Stuff I Wish They'd Taught Me in Class: Part 9--How To Deal

When it comes to dealing with abusive patients, exacting revenge may feel good for the moment, but for years to come, you will have to live with that decision


I worked in a pretty rough area. It wasn't pleasant at all. The constant verbal and sometimes even physical abuse coming from the patients seemed never ending.

Working in a high crime area, it wasn't uncommon to see displays of absolute disregard for human life on a constant basis...husbands beating wives, mothers beating children, children beating other children...senseless murders, assaults and abuse. I kept a stiff upper lip, trying to work through it all, but it wasn't until one night that I realized just how much of a toll it took on me.

We had a patient we saw constantly for the same thing--drug overdose. Once a week we would get a call for him lying in some house or on some roadway and we'd have to pick him up, give him the $25 drug that ruined his $300 high, and he would spend the rest of the trip hurling verbal assaults at everyone in his path. He seemed to take delicious pleasure in telling the female providers what he'd do to them if he caught them alone and telling the male providers how they would find him in bed with their significant others before they made it home.

One night, after running all day with absolutely no rest or enough time to grab a bite to eat, we were called to him again. I was so spent that shift that his verbal assault hit harder than it ever had before. This time, he was more than just an overdose; he had been assaulted and quite badly. As I grabbed his arm and wrapped the tourniquet around it, I saw a decent vein. He started goading me on, calling me every derogatory name under the sun, trying to get a rise out of me. I reached into the front pocket of my bag and pulled out a 14G IV needle. I knew the vein would never support it, even though it looked good, as past experience showed that his veins were so shot that they would barely support a 20, let alone a 14. I held onto the needle, the anger and frustration of countless interractions with him welling up into me.

The voices of countless providers raced through my head, talking about how they exacted their own brand of revenge by doing nearly the same thing I was about to do. I thought about the satisfaction I'd get from inflicting the momentary pain, my brand of revenge for every hurtful word and action that had been heaped upon us. Yet...

I put it down and reached for the 20.

After the call, I found myself sitting on the back step of the ambulance taking slow, measured breaths. A realization dawned on me: dealing with these types of patients was something that couldn't be taught in a textbook or lecture. It had to experience it on a personal level. We learn how to diffuse these situations and keep them from escalating, but we are not taught how to deal with the flood of emotions that come in response to such situations.

We must learn how to stop, take a breath, and rein ourselves back in. We are no better than the ones who abuse us if we do the same. That night, I became aware of how much I needed to learn about how to deal with what was going on. I taught myself that these types of patients usually have no control; it's the drugs, alcohol or disease process speaking. Take all those things away and your patient is probably as normal as you are. Also, exacting revenge may feel good for the moment, but for years to come, you have to live with that decision. It's hard to move past it, but it can be done. Pause, take a breath and keep moving forward. If I could do it, I know you can as well.

Shao Trommashere is a paramedic who has worked for close to a decade in EMS and in the fire service. She completed paramedic class in 2007 after working as an EMT since 2002 in the Northeast corner of the United States. She also has a blog called Looking Through A Pair of Pink Handled Trauma Shears.