Slither

We are called to a nursing home for a lift assist. I have never done a straight lift assist in a nursing home before, so I am a little puzzled. Isn’t this something that nursing homes are supposed to do themselves?

The short, squat nurse demands to know why we have brought in our stretcher, monitor, house bag, oxygen and long board. “We don’t need the stuff. We just need you to help pick him up. You don’t need all that.”

“We always bring it,” I say.

“Suit yourself. Follow me.”

On the way, we walk by a hoyer lift, which I take as a bad sign. It doesn’t appear broken.

“He slipped and can’t get up,” the nurse says pointing in the room. “The guys here don’t know how to lift.”

My preceptee enters the room first and I hear a voice say, “A girl, they send a little girl?”

I enter the room next. There on the floor is a human blob. Jabba the Hut. I have a hard time making out the flat flabby legs from the flab that emanates from al sides of the patient. He sits upright, his head like the cooked yellow yolk of an egg, with his fat all the white surrounding it.

“Two of you,” he says, “Just two of you?”

My other two partners come in the room, nearly running into each other as they stop suddenly at the sight of the patient.

“You guys don’t look very big,” he says. “You’re going to need an army to lift me — me — the fat guy — the humiliated fat guy.”

“We should be able to do it,” I say.

I have picked up big patients before, patients even heavier than this one, who I am guessing is 500 pounds tops. I have a great method. I slide a board under them, lay them down, and strap them to the board. I have two people — preferably strong firefighters or cops on each side of the board near the head, facing each other, holding the board under the patient’s arms. I have my partner stand in front. I take the end of the board, squat down and lift up, as the two responders pull up on their sides of the board. My partner in the front is there just to help balance the patient as we use the leverage of the board to get the patient to a standing position, from which the patient can either walk or we can slide a giant wheelchair underneath them.

The problem here is the patient’s mishapen legs make it impossible for him to stand, so that method is out. Adding to the problem, the patient has numerous open wounds on his legs.

I announce my plan — get the patient on the board, and then try to lift the board up enough to get the head of the board on the bed, and then we can lift the other end of the board from the feet and swing the patient around onto the bed.

But then the nurse starts telling me how she would do it.

I just look at her until she quiets. “You called us?” I said.

“Yes,” she says.

“That’s right,” I say, “And we have it under control, thank you.”

I think I imperceptibly nod toward the door for her to leave.

In the meantime, my partner has radioed dispatch for some first responders to come help, and before I know it the radio is full of units coming out to help. “We need more strength here,” my partner said. I don’t know if it is the desire to help or curiosity that is bringing them, but it seems everyone wants to come help.

“We’ll at least get her on the board and then wait for them to help lift,” I say.

It takes awhile, but we get the board under the patient, with much moaning and groaning from the patient, who seems to protest at any touch of his skin. The constant “owws” bring the nurse back into the room. “Why don’t you wait for the others to come?” she says. “You’ve got to be careful with his legs.”

This time I definately nod toward the door. “We’re just putting him on the board. We’ve got it.”

While the board is too wide to disappear in the patient’s bottom crack, the thought does come to my mind. There is more of the patient on either side of the board than there is on the board. We need to link two nine foot straps together to properly secure a strap around the patient’s middle.

Our support arrives — more it seems than can fit into the room. I pick three to help. I have two on each side, one at the feet and I have the head. The patient sits upright on the board. “Don’t drop me. I don’t want to be dropped.”

“We never drop anyone on days that end in ‘Y’,” one of my partners says.

“That’s reassuring,” the patient says.

“It’ll be okay, trust me,” my preceptee says. She had been doing a fine job easing the patient’s mind. I think my annoyance with the nurse has scared the patient.

I stay away from my normal routine of ‘We won’t drop you, not after what happened to the last guy. The last guy? Oh, that’s right, we’re not supposed to talk about that — the lawyers, you know.’

“Just don’t reach out,” I say.

I bend down in the squat position, and start to lift, driving my legs up. Something is wrong. The patient wavers and reaches out frantically. I can feel the board starting to split. “Abort!” I say quickly, and we set the patient down before the board can disintegrate.

“Do you want me to call the fire department?” the nurse says from the door. “That’s who we asked for.”

I ignore her. She leaves again.

“You’re going to have to lay down,” I tell the patient. “I know it might be hard for you to breathe, but we need to distribute the weight across the board, and not have it all in the center. And you can’t reach out.”

“You’re going to drop me. I know you’re going to drop me. You’ve never had anyone as fat as me.”

I keep my mouth shut.

I reposition everyone. I share the end with another strong EMT. We lift on my count. Up we go and over onto the bed. The force takes me off my feet and onto the bed. I feel the patient slither over me. I at least have some of the board between us and I can pivot it enough to keep from being crushed.

“I squished him,” the man says. “Oh, god, this is embarrassing. Is he all right? I squished him.”

“I’m fine,” I say, my eyes saying to my partners, “Help me out here.”

I make it back to my feet. People look at me with astonishment as if I have come out of a collapsed coal mine after they thought there could be no survivors.

“I’m okay, I’m okay,” I say.

On the way out, the seated nurse says, “thanks for coming.”

I give a little wave and keep on going, headed for the merciful exit.

5 Comments

  • Chris in SE TX says:

    Please, for God’s sake, PLEASE tell me this patient did not get this way IN the nursing home!!! Please tell me while staying there he will be put on some kind of supervised diet that will help him return to a human form and give him back his dignity….I think whoever is responsible for a person getting this overweight should be held CRIMINALLY liable. There is a point where a person is no longer able to purchase and cook food (like in this case) and whoever is feeding that person is, in my opinion, abusing someone who is unable to protect themselves….Not to mention, these patients are causing a tremendous drain on health care resources. Whoever pays for it, be it taxpayers or insurance, we are all paying for it. Isn’t it one of the main arguments for MANDATORY seatbelts or helmets? That the choice of the individual makes other people pay for his choice?

  • Today My Name is... says:

    Oh wow…I gotta give you your props for holding it together. Nice job!! I’m sixteen and I’m in training to be an EMT…Any tips??…

  • Anonymous says:

    Due to certain patients, our system had to implement a protocol that basically says if we encounter a patient that’s too heavy to lift, we call the dispatcher, tell them the situation. A manager comes to the scene, evaluates the patient and situation. The manager determines what we should do: call for lift assistance from fire, or just leave them due to limitations of our equipment and ambulances.That report is taken to a committee, and the medical people on the committee make a determination if this person is to obese to handle. We are issued a “no transport” directive if deemed appropriate.When a 911 call comes from that residence, we respond and render what care we can, but we don’t take them to the hospital because they’re too obese to fit on our cot or in our ambulance.We use the standard cots with about a 700 lb capacity. You hit 700 lbs, and you’re going to die at home eventually because we can’t safely lift or transport you. It’s not a common thing to have this happen, but there’s a few people that are over 700 lbs we encounter. The patient and the home nurse or relatives are aware of this, too.Mind you, theses aren’t just people we’re too sissy to lift. These are people that need, literally, a forklift and engineered plywood frame to lift them — after you saw a hole in their house to get them out. I know of several services that have similar protocols. If you have a protocol review committee and can give input, this is a very valuable protocol to have because it’s not if, but when, you encounter a patient >700 lbs that you can’t put on a Stryker cot.

  • Katherine says:

    Great post Peter! The book should reach you any day.

  • rookie bebe says:

    Chris says: Isn’t it one of the main arguments for MANDATORY seatbelts or helmets? That the choice of the individual makes other people pay for his choice?My answer: I work in Georgia. The STATE law here says nursing homes CANNOT use bed railings or any kind of restraint. Supposedly someone’s loved one got their head caught, blah, blah.Because of the stupid law, we have to transport too many pt from the nursing home to the hospital because they fell from unknown height. The other night we returned a woman who’s fallen out of bed 4 times in the last year and because of no railings she has accidents and sustains broken bones every time. The law must be changed!!! I wish I knew how to get a riot started over it.

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