The Help He Needed

As a paramedic captain for the Los Angeles Fire Department in the early 1980s, I responded to assist in handling a field problem in central Los Angeles. Upon my arrival at the location, it became apparent that the problem was indeed a big one: a male somewhere in the area of 800–900 pounds needed to be taken to the hospital. Unfortunately, the patient had been bedridden for several years, and it was impossible to carry him out the bedroom door. The engine company had thought about it and requested a truck company for tools and additional manpower. Now several challenges faced the rescuers: first, not to injure the patient (or themselves) at any time; second, to carefully and properly remove him from the bedroom; and third, to transport him to the hospital.

Before we began the operation, I spoke with all members on scene to ensure that everyone was on the same page in terms of tactics and strategies to be utilized. Medically, the patient was stable and thankfully stayed that way during most of the planning and actual dismantling of his apartment. Emotionally was another story.

I recall even today, although it is nearing 30 years since this event, that obesity is not just the balance between calories and burning them off. In morbid obesity, it can be quite complicated and may be genetic. While I did not hear any unkind comments by rescuers toward our patient, I did sense some feelings from a few of the personnel that this was unnecessary, and should have been avoided by the patient, his family and his doctors.

I can only imagine how the patient must have felt with 8 to 10 fire personnel working to remove him from his confines to transport him to the hospital. Both on-scene paramedics were contemplating an IV “just in case,” and the scene attracted the media as well. I could see the patient was terribly embarrassed by the ordeal, and he began to cry. It took a couple of hours to extract him from his apartment, which required dismantling the entire door and wall. The crew literally took them apart so the patient could be carried out. They used a large, flat board to carry the man, carefully strapping him down to prevent injury. I oversaw the entire operation, and it was flawless. It took eight firefighters to carry this 800+-pound patient to the ambulance, and it was necessary to take out the gurney from the unit and merely lay the board on the floor. I had the paramedics put two boxes under the head to make it easier for the patient to breathe. He was subsequently transported to a county facility for treatment and then to a different location for treatment of his morbid obesity.

Five years later, I had the opportunity to meet up with this man again. I could not have identified him. He was a totally transformed individual who perhaps weighed about 250 or so. He not only remembered me but everything that occurred that summer day. He remembered the kindness shown to him by all present, and being carried by careful hands. He told me how embarrassed he was, and that was why he’d accepted treatment and subsequent surgeries to control his obesity and extend his remaining life.

It was a lesson for all who participated on that day—a lesson in tolerance, acceptance and knowing that all present had done a fine job. Years later, when I had been promoted, firefighters and paramedics alike who were on scene that day would come up to me and say, “Hey, remember that guy who weighed over 1,000 pounds…?” Interestingly, his weight has gotten heavier every year with the story, but isn’t that how it always goes?

I tell my college students (EMTs) this story as a lesson in tolerance and to treat each and every patient with respect. Whether an overdose or any call, at 3 p.m. or 3 a.m., we must do the best we can and stay compassionate.

Alan R. Cowen, MA, EMT-P, served as a deputy fire chief for the Los Angeles City Fire Department, CA, and is an associate professor of emergency services at Los Angeles Valley College. He is a member of the EMS World editorial advisory board.