Patience

Preceptees come in all types, ranging from those who are so smart you have to reread your books at night just to keep up with them to those who think the excuse “well, we didn’t go over that in class” covers them from any need to improve further. I’ve had preceptees for whom, on arriving at a scene, I had to open the back of the ambulance, and say, “Are you planning on getting out anytime soon?” to those who were already in the house with the patient intubated, a IV in their necks, and were whirling the defib paddles like numb-chucks before I could even make it in the door.

Some preceptees are dark clouds – I had one who got a tube on her first call, and who it seemed we went to so many multiple shootings, I actually considered buying a bullet-proof vest. And I had others who were white clouds, people who towns wanted to hire out because when they were on duty trauma and disease took the hours off.

When I first started as a preceptor I think I was much more accepting of a new medic’s ignorance because I was so close to my own precepting period where I frankly didn’t know much and felt it a miracle that I passed. Now I am less understanding of gaps in learning. But also back then I was not as forgiving if they missed an IV or their first shot at a tube. I’d push them right out of the way. I’m much more laid back now. I’ll be right at their side, schooling them in how to tube, manipulating the neck for them, coaching them through it or letting them go for the IV on the third try, if I think they will get it this time.

My new preceptee is a man just a few years younger than myself. I believe he will be the kind of paramedic the company needs. He is kind to the patients, intelligent, and not at all rash. Unfortunately, as far as his precepting goes, he is a white cloud. We have only been together a couple weeks, but we aren’t getting much. The one morning there was a code, it came in just before our shift, and hearing it on the radio, I responded right to the scene and met the night medic there, and we worked it together. My preceptee was waiting at the barn when we got back. “Fifteen minutes later and you would have had the call,” I said.

“Oh, well,” he said.

I consider patience one of my better qualities. My preceptee is patient too. The knock on him has been that he might be too slow on scene. I’m supposed to evaluate him on that. We haven’t really had a bad call yet to test how quick he can move when he has too. It’s true he moves a little on the slow side on the calls we’ve been on, but not in a bad way. He reminds me somewhat of Columbo, the TV detective. He has a slow manner, but he is bright, and he ends up with the patient’s full attention. They feel he cares about them, that he listens.

Several of the calls we have had have tried my patience. I guess I am anxious because I want to get good calls for my preceptee. Here’s some of the ones we’ve had this week. The 80 year old man, fully dressed, who called because his home BP cuff gave him a reading of 106/72 and his pressure is usually 120/80, and he is concerned and believes he should go to the hospital because he felt slightly lightheaded when he stood up. The man is upset we brought the stretcher in, he can walk, he says, and no he hasn’t called his doctor. The woman who has a knot in her back and instead of driving to the hospital, drove back to her retirement community because they always call an ambulance for her and she could park her car, and then have the retirement community send their courtesy van when she is done seeing the doctor in the ER. The nursing home patient discharged a few days ago with pneumonia who is requesting to go to the hospital because he is worried his pneumonia is acting up, not because the staff has thought he should go.

And then there is Hazel. Hazel is a skinny old woman with a wig, who looks like a scrawny bird. She lives alone, and always wears a yellow bathroom that is faded and stained. Her house stinks of cigarette smoke. She has early dementia and calls us several times a week for nonspecific complaints. She’s constipated, she wants her blood pressure checked, and she didn’t sleep a wink all night. Sometimes her neighbor is there when we get there – her neighbor said Hazel once called her twenty-two times in one day. Lately, my approach to Hazel has been, you want to go to the hospital, get your coat, let’s go. I can’t take the smell in her apartment. It’s like she has smoked three packs a day for fifty years and has never once opened a window. When I first started getting called there, I tried to get social services involved believing she needed to be in a nursing home because of her increasing dementia. One day I gave her a HIPPA form. She started reading it, and then got bored and put it down. Then she discovered it again and started reading it again, and then got bored and put it down, only to discover it in her hand, and start reading again. I saw her in the hallway five hours later and she was still reading the HIPPA form like it was a racy novel.

The hospital has stopped working her up, and now she just goes to the waiting room. She isn’t demented enough I guess for a nursing home. Still she keeps calling. My preceptee has been with me to her house three times already. He’s very patient with her. I end up standing outside, breathing the fresh air, while he helps her lock up her house and get her things.

Yesterday was a slow day. We sat around a long time until we finally got a call. It was at an elderly apartment complex that just opened in a renovated building that used to be a nursing home. The call was for a medic alarm. A red light was flashing on the alarm board by the front door. The neighbors, seeing the flashing light, called 911. The night medic had warned me about the new place. The night before he’d talked to a commercial crew who had responded there, and taken the patient in. No one answered the apartment door, but before the policeman tried to kick the door in, I had him call dispatch and check and see if it was the same apartment as the one the crew went to the night before. It was, and dispatch now told us they had transported the resident. It seems no one had reset the button. So we cleared. One call, no patients.

We were so bored by then, I suggested we stop at Hazel’s house, walk in and say, “What’s wrong today? You called for an ambulance?” just to see what she would do. Whether she would be upset that she didn’t remember she had called for an ambulance or whether she would think that she had.

I know that wouldn’t have been very nice, but hey we were just cracking jokes, trying to pass the time. We spent much of the day watching the news coverage of the death of the crocodile hunter. What a bummer that was. At least he died doing something he loved. We joked that we were surprised it wasn’t a crocodile that had gotten him. Instead, it was a sting ray. Maybe it was an out-of-town job, we guessed. The crocks got together and called in a hired tail to do the job. Stingy. Made it look like a freak accident. But it was a hit. The word would get around the outback. Teach anyone else to mess with the crocks.

I know it’s not politically correct to make fun of an old lady with dementia or someone so recently tragically killed. Poor taste. But that’s how it is sometimes, particularly when you are bored. Paramedics with time on their hands.

Nothing for the rest of the day. At least it was a holiday. Double time and a half pay. Still I felt like a bad host. Instead of being out there being big bad paramedics – doing codes and MIs and rollovers and pushing all kinds of drugs, showing my preceptee the street life, we were sitting in the base living room, bored, reading the newspaper over and over, watching the same clips on TV. I was feeling restless. My preceptee sat in the arm chair, mouth o
pe
n, snoring.

This morning, while we were talking about how today would be the day we’d get the good calls he needs before getting cut loose, the tones on the radio went off.

“Unit One!” the dispatcher called.

“Note the urgent quality to the dispatcher’s voice,” I said to my preceptee. “This is going to be good.”

“Unit One,” I answered.

“Female. Constipation.” He gave the familiar address. My preceptee started laughing.

“Hazel,” he said.

My preceptee does his usual stellar job with Hazel. She is all agitated. “I didn’t sleep a lick last night. I’m constipated. I feel horrible all over. I’m a wreck. I didn’t sleep at all. Close the door, you’re letting the cold air in.”

“I need to hold the door open,” I say, “Because there is no air in here. I can’t breathe.”

“Close the door. My, what a draft. I feel terrible. I hardly slept a lick,” she says.

“Fine,” I say. “I’m waiting outside.”

“Don’t mind him,” my preceptee says, “He has a respiratory problem.”

They come out of the house fifteen minutes later. She’s wearing her yellow stained bathrobe and tennis shoes and carrying her little purse, her wig slightly off kilter on her head.

The ED is not too busy today and the triage nurse assigns Hazel a bed in the non-urgent wing.

My preceptee gives the room nurse a report. I hand Hazel her HIPPA form.

4 Comments

  • Eric Smith says:

    Patience is definitely an acquired skill. Unless you’ve got 10 runs stacked up waiting for a truck, you can always take a few extra minutes to listen to the ramblings or stories of a patient until you move the patient along in the continuum of care. Sounds like you and your partner/preceptee take those extra steps with your patients.

  • Virginia S says:

    Don’t worry, I’m sure you’ll get some good calls soon. Sounds like your newby is a nice guy with lots of patience.

  • Anonymous says:

    I’m a new medic. I worked with a variety of older medics during my clinical shifts. They came in quite a continuum. One was a very experienced and older medic who clearly did not like me at all, and dinged me on my eval for not being able to obtain a blood pressure in the moving truck that was to his liking. He seemd burnt out, uncaring, and had quite a few homophobic and racist views that I didn’t care for.Another was very patient, but seemed to want nothing more than to have every A&O patient sign a refusal. The best was a woman who’d been a medic for about 15 years. She seemed quite crabby initially, telling me all the things I was expected to do, and especially the things I was never to do under any circumstances. I didn’t think the shift would go very well until we had a tough call. I figured her to be burnt out, like the first guy I mentioned, but she wasn’t. She had this way of looking at situations that went way deeper than the average person. She was tough, and compassionate towards her partner, me, and the patient. It was a call that went technically well, but emotionally not so well. That she asked me, “How are you feeling about this” meant a great deal.Some of the medics were crabby. They seemed to have forgotten that they were once students too. They forgot that intubations in surgery aren’t like intubations in a bathroom. They forgot that IV starts in the ED and classroom aren’t like IV starts in the dark of a moving truck.I will precept medics some day. I hope I don’t forget what it’s like to be a student. I hope I’m always a student.

  • Stacey says:

    That sounds like 90% of my ride time.

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