Part of the job

Code 3 for intoxicated subject.

The cops have a very dirty young man sitting on the curb, handcuffed. He is drunk, and he is being a total asshat. He keeps asking why he is being detained. For a moment, he looked homeless.

“This guy was sitting in front of a stranger’s apartment, completely naked, covered in shit. We somehow got him to put his clothes back on.”

Two of the 3 cops are not wearing gloves.

You guys actually touched him? My god.”

He is probably not homeless. He looks like just another college student who didn’t know when to stop. It’s just that the poo caked all over his feet and hands are kind of dried up in the way we only see in homeless people and neglected old people.

It is so gross that we actually bag his hands and feet.

“I’m sorry,” I offer my partner.

“It’s part of the job,” he maturely replies.

Then it hit me. IT IS SO NOT PART OF THE JOB! And it absolutely does not have to be. How is it that people’s unbelievably bad behavior is just par for the course? When did it become just another day when some asshole spits blood in our direction? Why have I not ever ended up pressing charges against combative drugged-up scumbags we are forced to fight when they get squirrely?

Just complain and don’t do anything

I read a couple of items about anti-frequent flyer programs and community paramedics the other day. Now, just like any other new idea, of course there is no shortage of resistance.

There was some discussion that centered on concern that the Fresno, California program would lead to some repeat caller who is legitimately sick with serious chronic conditions (like repeat episodes of hypoglycemia or COPD exacerbation) being denied care or transport. I don’t buy that at all. I may sound all grumpy and dismissive on this blog, but I can tell you even the most cynical medic doesn’t think 911 abuse when s/he finds an actual sick person. Even if it’s the same person. Besides, Fresno blacklisted only 8 people in 3 years. Sounds pretty careful and judicious to me.

Now let’s look at the California Nurses Association. They – surprise, surprise – oppose community paramedics, claiming safety concerns because paramedics are too stupid to do it and people are going to be dying left and right as a result. Listen, California Nurses Association, I have met many of your folks, and while most are competent RNs, many are forever complaining about why paramedics are bringing patients to the ED and generally failing to display any sort of sense. The irony is fucking delicious that you oppose the concept of trying to reduce 911 calls and ED visits. Like any profession, you have your share of idiots too, especially in such non-ED settings as Not My Patient Skilled Nursing Facilities and everyday clinics (and this McDonald’s). That’s not even including all your visiting and hospice and advice and school and jail and dialysis nurses who call us for the absolute dumbest fucking bullshit.

And what have YOU done all these years to reduce repeat 911 callers and repeat ED visits other than give people such shitty discharge instructions as “call 911 if you don’t instantly feel better” and “come back when you need your band-aid changed”?

Saddest thing I’ve seen in a while

Code 3 for stroke.

An elderly man is supine on a bed. His family is there, and they’re the historians since the man is baseline non-verbal but clearly has as good an understanding of his surroundings as anyone. They say they called because he was “weak” and unable to sit up.

It’s quickly obvious that he isn’t moving his right arm or right leg.

“Does he usually move his right arm and leg?”

“Yes.”

“Fully?”

“Yes.”

“So when did he stop moving that side?”

“Yesterday morning.”

I don’t even bother asking why they didn’t call 20 hours earlier. It’s not like their answer, in the unlikely event that it isn’t “I don’t know,” regarding this at-one-point-potentially-reversible devastating disability is going to make anyone happy anyway.

One by one, I ask him to move each extremity. When we get to his right leg, everything appears motionless as he tries and fails, and when he realizes this, he then lifts his right leg off the bed with his left foot.

It is almost surreal.  Definitely poignant.

You should wear a helmet but you don’t have a brain anyway

Code 3 for fall.

So there’s a ladder on the ground. Looks like some guy fell off of the ladder.

Apparently, this person thought it a good idea to rest his ladder against a rolling metal gate, the type commonly found in driveways, while he was doing some work high off the ground. rollinggateObviously, when a car triggers the sensor, the gate opens.

Except this guy’s ladder was resting against the gate. So, as the gate opened, the ladder fell, and he fell with it.

Normally, this would be the end of the story. This guy, however, insists that people were “messing with” him by opening the gate.

“Dude, just let it go.”

What’s his name?

“I’ve just been calling him ‘Sir’ the whole time.”

I’m not ashamed to admit it, as explained in this article, for our purposes, names are kind of pointless.

It doesn’t change how I fix a patient’s so-called emergency. (My brain is busy deciding how to fix the emergency.)

It doesn’t change what the emergency it is. (My brain is busy determining what the emergency is.)

It doesn’t change how nice or not nice I am. (My brain is busy processing which to be based on how nice or not nice the patient is.)

My brain is otherwise occupied.

She’s still pretending to be dead

Echo for unconscious, not breathing.

“M12, your patient is now breathing.”

In other words, she was never not breathing.

A Spanish-speaking woman in her 60s is lying on the floor with pillows under her head. Looks like a duck, swims like a duck…

Her family – and there are a lot of them – says that there was a “heated” discussion before the woman sat on the couch and stopped talking.

“We got scared and thought she wasn’t breathing.”

I can see why the American Heart Association stopped asking people to check breathing. Apparently no one knows what breathing looks like even though everyone knows how to breathe.

The woman is still feigning unresponsiveness. I’m completely over it. Check that – I was over it when the “now breathing” update came earlier.

“What hospital?” I lazily ask.

“Does she need to go to the hospital?”

There is no question that sets me off more in these situations – you know, dumbshit psych/anxiety/drama calls that seem to always involve chest pain/shortness of breath/unresponsiveness. Obviously she doesn’t need the fucking hospital. But, (a) she’s still pretending to be dead*, and (b) for such stupidity they should be inconvenienced a little. Besides, it’s not like they have such important matters as curing cancer to get back to. If someone is doing anything important, usually s/he doesn’t let some idiotic drama interrupt.

“You cannot call 911 and tell us someone’s dead so we drop everything to rush over here and then when we get here say everything’s fine and you don’t need to go to the hospital. This is not how it works.”

“We were just scared.”

“Well, she’s still pretending to be dead. So tell her to knock it off and get on the gurney!”

*I just love how even old people are so fucking immature

You call, we haul. Now get in the friggin' ambulance.

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