Today is the last day my latest preceptee will be with me. Tomorrow he rides with our chief paramedic, who if all goes well will formally approve his being “cut loose” to be a paramedic on his own. My preceptee has been with me for nine weeks and has been, by all standards, “a shit Magnet,” “a dark cloud,” “a horseman of the Apocalypse…” On most days, the tones start going off when he walks in the door and don't stop until he leaves.
While I have had preceptees who couldn’t buy a critical call, we’ve done cardiac arrests (five), respiratory arrests, multiple motor vehicle accidents with prolonged extrication, stabbings, falls from roofs, countless major medicals alerts, seizures, CVAs, internal defibs going off right and left. You name it, we’ve had it, including all the routine ALS calls as well, the UTIs, pneumonias, nausea and vomiting, weakness and malaise calls. He’s done his share of all of them and done them well enough that it is now time to boot him on. Besides I’m ready to start doing calls on my own again. My preceptee, perhaps feeling sorry for me, even let me do the intubation on our cardiac arrest yesterday, while he got a chance to use the EZ-IO drill for the first time.
Back when I was being precepted, I remember feeling hurt one day when my preceptor told me he was going to cut me loose because he was getting tired of me. I know the feeling. While I enjoy precepting, sometimes I just want to do the call, get it over with and move on to the next one or at least go back to reading my book or the movie that is paused on the DVD player back at the base. I remember one time my preceptor looking at me like I was an idiot as I fumbled through a call. Finally, in front of the patient and bystanders, he wrote me a note on a piece of paper and handed it to me(instead of slapping me upside the head). “This is a cocaine overdose!” the paper said. I also remember how he would pace about at the hospital as I carefully, painstakingly, tried to write a proper paramedic run form. What now takes me only minutes to write used to take me twenty to thirty minutes, not counting the ones I had to rip up and start over on.
When I first became a preceptor I believed that the closer you were to being precepted yourself, the better a preceptor you would be. And now all these years later, in many ways I still feel that is true. While I am much more patient with a new medic’s skills than I was as a new preceptor (miss the IV or the tube, try again, no problem where before I was more likely to elbow a preceptee out of the way,) I find I am less patient at letting them work their way through a scene. I am too quick to say, you can do that in the ambulance (ask a stable alert patient for their democraphic information) or let’s get going (instead of sitting there on scene in the ambulance when we are facing an easy twenty-five minute ride to a distannt hospital) or to interject, ask them when this all started (already!). While part of a preceptor’s job is to teach, the other part is to sit back and be invisible – to let the preceptee figure it out for themselves, but I am finding it harder to be “invisible.” I think maybe I am so far removed from what a new paramedic knows or doesn’t know that I can’t relate as well. I may assume what I shouldn’t or not assume what I should.
I had a writing instructor tell me once that the beauty of Chekhov (the great Russian short story writer)’s work was you felt the effects throughout the story and were deeply moved at the end, but you could not see how he produced it. The first novel I ever wrote when I was in college, I had another writer read and his comments were “I never understood how hard it was to write a novel until I read yours.” The point I think was you could see every board and nail, every paint brush stroke. It was very painstaking and transparent.
On a routine medical a few weeks ago, a new EMT charged ahead of us, racing down the nursing home hallway and then into the patient's room where she immediately stuck her fingers on the patient’s neck to count the carotid pulse. The only problem was the patient was alert and oriented and the call was for skin tear to the knee. While the EMT wasn’t wrong to get vital signs, you could painstakingly see the attempt to put classroom learning into the real world. On another call, an EMT interrupted our questioning of the patient with chest pain to proudly announce the patient was allergic to penicillin.
In both cases, these EMTs were showing the boards and nails of their craft (getting pulses and taking allergies) but not demonstrating any artistry. They were in fact being quite clumsy. Chekhov probably had a harder time explaining how he put his story together than a freshman English teacher has explaining how to write a basic paragraph.
I am not claiming to be a Chekhov of paramedics. Far from it. In addition to having many clumsy moments of my own, paramedicine because it is done in real time, prevents a paramedic from ever demonstrating the flawlessness of a writer, who has ample time to rewrite, and iron out the rough edges of each performance. What I can say is that I do calls better than when I started. I am both more thorough and more concise, and certainly more efficient. There isn’t a lot of wasted motion or time. Ask me how or why I did what I did and the answer is not simple, but more of a dissertation. Not I did B because B follows A and comes before C, but I did G because of K, B, Y, L, P, and several other factors that don’t have letters. When I started precepting I had more simple advice. Never do this. Always do this. Now I find that rules are less rigid. The instruction is more zen theory than facts. I probably am more confusing and make a lot less sense than I did when I started precepting. I know what I told you to do after the last call, but this situation was different. Here’s why. Etc. Etc. And I wonder then if they really understand when they say yes, but have that puzzled look in their eyes. What is he talking about.
The preceptee/soon-to-be-medic-on-his-own will do fine. He is an affable young man who treats patients, their families, and other medical staff with respect. While I have had more advanced preceptees and certainly less advanced preceptees, I have to remember that when I precepted years ago, I was far from being at the head of the class in terms of knowledge and experience. What I do know now is that being a good paramedic is less about knowing everything when you first hit the streets than it is about being willing to learn from each call, critique yourself, and constantly seek out ways to improve, to develop your own theories of practice and a style that works for you and your patients.
I will give you high marks for your potential. Good luck tomorrow. It has been a pleasure precepting you.
Tuesday, February 26, 2008
Thursday, February 21, 2008
Billing
My paramedic preceptor told me many years ago, “You’re a paramedic, billing isn’t your job. A patient doesn’t want to be asked their social security number when they’re having a heart attack.”
Consequently, I didn’t pay too much attention to the back of my run forms. Sometimes I’d turn them in with the backs blank and not hear much about it. Every now and then, I’d get them kicked back and I’d be told to fill out the back. I’d fill out the back, but not always get the insurance information. Then at work they started a program where you got a dollar for every patient you obtained full billing information on. That was great. I got insurance on everyone and was pulling in an extra $25-$30 a week. That program didn’t last. A new company came in and we were told it was our job to get the information, and we shouldn’t have to be paid to do a job we were already being paid to do. I’d get the insurance information, but not if it wasn’t readily available. If the patient had it on them, fine. If I had to track it down, that was another story. And signatures. I’d get signatures if the person was talking to me and not in any kind of distress, but my compliance wasn’t near 100 percent. Sometimes I’d get the forms kicked back. You need a signature or a reason why they couldn’t sign. My favorite was when this would happen on cardiac arrest patients. Reason signature not obtained: Patient DEAD! Of course it wasn’t just dead people I wasn’t getting the signature on. Some of our patients are shhh! pretty nasty. Not the type of people you want to hand your pen to. My old reliable standby was: Reason signature not obtained: PHGLEM ON FINGERS.
But times are changing. I just sat through a two hour long class on documentation that told us how Medicare is refusing to pay many of our bills because the information on the back of the cards is not complete, the information doesn’t match what is on the front, there is no signature, there is no signature from the receiving facility acknowledging receipt of the patient. I was told Phlegm on fingers was not acceptable as a reason signature was not obtained. Your run form isn’t complete, it comes right back to you. I admit I am like a dog. You beat me over the head a few dozen times and I am trained. You let me wander, and I’ll wander. You build an invisible electric fence around me and zap me every time I cross its border, I will soon cease my wandering ways.
I admit to taking a certain pride now in turning in a completed run form with all the “t”s crossed and “I”s dotted. Much in the same way when I was a new EMT I enjoyed properly c-spining a patient, securing all the straps and the towel rolls.
There is a hospital where we transport patients that really annoys me. When we bring the patient in, we have to stop and get the patient registered first. The triage nurse will not even look at us until the patient’s name pops up on her computer. Sometimes we arrive and there is no registrar there. The nurse will go find the registrar, and then sit and wait for her to register the patient before getting our verbal patient report. (To be fair, if we are bringing in a cardiac arrest or a full trauma patient, they do have procedures for us to go right past GO). I was there the other morning and one of the hospital big wigs was there glad-handing with the staff when we rolled in. No registrar. We sat there while he glad-handed (his back was to us). I saw the triage nurse start to get nervous and then she ducked out and dragged a registrar out of the break room. Another nurse started asking us questions about the patient before the registration was done. I really wished the bigwig had been there at a truly busy time and wished the staff had acted the way they normally do, and it could have been explained to him that per the hospital’s policies (not the nurses) care at his hospital doesn’t start until the patient is registered and has confirmed billing and signed the proper forms.
I was at the same hospital later that day when I heard a firefighter/paramedic say to a family member, “We’re fire-medics we don’t care about billing. Your mother shouldn’t have to worry about giving out her social security number when she’s sick. That’s for the commercial ambulances.” That comment really ticked me off. Arrogant prick, I thought.
I have always been a medic who works up his patients fairly thoroughly. If you are old and not feeling well, you get an ALS workup. IV, monitor, 02 if you need it. I do it to be thorough, and also when I was a newer medic, it helped me hone my IV skills. I could justify it both as being thorough as well as enabling the company to get the ALS rate rather than the BLS rate. Back when we used to draw bloods, I’d draw the bloods. I remember at the time another ambulance service told its medics not to draw bloods because the cost to the service was too great (IV plus bloods was the same billing rate as IV). I liked that our service never once questioned our care. Sometimes you could say the IV and the bloods were done more as a convenience to the hospital than absolutely medically necessary. Handing over the bloods and saying you had gotten an IV always drew a smile and warm thanks from the ER nurses. Then the hospitals stopped taking our bloods. Some people felt the reason was the hospital could then charge big bucks for the blood draw. $100 or more bucks for a blood draw on an itemized bill. Everyone looking for revenue.
At the documentation class we learned that while Medicare is making it much harder for ambulance companies to get paid, they have changed things so that an ambulance company can get a paramedic rate simply for an evaluation as opposed to doing actual paramedic skills. For instance having a paramedic evaluate a patient produces a bill the same amount as when a paramedic does an IV and pushes 2 ALS drugs, including drugs that can be very expensive. Only if the medic pushes a 3rd drug does the bill go up. So whereas in the past, my putting in an IV lock brought in increased revenue to an ambulance company, now it costs them money. I don’t pretend to understand all the intricacies of billing nor do I have an idea of a fairer way to bill. I’m just pointing out that there are many calls that cost the ambulance company way more in supplies and medicine than they can bring in (not to mention the calls they simply don't get paid for) and there are calls that are very profitable. I am sure hospitals face the same thing. At the end of the year, they are either in the red or in the black. Too many years in the red and they go out of business. This happened to the first ambulance company I worked for( a small private company in Massachusetts). We started having supply issues, and then we noticed we were being sent out on the road in unsafe ambulances, and then we had to race to the bank on payday to get our checks cashed before they bounced (which sometimes happened to those who waited until Monday to cash theirs), and then one day they told us they were boarding the place up. Instead of complaining about unsafe ambulances, we were complaining about the line at the unemployment office.
There is always talk these days of paramedic shortages. But there are way more paramedics now than there were when I started when some people who went to medic school couldn’t even get precepted because there were so few paramedic slots to fill (Medic salaries were much higher than EMTs back then). Changes in billing have made it more profitable to have more paramedics. Some services strive for a paramedic on each ambulance.
I don’t mean to point fingers here at anyone. I just think that we are all naïve if we say money isn’t a factor. We may not have gotten into this business to make money, but we all need to live.
If we think what we do is important, we need to get paid for it. If we find ourselves with crappy equipment and low wages, it might be because we are not doing a good job of recovering what we are worth. Some hospitals close because the cost of the care they provide is greater than the money they bring in. If a fire service doesn’t want to bill the insurance companies or federal government for the services they provide, well, the people in their town are just going to have to pay higher taxes to support that fire service. Someone has to pay for those saline locks, that LifePack 12, and that dose of Zofran. A few years back many volunteer services refused to charge because they were VOLUNTEER, but with time, just about all of them now bill. They faced reality. They may not sic aggressive bill collectors on their patients, but they certainly do bill everyone with insurance and rightly so.
What does this all mean for me? I will try to fill out the backs of my run forms and get the needed signatures. I am not going to withhold treatment before I get insurance information. No one has ever suggested that. But in response to my first preceptor, I have to say collecting billing information is part of my job. Nothing comes for free. We – commercial services, volunteer services, fire services, hospitals -- are all professionals – and we need the resources to do our jobs.
And I still love my job.
Consequently, I didn’t pay too much attention to the back of my run forms. Sometimes I’d turn them in with the backs blank and not hear much about it. Every now and then, I’d get them kicked back and I’d be told to fill out the back. I’d fill out the back, but not always get the insurance information. Then at work they started a program where you got a dollar for every patient you obtained full billing information on. That was great. I got insurance on everyone and was pulling in an extra $25-$30 a week. That program didn’t last. A new company came in and we were told it was our job to get the information, and we shouldn’t have to be paid to do a job we were already being paid to do. I’d get the insurance information, but not if it wasn’t readily available. If the patient had it on them, fine. If I had to track it down, that was another story. And signatures. I’d get signatures if the person was talking to me and not in any kind of distress, but my compliance wasn’t near 100 percent. Sometimes I’d get the forms kicked back. You need a signature or a reason why they couldn’t sign. My favorite was when this would happen on cardiac arrest patients. Reason signature not obtained: Patient DEAD! Of course it wasn’t just dead people I wasn’t getting the signature on. Some of our patients are shhh! pretty nasty. Not the type of people you want to hand your pen to. My old reliable standby was: Reason signature not obtained: PHGLEM ON FINGERS.
But times are changing. I just sat through a two hour long class on documentation that told us how Medicare is refusing to pay many of our bills because the information on the back of the cards is not complete, the information doesn’t match what is on the front, there is no signature, there is no signature from the receiving facility acknowledging receipt of the patient. I was told Phlegm on fingers was not acceptable as a reason signature was not obtained. Your run form isn’t complete, it comes right back to you. I admit I am like a dog. You beat me over the head a few dozen times and I am trained. You let me wander, and I’ll wander. You build an invisible electric fence around me and zap me every time I cross its border, I will soon cease my wandering ways.
I admit to taking a certain pride now in turning in a completed run form with all the “t”s crossed and “I”s dotted. Much in the same way when I was a new EMT I enjoyed properly c-spining a patient, securing all the straps and the towel rolls.
There is a hospital where we transport patients that really annoys me. When we bring the patient in, we have to stop and get the patient registered first. The triage nurse will not even look at us until the patient’s name pops up on her computer. Sometimes we arrive and there is no registrar there. The nurse will go find the registrar, and then sit and wait for her to register the patient before getting our verbal patient report. (To be fair, if we are bringing in a cardiac arrest or a full trauma patient, they do have procedures for us to go right past GO). I was there the other morning and one of the hospital big wigs was there glad-handing with the staff when we rolled in. No registrar. We sat there while he glad-handed (his back was to us). I saw the triage nurse start to get nervous and then she ducked out and dragged a registrar out of the break room. Another nurse started asking us questions about the patient before the registration was done. I really wished the bigwig had been there at a truly busy time and wished the staff had acted the way they normally do, and it could have been explained to him that per the hospital’s policies (not the nurses) care at his hospital doesn’t start until the patient is registered and has confirmed billing and signed the proper forms.
I was at the same hospital later that day when I heard a firefighter/paramedic say to a family member, “We’re fire-medics we don’t care about billing. Your mother shouldn’t have to worry about giving out her social security number when she’s sick. That’s for the commercial ambulances.” That comment really ticked me off. Arrogant prick, I thought.
I have always been a medic who works up his patients fairly thoroughly. If you are old and not feeling well, you get an ALS workup. IV, monitor, 02 if you need it. I do it to be thorough, and also when I was a newer medic, it helped me hone my IV skills. I could justify it both as being thorough as well as enabling the company to get the ALS rate rather than the BLS rate. Back when we used to draw bloods, I’d draw the bloods. I remember at the time another ambulance service told its medics not to draw bloods because the cost to the service was too great (IV plus bloods was the same billing rate as IV). I liked that our service never once questioned our care. Sometimes you could say the IV and the bloods were done more as a convenience to the hospital than absolutely medically necessary. Handing over the bloods and saying you had gotten an IV always drew a smile and warm thanks from the ER nurses. Then the hospitals stopped taking our bloods. Some people felt the reason was the hospital could then charge big bucks for the blood draw. $100 or more bucks for a blood draw on an itemized bill. Everyone looking for revenue.
At the documentation class we learned that while Medicare is making it much harder for ambulance companies to get paid, they have changed things so that an ambulance company can get a paramedic rate simply for an evaluation as opposed to doing actual paramedic skills. For instance having a paramedic evaluate a patient produces a bill the same amount as when a paramedic does an IV and pushes 2 ALS drugs, including drugs that can be very expensive. Only if the medic pushes a 3rd drug does the bill go up. So whereas in the past, my putting in an IV lock brought in increased revenue to an ambulance company, now it costs them money. I don’t pretend to understand all the intricacies of billing nor do I have an idea of a fairer way to bill. I’m just pointing out that there are many calls that cost the ambulance company way more in supplies and medicine than they can bring in (not to mention the calls they simply don't get paid for) and there are calls that are very profitable. I am sure hospitals face the same thing. At the end of the year, they are either in the red or in the black. Too many years in the red and they go out of business. This happened to the first ambulance company I worked for( a small private company in Massachusetts). We started having supply issues, and then we noticed we were being sent out on the road in unsafe ambulances, and then we had to race to the bank on payday to get our checks cashed before they bounced (which sometimes happened to those who waited until Monday to cash theirs), and then one day they told us they were boarding the place up. Instead of complaining about unsafe ambulances, we were complaining about the line at the unemployment office.
There is always talk these days of paramedic shortages. But there are way more paramedics now than there were when I started when some people who went to medic school couldn’t even get precepted because there were so few paramedic slots to fill (Medic salaries were much higher than EMTs back then). Changes in billing have made it more profitable to have more paramedics. Some services strive for a paramedic on each ambulance.
I don’t mean to point fingers here at anyone. I just think that we are all naïve if we say money isn’t a factor. We may not have gotten into this business to make money, but we all need to live.
If we think what we do is important, we need to get paid for it. If we find ourselves with crappy equipment and low wages, it might be because we are not doing a good job of recovering what we are worth. Some hospitals close because the cost of the care they provide is greater than the money they bring in. If a fire service doesn’t want to bill the insurance companies or federal government for the services they provide, well, the people in their town are just going to have to pay higher taxes to support that fire service. Someone has to pay for those saline locks, that LifePack 12, and that dose of Zofran. A few years back many volunteer services refused to charge because they were VOLUNTEER, but with time, just about all of them now bill. They faced reality. They may not sic aggressive bill collectors on their patients, but they certainly do bill everyone with insurance and rightly so.
What does this all mean for me? I will try to fill out the backs of my run forms and get the needed signatures. I am not going to withhold treatment before I get insurance information. No one has ever suggested that. But in response to my first preceptor, I have to say collecting billing information is part of my job. Nothing comes for free. We – commercial services, volunteer services, fire services, hospitals -- are all professionals – and we need the resources to do our jobs.
And I still love my job.
Monday, February 18, 2008
A Paramedic's Diary
There is a new paramedic book out available as of now only from Amazon.UK, called Paramedic's Diary
by Stuart Gray, a London paramedic and the author of the A Paramedic's Diary blog.
It is a good read. EMS in England is much like it is here. They have a wonderful term -- "a suspended" -- which means a person dead, but still workable.
Gray's work is an excellent companion to Tom Reynolds' Random Acts of Reality blog and book Blood, Sweat and Tea.
by Stuart Gray, a London paramedic and the author of the A Paramedic's Diary blog.It is a good read. EMS in England is much like it is here. They have a wonderful term -- "a suspended" -- which means a person dead, but still workable.
Gray's work is an excellent companion to Tom Reynolds' Random Acts of Reality blog and book Blood, Sweat and Tea.
Sunday, February 17, 2008
Hair
If you are a football fan, have you noticed lately how many more players sport dreadlocks under their helmets. You watch the player on the team you are rooting against run with the ball and you can't help but think, someone ought to grab that guy by his hair and tackle him. That would be the last time he wears dreadlocks hanging out of his helmet.
Note: Nothing against dreadlocks directly. I love Jamaicia. Every time I go, I buy another Bob Marley t-shirt. I own 5 of them now.
Now my hair as it tends to do starts growing a little on the long side. I just don't like going to the barber. And I am very busy so it is hard to find time. In winter at least I can wear a snow cap and keep my hair tucked up under it, although if I am not carefull there are some clumps that hang down by my ears.
So we go to a call for an old woman who has fallen out of bed and been on the floor in her urine all night. She doesn't appear to be hurt, but she is a big woman, who in addition to suffering from some dementia, is also almost completely deaf. To get her up, we put her on a board, tie one strap around and then plan to lift her up to her feet to see how she does standing. Normally I always take the head. I have to lift, but I also get to avoid a panicked, urine soaked patient from grabbing me as the board comes up to the standing position. Unfortunately today, my preceptee is running the call and he is in the head position and I can't figure out a way to switch places without tipping off the reason why. So I'm stuck on one side.
We lift her up. I am watching her body to make certain she doesn't slide too much in my direction. She reaches out. She grabs my hair -- a handful right by my ear and she starts to pull. I scream. I scream! I swear! I cuss! She is deaf and has dementia and has no idea she is pulling the hair out of my head. I can't grab her hand because I'm holding her and the board. She is finally standing now and I grab her wrist and she is still holding on to my hair for dear life, while my partners try to pry her fingers loose.
Only when they turn her head so she can see what she is holding does she let go. She says nothing. She smiles at me and then leans forward and kisses me. Her eyes twinkle.
***
My next day off. Here's how its going to go. I walk into the barber's and sit in the chair. I pull off my hat. "Use the razor," I'll say. "Short all over -- just make it look nice."
My apologies to all you dreadlocked football players. I guess I got payback for my hurtful thoughts.
Note: Nothing against dreadlocks directly. I love Jamaicia. Every time I go, I buy another Bob Marley t-shirt. I own 5 of them now.
Now my hair as it tends to do starts growing a little on the long side. I just don't like going to the barber. And I am very busy so it is hard to find time. In winter at least I can wear a snow cap and keep my hair tucked up under it, although if I am not carefull there are some clumps that hang down by my ears.
So we go to a call for an old woman who has fallen out of bed and been on the floor in her urine all night. She doesn't appear to be hurt, but she is a big woman, who in addition to suffering from some dementia, is also almost completely deaf. To get her up, we put her on a board, tie one strap around and then plan to lift her up to her feet to see how she does standing. Normally I always take the head. I have to lift, but I also get to avoid a panicked, urine soaked patient from grabbing me as the board comes up to the standing position. Unfortunately today, my preceptee is running the call and he is in the head position and I can't figure out a way to switch places without tipping off the reason why. So I'm stuck on one side.
We lift her up. I am watching her body to make certain she doesn't slide too much in my direction. She reaches out. She grabs my hair -- a handful right by my ear and she starts to pull. I scream. I scream! I swear! I cuss! She is deaf and has dementia and has no idea she is pulling the hair out of my head. I can't grab her hand because I'm holding her and the board. She is finally standing now and I grab her wrist and she is still holding on to my hair for dear life, while my partners try to pry her fingers loose.
Only when they turn her head so she can see what she is holding does she let go. She says nothing. She smiles at me and then leans forward and kisses me. Her eyes twinkle.
***
My next day off. Here's how its going to go. I walk into the barber's and sit in the chair. I pull off my hat. "Use the razor," I'll say. "Short all over -- just make it look nice."
My apologies to all you dreadlocked football players. I guess I got payback for my hurtful thoughts.
Saturday, February 02, 2008
Not a Scratch on Her
The call is for a rollover, no injuries. Non-priority dispatch. When we arrive we see the car off the road into the bushes. The officer tells us the driver, who is claiming no injuries, is sitting in the police car. As the officer is talking to us, a bystander approaches and interrupts. "When I got her out of the car she wasn't right," he says. "She wasn't acting like she is now."
I nod and say thank you and go back to hearing the officer describe the accident. She lost control on the curve, jumped the curb, rolled and went into the bushes. She told him she thinks she hit the accelerator, instead of the brake.
I go over and check the car while my preceptee talks to the patient. The car is in good condition, considering it rolled. There is no internal invasion. All airbags deployed, including the side air bags. The bushes slowed and caught the car like a giant safety net. There was no sudden deceleration.
When I walk back over to my preceptee and the patient, I can see she is a young woman in her early twenties, who is wiping tears from her eyes. She says she was on the way to pick her daughter up from day care. She says she is okay and thinks she doesn't need to go to the hospital. It’s a little chilly out, so we ask her if she minds if we get her into the back of the ambulance where it is warmer and more space so we can check her out a little more thoroughly.
We do a full head-to-toe assessment. Good vitals, not a scratch on her. Good thing she was wearing her seat belt. We all agree on that. She tells us her husband is out of town, but her father is coming down to get her. He should be there in about fifteen minutes. We tell her we'll wait with her until he gets there and then we can all discuss our transport options.
While waiting, we ask her to describe again how the accident happened. She says she was driving and she had a little episode where she was aware of things, but couldn't really respond to them. She thinks that's why she lost control. We ask her to elaborate.
"It started a few months ago," she says. "I just froze for a few seconds. It was very odd. It's happened a few times since. I saw the doctor. He doesn't know what is causing it. I'm scheduled to have an MRI next week."
I tell her it sounds to me almost like an absence seizure. An absence seizure while driving would cause you to lose control for a moment, cause you to mistake the accelerator for the brake. That's probably what happened, we speculate. I remember what the bystander said now about her not being right. Something medical definitely happened.
Her father arrives and he hugs his daughter and asks if she is okay. She says, she's fine and thankfully Tammy wasn't in the car.
"We never should have allowed you to drive with what's going on -- until we know what it is. I think about what could have happened."
"I'm all right, Daddy," she says.
We talk about the options with them. We can take her to the hospital and get her checked out, which is what we recommend or he can take her to the doctor or call us back if anything happens. He doesn't know what to do. She just wants to get her daughter and go home. We suggest that maybe we should call her doctor and discuss it with him since he has been treating her. We could call him and she what he would like us to do.
They both agree that is a good idea.
We call the doctor and repeat that there is not a scratch on her and that we think the crash was likely caused by another one of her episodes. We can take her in to be evaluated if he'd like. He hesitates a minute and then says, maybe we should bring her in and get her MRI today instead of next week. We agree that is a good decision and I hand the phone back to the father can hear the doctor's recommendation directly. The father thanks the doctor and then tells the daughter he will go get Tammy at the day care and then meet us at the hospital.
On the way into the hospital, as I watch my preceptee interact with the patient, I think what a sweet young woman she is. Very pretty in an unassuming way that she probably doesn't realize how pretty she is. She shows us pictures of her daughter and I show her some of mine.
We leave her at the hospital and wish her well after giving the nurse the report. I'm thinking lucky young woman to have her seat belts on and to be in such a protected car, lucky to have gone off the road where she did, where the land would catch her and ease her car to a halt. Someone was looking out for her.
***
Later in the shift, when we are back at the hospital, I see the nurse and ask how that young woman made out. I see something terrible in his face. He gestures for me to follow and then I see the woman on a bed in the hallway, her back to us, just a few feet away. She smiles on seeing me. She wears a hospital gown, her daughter playing in her lap, her Mom and Dad standing by the foot of the bed, looking on. "Is it all right if I tell the paramedic about what we found," the nurse asks.
"Sure," she says. "He's one of the men who helped me," she tells her mother.
The nurse says, "The MRI found a glimona -- a mass."
I know what a glioma is.
"Oh," the young woman says brightly, "That's good -- they have a name for it."
Her mother and father nod, but there is no brightness in their eyes.
I nod and say thank you and go back to hearing the officer describe the accident. She lost control on the curve, jumped the curb, rolled and went into the bushes. She told him she thinks she hit the accelerator, instead of the brake.
I go over and check the car while my preceptee talks to the patient. The car is in good condition, considering it rolled. There is no internal invasion. All airbags deployed, including the side air bags. The bushes slowed and caught the car like a giant safety net. There was no sudden deceleration.
When I walk back over to my preceptee and the patient, I can see she is a young woman in her early twenties, who is wiping tears from her eyes. She says she was on the way to pick her daughter up from day care. She says she is okay and thinks she doesn't need to go to the hospital. It’s a little chilly out, so we ask her if she minds if we get her into the back of the ambulance where it is warmer and more space so we can check her out a little more thoroughly.
We do a full head-to-toe assessment. Good vitals, not a scratch on her. Good thing she was wearing her seat belt. We all agree on that. She tells us her husband is out of town, but her father is coming down to get her. He should be there in about fifteen minutes. We tell her we'll wait with her until he gets there and then we can all discuss our transport options.
While waiting, we ask her to describe again how the accident happened. She says she was driving and she had a little episode where she was aware of things, but couldn't really respond to them. She thinks that's why she lost control. We ask her to elaborate.
"It started a few months ago," she says. "I just froze for a few seconds. It was very odd. It's happened a few times since. I saw the doctor. He doesn't know what is causing it. I'm scheduled to have an MRI next week."
I tell her it sounds to me almost like an absence seizure. An absence seizure while driving would cause you to lose control for a moment, cause you to mistake the accelerator for the brake. That's probably what happened, we speculate. I remember what the bystander said now about her not being right. Something medical definitely happened.
Her father arrives and he hugs his daughter and asks if she is okay. She says, she's fine and thankfully Tammy wasn't in the car.
"We never should have allowed you to drive with what's going on -- until we know what it is. I think about what could have happened."
"I'm all right, Daddy," she says.
We talk about the options with them. We can take her to the hospital and get her checked out, which is what we recommend or he can take her to the doctor or call us back if anything happens. He doesn't know what to do. She just wants to get her daughter and go home. We suggest that maybe we should call her doctor and discuss it with him since he has been treating her. We could call him and she what he would like us to do.
They both agree that is a good idea.
We call the doctor and repeat that there is not a scratch on her and that we think the crash was likely caused by another one of her episodes. We can take her in to be evaluated if he'd like. He hesitates a minute and then says, maybe we should bring her in and get her MRI today instead of next week. We agree that is a good decision and I hand the phone back to the father can hear the doctor's recommendation directly. The father thanks the doctor and then tells the daughter he will go get Tammy at the day care and then meet us at the hospital.
On the way into the hospital, as I watch my preceptee interact with the patient, I think what a sweet young woman she is. Very pretty in an unassuming way that she probably doesn't realize how pretty she is. She shows us pictures of her daughter and I show her some of mine.
We leave her at the hospital and wish her well after giving the nurse the report. I'm thinking lucky young woman to have her seat belts on and to be in such a protected car, lucky to have gone off the road where she did, where the land would catch her and ease her car to a halt. Someone was looking out for her.
***
Later in the shift, when we are back at the hospital, I see the nurse and ask how that young woman made out. I see something terrible in his face. He gestures for me to follow and then I see the woman on a bed in the hallway, her back to us, just a few feet away. She smiles on seeing me. She wears a hospital gown, her daughter playing in her lap, her Mom and Dad standing by the foot of the bed, looking on. "Is it all right if I tell the paramedic about what we found," the nurse asks.
"Sure," she says. "He's one of the men who helped me," she tells her mother.
The nurse says, "The MRI found a glimona -- a mass."
I know what a glioma is.
"Oh," the young woman says brightly, "That's good -- they have a name for it."
Her mother and father nod, but there is no brightness in their eyes.
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