Confused Dizziness

I was on my way home from the grocery store in a neighboring town when the tones for their ambulance went off. Medical box 800, station 8, 18, 28, paramedic 1. Sick person. I decided to go to the scene since I was only two blocks away. I could at least start care until Rising Suns ambulance and the county paramedic arrived. The house is plain, at the end of a cul de sac. I walk in through the open car port door and call out “Fire Department”. My voice echoes through the empty house. There is a kitchen table, and a couch in the living room, but that’s about it. There are a few bags of newspapers stacked on the hard wood floors. I hear a voice from one of the back bedrooms call out. “She’s back here.” A small elderly woman shuffles toward me and tries to explain what is going on, but her story is fragmented and I have a hard time piecing the incident together. I walk to the back bedroom and find Mrs Jones, who is the sister of the woman who led me to her, lying in bed looking like she is in obvious discomfort. “Hi Ma’am. My name is Keith. I am an EMT. What’s going on today?” “I was doing laundry and started to feel sick. I’m dizzy.” Her sister adds some information that doesn’t make sense and confuses my assessment. “Ok. When did you start to feel dizzy? “A while ago.” “Why did you call 911 today?” “It just got real bad.” Dizziness can be nothing or a sign of something serious, like a cardiac event or stroke, especially in elderly patients. I made a mental note that this lady may have a real problem. “Do you have any chest pain?” “No.” “Hold your arms out” She does and there is no drift. They stay straight. “Smile real big.” Her smile is equal. “Say Baltimore makes Dominoes sugar”, which she says without slurred speech. I explain that I wasn’t making her do silly things. That was a test called the Cincinnati stroke test, and while I can’t be certain, it doesn’t appear that you are having a stroke. “Do you have any medical problems?” She tells me she has hypertension, and vertigo. Bingo. “Does this feel the same way when you had vertigo before?” “Yes.” “Do you take any medicine?” “Yes.” “Do you know what it is?” Mrs. Jones tried to fumble through her medication list but had a hard time remembering it. Her sister tried to help, but really didn’t. Can I see the medicine you take? “I feel like I’m going to throw up.” Great. I don’t like vomit. I often feel like joining my patients who are vomiting. Why did I take this run? I didn’t have to. I was on the way home from the store, and now I am going to blow this beautiful afternoon in the back of an ambulance with a puking patient. Hopefully the county paramedic will think this is a critical patient and take it. Mrs. Jones sister shuffles down the hall with a plastic grocery bag full of medicine bottles. I sort through them to give me an idea of what she is taking, which will also help fill in some of the blanks in her history. Mostly they are blood pressure medication and vitamins. One full vial is for vertigo. “Mrs. Jones, have you seen a doctor about your vertigo?” “Yes” she says between wretches into another plastic grocery bag. “Did he give you medicine for it?” “Yes he gave me something, but I don’t have any.” I held a full bottle of Meclazine in my hand, filled a week ago. “Mrs Jones, you are vomiting because you are dizzy, and you are dizzy because you aren’t taking your medicine.” “I don’t have that medicine.” “Yes ma’am, you do. It is right here.” “That’s not mine.” “Yes it is. Your name is right on the label.” “No it’s not.” “She doesn’t have her dizzy medicine.” Her sister adds. “I am holding it right here. Here, look at the label.” I point to her name. “That’s not mine.” “That’s not hers.” Her sister reinforces. I stood there dumbfounded about how I can convince this patient that this meclizine was in fact hers, and it would fix her vertigo. The county paramedic unit arrived and I started to give my patient care report. “This is Mrs. Jones. She is complaining of dizziness that started a while ago but got worse today.” “I know Mrs. Jones.” the paramedic interrupted. She was obviously disgusted by being called to the same residence, for the same problem 4 times in the last 2 days. “The patient is non-compliant with her medication.” Yep. She was. And now I get to transport her to the hospital as she wretches into a grocery bag. We place her on the stretcher and wheel her out through the living room. I look around the barely furnished house. It doesn’t seem like these people are able to take care of themselves as hard as they may try. We load her into the ambulance, and I tell the driver to take it nice and easy to Union. This is a low priority patient. She is sick, but we know what is wrong, and it isn’t a life threat. As we ride to the hospital I try again to convince her that her problem is that she isn’t taking the medicine that would fix her dizziness. She gets agitated and tells me to stop calling her a liar. “No ma’am, I am not saying you are lying. I am just saying you are a little confused about your medicine. This is yours and it is for dizziness.” I point to the bottle. “No its not.” Ok. It’s not. I called social services when I got into the station, not as punishment, but for help. It was apparent to me that these folks were not able to care for themselves. They needed outside help, way beyond the scope of what I could offer. The best I could do was what I did…try to explain this was her medication and it would help, and call social services who hopefully could set up some kind of regular visits to check on the Jones sisters.