Patient Reunions

I have been having a correspondence with a woman who was badly injured in an automobile accident a number of years ago. She wrote to me yesterday about how a paramedic had visited her in the hospital and she thought he was upset because she did not remember him. She felt guilty that she did remember him or never learned his name even when he came to visit.

I wrote back that I did not think she should feel guilty. One, its
natural not to remember trauma -- I think it is part of the body's defense mechanisms to blank it out. Two, I think having to thank someone is wrong because we are after all just doing our job, and just because you help someone shouldn't neccessarily require them to owe you gratitude.

I know there are many medics who often go visit their patients in the hospital to check on them. Not being remembered is fairly common. I often stop back and see them during the course of the same day if they are still in the emergency room and I am bringing in another patient, I'll stop in and chat. But I have never gone up to the floors to check on them or tried to arrange a meeting once they have left the ER. Many of them I could be standing next to in a check out line and I wouldn't remember them and they probably wouldn't remember me.

One benefit of working frequently in one town is having repeat patients, but our relationships exist mostly only when I am called to help.

I think patients have a right to privacy, a right not to be reminded that they were once vulnerable and dependent on a stranger.

While I like to know what happened to a patient, I do not feel the need to go up to their hospital room and expect to recieve their thanks.

***

I have never had a Rescue 911 style picnic reunion with a patient. I have occasionally had patient's come up to my ambulance and say thank you for taking care of them, and I ask them how they are, but I often don't remember them. Many times I have had word sent to me, particuarly in the suburban town where I reguarly work, through people who work on the ambulance with me and know the patients socially, the patient's update and thanks for my efforts.

Over the years I have had some strange encounters with ex-patients:

1) A couple mornings a week (while on duty) I used to the Country Diner for french toast and bacon. Its the local hangout in town. Most of the crowd is old folks, retired people who take their time drinking their coffee. Going there I felt a part of the town like we were the good guys and everyone liked us and smiled good morning and have a nice day.

One morning I'm sitting there and see this old guy looking at me. He looks familiar, but I can't quite place him. I figure he has to have been one of my patients.

He finally comes over. "You remember me?"

"Yeah, yeah," I say, "How you doing?"

"You took me to the Hospital."

"Yeah, I remember," I say, although I don't. "Glad to see you're doing better."

"Better? Huh! I got a bill for three hundred dollars from you fucking people. Three hundred dollars for a back injury. I went to the doctor and he said there was nothing wrong with my back. They kept me there in the hospital eight god damned hours. And then they sent me home, I didn't have any god damned clothes. All I had was that johnny you put on me. I had to take a cab home, bare-assed. I don't know what kind of outfit you're running but hell if I'm giving you three hundred dollars so you can buy french toast and bacon every goddam morning."

Everyone in the place is watching him yell at us.

"Pip it down now, Edgar," Mary Beth, the regular waitress says. "Show some manners."

"I'm sorry, you were disappointed," I say.

"You aren't getting my money," he says. "This god damn town is going to hell in a hand basket," he says, as he walks out.

"Don't mind him," Mary Beth says, "He's an old pain in the ass."

It takes me awhile, but I finally remember him. He lived on the second floor of an apartment building. He was having a pain going into his back, and had been vomiting. I like to put my patients into a hospital johnny so I can access them better, palpating their abdomens, listening to lung sounds, putting on the ECG . When they get to the hospital, they are all set, and don't have to have their IV bag delicately weaved through their clothing as they are changed. I remember now getting him into the johnny. We usually always take their clothes along with us so they have soemthing to wear when they get discharged. We must have left his clothes there.

I have this image of him, standing his bare butt sticking out of his johnny as he stands on the street corner signaling a cab. The old bastard.

I stopped eating at the Country Diner after that.

2) An Encounter

3) One of the better reunions I had was when I was sent for an unresponsive man and found him sitting outside on a garbadge can, leaning against a garage. His friends said he drove over, was talking to them and just went unconcious. It seems like he is stroking out. He is completely flaccid on one side. I verify that he indeed did drive to that location and was fully functioning. I get him in the back, and we're off lights and sirens, I'm planning on calling in a stroke alert. I take the man's wallet out and look at his license. It is a name I recognize. I don't recognize many names, but this one stuns me because it is the name of a cardiac arrest I worked. I had found the man outside where he worked as a yard man, apneic, pulseless. I shocked him into aystole, then intubated him, and started pounding in the drugs. Halfway to the hospital I got a pulse and BP back, but no purposeful movement. I figured it was just the epinephrine that got him back, and that as soon as it wore off, he would go back to being dead. I've gotten BPs back on a lot of codes, but unless I get purposeful momement I pretty much write them off as dead. And as I have mentioned, I rarely follow up once they leave the ER.

Anyway, just then the guy starts coming around, opens his eyes, regains use of his left side and starts talking to me. He was just having a monster TIA. I ask him if he ever had a heart attack and he says yeah. I ask him where he used to work, and sure enough he is the guy. His family is in the ER when I bring my completed paperwork back to the room to drop it with the nurse, and I get in a conversation with them. They said they had tried to find me at one point to thank me, but didn't know who to call. They ended up leaving a message with the fire department who wasn't even involved with EMS in that town. Still it was nice meeting his family in the ER and being called his guardian angel.

4) Probably the worst reunion was when I had to do a nursing home transfer of a woman who I had tried to help, who was an asthma code. She wasn't breathing when I got to her address. Another crew was carring her across the yard. I got her back, but I had difficulty getting the tube at first, and although she lived, she suffered an anoxic brain injury. If I had gotten the tube on the first attempt, I think she might have done better. Seeing her in the nursing home was tough. She was alive, but no one was home. She had a trach and skin infections, and a foley catheter and a feeding tube. She was the only one I tried to see up on a floor when she was in the ICU, but the staff wouldn't let me up because the family didn't want visitors, although the staff did give me an update.

Maybe I should visit my patients more. Maybe it would give me more personal connection to all patients. The might be a good thing, but it might also make the job more difficult.

I think for the time being I am just going to keep trying to ask the patient's their names when I am with them, use mine and be as nice as possibile during the limited time we have together. Then the patients can go on with their lives and I can move on to the next patient.

***

Three calls so far today. A back pain due to sciatica, a nursing home abd pain, and a woman with neck pain who we c-spined after she wacked her head going up the stairs. She'd didn't want to go to the hospital, but she couldn't move her neck and it hurt when I touched it. I am interested to find out what her x-ray looks like. I'll check if I get back there today. Or if not, I'll try to follow up with the nurse.