Oh no - You're A Cowboy? Does Your Scrotum Hurt?

A few years back (excuse me while I adjust my Pandora music station to Pure Prairie League genre for added calmness, sans Ativan), I was at a farewell party for one of the ER docs.  It was a gathering of many personalities, mostly ski patrol, EMS, fire, police and hospital employees.  We all came from different sets of circumstances, that brought us to a point in our lives, where being first responders was what we craved as our drug of choice. Adrenaline. "The ride, the ultimate ride".  There's nothing like it.

Red light blinking fire trucks, sirens, the noises, the smells, the guns, the sight of a trauma surgeon slicing into a stabbing victim's chest, and performing open heart massage (at Denver General); the smell of blood and the endorphin rush that follows. From the First Aid worker who might apply a band-aid to a small blister, all the way up to CPR on someone you know is already gone; the job is never easy, and you take home each and every patient you treat, no matter the outcome.  Some sit in the back of  my mind to this day - almost a 1.5 yrs after I started my last IV on a patient, at 35,000 feet, in the back of an airplane, on the way to Phoenix.

My birth mother had suffered a near fatal cardiac arrest back in March 2010.  Ironically, as a flower power protesting fool of a liberal loving Democrat, she was at an Obama styled health care rally, when she suddenly "grabbed her chest and dropped, mid sentence", as one witness later told us.  The last 2 pictures of my mother were her holding a sign  "Obamacare for everyone", and the next one was of her on the ground and 2 off duty Wyoming EMTs performing CPR, and a Tempe Police Officer trying to get Fire/EMS to the scene.  My mother was lucky that she survived her ordeal.  LESSON ONE HERE FOLKS - LEARN CPR, IT SAVES LIVES!


In May 2010, one day after ankle reconstruction, I boarded an airplane for my "turn" at being with my grandmother, and also to see my mother.  Crutches and all, I hobbled on to a United flight.  It never fails, I usually have a kid who's parents failed "Control Thy Child", to the larger person who kicks my seat, to the little table that doesn't stay up for the duration of the flight.  This particular flight was like every other I've been aboard.  I got the "kicker".  A big bubba, with a 10 gallon cowboy hat, and cowboy boots for added seat kicking ability.  Well, damn it all to hell, 45 minutes into a 90 minute flight, my beloved kicking cowboy starts really gets restless behind me.  Forget about the fact that I'm in a cast, with a set of toes that scream, "Pedicure Please", when I over hear the cowboy say..."I think I'm having a heart attack".  You've got to be kidding me?

This is your decision making moment.  Do you remain silent, for fear of some crazy outcome that results in litigation, or do you do the right thing and turn around at look at the flight attendant and say, "I'm a medic, can I help"?  Okay, so I have a knee high cast, one day fresh from surgery, and purple toes...what are you going to do?  Let the guy croak?  So, to the back of the plane we head, where I then discover that the budget cuts allow airlines to fly "pillow free.".  Bubba gets a huge wad of plastic garbage pail liners as a pillow, and I ask the flight attendant about first aid kits, IV solutions and needles.  And an AED.  Bubba's main concern was that he not lose sight of his gigantic, "I ride livestock for a living" belt buckle.  In the cowboy world of bulls, broncs, etc...these heavy belt buckles are like gold.  "Sorry buddy, but I've got to get your shirt open, and loosen your pants a little bit."  Bubba, being a true cowboy says..."well okay darling, if you've got to let the dragon out".  Really, do you honestly think being in the back of an airplane at 35,000 feet has summoned a sexual encounter out of me?  Settle down cowboy!

The first aid kit...if that's what you call it, was by no means set up for cardiac arrest.  No cardiac meds.  Bubba could ask for aspirin, but there are so many fine guidelines of what one can administer.  Sealed aspirins in blister packs are ok; nothing out a bottle.  "Bubba Cowboy, are you allergic to aspirin?"  "No...good take these".  He got the full pat down; all 4 quadrants palped, BP, and me listening to his heart and lungs.etc,(He informed me that his heart was beating for only me) the rapid assessment, and subsequent assessments.  What I had the most regret for (and it was for him, not me) was the only size catheters were 16g, and those suckers hurt going in.  He had a great AC vein, and I got it on the first try...good thing since the first aid kit only had one. No LR on board, only saline.  It's better than nothing.  He got the 12 lead  EKG and 2 big AED patches applied to the big old bubba barrel chest/belly, and we landed in Phoenix 25 minutes ahead of schedule.

As we were prepping to land, he looked down at my foot, which by now, had blood seeping through the post operative cast, and said to me...."well what did you do little lady?"  This guy was a charmer a minute.  I just finished up asking if you had scrotal pain, and you want to call me little lady?  Did you think that was a marriage proposal earlier?  I told him, "oh, just some ankle surgery yesterday, no biggie".  He proceeds to tell me of this great cowboy surgeon he knows in Steamboat.  I look at him and ask really, who. "Well, little lady, Sisk is his name, and broncos and pretty women are his game."  8 seconds with this bull riding bubba was simply too long.  Of course, the master of surgery was indeed Dr. Michael Sisk, my doctor, who's last words to me were, "Anniemac, please try and relax in Phoenix, and be a good girl and please don't over do it".  Rules are made to be broken, right! 

P.S.  Big Bubba Cowboy did have severe hypertension, and earned himself the birthing of a calf sized kidney stone out of  the "Dragon in his pants". He's probably out there, still charming little ladies, with a healthier heart.