P.F.A.

"Engine 3 and Ambulance 2, respond to __ ________ St. for the unconscious party."

Yesterday was my first full 16 hour Saturday since my injury. I'd worked 3 8 hour Saturdays prior to yesterday, but it was my first day with, other than not being able to pick up a stretcher or anything weighing more than 5 pounds, no quarter asked or given. I was on my way to fuel the fly car/command vehicle (a Ford Expedition with lots of horsepower and a complete light show) when the above call came in. I was approximately 5 miles away from the address given and I hadn't made it to get gas yet. Plus, I was the only ALS unit available. So I went.

When I arrived, an engine company and the BLS ambulance that was dispatched were already on scene so I went in. The patient, a 72 year-old female, was not unconscious, as the call was originally dispatched. However, she was not thriving well, mildly dehydrated, and not saying very much. Her husband and daughter were also present, and they were somewhat distraught; the patient - wife and mother that she was - had a history of multiple myeloma and was being treated with chemotherapy. Cytoxan and Revlimid were her chemotherapy drugs, plus she was being given Prednisone and another medication that escapes me. She had a PICC line in place. Family reports no other significant medical history or allergies. Assessment found her to be alert and oriented appropriately, no fever present, but she was tired. Vital signs were acceptable; no hypo/hypertension, no dyspnea, but a slightly elevated heart rate was noted. No complaints of shortness of breath or chest pain, patient denies changes in mental status, nausea, vomiting, or any other complaint other than the fatigue.

The EMT's on the BLS crew felt comfortable transporting her (and I was comfortable with them doing so), and they let me know that they were preparing to go within a few minutes.

While the BLS crew and the firefighters on scene assessed and moved her, I spoke with the family. Her husband, age 76, was visibly upset and extremely anxious. He appeared, at least to me, to need to be talked off a ledge. The daughter was much less of a mess, but she was still having a hard time. They were both going to the hospital with her, and the daughter had planned to drive both herself and her father in. He, however, wanted to be with his wife, which is understandable, but considering the dynamics in play I was concerned that his stress levels would potentially ramp the patient up, which in itself wasn't a good thing.

So I offered to do something I don't do often: I asked him if it would be okay if I drove him into the hospital. He immediately asked me if we would be going with the ambulance, and I assured him we would be. So he rode in with me and we followed the ambulance to the Boston hospital the patient was being transported to.

We got into my vehicle as the BLS crew was loading her onto theirs, and he immediately started talking. It was as though he was unloading his cares, his fears, his life - onto me. So I listened. And I got a lot more than I expected.

This man - I will call him Jacob - and his wife had been married for coming up on 53 years. They had three children, two of which live outside of New York City in addition to his Boston-based daughter. Jacob was a product of the psychology program and UNH where he'd earned his Ph.D. in psychology in 1962 - the year I was born. He'd had a successful psychology practice that he'd retired from approximately 6 years ago. And he was incredibly worried about his wife; the MM diagnosis had been fairly recent - he told me she'd been diagnosed in 2009 - and prior to that she had been remarkably healthy. But the off-and-on treatment she'd been undergoing was taking its toll on her, and he told me she was starting to lose her will to live.

As he was telling me this, the tears were running down his face, and it was all I could do to concentrate on getting through traffic without us becoming victims ourselves. My actions during this incredibly one-sided conversation was to just sit there and listen. Occasionally I asked him a question or validated something he said, but other than that I said very little.

This occurred in an approximately ten minute time frame. When we arrived at the hospital, he and I got out of my vehicle and went to the ambulance where the crew was unloading his wife who, surprisingly, was looking a bit better. And she had a curious smirk on her face that I couldn't quite figure out until she said, "now Jacob, you don't need to worry so much. I feel a little bit better." The poor man's eyes welled up again, and as he walked in to the ED with his wife and the crew, I had to slow down and take a deep breath before I followed them.

It was probably one of the more intense experiences I've ever had providing psychological first aid to a family member of a patient. It happens more often than not that the patient - the person we are called for - is not always the one in need of care. Sometimes family members need it just as much, but usually in a different sort of way.

And I realized afterward that he really did need it; with the limited knowledge I have about MM, I know he will lose her at some point, unfortunately most likely sooner than later. And I'm afraid if this gentleman doesn't have good support from his family, he's going to be lost as well.

If nothing else, one thing is certain: this one will stay with me.