Saturday, November 28, 2009

Helping those who don't want to be helped

Although firefighting is where the real excitement is, the majority of the calls we run are medical in nature. That's ok, though, I actually really enjoy medicals. I like the times when we're able to make a difference in a patient's life when things are going really badly. Helping someone out of a wrecked car, keeping an unstable patient alive until they get to the hospital, or even just providing a little comfort to someone who is dealing with a scary illness or injury; those things are all good experience and are their own reward.

Admittedly, there are many people you can't do much to help. Plenty of people are just not savable (already dead for too long, injury inconsistent with life, etc), and many others are not true emergencies and involve people who are just in a hard socio-economic group and the only way they know of to get medical help for any condition is to call 911.

But then there's a third class of medical call, one I had not experienced until just recently. You see, some people for one reason or another don't want your help at all and are angry at you for even being there. That's new to me.

The day of Thanksgiving, I ran a call to a middle-class neighborhood residence. It was dispatched as "Unconscious", and on the way we got enough information to know that this was a young guy who was visiting his parents for Thanksgiving, and who had gone into a really heavy state of sleep. So heavy that when he rolled off the bed and hit his head, he didn't even wake up. We were advised that he was taking Xanax, and one of the side-effects of Xanax is possible drowsiness, but this level of unresponsiveness was a little bit past "drowsy".

When we arrive, we walk into a bedroom and see...nothing.

"He's behind the bed!", the dad notes from the hallway.

We peak over the bed, and there he is, facedown and contorted up, wedged between the bed and the wall.

"Check his breathing, please" the Captain murmurs as he begins to open the med-bag.

Leaning close to the kid I can hear respiration and can feel it on my face. Smell it, too. Definitely breathing.

"He's breathing, but it's a little shallow, probably due to his position. Shall we move him?".

We each grab a body part and move him out into the center of the room. He moans and moves a bit as we move him, but goes flat out again as soon as we lay him down.

"Let's get him on some O's", I hear from over my shoulder.

I pull a non-rebreather out of the packaging and hook it up to the oxygen bottle that's already been primed for me, then apply it to the patient's face. He doesn't like that.

Sitting up groggily he yanks the mask off his face and asks what's going on.

"You were pretty unresponsive there, for a while", the captains says to him, checking his pupils (which are currently small pinpoints).

"I wass nnnapping" he slurs.

Now we have a paramedic from the ambulance in the room, already briefed by the parents, who asks what's been going on, pointing out that the heavy sleeping, The grogginess and slurred speech seem to indicated something is wrong.

"I'mmm sleeeepy" he manages to get out.

"Well, your behavior is not quite what we'd expect from someone who is just sleepy."

He REALLY doesn't like this

"Well! I didnn't knnnow...that..that...that therrre was a RIGHT wayyy to be SLLLEEPY!"

"Calm down, buddy..." the medic says

"NO! see, you'rrre starting to piss me off herrre! Herrre's what's going on...", his speech is improving a bit as his new found anger cuts through the haze, " all are in THIS house...telling ME how to be f***ing sleepy!....and I don't apppppreciate it....So all five of you motherf***ers can just take a flying f*** out the g**damn window....cause I swear if I find out where YOU live...."

by this point the medic's motioned everyone out of the room and were back out front, police on the way. Once someone starts to get potentially violent we are supposed to have law-enforcement on scene to handle that kind of stuff.

While we're talking out front, I'm still trying to figure this out. I mean, I don't even know this guy, so I shouldn't care, but the fact that he's so upset at us for coming in here to try and help him is bothering me a bit. It stings when you reach out with compassion and get met with anger.

As I though about it, I began to see why the guys who have been on the job for a long time seem more likely to be rather unconcerned regardless of the situation (almost to the point of being dispassionate). Apathy is hard to offend. If you don't care about someone that much, nothing short of a physical assault is really going to hurt you. But if you put yourself out there emotionally; if you try to feel some empathy for someone who's having a rough day and you do your best to have concern for them and help them, and they reject you, it feels like pretty much any other relationship where you get something nice pushed back in your face. Far safer to not care that much in the first place.

But is that unfairly punishing the patients who need empathy for the actions of those who are going to be a jerk about it? Certainly the number of people who call 911 who would benefit from some reassuring attention far outweigh those who are going to lash out at you. Should we dispense compassion based on nature of the call? Cardiac patients get sympathy, drug-addicts don't? That doesn't seem quite right either.

I guess I don't really have answers yet, just questions. Hopefully they'll come to me before the day arrives when I too start looking at patients with empty and uncaring eyes.

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