By Michael Goldstein
By Dennis Romero
By Sarah Fenske
By Matthew Mullins
By Patrick Range McDonald
By LA Weekly
By Dennis Romero
By Simone Wilson
At least, that’s what I thought.
I get a call for an unconscious male outside a shopping mall. That description, of a “man down,” is the vaguest one out there; it can mean anything from a medical cause (syncopal episode, seizure, low- or high-blood-sugar diabetic, stroke, heart attack, drunk, or drug overdose) to a traumatic one (assault, stabbing, gunshot wound). He could be sleeping or he could be dead.
This patient is none of the above. When asked what hurts the most, where his pain is, what his reason was for calling 911, he says the same thing over and over.
“I can’t function.”
We walk him to the rig and sit him on the gurney inside and the paramedic and I climb in the back. The barrage of questions begins. Pain in your head, chest, abdomen? Difficulty breathing? Is there ringing in your ears, is it difficult to see, can you squeeze my fingers and wiggle your toes? Do you have heart problems or diabetes, do you feel confused, weak, dizzy? Have you fallen, been hit or bruised, can you describe how you’re feeling, do you have any pain, and has this happened to you before? What have you had to eat or drink, what medications are you taking, what kind of medical problems do you have? Drugs, alcohol? Anxiety, stress, panic attacks?
“I can’t function.”
He’s alert and oriented, knows where he is/what day it is/his name, but to every other question he says the same thing. He can’t function. He’s not taking meds, he ate lunch not that long ago, he feels “warm” from having been sitting in the sun, he doesn’t want to hurt himself or anyone else, and one more thing: He can’t function.
At first it’s kind of funny, then it’s annoying, then it’s sad. The paramedic sits there, asking, asking, going through his store of medical information, the mental checklist. Interrupting, I report the guy’s vitals one by one: His breathing, pulse and blood pressure are fine; his lungs are clear bilaterally. His blood is fully oxygenated and traveling to the farthest reaches of his body. His pupils are PERL (pupils equal, round and reactive to light), his skin signs are normal, he’s not altered in any way, and his blood sugar is perfect.
There is a moment of silence and we all sit there. If there were a clock, we would have heard its ticking. The paramedic is frustrated, but I am somewhat in awe. This man walked out of a shopping mall on a Thursday afternoon. He didn’t make a purchase. He probably walked toward his parked car, or the bus stop, and then just stopped dead in his tracks, not knowing if he wanted to go home, stay put, or return to the mall to buy something. Not knowing if he was hungry, thirsty, tired, lonely, restless, anxious, sick or crazy. He only knew he didn’t know. It’s not a medical complaint, and there isn’t a thing we or the hospital can do, but all the same, he can’t function. What do you do when you can’t function? You call 911. Who else are you going to call?
Something criminal happens, and 911 sends the police; if there is a fire, the fire trucks arrive; he has a medical problem and here are the paramedics and EMTs; and when things are real bad, you get all of the above. But when someone’s mind starts to go, there is no system in place. If you can’t function in this society, you’d better have friends and family, because otherwise, you are shit out of luck.
In the end we take him to the hospital. I sit in the back and don’t say a word. I keep thinking of a clock for some reason, the one that would be ticking because it is so quiet. The one we don’t have.
You avoid looking at yourpatient, you have learned this much on the job at least: Patient is 95, female, complains of chest pain. The live-at-home nurse called 911 because she wasn’t sure how severe the old woman’s condition had become. They both speak Russian, you half-listen to the firefighters struggle with the language barrier while you hook up the 12-lead EKG. Move the 95-year-old breast out of the way, line up V4 with the midclavicular line, line up V6 with the midaxillary line, the rest is easy. Ma’am, we’re going to take a picture of your heart, you say, knowing that she’s not listening. Hold still for us, okay?
She is strong and angry; you feel it coming off her in waves. Feel it but don’t see it; you still won’t look at her. She is not the boss of the scene, the lead paramedic is, so you turn to him with the first copy of the EKG readout, which you wish you understood better but don’t. He looks at it, nods; you start to put her on oxygen but he shakes his head. Thumbs over his shoulder. Do that on the rig, we’re going to load her up and go.
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