The Unlovable

Even on calls where I don’t think I can make a difference, like an obviously dead 90 year old woman who died in her sleep and was found at noon the next day, I can. The family members then become my patients, and how I act and what I say can have a big impact. There are a lot of lonely people out there who use EMS for companionship. And it gets frustrating to respond to the same address time and again, for really nothing medically. And so sometimes, patience wears thin on calls like this. But on those runs where I can show compassion for even the unlovable is where I can make the most difference. I pulled the diapers up on Mary, again. We usually found her on the floor, in a puddle of urine, depends around her knees. It was usual to respond for Mary two times a month while she was alive. She had a perfectly healthy able bodied niece living with her who was useless. She normally stood in the dining room, or sat with her arms folded, unconcerned that her aunt had been sitting in her own feces on the floor for a few hours, and never raised a finger to help us clean up her aunt. The calls to help Mary were often for a person fallen or unknown medical problem. We would arrive, walk in through the chronically open garage door, knock on the kitchen door. “Fire Department.” “Ok I’m in here. The door is open.” Would come the feeble response, and we would enter, find Mary on the floor, next to her potty chair, niece nearby bitching about how “she missed again” doing nothing to help. “Hello Ms. Mary. Are you hurt anywhere?” “Oh, no. I just can’t get up.” “Ok are you sure you aren’t hurt?” “Oh, yes. I don’t hurt anywhere.” “Ok what is the best way for us to help you up?” And the conversation would usually go the same every call, with Mary’s niece yapping in the background. We would get under each arm stand her up, pull her diaper up, or put a clean one on, and sit her in the chair of her choice, usually the one by the front window so she could look outside. This went on for years. Then we didn’t get calls to help Mary anymore, and I learned that she finally died at 89. The quality of her life in the last 5 years was horrible. I watched Mary deteriorate over the last 15 years. She was my first patient as a Maryland EMT. We were alerted for chest pains. I responded by myself and knew I would get there well ahead of the county paramedics since our station was just a mile away. I found Mary sitting in her chair at the front window. She was grey and sweaty and I knew she was sick. Hello ma’am. My name is Keith. I am an EMT. What is going on today? She told me that her chest hurt, and after a line of questions related to her pain, I learned that it started when she took the trash out, that it was sub sternal and radiating to her left arm, that she had a heart attack five years ago, and this felt just like that. I hoped the paramedics were close, because there wasn’t much more I could do for this patient besides give her high flow oxygen. I waited with her for the paramedics, and reassured her. I held her hand and rechecked her vital signs and pain. When they finally arrived, they confirmed that she was having a heart attack, gave her drugs to keep the arteries that feed her heart muscle alive as open as possible to keep the blood flowing to the heart, and we rushed to the hospital. And that would be the trend with Mary and I over the next ten years. There usually wasn’t much I could do for her, except be kind, even in the middle of the night when all she needed was a diaper change. It wasn’t always easy to show Mary compassion. But we always did. It was usually all I could do. I was saddened to hear that Mary died, but I was also relieved. That poor woman’s quality of life was crap for the last five years and at least now it was over. Her house was auctioned. At least it didn’t go to Mary’s niece. It seems that any trace or remembrance of Mary is gone. But I remember her.