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Trading Puke

10-2009-Haskell-istock

Warning:You should not read this column if you have a sensitive gastrointestinal (GI) tract, are pregnant, have a compromised immune system, or have just inhaled a three-quarter pounder in 30 seconds because you haven't eaten since you came on shift at 0700 and it's now 1530 and you're sure the tones are about to go off again. If you suspect you may be suffering from emetophilia, you should only read this article in a private place.

Why do we do EMS? Do we do it for the glory of reducing morbidity and mortality, alleviating pain and suffering in the prehospital environment, one grateful patient at a time? For the satisfaction of being a highly paid and skilled professional, praised by our patients and loved by our communities, routinely snatching life from the jaws of death? Or perhaps for the excitement -- for the sights, sounds and smells of EMS. That's it! Especially for the smells.

One of the great, universal and ubiquitous station house questions, a question that has stood the test of time and has been passed down in the lore of generations of EMTs and firefighters, is this: What makes you puke? For some, it's the sight; for some, the texture; for others, it's the sound; and for many, it's the smell. For still more, it's the combination platter of sound and smell, or sight and sound, or texture and smell. Every individual has their own piquant combination of sensory delight that tickles the gag reflex.

Some claim they're immune, but we all know there is some particular combination of delicacy that will send even the most seasoned rescuer over the regurgitory edge. Perhaps it's a bouquet of trailer funk combined with the aroma of two-day-old GI bleed? Or maybe it's the saut of the acrid aroma of cat urine combined with the delightful fragrance of dog feces mixed in with the enchanting visage of weeping "pustilence?"

I call one of my very favorite olfactory extravaganzas the "intubating the patient with small-bowel-obstruction delight." You know, when you insert the laryngoscope blade in the mouth, get real close and peer into the posterior oropharynx, and the pungent aroma of fecal matter hits you first, followed by the realization of what it is you are actually seeing coming out of the esophagus. That, my friends, is the trifecta! The smell of crap is bad enough, but it should never be coming from THERE.

Perhaps my very favorite aromatic experience came when we were dispatched to a 10-50PI (motor-vehicle crash with personal injuries, to the uninitiated.) It was a minor crash. The two patients were the driver and passenger, boyfriend and girlfriend. They had both been drinking. We got them in the truck, boyfriend on the cot, girlfriend on the bench seat. Suddenly the boyfriend says "I'm sick. I'm gonna puke." So somebody tilts the board up to the left, and the boyfriend upchucks right on, well, you can imagine. And how do you think his girlfriend replied? You got it, hit him right back with a return volley. And what do you think happed next? You got it, everyone within hearing and smelling distance added their own contributions to the human effluence.

By the time it was over, stuff was actually flowing out of the back of the ambulance. It was as close to the so-called Roman "vomitorium" experience as I care to get. And they actually pay us for this kind of fun? Well, unless we volunteer for the experience, of course.

EMS: It's not just a job; it's an adventure!

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