A Bigger Ambulance

"You're going to need a bigger ambulance," the police officer says when we pull up in our van.

"I don't like the sound of that," my partner says.

Niether do I. Already I can feel my back tightening up.

Inside the small dirty apartment we find a tiny older woman, who points us down a hallway. At the end of the hallway in the bedroom, our patient sits on the edge of his large bed, leaning against a cane. I'm guessing he is 600 pounds -- a wide 600 pounds. The man, in his late thirties, says this is the heaviest he has felt, and his heaviest recorded weight is 619. He says he has been retaining water and feels bloated. "I can't even get up to go to the bathroom anymore," he says. "I had to pee into a water pitcher just now," he says. "Basically I'm drowning in my own fat."

I pride myself on my ability to figure out situations, but when we find out that our bariatric ambulance, which is capable of transporting people up to 1000 pounds is out on a distant call, I am at a loss. Our dispatcher tells us to unscrew our stretcher mount and use a fire department stokes basket. The problem is the local department's basket is only rated for 350 pounds, plus the man cannot lay flat. He is too heavy and too wide to even consider our stretcher. And there is no way he could walk out to the ambulance and try to step in and sit.

While we are trying to figure out what to do, the tiny woman, who by now we know is the patient's mother, asks her son if it is okay if she has a can on his minestone soup. He thinks about it, then says, "okay, I guess, go ahead, you eat it."

Strange.

Back to what to do with him. The only option I see is to get a flatbed truck, but it is pouring rain out. The cop finally comes up with the solution. He looks stable, why don't you just wait for the big ambulance. They tell us it will be an hour and a half at least. But the man's problem is not acute. The bottom line is he's 600 plus pounds and feels crappy because of it. He agrees to wait for the big ambulance, signs a refusal, and says he will call us back if he experiences any problems while waiting.

We go back out to the ambulance and clear. Our dispatcher won't let us leave the scene. He sends a supervisor on a priority to see what is going on. They had sent us on a priority one for difficulty breathing, we have mentioned the patient is large, and now we are clearing refusal. Sounds suspicious, even though we have thoroughly assessed the patient and found him stable and we did set it up with one of the dispatchers to have the big ambulance sent to the address as soon as it is available. We meet the supervisor outside, and explain the situation. This is a chronic problem, not an acute problem. Since we have a bariatric ambulance, and there is no rush, it makes the most sense to wait till it is available, as opposed to taking him in through the rain on the back of a flatbed. He won't fit in one of our van ambulances. The patient prefers to wait for the big ambulance. We go back in to talk to the patient. We find him happily eating cherry popsicles.

***

They station us near the scene. We are certain that when the big ambulance becomes available, we will be sent to do the call. Then we get called for another emergency in the town. While we are on scene, we hear a crew being dispatched for the 600 plus pound man. We hear later that when the crew of the bariatric ambulance takes him in, the hospital staff says, don't leave, he'll be going home as soon as the doctor sees him. Evidently, he is a frequent flyer, although an increasingly larger frequent flyer.

The call we are at is for a man with COPD and a probable respiratory infection. I have taken him in before. He is the man who called the ambulance a few moments before the child was run over by his mother in the same town. If he hadn't called 911 when he did, my partner and I would have been the crew dispatched to that horrific scene. He spared us from that call, and now he has spared us from the 600 pound transport. I shake his hand when I say good bye to him at the hospital.

***

Eight calls total. The above two and a nursing home transfer to the wound care center, a broken knee in a nursing home(gave her morphine), a female heroin addict with HIV with pnemonia which weakened her to the point she couldn't get out and get her fix so now she was in withdrawl, a 60 year old man in heroin withdrawl, a motor vehicle with no injuries, and a mentally retarded kid who lay down and said he felt sick and wouldn't get up.

Let's of driving, lots of rain, lots of traffic, the days are getting darker. My back hurts just from looking at the 600 pound guy.