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Tuesday, December 27, 2011

Stubborn Medics

Most of us in health care, especially emergency medicine, know that we make the worst patients. Even though we should know better we usually don't call 911 when we should. We wait until we absolutely have to. When I developed gall stones I was in so much pain I couldn't stand upright. I couldn't drive. I couldn't think straight. But did I call 911? Nope. Too stubborn. I didn't really want to ask my parents to watch the kids or ask my wife to take me to the ER.

So we got a call around 2 in the afternoon for a fall with injuries. When we arrived on scene we found a 60 year old man laying in a recliner. His wife informed us that he had fallen in the bathroom the day before and broken his hip. He had then crawled into the living room and into the recliner instead of calling for help. When she arrived home from work she found her husband pale with pain, but he refused to let her call 911.

She then told us that her husband was one of the first paramedics in Oakland some 30 years ago. He had had his picture in the paper and everything. That instantly explained his lack of interest in calling 911. She continued to explain his reluctance by relating the story of his last hip fracture 3 years ago. The medics just manhandled him onto the gurney with no pain medication. He didn't want a repeat of the performance.

I assured my patient that things would be different this time. I don't think the salty old medic believed me. I then started a line on him. His BP was borderline low so we only started him off with 3 mg of Morphine. We then used a KED to stabilize his hips. While we moved him onto the gurney (as smoothly as possible) we gave him a fluid bolus to bring up his BP with the hopes of being able to give him some more pain medication in the back of the bus.

Next time I hope that he will be a little more willing to call us.
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