22 December 2006


911 from 0700-1700 on 12/20, ALS transfers from 1700-0700, BLS transfers from 1000-1800 on 12/21. Comatose on couch at 2030 on 12/21 while K is out playing bball and I'm on call for the FD - who thankfully don't get any calls. The overnight wasn't actually that bad, I slept from 2a to 5a and got a nap during the break between ALS and BLS transfers, so I'm not complaining about the schedule. I do have to say that I find my patience runs thin when I'm tired though, so here's two transfer stories. I do have a 911 story I'll try and share tomorrow.

0130 transfer patient from west-side hopsital ER to psych/detox center next to the east-side hospital. 23 yo female, depressed, not suicidal. Fine, fine, hop on board the sad bus and let's go. She's got an extensive list of meds and medical hx with her but nursing report indicates she's fine, normal vitals, so on and so on. Less than a mile from our destination, she looks at me and says, "I don't feel so good. My chest hurts and my jaw hurts." My internal BS sensor is screaming, but she does have a history of cardiac dysrhythmias, so I reassess vitals to find a slight elevation but still within normal limits, pulse strong and regular. She also has a history of anxiety, but denies that has anything to do with her current feelings.

When we arrive, medic is a little surprised that I head inside for a few minutes because we normally drop them off at the door. An aide and a social worker greet us, I hand over the paperwork and get the you're dismissed look just as I start to explain that she's developed chest pain and get their attention again. I try to accurately explain the situation and my assessment of her condition when the social worker looks at me and says, "Did you do an EKG?" Nope. "Do you want to?" I didn't answer that question because clearly, if I wanted to, I would've done it. The social worker finally turns her attention to the patient and eventually they agree to admit her for her fourth trip through their system. I left and had to explain the situation to the medic, who backed up my actions and assessment since she'd heard the nursing report and read the history documents. I worry that I wasn't being patient enough, caring enough, but everyone I talk with agrees that I was at least 10x nicer to the patient than they would've been. Just the fact that the medic didn't know there was an issue speaks to how nicely I treated her. I don't know how to feel about that, but I truly believe that there was no current cardiac issue with the patient.

1630 transfer patient from a nursing home to an emergency department, issued as a "go now" call from dispatch. Limited patient info enroute indicates 80's female with fever. Even though I'm on a BLS transfer truck, there happens to be a medic working with me so we treat this as a 910 (get it, 1 less than 911) call. When we get there, we head to the nursing station and are pointed down the hall to the patient's room - I leave them a parting shot asking about paperwork to go with the patient since they seem to be fairly ignoring us while continuing their social conversation.

In the room is the patient (and her roommate), her son and her husband. No staff. We start getting ready to move the patient to the stretcher and start asking questions of the family since they are the only ones there. An aide shows up and thrusts paperwork in my direction and is three steps toward the door before I look up. I ask her if she knows anything about the patient. Of course not. In a tone tinged with both annoyance and sarcasm, I ask if she could please send us someone who does know something about this patient. The family is looking at me somewhat slack-jawed at this point, so I apologize to them and explain that it would really be more realistic to have the nursing staff explain why they called us and what the patient's situation is than for us to continue to give the family the 3rd degree. They are in complete agreement and the son explains he's just surprised to see someone sticking up for his mom who has never even met her before.

I don't get into it further because the medic is working with the patient and I want to make sure I'm on top of what is going on and what he needs from me, but ultimately I just want to make sure that our patient gets our best help which means knowing what the heck is going on. Things clear up a little after getting some more information and we have an uneventful trip to the hospital. The ER is packed and they don't have a room for our patient, so we wait in the hallway with her for more than a half hour and I continue to chat with her and keep her occupied. I actually don't mind the wait because the ER staff is attentive to our patient even though they don't have a room for her, and the doctor who had seen her earlier in the day came down from the floor to take care of her specifically since the ER was so busy. That is the kind of care I can deal with and I will be patient all day if you can show me that you give a care and that I'm leaving my patient in a good place.

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