We all have our “regular” patients, don’t we? I’m not referring to our regular diabetic wake-ups, or the guy who is working on his twenty-seventh stent, or the COPDer who can’t breath again because her power chair in kinking her 50-foot long industrial nasal cannula. No, I’m referring to the regular patients we don’t care for.
They usually stink, frequently are incontinent, and their emergent requests usually coincide with the weather or meal times.
My zone has at least half a dozen of these “regulars.” They call us, sometimes multiple times per day, and have a steady, somewhat predictable pattern of hospital preference.
I took one to a local hospital once because he was hungry and wanted a sandwich.
Most providers are mean to these people. EMS, fire, police, nurses, doctors, hospital security staff, and even custodians are mean to them.
“Oh, god. It’s you again? Go sit out front.” is what I usually hear when wheeling them in to the ER.
Sure, they are a pain in the ass. They tie up the system with their nonexistent complaints. They waste resources. In my system, if you call, you go to the hospital. Unless of course, you don’t want to.
That’s just how we do it where I work. And I’m okay with that.
So what’s the harm in being nice to the regulars?
I make it a point to be overly nice to them. Slimm says I exhaust my “nice tank” on them, and have to have a soda to refill it. I don’t like them, but I sure can fake it pretty well.
I’ve gotten to know several regulars, and they can (usually) remember me by name (if they are sober enough). They tell me stories about their families that don’t want anything to do with them. They tell me they quit drinking yesterday though their gin breath. They sometimes ask me if they can smoke before we go inside the hospital, and I usually let them. They point out their good veins for the students, and gladly give themselves up, like a live IV arm, for practice.
Sometimes I ask what their complaint is, but usually not. Their complaint doesn’t matter. They just want someone to sit with them for a short while, and to be nice to them. I am happy to make their day, even if it’s at the expense of my “nice tank.”
Sure, I hate running the call just as much as the next guy, and I know these people are simply a tax on our system. But, as a wise mentor once said: “you’re gonna run the call, so just shut up and run it well.”
They are people too, just like the old ladies that just want their hand held.
Many of us empty our nice tanks more than we’d like. But for some patients, we are all they have.
Several years ago when I first became an EMT, I worked for an agency who frequently picked up a guy in a less-then-desirable neighborhood. For the sake of the story and HIPAA, we’ll call him Frank. Whenever we went to “visit” him, he was always intoxicated/high on something. He was always dirty. He was always incontinent. The local PD would find him under the same highway overpass, every night, same time, like clockwork. Many of my fellow providers, like you describe, were anything but pleasant to him.
One night at the hospital, I was discussing Frank with one of the social workers. It turns out, the social worker I was speaking with was working at the hospital on the night Frank’s family was brough into the ED. Frank’s wife and 2 young daughters died a tragic death when their home caught fire and were unable to escape. Subsequently, Frank pretty much lost all of his sanity.
After learning of the horror that he experienced, many of us took a different approach to a guy who, of no fault of his own, simply needed people in his life.
As the saying goes: Be kind, for everyone is fighting some kind of battle.
Excellent post.
Amazing story. That’s a good learning experience for the new EMSer.
We won’t learn anything about Frank if we don’t ask him.
Thanks for the story.
Sometimes I find it helpful to imagine what it’s like to be in their situation.
But mostly, I just try to remember that it’s our job to be nice.
I cannot agree with you more. I am a Field Training Officer and I recently had one of these patients you speak of. My trainee was being short with the patient and critical of their lifestyle. I am the type of paramedic that will notice the obvious elephant in the room, make a treatment decision, and go looking for the zebra that most will bypass.
His actions were immediately corrected and the issue was discussed after the call.
When these people make it to the ER, most of them are given their “sandwich” and are forgotten about. Sometimes people, we are the only medical care they receive and at times they are some of our sickest patients (zebra in the room). So I believe its only morally and ethically necessary to treat them just like any other patient.
Thanks for the awesome article.
Thanks for the encouragement. I have a high regard for FTOs. It’s a tough job to be able do right.
Excellent column. When I was a brand new EMT, which was quite a long time ago, we went to a nursing home to take a patient to a medical appointment at a hospital quite some distance from the nursing home. Across the city that is – all the way across – and around here there’s a lot of city. This particular facility was not known for being the best place for people to be.
As we were arriving at the patient’s hallway, we could hear someone screaming and crying out and somehow I just knew it was our patient – and I was right. Every time she was touched, she’d scream, and screamed when we moved her to the stretcher.
Well, being me, I was patient and kind, though rather “over” (as the kids say) the screaming. But rather than just transport her and fill out the paperwork, we began to talk. She was completely alert and conversant. The screaming came from pain – she had MS and it hurt for her to be manipulated. I really can’t imagine what it must be like to hurt every time you’re touched.
As we began to talk, I found out that she was 20 years younger than I thought – made to look older by the disease progression – and that she had been a professor of art at a major, major nationally reputed university. We had a wonderful talk, between her expressions of pain.
Thereafter, when I’d hear a dispatch to take her, I’d always jump in and offer to run the call. Naturally the other unit was very agreeable but my driver not so much. Still.. she and I shared a many hours of great conversation on artistic subjects.
It taught me to get underneath the surface of patients and see who you have. You may be surprised.
been reading your blog for a few months, but this is the first one I’ve had to comment on. I’ve never honestly understood why someone would be mean to a patient, even a regular PITA one. Yeah you’re going to see this all the time, and its generally for something stupid, but don’t be mean to them. They’re people too, and its like everyones said before me, you don’t know their past, at least not the full story.
One of my instructors gave us some advice before we started our ride alongs. “Be nice to your patients, even if they’re the PITA ones, and you’ll have those. You may never know whats going on with them beyond the call. And be nice to your precepts too, you never know when you’re going to be the one on the stretcher. And trust me, we’ll remember you.”