What do you know?

blog medicWell, Ma’am, a great deal more than you.  Especially when it comes to emergency response protocols, anatomy and physiology, the effects of alcohol on the clotting factor of blood and what my job is.

THE EMERGENCY

A woman in a wheel chair has rolled herself into a hotel lobby, bleeding from the nose, asking for an ambulance.

THE ACTION

The engine has advised us to slow to a code 2 response and we are happy to do so.  As we arrive on scene I see the engine crew on the sidewalk having an animated discussion with a very alert and oriented woman with cotton balls stuffed up her nose.

As the door to the ambulance opens I now have the audio to match the pointing and head shaking.

Engine Medic: “Have you called your doctor, any doctor, about your nose bleed?”

Hell on Wheels (Could have been Helen, I can’t recall): “I’m not saying anything to you.  You are not a doctor.”

HM: “He sure isn’t.  Anything remarkable?” Is my question and the head shake my answer.

HM: “Then thank you Sir, we can take it from here.”

I introduce myself to our client and ask her to define a chief complaint.  Most times the person who called us has a singular issue they wish our assistance with.  My dad can’t breathe, for example, or I cut off my foot.  But this client goes into a laundry list of complaints ranging from before I was alive finally ending with what got us involved today.

“My nose is bleedin’.”

And it was.  At least it had been.  Hard to tell with her constantly moving around telling me to get her to St Farthest before she dies from it.

HM: “How long has it been like this?’

HOW: “Since 1 AM, I haven’t slept! Why all the stupid questions, let’s just go.”

A quick glance at the time, 6 PM.

HM: “Have you made any attempt to seek an evaluation without calling 911?  A clinic or an urgent care?”

HOW: “Honey I just got here and don’t have time for all your 20 questions.  I need a doctor, I need my pills.”

As my partner is confirming the vitals we got from the engine, I begin my social worker intake interview.

HM: “You mean you need a pharmacy.  The doctors don’t dispense medicine, they write prescriptions.  Is your prescription empty?”

She shoots me a look I get often wen I bring reality into these conversations.  The head snaps around on the thick neck to me while leaning back slightly, eyes wide and a look of anger around the mouth.  Then it comes out.

HOW: “What do you know?  The paramedics where I’m from never disrespect me like this.”

HM: “What do you mean disrespect you?  I’m trying to establish if an ambulance ride to the hospital is the best option for you right now.”

I feel my tired arms leaning onto my knees as I stand bent over trying to stay in her line of sight as she realizes I’m not the pushover medics she left behind in whatever town she sailed in from.  A quick stretch and I ask her the magic question.

HM: “Do you want to do the right thing or would you like an ambulance ride to the hospital?”

HOW: “Do your job and take me to the hospital.  But somewhere where I can get seen fast, and get something to eat.”

My hands are back on my knees and I’m as in her face as I can be without losing my cheerful disposition.

HM: “Are you looking for a ride to food?  Because if you are we actually have that resource here.  You’ll have to wait a little while, but I can get you a free ride to a shelter and a warm meal.”

HOW: “I don’t have time for that, I need my pills now.  I have chest pain.”

Had I been a TV detective, this is the part where I bang on the interview table and go into a well prepared speech about the abuses of 911 and how the best thing she can do for everyone is go back where she came from.  Where she came from easily has a lower cost of living, but that has not entered into her equation.

But I am not a TV detective so she steered the power wheel chair over to the ambulance and told us how she has so many leg problems she is on disability.  Then she stands, climbs in the ambulance and sits on the cot with a familiarity some folks on the job don’t show.

We sigh.

HM: “Chest pain you say?”

HOW Now with arms and legs crossed: “Yup, let’s go.”

HM: “That means an IV, and I’m not all that good at them.”

HOW: “Oh no you don’t, you ain’t touchin’ me with no needles.” Her head is shaking almost to a point I think she’s going to hit it on the cabinet doors and then need an ambulance.

HM: “Yup, let’s go.”

On our short trip to St Closest she wanted to discuss the finer points of how I don’t know what I’m talking about and only Doctors understand what she is going through.  My lips were sealed, only asking my billing and pertinent negative questions and completing my report.  She refused a line, a trace and everything else except another BP.

When we made it inside she commented that the ER had an odd odor to it and she wanted to know the name of the hospital.

HM: “St Closest, why?”

HOW: “Tomorrow they’ll take me somewhere better.”

Report finished I left, smile on my face, almost wanting to work the next day just to see if she does it.

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20 thoughts on “What do you know?”

  1. Grrrrrrrrrr!! Grrrrrrrrrr!! Count to 10. 1…..2……3…….4…….5………6………7………8………9………10! And breathe!

    Makes me mad even sitting here, without having to actually take her where she wants to go!

    Time for the new and improved HM system of care to hit the streets of San Francisco me thinks!

  2. Hey, how’d she get to SF?! I just took her in from the trailer park last week. No, nope, no…mine refused care when we told her she would have to go to the closest appropriate hospital not the other one 40 miles away near her daughters house.

    Heh.

  3. Grrrrrrrrrr!! Grrrrrrrrrr!! Count to 10. 1…..2……3…….4…….5………6………7………8………9………10! And breathe!

    Makes me mad even sitting here, without having to actually take her where she wants to go!

    Time for the new and improved HM system of care to hit the streets of San Francisco me thinks!

  4. Hey, how'd she get to SF?! I just took her in from the trailer park last week. No, nope, no…mine refused care when we told her she would have to go to the closest appropriate hospital not the other one 40 miles away near her daughters house.

    Heh.

  5. Oh my that sounds frustrating! But very well handled. The joys of the job to look forward to… Do you get many, erm, difficult pts? And can anyone’s (country’s) services refuse transport?

  6. Oh my that sounds frustrating! But very well handled. The joys of the job to look forward to… Do you get many, erm, difficult pts? And can anyone's (country's) services refuse transport?

  7. you were practically poking a mean bear …. She must be related to the 06D we talked to 3 times today, who said our questions were silly, stupid, and useless as he hung up on 9-1-1 — then going mean and nasty to the Medics who came to help him.

  8. you were practically poking a mean bear …. She must be related to the 06D we talked to 3 times today, who said our questions were silly, stupid, and useless as he hung up on 9-1-1 — then going mean and nasty to the Medics who came to help him.

    1. I saw this all too many times when I worked in Triage in the hospital…most local units would simply check with our charge nurse, and then send that patient right back out to me. Now they would have to start waiting all over again.

      In a sense, I can understand the frustration at having to wait so long…but there were always the exceptions that made my heart glad that they would have to be ‘inconvenienced’ anew!

  9. My sympathies and empathies…all too many times we see such patients, who usually are on public support and yet that person drives a better car than I, has better, newer furniture than I, has satellite TV, etc. Yet I’m asked if we can hit the drive through on the way in, and, oh, can I float a loan until the next support check comes in? Yet I don’t know what I’m doing nor talking about…For this I went to college.

    Still, for all that aggravation, I love this job.

  10. My sympathies and empathies…all too many times we see such patients, who usually are on public support and yet that person drives a better car than I, has better, newer furniture than I, has satellite TV, etc. Yet I'm asked if we can hit the drive through on the way in, and, oh, can I float a loan until the next support check comes in? Yet I don't know what I'm doing nor talking about…For this I went to college.

    Still, for all that aggravation, I love this job.

  11. I saw this all too many times when I worked in Triage in the hospital…most local units would simply check with our charge nurse, and then send that patient right back out to me. Now they would have to start waiting all over again.

    In a sense, I can understand the frustration at having to wait so long…but there were always the exceptions that made my heart glad that they would have to be 'inconvenienced' anew!

  12. My sympathies and empathies…all too many times we see such patients, who usually are on public support and yet that person drives a better car than I, has better, newer furniture than I, has satellite TV, etc. Yet I'm asked if we can hit the drive through on the way in, and, oh, can I float a loan until the next support check comes in? Yet I don't know what I'm doing nor talking about…For this I went to college.

    Still, for all that aggravation, I love this job.

  13. I saw this all too many times when I worked in Triage in the hospital…most local units would simply check with our charge nurse, and then send that patient right back out to me. Now they would have to start waiting all over again.

    In a sense, I can understand the frustration at having to wait so long…but there were always the exceptions that made my heart glad that they would have to be 'inconvenienced' anew!

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