My friend Lilly

Lilly* has schizophrenia. As if that isn’t enough, she was also born early, to a cocaine-addicted mother, with hydrocephalus. She also has bi-polar disorder, diabetes, and is legally blind. Her growth was severely stunted by all of her problems, and even though she is in her mid thirties, she is barely 4 feet tall. Lilly’s mother and her crack-dealing boyfriends abused her as a child.

Lilly’s aunt “takes care” of her. What she actually does is provide a place for Lilly to live. Auntie tries, and she tries hard. But she can’t do it. Auntie says Lilly is family, and family takes care of family. Auntie makes sure Lilly gets all of her medications every day, and makes sure she is well-fed and clothed.

Auntie doesn’t have much. She lives on a paltry disability check she gets, and her son contributes some of his earnings he makes selling drugs in the neighborhood. I can’t imagine how they manage to eat, much less afford their home. Auntie inherited the home from her mother when she died a few years ago, and somehow makes the mortgage payment.

Lilly doesn’t want for love. Her cousin, her Auntie, their extended family, and even the neighbors all care about Lilly. But Lilly is sick.

Lilly has psychotic breaks about three times a week, and has been for several years. She throws things in the house, punches walls, scratches cars with keys, screams, swings at people, and does all the things to be expected.

She can’t help it.

So the police go to the scene to make sure she doesn’t physically hurt anyone, and to try to stop Lilly from causing more property damage. They don’t arrest her, because she doesn’t need to be arrested. They call for an ambulance, because she needs mental help, and there is no such thing as a mental health house call where Lilly is. The call for the ambulance invariably triggers a call for a fire crew in their engine.

But the loud noise from the engine makes Lilly agitated, and the crew doesn’t really know what to do. They just know they aren’t needed there, but they have to be there until we can get there.

So we show up, and we spend the next thirty minutes doing everything we can to talk Lilly down.

I like Lilly, and I would like to think she feels the same way about me. We have a routine: I kneel down and remove my sunglasses so we can make eye contact, I touch her shoulder and introduce myself, and she screams at me. I tell her that I am here to take her away from what is making her upset, so she can go talk to someone if she wants to, or so she can be alone for a little while.

Lilly always agrees. Sometimes it takes longer to talk with her, but she always agrees.

Then we take her to the hospital her Auntie chooses, since Auntie has power of attorney.

The hospital staff is incredibly nice to her. They all say hello, and they smile. They allow her to keep her clothes on, and they give her a soda and saltine crackers.

Sometimes, a physician will sign an involuntary hold order, and Lilly has to go to an inpatient center for several days. But that doesn’t fix the problem.

I really don’t know what Lilly needs. I think she needs a nursing home of some sort, or at least an assisted-living facility. But I don’t know how that would help.

I just know the current situation isn’t working.

Poor Lilly is a horrible victim of a horrible situation, and she can’t help it.

 

*Not her real name, of course.

Sunday again

We quickly realized it was Sunday, however, when we got the call for the “person who fainted” at a church.

Bystanders said the “victim” was “struck by the holy spirit during worship.”

Can you describe the assailant? Should we get PD out here?

This lady is laying on the floor, not speaking. She follows commands, though. Stroke assessment is normal. Blood glucose is normal. Vital signs are better than mine. She’s hyperventilating, of course. She’s just not talking. Maybe something is wrong with her.

And maybe Kim Jong Un is serious.

She gets snapped out of her pseudocatatonic state when some random woman starts yelling at her, snapping her fingers in her face.

“BY THE BLOOD OF JESUS I COMMAND YOU TO SPEAK!”

So the entire ride to the hospital she continues to say “Blood of Jesus, blood of Jesus.”

For twenty minutes.

An hour later, after the attention she was seeking had subsided, she walked out of the hospital.

 

The fine line between personal and professional

I can appreciate concern for another coworker’s well-being, I really can. Bad stuff happens to the good guys.

And it is a nice gesture to offer an ear to listen or a shoulder to lean on or a cold beer to drink followed by the other two. But demanding someone talk to your ear or lean on your shoulder or drink your beer is going a little too far.

People deal with their own demons in their own way.

There is a fine line between being concerned and being to nosy. When someone tells you that their private life is none of your business, they probably mean it. When someone can continue doing their job like they always have, without their private lives impacting their work, then the offer of the ear, shoulder, or beer is enough

We can’t demand that people talk to us about their problems. All we can do is offer to listen.

Should we transport suicidal patients?

I don’t know about where everyone else works, but here, we transport lots and lots of psychiatric patients. Some of the patients will be in any system; those who are noncompliant with their medications, or those who have psychotic breaks. It happens, and like I’ve blogged before, it isn’t the patient’s fault they have this disease.

But this time of year has an increase of patients who are “suicidal.” A typical one would be a girl who was just dumped by her boyfriend who says she is “going to hurt herself” if they don’t get back together. The ex-boyfriend gets all concerned (and nothing is wrong with that), calls 911, and 911 sends an ambulance, a fire truck, and a police car to the ex-girlfriend’s house.

The ambulance and the fire truck park several blocks away, and wait for the police officers to “clear” the scene, making sure it is safe for EMS to enter. More times than not, they send the fire department back in service, saying they only need EMS to transport.

So when we arrive on scene, the officer gives us the story, and the ex-girlfriend corroborates the story, saying she only said she was going to hurt herself to try to get back with her ex-boyfriend. Like that would help.

Then the cop tells the lady she has to go to the hospital. “Why?” she asks. “Because you might be a danger to yourself or someone else.”

Stop right there.

If the 911 dispatcher thought this individual might be enough of a danger to herself or someone else to send a police officer, and the police officer comes out in plain English and says that the individual is a danger to herself or others, why is EMS tasked with transporting the individual?

What is a hospital going to do for this person, except punt her to a psychiatric hospital, when likely all she needs is a psychiatrist, and maybe some antidepressants? What would a transfer and an involuntary hold do to this person? Would your job be okay with it if you just up and missed 4 or 5 days from work? Would they be okay with you telling them that you were placed in a psychiatric hospital for several days against your will? Would your coworkers judge you or talk bad behind your back?

Mental health is a serious issue, and we should do better for these people, instead of potentially ruining their already perceived ruined life.

They can’t help it

Often, we are presented with patients who have a mental status that is frequently described as “altered.” Mental status can be altered for a myriad of reasons, but the point remains the same. They can’t help it.

Patients with mental disease, schizophrenia for example, have a chemical imbalance in their brain. Their brain does not work like it should. These patients will take medications in an effort to correct, or control theses imbalances, which can help them function better in society. Oftentimes, the schizophrenic patient will take their medications, and feel better, and mistakenly stop taking their medications, thinking they have been ‘cured,’ but the underlying problem of a chemical imbalance is still there. They can’t help it.

Patients with dementia, or Alzheimer’s have a different problem. These patients lose functional brain capacity, or their cognitive ability They actually lose brain matter. These patients are, for the most part, pleasantly confused in my experience. Medications can be administered to these patients that can slow the progression of the disease, but it can’t be reversed. Dementia will eventually progress to the point that the patient is essentially an infant again, requiring everything to be done for him or her. Sometimes, patients with dementia can be aggressive, or combative. Mostly because they are unaware of their surroundings, and unable to process events like you and I. They can’t help it.

Intoxicated patients can be under the influence of any sort of drug. Alcohol being the one most of us think about when we hear the word “intoxicated.” Alcohol impairs cognitive function in the brain, and lowers inhibitions, which probably has a large part to do with it’s popularity on college campuses. While the amount of alcohol consumed may be largely the responsibility of the patient, the patient, at some point, is not in control of themselves. They can’t help it.

Patients who present with hypoglycemia, whether diabetic or not, may at times appear intoxicated. We have easy diagnostic tools to detect hypoglycemia though. Hypoglycemic patients have a low serum blood sugar, which is the ‘fuel’ needed by the brain to function correctly. If the brain doesn’t get enough fuel, it stops working correctly. These patients can present with all sorts of mental status changes, from the incredibly physically strong, to the classic ‘white out’ symptoms, and everything in between. We can fix this problem relatively easy. We start an IV and give some dextrose, or squeeze some oral glucose between their gums and cheek if they have a gag reflex, or we stab them in a large muscle and inject some glucagon. I’ve never met a hypoglycemic patient that wasn’t apologetic for ‘getting that way.’ But it’s okay, I tell them. They can’t help it.

Addicts also have chemical, and maybe structural, changes in the brain. The urge to ‘get that fix’ may override the basic need for food, shelter, water, or any other necessity. Addicts will, and do, use any means necessary to procure their drug of choice. Rats have been known to choose heroin or cocaine over food, to the point of starving themselves to death. People have been known to get so high on drugs, that they kill themselves through exertion. Addicts are wired differently in their brain. They can’t help it.

When we are called to these patients, for whatever reason, our duty to the patient does not change just because they have an altered mentation. Sometimes, we have to strongly coerce patients towards an ambulance, or transport to the hospital. Sometimes, we are forced to physically restrain patients to protect not only ourselves, but bystanders, and even the patients themselves. When we have to restrain a patient, for whatever reason, it’s important to remember why we are restraining, and to make sure we do it safely. After all, we can help it.

These patients don’t mean to fight. They would be horrified to see their behavior on video when their mental status was altered. We have to remember that they can’t help it.

Arguing with patients is pointless, especially when you aren’t arguing with someone who has all of their faculties. Yelling at a patient means you are losing control of a situation. Threatening a patient with an altered mental status means you have lost control of the situation, as well as your emotions. Someone else should probably take over at that point.

You can control yourself, and your actions. The patient can’t. They can’t help it.

The patient relies on you to help them.

Good conversation

“Medic Four, respond to a psychiatric patient off his medications.”

“Yeah, okay.”

This call sounds easy enough. He is either nice crazy, or mean crazy. If he’s mean crazy, the nice man in the Crown Victoria will take him to the hospital.

I enjoy taking care of the psychiatric patients. They are the few that cannot help their situation. It’s not their fault they have mental disorders. I rarely have seen a mean psychiatric patient.

I like to think I’m pretty good at talking them down.

Officer McHugearms waves us up the driveway to the house, which is actually more like a halfway house as opposed to a private residence. There are 5 or 6 people who live in this house.

It turns out our patient is a new resident here, after being placed in this home about 3 weeks ago. Interestingly enough, he has been without his Depakote, Risperdal, and Seroquel for the same amount of time. He’s nice, but probably needs to be medicated. We have interesting conversation on the way to the hospital.

“I don’t like to fight. I”m scared to fight.”

“I don’t like to fight either. I’m a lover, not a fighter.”

“I’m a lover too.” He says. “I masturbate a lot. I like to look at the Maxim magazine.”

“Oh, yes. Pretty girls are in those magazines.”

“They are pretty. I like to look at them and masturbate. I have a mat on the floor because the lady has carpet, and I don’t want to mess up the carpet, so I got a mat.”

“So, how about those Packers?”

Good talk.

 

 

EMS Emmy Nominations

We really should give awards to some of these people. These alleged “patients” as we usually refer to them. I like to reserve the term “patient” for someone who is actually ill, or injured, or generally needs something other than a swift kick in the ass and a Kleenex.

Lots of people that wind up in the back of my ambulance could use a swift kick in their ass.

Some recent nominations:

        • The 15-year old who developed a “headache” prior to an exam in school, and suddenly was unable to see. But she saw well enough to text her friends on her iPhone. And had the nerve to ask for my wifi password.

        • The middle-aged guy having “seizures” who, when asked “Are you having a seizure” responded “Ye-e-e-e-e-e-e-s-ssss.” “Just tell me when it’s over.” “Ok-k-k-k-k-k-ayyyyyyy.”

        • The twit who “fainted” during an argument with his wife. And continued to play “unconscious” on the way to the hospital, except for looking around when he was being ignored. (Give him a “C” for effort.)

        • “My neck hurts really bad. He hit me from behind really hard.” Says the woman involved in a motor vehicle collision. In a parking lot. At a stop sign. With no damage.

        • The 20-something guy with tattos and track marks with “kidney stone” pain, who says the only thing that makes his pain better is “that ‘D’ medicine, I don’t remember the name.” “Do you mean “Dontcareatall?”

        • The mother that insisted the ambulance take her child to the hospital for a splinter in her teenage son’s foot, and wouldn’t let me remove it. Even though I had tweezers, and the kid wanted it taken out instead. “It might get infected, and they will probably keep him at the hospital. Yeah, keep him for 10 minutes, until they remove that tiny piece of wood.

        • Any patient with an anxiety attack.

        • Any patient who needs a medication refill. (Do I look like a pharmacy?)

        • The women who suddenly go into labor at 36 weeks, with contractions 10 minutes apart, especially when they tell their baby-daddy to follow the ambulance. Seriously, you’ve been pregnant for 36 fucking weeks, you have had plenty of time to arrange a ride to the hospital. This shouldn’t be a surprise.

These are just a few. There are many, many more. I’m sure those of you in this business could add to this list.

And some wonder why I don’t like people…

I still don’t like people

It’s been 5 weeks since I began taking the magic pills the omniscient psychiatrist prescribed me after a 45 minute conversation. Granted, my original post regarding my general disdain for people was only a week ago, but blogging doesn’t always happen in real-time.

The impetus for my visit to this psychiatrist was a particularly bad call, with an outcome none of us on scene could have prevented. It was one of those once-a-career calls, and I am glad to have it behind me. I am a better person, and a better paramedic because of what I see and do at work. And me being a better paramedic affords me the ability to take better care of my patients.

 

As I have mentioned before, I really do enjoy taking care of my patients. I get an immense amount of satisfaction out of meeting a person in their time of need (however rare that might actually be), when they are counting on me to make them feel better. I enjoy the ‘thank you’ that I get after I make someone feel better.

Plus, emergency room nurses are hot.

It wasn’t my idea to visit this doctor of the mind. It was at the suggestion of a good friend, a non-EMS friend, with whom I talk about some of my work. I don’t use him as therapy, mind you, but he is interested in my work. We were in the middle of a golf game not too long after the aforementioned call, when he asked why I was more quiet than usual. I mentioned that this call was weighing on my mind, and he suggested I see a psychiatrist he knows, and even offered to pay for the session. 

Really, I went because I’m a cheapskate. And a free hour away from a toddler? Sign me up!

Anyway, I digress.

After 45 minutes of a conversation in a very well-appointed office, fancypants lady doctor “diagnosed” me with post-traumatic-stress-disorder and an avoidant personality disorder. She didn’t get the hint when I asked her which she thought came first, the dislike of people, or the traumatic stressor.

She was all to enthusiastic to write me a prescription for Paxil, but I was none too eager to take it. Take it I did, and I wound up filling the prescription a few days later. The brand-name. I don’t do generics. Except golf balls on par threes with a long carry over water.

I digress again.

So about a week after filling the prescription, I began taking the pills as prescribed. 20 mg of Paxil in the morning. I usually take it with my Mountain Dew. I read through all the indications and side effects, and while I certainly don’t think I meet any of the indications, I don’t have a fancypants diploma hanging on my wall. Nor do I have a well-appointed office. My office is sparsely furnished.

I have noticed mild changes since beginning Paxil, but none of it positive. None too negative, either. Since several readers were curious to know about my sex life, no, there have been no sexual side effects, and my sex life is fantastic. I haven’t gained any weight. Well, not that I know of. I haven’t stepped on a scale in years. But my pants still fit the same, and I haven’t had to buy any new belts.

What I have noticed is almost a ‘numbing’ sensation. I find that I am more likely to interact in large groups, which may mean it is helping with my borderline anxiety with large groups of people. While I am more likely to be with groups, my creativity and desire to try new things is dulled. I’m also more somnolent, which helps, because I really enjoy sleeping.

I still don’t think there is anything wrong with me. I simply don’t like people. I prefer to be alone, or with a very select people. I enjoy golf because it’s an individual sport, and I can be by myself for 4 hours without being bothered by others. I am simply an introvert. And that’s okay with me.

I still don’t like people. i don’t think pills are going to change that.

I don’t like people

I don’t like people. True story.

Sure, I like taking care of people, but, as a whole, I don’t like people. Mostly the issue lies with dealing with the utter bullshit people pull. Sure, there are exceptions to the rule, but they are just that: exceptions. Generally, I like my colleagues and coworkers, and enjoy working with them. But out of uniform, I don’t like them. I like meeting new colleagues, and enjoy hearing their ideas. But, if it’s not EMS related, I tend not to care.

Don’t get me wrong, I don’t wish ill on anyone, or want anyone to get injured. But those genuinely ill or injured people are getting fewer and further between. Maybe it’s the years upon years of pretending to take “complaints” of neck pain from a parking-lot fender bender seriously, or maybe is burnout, I don’t know.

I would much rather spend a day at home, alone, than with others. I certainly wouldn’t consider myself a loner, or recluse though. I have friends, mind you, but they are a very small group. 2 of my roughly 10 friends aren’t involved in public safety. And I don’t see them often enough. But at the same time, I see them plenty enough.

It got to the point that a loved one suggest I see a psychiatrist, so I did. Nice enough lady with the fancy diplomas on her wall. She said I exhibited signs of an “avoidant personality disorder.”

“What’s wrong with not liking people?”

“It’s not normal. It’s not supposed to be like that. You should like, and want to be around, people.”

“Why?”

Then she spewed some crap about “normal” relationships, and prescribed me some magic pills that were supposed to make me happy. Even though I’m not unhappy. I told her I wouldn’t fill the prescription, and that she was wasting paper and ink, but she wrote it anyway.

Maybe it’s burnout, maybe I’m tired of putting up with the stupid crap that people do. Maybe it’s normal, and nobody else out there wants to admit it.  Maybe, just maybe, I should fill that script for the magic pills, and see if they make me a better person.

Have you seen this cat?

Missing: Approximately 12 year old, 11 pound, Siamese male cat.  Answers to “Buttercup” or “Lorenzo”

Buttercup’s owner is currently admitted to local hospital, and cat may be lost and in need of assistance.

Use caution when approaching the cat, as he is known to be very neurotic at times, especially when separated from his neurotic owner for extended periods of time.  When communicating with Buttercup, it is best to use an inside, high pitched, baby-talk voice.  It is very important that you explain every single movement to Buttercup, lest he suffer a feline psychotic break.

Buttercup may be in need of medical attention, and has been known to crave antifreeze when left home alone without his owner.

If found, Buttercup is easily soothed by large numbers of QVC boxes, bolts of fabric, and Peter Popoff marathons.

He might just need a normal owner.