When I was working at the state, the Department of Income Maintenance (DIM) tried to pass a proposal that said it would not pay ambulance companies for ambulance trips that on review of the run forms were determined not to be true emergencies. I used my position to help kill the proposal, which had outraged doctors and ambulance companies alike. The problem with the proposal was severalfold. One, once an EMT makes contact with a patient, a medical relationship has been established. If the EMT doesn’t transport, he is legally abandoning the patient, unless he gets a signed refusal from the patient. EMTs are not allowed to diagnose. They can make clinical impressions, but only doctors can diagnose. The doctors on whose license the system runs did not want this liability. The ambulance companies, who by law are required to transport people regardless of their ability to pay, did not want to get stuck with the bill for thousands of transports that a bureaucrat would deem unnecessary. What’s an emergency? Sometimes indigestion mimics a heart attack. Who would decide? Instead of going after the people abusing the system, the so-called patients, the state was going to make the ambulance companies pay and put the EMTs and doctors at medical risk if one of the nontransports later decided to sue. Also, by denying the ambulance companies payment for these trips, they would cause prices to rise for everyone else.
I think what the state needs is a clear set of guidelines that the EMTs can use to determine whom they can refuse and to provide some liability coverage. And maybe give them taxi tokens they can give to patients so the patients can take cabs to see their doctors. Clearly, people with small cuts don’t need an ambulance. Nor do people with runny noses. They should be made to appreciate the cost in some way, instead of taking it as a right. It is a complicated issue. Inevitably, in any triage scheme, errors would be made. The elderly man, not feeling well, given the taxi token, drops dead in the backseat of the cab. It is the lead story on the six o’clock news. Legislators panic and the triage plan is scuttled, and we go back to the current system, where paramedics are tied up on BS calls while people are dying of cardiac arrests and bad trauma with no medics available.
Using my position in the health department, I argued well enough to kill the DIM proposal at least for the time being, but I didn’t change the situation. The problem is still there. I didn’t like government because almost every issue was difficult, every solution caused a new problem, and it was impossible to get people to agree on common solutions. And it was always easier to stop change than to make change. Whatever you did, you were pissing someone off.
I know that top people in government and civic groups can have a bigger positive impact on patient care (they can also do far more harm) than a single paramedic. Maybe someday I will be back in a role where, fortified with what I have seen on the street, I will have greater strength, patience, and moral authority to make change. But right now I need to be at this level. I like things simple. You call 911. I come and I take care of you, or at least try to. And notwithstanding an occasional bad mood, I like being the good guy.
Viewpoint
We’re sent on a three to Mather Street for severe leg pain. It is a second-floor apartment of an old house that has an outdoor porch. The ceilings are high and there is a fireplace that is closed off. One of the big windows has a plywood board in place instead of glass.
A thirty-year-old woman is lying on a dirty black leather couch. She is wearing a “doo-rag” on her head. “My leg is killing me,” she says. “I got this pain that runs from my side all the way to my toes. I went to the hospital yesterday and they gave me some pills, but the pain just wouldn’t go away. I got to get some relief.”
I examine her. Her vitals are normal. There is no pain on palpation, and she has the full range of movement.
“Where’d you go yesterday?”
“To Mount Sinai.”
“What did they tell you?”
“They didn’t tell me anything. They just gave me these pills, and the pain didn’t go away. I was up all night. I got to get some relief. I want to go to another hospital. They got to fix me.”
She sees something in our faces.
“You don’t understand,” she says. “I’m in pain.”
“All right.”
We walk her down to the ambulance and drive her crosstown to Hartford Hospital. They put her in the waiting room.
I am worried about my attitude. I have talks with others about it. A friend of mine, an ER nurse, had to leave the ER because she saw it happening to her. After seeing so many people of certain races and ethnic backgrounds abusing the medical system, having multiple kids and then not caring for them, coming in addicted to drugs or cut up from fights, she had to get out. She felt she wasn’t a bad person, but she started stereotyping.
My girlfriend Michelle, who is black, said she started feeling the same way toward her own race after working as a paramedic in the city for many years. I see it in a lot of EMTs. They are not inherently bad people, but when they work for a living and see others living off the dole, they get angry. Not that they would really want to change places, but they see something is clearly wrong. It’s too easy to sit behind a desk in a lawmaker’s office, proclaiming all sorts of stuff about peace on earth and love thy brother. It is unsettling when you deal with it face-to-face.
Weicker used to cite the Episcopal hymn “Once to Every Man and Nation.” He’d quote: “Then it is that the brave man chooses, while the coward stands aside till the multitude make virtue of the faith he had denied.”
I want to be that kind of a paramedic, where I can say it is my job to take care of the sick, to stand like Horatio on the bridge against all the hate, prejudice, and scorn that society—and sometimes I myself—feels.
We’re called for a woman with low blood pressure in Newington, a nice suburb south of the city. In the upstairs bedroom, we find a large woman lying in bed with a washrag on her forehead. She had surgery the day before on her hand and the pain pills have made her nauseous. Glenn rolls his eyes at me and I agree the lady is a mental case. Still, we help her onto our stair chair and carry her down the carpeted stairs.
“Where is my granddaughter?” she asks dramatically. Once the granddaughter appears, she says, “Don’t let her see me like this. Oh, Kathy, Nana will be all right. Don’t you worry.”
We get her on the stretcher and tuck her in, under the watchful eyes of a police officer, who is on the scene to help out and who, in checking for the paramedic patch on my left shoulder, makes certain our company has sent a paramedic and not a basic unit as the terms of our contract with the town state. Feeling a strain in our backs, we lift the woman into the ambulance and head to the hospital.
I know if she lived in the inner city we would have at least tried to make her walk—because she probably could. But this lady might have lodged a complaint against us, even though she was well enough to walk.
It bothers me that I seem to have two standards.
Brave Attempts
In 1994, my best friend, Brad, decided to quit his job as an assistant U.S. attorney and run for Congress. It was quite a risk for a father of four with a big mortgage on his house, but he said he was tired of watching his fellow law-enforcement officers go into the streets undermanned, underarmed, and without the support of their government. He saw too many criminals go through the revolving-door justice system and get back on the street to commit more violent crimes. He asked me to help him, and I could not say no. He is a good, decent man who wanted with all his heart to make a better world for his kids. I will always remember on election eve standing with him and the four kids in the twilight, holding his campaign signs as cars drove by. Each toot of a horn thrilled him, and as it got darker, he was reluctant to leave, believing that each car that came by was another vote, and maybe the one that would put him over the top. We stayed until we faded completely into the darkness.
Some of his views were different from mine, but I understood where he was coming from. He called for tough sentences, an end to welfare giveaways, and balancing the
budget. He became one of Newt Gingrich’s protégés, a breed of young Republican who lined up behind the Contract with America, a platform of term limits, less government, and stiff criminal sanctions. While I love my friend and agree that changes—big changes—need to be made, I fear a selfishness behind this conservative movement and an ugliness at its fringes. At the same time, I cannot say the old way has worked, and it may in fact have done more harm than the tough love the new Republicans preach. And there is an awful truth behind Gingrich’s mantra during the campaign: “Twelve-year-olds are having babies. Fifteen-year-olds are killing each other. Seventeen-year-olds are dying of AIDS. Eighteen-year-olds are receiving diplomas they cannot read.”
One of Weicker’s big achievements was the Americans for Disabilities Act (ADA) that he wrote but which passed after he had left office. The ADA was a wonderful idea to help the disabled have full access to society, but it also came at great cost in terms of implementation. Small businesses claimed compliance would cost jobs, and maybe even put them out of business. There is a price to be paid for all laws, and sometimes the price is so high, in the end the law does more harm than good.
In a debate, Brad’s opponent spoke about all the wonderful things he had mandated as a congressman for the government to do to help the people. Brad was able to respond: well, we’re stuck paying for all those mandates. He was right. Yet I felt there was something restraining the spirit of that argument. It was cold realism, not the soaring inspiration I felt with Weicker. But maybe sometimes you have to let realism go to achieve greater possibility. I think maybe we are at our best when we refuse to set limits.
This year Connecticut hosted the international Special Olympics, which Weicker chaired. It was a big success not just for the athletes, but also for letting the person on the street see what these people are capable of doing and for bringing everyone closer together. Weicker often liked to cite the Special Olympics pledge in his speeches; “Let me win, but if I cannot win, let me be brave in the attempt.”
I am working with John Hart, who works full-time as a technician in Hartford Hospital’s ED and only part-time now on the ambulance. He’s been in EMS and firefighting for over ten years. He misses the streets, he says, but the other job pays better and he’s got a wife, kid, and mortgage. We’re sitting outside Saint Francis, passing the time between calls, just bullshitting. We’re talking about how the job can affect your views on things.
Our conversation turns to the races. He says before he started working in the city he didn’t care for Hispanics or blacks, but now after seeing where they live and dealing with them, whether in the back of the ambulance or taking their blood pressures in the emergency department, he feels differently. He says he’s screwed up a lot in his life, and through sheer luck, he’s where he is today and not in some dark place. He has some sympathy for misfortune. They’re all just people, he says, living in different circumstances.
I like what he says.
Incident Report
We do a minor motor vehicle accident (MVA) in Hartford. There is little damage to either car, but a little girl sitting in the backseat without a seat belt has a cut on her forehead that a passing EMT has already bandaged before we arrive. The mother wants us to take her to John Dempsey Hospital in Farmington, where the girl, who has a brain tumor, has just come from the doctor’s office. The mother says she will follow in her own car, but the cop tells her the car is inoperable. The left front tire is flat. We have her ride in the back with the daughter, whom we have c-spine immobilized. We go to the hospital on a three—no lights or sirens.
The girl is alert and oriented, suffered no loss of consciousness. Her pupils are equal and reactive, and she has the full range of feeling and movement. Her vital signs are fine. At the hospital we get her transferred to a bed in the ER, while her mother goes to the registration desk to check her in. I leave my run form with the nurse.
“Did you get the mother to sign her refusal?” Glenn asks when I return to the ambulance.
“I’m sorry,” I say. “I thought you’d gotten it.”
“I got the others. I told her I’d get her to sign on the way or at the hospital.”
I take the form and find her just getting off the phone in the waiting room. “I need you to sign this refusal form for yourself,” I say, putting an X where she should sign her name.
“I ain’t signing that,” she says. “I didn’t refuse no treatment.”
“Ma’am, this is to prevent you from getting a bill. It does not prevent you from seeking treatment now. It just says you didn’t want us to treat you, so we transported you as a nonpaying passenger rather than as a patient.”
“I ain’t signing my rights away,” she says. “I didn’t refuse treatment. I was talking to the policeman and I can’t talk to two people at once. I know what you’re trying to do, and I ain’t signing no rights away!”
“Ma’am, you don’t need to shout.”
“You can’t force me to sign nothing!”
A secretary, who is also black, comes out and tells me to stop upsetting the woman.
I look at her, and say, “Excuse me, I am not upsetting her. I am in a legal position where I must obtain her signature.”
“You are upsetting her. Now let her go see her daughter.”
“This is not your business. I am trying to get her to sign a refusal of treatment, which will spare her a bill and legally protect me.”
“You lying!” the woman shouts. “I didn’t give away any rights.”
“There is no need to shout,” I say. “Please act like an adult.”
“You the one who’s not acting like an adult. Trying to take away my rights and lie about me.”
A nurse comes out and in a calm voice tries to find out what is going on.
I start to speak, but the woman shouts over me. “He’s lying about me! I can’t talk to a policeman and them at the same time! I didn’t refuse nothing!”
The nurse listens to her rave, and then asks, “Are you injured?”
“I hit my head,” she says.
“We’re going to have to put a cervical collar on you then.”
“I want to see my daughter. Where’s my daughter? She got a shunt in her head. Maybe they don’t know what that is.”
“We know what that is,” Glenn says. “Your daughter is fine. She has a cut on her forehead.”
All during this I am thinking I hate black people like this. The lady is ignorant. She is trying to make herself into a victim, and she is trying to turn all her problems—her poor driving, her daughter’s plight, American evil—on the two of us. I almost say this to Glenn as we sit at the hospital writing lengthy incident reports to document the episode. But I don’t say it because I know it is a bad thing to say, and because I know that if the lady was white I would not have said I hate ignorant white people. I would have said, what a fucking bitch, but it would not have been racial.
I am pissed off at the secretary for assuming I was the one instigating the shouting and that I was terrorizing a nice black woman whose poor little daughter was injured. I am tempted to take her aside and lecture her about how unprofessional it was for her to attack me, to tell her how I just spent the last forty minutes with this woman, taking special care of her daughter, calming both of them, being professional, and that she has no right to put on an act like this.
Before leaving I go to wash my hands. In the men’s room, I look at myself in the mirror. Who am I? What are my true feelings? Why can’t I see this woman for what she is—a scared, poorly educated mother who’s probably had a hard life full of defeats and prejudices against her, who loves her daughter and just wants her to be all right? Where is my compassion? My understanding?
As we drive back toward the city, I say aloud, mimicking the woman, “I ain’t giving up my rights. I ain’t giving up my rights.”
But it doesn’t make me feel any better. I feel uneasy.
SIX MONTHS
Six Months
I’m on scene at a
motorcycle accident. A huge man—a weight lifter with thighs like the trunks of oak trees—lies in the middle of Albany Avenue. His bike is on the ground ten feet away with no significant damage. He was wearing a helmet that has only a few scratches on it. He is alert and oriented. His pupils are equal and reactive. He is a little bit diaphoretic and grimacing in some pain. He has a strong pulse at 100. I cut his pants and shirt off. I see no deformity in any extremity. He is breathing fine, his chest rises symmetrically. His abdomen is soft, non-tender. He has pain when I press his right thigh, and his pain goes down to his knee. He can push against my hand with his feet, though it causes his right hip to hurt. I apply a cervical collar to keep his neck in line in case of spinal injury. Then with a policewoman holding traction on his head in line, Glenn and I roll him gently onto a backboard. I apply a belt around his waist and head rolls around his neck, which I tape securely to the board. Glenn is coming back with tape to secure his feet before we lift him. His body hangs over both sides of the board. When I hear the cops saying, “This is service,” I look up and see Dr. Morgan walking up to me. “Have you alerted Saint Francis?” he asks.
“Not yet,” I say. “I’m not too concerned about him. No loss of consciousness. Was wearing a helmet—just a few scratches on it. He’s got a good pulse, some pain in the right hip and knee, but no visible deformity, full neuros intact.”
“Very good,” he says.
“Trying to rustle up some business?” someone says.
Dr. Morgan goes back to his car, and the cops are all abuzz about him. You can tell how much they respect him, as I do.
With the cops’ help, Glenn and I lift the man onto the stretcher and into the back of the ambulance. I take his pressure—140/80. He is still grimacing. The sweat beads on his forehead as it does on mine. It’s hot in the back of the ambulance. I want to get a line, but his arms are massive, and we are already en route to Saint Francis which is only three blocks away. Our total scene time is seven minutes, with total call time under ten minutes.
Paramedic Page 15
