Denial is not really an emotion in and of itself. It is a result. It is a reflex. It is a weakness. And it is selfish. If there is anything that is going to drive me away from EMS and medical care in general, it will be denial. I am sick of it. Sick of it up to here. Picture me standing on my tip toes with my hand extended far above my head.

Case in point: A couple of years ago one of my neighbors came to my house in a panic. When I opened the door she frantically asked, “You’re a paramedic aren’t you? Come quick! I think the man across the street is having a stroke!”

I followed her to an older couple that lives across the street. They were both sitting on the porch. She was smoking a cigarette and rocking back and forth in her rocker just like she has done for years. The husband wasn’t looking well though. He was slumped over to one side with an obvious facial droop. He was breathing adequately, but was unable to speak or move. Upon first glance it was obvious that he was having a stroke. If he wasn’t then something else horrible was happening to him and he needed immediate medical attention.

“Oh my,” I said, “yes he is definitely having a stroke. We need to get him to the hospital quickly.” I pulled my cell phone out of my pocket and started calling 911.

“Well how do you know he is having a stroke?” his wife asked suspiciously.

“Ma’am, look at him. You know this isn’t normal. That’s why you sent your neighbor to come get me. The same thing that scared her into getting me is the same reason why he needs to go to the hospital.”

“I understand that, but how do you KNOW he is having a stroke? He might not be.” She continued to rock and smoke like nothing had happened. “Maybe we should wait awhile and see if he gets better.”

“No offense ma’am, but I have been a paramedic for 15 years. That’s why your other neighbor came to get me. You all have asked for my opinion, and here it is: he is having a stroke and this could kill him. The answer is ‘no I do not KNOW he is having a stroke.’ But I do know that there is a high probability that he is having a stroke and if you don’t act quickly he will most likely suffer irreversible brain damage or death. So to cover our bases, let’s just go to the hospital and have a CT scan.”

“Yes…but you don’t KNOW he is having a stroke. I think we should wait to see if he gets better.”

This kind of idiocy gets my blood boiling. As I said, if anything drives me from this industry, it will be this. This and the fact that this behavior is tolerated and even to some extent encouraged. I’ll explain that a bit later in this post, but for now let’s go back to the story. I decided to drop the big one.

“Ma’am, no offense, but what you are saying makes no sense at all. He is over 65 years old, and he is insured by Medicare. So being worried about a bill would be one thing, but you really don’t have that excuse. Medicare will pay for his treatment, the CT scan, and the ambulance that will take him there. There is a hospital less than a mile away that is capable of reversing this condition and saving his brain. You are suspecting he is having a stroke just as much as I am or you wouldn’t have sent your neighbor to come get me. The problem is that I did not give you the answer you wanted to hear. You wanted to hear that he will be alright and this will all go away. That is not the case. He is sick, and his life is in danger. If you don’t act quickly he will either die or be permanently disabled. There are about 100 reasons to take him to the hospital, and absolutely no reason not to. Other than the fact that you are scared and acting irrationally. Your inability to act is hurting your husband, and it may kill him. I have already called EMS, and they will take him to the hospital.”

“Well you SAY that…but how do you really KNOW?” She was now rocking back and forth in her chair at a faster pace with a creepy smile on her face like she knew something I did not. She also continued to smoke like a freight train. For a moment I thought maybe there was something really wrong with her and she perhaps wanted her husband dead. But then I remembered what I do for a living and how many people I have seen act in exactly the same way. Nope, she’s just bone stupid. And slow. And selfish. And creepy.

“Ma’am, you asked me for my help, and I called 911. If you care about him at all you will stop acting like a fool and let EMS take him to the hospital. You are being ridiculous. I’ll be across the street if you need me.”

And I walked away. Just like that. When I am being paid to work on an ambulance I am made to deal with idiots like this, but I was going to be damned if I was going to engage in another circular argument with a creepy selfish idiot in my off time. A few minutes later EMS arrived. She must have given them the business too because they were on scene for almost an hour. The hospital is literally thirty seconds away, and it took the crew an hour and a supervisor coming on scene to get the poor guy off the porch. Upon arrival he was diagnosed with a stroke and treated. He survived that incident, but had a long stay in the ICU. Soon after coming home he had another vascular event and died from it. To this day my neighbor won’t talk to me. Why? Because all of this was somehow my fault, of course.

But this isn’t limited to the patients and the families of patients. This kind of stupidity has crept into the minds of providers as well. If you haven’t noticed, I feel very strongly about this subject and want to rant like a sun gone supernova. Consequently I would like to stay away from real work cases so that there isn’t a record of me talking about a patient or a family member like a knuckle dragging idiot. The neighbors are okay. None of them have a computer or even know what a blog is. I could give them my laptop, the url, and an hour and they would still never read this. (But if they did, their lips would be moving.) So let’s describe another situation I had with my vet almost 20 years ago.

When I was in my early 20’s the family cat had what appeared to be a seizure and a stroke. (Notice a theme yet?) I talked to my parents about what to do, and as usual, yours truly was ‘volunteered’ to take the animal to the vet. My parents are the kings of denial, by the way. Just the other day, someone from Webster’s came by my parents’ house to take a picture of my dad for the ‘denial’ entry in their dictionary. I asked what they wanted done about the cat. They had no answer. They just shoved a credit card in my hand and pointed me towards the door. Even before I was medically trained, I was always the cool rational one of the family.

So I took our sputtering, drooling, sad little 18 year old house cat to the vet. He asked me what had happened, and I said that I witnessed something that looked like a seizure and since then the cat has been very disoriented, unable to walk, and appears to be favoring one side. She growled, hissed, and carried on as if she was in pain and at times she would labor to breathe. He examined her, and stood her up trying to get her to walk. She just crumbled to the table in a pile. For a moment she looked like she stopped breathing. Then she sputtered, coughed, barfed all over the table and began to carry on as she had been for the last few hours.

“So, is it a stroke?” I asked.

“Most likely, yes,” he said looking concerned.

“That’s pretty bad isn’t it? I mean, there’s no hope for a cure, isn’t that correct?” I asked.

“Unfortunately, that is the case.”

“Okay, well I suppose it would be best to put her to sleep. How much will that cost?”

“Well, hang on a second,” his words hung in the air while his eyes looked upwards. He spent some time searching for the right words. When he found them his voice was soft and overly soothing. “These matters are very complicated. Many of our owners wish to take their pets home with them.”

The cat started howling again. She flailed sideways, unable to gain traction on the formica counter and slipped striking her head against the table. I cupped a hand around her head and tried to steady her. “I’m not really sure what you are getting at,” I said, “are you saying there is a chance she might get better?”

“Unfortunately no, but still, there are other factors to consider when making this decision.” He spoke cryptically and in circles.

“Look, I don’t want you to think I am a cold pet owner or something, but this animal is having seizures, laboring to breathe, peeing and defecating on her self, and howling as if in pain. If there is no hope of improving her condition, then why on earth would I want to take her home?”

“Some pet owners wish to spend some more time with their pets before making this decision,” he paused cryptically again, “as I said these things are complicated.”

“So are you suggesting that I take the animal home?”

“If you wish.”

“Okay, forgive me but I am getting a bit frustrated here. The animal has no hope of recovery, correct?”

“That’s correct, yes,” he said slowly.

“And it is obvious that the animal is suffering, correct?”

“Well, suffering is a relative thing,” he said thoughtfully, “we can’t really know what the animal is feeling. We also have to take your feelings into account as well.”

“Alright. Look, I am specifically asking for your medical opinion. When you answer this question, I would like you not to take my feelings into account at all. The only factor you should take into account when answering this question is the well being of the animal. Because she is the one who is sick and suffering. Not me. So, in your medical opinion, should this animal be put down?”

“Well, it’s not as easy as all that. You see…”

“Oh Christ, put this cat down before I walk out of here and find another vet who CAN answer a simple question.”

A few minutes later, the best possible outcome for the cat was reached. He gave me a box to take home, and I had to deal with more oddness and double speak from my parents. I wound up burying the thing by myself in the side yard. My mother was very disappointed in the outcome of my trip to the vet. I explained to her that it was really the best thing for the cat. She started crying and accused me of being cold.

“No,” I said looking at my mother, “cold is keeping a suffering animal alive because you don’t have the emotional strength to do what you know you have to do. What I did was understanding and compassionate. Of all people, I would think that someone who grew up on a farm would understand that.”

Yep. That went over well. Notice that my parents do not speak to me anymore. This is because I confronted my father about his denying that his behaviors are going to lead to the amputation of his legs. I was being concerned. I was speaking the truth. And so now they don’t talk to me. And my father’s legs look like doughy, scaly tree trucks weeping yellow fluid. Natural selection taking place before my very eyes.

So what do we do about this? If you have been in EMS for any length of time, you must have run a call like this. Oddly enough, they seem to occur with the most clear cut calls which are heart attacks and strokes. If someone has the sniffles they won’t think twice about calling a quarter million dollars worth of government owned equipment to their house at three in the morning so their family can drive to the hospital right behind you in their perfectly functional car. But when they have chest pain radiating down the left arm with nausea, diaphoresis, and palpitations they will wait for hours to call 911, refuse treatment when you arrive, and try to sue you for abandonment afterwards.

But wait…I have the solution. No one wants to hear it. But I have the answer. In order for this master plan to take effect, we would have to make me the new Emperor of the Known Universe. With that as my title, blood would run in the streets for weeks, but I assure you, after the carnage the trains would run on time and natural selection would be allowed to take place. So now, hear ye, hear ye…Buck the Emperor of the Known Universe shall make his first decrees.

 1. No religion shall be recognized by the state. Sorry…ahem…the Empire. So all you Christian Scientists out there who won’t take your kids to the ER when they break something…sorry, a charge of neglect for you.

2. The only person allowed to refuse care is the patient. No exceptions. So, if you would like to take part in the natural selection process, then go ahead. Other family members and care givers will not be allowed to refuse care for a person that cannot give consent themselves. Period. The end. Emperor Buckman has spoken.

3. Emperor Buckman will also decree that all nursing home patients who are a ward of the state shall be evaluated for orientation and quality of life and we shall come up with a criteria to make those patient’s DNR’s when appropriate. Call it a Death Panel if you wish. It has a nice ring to it.

4. Also, all nursing home patients who are wards of the state shall be registered organ donors by default. Human recycling is a good thing.

5. All unconscious or incapacitated people shall be treated for their illnesses and injuries under implied consent. All family members who try to interfere with this care for any reason (except legal DNR’s which are encouraged) will be detained by the police and charged with endangerment and obstruction of an emergency crew. They shall be beaten in front of the EMS crew for their amusement before they leave seen. Then the offender will be sentenced to community service taking care of nursing home patients with the same diagnosis that they were refusing to have us treat. So my neighbor would be sentenced to 500 hours of ass wiping and drool cup changing in the stroke ward of the local nursing home.

6. All EMS crews shall wear microphones and recording devices (like many police departments currently do) and all patient refusals shall be recorded. If the EMS crew says, “The symptoms that you are exhibiting may be a deadly disease which may lead to permanent disability or even death. It is my recommendation that you come with us to the hospital,” and the patient still refuses, the patient will be held accountable for his or her actions. If they later try to sue the EMS crew for abandonment they shall be beaten in front of that EMS crew for their amusement and mine.

And that’s how we will roll in ‘Buckman’s Totalitarian Regime O’ Common Fucking Sense.’ Denial shall not be tolerated.

 However, after I wake up from that dream, I am left with the ridiculous world that we live in. A world where the most irrational person on scene with the least amount of medical knowledge is allowed to make ill-informed and even harmful medical decisions about people who cannot speak for themselves. And yes, we have the right to transport people under implied consent. And that stupid family member may actually be charged with something in the future…but you know as well as I do that this never happens. Meanwhile, someone who is having a stroke or a heart attack and is loosing brain cells or muscle by the second languish while we entertain the ignorant ramblings of the one person on scene who is too mentally close to the event to make a rational decision.

Meanwhile we allow stupid family members to scream and physically threaten us because their 96 year old great grandmother riddled with Alzheimer’s and cancer is not doing so well with this fifteenth bout of pneumonia and we offered to discuss withdrawing care. Have you ever had that pleasure? Have you ever called security to deal with a cro-magnon retard family member like this? They just sit and watch them go off. Occasionally they will say, “Sir, would you please calm down?” They don’t ever beat them with maglights and thrown them down the back stairwell like I so nicely suggested.

Yep. Denial. That’s what will make me quit. That is the straw that will break the camel’s back. It’s just a matter of time.