We all have those addresses that get our blood boiling.  The one you know by heart.  When the address comes over the radio we can recite the person’s name, social security number and even their first 4 medications.

For me the new address, since there are folks like this in every area, is causing me more headaches than it should.

The first time I met Bernie (Bernie is Erma Fishbiscuit’s brother. Yes, I’ve added to the Glossary of Terms! Found under the Who is HM tab) he was sitting in bed, unbathed for weeks, arguing with his home health care worker about how short of breath he was and that she can’t leave him yet.  Bernie didn’t want his daily companion to leave.

Unfortunately Bernie didn’t let the care taker do anything much for him when she is there.

He won’t let her change the bedding.

He won’t let her cook him food, he’d rather snack all day.

He won’t let her clean up the room he is in for fear she will steal something.

The poor care taker sits and watches him slowly dying simply because he won’t let her help.

So here we are on a code 3 dispatch, ambulance trailing because Bernie won’t let anyone under the rank of MD help him.  But what can we as Paramedics and EMTs do?

When Bernie and I start to have an honest discussion about quitting smoking, or at least agreeing to walk the length of the apartment to get his smokes each day, he demands transport, spinning yarns about how long they will keep him there.

We all know he’ll be home tonight, if not this afternoon, right back where he started.

The care giver knows she should be doing more, but is a frail thing and if she and Bernie got into a shoving match, we’ll be here for her instead of him.

Bernie refuses to listen to reason.

“I have asthma” he tells me.

“You smoke too much” I tell him noting the stench from the nearby overflowing ashtray sitting on the oxygen machine.

“You’re no doctor, what do you know?” I’m challenged.

“No, not a Doctor, but I don’t need to be one to see what you’re doing to yourself” he hears.

The private ambulance company is more than happy to take him in since he has private insurance and I am once again reminded why my premiums keep going up.

The health care practitioners at the scene, the ones most experienced to make a determination of most appropriate resources for this person, are powerless to effect change in this situation.

We could call his insurance company and ask them to send more people.

We could ask them to send a counselor to discuss with Bernie the importance of taking their advice.

Calling Adult Protective Services might bring a case worker out in a few weeks, but we’ll have been there dozens of times by then.

Bernie doesn’t want our help, just a ride.

On our most recent visit, I moved his pack of cigarettes to the other side of the room and reminded him of the real possibility that he will kill himself AND others while smoking on oxygen.

Then I helped him to the cot and along to the ambulance for yet another treat and release at a not so local ER.

What can we do unless the system adjusts to let us assess, refer and release Bernie?  The insurance company, fire department and ambulance company could save 10s of thousands of dollars on one person each year.  And that’s just one person.

They need savings, I can offer tons.  So long as Bernie realizes that when the Paramedic arrives without an ambulance he isn’t getting an automatic taxi ride, then listens to what we have to say and becomes an active participant in his own health we all win, especially Bernie.

And Bernie is not one of the uneducated poor often blamed for EMS abuse, but one of the growing trouble spots in EMS.

Bernie is a baby boomer.

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