The guy sits on the cement floor when we enter the warehouse. Co-workers kneel on either side of him, holding his hands. There are tears coming down his cheeks.
“What happened?” I ask.
“The beam dropped on his boot.” The co-worker points to a twenty-foot long steel beam that lays nearby under a hoist, but not connected to the hoist.
“Let me take a look,” I say.
I undo his boot and look at his foot. On first glance I don’t see any marks. It looks like a normal foot to me.
“My toe don’t look like that,” he says. The big toe is pointing more toward two o’clock than high noon. I take off his other boot to compare. That toe points to high noon. I notice then that that toe looks much fatter than the toe in question. The toe in question looks rather flat. I touch it lightly and he winces. Okay.
We lift him to the stretcher and get him in the back of the ambulance.
“How bad is your pain?” I ask.
“It hurts some,” he says.
“I can give you some medicine for your pain. Are you allergic to any meds?”
“No,” he says, “but I don’t want to pass out.”
“No, I’ll just take the edge off.”
“That’s okay. It’s not too bad.”
“Are you sure?”
“Yeah, I’m fine. It’s not too bad.”
Okay then. I turn the call over to my BLS partner, and go into the front to drive.
As we are driving down the road, we pass the ambulance headquarters where I see our paramedic student has just pulled in. I stop and motion her toward the ambulance. “Hop in,” I say, “We have a call. We have a patient in the back.”
She gets in, and I start off again to the hospital. The next thing I know I see a car racing behind me in the side mirror, pulling out and trying to pass me, then instead of passing, just driving side by side like we are in the stretch at Daytona. I glance angrily at the mad driver, only to recognize my 8:00 A.M. EMT partner and her husband trying to flag me down. I ask my partner in the back if he wants to do a switch on the fly, and he says yes, so I pull over. The 8:00 A.M. EMT gets out of the car, and he gets out of the back. I have her drive and I get in back, while the other EMT gets in the car with her husband.
Now that I am in the back with the patient again and the paramedic student, we press him on his pain again, and he relents and agrees to get a little of the pain medicine. We give him 3 mg of morphine to start, just to see how he takes it. He is not happy having to get an IV, and when we push the medicine, he feels flushed, and says he doesn’t want to pass out. It's common to feel flushed, I tell him. It will pass. But he is apprehensive, and says he can take it, so we hold off on any more for the time being.
When we get to the hospital, I hear him admit to the nurse his toe is really hurting now. The x-ray will show he has fractured his foot.
That night when I see the EMT who was first on the call, he tells me that as soon as I got out of the ambulance to drive, the guy confided in him "This pain is baad!"
“Dude,” the EMT said, “But you just told the medic you were fine!”
The point of writing all this is so many patients try to be stoic at first. I see the same scenario all the time, particuarly with men. They all try to suck in their pain. And while I am much more aggressive with pain management than I used to be, I need to be more so. I am tired of hearing people deny pain, only to watch them suffer as we near the hospital and at the hospital while they wait to be treated. There is no need for people to suffer trying to be macho.
The guy could tell my partner about the pain, but not me because I was the authority figure -- the Man.
But if I am the Man, then the Man needs to do his job and sell his patients on his specialty wares -- on the pain relief that they need.
I’ve got to work on my rap:
"Hey, Check it! Check it! I got Blue Star, man, Blue Star. This stuff is premo, premo, man. Code three rating, man. I got the best, right here, man, right here! Check it! Check it out!"
***
Postscript: Several Days Later
Lady falls coming down the front steps, carrying her baby. She twists suddenly as she falls so she will land on her back, and protect the baby. She does, but she hears a snap in her ankle and is in severe pain -- lying there on the front lawn.
I don't need an X-Ray to see it is broken. 10 out of 10 on the pain scale. No allergies. Medication time. She weighs 200 pounds. I give her 5 of Morphine. It takes the pain down to a 7, but she is considerably calmer. My routine has always been to give 5, wait a few minutes, then move the patient, and then give them more if they need it in the ambulance. Today I decide to give her another 3 before we move her. I can do that now under the new weight-based protocols. I give it to her. We wait. She has been having a conversation with the neighbors. All of sudden she says something about not buying ice cream sandwiches, when she starts laughing. The laugh does not end. It goes on and on. She is laughing so hard I am worried she is going to pee herself.
"Looks like the Morphine is working," her neighbor says.
In the ambulance, I give her the last milligram allowable under standing orders. She is still cracking herself up.
I'm thinking: I've got the product.
