To Tell the Truth

Saturday, March 19 2005

I have learned, in my short time in EMS, to listen to the patient – but never, ever to blindly believe them.

Because sometimes they can’t tell the truth…

As I was driving southwards one evening a pickup truck ran through an intersection in front of me, attempted to turn northbound, at speed, and instead rolled over a half dozen times. I called 911 and pulled off the road, then went over to the wreck. Still a civilian, this was many years ago.

The woman and her husband were both ejected. Husband was tossed farther, the woman had landed in brambles at the base of a railway embankment. Both conscious.

As I approached the woman her husband half-stumbled, half-crawled over to her. The most I could do at the time was cover the woman with my coat and try to keep the distraught man from moving her while we waited for EMS.

I asked them, “Was there anyone else in the car?” Both said, “No.” But it turns out they were going into shock and not thinking clearly – their 12-year old son was still in the car. As far as I know, they all made it, but still – I didn’t check the car because “there was nobody inside.”

Because sometimes they won’t tell the truth…

On the scene we can ask, “Do you have any medical history?”. “No.”

As we load the patient, we ask, “Ever been hospitalized for anything?” “No.”

En route we inquire, “Have you ever seen a doctor for anything serious?” “No.”

Arrived in the ER, we turn the patient over to the nurse and give our report.

The nurse will turn to the patient and say, “So, Mr. X, any medical history?”

“Why yes. I had a heart bypass operation last year – this was after a dual lung transplant – but before my hip replacement…”

The nurse will look at us as if to ask, “Why didn’t you mention this?”

We stare wide-eyed at the patient, pointing ineffectually and whispering “He never said that. We asked but he never, he didn’t…”

Briefly, the patient’s eyes flare red as he smiles, but the nurse doesn’t catch that either.

One of my instructors called it addonis tidbitis, defined as “The relevant information that the patient suddenly remembers only once he or she is discussing it with the ED physician, making you look like an ass”

And finally because sometimes they do tell the truth…

My patient was having a tough time. Every time his eyes uncrossed and focused on me, his head would drift forwards or back and I’d be out of focus again.

“Quantas cervezas?” I asked again. “How many beers?”

“Cuatro.”

“My friend, you have had more than four beers.”

“No, no, cuatro cervezas!”

“I’m not the police – I’m trying to help you. Any drugs, drogas?”

“No drogas”, he giggled.

“Cuatro cervezas, eh? Cuan grande, how big?”

His smile slowly grew wider, and wider. Held his hands waaay apart. “Cuarenta!” he shouted, and laughed as he fell back onto the bench seat. Four forty-ounce beers.

Okay, that I believe.

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