Sunday, April 11, 2010

Smile And Nod

That is a catch phrase my Wednesday partner – who is also the duty Supervisor in Boston on Saturday – uses on a regular basis when we encounter abject stupidity.

Yesterday’s tour had a couple of calls that involved people who just don’t get it. And with both of these calls it was all I could do to “smile and nod.” In fact, one of these calls involved writing an incident report due to a couple of adults who were not acting as such. The other will require submitting a report to the Department of Elder Affairs or Department of Social Services, whichever one ends up being the one we have to notify.

I’ll start with the second call first as this was the order in which this all went in. We were dispatched for a 93 year-old male who fell. Arrived on scene to indeed find this elderly gentleman flat on his back in his bathroom. He was awake and alert and he told us that he lost his balance while trying to get on the chair lift that is installed on the stairway of his house. There was also a fair amount of blood on his bathroom floor; he cut one of his fingers and wasn’t sure how he did that.

One of the things that he made clear was that he didn’t want to go to the hospital. Normally, as long as everything was as it should have been, we likely would have turned him loose. But we couldn’t.

The reason was because his daughter, who was supposed to be his caretaker, had gone out and left him alone for a couple of hours and returned home rather impaired. Actually, I’m not sure “impaired” is descriptive enough.

She was hammered. And she kept insisting that he had a Urinary Tract Infection – evident, according to her, by the cyanosis present under his fingernails. However – there was no cyanosis present. And he wasn’t presenting to us with altered mentation or any other symptomology that would indicate that he was dealing with an infection of any sort.

It was an indication to me, however, that the daughter was a bit of a mess. But I still remembered to “smile and nod.”

The bottom line was that he simply wasn’t safe at his home. So we ended up transporting him against his wishes to the VA hospital in West Roxbury, even though not only did the doc we talk with want to see him, but the Newton Police wanted him out of the house also. So did the daughter, for that matter. And ultimately he understood why he went with us and agreed that it was probably the best course of action.

The other incident happened at 3:00AM this morning. Dispatched to an area residence for a 20 month-old female having a seizure. Arrived on scene 4 minutes after we were dispatched (the contract gives us 6) to small child who had been seizing, according to the officer on the responding engine company, for approximately 20 minutes. We found the child was indeed actively seizing – her gaze was fixed and she had non-purposeful movement going on. The good news, however, was at least that she was able to protect her airway and was breathing.

But she was still actively seizing.

The child’s father wanted us to transport her to Children’s Hospital Boston. But – we couldn’t do that. First, remember the seizure activity. That in itself precluded us from going that far; for us to bypass the closest hospital would have been a violation of our protocols. The closest hospital, incidentally,  was the Newton-Wellesley, which was one mile and less than six minutes away. That was where we ended up transporting her. The parents, especially the father, were not happy about that. In fact, the child’s father said – and this is a direct quote – “you guys are idiots” as we were heading out.

In the end, they got their way and their child ended up going to Children’s with a non-dedicated ALS truck. Fortunately one of the medics on the truck was my former partner Jenn and her partner Mike who are both people that I was very happy to see. She got the mother calmed down, got the father out of sight, and explained to her why we took the actions we took. I think she got it.

But it was hard to “smile and nod”; I really wanted to punch the father’s lights out. But I did write an incident report, as did Flo, my partner. The ED staff also wrote reports as these people gave the nurses and the attending doc a really difficult time as well.

I hope I never encounter this family again. I would certainly do what I had to so that this child was cared for properly. but I’m not sure that I would be so good to these parents. Especially the father.

He was a tool.


Elizabeth @ The Garden Window said...

If my child had been actively seizing for 20+ minutes, I would want her transported to the nearest hospital to get her assessed and properly stabilised, and worry about transport to a specialist unit once she was safe and stable.
People never cease to amaze me, I must be honest.

Fitting for that length of time is not good. Did they make a diagnosis in the end ?

Pete Mac said...

If you tried to put these stories in a fiction anthology, your editor would reject them as too "unreal". The truth indeed, is stranger than fiction.