Sammy

I've been avoiding this post for at least a week.

There's this guy that I've been picking up lately. His name is Sammy. The first time I had him it came accross as a Cardiac Arrest. We almost took out a cop car on our way there.

And there he was, walking in the street like an idiot, his mouth wide open, breathing exagerrated as though he was gasping for air. My partner had had him before many, many times. "I need oxygen! I can't breathe!" he would yell between breaths.

Lungs clear and equal. Oxygen saturation 100%. Diagnonsis: EDP (Emotionally Disturbed Person). That's shop talk for "Lunatic," in case you didn't know.

The funny thing about being in EMS is that you see enough EDP's that you learn to recognize them on site. The moment a person opens his or her mouth––and sometimes it doesn't even take that much––the diagnosis becomes clear.

I always have a hard time with EDP's. I just, I don't have any compassion for them when they call 911. I just don't care. They are a waste of my fucking time. Sometimes, a person wigs out cuz something bad happens and that's understandable. But the drunken lunatic that calls 911 twice a day––well, I really don't care if he gets run over by a truck. Really, I mean it. I just don't even view them as human beings.

The irony behind all this, of course, is that my mom would be one of them if things in her life had turned out differently. She is officially an EDP. Certifiable. But she is also a good person with a big heart.

But growing up with my mom prepared me--hell, predisposed me--to this job, to this line of work. Being a paramedic is about managing chaos well, and my childhood was, well, mostly chaos. Mom flipping out, breaking things around the house. Screaming at 3am and waking the neighbors. Crying inconsolably. You get the drill.

But that childhood made me who I am today. Now I thrive in chaos. It suits me well––it makes me comfortable.

But there are the EDP's themselves. I can't bring myself to look them in the eye as though they were human. I just, I can't do it. It would bother me too much. I'd rather hate them than let that happen. Nothing is worth that price.

Really, Sammy just needs a place to live where people will take care of him. He is not fit or meant for society, at least not when I see him. He is straight EDP––so far gone from the realm of the normal that there's no mistaking him. Everyone, even the neighbors, know he's crazy.

He was asking for oxygen, saying he was having an asthma attack. We had a student and she was preparing an albuterol treament.

"Hold it there kiddo," I said. "What's this guy's chief complaint? What's wrong with this guy?"

The student looked at me, slightly confused. "Shortness of breath," she said, nodding her head, "he says he can't breathe."

"Okay," I retorted, rolling my eyes, "but what do you see, what do you really think is wrong with him?"

"What do you mean?" she said, still lost.

My partner hopped into the mix, trying to talk her down from the ledge off which respectable, street-wise medics like us hope never to fall. "What's really wrong with him?" he asked, trying to rephrase things somehow. The whole exercise last five minutes and went nowhere. Finally, I lost it.

"The guy's a fucking EDP!" I shouted. "He's a fucking lunatic, and oxygen does not fix crazy people."

Meanwhile, Sammy started crying. "I need oxygen, please!"

I refused to make eye contact with him.

"Let me put it this way," I explained rather flatly, "what's going on my paperwork? Am I gonna write this up as a Diff Breather? Or as an EDP?" My student nodded as I said 'EDP.' I paused for dramatic effect. "So if he's an EDP then why the fuck are we giving oxygen!"

"But there's no contraindications for oxygen," she replied. I cut her off.

"We're feeding into this fucker's little game. He calls 911 because he wants attention, and every idiot who gives him oxygen and a nebulizer treatment is encouraging this shit. Remember, we dispense treatment because we think something's wrong with the patient, not because they ask for it. We run the show––not the patients, remember that."

We took Sammy to the city hospital. On the way, our student put an oxygen mask on him on the way there. I glared into the rear-view mirror with disapproval.

We walked him into the ER from the ambulance and made him carry the unplugged oxygen mask in his hand.

As we stepped inside, an EMT looked at us sidelong. "Okay, which one of you was it?" she said "Which one of you gave Sammy O2?"

I shook my head and pointed at the student. The EMT laughed. "And you guys let her?" she asked.

I looked away feeling slightly embittered. At the same time, the triage nurse pointed him to a seat and told him to sit down. He was going straight up to the psych ward, which made us and him happy.

That's all I wanted: Sammy away somewhere. I didn't care if it was in a psychiatric ward or a shallow grave. I just wanted him gone--and right now I'm tired and honest enough to say that I didn't care where it was.

Comments

[Airway Control]

Wow, that was a terrific story! You've definitely got writing skills. Well done. In one paragraph, you captured the essence of much my frustration working in an ED:

"We're feeding into this fucker's little game. He calls 911 because he wants attention, and every idiot who gives him oxygen and a nebulizer treatment is encouraging this shit. Remember, we dispense treatment because we think something's wrong with the patient, not because they ask for it. We run the show––not the patients, remember that."

Unfortunately, many people think we work in the customer-service industry. Fuck that.

[radtec]

Great post. I wonder..if the reason most folks don't want to deal with the EDP's of the world, is because somewhere in the back of our heads..we all know it could be us. One extra stressor..one major blow to the psyche, one bang on the melon. We are all a knot on the skull away from this guy and losing it. It doesn't do any good to wonder what he used to be...cuz that was then and this is now. As long as you are doing what you're supposed to, and he is getting some care in the ward, then I call that an even deal.

[Kim]

THAT was one powerful post!

The thing is, had there really been something physically wrong with Sammy this time, you would have seen it, you would have known the difference and you would have treated him accordingly.

The only way to stay sane in this business is to be honest with how we feel, good or bad, whatever.

Do you feel better now that you posted it?
I hope so. You did what you had to do and an EDP got three hots and a cot for at least a day.

Sounds like a good deal to me.....

[Kelsey]

Try to take a step back and remember the basics. Maybe some of your "EDP" patients really have a medical problem. Even emotionally disturbed patients have a problem, albeit a chemical problem in their brains. Everyone needs to be treated as though they are having an emergency.

Take this last weekend. We had a patient complaining of his "throat being tight". We cleared the fire department, because it looked like he was having an anxiety attack... Another bullshit call according to my partner. While we were trying to calm him down, he arrested on us, and we were by ourselves trying to code this guy until fire could get back.

Maybe a little compassion is all Sammy needed.

Treat everyone as a medical even if you see them five times a day.

[Carmelo]

Where have you gone?

[traumadude]

I am both a medic and an ER RN I have been on both sides of the ED RN report. Giving and getting it. We have all had these patients. They are stressful to say the least however I think your treatment of him and your obvious discontent for him is a perfect indication that you are burned out and perhaps should look for another job.
I agree with the comment made my kim. Psych patients have legitimate issues just as much as the pt having an MI, stroke or an overdose. We dont get to pick and choose who we care for..not in this job..you take what youre given. We dont get the glory call for every patient. Yes some patients do need extra attention--like Sammy.

"We run the show––not the patients, remember that." I also disagree there. We dont run the show..the patients do. We are there for them..theyre not here for us. Yes patients dont always know whats best for them but those days of "lay there and shut up and do what I say" are over.

"Really, I mean it. I just don't even view them as human beings." This whole post shows over and over again that maybe you nee to get out EMS and go sell cars. I am truly glad I dont work or live in your city

[bing]

I like that!

[Ragamuffin RN]

At first I thought Carmelo & Kelsey were perhaps a little harsh but after reading the rest of your posts I don't think they was harsh enough!

I worked as a Pediatric ICU nurse for 13 yrs and had the misfortune to encounter nurses & techs who had lost there compassion and empathy d/t burnout (or perhaps they never had it). I always swore I would quit before I ever became that way.

When you lose your ability to see the humanity in others (whether they be lunatics, drunks, drug pushers, prisoners or anyone else who is suffering misfortune from the mistakes they've made) you need to get out of the healthcare field. After all, the majority of persons we see are the broken and they deserve all the compassion we give them.

You're not doing anyone any favors by being a paramedic who just doesn't care! Yes, honesty is a good thing but it can also just show you are a pr--- (rhymes with stick). Get some counselling but stop working as a paramedic, at least for now. Right now, mentally you're no different from the EPDs you so much despise.

[vikyi]

Great site!!