Stupidity and Boredom
"People just don't understand that about 99 per cent of this job is bullshit." When I was in paramedic school one of my fellow students uttered those words. And to this day I have not found a better description for the feeling that grips me occasionally.
I first picked her up on Thanksgiving night at around 11 pm. Her "home healthcare worker" was nervously on the phone talking to a 911 operator while the patient, a 71 year old woman sat in bed in no apparent distress.
"She can't breathe!" Amy Alarmist yells as she hangs up with 911.
I look at the patient and see that she is breathing just fine with a nasal canula in place. "Hi, hon, I'm Nick. What seems to be going on tonight?"
"She can't breathe," the woman says again.
"Can you step out for a minute please?" I ask the caregiver, getting a bit annoyed as the patient is obviously breathing. She's pink, shes warm, shes happy.
"No, take her blood pressure."
"Be quiet and let me do things my way. " She simmers down.
The woman on the bed tells me she has had Parkinson's for over 20 years, shakes wrack her body fairly regularly. She asks for more oxygen so a I put a non rebreather on her at 10lpm despite her O2 sat being at 99 on the canula. I ask the woman what she would like to do and she says she doesn't want to go to the hospital. When I move to take the non rebreather she tells me to leave it in place, she needs it.
"Then I have to take you to the hospital."
"Why?"
"Because I can't stay here all night and give you oxygen. "
She gets a bit pissy and asks "Why not? Shouldn't you be here to take care of me?"
I start to try and tell her that I cannot stay and then decide its better not to try and explain the inner workings of emergency service to an asshole.
We transport her to a different hospital than my fire service favors because the people at Concord Hospital are "not very nice and they don't take care of her there." the home healthcare woker states.
On the way into the hospital the woman refuses a 12 lead, tells me not to give her an IV and allows me to take only one blood pressure because "it is uncomfortable."
I saw her again yesterday at about three in the afternoon. The CNA from Hell was on the phone with 911 again, all up in arms because the patient was having trouble breathing. Dispatched at Delta level, the Lakes Region Fire Dispatch code that means an imminant life threat, the only higher is Echo and that means that life has stopped.
When I walk in the CNA tells me. "She can't breathe and her chest hurts. She devloped a rash two minutes ago."
I nod and ask the patient whats going on. She states that her Parkinson's is acting up and she doesn't want to go to the hospital. She tells me she's had the rash for two days. I do an assessment and find that all of her vitals are not only within normal limits but they are also in the healthy end of the spectrum. Her rash seems to be heat related as the room is close to 95 degrees and when we open the window she does a lot better. She vehemently refuses an ambulance ride stating that she will be at her doctor's the next day.
Her CNA demands to know what is different about the oxygen condenser on the floor and our oxygen bottles, telling us that if ours are better than we need to leave one. I repress the urge to tell her to fuck off and describe how both of them provide the same amount of oxygen while the patient signs a refusal.
Five hours later I am back in the woman's bedroom. The CNA, who apparently never leaves, is just hanging up with 911 tells me that the woman can't breathe. Again she is breathing just fine and states she doesn't want to go to the hospital. "Her chest hurts in here." The woman pushes on the patient's abdomen and the patient says "No it doesn't."
This time she's going to the hospital. I'm not playing the press three buttons and watch the circus show up game. She refuses to be carried down the stairs and insists we put her in her electric wheelchair which she promply destroys a section of the moulding of her wall with. After piloting the craft for five feet, she springs up and walks outside, sitting on our stretcher. She refuses IVs, 12 leads and won't let me do a blood pressure because it hurts.
Her CNA follows us to the hospital in the patient's van, driving with four way flashers going as we instructed her not to do. Again we have to go to a hospital well outside of our area because the "people at the other one don't do anything for me."
In an effort to find out just why I need to take this woman to the hospital I ask her what is going on and she states that she feels "Like my whole body is a board." When I aks her what that means she states she doesn't know and when I ask how long its been going on she tells me that she's felt like this for 20 years. I ask her why she called 911 and she tells me that the hospital won't help her and I shoudln't take her there.
Too late, we're about fifteen minutes away now.
She gets mad that I put the pulse ox monitor on her finger and takes it off, telling me to leave her alone that she doesn't even want to be here. When I ask her if there is anything I can do she tells me that she has no problems other than the Parkinson's and that she wants them to fix her medication. She asks me why I didn't just stay at her house and give her the "good oxygen that my caretaker (the asshole in the van) tells me is better than mine."
The caretaker is waiting at the hospital and follows us in. I pull the nurse aside and tell her the whole story. At some point a social worker will sort this whole mess out.
911 is set up for use by people with emergencies. But what constitutes an emergency is up for debate. Some people only call 911 if they are on death's door and even then they don't want to. I once went for a med call on a guy who had been sliced from naval to neck by a shard of glass, he worked as a glazer and had droped the piece he was trying to fit into a window pain, he ended up being LifeFlighted to Boston, from the scene, for extensive trauma surgery. He stated he was going to drive himself to the ER but his boss wouldn't let him-- the guy seemed annoyed that he wasn't allowed to drive himself. My dad cut his finger off and drove himself to the hospital where it was sewn back on.
Thats the glamorous part of my job that shows like Third Watch and Rescue 911 (old school but you know you love the "Shat") publicize. What they don't show you is that the vast majority of people who dial 911 do so because they are bored. Pushing buttons on your phone will magically make a group of people appear with red lights flashing and all sorts of interesting questions to entertain you for an hour or so. People with nothing better to do have made a habit out of dialing 911 and stating they have a horrendous complaint and in reality they are healthy enough not to need emergency care. But when they call for "help" a bunch of cool things happen, even their neighbors get in on it, coming out and poking around, standing around and watching, some even walk up in the house prompting me to ask "And who are you.....? What's your purpose.....?"
Then they are the stupid people. CNAs who call for non emergency non events go into that catagory. 911 stands as a great shining hope for anyone who can't figgure out how to turn off their TV (an actual three AM Charlie level call I was sent on for a person "with difficulties.") people who took a dump four hours ago and saw that it was blue, people who have an itchy tongue for three days and my personal favorite a patient who had her appendix out in 1975 and states that it hurts again.
Emergency service workers, myself included, love their jobs because they allow us to make a real and immediate difference in people's lives. And that's the draw to this line of work. Deep down all of us have ADD and being a teacher or a preacher or a social worker or whatever is just not immediate enough for us. I know that when I push D50 on a diabetic with a sugar reading LO on the gluc they will become concious again, when I open up an Inch and Three Quarter on a roaring stove fire, it'll knock it down. So the reason I do my job is that I like to fix things but society has too many problems that can't be fixed quickly. Stupidity and boredom leading to misuse of the emergency system is one of those problems that unfournately will not be fixed.
But despite the fact that 99 per cent of my job is bullshit, I have that one percent that makes it all worthwile. Like the chimney fire in Strafford that got me back into the red stuff after five years off of Holden. Theres very little better than crawling through a smokey house with your buddies on a hoseline and tearing the place apart in an effort to put out a fire. The smoke smell stays in your gear and when you've got that coat on at three am for a person who stubbed their toe, the smell registers in your mind and even through the annoyance at being woken up for nothing, you think "Eh, its not so bad."
I first picked her up on Thanksgiving night at around 11 pm. Her "home healthcare worker" was nervously on the phone talking to a 911 operator while the patient, a 71 year old woman sat in bed in no apparent distress.
"She can't breathe!" Amy Alarmist yells as she hangs up with 911.
I look at the patient and see that she is breathing just fine with a nasal canula in place. "Hi, hon, I'm Nick. What seems to be going on tonight?"
"She can't breathe," the woman says again.
"Can you step out for a minute please?" I ask the caregiver, getting a bit annoyed as the patient is obviously breathing. She's pink, shes warm, shes happy.
"No, take her blood pressure."
"Be quiet and let me do things my way. " She simmers down.
The woman on the bed tells me she has had Parkinson's for over 20 years, shakes wrack her body fairly regularly. She asks for more oxygen so a I put a non rebreather on her at 10lpm despite her O2 sat being at 99 on the canula. I ask the woman what she would like to do and she says she doesn't want to go to the hospital. When I move to take the non rebreather she tells me to leave it in place, she needs it.
"Then I have to take you to the hospital."
"Why?"
"Because I can't stay here all night and give you oxygen. "
She gets a bit pissy and asks "Why not? Shouldn't you be here to take care of me?"
I start to try and tell her that I cannot stay and then decide its better not to try and explain the inner workings of emergency service to an asshole.
We transport her to a different hospital than my fire service favors because the people at Concord Hospital are "not very nice and they don't take care of her there." the home healthcare woker states.
On the way into the hospital the woman refuses a 12 lead, tells me not to give her an IV and allows me to take only one blood pressure because "it is uncomfortable."
I saw her again yesterday at about three in the afternoon. The CNA from Hell was on the phone with 911 again, all up in arms because the patient was having trouble breathing. Dispatched at Delta level, the Lakes Region Fire Dispatch code that means an imminant life threat, the only higher is Echo and that means that life has stopped.
When I walk in the CNA tells me. "She can't breathe and her chest hurts. She devloped a rash two minutes ago."
I nod and ask the patient whats going on. She states that her Parkinson's is acting up and she doesn't want to go to the hospital. She tells me she's had the rash for two days. I do an assessment and find that all of her vitals are not only within normal limits but they are also in the healthy end of the spectrum. Her rash seems to be heat related as the room is close to 95 degrees and when we open the window she does a lot better. She vehemently refuses an ambulance ride stating that she will be at her doctor's the next day.
Her CNA demands to know what is different about the oxygen condenser on the floor and our oxygen bottles, telling us that if ours are better than we need to leave one. I repress the urge to tell her to fuck off and describe how both of them provide the same amount of oxygen while the patient signs a refusal.
Five hours later I am back in the woman's bedroom. The CNA, who apparently never leaves, is just hanging up with 911 tells me that the woman can't breathe. Again she is breathing just fine and states she doesn't want to go to the hospital. "Her chest hurts in here." The woman pushes on the patient's abdomen and the patient says "No it doesn't."
This time she's going to the hospital. I'm not playing the press three buttons and watch the circus show up game. She refuses to be carried down the stairs and insists we put her in her electric wheelchair which she promply destroys a section of the moulding of her wall with. After piloting the craft for five feet, she springs up and walks outside, sitting on our stretcher. She refuses IVs, 12 leads and won't let me do a blood pressure because it hurts.
Her CNA follows us to the hospital in the patient's van, driving with four way flashers going as we instructed her not to do. Again we have to go to a hospital well outside of our area because the "people at the other one don't do anything for me."
In an effort to find out just why I need to take this woman to the hospital I ask her what is going on and she states that she feels "Like my whole body is a board." When I aks her what that means she states she doesn't know and when I ask how long its been going on she tells me that she's felt like this for 20 years. I ask her why she called 911 and she tells me that the hospital won't help her and I shoudln't take her there.
Too late, we're about fifteen minutes away now.
She gets mad that I put the pulse ox monitor on her finger and takes it off, telling me to leave her alone that she doesn't even want to be here. When I ask her if there is anything I can do she tells me that she has no problems other than the Parkinson's and that she wants them to fix her medication. She asks me why I didn't just stay at her house and give her the "good oxygen that my caretaker (the asshole in the van) tells me is better than mine."
The caretaker is waiting at the hospital and follows us in. I pull the nurse aside and tell her the whole story. At some point a social worker will sort this whole mess out.
911 is set up for use by people with emergencies. But what constitutes an emergency is up for debate. Some people only call 911 if they are on death's door and even then they don't want to. I once went for a med call on a guy who had been sliced from naval to neck by a shard of glass, he worked as a glazer and had droped the piece he was trying to fit into a window pain, he ended up being LifeFlighted to Boston, from the scene, for extensive trauma surgery. He stated he was going to drive himself to the ER but his boss wouldn't let him-- the guy seemed annoyed that he wasn't allowed to drive himself. My dad cut his finger off and drove himself to the hospital where it was sewn back on.
Thats the glamorous part of my job that shows like Third Watch and Rescue 911 (old school but you know you love the "Shat") publicize. What they don't show you is that the vast majority of people who dial 911 do so because they are bored. Pushing buttons on your phone will magically make a group of people appear with red lights flashing and all sorts of interesting questions to entertain you for an hour or so. People with nothing better to do have made a habit out of dialing 911 and stating they have a horrendous complaint and in reality they are healthy enough not to need emergency care. But when they call for "help" a bunch of cool things happen, even their neighbors get in on it, coming out and poking around, standing around and watching, some even walk up in the house prompting me to ask "And who are you.....? What's your purpose.....?"
Then they are the stupid people. CNAs who call for non emergency non events go into that catagory. 911 stands as a great shining hope for anyone who can't figgure out how to turn off their TV (an actual three AM Charlie level call I was sent on for a person "with difficulties.") people who took a dump four hours ago and saw that it was blue, people who have an itchy tongue for three days and my personal favorite a patient who had her appendix out in 1975 and states that it hurts again.
Emergency service workers, myself included, love their jobs because they allow us to make a real and immediate difference in people's lives. And that's the draw to this line of work. Deep down all of us have ADD and being a teacher or a preacher or a social worker or whatever is just not immediate enough for us. I know that when I push D50 on a diabetic with a sugar reading LO on the gluc they will become concious again, when I open up an Inch and Three Quarter on a roaring stove fire, it'll knock it down. So the reason I do my job is that I like to fix things but society has too many problems that can't be fixed quickly. Stupidity and boredom leading to misuse of the emergency system is one of those problems that unfournately will not be fixed.
But despite the fact that 99 per cent of my job is bullshit, I have that one percent that makes it all worthwile. Like the chimney fire in Strafford that got me back into the red stuff after five years off of Holden. Theres very little better than crawling through a smokey house with your buddies on a hoseline and tearing the place apart in an effort to put out a fire. The smoke smell stays in your gear and when you've got that coat on at three am for a person who stubbed their toe, the smell registers in your mind and even through the annoyance at being woken up for nothing, you think "Eh, its not so bad."
posted by Nick Stabile at 12:14 PM
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