Memorable Patients and the Lessons They Teach
I’ll never forget his name. John. I’ll never forget the way he carried himself as he shuffled up to our ambulance in a proud posture that hid his 94 years. I recall his pressed shirt and slacks, something from the J.C. Penney catalog, and an out-of-fashion Members Only jacket that didn’t suit him. I guessed it to be secondhand, possibly a bargain item from the local Goodwill. I was 19 years old, a new EMT, and I remember thinking—and this is hard to admit—that I’d rather not have anything to do with the old man.
I was working a double EMT car, assigned primarily to interfacility transfers around San Jose, CA. John needed a ride to an appointment with his doctor in Redwood City. The trip would take us around 45 minutes. John was a “milk run.” He took his seat in the captain’s chair and stared out the window at the neighborhoods passing by. I got the feeling he didn’t get outside much. I started some small talk with a question that seemed appropriate for the moment. “Have you lived in the Bay Area long?”
John turned from the window and smiled at me. “All of my life.” And with that, we began one of the most memorable conversations I have ever had with a patient.
John’s great-grandfather had been a local legend in California’s frontier days. John’s immediately recognizable surname lent credibility to the somewhat dubious-sounding claim. He told me about his memories of his great-grandfather as a child. He spoke of orchards and ranch lands now covered by the neighborhoods I grew up in. It seemed that there was nothing he didn’t know about the history of this place of my youth.
As the neighborhoods passed by, I came to know my home in a whole different way. John was the first in a long line of patient teachers who have mentored me. He taught me an essential lesson: Patients, young or old, can be amazing teachers if we are willing to learn from them.
I got to thinking about John the other day and realized he’s still my most memorable patient. I wondered how many other EMS providers had stories about patients like John who entered their lives and helped them redefine themselves, leaving an indelible mark upon their lives or careers. Sometimes these most memorable patients change the way we see patients in general; sometimes they change the way we see the work we do; and occasionally, they change the way we see the world.
I decided to ask some of the caregivers who have left a legacy in EMS about the patients who have influenced them along the way. I asked them to tell me stories about candid moments in their lives when they allowed the patient to become something more. I wanted to know about the patients who challenged them to think differently about themselves, their jobs and their roles in the world as caregivers. These are their stories.
Dr. Bryan Bledsoe
Most paramedic students will find at least one textbook authored by Dr. Bledsoe in their required reading syllabus. A former paramedic, Dr. Bledsoe is an ED physician with a lifetime of EMS experience. He is a speaker, author, event organizer and advocate for prehospital services. Coincidentally, two of Dr. Bledsoe’s most memorable patients were victims of house fires.
I was working in my hometown of Ft. Worth, TX, in 1975. We ran six ambulances back then, and we ran constantly. My fiancée was a receptionist at the local hospital, and I had just finished my paramedic training.
I went out early one morning on a house fire. We had one patient. She was burned on the face, the upper neck and torso, and on parts of her upper extremities. We loaded her up and transported her to the hospital. It was a pretty simple call to me. I didn’t find out until afterwards that the patient was my fiancée’s mother—-my future mother-in-law. I had never met her.
I remember another time, around 1976 or 1977, when Ft. Worth was evaluating the role of paramedics. There was another house fire; this one was in the middle of the night. Firefighters pulled two young girls out of the house. They were both between six and eight years of age, apneic, and one may have been initially pulseless. We performed an aggressive resuscitation effort on both of them and were successful in resuscitating them with good neurological outcomes. It was one of the first times we were able to intubate and use all our paramedic skills—and we knew that it had made a difference.
We got postcards and letters from both children for the next 10 years, until they were almost 18. Even after I left EMS to go to medical school, I frequently got Christmas cards and such from them both. Over the years, I got to follow their lives and learn how much of an impact our care had had on them.
We were new paramedics in a new system. We ran so many calls that it was easy to forget that we weren’t just dealing with clinical cases, we were dealing with people. Both of these cases reminded me of the real impact we have on peoples’ lives. What we do, or don’t do, can have such a significant effect on someone’s life.
I still remember thinking that my mother-in-law’s situation was no big deal. We gave her some fluid and some analgesia and went on with the shift. Then I got to see her transferred to Dallas’s Parkland Hospital, where she would spend months in a burn unit; and then to go through the rehab, the skin grafts and the pain of multiple surgeries. I was able to see how a simple call (for me) could impact a patient and a family immensely. I would have never been exposed to that if I hadn’t been marrying into this family.
These patients reminded me that no matter how tired I am, no matter how trivial a call may seem, it has implications far beyond what I can see. While our patients can quickly leave our memory, our impact on them will stay for a lifetime. It is our duty to assure that their memory of us is positive.
Alice “Twink” Dalton
Twink is an EMS educator who has been involved in prehospital services for over two decades. She is a full-time clinical educator for Pridemark Paramedic Services in Boulder, CO. Like most contributors, Twink had a hard time choosing just one patient as her most memorable. She told me stories of a cursing biker who taught her about the fine line between anger and fear, and a shotgun-wielding assailant who taught her about scene awareness with the not-so-subtle reminder, “If I’da wanted ’em to live, I wouldn’t a shot ’em.” Ultimately, she decided that her smallest patients have taught her the most profound lessons.
My patients always teach me lessons. Sometimes they teach me about medicine, sometimes about compassion and sometimes about just being human.
It’s the kids who seem to teach me the most poignant lessons. There was the child I’ll call Jamie who taught me the most about love. We were dispatched to a GSW to the abdomen. We didn’t hear the age very clearly, so weren’t prepared for eight-year-old Jamie. He and his brother had found their father’s shotgun under the bed. Jamie was shot at close range. Close enough that most of his internal abdominal organs were exposed. He was wide awake. I attempted to talk to him and reassure him, though I don’t remember what I said. I do remember that I was horrified at the extent of his wound.
We worked feverishly, applying oxygen, packing his wound and trying to start IVs. He didn’t say much; he just watched what was happening with wide, frightened eyes. At one point he looked up at me and said, “Mrs. Nurse, will you hold my hand? I’ve never died before and I’m scared.” At that moment, he became my child. I took off my glove, held his hand, and loved him as best I could for as long as we had together. He died in surgery.
And then there was a four-year-old I’ll call Sadie, who “fell” down the steps—or so her mother said. Sadie would not move her left arm. When I palpated her humerus, close to her shoulder, she winced. But that was the extent of her response. We knew something was wrong so we told her mother we were taking her to the ED. Her mother stated she would follow us to the hospital in her car.
I held Sadie on my lap all the way but she wouldn’t cuddle. I tried to talk to her but she wouldn’t respond. When we arrived, I gently put her over my shoulder, protecting her left arm. As we walked in the ED doors, her mother was behind us. Sadie looked up, saw her mother and said, “Mommy, if I died, would you love me?”
Sadie’s statement is as multi-layered as the lessons of child abuse are. Sadie had a greenstick fracture of her left upper humerus from being twisted until it broke. Her mother had inflicted the injury. But all Sadie wanted was to be loved by her mother, the one who abused her.
The obvious lessons of child abuse are the ones we learned in class. The more subtle ones are seldom appreciated. How many times do we abuse ourselves or allow ourselves to be abused, only to seek the approval and love from those we consider important to us? I find myself thinking of Sadie…
Paul is the director of the paramedic training program at the University Medical Center at Stony Brook, NY. A popular speaker and author, he is an assistant professor of clinical emergency medicine. In his 21 years as a paramedic in New York, Paul relates that few patients gave him cause to reflect on his work quite so much as one older man who left him thinking for days afterward.
I had been working in New York for about 11 years as a paramedic. We used to cover an area in Queens called Queens Blvd. Each borough has one large thoroughfare. In Manhattan, it’s Park Ave. In Brooklyn, it’s Empire Blvd. Queens Blvd., 16 lanes wide, is the one that cuts a swath through the borough of Queens. The median age at that time in Queens was about 55, and the people who lived there would try to cross this street, but they didn’t move quickly enough and the cars would just blast them.
We got called for a pedestrian struck one evening. This wasn’t uncommon and it never really bothered me much, but to give you some background, when I was about three, my grandfather was hit by a car and killed. A bus had hit this guy, and when we got on scene, he looked exactly like my grandfather in all the pictures I had of him. It totally stunned me for about five seconds. I ran the call and took him to the hospital, but I thought about the patient for days afterward. It was like seeing my grandfather’s death again and experiencing it in real time.
The call made me think about what it would be like to work in a small town and know the people you’re treating. When you work in a large city, for the most part, you treat anonymous people. While that was the case in this instance, it certainly didn’t appear to be. Of all of the calls I’ve run, that one made the biggest impression on me. It felt like I was treating my grandfather and that was horrific to me.
I had spent my career treating anonymous people. No matter what happens to anonymous people, you only have to be a part of it for 15 or 20 minutes and you move on. This felt different. For a moment, I felt like I was in the victim’s shoes, or at least the victim’s family’s shoes. That’s not a pleasant place to be. It reminds you of how fleeting life is.
Mike’s EMS career has taken him from the streets of Denver, CO, to the conflict-torn regions of Israel and Palestine. He sees himself as a lifelong student of the world. He is a speaker, author and consultant on all things EMS. Mike can tell paramedic war stories better than anyone I know. His story about one Halloween night shift in Denver had me laughing hysterically, but all the laughing stopped when our conversation turned to his story about his last moments with his most memorable patient.
We were posted just off Colfax Avenue in downtown Denver, right across from the topless shoeshine parlor and Kitty’s Adult Mini-Cinema. It was late in the evening, and there was a group of kids across from us standing on the corner. A younger kid rode by on his Stingray bicycle and one of these kids reached out and punched him in the chest, knocking him off his bike.
I looked over at my partner and we decided that he had gone down pretty hard, so we should probably go have a look at him. We drove over and blocked traffic as I gathered my things. I wasn’t in any hurry. I figured I’d give him a minute to catch his breath and figure out if he was hurt or not.
As I walked over and knelt down beside him, I immediately noticed a stab wound in his chest just to the left of the sternum. The kid who had punched him had a knife in his hand that we hadn’t seen. We tossed him on a backboard and took off for the closest trauma center. He remained awake and alert. I got the first IV started and grabbed the bag and infusion set for the second when I made that first human-to-human eye contact with him between the bag and the infusion set.
After you’ve been doing this for a while you get a sense…a sense when you know that someone is going to die and nothing that you do is going to change that. I knew in that instant he was going to die. I looked into his eyes and I could see that he knew it too. He was 14 years old. There was this crystal-clear unspoken communication between us.
I said. “Is there any message that you want to get to anybody? Is there anything that you want to say?”
He said, “No, both my parents are dead. There’s really nobody…but thanks for asking.”
Then he reached out and he put his hand on my leg and he kind of patted my leg as he said, “You know…it’s going to be okay.”
I just said, “I know that.”
I put in the next line and drew a set of bloods as my partner called a report in. We pulled into the ED and he arrested about five minutes later. The ED staff did an open thoracotomy. He was not resuscitated.
I realized afterward that if I had not made that empathetic connection and that contact, he would have died alone. I thought about how many patients I had cared for up until that time. I had always been friendly and polite and kind, but I don’t know that I always made that deep unspoken connection of empathy and compassion. He really taught me that I needed to do that every time I took care of somebody.
That call taught me a lot about the essential humanity that comes from the deep connection that you can open up with the people who are in your care. There is a powerful exchange that can happen. I live in the hope that it is helpful for them and I know that it’s been good for me. It has kept my heart open, kept my connection with others alive, and it’s the primary reason that I’ve never even experienced a moment of burnout running calls.
Are You Ready?
When will you meet your most memorable patient? There is an old Buddhist proverb that says, “When the student is ready, the master appears.” The proverb implies that to learn all that our patients have to teach us, we must first be ready.
Young or old, our patients are often gifted to see the world with amazing clarity. They view their lives through the lenses of illness and injury. From that vantage point, they offer profound insights. If we are open to receive these lessons, they can change us immeasurably.
Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colorado. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at www.theemtspot.com.