Today I did something for the first time I had never ever done before while working in EMS. In this job you learn when you are sitting around waiting for a call that if the urge to use the bathroom comes upon you, you act on it because it sucks to be suddenly hurtling down the road on your way to a cardiac arrest having thinking to yourself, "Boy do I have to pee. Damn, I should have peed when I had the urge." Or worse. Once you get on the call, however, your adrenaline takes over and your urge fades to the background at least until you get to the hospital, then as soon as you have unloaded your patient and turned over care, you make a beeline to the bathroom.
Here's what happened today. We get called for "leg pain" and climb the stairs of an apartment to the second floor to find a large(220 plus) 50-year old woman sitting on the bedspread of a kingsize bed on top of a bed pan, with her pajama pants pulled down. Her aged mother says the patient, her daughter, hasn't gotten out of bed for five days even though there is nothing wrong with her. She has a history of mental illness but has not been on any medications or seen any doctors for over a year. She refuses to get out of bed for us. I ask the patient why she can't get out of bed, she says her leg is stiff, but when we approach, she seems to be moving it very well when she tries to kick us. Her mother says she is also diabetic, so to check her sugar, it takes three of us to hold her down while she kicks and tries to swing her arms and bite us. Her sugar is 148 -- normal.
We discuss our options then with the police officer. I say it is clear she is a threat to herself. She is obviously mentally ill. He questions her some and agrees. We each take a turn trying to persuade her that she needs to come with us, but she will have none of it. Even our threat to remove her by force doesn't phase her. "Bring it on," she says, "I ain't going."
We are on the second floor and stairwell is narrow. None of us is looking forward to wrestling with her, and fighting with her down the stairs. We decide to try to just medicate her. I tell everyone that once I give her the medicine we will need to wait at least ten minutes for it to take effect. A few weeks ago, I sedated a 16-year old in the city and the cops were impatient and tried to move her before the medicine had a chance to really work so she fought us, kicking and screaming all the way out to the ambulance, and only then after we had tied her down did she fall asleep.
The cop starts writing a PEER(Police Emergency Evaluation Request) that gives us the power to take her against her will. I prepare my two syringes. As I lay out my equipment -- the narc kit which has the ativan, the med kit which has the haldol, the IV kit that has the syringes and alcohol -- I think that I should have a premade sedation kit (like the OB kits), but one that would include a tape of relaxation music -- the sound of waves or light rainfall -- to put on the music player and maybe candles or incense to burn. When I am ready, the others hold her down, while I wipe her arm down then inject her, first with the Ativan, then with the haldol. Then we sit back and wait.
Suddenly I have a terrible stomach ache. I try to ignore it, but it only worsens. I have had stomach aches before on the job, but then I was always caught up in the call and managed to fight through it. But here I am standing waiting -- at least ten minutes for the drugs to take effect -- and I am about fifteen feet from the patient's open bathroom door. I try to suck it in, but it is like a stabbing knife. I think about my ability to keep it in if the medicine maybe doesn't work that well -- the patient is a big woman, and we have to carry her fighting down the stairs. Finally I can't take it anymore. I ask the patient's mother if I may use the bathroom. She says yes, and a few minutes later, I walk back out. Are you okay? they ask. I nodd. Just fine, thank you. I am a new man.
We wait another five minutes, and then pick the woman up with minimal resistance, place her on the stair chair, carry her down to the stretcher, and she sleeps all the way to the hospital.
