I am just about asleep when the radio speaks.

It’s easy to get used to sleeping with the dispatch channel on. For one thing, there’s not a lot of radio traffic on the repeater unless there is something big or several modest somethings going on. You get to the point where you don’t even hear the radio traffic for other agencies. You hear the traffic for you, though; wakes you right up.

Over the radio, the dispatcher says,

“Fire Department, South Podunk Rescue, stand by for tones.”

South Podunk is an outlying town for which my department provides ambulance service. South Podunk Rescue is the local first responder service; they will beat us to the patient and begin care.

The tones for the two agencies begin to play. I jump up and pull on my pants, jumper, and boots.

“Fire Department, South Podunk Rescue, respond to 486 Center Nowhere Road in South Podunk for an overdose, repeat, Fire Department, South Podunk Rescue, respond to 486 Center Nowhere Road in South Podunk for an overdose, time of the tone zero-zero-twenty-two.”

I zip up the boots, grab my radio off the charger, and go out the door. I walk into the dayroom; my partner, Mr. Peabody, is already out on the apparatus floor. I go through the door, grab my jacket out of my locker, and head to the front end of the ambulance by the bay door while pulling on my jacket and strapping on my radio.

I can see that Peabody is already in the truck. I open the bay door while Peabody gets the truck started and pulls it out of the bay. I press the button to close the door then get in the passenger seat. Peabody signs us on the air and away we go.

Peabody has a good idea of where we are going. It’s snowy and cold.

Along the way, dispatch comes up with some additional bits of information. The overdose was intentional. The patient is breathing but not responsive. The medication is a common over-the-counter compound.

We talk to the PA at the local hospital on the patch channel and apprise him of what is going on. He says to call him as soon as we get there and confirm the medication and dosage.

No members of South Pudunk Rescue have signed on. They are toned three times, several minutes apart.

We waste no time getting to the scene. We pull up to find a calm person standing at the end of the driveway. They motion us in. Peabody is going to jockey the truck around for better access so I jump out, grab the first-in bag and the monitor out of the back, and head over to the person. The person waves me down a walkway through some trees to the house. The walkway is more of a sled trail than anything else. It hasn’t been cleared of snow and it appears to have been used to drag stuff between the parking area and the house. It is the only access to the house. It leads down to a deck apron that surrounds the house. The house is seventy or eighty feet from the parking area.

A calm family member meets me at the door and briefs me on the patient. The patient has taken fifty tablets of the medication, here’s the bottle, patient’s back here. We step through a great room, into a hallway, into a bedroom. There is a king size bed in the room. On the bed are two people. One person is supine in classic patient form; flat on it’s back. Another person is on the bed on their knees next to the patient; this person is nearly hysterical. Two other people stand off to the side and watch; a male and a female. A family, perhaps.

The patient is naked except for undergarments. The patient is large. The patient is snoring.

I quickly check the patient’s level of consciousness. The patient is unresponsive. I lift the patient’s chin but the snoring does not go away. I put the patient on oxygen. I quantify the patient’s vitals and hook them up to the monitor. They are slightly bradycardic at 58 and on the hypotensive side at 100/60. Blood sugar is fine at 130. Their pupils are dilated.

I call the hospital and speak with the PA. The PA recommends an NPA, guard the airway, then go direct to the regional trauma center. Pretty much what I would pick on my own.

Peabody comes in and realizes that we should get South Podunk Fire to help move the patient. He calls dispatch; they tone the local fire department.

I am standing by the side of the bed; the patient’s head is next to me. While I am talking to the PA, I am holding the cell phone between my cheek and shoulder while I am pulling stuff out of the first-in bag.

I realize that I don’t have the pill bottle anymore. Somehow I have dropped the overdose container.

I look everywhere; in the first-in bag, around the patient, in the linens.

Luckily I have already looked at the container and know the pill size. Not very professional, though. The patient’s partner clearly thinks I am an idiot.

I put the NPA into the patient; still snoring. We slide the patient onto the stretcher, head-first. We cover and strap them. We explain to the partner that we’re only tying the patient’s hands together with gauze because we don’t want them to flop around. The partner looks horrified.

A number of firefighters have shown up. They take the stretcher out. I gather up our gear and follow.

I pass the stretcher on the deck and run up to the truck. I put the gear away and start setting up for an IV. The patient arrives and is placed in the back. Peabody puts the patient back on the monitor while I start the IV.

Someone asks if I want a paramedic intercept. I don’t think I really need one but it is an offer one can’t refuse. I’ve done all that can really be done before we get to the hospital. On the other hand, if the patient crashes and I’ve turned down a paramedic, I’m in trouble. So I say okay.

I can hear the radio traffic. Dispatch goes seeking a paramedic.

Peabody gets in front and we head off towards the hospital. Dispatch announces that a paramedic will meet us enroute.

I monitor the patient. A few minutes later, we stop. The side door opens and the paramedic hops in with several bags of gear. We drive on.

The paramedic looks around, checks out the patient. They decide the patient needs a tube. I’m skeptical; the patient is breathing on their own. They’ve got snoring respirations but they are moving air just fine. Good O2 sat. 15 nice breaths a minute. The paramedic doesn’t like the snoring, though, and wants to tube the patient. They are the senior resource and are in charge of patient care.

The paramedic gets out the laryngoscope and the tube. The paramedic does not have their med bag; they just have what we carry on our truck for meds. No narcotics; no RSI drugs.

I get out a bag valve mask and prepare suction. I preoxygenate the patient.

As the paramedic starts in with the laryngoscope, the formerly-unresponsive patient starts to gag and struggle. I hold the patient’s hands down. When the tube gets near the cords, the patient starts to thrash. This is not going to work. The paramedic pulls out.

We drive on. The patient returns to unresponsiveness.

The paramedic decides to nasally intubate the patient. I’ve never seen this done before though have heard about it happening in extreme circumstances.

The endotrachial tube is much larger and stiffer than the NPA. The paramedic greases it with lubricant, stuffs it into the patient.

The unresponsive patient practically sits up. It takes both of my hands to hold the patient’s hands down.

Clinically, we say this patient does not tolerate the tube. That’s a clean, detached way to say the unanesthetized patient can’t fucking deal with a tube the size of a dry-erase marker shoved into their sinus cavity and down their throat.

The paramedic decides this won’t work, either. He pulls the tube out of the patient’s nose. It bleeds.

We drive on. The patient returns to unresponsiveness.

We arrive. We take the patient inside.

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