EMT's and Paramedics are medical professionals that have medical skills and knowledge that I don't but don't always get the respect that they deserve.

And ZZZ--thank you for remembering that I told the story before. It always surprises me when anyone here pays any attention to anything I say. I can't say it surprises me when people remember what I say better than I do.

[zion zig zag]

And ZZZ--thank you for remembering that I told the story before. It always surprises me when anyone here pays any attention to anything I say. I can't say it surprises me when people remember what I say better than I do.

Please see my apology above.

[Meadow Skipper]

^ I wasn’t referring to you OG, just trying to relay some amusing (to me anyway) anecdote.

[bendtheski]

^^^there’s a lot to unpack in that and I’d encourage you to see a doc. I’m curious why you didn’t go to the ER that night? Most people don’t come back from true agonal respirations without cpr. Snoring from a hunched airway seems more likely.

If it was positional asphyxiation, what caused it? Most likely she had a vasovagel episode on the toilet, but could she have had a seizure? What caused her to need help to the toilet? Good luck man, go tell her doc that story


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She works for a doctor’s office, and was on the phone with one of the providers first thing in the morning. Doc agreed with the vasovagel episode diagnosis. The hunched airway is probably the more likely suspect, but it sounded identical to agonal (at least on a 9-1-1 call anyway), and pretty well scared the shit out of me. Two weeks ago and I’m still freaked out about it!


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[bendtheski]

Bend--I hope you never have to go through something like that again.

2 years ago my wife wasn't feeling well. She had full on GI's, pulse 130's, BP in the 50's and 60s, O2 sat in the 80's. I had to argue with her for quite a while to let me call 911 and I was going to do it anyway when she relented. Pretty soon the house was full of (unmasked) EMT's and firefighters, most of them standing around doing nothing. Seven people I believe. In the hospital she had patches of pneumonia both lungs. With fluids and antibiotics she got better quickly. Multiple covid tests were negative. They called it atypical pneumonia (doctor note for we don't know what the fuck it was). I think is was aspiration pneumonia, but not sure. I'm pretty sure if I hadn't gotten her to the hospital she would have died.

She has had two other health crises since--all prevaccine. In all three cases I was not allowed to accompany her because covid, which I think significantly impaired her care as she isn't very good at relaying what is going on. If I had to do it again they would have had to call security to throw me out. Sure, doctors can call me on the phone but it's not nearly the same. I still don't think they've gotten to the bottom of what's going on with her but it's hard to convince her to pursue it when she's feeling ok and she doesn't like me getting involved with her health. (Maybe because many years ago, 6 weeks after getting back from NOLA, I misdiagnosed her Hepatitis A as simple fatigue.)

Re dying on the toilet--a surgeon who kept working way way too long died in the clinic on the pot with his pants around his ankles getting CPR. I made sure to retire before that was me.

Thanks OG. Probably a decade ago she had a bronchial spasm (she’s asthmatic) and was having a ton of trouble breathing so straight to the ER. When her saturation didn’t improve immediately after steroids, they said they wanted ti keep her on oxygen for the night and monitor. Didn’t seem too serious, so I went home, figuring I’d come back first thing and pick her up right as rain.

I received a call at 2:30a that her saturation was dangerously low, and she had to be intubated. They were transferring her from Summit Medical to the ICU at St. A’s. I spent the next week at her bedside, every day losing a little more hope, but then after 5 days on a vent, they were miraculously able to ween her off, and she quickly improved.

That was actually worse and scarier than what happened two weeks ago, but seems worse being more recent. I mention it only because as we started to learn about COVID, about the shortage of vents and associated meds, and family members not being allowed visits, we were worried sick, and I remember thinking how awful it must be for them. I was lucky to be able to be with her in ICU, to play our favorite David Byrne for her on my phone, and to cry my eyes out.

Fuck I’m happy she’s still here, and sure you feel the same.


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[PB]

When some one who means everything to you has a medical emergency, calm objectivity goes out the window. When I was starting my hypertension medication I passed out while eating dinner one night, came to with my wife in tears, screaming at the 911 operator that I was dying and that she would crawl down the electrons and strangle the operator if the ambulance isn't here 5 minutes ago. I doubt I would be so diplomatic if reversed. So best not to hold any one emotionally distraught to too high a standard.

[jono]

So much easier to be the patient. My wife has been awfully emotional lately about how I'm not dead or whatever. I may owe her a hug. Or six.

Congrats on the good outcomes!

[skiJ]

Thanks OG. Probably a decade ago she had a bronchial spasm (she’s asthmatic) and was having a ton of trouble breathing so straight to the ER. When her saturation didn’t improve immediately after steroids, they said they wanted ti keep her on oxygen for the night and monitor. Didn’t seem too serious, so I went home, figuring I’d come back first thing and pick her up right as rain.

I received a call at 2:30a that her saturation was dangerously low, and she had to be intubated. They were transferring her from Summit Medical to the ICU at St. A’s. I spent the next week at her bedside, every day losing a little more hope, but then after 5 days on a vent, they were miraculously able to ween her off, and she quickly improved.

That was actually worse and scarier than what happened two weeks ago, but seems worse being more recent. I mention it only because as we started to learn about COVID, about the shortage of vents and associated meds, and family members not being allowed visits, we were worried sick, and I remember thinking how awful it must be for them. I was lucky to be able to be with her in ICU, to play our favorite David Byrne for her on my phone, and to cry my eyes out.

Fuck I’m happy she’s still here, and sure you feel the same.


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A post positively worth preserving...

Thank you. tj

[old goat]

Please see my apology above.

I saw it, and thank you. I'm sure there's some background behind the raw nerve I touched, that I don't need to here.

^ I wasn’t referring to you OG, just trying to relay some amusing (to me anyway) anecdote.

Sorry for misunderstanding. However, it's only fair to mention that while I wasn't giving any orders, my wife, an ex cardiac ICU nurse, was giving plenty. Like telling the EMT how to take her blood pressure. In fairness to my wife, she was quite hypoxic and hypotensive at the time. The EMT didn't let it bother her.

I've certainly known doctors who behave as you describe. I heard about a case where the doctor, actually a dentist, was right. Perhaps the only such case in history. Happened when I was a fellow in Tucson and it made the news. Car accident in the middle of nowhere. Ambulance and non-medicl heiicopter on the scene. The crew wanted to fly the victim on the skid--like skis when you heliski. Dentist arrived on the scene and identified that the patient was bleeding heavily in the upper airway and needed to be kept suctioned and the airway open. Advised that he be transported by ambulance with a crew who could manage the airway. LE on the scene threatened to arrest the dentist. The patient was flown and died of asphyxia.

She works for a doctor’s office, and was on the phone with one of the providers first thing in the morning. Doc agreed with the vasovagel episode diagnosis. The hunched airway is probably the more likely suspect, but it sounded identical to agonal (at least on a 9-1-1 call anyway), and pretty well scared the shit out of me. Two weeks ago and I’m still freaked out about it!


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A severe vagal reaction can be terrifiying. I once had a patient do that in clinic doing some minor procedure. That didn't need sedation or an IV. We had a crash cart and a nurse who hadn't taken care of a sixk patient in decades. The patient looked like death, agonal type breathing. The longest and most terrifying 5 minutes of my life, until the patient came to. And I realized that it's one thing to run a code with a bunch of other people who know what they're doing. It's another to be essentially alone. That's the thing about doctors--we're trained to work with lots of equipment and other trained people. On our own, out of our environment we're as useless as Boy Scouts.

[TahoeJ]

The subtext here is that Nevada County aka Truckee - despite being in California - had a pretty vocal anti-mask contingent and those guys rolling in at that time without masks was (probably) fairly interpreted by OG as a “fuck your mask rules” flex. So I’d have been annoyed too. I have EMS friends who got shit from co-workers for pulling rank and making them put on masks when entering residences.

[old goat]

The subtext here is that Nevada County aka Truckee - despite being in California - had a pretty vocal anti-mask contingent and those guys rolling in at that time without masks was (probably) fairly interpreted by OG as a “fuck your mask rules” flex. So I’d have been annoyed too. I have EMS friends who got shit from co-workers for pulling rank and making them put on masks when entering residences.

It was in Sacramento--we had to retreat there when my wife broke her ankle. That attitude was and is pretty widespread in the LE an FD community. To be fair the TruckeeFD crew that got her down 2 stories to my car to drive her to Kaiser were wearing masks.

[bendtheski]

I just never know what kind of reaction I'll get around here, but thanks everyone for providing a ton of great information, and maybe setting my mind at ease a little about my wife's health. I forgot to mention, she had a super-painful leg cramp at the outset of this, which is why she was wobbly and needed help to the bathroom. Her doctor explained that the vasovage episode can be triggered by severe pain, exhaustion (I think), and other stuff I can't remember now. I should have known the dentists of TGR would have good intel on the subject!

I can fully appreciate zzz's rant after 15 years in public safety, the past 7 of which have been about nothing but cutting back everywhere. We seem to currently have a pretty contentious relationship with our Commissioners and County manager, and it's killing morale and impacting response times/outcomes, whether anyone wants to acknowledge it or not. I don't know how you avoid burnout when you're constantly struggling to recruit and keep people for $4-5 less/hr than neighboring agencies, and 40 hours + on console every week for almost a year doesn't leave me much time to manage my division, but I'm still hanging on and trying not to be the biggest black hole of negativity in the room.

Reading some of the comments, it reminds me of my place in the response chain. I will never have the medical expertise many of you do, but you would probably never be able to calmly and professionally tell a caller dialing 9-1-1 is not a good way to test their new device. Don't even get me started on the traffic complaints... It's also sort of a gut check to be on the other side of the chain, being the one with the medical emergency. I don't think it's necessarily a bad thing to feel what it's like when it's your emergency, not someone else's that you can be clinical about. I know my triggers are more aural than visual, but I'm guessing we all have them as a result of previous traumatic incidents related to our work. I've built up a pretty good callus over the years, and it's not the worst thing to be reminded that no matter what mood I'm in at the office, my caller is likely having their worst day ever, similar to what I've experienced a couple of times now. Those people deserve the best I can give, regardless of external factors, and this recent event has helped bring that point back into sharper focus.

Thanks everyone for your kind words and sharing your knowledge.