Just an Ambulance Driver

I’ve made a concerted effort recently not to complain so much. The world is changing, and my job is changing, and the people we encounter are changing. There’s no point in complaining about these things, because complaining won’t fix them.

Tonight, though, I couldn’t help it. We ran the entire night, eight calls in eight hours. Not one of them was serious.

We began with a heart attack call at an East Boston housing project. Or, at least it had been classified as a heart attack. Someone called 911 and said the woman was experiencing chest pain. She wasn’t. She complained only of being nervous. Someone had stolen her Klonopin, she told us. She lets all of her neighbors come into her apartment to borrow things, she said, and one of them must have stolen her medicine.

So, of course, she wanted an ambulance to bring her to the hospital to get another prescription. Because that’s what you do when you need more pills, don’t you? Take an ambulance to an emergency department? Refilling a prescription is indeed a life-threatening emergency.

On the way to the hospital, she talked about her predicament with great emotion. “Why doesn’t my doctor believe me?” she demanded to know. “He said on the phone that he wouldn’t write me a new prescription. He says he has to guard against drug abuse. Does he really think I’m going to abuse Klonopin? Nobody abuses Klonopin.”

“If nobody abuses Klonopin, then why would somebody steal yours?” I asked.

She never answered the question. Instead, she changed the topic.

After that, we went to a senior citizens’ complex for a man who couldn’t breathe. Or so we were told. In fact, he’d suffered a stroke nearly ten years ago, and has breathed through a tracheotomy tube ever since. Tonight, while a nurse was checking up on him, she attached some kind of adapter to the outside of the tube, something that was supposed to help him talk. This made no sense to me at all, since, according to one of the man’s daughters, he’s been in a coma for almost a decade.

When the nurse saw him struggling to breathe, she immediately removed the new piece. The man’s breathing returned to normal. We talked to all three of the patient’s daughters, and they agreed that he looked just like he always does. But the nurse insisted on sending him to the hospital. She’d already talked to a doctor, she said, and she wanted him to come in for an evaluation. So off we went to the hospital, with a patient whose problem had been resolved, based on the word of a nurse who had panicked, on the orders of a doctor who was miles away.

Next we went to a homeless shelter. Like our first call, this one was billed as a cardiac problem. One of the shelter volunteers came outside to meet us. “He’s really intoxicated, and he’s putting up quite a fight,” he said. “I don’t know if he’ll want to go with you.”

“Then why did you call us?” my partner asked.

“Well, he wanted to go outside to smoke, and when I told him he couldn’t, he said he had chest pain and wanted to go to the hospital.”

A drunk man was demanding an ambulance after having being denied the opportunity to smoke. It didn’t sound like much of a cardiac problem to me. But there was no point in debating the issue. We went inside to look at him.

“What’s happening tonight?” I asked the man.

“Got pains in my chest,” the man snorted, glaring at me angrily.

“How long have you had these pains?”

“Since yesterday.”

“Off and on? Or continuously?”

“The whole time.”

“Have you ever been to a hospital for these pains before?”

He looked at me as if I were an idiot. “Yeah. Yesterday.”

“You went to the hospital yesterday for this pain? And you’re still having it?”

“Yes! That’s what I’m telling you!”

“Well, what did the doctor say yesterday?”

“He didn’t say nothin’.”

I can’t stand it when people say that to us. No doctor in the history of medicine ever discharged a patient without explaining the diagnosis. Even if a doctor admits that he can’t identify the cause of a patient’s illness, he will always tell the patient something. And if you were discharged without being told anything, then wouldn’t you be curious enough to ask what the diagnosis was?

Not this man, apparently. When I asked again what the doctor had told him was wrong, he said, “Look. Are you going to take me to the hospital or not?”

Yes, sir. Right away, sir. Step outside to our ambulance. We’re the highest-paid taxi drivers in the city.

Next we went to our favorite destination: a neighborhood health center. According to the doctor there, our patient had come in with dangerously low blood pressure, so she’d started an IV.

The man was sitting up in bed, looking quite comfortable. I asked him how he felt.

“Pretty good,” he said.

“What made you come to the health center today?”

“I was feeling a little tired.”

“You feel okay now?”

“Yeah. Sure.”

I took his blood pressure. It was 140 over 80. Normal.

“Want me to walk out to the ambulance?” the man asked.

“No, that’s okay. We’ll wheel you out on the stretcher. If you’re feeling tired, we don’t want you walking around.”

We started toward the door.

“Wait!” the doctor called. “You can’t leave yet! I haven’t written my report!”

This left me speechless. The City of Boston operates just five paramedic units on the day and evening shifts, and one of them had been tied up on a call that could have been handled by a taxi. I can understand an ordinary citizen making this mistake, because many people just don’t know any better. But this was a doctor. She’s supposed to know how the health system works. And she wanted to keep twenty percent of Boston’s paramedic resources waiting while she trotted off to her office to write a report.

I’d had enough. I was about to tell her not to bother writing her report because we were leaving without it. Fortunately, my partner intervened. “You can fax it over to the hospital,” he said. “It’ll get there before we do.”

This sounded like a good idea to the doctor. I felt like screaming as we wheeled the man outside.

After that, we went to a nursing home. A nurse had called 911 because the patient had felt lightheaded briefly. By the time we arrived, he was feeling fine. But the nurse insisted that he go to an emergency department. She was concerned because his heart rate was low.

We checked the man’s pulse. It was 68. The low side of normal.

“Do you have high blood pressure?” I asked him.

“Why, yes. I do.”

“Do you take medication for it?”

“Yup. I take something called Toprol.”

“Thank you, sir. That’s helpful to know.” Toprol keeps blood pressure in check by slowing the heart rate. His heart was beating slowly because it was supposed to be beating slowly. Once again, we were taking a patient to the hospital on the instructions of a healthcare professional who didn’t understand that his condition was normal.

And finally, with twenty minutes left to go in the shift, we were sent to the opposite end of the city, where a woman was having trouble breathing. After cleaning a bathroom, she’d sat down to smoke. Now she was having trouble catching her breath.

Imagine that. Feeling short of breath after smoking.

Fortunately, a pair of EMTs arrived on the scene before we did. Recognizing that we couldn’t do anything to fix the patient’s smoking habit, they cancelled our response.

Returning to the station, I realized why I felt so frustrated. It wasn’t because the people who’d called us didn’t seem to understand the definition of an emergency, although that was certainly true. And it wasn’t because we had been kept busy all night on non-urgent matters, making us unavailable for true emergencies—although that was certainly true as well.

What really bothered me was the way our job has changed. Together, my partner and I had more than forty years of experience handling emergencies. We are extremely well trained. We’re certified in CPR, and Advanced Cardiac Life Support, and as hazardous materials technicians. We’ve attended Advanced Trauma Life Support courses alongside physicians, and Critical Care Transport courses alongside flight nurses. We’ve handled hundreds of cardiac arrests, and hundreds of shootings, and at times, we’ve even rescued people from fires and wrecked vehicles.

And what did we spend our night doing? Driving healthy people to the hospital without even treating them.

Now, don’t get me wrong. I’m not saying that I’m too good for this kind of work. I’m not above taking care of a stroke victim, or a man who nearly fainted, or a woman suffering a panic attack. But this isn’t the way the system is supposed to work. Wheelchair vans exist for a reason. They are supposed to be used for the transport of people who can’t get around on their own, but don’t have a medical emergency. Something is clearly wrong with a system that utilizes highly trained, highly paid, experienced health care providers to transport relatively healthy people back and forth to hospitals, where they don’t even rate a bed in the acute section of the emergency department.

And yet, that’s all we did tonight.

I’m not sure where the problem lies. Maybe nurses who work outside of hospitals need to have better training in the identification of emergencies. Maybe doctors need to be told that city ambulances are not taxis. Maybe the city should buy more vehicles, and hire more EMS personnel. Maybe the people taking the 911 calls should be allowed to ask more questions, to get a better idea of what’s really going on at the scene.

But what do I know?

As far as most people are concerned, I’m just an ambulance driver.