Note/SuperImposed

We were sent to a group home for a fall only to find an apparently uninjured 50 year old woman with Down's laying on the floor, saying her back hurt and to call her mother with the bad news. The aide was on the phone telling her supervisor they had called the ambulance to cover themselves. The physical survey was unremarkable. The aide told me the woman had hit her while they were arguing over a napkin, then the woman had pulled at the napkin, then let go, hit against the wall, then fallen slowly to the floor.

I have been a really good paramedic since I came back from the Dominican. I just really have been at the top of my game both medically and as importantly with the bedside manner. I have been battling some bad news about the health of a friend and it was starting to break me today, and I snapped at the driver on the way to the call for going to slow looking for a turn when clearly there were no turns visible. Anyway, I have been to this home many times before often for similar calls, so I just ask which hospital, put the patient on the stretcher and take them in. It is easy than getting upset, and it isn't even my place to get upset.

So we're riding in and I am reading through the big blue book with all the patient's history, and here is the gist of the patient's story. Born to older parents, she lived with them at home for many years. Her mother is a nurse, and she often went in to work with her and volunteered helping the elderly patients. She was beloved. Her father died, and then, her mother aged now and in a wheelchair, was having a harder time taking care of her Down's daughter, who getting older herself started having some mental problems, and one day, attacked the mother. The mother scared of her daughter could no longer care for her and the daughter had to be removed and was placed in this home a few years ago.

Here is what the nurse wrote in the notes introducing the patient to the staff:

"This is a very difficult and confusing time for Y. She was born with disabilities and her family embraced her and cared for her throughout her life. Her parents aged. Her father died and her mother is increasingly frail. This is frightening to her and she has no idea how to manage in the future.

As a result of her Down Syndrome, she is more likely than we are to have problems with dementia. That means that her memory is failing her and that she has to come up with an explaination in her own mind for the things that no longer make sense because her memory is failing her. She has created a host of "friends" who are part of her everyday life, as well as the notion that she is pregnant and will soon have another child. What a wonderful way to surround yourself with the family that you see is dying off!

The false ideas that her mind creates serve to provide comfort and safety against fears of aloneness and isolation that she cannot imagine she could endure. We have to learn how to live with these things and to help her to feel more secure.

The memory loss that comes with Alzheimer's Type Dementia can be hard to deal with. And it can be seen as a wonderful protection against the many things that memory would serve to present as unbearable. Imagine being more than 50 years old and having nothing but the security of your parents love. So, as memory fails, and fears of being left alone in the world increase, you develop ideas about any number of people who will be here to share your life.

As we care for Y and come to learn her strengths and limitations, we must also understand that her life has been very different from ours and from the lives of people whom we are accustomed to serving. Until today, she has been protected by the love of family that many we serve have never known. And it was her behavior that brought that to a halt.

While we have many thoughts about how wonderful it is to serve people who would, without the care we give, be in institutions, we must understand that Y has known a lifetime of family and safety. We are not rescuing her from something awful, we are supporting her in a time of tremendous loss and separation."

You find poetry in most unexpected places.

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Only other call was for an old obese woman diabetic, short of breath with a high blood sugar.

***

I was supposed to work in the city tonight starting at six. Ten minutes to six a call came in for a motor vehicle and we responded to find a Saab wrapped around a telephone pole. The patient was pinned in the driver's seat, the door against her hip, the airbag deployed, the steering colum broken, and the patient was screaming about how bad her head hurt. It was split open in back. I didn't think we were going to be able to get her out of the car with out the fire department. Two of the cops were banging away against the passenger door. I was talking to the patient through the window. I made sure to tell him my name and say I would stay with him. I kept looking up at the wires on the telephone pole. They weren't loose or anything, but I was standing right under them. the car was rocking. It was on an incline. Glass was flying. I got an 02 mask on him and a collar, and amazingly the cops got the door open. I still didn't think we were going to get him out. The door was halfway across the front seat. I went in through the now open passenger door and was able to link and pull her him out onto a board. He was very pale. His hip was killing him now. We got going to the hospital right away. His heart rate was up 160. He was screaming for me to give him something for his pain, but he wasn't stable enough for me to give it to him. The night medic had met me on scene so he rode in with me which was great. We got the trauma room and he was headed for surgery when we left. The x-ray of his pelvis looked like two people superimposed. The left side was almost on the right.

I was in the EMS room writing my report when I saw the other five people reach for their pagers. Then all said at once to me, they're looking for you, you're supposed to be in the city. You're on the schedule. I called in and told the supervisor I had arranged with another supervisor a couple days ago for them to come get me in an ambulance at the suburban post at six and then drop me off there at midnight, and he said it was all set. The message didn't get through. I told the supervisor I was still at the hospital. They didn't have anyone to work with me anyway, and since I was beat, they said I could just go home, so tonight instead of eating in the ambulance in the rain, I've had a steak and a beer and some fried green plantain, and am soon for bed.