12.05.10 | 7 Comments

We had just checked out our truck and gotten in service when dispatch erupted with the usual nonsense.  They started asking trucks for their location.  There were short pauses followed by quick bursts of radio traffic.

“They’re all ramped up about something,” theorized my partner.  He was a brand new EMT but wise beyond his experience level.  Common sense goes a long way in being an EMT.  In fact I would rather work with a rookie with common sense than a veteran any day.  I’ve got nothing against veterans per se…well…that’s the subject of another post.  But there we were, just knowing that dispatch was going to tell us to go do something stupid any second now.

“Be enroute to a rollover county run, MVA with multiple patients,” squawked the radio.

“There it is!” proclaimed my partner as he lit it up.  “I knew we were going to get a piece of something.”

“A piece of what?” I asked, sounding a bit disgusted.  My partner’s enthusiasm was well received, don’t get me wrong.  And I did like working with him.  But sometimes I thought he was blinded by a bit of naivety.  “If we are playing second fiddle from this far away, all the good patients will be gone.  We are going to be left with the whiners trying to milk the neck pain so they can sue and go on disability.  I don’t exactly want a piece of that.”

But my partner, ever the optimist, was unfazed and drove us quickly to the scene.  Upon arrival we found two sedan type vehicles that had barely bent metal, parked cockeyed in the street.  It had been a fender bender.  The drivers really should have moved the vehicles from the roadway, but they seemed too busy arguing and hamming it up.

“Hey Redbag!  We have two for you right over there.  The pink and white shirts sitting over there on the curb.”  This paramedic was familiar with me from the old days and was using a nickname for me unknown to my partner.

“Long story.  Remind me later,” I said to him while I walked up to our patients.

She looked barely eighteen, if that.  She was a dirty died blonde wearing skin tight jeans that must have taken fifteen minutes to get on and button.  She was of course smoking and talking on her cell phone to a friend.  Whatever conversation she was having was far more important than talking to the paramedic who just drove code three all the way across town, so I turned my attention to her boyfriend.  He was a tall one, wearing stone washed jeans that looked a bit immature for his age.  He was about 6’ 4”.  His basketball shoes were snowy white and immaculate.  Gold chains accessorized a simple Fruit of the Loom white undershirt.  He was smoking as well and had just hung up from his cell phone conversation, so I was able to have a word with him.

‘Hey, I’m the paramedic that has come to look at your injuries.  Were either of you hurt in the collision?”

“What?” he fumbled for a moment looking slack-jawed, “Oh yeah, we were in that wreck, man.  We got to go to the hospital.  Hey look, it wasn’t my fault.  That lady was coming up the road right here…”

I interrupted before he got too far.  “Sir, I’m not with the police.  I am not here to assess blame of fault, I just want to know if you are hurt and whether or not you wish to go to the hospital.”

“Huh?  What?” he managed to get out while staring at me blankly.  “Like I said, we were coming out of this parking lot when this crazy lady came out of nowhere…”

“Sir, I don’t think you understand.  I don’t want to hear the details of the accident.  The cops will want to hear that.  I want to know if you’re hurt.”


“Sir, are you hurt?  Are you injured?  Or did the seatbelts and airbags do their job?  Maybe you’re not hurt at all.”

“What?  I wasn’t wearing a seatbelt.  But yeah, the airbag went off,” again his jaw went slack.

“Sir, are you hurt?  Do you want to go to the hospital?”

“Yeah, yeah.  We both need to go.”  His girlfriend was still on the phone, paying no attention to us.

At this point he stood up as if to leave.  As he stood up his pants fell ever so slightly off his buttocks to expose a bit of his underwear to the world.  His appearance was carefully calculated to look like the black male stereotype that pervades TV so much these days.  I want to be very careful here.  This is a young white male trying to emulate his perception of a stereotype, not what black culture really is.  And that is the weird thing about so many young males in this part of Kentucky.  They love to emulate the ‘gangsta culture’ that has permeated into so much popular culture, but at the same time they are intensely racist themselves.  I constantly hear white people in this neighborhood dressing like what the consumerism pop-rap culture has marketed to them, but they fear and loathe black people.  It is not unusual to hear people dressed like this use horrible racial slurs and get in racially charged fights with young black members of the community.  There is a paper in this somewhere, but I am simply too tired to write it.  The immediate problem was that I had a patient who is claiming he wants to go to the hospital and getting up to walk away.

“Sir, where are you going?  If you want to go to the hospital then you need to sit right here and stop moving around.  We may need to splint some of your injuries.  You haven’t even answered me about whether or not you’re hurt.”

“I’m not going to the hospital on that thing!”  The girlfriend had finally spoken.  Actually she was screaming.  And of course it was over the top and overly dramatic.  She had found time in her busy schedule to get off the phone and acknowledge my presence.

“What do you mean that thing?” I asked.  “It’s just a cot.  And I haven’t even got to talk with you yet.  Are you even injured?”

“Of course I’m injured!  I’ve been in a car wreck!  I need to go to the hospital!”  Her face was frantic.  There was panic in her eyes.  She was shouting and on the verge of tears.  Her only visible injury was a small scratch above her right eye.  There was very little blood and it was already obvious that no stitches were needed.  I’m not sure it was even worthy or a band-aid.  Wiping the dried blood away with a wet 4 X 4 and letting it air dry probably would have been all that was necessary.

At this point I just wanted to turn around and walk off.  There was nothing wrong with these people.  They were just young and excessively dumb.  And this was the beginning of a chain of events that would do nothing but waste the precious time and limited resources of many heath care workers starting with me.  But I am of course not allowed to walk away.  I have to take all complaints seriously.  And saying things like, “What you two idiots need is a half a brain between you and maybe a band-aid,” is simply not allowed.  So I resolved myself to plowing through this to the end.

“Okay…the both of you…hang on just a minute.  You are crying like you just had your arm ripped off, but you wouldn’t even acknowledge my presence when I first got here.  And you,” I turned around to talk to the tall one who was still attempting to walk off, “you need to come back here, sit down, and talk to me.  Now, both of you have demanded to be taken to the hospital, but neither of you have told me just exactly where you are injured.”

“Well look at me!  My face is messed up!  I have to go to the hospital!”  The young woman whose voice was cracking while spittle flew from her mouth had managed to get a dried fleck of blood to stick to her finger and hold it out for my inspection.

“Ma’am, that’s a very small scratch.  It isn’t even close to needing stitches.  Are you hurting anywhere?”

“Of course I am,” she screamed.  Now she was crying uncontrollably.  “My face hurts!  And my neck hurts!  And there’s blood on my head!  And I have Bell’s Palsy on this side!  Am I going to die?!?!”

“No, you’re not going to die.  But, you want to go to the hospital.  And you are telling me that your neck hurts, so I would like to put a collar on you to keep your neck still, place you on a board and go get some x-rays…” I found my words being cut short by a shrill scream.

“You’re not putting me on that thing!  No freakin’ way!  People die on those!  I don’t want to wear anything!  I’m claustrophobic!”

“Okay, okay.  Just calm down.  There is no reason to get this worked up.  I’m not doing anything bad to you.  If you want to be seen by the hospital, which you say you do, then we need to take all the proper precautions and make sure nothing is broken.”

“Nothing’s broken!  My head’s messed up!  Just take me to the hospital!”

“Baby, you got to just calm down,” even the boyfriend had finally had enough.  “Mister, she’s just like this. She starts screaming at everything, that’s just how she is. She’s not making any sense and she doesn’t mean nothing by it.  Baby, just do what the man says and wear the collar.”

“Whoa, wait a minute,” I said.  “Ma’am, calm down and look at me.”  For the first time she quit screaming and gave me her full attention.  “Thank you.  Now didn’t you just say that nothing was broken?”

“Yes!” she said defiantly.  She wasn’t screaming anymore.  Now she was in pouting mode.”

“Okay.  If you don’t think anything is broken, then why do you want to go to the hospital?”

“Because my head’s bleeding!”

“Okay, like I said, that’s just a scratch.  I’m looking at it right now.  It you want to go to the hospital, then fine, I’ll take you.  But if you refuse to let us do any care for you and you don’t think anything is broken, I’m having trouble trying to figure out why you want to go.”

“What the hell does that mean?” her voice started to rise again.

“Look,” I was struggling to make this just a simple as humanly possible considering my audience, “If you think you’re hurt, you should let us take you to the hospital and treat you.  You say that nothing is broken, yet you demand to go and be seen.  But you won’t let me do anything for you.  That just doesn’t make any sense.  You are demanding to go to the hospital, but you are refusing all the care that goes along with it.  If you don’t want anyone to touch you or splint anything, why would you bother to go in the first place?”

“What?” she threw her hands by her sides in a gesture that was meant to convey exasperation.

“Look, the only reason to go to the hospital is if you think something is broken or you have a concussion.  If that is the case, then we need to splint everything so that you are still until we can take x-rays.  If you refuse this care, there is really no reason to go.  Moving your neck around like that when you are complaining of pain just doesn’t make any sense.  If you want it taken care of, let us splint it.”

“You are not getting me on that thing!”  Again with the pointing and the crying and the screaming.

“Alright, I give up.  Just sit there a minute.”  I turned my attention to the boyfriend who was still attempting to wander off, but my partner had blocked him and started doing what looked like an assessment.  Since he was taken care of, I turned back to the frantic young woman.  “You know what?  Fine.  I give up.  Just sit there for a minute, and we’ll put your boyfriend on the cot.  You can ride in a seat, but you are going to sign some release forms first.  For now, just sit there out of the way.”

But then it happened.  A do-gooder arrived on scene.  From the looks of her, she seemed to be a friend of the family or something.  She was a little older than our patients and talked to them with some authority, but not as a parent would.

“Honey, you need to do what this man says.  You need to get on that cot and go get checked out.”

The patient started crying again.  There was a new audience for her theatrics so she decided to turn it up a notch and start fresh with her histrionics.

“Whoa, ma’am.  I’m not sure who you are, but I had just about gotten her calmed down.  To be honest, now that you are here, perhaps she could go with you.”  I looked back at the patient.  “You don’t want to be in a collar right?  You don’t want any x-rays right?  You don’t want to lay on the cot right?  Then why don’t you just sign my form and ride up to the hospital with your friend here?”

“Oh no!”  The woman looked shocked.  “She needs to go get checked out.  Look, there’s blood on her head!”

This started a new level of uncontrolled crying that I did not know was possible.  It was even louder and more annoying than before.  I had finally had enough.

“Ma’am, I don’t know who you are, but you can stop right there.  She has a scratch on her head.  Do you hear me?  A scratch.  And she is refusing all care anyway.  Just about everyone here is demanding this and that except for the only one here who has any medical training which is me.  So please, okay, just back up a minute.”

I looked over at my partner.  He had gotten the other patient to actually sit down on our stretcher and was making some progress.  I looked over and mouthed the words “No backboard?”  He rolled his eyes out of sight of the patient, waved his hand dismissively and continued to strap him in.

“Okay,” I said with new authority to the ridiculous woman on the curb, “I’m going to load your boyfriend up in the ambulance.  You can talk to your friend here for a second and calm down.  If you want to come with me, then fine.  If you want to go with her, that’s fine too.  But we can’t stay here all day so you are going to have to make a decision by the time I come back.”  I left her in sight of the other crew working the scene, and they nodded that they would watch her.

We lifted the cot and I helped my partner load the boyfriend in the back.  He started to take a blood pressure and get some demographics.  With things looking sane in the ambulance I decided to go back out and see what the decision of the other patient was.

On my way back, the friend of the family intercepted me.  “Sir…sir?  I’m sorry about her behavior.  She’s always just been like that.  She tries as hard as she can.”

“Is she disabled in some way, or does she have any special needs that I need to worry about?”

“No, no, no!” exclaimed the woman, “No, she’s just high strung.  Let me talk to you for a minute to explain.”

I cut her short.  “I’m going to be honest with you.  Do you see that fire truck?  Do you see those police cars?  Do you see these ambulances?  There must be a dozen emergency workers here and over a million dollars worth of equipment.  This equipment, and personnel are for shootings, stabbings, burning buildings, robberies, murders, strokes, and heart attacks.  She has a scratch on her head.  If she wants to go to the hospital, then fine.  But I’m not going to waste any more time in the middle of this street talking about how mentally delicate she is.  I’m done and we’re leaving.”

I probably shouldn’t have been that blunt, but to be honest I do that more and more nowadays.  I’m not sure who did it, but somewhere back during the late 80’s or early 90’s someone walked to the backstage area of our culture and flipped what I sometimes refer to as the “Permissive Switch.”  If this were the 1970’s and someone was acting like that everyone on the street including the friend of the family would have been all over this girl.  They would have defended us.  They would have realized that a dozen personnel and over a million dollars worth of vehicles and equipment has no business catering to a hysterical girl with a scratch on her head.  I am not sure who decided that everyone needs to have their delicate feelings aired and considered no matter how whacked out they are, but I am done with it.  I want to find the person who went backstage to flip that switch, and I want to punch him in the gut.

“Okay.  Are you going with me or are you going with her?”  I folded my arms and waited for an answer.

“I’m going with you,” she said after a short pause.

“Okay.  Get up.  Let’s go.”

We walked back to the ambulance and I instructed her to sit in the captain’s seat.  My partner started to take her blood pressure and I rummaged around for a bit of paperwork.  Since I had both of them together and departure was immanent, I decided to tally the aches and pains.

“Alright sir, where does it hurt?”

“My back, and my neck, and my belly.”

I shot a look at my partner that was laser focused with anger and venom.  He looked mortified.  “He didn’t mention that before.  He was denying all that a minute ago.”

“Yeah.  Everything is starting to hurt now though.”

“That’s alright,” I tried to use a calm and soothing voice.  It was all an act.  Maybe they knew it.  Maybe they bought it.  I didn’t care.  “It’s never too late to package a patient.”

I winked at my partner to let him know that I didn’t want to drown him in a shallow bathtub.  We then proceeded to apply a board and collar while he was lying on the cot.  It wasn’t pretty, but it got the job done.

“And you,” I said starting towards the girl, “You need to sign and initial the back of this run form.  What this states is that I am a medically trained professional.  And in my opinion you need to be collared and splinted, but you are refusing.  Sign here…initial here.  I am also writing exactly what you have refused in the narrative.  I want you to sign this as well right here.  Alrighty then.  Now that that’s out of the way, let’s go to the hospital.”

We then started what for me seemed like the longest ride to the hospital in history.  This post is getting a bit long, so to save you from this turning into an epic novel, I will try to summarize the ridiculous events that transpired on that transport.

She of course started crying several times and asked me repeatedly if she was going to die.  I told her no, but I gathered from the sheer amount of times that she asked that she didn’t believe me.

Soon after that her boyfriend finally told her what he was so nervous about on scene.  (Remember he kept trying to walk off?)  He told her that one of the cops had looked him up and found out that he still had one warrant that was active.  Still being the operative word here.  I gathered from the conversation that ensued that he used to have many warrants, but had taken care of them somehow.

After that crisis was over she started complaining about lip and tooth pain.  I asked what this was about.  She said that the already had an abscessed tooth (dental hygiene not being one of her strong suits) and that the “gunpowder” from the airbag had inflamed it.  I attempted to explain that there was no gunpowder in the airbag.  She didn’t believe me.  Then she demanded Anbesol.  When I told her that we didn’t carry that on ambulances she was shocked.  She then called three different people until she found one that agreed to buy her a bottle of it and bring it to the hospital for her.  Then she asked if Chapstick would further inflame her lips that were already hurting from the gunpowder.  I again explained that it wasn’t gunpowder.  She again didn’t believe me.  Then she started to cry again and ask if she was going to die.

Soon after that she asked me if the hospital was going to charge them.  I told her that the hospital was going to charge them for care, and there would be a charge from the ambulance too.  She was shocked by this and said something to the effect of, “They are going to charge us again?”  I asked what she meant.  That’s when she told me the story of the other car accident they had a few weeks ago.  The hospital had charged them.  The ambulance had charged them.  I asked her why she didn’t think the same thing would happen again.  This seemed to throw her for a loop and she started crying again.  She again asked if she was going to die.  I had decided to stop answering that question.

Just before we got to the hospital, the boyfriend told me that he needed a copy of the accident report.  I again reminded him that I was a paramedic and not a police officer, and that he would have to contact the police to get a copy.  He became frantic and told me that he needed it tomorrow.  I thought about letting that go, but curiosity got the better of me and I asked why.  He stated that he needed it for court first thing in the morning.  I asked him why he was going to court in the morning and he became guarded.  Then I asked what possible bearing this unrelated accident could have on whatever was going on in court tomorrow.  He insisted that he needed it for evidence.  At this point I just stared off into space wishing that I would have a sudden stroke and lose consciousness so that this conversation would end.  I didn’t.  I had to keep coping with it.

As we went through triage the nurse became as confused as I was.  At first there were all the usual questions like, “Why isn’t she on a board and collar?” But after four or five attempts to gain information she looked at me in a way that let me know that she now understood how stupid they were, and just tried to get them in a room.  The nurse asked a few more questions about her medical history than I did and learned that she had just had a baby a few months ago.

I practically did a Sid Caesar spit take, “You’re a mother?!?!”

We finally got them to a room.  We laid him on a bed.  He immediately tried to get up.  I explained that no care had been done to him yet.  He needed to remain splinted.  He then told me that he didn’t need to be splinted.  I asked him why he let us do it in the first place if he didn’t need it.  This threw him for a loop long enough that we were able to exit the room while he was staring up at the ceiling trying to think of an answer.

As I was completing the two run forms for this mess my partner came up to me with a conspiratorial whisper, “Hey, look back in that room.  Be careful.  Don’t let her see you.”

I nonchalantly stepped to the side so I could view the room over the desk.  There she sat.  Our patient.  Sucking her thumb.

After I had finished the paperwork I walked outside with my partner.  He apologized for not immobilizing the boyfriend right away.

“Don’t worry about that.  There wasn’t a thing wrong with either of them other than the fact that they are both so fucking stupid I don’t know how they manage to continue walking upright.  No, what I want to talk to you about is your career path.  I keep hearing from you that you want to get off this transport truck and work in a real system.  A 911 system.  And I’m here to tell you that that’s it, what we did right there, that’s 911.  I’ve done that shit for years now and I can’t take it anymore.  You’re not going to be a hero.  You’re not going to save any hot looking women from certain doom.  No sir.  You’re going to do that shit.  Over and over and over again in what can only be described as a plane of hell reserved for retards and health care workers.  They’re doomed to keep getting hurt and calling 911, and we’re doomed to keep taking care of them over and over again.  Still want to do this?  Cut it the fuck out.  Go to college and forget this shit.”

“Man, I hear this from a lot of old timers like you.  But I still love it.  It’s in my blood I guess.  I still want to do it.”

“AAAARRRRGGGGHHHH!  What the fuck!  There is nothing in your blood but red blood cells, white blood cells, platelets, proteins and plasma.  There is no EMS in your blood.  Run from here.  Run from here screaming and lock your fucking door behind you.  I got news for you kid.  Every once and awhile…not often…but every once and awhile some innocent person gets a stroke or a heart attack or gets in a car wreck and needs help.  You know what they do?  Half of them don’t call 911.  They drive themselves in.  A quarter of them die.  And the other quarter of them are all pissy with you cause you’re not hopping fast enough for ‘em.  And that’s the innocent sick people.  The rest of them are guilty.  They shop at Walmart and buy crap.  They eat at McDonalds and fill their face holes with fat, salt, and sugar until they become obese.  Then they go to the gas station and buy cigarettes to ruin their lungs.  They get diabetes but never prick their fingers.  Then they abuse prescription meds spending hours and hours shopping doctors until they find one that writes that magic prescription that will get them high.  Why they don’t just go down the street and buy a bag of weed is beyond me, but they never do.  Then after a while they are so fat that they have to buy a rascal scooter.  And there they are, riding around in their house…smoking…with 60 feet of nasal cannula.  And one day the wheel to their rascal scooter rolls over their O2 hose.  They get short of breath.  So what do they do?  They light a cigarette.  And then when the really can’t breathe they think, ‘Damn!  I better go get a Twinkie out of the pantry.  That’ll make my fat body feel better!’  So they roll forward, and the O2 that was backed up in the line gets blown in their face while they’re taking a drag and now their fucking face is on fire.  And that my friend is when they call 911.  And you are just about to get off on time when those fucking tones drop, and you wind up missing dinner with your family for this patient.  This morbidly obese, prescription drug addled, diabetic Twinkie eating, emphysema chain smoking loser trapped under a tumped over rascal scooter with their face on fire.  That’s 911.  Fuck a bunch of that shit right up deep in the ass.”

There was a long pause.

“You still want to do this for a living?” I asked.

“Yep,” he said.

“Fuck it.  Let’s go get a taco.”