Always Believe Your Patients
Your patients owe you no explanation.
So we are going to start off with one of the most impactful calls of my career in EMS.
Let’s set the scene. I was a Baby EMT. My card was still wet with ink from the printer.(When New Jersey still printed cards.) I was on my first volunteer ambulance corps, we had checked the truck and were just hanging out in the crew room. It was our driver, my senior EMT and myself. We had dinner and were just sitting around watching something mindless on TV. Then the tones dropped. My heart rate spiked and I was running to the ambulance and in the back before the tones even finished. My senior EMT looked at me like I was embarrassing him.
I was eager. I wanted to show off what I learned in school. I wanted to show what I knew. I didn’t even hear what the call was for I had ran out so fast. Sitting in the captain’s chair in the back of the ambulance I was buzzing with energy. We pulled out of the bay lights and sirens and my heart rate jumped even more. I had the biggest smile on my face and was ready for anything. My senior EMT had the clipboard and the paper chart started, the driver was focusing on the road maneuvering through the little traffic on the road and making sure we got there safely, and I was in the back putting my gloves on and grabbing the jump bag before we were even stopped. My senior turns around and looks at me, he says “Hey Nick this is your patient, also it’s for an unknown medical so make sure you do a really good assessment.” I nodded and gave a thumbs up.
We arrived on scene and I jumped out the side door. I strutted up to the house like I was the most important person there. I knocked on the door and this older gentleman opens the door. He ushers us into the foyer of the home. I turn to him and start my assessment. I ask him why he called 911 and what was hurting him. That is when the first curveball hit. “Oh I didn’t call my wife did, she isn’t feeling well.” I asked him where his wife was and what her health status was right now. He told us she was in the bathroom and she would be right out.
As she walks out of the bathroom I am confused. She looks like a totally healthy person. She’s smiling, no issues, walking, no extra work of breathing, not clutching her chest, nothing. They tell you in school to look for life threats, and I see none. School prepares you for the shitty patients. They teach and show you the patients who are dead, who are actively having a stroke, or are turning purple from not breathing They don’t really talk about the patients that are perfectly fine.
I do my full assessment, head to toe. I ask every question in the book, I follow the SAMPLE and OPQRST even though she doesn’t really have a story of how she is feeling. Her vital signs were fine and her assessment was unremarkable. This was a healthy looking and sounding woman. But, for some reason, she kept saying she just didn’t feel right.
Here is I want to take a break and back up from the story for a moment. As the title of this story suggests, something is going to happen to this patient that was totally unexpected. These stories, at the time I am writing them, are over 10 years old. These were the first few patients of my career, I have seen thousands since. The details are fuzzy. But, the thing I can promise you with this patient is that when she walked into my ambulance she looked like she was perfectly healthy. Ok, back to the story.
So, we discussed going to the hospital or staying home. The patient ultimately asked if we could take her to the hospital. We agreed. She was persistent that she could walk to the ambulance. We just saw her walk out of the bathroom with no issue. What could go wrong with walking her to the ambulance? So we walked her right on out, into the ambulance, and she sat on the stretcher. (Bet you thought she was going to fall.)
In the ambulance the lights were bright and the ride was bumpy. I sat on her right and my senior EMT sat on her left. He was more focused on the chart than on the patient. At this point there wasn’t much to do but take the 15 minute ride, no lights or sirens, to the hospital of her choosing. It was early in the morning so there was no one else on the round.
On the way I kept talking to her, she didn’t really want to talk, she just wanted to nap. Which I completely understand. Who wants to be annoyed by an eager 18 year old at 3 or 4 in the morning asking the same questions over and over again. She asked me to turn the lights down because it was so bight so she could rest her eyes. So, I obliged and turned them down a level. She asked me again to turn them down, they were still too bright and were hurting her eyes. I kind of was confused at this point. The lights weren’t overly bright and she was covering her eyes like she was in the direct sun.
She then began to grab her head and complain she was having a terrible headache from the lights and to turn them down as much as possible. Her exact words were “it’s the worst headache of my life.” This was the point that I went from wondering what could possibly be going on to concerned. I immediately turned the lights down to the lowest I could while still being able to see. Then, I decided it was time to dig deeper.
I performed a simple stroke assessment. Grab my hands, squeeze, smile, hold your arms up, move your legs. There it was, she couldn’t move anything on the right side of her body, she had a massive facial droop, and she couldn’t speak anymore. I told my senior EMT, his response, it’s fine don’t worry about it. This is where I decided I needed to grow a back bone or this patient was not going to have a good outcome. I stuck my head into the front and told my driver I either need a medic unit or you need to get to the hospital 5 minutes sooner. On the lights went and off he went to the hospital. I called the charge nurse and explained the situation.
We pulled into the ER bay and the whole team was at the door. They ushered us in. My senior going to the desk to register, I gave my absolutely terrible shakey voiced report to the ER doctor, nurses, and the neurologist. They rushed her to CAT scan and it turns out she had a brain bleed.
Now, was I ultimately the key point in this story that saved her life…..no. But this call taught me a lot. It taught me that patients didn’t read the textbook, only we did. The patients don’t need to justify to you how they are feeling, they simply need to tell you how the are feeling. Patients are funny people. They have these symptoms that only they can feel and they can’t explain it to you very well. You get statements like, “I don’t feel right,” “I just can’t explain it but something is wrong.”
This patient taught me the biggest lesson of my career. ALWAYS BELIEVE YOUR PATIENTS. Patients have no obligation to justify to you that they are sick. They are our patients and we are tasked with treating them respectfully and with dignity. They don’t need to show us with crazy abnormal vital signs or with obvious symptoms. They just need to say “Something isn’t right” and we should be treating them like our sickest patients with all the symptoms in the world.
-The Baby Medic
