By Hillel Aron
By Joseph Tsidulko
By Patrick Range McDonald
By David Futch
By Hillel Aron
By Dennis Romero
By Jill Stewart
By Dennis Romero
Come back, come back!
The patient I am treating has myriad infectious diseases and is spouting off a narcissistic soapbox tangent about what’s wrong with her life, her health, my clumsy efforts to help. Meanwhile, the rig is lurching because my partner is tired and resents this patient’s intrusion on his sleep cycle. It is 3 a.m. on a Monday night, Tuesday morning, whatever. I peer out the back of the rig at the streams of light. The police car is probably still behind us — should I have insisted that an officer ride in back with me? A moment ago, she’d been crawling up my arm, literally, demanding to see my pen and wanting to know what I’d done with her children — why had I killed them, why was I taking her to the graveyard, when she just wanted to go home. I pictured the pen being driven into my throat, so I gulped away my sleepiness and threw my forearm into her sternum with my weight behind it to sit her back on the gurney. I looked at her with an icy strength I didn’t feel and said in my best warning voice: “Hey, be nice to me and I’ll be nice to you. I promise not to take you to the graveyard. Now relax.”
My paperwork is sprawled about the rig. I’d take wrestling a psych patient over filling out paperwork any day. Name, birthdate, Social Security number, medical-insurance ID, height, weight, age, medical history, allergies, meds ... on and on. She’s changed her mind three times about her home address, not to mention having given six digits for her phone number, so I give up. The most important part of the paperwork, medically speaking, has yet to be filled out. In a few minutes I will give a report to the triage nurse, explaining who the patient is and what’s wrong with her, and I still don’t know what I’ll say. She’s violent, diseased, angry, but there is no apparent drug use; she’s probably a psych patient who is noncompliant with her meds. ...
Does it hurt anywhere? I ask loudly, interrupting her rant. Where is your pain? “Fuck you. Where are my kids, you bitch ...” and off she goes. Okay. Chief complaint: pissed off. Chief complaint: Threatened an officer outside a 7-Eleven, then insisted she had severe pain that has now vanished. Chief complaint: Probably doesn’t have a home, so the hospital is as good a place as any. Chief complaint: bilateral full-bodied “fuck you” pain with good circulation, sensory and motor.
I’m going to die this way, I think suddenly. I’m going to catch Hep C from a patient, or tuberculosis, or, at the very least, MRSA. I will get slammed in an ambulance crash, crushed by a burning building, shot by a gangbanger, blown up by a terrorist, exposed to a hazmat leak. I make minimum wage, risk my life in a war zone, and for what?
I’m almost tearing up, I’m so self-involved. The car lights are getting blurry and the paperwork is forgotten. I look back at her to find her quietly studying me. I have treated her before, I realize with a start, when I first started doing this. I have a painful, blindingly self-aware moment: Here I sit, another burnt-out EMT, with a wrinkled uniform and scuffed boots. My boots! When was the last time I polished them? Her eyes are momentarily clear and lucid and she smiles. “You’re very pretty,” she says.
Thanks. The rig stops and my partner ambles around the side to open the backdoor. His face is miserable as he puts on a fresh pair of gloves.
We’re here, I say.
Let me tell you a secret: In our job, it’s better when there are things to do. The worst kind of patient is the one we can’t help. Want to know the most infuriating chief complaint out there? Abdominal pain. We hate treating abdominal pain in the field. When someone has abdominal pain, whether it’s mild indigestion or a life-threatening aortic aneurysm, the treatment is the same: Drive to the hospital. That’s it. They could have an ulcer, blood in their GI tract, kidney stones, a bladder infection, appendicitis; they could have internal bleeding from a bruised solid organ or the swollen infection of a hollow one. They could be throwing up bright-red blood or vomiting “coffee grounds” — digested blood. This could have been going on for weeks or hours. The most you can do on your way to the hospital is get an accurate description of where in the body the pain is occurring, signs and symptoms, and severity. The triage nurse takes it from there, but God forbid you finish your assessment on the rig and still have even one minute to go on your ride to the ER. That’s one more minute of sitting there, listening to someone scream their head off, ask for pain medicine, tell you they’re going to throw up. You can sympathize with their pain, hand them a basin, tell them no pain medicine is allowed until some tests are performed at the hospital, but what it feels like you’re saying is: I’m useless, I can’t help you; just sit tight in this overrated taxi and we’ll get you there.