My wife is not my number one fan.  But she probably is my number one critic.  I take her comments very seriously though.  She is probably the best proof reader I could hope know, much less be married too.  She was a paramedic for a few years, but did not take to the profession as well as I did.  (What am I saying?  I never took to it well either.  Let’s just say I stayed in it longer than she did.)  She has read my most recent blog posts and has relayed a couple of stories to me that I just have to pass on to you.  These are fantastic examples of patient and family stupidity that are indicative of the things of which we are forced to be tolerant and understanding.  Tolerant and understanding to a fault.

In the late 90’s she had just graduated paramedic school, and was performing her ride time with the Dallas Fire Department.  Dallas Fire ran almost 40 ambulances with double paramedic crews at that time.  It was common to make over 20 calls in a shift and get no sleep.  One of the calls she ran was for a possible choking.  She arrived on scene to find an adult woman with her father.  The daughter stated that she had swallowed a piece of beef that seemed to get stuck in her throat, and she thought she was choking.  I will say that again.  She stated that she thought she was choking.

Obviously, she was not choking.  My wife was friendly and respectful when she tried to explain that if she could talk, then there could be no way that she was choking.  She then tried to explain how food can sometimes get lodged in the esophagus and become extremely uncomfortable.  She started telling the patient that there was no danger to the airway, but the object (in this case a piece of bread) can be dislodged by drinking some water, or in extreme cases, the ER can administer glucagon to help relax the throat muscles.

But the father became angry.  “This is ridiculous,” he shouted, “she is obviously choking and you need to do something!”

“Daddy!” cried the daughter, “I think you need to do the Heimlick maneuver!”

He then proceeded to walk over to his daughter, get behind her, and started to do abdominal thrusts while she cried out in pain.

“Wait!” shouted my wife, “Stop!  Think about this.  She can talk.  She can breathe.  She hasn’t passed out.  Please listen to me, there is no need for this.  Let’s talk a minute.”

“You obviously don’t know what you’re doing!” exclaimed the father who continued to thrust his tightened fist into his daughter’s abdomen.

My wife tried to tell them that if this procedure was done for no reason that there was a chance that the patient’s organs could be injured.  It is basically the equivalent to punching her in the stomach repeatedly.  But they wouldn’t listen.  He kept doing it while she was coaching him at the top of her lungs.  Airway clear.  Voice bellowing.

And of course nothing was dislodged.  They just stopped for no reason, somehow having reached some threshold where they had become satisfied with their efforts.  My wife’s warnings and protests were ignored.

After this my wife was completely shocked to find her preceptor chewing her out.

“You can’t go around telling patient’s things like that!”

“Like what?  Like performing abdominal thrusts can be harmful if there is no reason to do them?”

“Yes.  And that drinking water can dislodge bread.  It is not your place to go around telling patients that what they are doing is wrong.”

“But it was,” pleaded my wife, “There was no benefit at all to doing that, and I can think of about a half a dozen reasons off the top of my head why that would be harmful.  Are we just supposed to stand around and let patients do harmful things without out ever trying to intervene?”

Her preceptor was unwavering.  Actually, her preceptor was completely nuts, and she had to have several conversations with the officers in the fire house about her behavior.  But this is what she was told.  And this is the message that several other students took home as well.

My wife ran another call when she was a student on an infant whose grandmother was convinced that she had died.  It was dispatched as an infant who was completely unresponsive.  She arrived to find a cooing baby sitting in her grandmother’s lap.

“So what happened here?” asked my wife.

“I was feeding her a bottle,” explained the grandmother, “when she stopped breathing and threw up.”

“So…” my wife paused, dumbfounded, “You were feeding her, she threw up, she’s fine now, and you called an ambulance?”

“Well she stopped breathing!  I had to do CPR on her!”

“Whoa, wait a second.  Are you trained in CPR?  Have you ever had the class?”

“No,” stated the grandmother, “But I know what I’m doing!  I had to help her!  I saved her life!”

“Ma’am, it is very unlikely that this child had some sort of deadly condition that was completely cured by a round of CPR.  If she had some sort of condition that led to her death, she would still be sick, wouldn’t she?  Look at her.  She looks fine.  You may have jumped the gun here and done chest compressions for no reason.”

“Oh please,” explained the grandmother, “I know what I am doing.  I have had to do this twice before.”

“Okay…” said my wife, “Could you explain the other two instances to me.”

“They were similar to this.”

“Did you go to the hospital both times?  What did the doctor say?”

“Well,” paused the grandmother, “we only went to the hospital once.”

“Wait, let me get this straight.  You thought that your granddaughter actually died, and you believe that you had done CPR and brought her back to life, and you didn’t go to the hospital to get treatment?  You actually believe that your daughter had an illness or a disease process that killed her, and you did not seek treatment?”

The grandmother became sheepish for a moment, but found the courage to continue being brazen a few moments later.  She was absolutely convinced she had done the right thing.  My wife tried to explain to her that doing CPR on an infant who did not need it could have caused all sort of complications.  Worst case scenarios end with internal bleeding or damaged organs.  But she wasn’t having any of it.  And neither was her preceptor.  After the run, she got another stern lecture.

“What do you think you are doing, trying to correct that lady and tell her how to take care of her grandchildren?  She was trying to take care of them the best way she knows how!”

“You’re kidding, right?  She could have seriously injured that baby,” my wife argued.  “I’m not sure we should do anything drastic like contact Child Protective Services, but if she continues to do CPR on her child every time she throws up, something horrible is going to happen.”

“It’s not your place to tell other’s how to raise their kids!  You better get used to that now!”

As I have said.  This particular preceptor was completely off her rocker.  Many medics at the Dallas Fire Department would have attempted to correct both situations.  However, many would have not.  They would have just taken report and transported.  There are many practitioners who believe that engaging or trying to correct family members in any way is not our role.  It may even leave us open to liability.

This is most likely one of the reasons why my wife is no longer a paramedic.  And who would blame her?  Let’s say she went to school to be a plumber.  And she was called to a house where the homeowner had a leak in the basement.  She might find a leaky pipe and tell the home owner, “See this pipe here?  The solder has just worn down.  I can fix this in no time.  I just need to replace this piece right here and sweat the connection, and you will have your water pressure back in no time.”

“Wait!” exclaims the home owner, “You don’t know what you are talking about.  I want you to get a giant roll of duct tape and wrap up this other pipe over here!  I know that water is dripping from this one, and I have no training in plumbing whatsoever, but I want you to wrap tape around this pipe over on the other side of the basement!  That will fix it!  After you do that, just turn the water back on and leave!”

Would any sane plumber do that?  Would a car mechanic follow the family’s wishes to change the break pads on a car whose battery has died and won’t start?  Would a computer repairman allow the family to tell him to change out a hard drive when the computer won’t boot because the RAM is bad?

The problem with other similar scenarios is that the human body is infinitely complicated and attempts to heal itself.  If a plumber identifies a leak, walks to the other side of the basement and tapes an unrelated pipe, the original leak will shoot water when the water is turned back on.  All will know that the treatment did not fix the problem.  However, the human body will continue to heal itself after the doctor has declared that the patient has a virus and the family demanded an antibiotic to treat the condition.  “See!  She got better!” exclaims the family.  “What do doctors know?”

It is also the case that there are not a lot of shows on TV about plumbing that make simpletons think they are experts in plumbing after being excited by a few episodes. 

My wife eventually threw up her hands in disgust and walked away from the profession.  To be honest, I sometimes wish I had done the same thing.

Yesterday was our anniversary.  We have been married for eleven years.  And I am proud to say that my wife and I are closer now than ever before.  No matter how rocky things get, and believe me they have been rocky lately, she is always there to help pick up the pieces and put them together into something that resembles a warm and comfortable home that I can’t wait to get back to.

And our marriage isn’t one of those white bread, mini van, shop at Wal-Mart, plastic marriages that grow tired and stale over the years.  She is constantly showing me books, movies, music, and sometimes even comics that will change my views on the world as I know it.  So many marriages decrescendo into a sort of stale companionship where both parties are just trying to get through the week with a minimum of effort.  How many couples of eleven years regularly stay up into the wee hours discussing books they have just read and how these new ideas should shape their daily lives?  How many wives suggest new jazz composers and zombie movies on a regular basis?

Yep.  I married the right girl.

I think I will stray from the medical field for a bit to write a few posts about some personal experiences.  Stay tuned if you are interested.  Never let this job define you.  Branch out.  Have a few drinks.  Watch a good zombie flick.  Find something to take your mind off this insane profession every now and then.  Find a good woman and marry her.

Until next time.

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