Sunday, June 3, 2012

Doctor, Doctor, you give me the blues...

Hard Wednesday:
My first five runs the other day left me grasping for a teddy bear, but the way the shift was spinning, the bear would have been mangy, missing its legs, and suffering a suppurating ear infection. The trajectory from professional medical indifference or incompetence to the depths of unsolvable misery stamped sorrow and anguish into our minds and hearts.
Right away as the shift was starting, we were called to the clinic down the block (one of two medical facilities within six blocks of each other along Bloomington Ave, but not the one we burned to the ground last winter: that’s a nice empty lot currently). A woman was having a ‘Severe Allergic Reaction,’ according to Dispatch’s comments. We arrived at the clinic and were escorted through the maze of hallways and cubicle-offices until we reached the room where a 50-something woman was sitting on a chair across from a doctor typing into a computer. The woman was lumpy and fleshy, but she was not presenting with allergic symptoms--certainly not severe reaction symptoms. Now, doctors have far more training than I do, so I defer to them in these situations. I asked him what was going on, and as he narrated what he’d been typing, I assessed the woman. Christie provided her an oxygen mask and took her vitals. Everything checked out in the normal range. 

The doctor’s report stated she had had her medications switched recently and now she felt she was having an allergic reaction. He said she’d stated she was having chest pains, difficulty breathing, prickles up and down her arms, and swelling all over her body. He said she’d come in this morning to have her medication checked again, but when she complained of an allergic reaction, they’d called 911.

I was listening to him, but I was focusing on the patient. The woman was breathing quickly but without strain. There was no swelling, no redness or blotching, no hives. She looked fine, basically. ‘Ma’am, do you have other medical issues?’
‘Oh yes,’ she said, nodding vigorously.
‘Do you have anxiety issues?’
‘Oh yes.’
‘Ma’am, let’s work on slowing down your breathing. You don’t seem to be getting enough oxygen, and that makes things tingle.’ We cut off the oxygen. Christie tried to get her to slow down. I asked the doctor what made him think it was an allergic reaction. ‘She said it felt like an allergic reaction and she was worried her throat might be closing.’
‘Did it appear that she was in a medical crisis?’
‘She needs her meds re-calibrated, so we thought it best she went back to where she got them.’

The paramedics arrived. I explained what we’d found. The patient was breathing much better, but still, she insisted, she was worried she might be having an allergic reaction. The medics smiled and patted her hand, then had us load her onto the stretcher.

I was fuming: a medical doctor calls 911 (has his staff dial 911) because a patient with anxiety history claims she thinks she’s having an allergic reaction--despite presenting with nothing more than anxiety-based shallow breathing. For a code-three EMS response and an ambulance ride to the hospital. A medical doctor.

Back on the rig, we pondered whether he was that cynical, lazy, or incompetent that he simply passed her onto the next facility rather than explain to her she was fine and to slow her breathing, or to have her schedule another non-emergency appointment with her regular doctor to check her meds.
We were finishing our morning station duties (mopping, cleaning bathrooms and common areas, checking the rigs, arranging inspections) when a call for Difficulty Breathing came in. We dropped the mops, phone, paper and headed out. Our patient was another 40ish-going-on-66 year old. She’d recently been diagnosed with congestive heart failure (CHF) and CHF-related asthma. Their apartment was thick with recent and ancient cigarette smoke, with teeming ashtrays perched on multiple surfaces across the rooms. The woman was sitting stiffly on the edge of a chair, laboring for breath. One look at her, in her eyes, and we could see she was deathly scared. Her failing lungs were literally suffocating her. Insufficient air exchange meant there was always fluid accumulating in lungs and in body, slowing choking her. We slapped the 02 mask on her and took vitals. Her blood pressure was over the moon. We tried to calm her and had medics bring their canvas in. 

There is a feral agitation to folks suffering this form of CHF. Both drowning and suffocating: hell of a slow death. And it is slow, and constant. They rushed her to the hospital, where the staff would give her a series of meds to drain the fluids and open her lungs. She’d feel better, briefly, and they’d release her. Within hours of getting home, the symptoms would return, and soon she’d be struggling to get enough air in, straining and fighting against the elephant foot of death grinding dead-center of her chest. We felt for her--that panic and fear are very real. Yet she and her husband would continue to smoke until they couldn’t lift the butt to their twitching lips any longer. Slow suicide.
We were between an inspection and shopping for lunch and dinner when the next call came in. A Possible Heart at the oncology unit of the medical complex on Chicago Ave. Hey, kids, want a really depressing field trip? Let’s go to the cancer ward! And off we went. It is strange to respond to these medical clinics and doctors’ offices. We are barely trained clods with 02 and AEDs--why do the medical professionals need us? I try to be inconspicuous, or at least unobtrusive, when we walk through the expansive, always crowded waiting room. So many people with cancer...

Our patient was a mid-50s woman with pancreatic cancer. She’d just had her second run of chemicals and was feeling very ill. ‘Are you having trouble breathing, ma’am?’ I asked. She shook her head. Her daughter said the first run, the previous week, had made her feel very nauseated. I asked if she felt similar now. She nodded. The woman looked ill. We took her vitals, which were on the lower side of normal. She was breathing normally. Not a heart attack. The daughter offered that her mother had been indicating her abdomen when she told the nurse she was having chest pain.

The woman made a urping sound and reached her hand toward her daughter, who swiftly grabbed and handed her mother the emesis bag. The mother vomited. The daughter was skilled at caring for her. ‘This is similar to response she had the first time?’ I asked the daughter. She nodded. I looked at the woman, who was vomiting discretely, almost calmly. She finished. Her daughter took the bag from her; I peered into it to ensure there was no blood. The mother looked much better, less pale green. ‘Do you feel better, ma’am?’

She nodded.
The primary side-effect of chemo is nausea and vomiting. This is a doctor’s office specializing in cancer treatment. A patient complains of pain in her abdomen after her chemo run. The don’t ask any follow-up or substantiating questions but call 911 for a possible heart attack.

I wanted to scream.
This woman was dying of pancreatic cancer. There’s no cure. She was clearly suffering from symptoms of the cancer and its treatment. WHY would we heap insulting, futile non-treatment with a dumb ‘emergency’ call that will only keep her away from her own bed and trapped in bureaucratic revolving wheel of waiting rooms and paperwork--how DARE we be so venal?

My best friend’s mother died from multiple myeloma a couple years ago. She was sick for over six years, nearly dying early into it, recovering/stabilizing for three, then going quickly. She had great pride and dignity, and the endless humiliating routine of office visits, waiting, disinterested treatment by the doctors and nurses, waiting, and the sickness itself wore her out. The indignities of being a patient, a number, were almost as bad as the cancer itself. I think of her whenever I’m in these offices. It’s just wrong. 

When the paramedics arrived, I explained to them that there had been a miscommunication, that there was no emergent issue, and encouraged them not to transport her. Too often, the medics arrive to something clearly not-serious and transport anyhow, because the risk or threat of being sued by a malcontent or scammer for mistreatment or dereliction trumps common sense. It’s easier to throw one more body into the churning machine than to help people help themselves.
We were unloading the groceries and settling down to lunch when the next call came, for an intentional overdose. Some self-harming calls demand we stage until police secure the scene. Others, it’s the captain’s decision. The comments stated the patient had taken too many meds and was semi-conscious in the front yard. I said we’d go in on our own. 

The address was two blocks away; we got there fast. I recognized her as soon as I stepped off the rig. A former frequent flier who broke my heart: young woman in a wheelchair due to losing use of her legs before she was thirteen. Poor, angry, bitter, fucked. A raft of associated illnesses, constant infections, miseries--to be so young and so trapped. I know there are many inspiring people who overcome disabilities. This woman isn’t one of them.

For a few years, she had lived in a dumpy apartment three doors up from the stoop where she was now nodding off. She, her capable and stressed-out partner, and their young daughter, in a dingy, cigarette-saturated efficiency. We’d respond because she was feeling ill, or she was in pain, or she needed more meds, or she was mad they hadn’t given her the right meds to address skin lesions, bedsores, chronic UTIs--the list was depressing. She had the curdled disposition of one long in pain and helpless to solve her own problems. We’d arrive, see that she wasn’t in acute distress, and then try to get her down to the ambulance. The landlord refused to put in a ramp, so her partner had to wheel her up and down the steps, a bumpy, jolting ride made worse by four to six months of snow and ice here. 

I tried several times to get her a case worker. When she stopped calling 911, I thought they’d found a solution. Or she’d moved and was now someone else’s problem.

It turned out I was right on both counts: her old man said he’d moved out over a year ago--couldn’t handle the stress of living with her, as well as taking care of her. He had sole custody of their daughter. He said they’d found her a live-in care facility, where she’d been for most of the past year. Except she’d just been evicted for failing to pay and for being unpleasant. She’d called him before the cab brought her to this stoop, informing him she’d been evicted and that she was OD’ing on pain meds.

Their daughter was clinging to the legs of a woman I deduced to be his new girlfriend. He told me the stress of the woman’s instability caused their daughter to rip her hair out. I looked again and could see a shorn, patchy scalp beneath her Twins cap. There wasn’t a lot of light or intelligence radiating from her eyes. Scared, dull, sad. I smiled and waved at her.

We had 02 on the woman and got her vitals. Her head was lolling onto her chest unless we held it up. She mumbled or slurred a few incoherencies if I pinched her shoulder to rouse her. I told her ex I was sorry--for him, for their kid, for her--and tried to patch some recent info together. It’s not his fault he fell for someone so fucked; it’s not his fault he moved on. He said she took the pills deliberately before getting in the cab so they’d take effect by the time she arrived. ‘To mess with you?’ I asked.

He shook his head. ‘Not even. To get to Abbott so she can get her infections treated.’ He explained that she had deep open wounds on both haunches, bed sores turned septic (with MRSA). Incredibly painful and hard to heal, these needed treatment but she couldn’t get it at the care facility. She had open sores on her ankles, too.
  ‘So, she OD’d to get into the hospital for some care?’
  ‘And a place to sleep. She can’t stay here. It’s unfair, too upsetting for our daughter.’
      I nodded. We kept her semi-conscious and breathing comfortably until medics arrived. MPD squad arrived and signed a psych hold for the medics (standard for someone self-harming, especially those incapacitated), earning her a three-day minimum stay on the psych ward.

I wished the guy and his kid well. We got in the rig and rolled slowly back to the station. The other two were unfamiliar with her and her story. I wanted to see a unicorn soar over a rainbow or something cuddly. Instead, I wrote up the reports directly, including potential exposure to MRSA. 

Life isn’t fair. We get that. Many people make the best of horrible situations. Many others flail and thrash and dig themselves even deeper into the mire. And some are just fucked for fair. I doubt I’d have a sunny disposition if I’d lost my legs at 12 and suffered chronic bed sores. I might make different choices, but, from a position of health and relative wealth, I don’t have a fucking clue how I’d react to hard times.
Aaaannnnd, speaking of which, we responded about ninety minutes later to the lobby of Rainbow Foods, our regular grocery store. Dispatch stated it was a man complaining of a GI bleed and said he was uncooperative on the phone, possibly drunk.

Yes, yes he was. He was uncooperative. He was certainly drunk. A chronic alcoholic homeless Native, one we see making rounds from Franklin Ave. to Lake Street. He was slouched against the Coke machine in the lobby of Rainbow. He was grouchy and eyed me suspiciously. I get that frequently. He was on a different wave length and had no patience for my patient interview. The wispy hairs of his mustache were three times over the legal drunk limit; his breath nearly melted my badge. We bantered. I kept my balance steady, ready to defend a blow if his drunk temper surged. Mostly he gave me shit. Which was fine. He was a homeless alcoholic with nasty sores all over his body, a failing liver, skin disfigurement from Vitamin B deficiency (from alcohol abuse--either B or C). He was on his way to the ER, unless the cops put him in Detox first. I could entertain some abuse. After all, it’s what I get paid to do.

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