Tuesday, December 24, 2013

Don't Lie - A Public Service Announcement

I recently came across this YouTube video:

This is utterly stunning that someone would make a video like this. As a public service, I will tell you that it will not work. If you come into the ER with a non life threatening condition, then you may have to wait. Life is difficult sometimes, suck it up and put you big kid panties on.

As an example, I had this one patient come in complaining of chest pain. We are a certified chest pain center, so he was immediately taken back and the "million dollar" work up began. He asked about his other complaint, but it was a minor one (it was the real reason he wanted to go to the ER). He was told in no uncertain terms that it would not be addressed since the chest pain is a major concern and it would take precedence over anything else. Epic fail on his part. He confided in me later and told me his doctor told him to complain of chest pain so he wouldn't have to wait. I was flabbergasted. What doctor would tell a patient that? I got the name of the doctor and told the patient that I hope he realized that the chest pain complaint would now be in his medical record, that the confession would be part of his chart and that he would be financially responsible for the whole work up. He said he didn't know. I informed the ER doc who, upon hearing the new discovery, shrugged and said he will call this doctor about his poor advice and the patient will only be seen for his initial complaint - he could go to his doctor or an urgent care clinic for his minor symptom.

So take this patient's hard knock lesson - don't pretend to complain of something you don't have to get into the ER faster. You may get harmed if we give you medications for the complaint thinking it is legitimate, you will be financially responsible for what we do, your deceit will be charted in your records, and you probably will not have your original complaint addressed. The other more important reason, you took nurses and doctors away from someone else who was truly experiencing something serious.

Friday, December 20, 2013

The Christmas Card

I wait patiently this time of year for a certain person to send me a Christmas card.

Over ten years ago, when I was working as a firefighter/paramedic, I went on a CPR call. This was the most unusual CPR I've ever worked. The patient was found awake with defibrillator pads on his chest that were placed by a bystander who was a nurse. She saw my confusion and said that she had shocked him several times and performed CPR - he would "wake up" after each shock.
My partner and I quickly did a 12 lead ECG. It wasn't pretty.

We rushed him into the back of the ambulance while the patient told me what happened. He said he knew  when "it" was coming and then wouldn't remember anything, feel extreme pain and then wake up.
As we were throwing a quick IV into him, the patient quietly said, "Uh oh, here it goes again."
His face turned bright red and he coded. We shocked him and immediately afterwards he yelled, "AAAAAARGHH - don't DO THAT AGAIN!!!"

Our eyes were as big as saucers - I've never experienced that before. During the ambulance ride, he coded a few times more and each time, waking up yelling and then apologizing to me for being rude.

"AAARRGH, you did it again."
"Well, you did it again. Stop doing that!"
He laughed, but I could see the fear in his eyes.
"We're going to get through this. We're almost at the hospital. Just stay with me, okay?"
"Okay." And he held my hand.

Later, we were told by the cardiologist that he had what's called "the widowmaker", a 99% occlusion of the left anterior descending coronary artery, more than 90% of people with this type of occlusion die.
The patient and his family visited our fire station about 2 months later and thanked my partner and me for saving his life. It was a very nice gesture since most of the time, we never get to find out what happens to the patient after they leave our care in EMS.

Since that year, every Christmas, my patient and I exchange Christmas cards. I look forward to hear from him every year. I have never done this with a patient before our meeting or since. There was something special about this patient and we bonded during that unfortunate call.
I received my card the other day and my special patient is enjoying another year with his family and grandchildren. His card reminds me that what I do matters to people and sometimes I need that to recenter myself.
I needed that reminder this year and I thank God for him still being in my life.

Monday, December 2, 2013


I haven't been motivated to write lately, especially after a certain shift that left me, well ....empty.
We had three codes that day. The first 2 were run of the mill, "it was just your time" type of code blue. This probably sounds horrible to non medical people, but it's a fact. I question the family's knowledge and decision when they want grandpa 'saved' at all costs regardless of the quality of life he will endure after the code. It's sad.
The last code was a pediatric one due to an accident at the house. Due to the nature of the circumstances, there was never any hope that the child would be resuscitated, but we tried. We tried everything we could think of to save that kid. All efforts were futile. The other nurse and I prepared the body for the parents to come into the room while the doctor went to talk with them. I was okay until I heard the unearthly wailing of both parents. I don't think I can truly describe the sound. I lost my composure and escaped into the break room bathroom and cried for a few minutes. I've never cried at work before. Once I got myself together, I had tons of paperwork to do and was interrupted occasionally because I had to cover my ears due to the wailing. I couldn't even finish everything that needed to be done because other patients, the ones that had such minor reasons, medical problems that should have been seen in a doctor's office or a clinic, continued to come out to complain about the wait or that they wanted food. I tried to explain that there had been several critical patients that tied up the doctor's time and they would be seen soon. They didn't like that or didn't care, one actually had the audacity to tell me that they were critical too. I looked at the reason for his visit - a complaint that he has had for over a year. I had three dead people in nearby rooms and this guy was giving me a hard time. I lost my capacity to tolerate stupid people for the rest of the day and counted the hours to go home.
I keep thinking about that mother, hoping she doesn't blame herself for her child's death. I can't even imagine going through that experience. I went home that night and hugged my children for a very, very long time.
My daughter noticed and asked, "Did you have a stressful day at work today, Mommy?"
"Yes baby, I did."