“I brought you in here to talk about a run.”  The Director had called me into his office.

“Shoot.”  I had nothing to hide.

“Well, a nursing home complained about you.  They said you asked too many questions.”

I was racking my brain to figure out who I had pissed off lately.  There were two or three candidates, but ‘too many questions’ wasn’t ringing any bells.  “Do you have the chart handy?”

“No.”

“Oh. Okay. Kinda weird to call me in here to talk about a complaint and not have the run handy isn’t it?  Do you remember what the run was about?”

“I haven’t read it.  All I know is that the Director of Nursing was hotter than hell and called in chewing ass.  I had to have marketing go over and smooth it out.  It almost cost us a contract.”  He was staring at me trying to be stern.

“You actually called me in here to give me the business about a run and you haven’t even read the chart?  Why don’t you go get it?  Let’s see where this takes us.”

“I hadn’t planned on reading the chart.”

I sat up in my chair a bit.  This was getting ridiculous. “Please. Go get the chart.  This conversation is going no where if I don’t even know which run we are talking about.”

He exhaled long and slow to let me know that he was exasperated with me.  Then he got up and went to the billing room to get a copy of the run.  I cooled my heels and played with the tchotchkes on his desk until he came back.

“Found it,” he said, producing the document. “See if this helps.”

*               *               *

We had been called to a nursing home the week before to pick up a patient who was completely unconscious.  We arrived to find the RN meeting us at the door.  This never happens and it always makes me suspicious.

“He won’t respond to anything,” she told me as we walked.  “He has snoring respirations.  He is also abusive to staff, so be careful.”

I thought that last comment was odd.  “Well, if he is unconscious, I shouldn’t have to worry about that, should I?”

“I’m just saying, is all.  He has given our staff a pretty bad time.”

We got to the room to find a man in his 70’s fully clothed and sleeping soundly on top of the bedspread.  And I used the word ‘sleeping’ for a reason.  I have been doing this long enough to tell the difference between unconscious and asleep.  This guy didn’t have snoring respirations.  He was simply snoring.  I wish I could sleep that good.  He was taking one hell of a nap.

His son was in the room and looking tense.  I said hello to him and went to his father’s side.  I have given up on sternal rubs long ago.  They don’t get you anywhere and are fraught with controversy.  I picked up his hand and squeezed and gave it a few slaps to see if that would bring him around.  Years of being smacked upside the head have brought me to this technique.  If they are lightly sleeping and I startle them, I already have hold of the hand that can slap me.  Saves time and wear on the scalp.  But my first attempt didn’t produce any signs of consciousness.  So it was time for stage two.

I leaned in and pried the patient’s eyelid open.  If a patient will let you pry their eyelid open without announcing yourself, and you can shine a light in there without them flinching, chances are they are fairly unconscious.  You have also just checked their pupils which you were about to do anyway.  For patient’s who are probably faking it I like to get my finger wet and swirl the inside of their ear without warning.  Yes, you heard that right.  I give fakers a Wet Willy.  It is not invasive.  It does not cause pain.  And yet no one can take it.  And I mean no one.  I have a 100% success rate on exposing fakers with the Wet Willy.  That’s a freebee.  You’re welcome.

But there was no need for a Wet Willy here.  The patient’s pupils were pinpoint.  He was just high as a kite off narcotics and was sleeping it off.  A pulse ox of 99% on room air told me he was in no immediate danger so I decided to ask a few questions.

“Excuse me, is he on any new medications?”

The son whipped his head around and the nurse immediately went on the defensive.  “Why would you say that?” she asked just a little too loudly.

“Well, this is pretty common.  His pupils are pinpoint.  I was just wondering if they prescribed him something new for pain and perhaps it was a bit too much for him and it made him go night-night.  It wouldn’t be the first time.”  I was really not surprised.  This does happen all the time.

The son suddenly looked very interested in what I had to say.  He came over and asked me to show him what I was seeing.

“I don’t know what you’re talking about.  He isn’t on any new meds.  He is unconscious and you better get him to the hospital quick!”

“Okay.”  I was sensing an uncomfortable dynamic here, so I wanted to just cut my losses and take off.  “We’re on our way.”

But the son chimed in.  “What can you guys do for a narcotic overdose if that’s what it is?”

“Oh it’s very simple to fix,” I offered innocently.  “There is a medicine that counteracts narcotics instantly.  It’s called narcan, and if we are wrong there is no harm done.  There are no side effects to the drug.  It won’t hurt to give it a shot.”

“I think you just better get him to the hospital.  I am telling you he hasn’t had any narcotics!”

Yep. There was tension.

“Okay, we are outta here.”

When we got to the back of the truck, the son was close behind.  He was asking a whole barrage of questions on the way outside.  It was pretty obvious that he was having second thoughts about the place and we were the first objective opinion he had access to in quite some time.

“Are you guys going to give him this drug?”

“Yes sir.  Like I said, there are no side effects.  It’s a freebee.  If it works, it works.  If it doesn’t we haven’t hurt him, so there is no reason not to give it a shot.”

“I want to watch if you don’t mind.”

I usually wasn’t comfortable having family members hang out in the back of my ambulance while I played with needles, but I was feeling sorry for this guy, so I agreed.  Before long I had an IV set up.  I drew up the medicine and injected it.

“How long does it take to work?” the son asked.

“Goddamnit!  I’m gonna punch you!”  His dad came up off the cot like a jack-in-the-box.

“About that long,” I replied.

He came up swinging, but we held his hand and said a few nice words.  In about thirty seconds we had made friends and he had calmed down.  Once he saw his son he was easy to deal with.  But I have to admit, the nurse was right.  He was the cantankerous sort.  He had quite a few choice words for us.  But I was fairly certain we could get him to the hospital without further incident.

The son was dumbfounded though.  “So let me get this straight.  The fact that you pushed that medicine, and it worked, means that there were narcotics in his system?”

“That may not be absolutely one hundred percent true, but yes sir, 999 times out of 1000 that will be the case.”

His stare got forceful and his jaw clinched.  “That’s all I need to know, gentleman.  Thanks for your help.  I will follow you guys to the ER now.”

Triage at this suburban hospital is known for delays and wait time.  I don’t think they have ever found me a bed in less than 30 minutes.  The son stood next to me the whole time.  I was his hero now.  I had proved that I knew what I was doing and that I was a straight shooter and the deluge of questions began.  I feel for these guys.  I really do.  It must be maddening to place a loved one in a nursing home and not know if they are safe.  I tried to put my game face on and answer questions as neutrally as possible.  But the cat was out of the bag.  The nursing home sucked.  I knew what I was doing.  And he wasn’t letting me go until he got some answers.  He started to go through the entire med list with me.  We found his dad wearing a transdermal patch that wasn’t even listed in his medication record.

“What is this?” He asked pointing to the patch.

“That’s a new medication for Alzheimer’s.”

“What?  He doesn’t have Alzheimers!  Damnit, I am his power of attorney and I am taking this off!”  He removed the patch and wiped the residue off.  Things were getting worse with each question.

“Here, what about this one?”  He was pointing to the word seroquel.

I hesitated for a moment because I new this one was going to piss him off.

“Come on, man.  I know you know what this is.  Please tell me.”  He looked desperate.

“Well,” I paused, trying to figure a way to put it nicely.  There was no way to do it though, so I just went for broke.  “That’s for bipolar disorder and schizophrenia.”

“What!”  He looked like he was going to punch someone.

“Now hold on, sir.  To be honest, your dad looks like he can be a handful sometimes.  Am I right?  I don’t want to defend the nursing home, but just to be devil’s advocate there may be other uses for that drug of which I am unaware.  If it helps psych patient’s calm down, perhaps those same properties could help someone like your dad.  Here, let me look this one up on my phone.”

So I typed ‘seroquel’ into Google.  This first page returned was the official site for the drug.  “Here we go, sir.  Let me just read for a moment.”  I scrolled down and one of the first things I saw on the very front page of the site was the following quote:

Elderly patients with dementia-related psychosis (having lost touch with reality due to confusion and memory loss) treated with this type of medicine are at an increased risk of death, compared to placebo (sugar pill). Seroquel XR is not approved for treating these patients.

My face must have let him know what kind of hand I was holding.  Never play poker with the family member of a patient.  “Let me see it!” he pleaded.  I showed it to him.  “What the hell?  Death!?!  Those bastards!”

“Sir, I’m sorry.  It was not my intent to get you all riled up.  I’m just trying to get through this…”

“Oh no.  You have nothing to worry about.  And I don’t mean to take it out on you.”  He took my hand and shook it with meaning.  “I want to thank you.  I need to help my dad get out of this place, and you are the only one who has taken the time to help me through this.  Both my dad and I owe you a lot.”

“Well sir, I’m glad I could be of help.  I hope you finally find a place you’re satisfied with.”

*               *               *

“And that’s the story, boss.  Honest.”

“Well I don’t know what to think.  I had written you up, and I was about to have you sign this.”  The Director pulled out a form of reprimand that was already typed out and held it in the air.

“Whoa, lemme get this straight.  You wrote up that reprimand and was about to light up my employee file without even reading the chart or hearing my side of the story?  I bet you didn’t even expect me to defend myself.  You just wanted to stick it to me and send me on my way?”

Silence.

“Isn’t part of your job having your people’s back?”  I looked at him expectantly.

“Well,” he put the document down.  “I guess we can let it slide this time.  But if this becomes habitual I will be forced to suspend you.”

“For what?  Recognizing and treating an overdose, being a patient advocate, and exposing nursing home misfeasance?  Could you make sure that is typed on the reprimand when you slide it over for me to sign?  Before I get a few days off, I wanna make sure my daughter knows that her dad has trouble putting food in her mouth cause he was doing his job so goddamned well.”

“I wasn’t going to write you up for that.  As I said, the nursing home said that you asked too many questions.”

“So, I’m not allowed to get enough information to treat an overdose?  If I know that a nurse is taking the prescribed narcs of one patient and giving them to another, I can’t even ask if they have been taking any new meds?  Why don’t you tell me how I should have handled that.”

“That’s not my job.  My job is to keep contracts, and to keep you in line.  You have you’re warning.  We’re done.”

And he was right.  We were done.  I quit just a few weeks after that.  See this other series of posts to get that story.  Do you work for a service like this?  Do you have to suffer through inept management?  What are you going to do about it?