Contact - Part 2

While we're in the process of returning the 96-year-old female from the previous post to her home, we receive a call for a "possible section 12." (Possible psychiatric emergency.) We call other services, but none are available to assist, and we've got the only ambulance, as the other is out of service for the night. It's just us. We finish the call we're on, and move to the next.

As we approach the scene, it becomes clear that no one on this call is particularly well-informed. We find police waiting at the front of the road in question - protocol for a section 12 - and after a brief conversation we move to the house.

At this point, there are three state police cars present, including a higher-up. Always a good sign.

They go to the house, which is obscured by a curving drive and woods. Lights turn on and off, and my partner remarks, "No gunfire. That's a good sign."

We wait around 20 minutes, at which point we see a female, appears to be in her 20s, walk towards the ambulance, flanked - but not restrained by - the officers. She hops into the back of the ambulance where I am with some paperwork and sits on the bench.

Silence.

I don't see anything major wrong with her. A cut hand, which doesn't seem to be bleeding much, but she has an airway, is breathing, and her skin looks normal. She's very stressed out, though, that much is clear - she looks around the ambulance with eyes that definitely reveal some sort of problem. She's looking for a way out, sizing up the space. I glance to the back doors, wondering if I should lock them. But, mostly, I sit there, hand on a clipboard, not knowing precisely how to handle the situation.

Abruptly, she yells at me in an accusing, angry voice, "Don't you have questions to ask me?"
"Errm... not just yet, ma'am."

A few more minutes of silence.
"Are we going to *freaking go already? I don't want to be here all night."
"We're going as soon as we can."
"Can I smoke a cigarette?"
"Not in here, there's oxygen."

We start to move, a development I'm very happy with. My partner hops in the back with me, and it becomes apparent quickly that small talk will not be possible. The patient won't let us near her to treat her hand or take vitals. We observe her, move to the hospital, and wonder why we were called in the first place - the information we got on this call was sparse.

In the previous post I mentioned how odd the inside of an ambulance can look, at for this patient, that was apparent. Not in her proper frame of mind, stressed out from the police pulling her from her home, and angry, she looked around the ambulance like it was an alien laboratory, for lack of a better image. The radio was making a variety of sounds, from static to bits of voices, and we were sitting in profound silence. To her, this wasn't a caring space where humans help other humans through their worst moments. This was an extension of the state, the state that was currently depriving her of her freedom to be left alone, for better or for worse.

We were all glad (except her, I think) to arrive at the hospital. We waited for a police officer, and walked her inside. My heart rate dropped from hummingbird to approximately human, and my partner did the hospital hand-off and dispatched me to go collect our cold, neglected dinner.

I couldn't help feeling like I should have done more to diffuse the tension. As a person about her age, I should have empathized with her more - I know how people of my generation perceive police officers, and it may have helped her to know that despite my uniform I was not a police officer, I was here to be an advocate for her rights and her well-being. As it happened, though, I just sat, silent, nervous, and looking at my first psychiatric call.

It's going to be a long time until I'm good at this.

Contact

The night began about as oddly as any I've had yet. I show up with my overnight gear at 6 p.m. to be greeted by two of the EMTs who were outside the garage, smoking a cigarette.

"If the last two hours are any indication, you're in for a fun night."
"Well, I'm just glad they all got it out of their system early tonight."
Grins all around, and I walk inside to find my team for the night has all traded off, and I'm with two experienced EMTs I haven't worked with before. We order chinese, and before it's ready, the phone rings. Transfer from the Hospital to a patient's home - not something we do often, but should be pretty simple. After one false start - the patient wasn't quite ready yet - we're ready to move her.

It's a 96-year-old woman. We approach her in her hospital bed, and as is fairly common, she's distressed at first, and understandably so. Three uniformed men are here to take her away; but she's happy to hear that she's going home, and once we let her know what's going on, she's not worried. She does, however, look at me, and say, "He's too small for me!" causing laughs all around. As we move her, though, a pained, terrified look comes over her face; it wasn't a very clean move. Her legs are clearly in pain, and we do everything we can to make her comfortable.

We move her out to the ambulance, and I turn on the lights and get the heat on. The first major mistake I made, that I only realized too late, was that we loaded this poor woman into the back of the ambulance without turning the lights on inside first, which I imagine must have distressed her. I'll touch again on this in my next post, where it comes up, but the inside of the Ambulance - which I find very comforting, because it's clean, orderly, and full of options for interventions that feel very empowering to me - can be very unsettling to someone who isn't used to it.

"Where are you taking me?"
"We're taking you home, ma'am." A smile. She's alert and understands what we say to her, but she asks the same question over and over again, which is very convenient - I like to be able to make someone happy with the same answer six times in a row.

I take vitals. Her arms are completely devoid of muscle - they're completely soft. I worry that the BP cuff will squeeze too hard, and she says it's cold, so I move her sleeve down and put the cuff over it. Her vitals are textbook perfect - 120/80 BP, pulse very strong (a little irregular), and good skin condition. I place my stethoscope on her chest to take breath sounds, and notice that they're strong, but very shallow.

Try an experiment to get an idea of what this is like. Spend a couple minutes taking breaths that only last at most half a second in, and see how little you can do breathing like that.

I pull my scope out of my ears, and I move to withdraw my hand from under her blankets, but I stop. A few moments pass, and my partner looks over. He sees I'm not listening, but my hand is still near the patient. "What're you doing?" He asks, bemused.

I don't know whether it was for warmth, comfort, or just human contact, but I replied, "She's holding my hand."

Definition

Embarrassing:
Walking into a patient's home with everything you need to solve a diabetic crisis only to find you haven't brought a band-aid for his finger.

Unprepared:
Being asked to take a pulse only to answer your captain with "Errm... might I use your watch?"

Learning:
Two mistakes I won't make again, at least.