We are sent on a priority one for severe pain at a nursing home. The home is in the southern end of one of our satellite towns — not a facility where we routinely respond. It is pouring rain and we race up the driveway and park under the awning. As we are pulling our stretcher a woman comes out and says, “The ambulance entrance is around back.”
“I’m sorry,” I say. “We don’t come up here much. Was there a sign?”
“Yes,” she points down the hill. It’s raining too hard to see anything.
“Didn’t see it. Sorry.”
We reload our stretcher and drive down the hill, and then up the back way. We find the ambulance entrance, but there is no awning. Fortunately, it isn’t raining quite as hard as it was just moments before, so we quickly pull the stretcher and race in.
A nurse looks at us as we come through the door. “Who are you here for?”
“We don’t know. Someone with severe pain. We were sent lights and sirens.”
“Oh, yes, this way.” She leads us down the hall, giving me the report as we go. The nurse is Indian, and speaks in a rapid syncopated accent. “This patient fell this morning being assisted to the bathroom. We did an x-ray that shows a fractured left lateral femoral condoyle.”
I admit it takes me a moment to figure out what she is talking about. It is partially the accent, but it is partially that I am used to people giving the plain English version, saying she broke her leg. The left lateral femoral condoyle, of course, is much more accurate and professional. In plain English the break is to the left femur where it fits with the patella — the knee. The woman, as expected, has swelling and pain just above the knee. She is in a fair amount of pain. They have given her tylenol only. I would like to give her some morphine, but she is allergic to it. We put a pillow under the the leg for comfort, and then put a sheet up around her head like a pullover hood to protect her from the rain. She now looks somewhat like Mother Teresa.
So we go to the hospital — again not one we routinely transport too. When we arrive, the triage nurse is being very sarcastic to a patient who is using her telephone. “You need to get off the phone, get off right now. Off, off off. I need to use the phone. You’re supposed to be dizzy, you need to lay back down.” She looks at me and says, “and what do you have?”
Before I can even answer, she is talking to another nurse, and making a comment about someone being a bitch.
I wait for her to look back at me. “And…” She looks at me expectantly. “You have?”
I try to keep my answer short and sweet to start because it seems she just wants to know the down and dirty while she digs among a stack of papers for a triage report form. “A fractured leg,” I say.
“And how do we know that?” She says it rather rudely, in such away like who am I to say she has a fractured leg because I am just an ambulance person. I can suspect a fracture, but I can’t say a fracture.
“How do you have an x-ray?”
“They took one already, read it, and determined she had a fracture.”
“And what time did this all happen?”
“This morning. She was being walked to the bathroom and she tripped and fell.”
“And it’s four o’clock now.” I am not certain whether her sarcasm is directed at me, at the patient or life in general, but the sarcasm is so thick, I can’t resist toying with her.
“Is there something unusual here?”
“Well, yeah. She fell this morning. Let’s say she fell at 11:59. Okay? Its now four o’clock.”
“And that’s unusual?”
“Yes. Why didn’t she come when she fell?”
“She’s from a nursing home.”
I am tempted to say, “Is this your first day as a triage nurse?”
Normally, the fall occurs several days before and they don’t get an xray for a day or two and don’t get it read for another day, and don’t transport till the day after that when the patient’s leg is massively swollen and bruised, and the patient is crying in pain. “They move slowly sometimes,” I say.
“And where is the fracture?” she asks.
I take delight in the answer. “Left lateral femoral condoyle.”
She looks at me blankly.
I point to the spot just above her knee. “Right there,” I say.