These are the words I have uttered time and again to patients who do not want to go to the hospital, despite being in distress. In my head I’m thinking “get on the damn stretcher before you code, you fool!”
Here’s the story of one of my first patients as a full-fledged EMT.
(I’ll keep the bloody bits short.)
Joe was a cranky old man who you could tell relished being a cranky old man. The kind of guy who was a ladies man in his heyday, but whom you knew was fated to be a little old man in a hat with a bad attitude. My partner and I roll into the room to find his home health care aide looking utterly hopeless and frustrated with her charge, and Joe in bed in his undies screaming at the firefighters to get the hell out. We go over to talk to Joe and as he shifts in bed, I see his bottom and top sheets are slowly turning bright red. Not good.
Joe is unhelpful. He’s fine. He’s not bleeding. Sorry you had to come all this way. Now get the hell out. “Um,” I say hesitantly, pointing to his sheets, “sir, you are bleeding, quite a bit. Why don’t we get that checked out?” He waves me away. Crazy girl. Let me be. The aide explains that we are the third EMS crew to stop by today. She keeps calling 911 because she can’t get one of his tubes to stop leaking (stomach, colon, or catheter), and she’s concerned about him, but he keeps refusing care. Apparently he didn’t consider bleeding to death an emergency. He was lucky to have such a great caregiver who didn’t put up with his nonsense.
Well, even Ms. Newbie knows that this is bull$**t, so I look at my partner, and we get down to business. After we get the vital signs (decreasing everything, except confusion and agitation which are on the rise), we go into offensive mode. My partner tries being rational, then stern. I am polite, then cajoling. My partner is fed up and turns into bad cop. “Get on the bed. We’re going. NOW.” No luck. Joe isn’t budging from bed, and he’s wobbily trying to shoo us away. We try the dramatic (but accurate) “You could bleed to death. We’ll just wait until you pass out and take you anways.” It made him pause in surprise, but he didn’t cave.
Finally, in a last ditch attempt, I get honest, and I appeal to his machismo:
Look, sir, I understand that you feel fine, but, you see… (*deep breath*) this is my first week as an EMT, and I just really want to get everything right. I need to practice on patients. Won’t you please just sit on the stretcher? I’ll ride in the back with you the whole time! And then if there’s nothing wrong with you, you can go home.
It was a purely instinctual move on my part. I was getting frustrated, and I wanted my partner to stop yelling, and I reallly wanted the patient to get on the stretcher. He was going to bleed out! But I didn’t yet know all the tactics to try. So I reverted back to the old “get out of a speeding ticket” trick that every woman learns at 17. I think I might even have conjured tears in my eyes. And it worked, of course. Proof that you catch more flies with honey than with vinegar.
Joe hesitated, then his face softened, he grabbed his panama hat from the bed post, and sat right down on the stretcher with a “but I’m still fine, okay?” Then he took my hand and winked at me.
At the hospital, the docs took one look at his sheets (which we brought with us), and called for a surgery consult and a belly CT. Poor Joe. Maybe macho Joe was actually terrified of what was happening? He was sick enough to require multiple tubes and a home aide, so maybe he was afraid he wouldn’t come home. I hadn’t yet learned to expect that from patients with a long medical history. I hope he got patched up quickly and flirted with the nurses.
What skills have you had to learn on the fly?
What methods of persuasion do you find most useful?