The Amazing Magical Vagina

A while back, my partner and I were assigned to the report of a woman in labor over on the west side of town. I don’t specifically remember, but I am sure that I ranted the entire way there about how labor isn’t an emergency and how billions (with a B) of women have had babies without my help. But that is just a guess based on past experience. Also based on past experience, I may have made snide, inappropriate comments about having nine months to save up cab fare. Every time I complain about OB calls, things go pear-shaped for me.

When we arrived, we found that the patient was a 19-year-old with her first pregnancy, 38 weeks along. She wasn’t high risk, had good prenatal care, and had no concerning signs or complaints. Her presentation didn’t make me want to lie her down on the living room floor: her contractions were about three minutes apart and lasted only fifteen or twenty seconds, her water hadn’t broken, there was no bloody show, nothing.

When I am on a labor call, one of my primary decisions is whether to put the patient into the ambulance and drive to the hospital or to deliver the baby in the patient’s house. If I think I can easily make it to the hospital, we can go to the ambulance. If I’m not sure, then the house is my preferred choice. I hate to deliver a baby in the ambulance. I actually put quite a bit of effort into avoiding it, as a matter of fact. Babies result in a lot of fluids, smells, and mopping. The ladies I see aren’t always the most… hygienic, if you know what I mean. So I would rather deal with all of that on their floor (or couch), rather than in “my office.”

In this case, with the mom-to-be being young, at the end of her first pregnancy, and with the contractions not lasting very long or being close together, I was comfortable with moving everyone to the bus and going to the hospital. I didn't think she would be delivering a baby very soon. The patient told us she couldn’t walk, but I explained how the L&D deck would have her pace the hallways for hours to move things along, so a little walking now would be a good thing. Walk she did.

We were a pretty long way from the hospital, so I didn’t feel like screwing around on scene. Having fifteen or twenty minutes to get to the hospital meant that I could start an IV enroute, rather than needing to do it before we started out. My partner got behind the wheel and off we went.

On the way to the hospital, the patient was very dramatic. The onset of every contraction was very easy to time, because the patient started howling, cursing, and complaining. Some women quiet down and bear through things, and some shout their hate of the world. This lady was of the second group. I got the IV into her and had time left to act concerned and engaged. I coached her on breathing (rather than screaming at me) and made the decision to take her pants and underwear off. This isn’t something I do unless I think delivery is imminent. I didn’t think delivery was imminent in this case, but I took her pants and drawers off anyway. I don’t know what made me do it. It was just something I did. 

After a few more minutes, the patient squawked at me: “The baby’s coming!”

I replied with my usual response to such statements: “Don't you dare push!”

I still didn’t think there was any way that this infant was coming out. Her contractions were still two or three minutes apart, and still only lasted 20-30 seconds. But her complaint was enough for me to take a look at things.

I spread the patient’s knees and lifted the bedsheet that was covering her to take a look. Just as I thought. Nothing. Just a normal vagina. Not swollen, no bulging, no fluids. It was a completely normal undercarriage.

I put the sheet down on her legs again and began to reassure the patient that delivery wasn’t imminent. “The baby’s out,” she told me.

Whiskey. Tango. Foxtrot. The baby wasn’t even close! Drama! This was nuts, I lifted the sheet to show her that there was no problem.

Son of a... She was right. There was a newborn lying between her feet.

I need you to understand how fast this happened. It was totally like a magic trick. Lift the sheet. See? Normal vagina. Put the sheet down, say the magic words (“The baby’s out”), and TaDaaa! Sweep the sheet back and there’s a baby! The whole process took literally three seconds.

Me, screwing up decisions on childbirth calls for decades... Source

Literally. Three seconds. Maybe two. Like a magic trick.

Public domain source

The infant was about a foot out of the birth canal. Between the baby and her mother was a wet spot where she skipped before landing between mom’s feet. She was a healthy, pink, angry baby girl. Crying like hell, and moving all extremities. Shouting like a three-month-old, she was moving so much air. I didn’t think she needed suctioning, really, she was doing so well.

The first words that little baby heard? “Goddammit. [Sigh] Yo, Dee, pull over. Gimme a hand back here.”

The Hardest Thing I Do

This story happened quite a while ago, but I is similar to situations that happen way too frequently. I responded to an unresponsive party on a train. Dispatch reported that the party may be a cardiac arrest. The train, which was full of other passengers, was stopped in the station waiting for us to deal with the issue. I boarded the train to find a 20-something male snoring and smelling strongly of alcohol. (He was not a cardiac arrest.) His skin signs were fine, there was no apparent trauma, and both his respiratory status and pulse were normal. I made the choice to wake him up and get him off the train; that way the dozens of other inconvenienced people could go on about their lives.

It took more work than I expected to wake this gentleman up.  Neither voice nor shoulder shake worked. I had to press the base of the SCM* to even get a grimace and a withdrawal. The man groaned and twisted toward his side, like a tired hotel guest who wanted to sleep in.  “Come on, dude. Up and at ‘em. We got to get off the train,” I said as I gave him a little more SCM pressure. That was enough for the man to get his feet under him and walk off the train.

I sat him on a bench to complete my exam and work up. The pain at his clavicle, along with moving a little bit, woke the man up a little more. Now he wanted to be aggressive and belligerent. He stood, though I asked that he not, balled his fists, and explained that he was going to kick my ass. The man began to shuffle toward me in an ataxic fighter’s stance.

This is not a person that puts me in an excessive amount of danger, in most cases. There is always a chance of getting hurt, I suppose, but my main concern at this point was the hassle his behavior was causing. I began to slowly back off, circle, try to talk him down, and get him into a position so I could finish my job.

He hocked up a big ball of mucus, spit it at me, and threw a giant, arcing haymaker that missed.

Do you know the call I’m talking about? Ever run a similar one? How about another example?

My partner and I responded to a downtown club during out-crowd on a weekend recently. We found a different 20-something male who was intoxicated and had received an ass kicking. I’m sure it wasn’t deserved, though. He had a laceration extending the length of his left eyebrow, smelled strongly of alcohol, and was shouting profane threats at the bouncers, police, my partner, and me.

I have a theory that men like this feel a subconscious need to regain face. This is especially true if they lost a fight in front of a girl. I think there is enough lizard brain peeking through the alcoholic haze to make a decision: Against whom should I regain face? The bouncer? Nope, already lost that battle once. The cops? Nope, not unless there is a female officer. Police are mean. The medics? Unarmed, here to help, softer than the cops. Yep, he’s going to decide to regain face against the medics.

I never understand why people direct their anger at me. I didn’t beat them up. I didn’t arrest them. In the end, it is just that I’m just the safest target for their impotent rage. They never run away, either. Just stand there and shout how they aren’t going to any damn hospital.

This genius was unhappy at my decision to take him to the hospital and decided that he had a right to my name, right at that moment. My identification badge was clipped to my chest pocket. He snatched it off my shirt and gave me a shove.

Have you run that guy?

As a final example, check out this video from YouTube.** It makes my guts tighten up. I have been there and I hate it.

Powerful waves of frustration and anger roll over me. None of this is my fault! Everything about this situation is due to someone else’s decisions! I shouldn't be treated this way!

In most settings, spitting on another full-grown man isn’t a safe action. There are unpleasant consequences. Snatching a man’s possessions and shoving him is not safe. Consequences. My uniform is what renders those actions safe. That, and my decision to walk away when I feel the tide of frustration and anger welling up. 

Contrary to the approach of a lot of EMS safety training, I walk away to protect the other guy’s safety, not mine. I have an unbroken seventeen-year streak of not engaging in my baser instincts that I’m trying to protect. I walk away, take deep breaths, imagine that my daughter was watching me, work at the gym until I want to puke, drink too much, bitch to my peers, complain to my wife, bike, jog, and all of the other better options than administering 80 kilograms of brutacaine to a patient deserving of a dose. They are better options (mostly), but not especially satisfying ones.

Sometimes the hardest thing I do at work is not do what I want to do.

*Sternocleidomastoid (SCM) pressure is a good way to apply humane painful stimulus to a patient. It looks better than a sternal rub, doesn’t bruise, and so on. The SCM inserts at the medial end of the clavicle, on a tubercle. Right as it connects to the clavicle, it bifurcates. Press straight down (toward the patient’s toes) with one finger. Don’t press into the airway, or into a carotid pulse; just press downward onto the clavicle at the bony bulge where the SCM inserts.

**If my video embedding skills suck, click this link: https://www.youtube.com/watch?v=UOX3fXSoNJk

Recognize!

A few years ago, I took a lead fall while ice climbing. I was putting up the first line of the day near Frisco and cratered. I was too high above my highest screw, so it was actually a ground fall. But the ground didn’t hurt me. The icy knob about halfway down caught my right crampon, twisted my foot, flipped me so I landed on my back, and broke my ankle. It was so early in the day I didn’t want to mess up the trip for everyone else. I sat to the side, built up a spot to elevate my foot, and piled snow over my ankle. After a few hours, I hobbled my way out to my truck and drove myself to the emergency department. My pickup was an automatic – I could drive it with one good leg.

My big dilemma came when I arrived at the ED. What was the issue, you ask? Well, good question, gentle reader. Was the dilemma where to park near to the ED? Oh, no. Could it be that my quandary would be how to make my way from the parking lot to the ED with a broken ankle? Nope. One might guess that my issue would be how to use the “normal” entrance. That would be a good speculation, but a wrong one. Most medics don’t know where the “normal person ED entrance” is. They only know the ambulance entrance. And that wasn’t my problem.

My problem that day was that I didn’t have anything that noted me as being special. I didn’t have any paramedic markings.

A few years later, I had appendicitis. I was working in the paramedic office at the time and spent the morning at the doctors office trying to deal with the searing gas pain that had been bothering me for a week or two. He sent me to the CT, and afterwards I was getting lunch (stir fry) when my physician called and directed me to the ED. I had a hot appy and they would be waiting for me. I wasn’t worried about going to the ED that time. You know why? That’s right. I was in uniform.

I’ve heard stories from medics about putting on paramedic t-shirts in the middle of the night before taking their kids to the hospital. I’ve heard of medics leaving a shirt with the patches visible in case they get pulled over. I have a Division sticker on the back window of my car. Sometimes we try to hide our affiliation, but we definitely want to be marked as being on Team Emergency Worker when it suits us. The two primary times it suits us to be identified as paramedics is when we present to a hospital and when we are pulled over by the cops.

I wasn’t looking for anything special when I broke my ankle. I didn’t expect to be carried through the department on a litter with trumpeters preceding me, or anything. (It would have been nice, but I wasn't really expecting it...) I was just looking to avoid the normal waiting room intake process. I didn’t want to sit there in a molded plastic seat with my once and future patients and broken ankle.

Good news! The charge nurse knew who I was! Apparently I am more recognizable than I realized. Notoriety is sometimes a good thing. (Infamous. I'm in-famous. That means more than famous, right?) A short couple of hours later, I was diagnosed with a medial malleolus fracture, splinted, and taken care of without problems. I even turned down opiates – my leg wasn’t especially painful and I had to drive myself home. Later, I ignored the orthopedist’s advice, so that ankle has bothered me since, but light duty was not pleasant. The best piece of the story is that on the evening when I went to the ED, I didn’t want to have to go through a busy waiting room. Success!

Colorado rules, by the way.