Have you ever been a patient in an ambulance, before or after becoming an EMS provider? Have you witnessed a loved one become a patient? How did it alter your perception of patient care? EMS World’s newest series, “The Patient-Provider Experience,” shares the stories of both patients and providers who have been impacted by their respective experiences with EMS—on or off the cot—and how these experiences changed the way they provide care.
I love being in the back of an ambulance. The bench seat is like a sofa to me. The jump seat is like a recliner. They are the furniture in my office, a place I know like the back of my hand. Or so I thought.
It was an ordinary day. Well, not really. It was my one day off that week, and I had a to-do list longer than my SpO2 probe cable (which, for some unknown reason, is 9 feet in length!). Laundry, bank, groceries, the usual. Then it was off to my parents' house, where the odd piece of mail still trickles in, a decade after I first ventured out on my own. With both of them at work, it was supposed to be a quick in-and-out.
While sorting through the pile of old mail, an exercise akin to assessing a stubbed toe, I felt an odd twinge in my back. Off to one side (the right) and down a little lower than my scapulae. Thinking nothing of it, I threw on my shoes and headed out the…hmmm…that twinge is actually quite painful…and within two minutes I was on the ground, asking myself, WTF?!
In denial that anything was actually wrong, I forced myself upright(ish) and headed for my car. That’s when I blacked out, but in a slow, foreshadowed type of way, like when the dumb sorority girl in the horror movie keeps walking down the dark hallway even though ominous music crescendos.
As I opened my eyes, all I could think about was the pain. I reluctantly admitted something must actually be wrong with me and did what any sick person would naturally do: began to diagnose myself. The list of differentials was very short. At the time I was a healthy 26-year-old who exercised at least twice a month. OK, once.
Pancreatitis? Not quite in the right place. A triple-A? Nope…no risk factors. Gallbladder? Nope, I’m not 40, fat, or female…A ruptured ectopic? Well, I can rule that one out.* A kidney stone? Can’t be—I’m too young. Besides, if it were renal colic, I’d be vomiting. [Insert sound of Blair vomiting here] (Please forgive the limitations of print media.)
Damn. It must be a stone! In my ureter! As the pain got worse, I suddenly understood what patients said when they rated their pain as an 11 out of 10. Mine was surely in the mid-80s, if not reaching triple digits. I tried to squirm, wiggle, bend, and twist, only to find that the pain became worse…and worse…and worse. I actually contemplated that I might be dying. I had to do something.
What do most people do when they think they're dying and their fingers work? They call 9-1-1. But a paramedic who calls 9-1-1 on himself? Are you kidding? I scrolled through my cell looking for friends I knew could keep my condition a secret. Finding none, I began to call others who lived near my parents. Someone would have to drive me to the hospital; stubborn as I may be, a syncopal, vomiting, tearful person should never** drive a car.
Voice mail after voice mail, I began to lose hope. Then, finally, my good friend and 9-1-1 dispatcher Alex answered the phone. “Alex!” I screamed. “Where are you?!”
“At work. You don’t sound good, is everything fine?”
“No, Alex, things are not fine. I need to get to a hospital…”
“I’ll send you an ambulance,” he offered.
“No! I’ll manage…bye.” I hung up. The pain was now 435/10. After 30 seconds of contemplation, I called Alex back. “Alex, I’m at my parents'.”
“They’re on their way.”
About an hour and a half later (note: this is my perception), an ambulance pulled alongside the curb out front. I agreed to go with them to the hospital. By “the hospital,” I of course meant Sunnybrook; it was my hospital, where I did my masters, completed my ALS residency; where I still have an ID card that gets me into places I have no business being. OMG—I was one of those patients now.
There were four closer ERs, but they agreed, and I (as any conscious paramedic would do) refused the stretcher and hobbled out into the jump seat. Twenty-five minutes later I was lying on a hospital bed, asking for 100 mcg of fentanyl, 5 mg of morphine, 10 mg of Toradol, 50 mg of Gravol, a squirt of midazolam (which they never delivered on) and a bottle of propofol, which I was denied because “it wasn’t indicated.” (Good call, Dr. Brooks!)
I eventually passed the 2 mm stone, more aptly described as a small asteroid from outer space. I began to think about what being a patient was like and reached a few conclusions.
First I still remember the names of everyone who introduced themselves to me, and for some reason resent those who did not.
Second, I remember feeling horribly not-in-control. After six years of immersing myself in the EMS world, I know what goes on backstage. Paramedics make bad patients; we desperately want to feel some of that control we're so used to. And that day the paramedics, the doctors, the nurses—everyone, they all understood that. And so they gave me a bit of control.
I’ve since looked into this whole ordeal of what makes a patient feel safe and cared for, and I’ll be sharing those insights at EMS World Expo in Nashville. Turns out you don’t have to be a little angel of a medic to make people experience compassion, even if you’re too tired to give a hoot. I hope you make it to my talk—I promise you’ll be better at your job for it.
* I guess Blair is a name for both guys and girls, so if you’re confused, I’m male.
* *Paramedics should never say never, unless explaining that they should never say never. I mean, you never know what you’ll MacGyver at 3 o’clock on a roadside.
To learn more about Dr. Bigham's EMS World Expo session "On Suffering: The Science of Compassion and Non-Pharmacologic Pain Management," click here.
After a decade working as a helicopter paramedic, Blair Bigham, MD, MSc, EMT-P, completed medical school in Ontario, Canada, where he is now a resident physician in the emergency department. After completing his Masters of Science at the University of Toronto, Blair worked as an associate scientist at St Michael’s Hospital in the fields of resuscitation science, knowledge translation and patient safety. He has authored over 30 scientific articles, led major national projects to advance prehospital research and participated in multiple collaboratives, including the Resuscitation Outcomes Consortium. He has taught and mentored clinical and academic paramedics and loves his new role teaching medical students. He serves as a volunteer on the board of directors for the MedicAlert Foundation of Canada and is a task force member for the International Liaison Committee on Resuscitation.