Paramedic v. Nurse

**Newsflash** Hold all presses for news release, the Gate Keeper is an a$$ because he asks questions to a nurse. Well who woulda thunk. Let me fill you in on this one.

We’re called to a local managed care facility (nursing home) the other night for a patient experiencing some difficulty breathing. When we get there, as usual, there is no nurse with the patient who is in need of emergency treatment. Let me stop and spin tires here for a minute.

Would somebody please tell me why it is o.k. to call for an ambulance that is supposed to transport a patient who is supposedly sick enough to be outside the capabilities of the facility…and yet doesn’t have a nurse close by to manage said patient who is in such bad shape. Furthermore, why do the nurses not have proper training on the use of oxygen therapy and the delivery devices for said therapy? Really!?! Wouldn’t you think that we’d need to have that little baggie under the mask inflated just a little bit, and guess what my genius friends…five liters ain’t cutting it and two liters per minute with twenty feet of canula ain’t gonna do it either.

O.k., so I go to the patient’s room and sure enough she is having a rough time of it with her breathing. I ask a young lady who follows me into the room how long this has been going on.

“Oh I’m just an aide…I’ll go get the nurse.”, she says and scurries out of the room.

The patient is CA/Ox4 and also has some secondary issues with pain in her abdomen (RLQ) radiating down her right leg. For this she has had a morphine pump prescribed by her primary physician. I’m more concerned with the breathing since it is so labored with use of accessories. She is also pale and diaphoretic and which narrows my differential down even more.

Before long a nursely looking type appears in the room. I think I recognize this fella from the hospital, and if I’m not mistaking he also works in the CCU, so I breath a sigh of relief and start my interview with him. The patient was having such a hard go of it breathing, I didn’t want to stress her any more by getting her to talk.

I turned from the patient to ask the nurse, “When did all this start?”

“I’m not sure…I don’t work here all the time”, he answers not realizing he has just let me down already. Is this a standard response for any nurse who works in a nursing home that is taught in orientation or is there a special nursing class just for excuses and responses to EMS personnel?

It wouldn’t bother me so much if it was only every other time, but this is EVERY time I go to a nursing home to pick up a patient…any nursing home it seems.

Not thinking I continue on, “What kind of health history does she have?”

“That’s a good question”, is all I get.

Thinking that I may actually get somewhere with the next question, much to my chagrin I try again, “what types of medication is she taking”?

“That’s a good question too”, he responds

Really?!?! You mean to tell me that with two years training and many more years experience, the only thing that I have learned to do is ask good questions. What’s more amazing to me at this point is that this guy has just recently graduated from nursing school with the same two years of training, albeit in a different discipline. Of course you would think that a nurse would at least know the answers to some of these general assessment questions.

I’m just plain disgusted at this point and ask if we can get a chart or something or get someone who does know what’s going on with this patient.

Just then another nursely looking type walks in with some papers cradled in her arm. Maybe we’ll get somewhere with this one I hope deep from within my soul.

“Here’s her paperwork” she says while thrusting some papers in my direction.

“Whoa, just a minute…what exactly is going on here…how long has this been going on?” I ask.

“I’ve already gave the report to the ER and Dr. Hey’you wants her brought on over”.

“Well, that’s all fine and well, but I have to treat her between here and there…she’s not looking too good… I need to know exactly what’s going on”.

By this time I guess I had said some magic word that gave me security clearance to some personal medical history and events leading up to this point. She started in with her rendition of what was going on while I was in the process of hooking up the EKG, which showed an old infarct or even maybe an area of ischemia.

I’m going to stop here with the “case study” just because I want to preach a little bit about being a professional.

First of all, if a physician had came in my truck, dressed in the same uniform and asked the same questions, would it have made any difference what questions were asked. After all, are we not the eyes and ears of the physicians who have given us standing orders to act on their behalf?

I know there are nurses who don’t like us for one reason or another, and most don’t want to hear our reports at handover only because they are going to ask the same questions that we just did. Many more will certainly not want to hear about any pre-hospital treatment performed because that will just remind them that we do assessment based treatments rather than physician ordered treatments.

The reason that I’m so fired up over this is because this nurse happens to be friends with another friend of mine and called him to say that I just came across as a smarta__ and acted like an a___ole because of the questions I was asking.

I am a professional. I am a patient advocate. It is my job and responsibility to assess the mental acuity, history and needs of the patient and then render the treatments necessary to preserve life and/or the quality of life until care is turned over to a higher trained individual, or in most cases someone in their charge, such as a nurse.

It does not matter to me who the patient is, where they come from and it certainly doesn’t matter what their social standing is. I refuse to accept the mentality that just because a person is in an environment such as a nursing home, that they have given up all rights to make decisions for themselves if they are able.

I can not tell you the number of times I’ve heard a nurse tell a patient “you have to go, the doctor said to send you over” all the while the patient is protesting going anywhere. If the patient can tell me who they are, where they are, how they are and why I’m standing there…they’re in control of their destiny, period. Now I feel the need to clarify something here. I know that sometimes a patient will not want to go for fear that they might inconvenience someone, but if their condition warrants a visit to the ER, it is still my job to advocate for the patient and I’ll do everything in my power to encourage them to seek treatment. But it stops there. I don’t and will not participate in the coercion of a patient to do something they do not want to do.

For the ones who cannot speak and think for themselves, I wish I had the power to say (after a thorough assessment) “No there’s no need to for them to go to an emergency room” just because they bumped into a door. I would love to protect those that don’t need or understand what’s going on from the battery of test and the isolation of the ER.

My tongue will bare the scars from the teeth that kept me
from saying the things I want to say, but my conscious will be clear because I gave every patient the best even when others around wouldn’t.


**Just to note. This same nurse does in fact also work in the CCU. This is the same CCU where the students from ALS cources go to do their clinical rotations for their respective program training. Supposedly they have a lot to teach up there, but I’m sure this one doesn’t understand what his true responsibility is to the medical profession.

What's in your wallet?

Years ago during a particularly tumultuous time in my life I decided that there were some things that I couldn’t do by myself. I was self employed at the time and business was good, but trying to run the business and working it at the same time was just wearing me down. Add on top of that the strains of raising a family while being away from home three or four nights a week and you see where this can lead to real quick.

With all the stress and strains of life weighing me down and my burdens many, I did what every red blooded American and convicted felon does…I sought God. Don’t groan yet, this is not a Sunday school lesson.

I didn’t necessarily have a churchy upbringing and it wasn’t a big part of my young adult life. However, I had had some exposure to the good Christian teachings as dictated by others that knew better how my life should be, so I wasn’t exactly clueless as to what was going on.

One Sunday morning I was sitting in church and for whatever reason, this one phase from the pulpit hit me and sank to the pits of my being… and stuck. Of course I didn’t know this at the time, but that seed had been planted and time would cultivate this seed to a tangible product.

“If you can, or will, find something that you are willing to do for free…that is your calling. But if you can find a way to get paid for what you are willing to do for free, you have found the keys to unlock for yourself a prosperous lifestyle.”

A prosperous lifestyle…hmmmm…sounds good. I could live with that.

Fast forward to present day reality if you will. I’ve realized what prosperity is not by now. Naturally when I first heard this I spent many hours and days thinking about what I could do that would lead me to the riches. Man, I needed to find something that I really loved doing and find a way to make me a lot of money doing it. That’s how I interpreted what I heard that morning. Now either I’m not doing something right in the riches department, or prosperity must be something else.

For those of you who find your sustainment in the delivery of emergency (or not so emergent) medical services you know what I mean when I say “You ain’t gonna get rich doing this”. I know it; you know it and it would appear that the establishment knows it as well. Yet we keep on doing this day in and day out. Some do it at two or three different places. Others do it as their chosen profession and still find time to do it for free. Still some just do it because they truly enjoy the experience for whatever reason and get nothing in return except for a small pile of personal satisfaction.

I have to say that there is nothing more satisfying that I can imagine myself doing at this point in my life. For all the flat tires in my system and red tape that I deal with along with the endless political posturing that we must endure, I truly love what I do.

There’s nothing more satisfying than knowing that you have intervened in someone’s life and truly made a difference somehow. Even all the rides that we provide across the U.S. on the biggest publically funded taxi service in the world are comical after the initial anger wears off.

I get paid every day in one way or another. Not by check of course, that comes too weakly (bi-weekly), but in greater things that are far more valuable.

Let’s not forget the stories told by the nursing home resident, needlessly on the way to the hospital for a little bump on the arm. I take some solace in knowing that I gave them a change of scenery for a few hours while being held a captive audience for their life story.

The difficult patients off their psych meds. They are convinced someone is riding on the tailboard following them, or the one who has cut themselves to shreds and wants to take me out with them. From them I will get patience and tolerance.

Even the drunk driver who kills another human being gets his/her due as well. They will allow me to realize that my job is to fix and sustain the human body; that’s why I’m not a police officer or a judge. He gives perspective.

The patient who waits until I get to their house before they decide to code. They give me the drive to stay on my game, to tirelessly train and study, they think that I can fix what’s wrong if they can just hold out until I get there. These guys give me confidence.

Who can forget the lady who is waiting at the curb with her suitcase as you pull up in an ALS rig that is the last available for the next thirty minutes or so? It’s a cold night and her power has been turned off because she has no money, she has nowhere to turn and seeks refuge from the cold night air in my bus. She’s also knows that when she gets to the hospital there will be a small portion of food available for her during a four to five hour work up that will be nothing short of a full physical. She pays out with compassion and understanding.

How about the guy that the cops have just fed a concrete and grass sandwich to because he beat his wife and kids and tried to resist an arrest. He makes me love my job too. It is because of this guy that I will never go to jail for loosing my temper and killing someone. If I can spend twenty minutes alone with him in a closed environment, knowing what he has just done, I can control my emotions and anger through anything. He gave me self control.

For the infant who met the enemy SID, the one whose body I will have to do unimaginable things to just so the parents will know that they tried…that I tried. This little one will give me a deeper appreciation for life and learn to protect the fragile memories with my undivided attention.

Finally there is the frail old man who is in the process of taking his last breaths. He has run his race and fought the good fight. He wears his memories in the wrinkles on his face and his body is so tired. There is nothing I can do now because he has already purchased his final ticket. It is gold and has a big stop sign embossed on it that tells me to let him go out like a champ. It tells me that he is in control of these final moments. We lock eyes and he breathes one final time; he is now just someone’s memory of happier times. He gives me respect and dignity.

Yes, there are times when I almost loose it with the way things play out on the job. I do not like the way things have to be done. There are too many injustices that we must overlook out of professionalism and decorum; but this is our job…this is what we do.

Until the dawning of a new day when society figures out how to deal with all its’ problems, we will continue to be the dumping ground. Because of this we will be the doctor, the nurse, mental health counselor, moderator, baby-sitter, guard, taxi driver, locksmith, doorman and the list goes on forever.

I will probably never get to buy a custom built yacht as a Paramedic, or even a used one for that matter. My cars won’t be fancy and my family won’t take lavish vacations to Europe. We’ll only have one house to live in and it will not be on the lake front. I’ll have to punch a time clock to verify my presence for the foreseeable future to generate a steady flow of funds to my bank account. But for all that I do not and will not have, this much I know; I am rich with the things that matter most.

The moral of the story?

Prosperity is not so much about what you can see; yes it helps to see it, but it’s about what you do with what you can’t see.

I’ll bring home a check that is redeemable for a small amount of cash… but the experience is priceless.