other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Sunday, May 31, 2009

Ironic Justice at the Airport

Most of my coworkers dislike responding to Logan International Airport. I suppose that's because so many 911 calls originate from there. The vast majority of those calls turn out to be non-emergencies, so I guess that adds to their sense of frustration. When you respond to the same place often enough, you begin to resent it.

But I've always enjoyed handling calls at the airport. For one thing, the conditions are ideal. The terminal is heated in the winter, air conditioned in the summer, and you never get rained or snowed on. Plus, there are plenty of elevators, so you never have to carry your patient up or down stairs. It certainly beats treating a patient in a cramped, third-floor North End apartment.

Recently, instead of sending us to the main entrances of the terminal, the dispatchers have been sending us to a gate that permits direct access to the taxiways. This saves a lot of time, because we don't have to go through the TSA checkpoint, and we don't have walk all the way out to the very last gate, which is where the patient always seems to be. Instead, we drive directly to the side of the plane. As a kid, my dad used to bring me to the airport to watch planes taking off and landing, and even now I find them fascinating. Driving along the taxiways, with 747s and Airbuses criss-crossing in front of us, makes for a pretty surreal experience.

I think of this now, because we just returned from an airport call. Categorized as an "unconscious," we were suspicious about its legitimacy from the start. "Twenty-one-year-old female, passed out," was how the 911 operator had described it. It sounded like someone had ordered one too many drinks while in flight.

And that's exactly what it turned out to be. We went to the gate, and drove along the taxiway to a 44-passenger commuter aircraft, where we found our patient, who was too inebriated even to stand up. The Massachusetts Port Authority firefighters had done their best to get some useful information out of her, but she'd refused to cooperate. They'd checked her blood sugar, which was normal, and they'd even tried to get one of her parents to come and claim her, but she'd refused to provide any telephone numbers.

I picked her up from one end, and an EMT picked her up from the other. We placed her on the stretcher and fastened the seat belts. "What are you doing?" she demanded. "I want to go home!"

"We tried to make that happen," a firefighter told her. "And you wouldn't work with us. Now it's too late. You're going to the hospital."

It was a fitting ending, I thought as we wheeled her to the ambulance. A night never seems to pass without somebody giving us a hard time. We elicit complaints about taking people to the hospital, not taking people to the hospital, taking people to the wrong hospital, sticking them with needles that hurt too much, taking too long to respond, giving them medicine they feel they can do without, and everything else imaginable. Sometimes it feels as if we can never please anyone.

This time, though, the patient who'd made things difficult for the firefighters and was giving us a hard time had succeeded only in hurting only herself. If she'd cooperated, she'd be on her way home right now. Instead, she gets to spend the next several hours trying to sleep in a busy, loud emergency department.

And why?

Because she refused to answer a few simple questions.

19 Comments:

Anonymous Anonymous said...

If she's "too inebriated to stand up" and passed out, then she's not capable of coherent thought, and thus it's pretty unfair to bitch and moan about how she wouldn't give any phone numbers. Someone, I might add, who had to clear those security checkpoints with ID, and was carrying tickets that may have been paid for by her parents.

Listen to Jill Bolte Taylor describe her stroke symptoms, and realize that the brain does really weird things when it is crippled. She couldn't call 911 because her brain wouldn't make the connection between that and "emergency." She tried to call her workplace, and couldn't conjure the complete number. When she found one of her own business cards, she had to dial by matching symbols...AND using her paralyzed hand to block numbers she'd already dialed. I'm not saying that stroke victims and drunks have the same symptoms- only that the brain reacts in strange ways to things that hurt it. Physical trauma, blood-brain barrier failure, or...poison.

Is it annoying that someone got so drunk that they became a problem? Sure. But does she deserve hate and blame for being unable to provide you with specific information? Not really. A little compassion might go a long way. You know, the kind of compassion that makes you and the state cops decide to give her some water, keep her in a room in the SP facility on-site for an hour or two, THEN ask her for the number of someone who can help her?

11:59 AM  
Blogger Herbie said...

One of the reasons I loved working Newark was being able to work on MIC-5, assigned to Newark International Airport. I met Sandra Day O'Connor on a plane once. However, they wouldn't let me race a plane on the runway.

12:50 PM  
Anonymous Beverly said...

Anonymous, if you worked constantly with the same problems, ad nauseum, and alcohol or drugs are the reason a million times over THEN you would understand what TS writes about. It eventually gets to you. It starts to kill you because your valuable, important time when you could be responding to a real emergency where your skills could save a life
is being usurped by yet another substance abuser.
You should have signed yourself "Resident from Fairy Land"

1:23 PM  
Blogger Fibro Witch said...

It is funny how people react. The EMT's who answered my 911 call could not believe I had called myself or gotten myself ready to go. With a bone sticking out of my arm.

Looking back on it, I wonder that myself some time. At least I could not find my car keys as I was about to drive myself to St E's.

1:50 PM  
Blogger brendan said...

Hey anonymous #1: if you think she's so drunk that she's not capable of self-care, what makes you think EMS has the legal ability to release her to state troopers until she sobers up?

I'm sure TS' compassion for drunk people lasted right up until the 2347823890472489758934758923475th such patient he encountered in Boston. Where do YOU work?

4:10 PM  
Anonymous JAM said...

Brendan: I agree with you wholeheartedly on your remarks to "anonymous". First responders tried to do the appropriate thing, contact a sober, responsible party. However, the patient would not cooperate. As what was mentioned in one of the replies about ETOH. It can mimic many other problems that we are not able to diagnose/treat in the field.

anonymous, please take the time to walk in the shoes of the providers in the field, and do what they have to do for as long as we have to do it, and you become as tolerant with this behavior as the rest of the providers...

4:56 PM  
Blogger TS said...

Herbie:

You would have lost anyway. :)

5:48 PM  
Blogger TS said...

Beverly, Brendan, and JAM:

Thanks for the backup. Sometimes I feel like bashing my head against a wall. No matter how hard I try to explain why certain patients frustrate me, some readers persist in characterizing me as either callous, insensitive, or lazy.
Your comments reminded me that I'm not the only one who feels as I do.

Thanks again.

5:54 PM  
Blogger TS said...

Anonymous:

Sorry, but I disagree with you, for several reasons.

First of all, every time I dare to express an opinion on my own blog, somebody berates me for my lack of compassion. I treat every patient with respect. I give them the care the need, no matter what I think about them personally. But that doesn't mean that I always have to enjoy it. You would be right to lecture me about compassion if I'd mistreated this patient. But I didn't. I did exactly what I was supposed to do. I treated her with respect, and gave her the necessary examination, and ensured that she was brought to a facility that would watch over her until she could take care of herself.

And no, leaving her in a police station would not have been a more compassionate alternative. It would have been a negligent one. I didn't send her to the hospital to punish her. I did it because she didn't meet the criteria for allowing her to go without care. A police station is not a suitable replacement for a hospital. If I'd been "compassionate enough" to leave her in a police cell, as you suggest, and she'd aspirated on her own vomit, then you and others would have skewered me for my laziness. She needed to be in a hospital, and we brought here there. The fact that she made herself more uncomfortable through her own choices--as much as I may have derived a small amount of pleasure from it--is a peripheral issue.

Something else that angers me is the fact that you, and certain others, always want to make these these things about something beyond the patient's control. This wasn't a stroke. It wasn't the result of diabetes or any other uncontrollable medical condition. The woman made a conscious decision to consume way much alcohol. Period.

Whatever happened to accepting the consequences of one's one choices?

5:57 PM  
Blogger Norma said...

Stupid drunk girl.

6:45 PM  
Blogger TS said...

To put it more bluntly! LOL

9:57 PM  
Blogger amusings_bnl said...

TS, you're allowed to get frustrated and express it. appropriately, with words, and not taking it out on stupid people like this drunk chick. anonymous is a dork for giving you a ration.

on another note, do you think it wise to include information in this entry about how you access the terminal areas and bypass TSA checkpoints? this little blog may not be read by many with ill intent, but that information could be handy to someone who gets their hands on an ambulance etc...

i love the part about how cool it is to drive down the taxiway etc... but you may want to clean this up and remove possible semi-sensitive info.

it was the first thing the popped into my head upon reading this.

keep up the good work...

10:15 AM  
Blogger TS said...

Amusings:

I gave that a great deal of thought, and was careful not to include any details that would prove valuable for someone looking to violate the physical security of the airport. I mentioned only that we enter through a "gate." The airport has more than one gate, and since vehicles of all kinds obviously have to enter and exit the airport regularly, I don't think I've said anything that isn't already common knowledge. Also, there are additional security precautions that come into play whenever we respond to the airport. I didn't provide any details about those, specifically because I don't want anyone to know what they entail. I appreciate your concern, and your point is a valid one, but I haven't revealed in this post any information that would prove of much use to anyone.

10:32 AM  
Anonymous wsweeks said...

As a Paramedic in a busy urban EMS System I can tell you that you can treat patients correctly and compassionately but may not have fun doing it. Does it show, probably, but when you make the same person EVERY shift because he does not eat enough before taking his insulin. Then when you give him D50 (sugar water in an IV) he gets irritated at EMS. This particular person has even went as far as threating EMS.

Paramedics are asked to be compassionate and "nice" in situations most people would call the police on (and definately not go back).

TS is just writing about a situation that shows peoples choices always have outcomes, some just may not be ideal...

Weeks

10:39 AM  
Anonymous scannerbuff1 said...

TS, you gave a great response to anonymous #1. Lots of good points, as always, you clearly knew what you were doing.
I guess when you deal with ignorant, argumentative people every shift, you learn how to respond to people like anonymous #1. It's a lot nicer than how I would have responded.

(I just had to say something...)

6:41 PM  
Blogger Herbie said...

TS,

I know I would lose, but it would be worth it.

Be safe.

6:52 PM  
Blogger Kathy said...

I've always felt that leaving an anonymous comment is synonymous with being an asshole. If I've got something to say - I'm going to say it, and you're going to know it came from me. If you're going to berate someone for something which you obviously know NOTHING about, please pull your head out of your ass long enough to see the letters that make up your name and then shove it firmly back up there again...

10:59 PM  
Blogger Last Angry Man said...

Kathy, you're too kind. ;)

6:48 AM  
Blogger TS said...

Kathy:

While you raise a good point, and while I certainly do appreciate the support, I try not to get bothered by anonymous comments. To some extent, all comments left on this blog are anonymous. Very few people leave comments under their real names. Most use only screen names.

That said, I want to thank you and the other readers for coming to my defense on this particular topic. Not infrequently, a reader will acuse me of being lazy, or callous, or rude in response to one of my posts. What's funny about this is that this always catches me by suprise. Sometimes I write things that I expect people to take issue with--and nobody does. Then I write a post like this one, which I expect will bother nobody--because we did everything by the book--and a reader will criticize me either for being lazy or being a jerk.

My reaction to these criticisms varies widely. Sometimes I feel angry. I want to say, "How can you criticize me for my handling of a homeless person? You've never dealt with a homeless person in your life! You have no idea what you're talking about!" Other times, I feel hurt. A comment will make me wonder if I really did handle a situation the wrong way, or if I'm being unreasonable for complaining about a particular situation.

When these things happen, though, it makes me feel a lot better to read comments like yours, because they remind me that not everyone agrees with the person criticizing me.

So, I want to thank you and everyone who takes the time to express an opinion, anonymously or not, and particularly those who come to my aid when I'm being verbally attacked. I appreciate it.

11:08 AM  

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