You three were absolutely wrong

Code 3 for abdominal pain. At the skilled nursing facility. Which is approximately 1000 feet from the ambulance entrance of the nearest ED.

Fucking kill me.

The fire crew and the 911 ambulance crew arrive at the same time, just slightly behind a private BLS ambulance crew, already unloading an empty gurney.

I think I know where this is going.

“Which room?”

“Uh, I don’t know. We didn’t call you.”

The staff politely insists that 911 was not called. But they ask around anyway.

After a few moments, “Sir, this way. Room 45.”

“OK. Thanks.”

It’s a few turns and a few hallways down. Guess who’s in front of us?

The private BLS ambulance crew.

“What room are you guys going to?”

“Room 45.”

Two nurses are in the room, and a staff supervisor arrives, noticing that there are just a few too many people responding to a patient who essentially just needs a ride.

“So who called 911?”

“I did.”

A woman in her 30s speaks up. She appears confused and near tears.

“They told me they called for an ambulance and it was going to be 20 minutes, so I called 911.”


“My grandma can’t wait 20 minutes! She’s in pain!”

Her grandmother is sitting in a wheelchair in the room, not in any apparent distress. She’s had abdominal pain for more than a day.

Perhaps sensing everyone’s dismay for the completely unnecessary, (wo)man-made, duplicate response, the younger woman who called 911 starts crying, “I’m sorry! I don’t want to get anyone in trouble!”

Why she thinks any of us would get in trouble is beyond me. Really, she should be asking if we fine people for this shit.

(Of course we don’t. EMS agencies have no spine.)

Perhaps because of the tears, the fire captain and the staff supervisor begin to console her, “It’s OK. You did the right thing. If it was my grandmother, I wouldn’t want her to wait either.”



The entire point of the private BLS ambulance is to run these very transfers from SNFs to hospitals. The SNF did what every oversight agency would LOVE for facilities to do but usually don’t – CALL AN APPROPRIATE PRIVATE BLS AMBULANCE TO TRANSFER THE PATIENT AND NOT A 911 AMBULANCE. The patient is obviously not in extremis. The ED is 1000 feet away. She could have wheeled her grandmother over there. The private BLS ambulance gave an ETA of 20 minutes, which is a perfectly reasonable response time for a private BLS ambulance, AND THEY ARRIVED BEFORE THE 911 CREWS ANYWAY!

This is exactly the time to say to her, “Yes, you absolutely should be sorry. You were impatient and did not want to wait. You called a 911 ambulance when a private ambulance was requested. You were being selfish and you are hogging scarce resources, scarce resources that other people in this city may need. You absolutely did not do the right thing. If it was my grandmother, I’d take the time to comfort her while waiting for the private ambulance instead of spending it tying up an emergency line talking to a stranger on the phone.”

But nooo, that wouldn’t be good customer service.

We don’t really care what your name is*

Code 2 for sick person.

An elderly woman with dementia is bed-bound, unable to provide information. Her adult daughter called because she had a fever.

“What’s her first name?”


“Hi Alicia, how are you doing?”

She turns her head but doesn’t say anything.

Some time later I’m inspecting her medications. The bottles don’t say “Alicia.” They say “Lydia.”

“Ma’am, what did you say your mother’s name was?”

“Her name? It’s Lydia.”


“So who’s Alicia?”

“I’m Alicia.”

“I see. I wasn’t asking for your name, you know…”

*At least not until someone needs to contact next-of-kin

Funniest thing I heard #4

“Keep your government hands off my Medicare!”

The difference between being helpful and just plain nosy

Code 3 for fall. On a bus.

As usual, there is never anything serious involving the words “fall” and “bus.”

Call notes:



This Mandarin-speaking woman keeps apologizing to me in broken English, saying she’s fine. She shows me some minor abrasions on her arm. She just wants to be on her way but the first bus driver called 911 and apparently refused to let her board.

And then a second bus driver called 911 again. He also apparently refused to let her board. Since she’s clearly not obviously injured, he must have heard about this via his bus radio. This bus agency sure has some great training.

As if that wasn’t enough, all the helpful nosy civilians at the bus stop keep pointing out to me that she also scraped her knee, including one man who actually interrupts me to point to her knee.

“She said she’s fine,” staring him down as he figures out my back-the-fuck-off look.

“I guess everyone here thinks a scrape is a huge deal.”

I ask her to show me her knee and, of course, just like her arm, it’s fine.

Thanks to all involved, she just spent nearly 20 minutes on a response no one needed to go on, and she missed at least 2 buses.

The next bus arrives, and, thoroughly embarrassed by all the unsolicited attention, she scurries onto it before anyone else unnecessarily prolongs her day.

On a personal note, some time ago I was walking to the grocery store on a day off, and I came across an old woman who tripped. I asked her if she was OK like a fucking sociable human being and helped her to her feet after she answered in the affirmative. I then watched for a few seconds to verify that she could walk steadily. I did not call 911.

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?”




“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.

Does everything have to be difficult?

Code 3 for the fall.

An “escape artist” from the neighborhood old people care home has done it again. But he didn’t make it far before falling down.

“What’s your name?”


“What’s your last name?”

“I don’t want to talk to you.”

“Well, can I have your last name?”

“The hospital’s got all that information.”

“Yeah, but they still need your name to actually get that information.”





“<Insert last name>.”

“Thank you.”


Diapered for a reason

We’re dropping off an older man with chronic diarrhea at the ED. He’s not bedridden, but he wears a hospital gown at home and is diapered. His assigned nurse enters the room, and right away I can tell she’s squirrely. She is wearing normal scrubs.

“Before he gets in bed, can you guys change his gown and take his diaper off?”

Considering the diarrhea, that seems to be a rather strange request at this point in time. His diaper doesn’t smell, doesn’t seem to be overflowing, and there is no commode in the room.

“Are you sure? The diaper keeps the mess contained. Do you have a fresh diaper?”

“Everything off, please.”

Changing patients at the hospital is not my job, but if the staff is cool, I have no problem helping them. This time, it’s not that I want to help this particular nurse, and I have absolutely no obligation to, but I feel bad for the patient.

So the patient is standing next to his bed, holding onto the railing. We change his gown, and pull his diaper off.

“Ohh, I have to go…”

Of course, right after the diaper comes off. A small amount of watery diarrhea hits the floor with a splat. It doesn’t really faze us. We’ve seen and smelled so much worse.

But it apparently fazes the nurse, who disappears in a flash from the room.

We set some towels down and wipe the poop off the man’s legs.

A couple of minutes later, someone walks briskly into the room looking like this:


Carrying towels, a huge stack of chux and a commode, this person goes, dead serious, “You know, norovirus is going around.”

It’s our nurse.

“Yeah, I know. That’s every winter.”

She covers the hospital bed from top to bottom with chux.

It’s a little late for that.