I want to compliment myself because I took a vow quite awhile back that I would stop whining about all the bad things in this job, and I think I have done a pretty good job of it lately. When you start letting things like lengthy triage waits and pompous health care providers (whether hospital, EMS, nursing home, doctor office or visiting nurse) and miserable patients and poor dispatching bother you, your day just feels so much heavier. Let it roll on by and it lightens your load. I also said I would try not to write about large patients in a negative way, and believe I have done so.

I do want to say that I am thankful for the word “bariatric” because today I had a large patient, who I was not quite, but almost a dick to, and I felt bad that I may have let my frustration over the call come through, and possibly may have made the patient feel bad about his weight. So when I had to call the hospital and give my report, instead of saying “morbidly obese,” which I think is somewhat of a hurtful phrase, I only had to say that my patient would require a “bariatric” stretcher and that meant the patient didn’t have to hear my calling him obese.

Enough on that for the time being.

The following events actually happened in reverse order, but I am going to pretend they happened in the order I am going to write them because I like the ending better this way.

Back to the bariatric call. Suffice to say we carried a man who had not been downstairs since December down the stairs in our stair chair. His complaint was a black thumbnail. He banged his hand a few weeks ago and the nail turned black. Enough said. He can’t walk due to his size. Looking at him, I asked how we had gotten him down the stairs the last time. He said we had used the chair. You look bigger, I said. I’m the same size, he said.

That may be, but I didn’t recall having such a hard time getting him downstairs as we did. I am sore in places I have never been sore before from lifting. My back, chest wall, groin and legs are sore like I tore millions of tiny muscle fibers. Oh, yeah, and our stair chair is broken. I also have some patient smell transference that is still making me a little nauseous and causing me even now sitting here writing this to feel like the patient is still sitting next to me. Too close.

When we finally got him downstairs and out into the yard where our stretcher was set up, it started to pour rain. No patient likes being out in the pouring rain, and we did our best to keep him dry until we could get him safely on the stretcher and into the back of our ambulance. Fortunately in one way, it stopped raining pretty quick, but in another, I feel like a good soaking would have done all of us good.

I will be curious when he is sent home (presumably by commercial ambulance) how they will get him back upstairs. Or maybe they will refuse. I can see someone becoming a prisoner on a second floor due to weight gain, and thus needing to be carried down, but I can’t see someone being carried up stairs to a place they cannot escape from without at least four people and an extended amount of time to help carry them. It’s an interesting issue. Can an ambulance crew refuse a carry-up? Would a supervisor go along based on health and safety issues? Would a company back them up? What does the patient do then? I’ll be curious to followup. I did warn the commercial crews I saw at the hospital that they may soon be called to take this patient back home. I did not say run for the hills. I just suggested they might want to be on the other side of town so as not to be one of the closest cars when the hospital telephone for transportation for the patient.

On the next call, I had a patient with abdominal pain and vomiting. She seemed okay en route. Stable vitals. Calm. Then just as we pulled into the ambulance driveway, I saw it coming. She gave me no warning. I saw it, recognized it, but there was no time to act. I was puked on, all down my leg and on my boots, warm, chunky puke.

Later, I was called for an intercept with a basic crew, who said they needed me for drugs. I grabbed my narcs, thinking the patient probably had a fracture and they needed me for pain control. When I got in the back of the ambulance, I found them log-rolling a man on a backboard who felt nauseous. He was a dementia patient who had run into a wall while jogging in the hallway and had been unable to slow down. No loss of consciousness. No change in mental status. Stable vitals. Pupils equal and reactive. Just a bruise on his nose. They did say he had already thrown up once. They asked if I could give him some phenergan to stop him from vomiting. They were transporting to a hospital twenty-five minutes away.

What are you going to do? I gave him some Zofran and the ride from there seemed to go well. Then when we got the patient in the hospital room, he said he felt like he was going to throw up, and then there it was. I reached to roll him, and he puked all down my arm and sleeve, and down onto my boots.

Memorial day. I hate doing standbys and parades. Every Memorial Day I am spared the standby because we always get calls and they have to pull us from the standby. Today, right at ten, we got one. Spared again. But it turned out the parade didn’t start until 11:30, so when we got back to town, we found ourselves, not just doing the parade standby, but actually being in the parade as the last vehicle.

It was great. As we rolled slowly down the main drag, people lining the parade route stood and clapped and thanked us. Little kids waved and then laughed as we hit the air horn. I recognized some of the people in chairs by the roadside as old patients. They all smiled and waved, and called out their thanks.

It felt good to be a paramedic.


  • Rogue Medic says:

    Probably best to have the parade before the double puke and the “exercise” on the stairs.The private company will probably not refuse to create a hazardous situation, but they may not be able to get the patient up the stairs, no matter how much he claims to be the same size. Maybe the department of health would be best able to deal with this fire hazard. Fire fighters should not be put at risk to pull this patient out of a burning building. While it is not burning now, there is no reason to believe that he is any better with fire hazards than he is with food.Many stairways are not wide enough for 4 people to carry the patient. 4 people might not be enough.Do they have a stair chair rated for more than 350 pounds? Most don’t seem to. The stretcher may be rated for 450 pounds, but the stair chair usually cannot handle that much.

  • Ellie says:

    Peter,I am the one who asked you awhile back to basically go easier on the obese,and you gave such a wonderful response by saying you’d try harder. I have definitely seen that in your posts. And I would like to add that I don’t think the things you said today are even in the same category…It is one thing to be overweight,even obese.It is another to be so huge that you are an incredible burden on everyone.To me,this is the same as the burden on society that meth addicts are.They aren’t just “hurting themselves”–now they are hurting you,among others…Sure,we all have to treat them with a measure of dignity,not unlike the dignity I often read you giving to drug addicts and drunks,because you are so good to them…But I think voicing your complaints on here is valid.These people are hurting you physically.It’s an epidemic,just like drug addiction.

  • YankeeMedic says:

    In regards to your bariatric pt I personally would have advocated and insisted that the pt get a social work consult. Obviously this pt should not be residing where he is. It is a danger for him and for anyone who has to come for his aid. In the city I work, we have several patients who are considered bariatric, unfortunately I cannot count them all on my hands and toes. My agency is trialing the Stryker Bariatric stretcher and I have had the opportunity to use it. It is a great device. Before then we used to used a device that looked like a home depot cart. Before then we just put them on a tarp and dragged them out of their house/apartment. Want to talk about embarrasing.

  • kvegas911 says:

    oh the back pain! Been there, done that. Much 800mg ibuprofens your way and a tens unit too.And on the flip side, every comment on this page is precise and well written, therefore I shall not duplicate them.

  • Brett says:

    Someone once asked me “since when is vomiting an ALS emergency” I replied “When they are vomiting ON ME”sorry to hear you got a double whammy!

  • Gertrude says:

    I too am a big fan of the word bariatric. It saves me from having to say things that can come off as rude. It also sounds way better than “I need a big boy bed”. The private company will probably call the fire depart for assistance getting the patient upstairs. Sorry you got the pukers. Those always make the day so much fun!

  • Witness says:

    I, too, am doing my best not to bitch, but God, it’s had sometimes.