Bariatric

I responded to a call for a sick person in a local trailer park, and since it was close to my station, I knew I would be the first one there. I arrived and knocked on the door. I heard a faint voice say “Come in.” I opened the door and found a morbidly obese woman, 500 maybe 600 pounds, lying half on and half off the hospital bed in her cluttered living room. She was naked from the waist down and I could smell the diarrhea from the door. “Hi Ma’am. My name is Keith. I am an EMT. Are you hurt anywhere?” I asked as I walked into the trailer. She told me she wasn’t hurt, and that her problem was diarrhea that she has had for 3 days. Her husband died 6 months earlier. I had no idea about how we were going to move her. She enveloped the side of the bed. I called for a manpower assist and continued my assessment. I asked the usual questions about medical history and medicines, and tried not to gag from the overpowering smell of the diarrhea. Paramedic 1 arrived and I gave my report. Annie, a paid paramedic with the county and a volunteer with a neighboring fire department looked at the situation. Teresa arrived along with about a half dozen other people all standing there gawking at this poor half naked woman. I covered her up with an afghan that was folded on her couch. We figured we would try to move her back onto the bed, and get her cleaned up in the process, then transfer her to a stretcher specially designed for morbidly obese patients, which we didn’t have. I called dispatch to have a regional ambulance transport company respond with their bariatric unit, an ambulance specially outfitted to move and transport morbidly obese patients. Annie, Teresa and I decided that we could use the sheet already under her as a sling to roll her back onto the bed. We went over the plan with our patient, and told her that we would need her to grab onto the rail on the opposite side of the bed to help us pull her back up. When we had her up off the floor, we would clean the diarrhea off of her butt and legs. I asked everyone to leave the room except for the 5 people we would need to move this woman. She was humiliated enough and didn’t need any more gawkers standing around. We wriggled the sheet into position, and on three we moved her slowly back up onto the bed. Annie got onto her knees and wiped as much diarrhea away as she could. I left the living room gagging, got a few breaths of fresh air outside and returned. We noticed that she had a vertical bed sore on her hip, right where her skin enveloped a post on the safety rail of the bed. I couldn’t imagine the discomfort associated with laying in the same position, with the rail digging into my skin. The fire department chaplain came in and recognized this patient. He is a retired minister and is approaching 90. He often parks his car in the middle of accident and fire scenes, which makes operations more difficult, and he almost ran me over on the scene of a fire once. He is the photographer for the department and still uses film. But his heart is huge and he has dedicated his life to the fire service as much as he has dedicated his life to the Lord. “Do you remember me?’ he quietly asks. “I deliver meals to you on Mondays.” He adds. “Oh yeah, I remember you.” “How are you?” the chaplain asks and starts to chat with this woman. Which is exactly the treatment needed. We really couldn’t do anything until the bariatric unit arrived. The chaplain kept her spirits up as much as possible while some of the firefighters tried to determine if the rickety porch would collapse under the weight of her, the stretcher and the 6 people moving it. The bariatric unit finally arrived after a 45 minute wait. We placed a transfer board, basically a piece of thin slick plastic that makes shifting a patient from one bed to another much easier, between the patients bed and the stretcher able to carry 800 pounds, and with as many hands as we could fit around the bed, slid the patient onto the stretcher in one move. The porch creaked and sagged, and we worried about it collapsing so everyone was moved off except for two and they slowly moved the stretcher down the plywood covered ramp. We attached the cable to the stretcher and winched the patient up the ramps attached to the back of the ambulance, locked the stretcher into its bracket, closed the door and sent the ambulance on its way. This was the end of the call for us, and soon we would all return to our dinner tables, families and jobs. We did well with a significant challenge. But this wasn’t the end for the patient. Her ultimate problem won’t be solved. She would return home alone, dangerously obese. The chaplain would bring her dinners on Mondays, and we would be ready for the next call here.