Meeting Miki

Taking Chances

Circa June 2004

“Metro Control to Ambulance Eleven, Double One, Eleven,” the VHF radio squawked in the dark cabin of the ambulance we’d been assigned for duty that night. We were on volunteer ambulance duty for the Cape Town Metro EMS, Brad was driving, and I was in the passenger seat. Our third was an ILS medic along to assist.

“Ambulance Eleven, Double One, Eleven, send your message Control,” Brad answered, one hand keying the radio microphone while he slowly guided the ambulance through the Saturday late-night traffic on Long Street.

“Please make your way to number 88, 6th Avenue, Belgravia for an asthmatic in respiratory distress, priority one.”

“Roger Control, en route,” Brad responded, flicking the emergency lights and siren switches on. I pulled out the map book and looked up the address given.

“Got it,” I said from inside the map book, “take De Waal Drive, N2, take the Jan Smuts off ramp and go south. Left at Klipfontein Road, second set of traffic lights take the Klipfontein slip-road on the right, traveling east, and then turn right into 6th Avenue.”

Brad piled on the speed, our red flashing lights and blaring sirens forcing cars to make space for us up a jam-packed Long Street. Once we hit Orange Street, it was easier going, and quicker. 8 minutes later we turned into 6th Avenue, Belgravia, looking out the cabin for house numbers. Belgravia is a Coloured area, one of the safer ones, but anything can happen on shift, anywhere. We drove down 6th Avenue, finally locating a house number: 6.

“Long way to go, all the way down to the end, probably,” I suggested.

Brad sped up and then suddenly slammed on the brakes, hard. Everything in the cabin fell onto the floor, or up against the windscreen, while I quickly braced myself against the dashboard. A pedestrian stood inches away from the front of the now stationary ambulance, bathed in white and red flashing light.

“What do you want?” I shouted out of the passenger window, expecting an emergency of some kind, maybe our patient on their way to hospital. The idiot just laughed at us and ran off to join a group of youths leaning against a wall, probably all of them, high as kites on Tik.

“Bloody idiots, you’re going to get yourselves killed,” Brad swore at them as we drove off again. But, by the time we hit the end of 6th Avenue, a T-junction we hadn’t seen an 88. No, definitely no 88.

“Ambulance Eleven, Double One, Eleven to Metro Control,” Brad called over the radio.

“Control here.”

“We can’t locate an 88 on 6th Avenue, Belgravia, Please can you confirm the call’s address?”

“Will do,” Metro Control responded.

“Let’s go around the block in the meantime.” I suggested. 4th, 5th, 6th, they all sounded the same and we were used to getting the wrong directions and having to drive around looking for patients. Usually the siren would bring them out if we were close enough. Sure enough, around the block, on 5th Avenue, the first house we saw on the left was 88. It looked quite run-down, but there were lights on in the front.

“Ambulance Eleven, Double One, Eleven To Metro Control. We have located an 88 on 5th Avenue. Will check for patient inside. Mark our arrival at A.”

“Roger,” was the short reply from Metro Control.

We all jumped out of the cabin, opened the rear, sliding door of the ambulance and grabbed all our gear: jump bags, Oxygen, ECG monitor. It was a lot to carry but there were enough hands to go around. We opened the gate and walked up to the front door. Standing on either side of the front door – you could never be too careful – we knocked loudly, announcing ourselves, “Ambulance service.”

The door opened immediately and we walked into the lounge of 88, 5th Avenue, Belgravia. It smelt old – musty and mildewed – and it looked old; black and white photos hung on the walls; the couch alone looked to be 40 years old at least. There were about 7 people seated around, staring at us.

“Did someone call for an ambulance,” I enquired?

“Yes,” a short, elderly lady replied, “for my daughter, she’s asthmatic, she can’t breathe.” She pointed toward the corner of the lounge, by the door leading out to the hallway. I looked and saw the youngest, most petite, stunningly gorgeous, Caucasian woman I had ever seen. She was squashed into the corner of the room, in a single chair, similar in design and age to the couch, sitting double with a very large, overweight Coloured girl.

I was stunned – she was beautiful. She had medium length black hair, slightly Slavic features, and beautiful, seductive eyes. Hunched over in the chair, she looked to be about 17 at most. What was she doing here, in the middle of Belgravia, white as a ghost, surrounded by this family?

“Please give us some room,” we asked. Everyone shifted around to give us access to our patient.

“Hi, we’re from Metro EMS, we’re here to help. What is your name?” One of us asked as we started with our Primary Survey. After a quick examination we had our results: GCS 15/15; Patient Red; Primary Survey compromised at Airway; inspiratory and expiratory wheezes, bi-laterally in bases and apices; tachypnea of 40 breaths per minute; tachycardia of 138 beats per minute; strong radial pulse.

“Mirrischka… but… you… can… call… me… Miki,” she answered slowly, obviously in distress.

More clinical observations: Patient speaking in words; use of ancillary muscles; and intercostal recession. We definitely had an acute case of asthma here. Brad was in the practical phases of his ILS training so he was keen to go through the entire Asthma protocol: monitor blood pressure; establish IV access; Saline, 200ml, TKVO administration; ECG monitoring, and then nebulization with a mix of Salbultamol and Ipatroprium Bromide.

We started our treatment. It’s not a particularly difficult protocol but it does take time, particularly the nebulization – it only goes as fast as the Oxygen flows and the medication vaporizes. Regular monitoring of Miki’s chest showed a slight improvement in her breathing, and her blood pressure and ECG didn’t indicate any abnormal reactions to the medication. After the end of the first nebulization, we could still hear wheezing, so we decided to repeat the nebulization.

The family sat around, engrossed in watching us work. I had a chance to look around the lounge in more detail. Photos, black and white, and in washed-out colour showed at least three generations had inhabited the house. I recognized the front of the house in one of old ones.

At the end of the second nebulization, we were happy with her airway – it had cleared up nicely. Proper protocol indicated that Miki should be taken to the nearest hospital for further observations and treatment. Being new in the service, we followed protocol to the end and gave Miki the option of either remaining at home, or coming with us to Hanover Park day hospital. It wouldn’t take us long in the service to realize that often taking a patient to the day hospital was more hassle for the patient than it was worth. The attending sisters and doctors were only interested in clearing out their ER, and had no compunction about kicking patients out in the middle of the night.

We stretchered her out of the house and loaded her into the back of the ambulance.

“Ambulance Eleven, Double One, Eleven To Metro Control. We have loaded one green, female patient, en-route to Hanover Park day hospital,” Brad informed Metro Control as he took the driver’s seat.

“Roger, proceed,”

I sat in the back of the ambulance with Miki, monitoring her vital signs and started on the paperwork: one MVI for every patient.

“Full name,” I asked?

“Mirrischka Mikhaila Roberts.”

I had her address, filled it in, indicated State patient. I checked my notes taken during our treatment and penned them into the MVI, including the medications and dosages we’d given her.

“Occupation,” I asked, looking up at her.

“Photographer, and Internet Porn Star,” she replied, with a wry, smile and a twinkle in her eye. She was clearly flirting with me.

“Really? What site,” I replied, grinning broadly?

“Wouldn’t you just love to know,” she stated defiantly, obviously teasing me.

I looked at her. She was a gorgeous girl, of slightly Eastern European features, stunning, feisty and forward. I definitely found her attractive, and intriguing: how had she ended up here, and what were the chances of me meeting someone like her? In the middle of the night, on the ambulance, in an area like this: virtually none. She was perfect – My Alice in Wonderland?

But, I’m a hard-liner, ethical, puritanical even and I would never abuse the patient-paramedic relationship by asking her out in the back of the ambulance. We carried on to Hanover Park day hospital and wheeled her into ER. It wasn’t too full: two stabbings and a mother and child took up three of the four beds. Matron sat, oversized in an old sturdy chair by the desk in the middle of the tile, white room. She looked wearily at us, waved us over to the remaining bed, and we transferred Miki to a hospital gurney, waiting for a doctor to appear so we could do our handover.

“Excuse me,” Miki asked me, “can I have your numbers, please.” She was still teasing but I jumped at the chance. Once she wasn’t my patient, there were no ethical boundaries in my head preventing me from dating her. I asked Matron for some paper, wrote our names down, and then only wrote my telephone number down. Sneaky. Apparently there was something funny about the way I scrabbled around for paper, and then neatly wrote down my details because to this day she still teases me about it: running around, big paper, small little numbers. She laughs and teases me about it at any opportunity.

I smiled and nodded, the only thing I remembered was: I’d found my Pandora’s box.

Meeting Miki