The man was homeless. He suffered from multiple sclerosis, and that's why he was confined to a wheelchair. He'd called us because of chest pain, although he was quick to point out that he wasn't having a heart attack. Several times he'd been treated for the same kind of pain, and each time a doctor had given him a clean bill of health.
A nurse at the shelter's clinic had called 911 on his behalf. As unlikely as a heart attack may have been, I couldn't really fault her for that. Patients who claim to know that they are definitely not suffering from heart attacks don't always know what they're talking about.
We examined the man and decided that the pain was more likely coming from some other condition. He winced as my partner applied the EKG wires. Asked if he could locate the pain by pressing on his own chest, he did so easily. While this doesn't necessarily eliminate the possibility of a heart attack, it certainly makes one less likely. His EKG was normal, as was his blood pressure. It was beginning to look as if he'd injured his chest in some way.
My partner stood behind the wheelchair. I stood in front of it, and together we lifted him onto the stretcher. As we did, I felt a twinge of pain in my lower back. As we pushed the stretcher to the ambulance, this pain shot down my right leg. It wasn't excruciating, but it was definitely noticeable. I must have been wincing--just as the patient had been wincing--because my partner asked if I was all right.
Not really, I told him. I think I did something to my back.
By the time we'd run the patient through triage, and settled him into a room, my back was feeling pretty tight. I mentioned it to a nurse, who arranged to have me examined. A short time later, a doctor declared me the victim of a herniated disk. "Nine times out of ten, these things heal on their own within a month," he told me. "Take it easy, and stay out of work for a week, and go to see Occupational Health. Surgery is an option if it doesn't get better, but I suspect that it will."
I thanked him and went home. That night, I did some Internet reading the subject of disk herniation. Sure enough, back pain coupled with pain in one leg was listed as a cardinal sign of disk rupture. Imaging tests, such as an MRI, aren't necessary to make the diagnosis, it said, because the nature of the symptoms corresponds so perfectly to the diagnosis.
The next day, I reported to Occupational Health, as ordered. The nurse practitioner performed the same tests that the doctor had done, but reached a different conclusion. "I don't understand why that doctor thought you had a disk herniation," she said. "He didn't even order an MRI. I think you have a muscle strain."
She wrote something into my chart. Then she looked up at me from across her desk. "There's no reason why you can't work with this," she said. "I mean, you're a paramedic, right? You wouldn't be lifting patients all the time, would you?"
For a moment I was speechless. How could a nurse practitioner be so clueless about the nature of a paramedic's job? It's bad enough that the public tends to have no idea what EMTs and paramedics do, but it seemed to me that a nurse practitioner should be fairly well versed in such things--especially when she was the one responsible for making decisions about whether I was physically able to perform my job.
"Actually, we have to do these kinds of lifts several times during each shift," I told her. "We frequently carry people down three or four flights of stairs. Sometimes they are very heavy people. We have to climb over things, and crawl under things, too."
"Oh," the nurse practitioner said. "I had no idea that it was such a demanding job. I thought you had people to do that for you."
At this, I practically fell off the chair. Like who exactly? A valet? A baggage handler? Oh, Jeeves, the man on the third floor appears to be suffering a heart attack. Be a good fellow and fetch him down for me, will you?
I wanted to tell her about the last time I was injured on the job--the time when a heroin addict woke up unexpectedly and fought with us as we carried him down three flights of stairs. Unable to let go of the chair, I supported the guy with one hand while fending him off with the other. We'd just about made it to the street when he latched onto my wrist with both hands and cranked down hard, causing a painful snap in my shoulder. The patient went to the emergency department, where he recovered from his overdose and was promptly discharged. Meanwhile, I went to the operating room, to have my damaged arm repaired in three different places.
But I didn't tell her about that. There didn't seem any point. She was already on the phone, arranging for me to get into physical therapy. "I have an EMT here who needs to work on his back strength," I heard her say. I couldn't be bothered to explain the difference between an EMT and a paramedic, or to explain just how physically demanding our job really is. I got the impression that she wouldn't have cared.
Now I don't know what to think. Two professionals, two conflicting opinions. Only time will determine which one is right, I suppose. I'll go to physical therapy, and either my back will get better, or it won't.