My preceptee got cut loose so I am back at work having to carry my own gear again. My rhythm is a little off, but I think I’ll get it back soon enough. Not much interesting so far – just the meat and potatoes of EMS in this town. 1) An old man with pneumonia in a nursing home, just put on antibiotics four days ago, but family wants him taken to the hospital anyway. 2) A middle-aged hyperventilating woman complaining of chest pain in the church lobby. At the hospital, the triage nurse asked me what I had. I answered if the correct diagnosis would advance me to the next round of the million dollar bonanza, I would wager anxiety. If I was being graded on being a thorough, prudent paramedic, I would have to say rule out cardiac considering she was obese and diabetic. 3) A minor motor vehicle with the driver complaining of neck and back pain. 4) An old woman who lives alone not feeling well for a month with vomiting today. This last patient is the one that tries me the most. When I ask her what medical problems she has, she says she doesn’t know. Her neighbor says she has dementia. The patient keeps saying she is cold as she lays in bed and tries to pull the covers back over her arms as I feel her steady pulse. She is very needy and her voice is high and very whiny and she is somewhat hard of hearing. Her apartment is crowded and we have to stair chair her down after moving a large bookcase. I try to tell her I think she has the flu ( fever, headache, vomiting, chills — a lot of it going around), but she insists she doesn’t because her doctor told her she didn’t, but she can’t tell me when she last saw the doctor. I have to raise my voice to communicate with her, but I can’t quite get the soft tone I want. I hear annoyance in my own voice. Some patients just get on your nerves, and I am struggling to stay nice. I am trying to figure out why she – particularly her voice — is affecting me so. About halfway through the call, I remember her. I haven’t had her for quite awhile, but I have taken her in multiple times in the past. Her voice is like fingernails on a chalkboard. The whole trip is “my arm hurts,” “my back hurts,” “I’m going to throw up.” “I’m cold.” “I’m uncomfortable.” All the while I’m trying to do my ALS assessment, IV, O2, monitor, and also write my report, clean the back and radio to the hospital. On routine calls with 15 minute transport times, I like to hit the hospital if I can with the back cleaned up, my gear in order and the run form mostly written, including billing and signature, but I fumble through this one. Reaching for the emesis basin. Repositioning her. Turning the heat up. Repeating myself every time I speak because she says “What?” I know I have been nicer to her in the past. I’ve been able to contain myself, not had to struggle this hard. “I’ve taken you in before,” I say. “Yes, you have. I remember you,” she says. “You have chronic pain, don’t you?” “What?” “You pretty much hurt all the time, don’t you!” “Yes,” she says. When we get to the hospital, I tuck my unfinished run form on the back of the stretcher, and then, after too much hesitation, get another blanket on her and wrap a towel around her head, giving her the Mother Theresa look. I finally earn a deserved or not “thank you” from her. I guess at least I can claim I hid my annoyance from her. But then again, she has dementia, and probably can’t detect it anyway or maybe she does detect it. “I used to live in a big house,” she says when I say goodbye to her. “Back when we had money.” Maybe she thinks if I know she has been rich once I would have treated her nicer. Or maybe she is just feeling sorry for herself. Either way, it makes me feel bad about what life does to people. In addition to working on unrustying my call skills, I have to get my empathy back into shape. Its hard to do the job long without it. Here’s an old post about her. Hurt
