I hate having to reach down under a patient’s clothes to put the electrodes on and try to guess where the proper placement is. I hate taking blood pressures over tight fitting sleeves or being at the ER and watching them trying to undress the patient with the IV line in their arms.
Sometimes when I bring a patient into the ER with a Johnny on, the nurse, if she doesn’t know me, will ask for the nursing home W-10. They’re from home, I’ll say. Where’d they get the Johnny? I put it on them. Interesting.
When it’s busy at the ER, or even when it’s slow, the nurses love it when I bring them in a patient with an IV, a 12 lead, bloods drawn, and gowned in a Johnny, the patient’s personal clothes already in a plastic belongings bag. I love it when they smile at me and say thanks. Good for the nurses, good for the patients, good for me.
Sometimes the patients don’t like getting into a Johnny. They dislike it in the same way they dislike an IV or having to give a history. They’ll do that at the hospital, they say. Just take me there.
I feel like saying, and once in awhile, if I let my mood get the best of me, I actually do say: You called 911 not a taxi. If you want medical evaluation and care and not tips on the horse races, then you need to let me do my job.
But I don’t force the Johnny on them. Often with women I will leave their bra on, even though they take it off in the hospital when they put the Johnny on. If the bra is not in my way, I let them keep their modesty. It helps if you have a female partner or there is a family member or nurse on scene who can put them in the Johnny for you.
Now we are getting to the time of year where it is getting a little tougher to put them in Johnnys. It may be chilly in their house and they are all bundled up in bathrobes, and it is cold outside. Sometimes you don't even try.
Yesterday I had a woman with severe abdominal pain. She was sitting on her bed in a cluttered room that our stretcher couldn’t reach. She was wearing one of those full length bathrobes from her neck all the way down to her ankles. Underneath that she had on a sweater, and beneath that a shirt and then a tee-shirt and then a bra. She said she was cold and felt nauseus. She had a history of ulcerative colitis. I helped her walk out to the living room where we got her on the stretcher and bundled her up in our blankets, and placed the towel around her head like a nun's habit.
I tried to assess her further in the ambulance. I couldn’t roll up her sleeves to be able to hear the BP. I had to palpate the abdomen through the bathrobe, so I finally had to at least get her arm out, which was difficult because she was large and slow moving. And then she told me she had a burning feeling in her chest. I ended up doing a twelve lead, reaching my hand in through the top of her turtleneck to get the top leads, and then going up under her tee-shirt at the bottom to get the others. The twelve lead was okay. I didn’t look for an IV because she told me she had a port.
When I got to the ED, I felt a little disorganized. A part of me wished I had gotten a family member to help get her undressed in the bedroom so I could have done a full assessment there, but with the way she was feeling, I think she just wanted to go to the hospital. If I had her in a Johnny I might have been able to see a vein, and get a peripheral IV, and then call the hospital to get orders for a judicious amount of morphine to take the edge of her pain.
Field assessment isn’t as easy as walking into a clean well light exam room to find your patient wearing just a Johnny laying there on the exam table. You want to be a professional, and be thorough, and not miss anything. But you also don’t like to trouble people.
I guess sometimes it’s a matter of choreography, of style, of making the moves and speaking the word music to make the patient comfortable, assuring them they will be warm and will not catch cold, and that above all they are in the hands of a medical professional, a caregiver, and not just an ambulance attendant.
