Clueless Perception

I have the opportunity to enter people’s lives on what is often the worst day of their life, or at least they perceive it to be the worst day of their life. A lot of times its not, and while the patient, or family may think their world is collapsing, the patient, on the scale of patients I have encountered, is relatively healthy. That doesn’t mean they aren’t sick, or don’t need medical care. It just means that the patient isn’t as critical as the family or individual thinks. And sometimes the opposite is true. The family has no clue about how bad the situation is. I was on my way to the store when the pager opened up “Medical box 707, station 7, 72, 73. Paramedic 1, unresponsive overdose, 5555 Rock Road, utilize EMS ops, 1553.” I was less than a mile from the scene so I responded to the house. Unresponsive overdoes often turn into respiratory arrests, and I knew I would be the first one there. I reviewed CPR steps in my head. I pulled into the driveway of the run down cape cod at the same time as Paramedic Tom Higgins. The front screen door was hanging by one screw on one hinge, some of the windows were broken, and the lawn hadn’t been mowed in weeks. I entered the home cautiously, not really sure if this was a safe place to be. Tom and I came into the living room where a group of 6 people sat and watched tv. One of the 6 was a 20 something female seated on the couch. She was blue and non-responsive. Tom and I knew immediately that she was at least in respiratory arrest based on her color, if not in cardiac arrest. We moved her to the floor. I opened her airway, and got two breaths in with a bag valve mask which is a bag that squeezes air into the patients lungs through a mask that seals over the patients nose and mouth. I checked for a pulse and was relieved that her heart was beating, but slow. I inserted a nasopharyngeal airway, essentially a length of surgical tubing with a trumpet flair on one end and a beveled edge on the other that is inserted into the patients nostril. Nasopharyngeal airways help keep an open airway without causing a gag reflex. I continued to squeeze the bag valve mask once every 5 seconds as Tom started an IV and drew up narcan into a syringe. The family still didn’t realize how serious this patient was, how close to death she is. They continued to watch the price is right on the tv behind us as we worked frantically to restore her breathing. When asked how long she hadn’t been breathing, the mother said “Not breathing? We thought she was sleeping.” Narcan counteracts opiate overdoses, and not long after Tom administered the drug, our patient started to breathe on her own. I make assumptions about people a lot. I try not to, but experience usually proves right. The house was dilapidated, the living room dirty, the family clueless, and the patient overdosed on an opiate. I automatically assumed she had overdosed on heroin, either accidentally or intentionally. The reality was that this low income family can’t catch a break. Our patient was in a car accident one year prior that broke her back. She overdosed on prescribed pain pills because of a change in the dosage. There was nothing intentional about her condition. Nor was she abusing or taking illegal drugs. We often look down at overdose patients. I know one paramedic, Rob, who uses these episodes as teachable moments. He has an excellent calm, non-demeaning manner and gently says you came close to dying today. Maybe you can get the help you need now. He has a respect for these throw away addicts, that many don’t. Most people don’t look at addiction as a disease process. They look at it as a weakness, something people choose to do, and something that people can easily stop. Just say no for Christ’s sake. It’s not that easy. My perception changes depending on the mechanism of the overdose. Not breathing because of illegal drugs? Get what you deserve. Not breathing because of accidental od on prescribed pain meds? Poor thing. I wish I were more like that Paramedic, Rob. Maybe this is because I need a reason to deal with tragedy. When I see a dead 20 year old, I need a reason why. Overdose on illegal drugs is a preventable thing and it isn’t just some random act. It gives a sense of security I guess. It makes sense of the senseless. Don’t do drugs, and you don’t wind up like that. It’s a simple cause and effect thing that makes sense to me. You did that therefore, this happened to you. Sorry for your luck. Next patient please. It’s the ones that don’t make any sense that are the harder to deal with. Our patient was alert by the time we got her to the hospital, and had significant back pain since the narcan counteracted all of her pain medicine. She was near tears. As we waited in the hall for a room, she realized there was something in her nose, looked cross eyed and pulled out the nasopharyngeal airway, obviously puzzled. We placed the patient in bed 17 and wished her well. She didn’t care too much about that. Her back hurt bad, and she wanted medicine to fix it, the same medicine that almost killed her an hour ago.