Tuesday, May 27, 2008

Street Wisdom

"The longer I am on the street the fewer answers I have. You lose your illusions. Your view of things leaves little room for wanna be’s or should have’s. People with answers still have too many illusions. Reality leaves no room for illusions."

Written my a much younger me, circa 1980's.

Sunday, May 25, 2008

Suicides are Not Painless

Suicides are painless. That line from the MASH TV show theme ran through my head the other day and I thought of the man with no face. Suicides are not painless. In fact they inflect more long lasting pain than they relieve. I discovered this the night a man put a shotgun under his chin and pulled the trigger. I had been to many attempts and successes over the years but this is the one that stands out above the others.


The only furniture in the apartment was a single chair. There was no TV, no table, nothing but this single chair in the apartment. The man had placed the chair in the center of the room and put the shotgun under his chin and pulled the trigger. When we arrived we found him still sitting up right appearing normal for all intents and purposes except he had no face. It looked as if someone had taken an ice cream scoop and scooped out his face leaving behind dried blood, broken bone and torn tissue. He had left no note or explanation for this last act. A faceless man sitting in a chair in the middle of an empty room, with not explanations, it had to be some kind of reflection of the life he had led, of the things he had done or had been done to him that led him to this end.


There was nothing for us to do but call him and wait for the cops. We loaded the gear back on the truck and waited. The cops, not wanting to do the paper work, were avoiding the call so we had to sit there with the person who had found the body and called. It was his son. He sat on the curb saying nothing for sometime. We stood around trying to give him some space. He finally began to talk maybe not to us as much as to himself.


He kept asking why but did not have any answers that gave him any peace. The pain of his loss was palpable. But the burden that he was going to have to carry was what struck me. The image of that single chair and the faceless man sitting in an empty room with the ceiling covered in gore would be etched in his mind for the rest of his life. With no note he could only guess why someone would do such a thing. It was as if he had done it to his son as well as to himself. He must have known it would be his son who would find him. It seemed such a cruel act to others more than relief for his pain.


I had seen how suicides were treated in the ER’s over the years. The doctors and nurses treated them derision and medical treatment that bordered on cruelty. When I would bring overdose that attempted suicide to particular one doctor he would always smile and order the largest NG tube he could, the “garden hose” as he would say. I never understood their feelings until that night, when I saw the impact it has on those around them. I never saw terminally ill patients who had real choices to make just people acting out, crying for help. I would always talk to them and try and “help” them during the time I saw them.


As I sat there with the son letting him talk I began to feel the real pain a suicide inflicts on those around them. It was going to change the son’s life in so many ways. It would change everyone’s life connected to him. It would add to the burdens in their own lives. The man suicide was so much like dropping a stone in a pond but the ripples were those close to him pain. Those ripples would be felt for the rest of their lives. The cops came, we loaded on the truck and left the scene. But that the guy with no face and his son on the curb never really left me. 


After the man with no face I changed. I saw those attempted who suicide the same way that the doctors and nurses did. As an act that inflects much more pain that it ever relieves.  I was abrupt and unsympathetic with attempted suicides. I made sure I followed standing orders to the letter and got them to the hospital as soon as possible. In my ways I think I provided better care than before. They got to the hospital quicker and got the help the really needed a psychiatrist or psychologist. I don't know if I was right or wrong in my approach, all I know it is the way I did it. As with most challenges on the street in the early days this one came with no handbook. So each of us was left to work our way through them on our own.  

Sunday, May 4, 2008

Nursing Home Nightmares

We received a call to one of the local nursing homes. Orlando seems to have more than its share  and I always hated calls to them. The level of care and the quality of care was almost universally less than it should have been. We were always faced with difficult and complex problems that rarely fit into any set of standing orders. Like the patient who had been seizing for an hour before they finally decided they should call us. Or the patient who had not had a bowl movement in a week and the staff had waited until the patient stomach was so distended it was causing them to have difficulty breathing  and only then to call us. It had come in as a difficulty breathing. Yeah a little O2 was going to fix that one. 

This one came in as a patient not breathing. It was that 3 am hour that I always hated in a 24 hour shift. I knew this one would be something nursing home staff always seemed to wait until the middle of the night to call. We arrived to find a coded emaciated patient in their 80's. I took one look and asked the staff if this patient had a Do Not Resuscitate order. They said no. As we began to work on the patient I asked them again to check their records I had a feeling that this patient just had to have a DNR. They again said no this patient did not have a DNR. They appeared perturbed that I had asked. 

So we worked the code and this time we brought the patient back. The patient had a heartbeat and was breathing on their own when we delivered them to the hospital. I was out at the truck refilling the drug box and airway kit when my partner came out. He told me that the patient did have a DNR after all. When the hospital had notified the family and they had been furious, sad and god knows what other kinds of emotions when you are told your loved one would continue to suffer. The amount of pain we were part of putting that family through still haunts me. I know, all we can do is go by the orders we have but we are part of the system. I did not report it because there was no one or nothing to report to. It was just another one of those wide awake nightmares we all seem to have in EMS.