One of the best parts of this job is the conversations you can have with your patients, but not yesterday. Every patient I had yesterday had dementia or was incapable of coherent verbal speech.
An old lady from a nursing home trips on a curb at the supermarket. Her friend says she is more disoriented than normal. “Who are you?” the patient says to me. “What happened? My head hurts. Where am I?”
I explain. “I’m Peter. I’m a paramedic. It looks like you tripped and hit your head. You’re at the supermarket.”
“How did I get here?” she says. She looks at me like she has never seen me before this instant. “Who are you?”
I explain again, and again. We go through the same conversation about ten times en route to the hospital.
“I’m Peter. I’m a paramedic. You tripped and fell. I’m taking you to the hospital.”
At the hospital, they CAT scan her and it is negative. She waits in the hallway for an ambulance to come take her home. I say hello when I come in with another patient. “Do I know you?” she asks.
The patient I am bringing is has Alzheimer’s’s dementia. The nursing home staff thinks she is having slight mental status changes. She babbles incoherently, her sounds more like those of an infant than formed words.
We do a 12 year old with MR and cerebral palsy who had a seizure and is only capable of grunting.
We finish the day with another Alzheimer’s patient who fell and screams her hip hurts. “Who are you?” she keeps demanding of me. She won’t let me touch her without screaming. “My hip hurts. My right hip. Don’t touch me. Who are you?”
“I’m Peter. I’m a paramedic here to help you?”
“Don’t touch me, my hip hurts? How did I get here? Who are you? Why won’t this man introduce himself?”
“I’m Peter,” I say. “I’m the paramedic who comes to help people who have fallen and have pain in their right hip.”
“Oh, really,” she says. “Who is he?” She points to my partner.
“He’s the left hip guy.”
“Well, neither of you touch me. My hip hurts.”
Her diagnosis reads “labile, psychotic, aggressive, hypermanic dementia.” She is on a Lorazepam/Diphenhydramine/Haloperidol topical gel every 6 hours.
I ask her to tell me how much pain she is in on a 1-10 scale.
“Pain, I’ll tell you about pain,” she says. “But why should I talk to you. I don’t even know who you are.”
A relative shows up and this gets her going all over again. “My hip hurts. I don’t know who these people are. Why don’t they just let me get up.”
I give her some morphine, but she still makes quite a commotion when we finally move her.
In the ambulance, the words continue, “Who are you? This isn’t good. I don’t feel well. Let me out of here. I don’t know you. Let me out of here right now.”
I give her some phenergan in case the “I don’t feel well” is her code for she’s feeling nauseous from the morphine.
“Labile, psychotic, aggressive, hypermanic dementia,” the triage nurse reads from the W10 I show her. She looks over at the patient, who is dead asleep on our stretcher, with her mouth wide open.
“A real chatterbox,” she says.