I Didnt Spend Six Years At Evil Medical School…

Thursday, February 17 2005

“As one of seven children, I was delighted to receive a bike for my birthday – until the other six kids each got a pony for theirs.”

No, this isn’t me, but as an analogy it works well. I decided for the last week or two, and continuing on, that I’ll no longer have my pager on when I’m not on duty. That way, I don’t get worked up about the calls I’ve missed. Works well. Reduces stress, I’ve found.

And we got five calls last duty! This effectively doubled the number of calls I’ve done so far in 2005. While all of the last batch of calls were medical (no traumas), and four were unremarkable, still, I have no cause whatsoever to complain. Either statistics, or the gods of EMS, are catching up to me, which is just fine.

Then, there was that fifth call…

I think most folks in EMS have some sort of self-image, a persona we adopt during patient care or an avatar we assume when arriving on-scene. Kindly, wise, gentle but firm in our dedication to providing care (“Yes, it’ll hurt, but you need this IV”), our personas do not necessarily reflect any aspect we may present to the world off-scene. “At home”, most EMS folk are a loud opinionated lot who laugh at fart jokes. Our dream TV station runs Southpark, ER, and Third Watch over and over.

It is my belief that such self-imagery is practiced by the medical side more than by the fire guys. Fire guys seem more to want to use axes to chop down non-burning stuff to get to burning stuff, which they then hose. If a non-burning person is in the way, they will firmly move them aside to continue with Plan A. I have not observed them to become Gentle or Kindly in the process. Fire waits for no man, I suppose.

We speak, however, of Bambulance Folk. Now, naturally, by assuming this persona your typical Bambulance Person will expect the patient to react in a certain way. It throws us when a patient reacts differently from our expectations, because sometimes these personas are all we have to control patients. Most of us pack another, spare persona – Stern Medical Professional – to fall back on in case the patient is, well, different.

It is not unheard of to be called out to a domestic disturbance because Husband is bleeding from where Wife walloped him upside his cheatin’ haidbone with his very own golf clubs. It helps to have Wife a little calmed down for The Nice Medics. Usually, domestics bring PD with them before we ever enter such a scene, but there are other situations.

Patients with low blood sugar, or drunks, or people on Bad Drugs. Combative from head injuries. Senility and dementia. New Mom freaking out because Baby Bunting went a-bouncing. We smile and soothe, they relax and cooperate. Good avatar.

When we smile and soothe and they do not relax and cooperate, it literally disarms us. Johnny Law may reach for the ‘cuffs, or place a meaningful hand on gun-butt; EMS folk can switch to Stern Medic, but that sometimes backfires as well. Mr. Drunk goes from uncooperative to “you wanna piece of me?” and there you are. Back up, back out, call for PD. The patient has called our bluff.

So that fifth call. Typical day in Trailer Virginia; 50 yoM possible seizures; caller is not at the residence. No further information. Lights and sirens, whee!

ATF a 50 yoM c/o intoxication; AOB; very uncooperative. No seizures. Patient was drinking heavily, got on the phone to a friend who became alarmed and called us. I have seen this call many times. As usual, the patient finally agrees to be transported to the ER for evaluation.

In my Mind’s Eye my avatar-self is being Kindly and Gentle, trying to get information from this patient. Smiling Benevolent Figure.

However, to the patient – who didn’t call us, remember, the friend did – I am Evil Incarnate, whisking him away to Fate Worse than Death. He agreed because he felt outnumbered by a Medic crew, a BLS crew, and an Engine crew.

I am Snidely Whiplash. I am every character ever played by Rutger Hauer. I am worse than Hitler. And so, I get no patient information, no medication list, no allergies, no history, no verbal response. I do get a teensy bit peeved and might just remember once thinking that a 14-gauge in a hand vein might do the patient some good, but cannot under our protocols start one as an EMT-B. Still, Snidely Whiplash Hauer Hitler is tempted.

I have yet to decide if my EMS Mental Toolbox needs space for more avatars, or if I should accept as fact that some folks just want to be left alone.

Anybody know?

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