Well, my failure to follow-through with my stated goal of blogging every day this month is a problem. But, hey, I was sick for a few days. Okay?
No, I mean this thing that happened today. Well, one of the things that happened today.
We pick up a patient for a possibly-life-endangering cause. Let’s say the patient has, um, chest pain and a long history of cardiac issues. Then, let’s say the patient has a new acute episode… Such that they call 911 immediately; so immediately that EMS is there with the magic bus just ten minutes after the onset of acute symptoms. Okay? While getting loaded and transported, the patient is concerned about, well, dying. Here, today, now.
Patients concerned about dying ask the same three questions.
“Is this it?” “Am I going to die?” “This is really bad, isn’t it?”
None of these questions have good answers in the prehospital setting. The fact that the patient has not immediately died as part of the episode is good, of course, but you can’t really tell the patient that surviving for the last ten minutes guarantees or even implies anything; the patient could code right now, us and them in the back of the bus, just as we make the pronouncement.
“Is this it?”
“Is this what?” Sometimes you just play dumb or hard of hearing. I prefer to validate my patients though I do try to stay away from open philosophical questions in the back of the ambulance. So I punt on this question.
“Am I going to die?”
I’ve heard other practitioners say “Not in my bus. That’s my rule.” To me, this answer sounds like tempting fate. I say “No” if I am relatively positive (like, say, the young person who has drunk too much Robitussin, feels odd, but does not realize that DM has no lethal dose), otherwise, “Not if I have anything to do with it.” In a quasi-flippant way, as if to say, nope, you’re not even in the same town as death.
“This is really bad, isn’t it?”
“Bad? Well, not good, maybe, but you’re doing okay.” It’s the truth. I’ve seen dead people and my patient isn’t dead. On the good/bad scale, this must be at least okay, right?
So then the bus pulls up to the hospital emergency department, backs in. We pop open the back door, jump out, turn around to pull out the stretcher, and notice a hearse parked right there.
“Yo, bud, your next ride is here!”
Okay, so maybe it’s me, but… Should a hearse be using the same door as the ambulance? I don’t think the patient saw the hearse, but *I* was offended. Not to mention, this means that the dead folk are wheeled through the ED to the hearse? How crass is that?