Steady hands on call

Certain people in the medical profession have the daunting task of performing their duties with the immense pressure of someone’s well-being—or even life—hanging in the balance. For the CN&R’s annual Health & Fitness issue, we chose to highlight local medical professionals who often work in emergency situations where decisions may mean the difference between life and death.

The following package of stories includes profiles of a pair of emergency medical responders, an obstetrics nurse, a cardiologist, an emergency-room triage nurse, as well as a nurse and paramedic who work on a helicopter-ambulance crew.

Each one experiences different mental, physical and emotional difficulties associated with her or his profession, but as the CN&R discovered, it’s all in a day’s work.

With lights and sirens

Emergency medical responders

As emergency medical responders for First Responder Emergency Medical Services Inc. of Butte County, partners Shaun Welsh and Robbie Berge work 24-hour shifts during which they are constantly on call.

Berge, an emergency medical technician (EMT), said that during a typical shift, they receive about a dozen calls for service, which can range from assisting with mundane ailments “like the sniffles or a stubbed toe” to disastrous vehicle collisions or plane crashes.

The partners often find themselves killing time in between calls, their ambulance ready and waiting nearby. The dramatic swings from inactivity to emergency situations make their jobs unpredictable and, at times, overwhelming.

Welsh, a paramedic, said the calls they respond to generally fall into one of three categories. “In Chico, probably half the calls are where we pick someone up and take them to the hospital, and they don’t require anything more than a Band-Aid,” Welsh said. “Then there are calls where people are sick, but not in danger. We’ll stabilize them or start their treatment before getting to the hospital.”

More rarely, there are true emergencies “where we don’t just have to stabilize the patient—we’re starting behind the curve and we have to work furiously to save their life.”

During one particularly exhausting shift, Berge responded to six such incidents, including two automobile accidents that caused “major loss of life.”

Understandably, being the first to arrive on the scene of gruesome car accidents and rushing critically sick or injured people to the hospital “with lights and sirens,” as Berge put it, can be too stressful for some. In fact, with six and seven years of experience as emergency medical responders, respectively, Welsh and Berge are already past the point where most in the field “burn out.” Berge said the average career length of an EMT is five years.

So, what takes a toll on Berge?

“Showing up to the scene of a child not breathing,” he answered without pause, adding that he’s a father of three children. “Everyone dreads it—nobody wants to show up to a call [involving] kids. You go, ‘Oh my God, that looks just like my daughter,’ and you freeze.”

As their careers have progressed, both Welsh and Berge have found it becomes easier to distance themselves from disturbing scenes. Maintaining a certain level of emotional detachment is necessary to perform under pressure, Welsh said.

“Don’t get me wrong, we care about our patients,” he said. “We’re not in this for the money. But if you connect with them too much on an emotional level, if you consider everyone your family, then you can’t make it through those calls.”

Berge said that his detachment is such that, once a job is done, he usually won’t dwell on the day’s events whatsoever. “Once you’re done with that critical call and you’re leaving the ER, you go, ‘Hmm. Where are we going to eat?’” Berge said. “It sounds terrible, but it’s true.”

“That’s the only way to do it,” Welsh agreed.

Special delivery

Obstetrics nurse

Obstetrics nurse Melissa FitzGerald and her fellow registered nurses at Feather River Hospital have a running joke about how well their bladders hold. That’s because they are so focused on their patients at The Birth Day Place—the hospital’s maternity ward—that they often forgo bathroom breaks.

To say FitzGerald’s work can be fast-paced is an understatement. Depending on the day, and whether she’s scheduled as a relief charge nurse—in which case she may spend a lot of time working with outpatient expectant mothers—FitzGerald could tend to anywhere from one or two patients to up to a dozen or more.

“It’s kind of like a contraction,” she said, using a birthing metaphor to describe her job. “Really intense at the peak, and we get breaks in between.”

She further explained that the facility is the equivalent of an emergency room for pregnant people. One moment, a patient may be whisked away for an emergency cesarean section, and the next moment, three or four laboring women may arrive simultaneously.

That certainly sounds stressful, and indeed it is at times. But FitzGerald has worked at The Birth Day Place for 16 years, which has prepared her for all sorts of scenarios. She started off as an obstetrics technician before becoming a licensed vocational nurse and then, about five years ago, a registered nurse. “I always knew I wanted to be a nurse … and working here as a tech, it just was home,” said FitzGerald, a mother of three.

She recalled a few hectic moments over the years, including rushing outside to “scoop up” patients into wheelchairs when their babies were “crowning,” which, in maternity vernacular, means starting to come out.

One of her favorite delivery stories involved a Brazilian woman who came to the facility on the verge of birthing her child. She was crying out “ay-ay-ay” very loudly over and over. When the doctor arrived, he asked whether he had enough time to change out of his street clothes. Just after he walked out the door to do so, FitzGerald yelled for him to come back. It’s a good thing, too, since the baby was born within moments. “It was a beautiful birth,” she said, recalling how the mother’s cries of “ay-yi-yi” turned, upon the infant’s birth, to a joyous repetition of “my baby!”

In addition to ensuring a safe delivery, FitzGerald said her focus is to provide a soothing, peaceful birthing atmosphere for the patients and their families. That means, as she put it, “helping them cope with labor, with the contractions. To me, there’s nothing greater.”

To that end, she noted that The Birth Day Place itself, which offers large, homey rooms, is a comforting environment. “We’re kind of like a birthing center and a hospital wrapped into one,” she said. “We can give you that at-home comfort, but give you everything a hospital can readily provide. I feel like it’s the best of both worlds.”

At the heart of medicine

Cardiologist

Dr. Peter Wolk is a cardiologist who’s practiced his trade in Chico for the past 30 years. He works with Northstate Cardiology Consultants on Cohasset Road as well as Enloe Medical Center’s Cardiac Catheterization Laboratory.

Cardiologists specialize in heart disorders and diagnose and treat patients for congenital heart defects, heart failure and artery disease. When on call at Enloe, Wolk can work up to 100 hours in a week.

“Yesterday I was on call, which means I have to cover all of my partners’ patients and my patients who are in the hospital,” Wolk said. “We had an extremely busy day. I had five acute heart attacks, so we had to go to surgery multiple times during the day and during the night. I worked from about 6:30 in the morning and I got home about 9:30 in the evening. Then I got called back in at 11 because we had two heart attacks come in. I didn’t get home until 2:30 this morning.”

Cardiology, he said, is a multifaceted discipline, though the variety of the practice may be lessening in these days of modern medicine and technology.

“It really crosses the lines of taking care of people on a chronic basis as well as being there under those tense moments when they need acute care,” Wolk explained. “That is one of the nice things about what I do—I get to step in during various times in a person’s life, and that is a really enjoyable way of servicing people.

“Unfortunately, in medicine, there is so much specialization now that people end up doing just one thing,” he said. “I’m one of the old-school guys lucky enough to have done everything over my career, which I think is a real advantage, because most of the time the tough decisions that are being made are not whether or not you can do something, but whether or not you should do something.”

The responsibility of having someone’s life in your hands becomes less intimidating over the years, he said, and a doctor has to be confident in his or her medical decisions.

“Everybody in this business has gone through trauma experiences not going well and has also had the experience of saving lives and making the right decisions,” he said. “After a period of time, you realize you’re only human. You’ve got skills and qualities you rely on, just like in any job. If you’re confident, then you are good at what you do and you accept that sometimes you don’t do a perfect job, but your intentions are always to do the right thing.

“That’s what really pulls you through when things don’t go right,” he reflected. “If you have the patient’s best interest at heart, you almost always are making the right decision.”

On the front line

ER triage nurse

From gunshot wounds, to babies turning blue, to fishhooks stuck in the strangest of places, Tammy Russell can never guess what manner of injuries and ailments she might encounter during a typical 12-hour shift in Oroville Hospital’s emergency room. As a triage nurse, Russell is the first face many ER patients—who are often the sickest of the sick, or suffering from recently inflicted and life-threatening injuries—see at the hospital.

“My job is to do a quick assessment of the patient to determine the severity of their condition,” Russell explained. “The goal is to make sure that the sickest patients in the greatest need are seen first.”

To do this, Russell takes many factors into account—the nature of the complaint, if they are having trouble breathing or speaking, if their bodies show visible signs of damage or bleeding, vital signs and much more. She then rates their needs on a five-level triage scale, with one representing the most urgent need for care (“They usually come in by ambulance,” she noted) and five for people seeking medication refills or following up on a doctor’s visit.

This is never a simple task. As anyone who’s visited an emergency room knows, they are rarely filled with happy, cooperative people. Wait times can be difficult to endure, and patients may not understand their conditions are relatively minor compared to others in need of more immediate care. Regardless, Russell must treat all complaints equally.

“Pain is subjective, and everyone experiences it differently,” she said. “You have to take each complaint at face value, and everyone’s description of their pain very seriously.”

“That’s where the art and science of triage comes in,” added Debra Cox, a manager at the Oroville Hospital ER. “You can’t judge how someone else feels pain, but you still have to determine who needs the most immediate care. Tammy is especially good at this.”

Russell said holidays at the ER can be particularly hectic, especially Halloween (“There are a lot of assaults, or some people might have a little too much fun,” Russell said). Flu season is also a particularly busy time, but Russell said that any random day can be just as hectic.

“You never know what to expect and it’s always different,” Russell said. “That’s part of the reason why I love my job so much.”

Cox said it’s important for visitors to be as polite and patient as possible to ensure the best ER visit, and both women stressed that an ounce of prevention can kill a pound of pain.

“The best thing to do is to avoid an emergency-room visit altogether,” Cox said. “Keep your appointments with doctors, finish your prescriptions, wear your seatbelt, exercise, and do whatever you can to stay healthy and safe so an ER visit isn’t necessary.”

Focused on the positive

Helicopter-ambulance crew

“We deal with death and destruction—heart attacks, car wrecks—but a lot of what we deal with is really positive, like helping a stroke victim get treatment,” said Tom Stedman, paramedic for Enloe Medical Center’s helicopter-based FlightCare program.

Stedman’s words are emblematic of the calm, compassionate attitudes displayed by both Stedman and registered nurse Eliza Anderson, a fellow FlightCare employee, during a recent interview. If one is looking for stories of blood and gore flowing easily from the mouths of two people immersed in a profession that deals with attending to and transporting the critically ill on a regular basis, one will perhaps be disappointed.

Anderson and Stedman work on what is essentially an “air ambulance.” They are two of a dozen medical personnel that Enloe has tasked—along with four pilots—with the job of manning the hospital’s air-based medical program. Enloe FlightCare has transported more than 16,000 patients since the program’s inception in 1985.

“Either we’re getting dispatched to a scene—the side of I-5, somebody’s field—to pick up someone injured or ill, or we are doing interfacility transport of patients,” Anderson said. Sometimes the work takes a FlightCare crew (consisting of three people: a pilot, a paramedic and a nurse) as far as Reno, Redding or San Francisco. Sometimes they have to fly at night, when night-vision goggles are worn by the flight nurse to help the crew navigate through darkness, perhaps challenging weather, and maybe some birds or ducks.

“What I really like about [the work] is I’ve never done the same thing twice,” Stedman said. “When my alarm goes off at 4:30 [a.m.] to be at work at 6, I have no idea what the day is going to entail.”

Anderson said that some of the most exciting FlightCare trips involve locating the scene of an accident that has occurred in a remote area, such as the time she was called out to an accident in the Bucks Lake area, near Quincy, involving an ATV that had run into a logging truck. The incident had been called in by someone on a cell phone who had not remained at the scene, forcing the FlightCare crew members to scour the area until they found what they were looking for. Often, though, they are equipped with GPS coordinates and are able to communicate with people on the ground, asking, “Do you see us?” until they find the location of the accident.

Then there is the challenge of finding a place to land that is “flat, clear of trees,” as Anderson put it, and the issue of whether or not dust or snow is going to blow up, potentially causing difficulty seeing.

And, of course, there is the life-or-death situation of giving emergency medical care to the victim of a debilitating accident or illness, and getting him or her into the helicopter and to the hospital.

“I don’t think you can continue to do what we do without focusing on the positive,” Anderson said. “I’ve had a couple of situations that have affected me greatly. We have to learn to process them so they don’t take on too negative a role in our life.”

“I really enjoy what I do, but going to see someone’s worst day is not what I want to see, but I am unfortunately really good at my job,” said Stedman, who said he has seen so many dead people that he “can picture every one, if I had to.”