You know, the ones where you are absolutely positive the patient is faking and then you go back to the hospital later on only to find the patient is on a vent and being rushed to the OR! I even told the nurse his name was Robert De Niro because he was such a good actor!
The call was for a 30-someting y/o m who said he was hit in the chest with a baseball bat at the local train station or “idiot portal” as my partner and I call it. The pt said he was hit one time in the chest and denied any other pain or trauma whatsoever. There was no visible trauma to his chest or anywhere else. The assessment was by the book and thorough.
So this guy, who was drunk as a skunk as well, was holding his chest, making moaning noises, crying, refused to walk to the gurney and was just really playing the part! Okay, now here comes the part where you all decide I’m just a heartless asshole who has lost all respect for humanity…but unless you have worked in urban EMS in one of the worst areas there is, you won’t understand. Basically, we tell this guy he is a pussy and needs to stop acting like a whinny little child! We weren’t exactly very nice to this guy…well, he wasn’t exactly nice to us either. He was one of those drunk assholes who thinks it’s okay to verbally abuse the people there to help him and be extremely difficult…like refusing to walk and refusing to answer our question and give us the information we are requesting. Just a complete asshole…I even remember thinking, “Geeze, I’d hit this guy with a baseball bat too.”
So we transport him BLS to the local trauma center (turned out to be a good thing he happened to live close to a decent hospital). We get there and explain to the nurses that this guy is the usual pain in the ass! Also, we find out he has been to this same hospital more than 10 times all for alcohol intoxication and assaults. The nurses and doc talk with him and completely agree with our assessment, but to be safe they do a chest x-ray and EKG which both are completely normal…no need for a head CT because he denies head pain, fall or LOC. We put him in a hallway bed and leave.
We bring another pt to the same hospital about 10 hours later and as soon as we walk into the ER the nurse points at our baseball bat to the chest pt and says, “look at your pt” (in a very lovely condescending tone as if his current condition is our fault). We look over to see nurses taking him off of a vent and bagging him as they prepare to rush him up to the OR. Apparently, he had been walking around the ER just fine for the last 9 hours but then when a nurse went in to check on him he was completely unresponsive with a blown pupil and projectile vomiting. CT reveled that he had a brain bleed and swelling due to a traumatic depression in the side of his skull (still at this point he has no visible trauma to his head…no swelling, bruising or hematomas. His head was completely normal on palpation and to the naked eye). The trauma doc said he’d most likely die.
Now where does this leave me? Should I feel bad for not being exactly nice to him? Should I feel bad for missing the fact that he had brain trauma? Should I feel bad at all? I don’t think so…but I kind of do feel bad about the whole situation. These kinds of calls happen every now and then…I mean the “boy who cried wolf” calls. We see so much bullshit and people abuse the system so damn much in this area that it becomes almost impossible to believe anything these people say (well, this pt didn’t say anything that would lead us to believe he had a brain bleed, but still). I don’t know…I don’t know how I feel about his call I guess. I feel bad but at the same time I don’t. Like, I realize it’s horrible that this guy will probably die but how much of that is really our fault? Not even the doc or nurses caught this, but of course in retrospect the nurses felt it’s necessary to blame us for what happened even though they were right there with us in calling the guy an asshole. I am somewhat human and do feel a least a little bit bad about all this…I’m not at work and it’s obviously on my mind, but I still have to go back to the “boy who cried wolf” theory.
Sorry if this offends you or whatever, but like I said, unless you have worked in an area like this you can’t understand how impossible it is for us to greet every pt with a smile. It just doesn’t work that way…
No matter how I look at it or try to justify the whole situation, I still feel horrible when I think about the fact that the last thing this pt experienced in his life was me and everyone else treating him like shit!
***No disrespect to those in rural EMS…You guys have your own challenges. I’d probably shit myself with a pt who’s going south if I wasn’t within 7 miles of the closest hospital. And also no disrespect to nurses…I love most of my nurses!
