Code 3 for the unconscious at a pool at an aquatic club.
An 9-year-old boy is lying on an exam table in the first aid station, and he says he feels fine. He looks alright. He tells us that he swallowed some water during a lesson, and then he didn’t feel well. When he left the pool with a staff member he threw up some water, along with some breakfast. He’s not sure what happened next, but the staff member says the boy then collapsed onto the lawn right in front of him and had to be carried into the first aid station before he began to become responsive again.
Sounds pretty straightforward – just about any parent would agree to go to the ED with us in this situation. Or so I thought.
I realize, quickly, that his mother is the subservient type who can’t make a decision to save her life. Her son tells her he’s fine, so she says he’s fine.
“Yeah, well, everyone feels fine after they wake up. It’s the passing out we’re concerned about. People don’t just pass out for no reason. Strange things happen to kids at pools. If we were comfortable with you not going to the hospital, we wouldn’t stand around trying to convince you otherwise.”
Indeed, drownings, near-drownings, secondary drownings are very serious incidents. A few months ago, there was a much circulated story about a boy who drowned in bed hours after getting out of the pool on his own. My partner also mentions another similar incident around where he lived where a boy was found dead in bed after being brought home by his parents after swallowing some water at a pool.
“It’s OK. I’ll just take him home.”
I don’t think she understands much. She speaks English but not very fluently.
She ends up calling her husband, who doesn’t want him to go to the ED. I end up on the phone with him, and he questions me about everything that happened to his son, as if I was there to witness it. He also seems very intent on verifying that his son did not have a seizure, as if that was the only thing in the world that would cause a loss of consciousness. I relay to him what the staff told me and now he wants to talk to the staff, as if they’re lying about the event. People always say not to judge anyone, but in the 2 minutes that I was on the phone with him, I decide that this guy is a domineering creep who thinks he knows everything. It’s always interesting how people know your job better than you do. For instance, homeless people always know my job better than I do.
I apologize to the staff as I hand one of them the phone for the interrogation. After he talks to the staff on the phone, he speaks to his wife, who tells us that her husband just told her to bring the boy home.
“He said our son is fine.”
“How does he know? He’s not even here!”
“Will you at least drive him to the hospital yourself? We’d have no problem telling you that he doesn’t need to go to the hospital if that was the case.”
“I’ll just bring him home.”
Frankly I don’t really directly care what happens to this boy. It’s not my son. I’m not going to miss him if he dies. I’d like to think that his parents feel that they should do everything for him to ensure he’s happy and healthy, but people make stupid decisions all the time. That being said, indirectly, I care very much about what happens to this boy, and here’s why:
1. There’s more paperwork when we don’t transport than when we do.
2. I’m going to have to document the hell out of the parents’ refusal of transport. Why I have to write a bunch of stuff to protect myself when I’m not the one being stupid is a constant source of frustration, given the sheer amount of stupidity everywhere.
3. If anything bad happens to him, a lot of people – from the State to my supervisors AND everyone in between, family or not – are going to want to know why we didn’t take him to the hospital. And the explanation that his parents are stupid and decided – against professional advice/nagging – to not bring him to the ED just doesn’t seem enough. I suppose it’s difficult to tell the parents of a dead child that it is all their fault, even if it is in fact all their fault.
My partner goes outside to grab some paperwork. I turn around to call the base hospital.
“XXX Base. Dr. YYY. Contact time 12:45.”
“Hi, this is unit ZZZ with an AMA call.”
AMA stands for Against Medical Advice.
“Sounds like that’s all I’m doing this morning.”
“Sorry, doc. This is an 9-year-old boy who swallowed some water at a pool, said he didn’t feel well, and then vomited some water. After that he collapsed in front of the pool staffer that was with him and had to be carried into the first aid room. The staffer described a loss of consciousness. He’s alert and oriented now. His vitals are…”
He interrupts me.
“I will not in any way, shape, or form consent to this AMA. Take him to the ED, and get the cops if you need to. I’ll even talk to the cops if they have any questions. This kid needs to go to the hospital.”
“Yeah, the parents are adamant about not going. I’m kinda glad you said that.”
“Re-contact if you have any problems.”
“Thanks. Incident number is XXXXXXX and the pt’s last name is YYYYYYY.”
Great, now we have to break the news to them. The mother I can handle, but I just don’t want to talk to the father again, asshole that he is. Somehow my partner ends up with the phone with the father on the other line, trying to explain to him how the base physician is concerned enough about his son that he is ordering that we bring him to the ED no matter what, and how it would be easier for everyone if we just left the police out of it. He acquiesces, but of course not without a bunch of ranting and raving.
“The whole health care system is broken!”
“I’ve been all over the world and this country’s got the worst doctors!”
“Everyone is overreacting! This is so unnecessary!”
“What are your names?”
Anyway, we end up at the ED without much fuss, and the father shows up, ostensibly from work. He looks like an arrogant, overbearing jackass. And then he opens his mouth and confirms it as he starts talking down to the nurse.
“Is there a doctor that’s going to come see him? I think this whole thing is completely unnecessary, but in any event, I want to know about every test that’s going to be performed on him and why it’s being performed!”
There are a lot of paramedics who are so burned out that they really don’t give a shit. About anything. I’m not sure exactly how burned out I am, but I’d like to think that I’m responsible. I’d like to think that I have a healthy fear of being in trouble and losing my license. I’d like to think that when I’m on a call, people can rely on me to make sound decisions, medical or not.
In this case, my partner, with more than 20 years of solid experience, and I could have just turned around and walked away with a signed AMA form, without the headaches and the condescension. We could have been back at the station napping or watching TV or reading a book. The boy would probably have been fine afterwards anyway, but it wouldn’t have been completely impossible for him to have a negative outcome. This wasn’t a cut finger or a stubbed toe. We could’ve made his parents happy at the pool even if it meant grief for them later on. But I don’t work like that. My partner doesn’t work like that. And apparently the base physician doesn’t work like that either. Even though it’s not my child, and I don’t really care about him per se, I’m interested in being responsible, especially when his parents are being irresponsible and intransigent, and I see this as my job.
I’d like to think that people who call 911 know that they can rely on this simple fact, but after being abused constantly, many of us just don’t care anymore, and as a result make poor decisions, leading to negative outcomes. These parents are fortunate to have a crew that, despite the burnout, is trying to be responsible for them and trying to nudge them towards good medical decisions for their son, but they don’t realize that. This is nothing new; we’re surrounded by ingrates. This is just a big “fuck you” in different words. In many ways, these people are no different than the drunk homeless dipshit on his third ambulance ride of the day.