Abuse

I am tired of being verbally abused by patients. I'm not talking about the run-of-the-mill obscenities and minor threats, that happens every day, every call. In the last week though, I have had 2 patients that are so incredibly abusive and belligerent that I have feared for my safety. And there isn't much I can do, either the police are unavailable or there isn't much more than a gut feeling about the person, no documentable reason to delay care. So I put on my professional face and carry on, praying for my safety and hoping I can move faster than the psyched out, drug riddled person sitting far too close to me.

The first one asked for drugs right on his 911 call, and they sent us lights and sirens across town with no police available. He started swearing at me the second I stepped out of my truck, demanding I give him prescription medications and a free coffee. He jumped in the back of our ambulance and then we were stuck. He became more and more abusive the longer we sat in the parking lot, to the point that waiting for police to arrive became more risky than trying to make it to the hospital without them. I was on the edge of my seat, talking him down the whole time, with the student behind me. My partner and I had already decided that the second he removed his seat belt, she was pulling over and the student and I were bailing. Fortunately we made it to the hospital without violence, but that was the longest 7 minute drive of my life.

Tonight, another one. The shelter calls us because he is crawling around on the floor, moaning in pain. When I ask him what is wrong, he rolls over, looks me in the eye and says, "None of your f-ing business". It didn't improve from there. Yelling obscenities, threatening to punch my partner and myself, trying to smoke in the ambulance....not what I want to be dealing with at 4am. I wasn't as concerned for my safety with him because he wasn't a huge physical threat, I can talk him in circles to keep him calm and move a hell of a lot faster than his drug-wasted body. It is still difficult though, to be in a career where I genuinely want to help people, ease their pain and care for their injuries, and I get this in response. Ever wonder why paramedics aren't always all sunshine and rainbows? This is why. The lowest, most vulgar, despicable free-loaders of society treat us like punching bags, and there isn't a damn thing we can do about it. Just stay calm, keep them calm, and pray we go home safely.

Croup

We can hear it from the sidewalk as soon as we step out of the ambulance. A cough as distinct as it is terrifying, the "bark, bark, bark" of a child with croup. We haul the stretcher through the ice and snow that is thickly coating the driveway, squeezing past a minivan to get to the front door.

"Bark, bark, bark". An adorable little boy, about 5 years old, is being held by his worried mother on the couch. There are many firefighters and even a police officer in the room, but I ignore them all as I focus on my little patient. He is pale, with a bluish tinge around his mouth and nose; wide terrified eyes stare up at me, but never really focus. He is fighting for breathe through his narrowed airway, all of his accessory muscles have been recruited to help him draw air in. He is the worst I've seen yet, he is rapidly reaching exhaustion and will stop breathing sooner rather than later as his airway continues to swell shut.

My partner is assessing his vital signs as I talk to the parents and get a history, all the while pulling out the medication he needs to open up his throat. Remembering my last croup call where my partner knocked over my mask with 4/5ths of the medication already drawn up, I recruit the firefighter with the steadiest hands to hold it for me. The one without kids of his own, most likely. I now must crack open 5 glass vials and using a syringe, draw out each 1mL amount of epinephrine. I must be as fast as possible, as this child is losing the battle, his eyes beginning to roll back before he fights his way back to consciousness. He's a tough little guy.

We get the mask on his face and carry him right outside. No waiting around for the meds to work, I don't want to have to ventilate this kid if and when he stops breathing. Then, about 2 minutes after the mask goes on, the magic happens. His cough lessons, his breathing eases, and he begins to cry and squirm like a scared 5 y/o should. "Mommy, I don't want to go! I'll be good, don't make me go to the hospital!". His Mom has tears of relief in her eyes as she reassures her little boy, and thanks me repeatedly. I am so happy I have the ability to treat this illness, I never get tired of seeing the rapid turn-around in these kids. He is breathing much more calmly now, and his Mom and I keep watch as he starts to fall asleep, exhausted by his previous effort to breathe, bathed in the glow of our strobe lights.