One afternoon, a nice 95-year-old man came in, referred by his physician, for new-onset A-fib. With him were two people: a neighbor and a coworker. Yes, this man was still working. At 95, he was working as a law consultant. He was very sweet and funny.
Through the course of the afternoon and evening it became apparent that he would be admitted to telemetry. Finally, at about ten pm, the two people at his bedside decided that they had to go home. I happened to be in the room at the time (thank goodness). The next-door neighbor said, "Don't worry, I'll look in on Vera for you."
"Who is Vera?" I asked. "Your cat?"
No. Vera was his slightly demented, frail, 97-year-old wife. She was okay to be left alone for a few hours during the day, but she tended to sundown at night.
I told the patient and his visitors that I didn't feel comfortable with leaving Vera alone all night by herself, even though the neighbor said that he would look in on her every hour during the night. I felt that Vera might even be alarmed if she saw a strange man in her apartment, or woke to find her husband not there, and that she might try to leave to look for him, or fall and break something, or otherwise injure herself. The couple had no children and no one who could come and stay with her.
I called the nursing supervisor and talked to the ER attending, and they agreed with me that we needed a social admit for Vera. She could even stay in her husband's room with him. I told the neighbor and coworker the plan, and that they needed to bring Vera back to the hospital.
About an hour and a half later, I got a frantic phone call from the coworker. She said that she had called EMS and that they were refusing to transport Vera; that one of the EMTs there said that they had no obligation to take Vera to our hospital, and that if he DID transport her it would be to Scary Ghetto Hospital a mile away. I told her to put him on the phone.
He SCREAMED at me about this being ambulance abuse. HOW DARE I tell this lady to call EMS for MERE TRANSPORT (which I didn't--I assumed she would call a car service or something). He DEMANDED the name of my supervisor and my name, which I cheerfully gave him, and said, "Are you refusing to transport? Will you transport her later when she falls and breaks her hip? I know for a fact that if you had been called to transport her husband [he was a walk-in] that you would have brought her along for the ride because she can't be left alone."
He hemmed and hawed and mumbled something about telling his supervisor, and then hung up.
I relayed the situation to the nursing supervisor and to our ER attending, who happens to be the director of our EMS training program. His eyes bugged out a little and he said, quietly, "Send him to me when they get here."
Minutes later, the ambulance showed up. They were walking in this little, tottering old lady. Even 17-year-old "I vomited once yesterday" cases get wheelchairs. Our attending leaped up, got a chair for the lady, and redirected the EMS guy while his partner wheeled her up to be triaged. He rolled his eyes and apologized for his partner.
The reunion of the couple was very sweet. "Vera!" said the elderly man. "I missed you! Now we can talk before we go to bed, just like every night!" She tottered over to his bedside and gave him a kiss. "I'm so happy to see you," she said.
So, did I do the right thing? Or am I a vicious EMS abuser?
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16 comments:
Uh, I would have probably seen if the neighbor would have brought her in. Probably the neighbor wouldn't have been a stranger to Vera, if they were close enough that he brought Grandpa in to the hospital and stayed with him that long.
I'd have maybe seen if Grandpa could have gotten a private room and maybe a cot for Vera instead of the full-on admit if she was "slightly" demented. At least if she starts wandering away, someone could direct her back to where she was supposed to go.
I'm not sure that the neighbor was that close (friend-wise). The two of them had brought the old guy in after a doctor's appointment. I was impressed that they stayed with him that long, too.
None of these people had cars (which is not uncommon in our city, as we have a great mass transit system) and I guess they didn't want to take a tottery old gal on the train or bus, and it didn't occur to them to take a cab.
She had to be actually admitted, because the administration was afraid that, unless she was put in a gown and bracelet, she would wander off and no one would stop her. Which, knowing some of the units in our hospital, is very likely. Sad, isn't it?
indeed. Right thing. +2 on you.
never try and do the right thing!!!
geez! you were also committing the other heinous wrong of trying to help someone.... shame on EMS for getting upset at you for trying to assist an elder and PREVENT a situation from getting worse. someone needs to teach them some respect.
A hundred people could have done it differently and still been right... who cares?! You showed compassion and care to two fellow humans. You rock.
What service do you put her on? Who gets stuck doing the admission? Do they have to embellish the chart to get paid?
Those are good questions, and I'm not 100% sure what the answers were. I know she was admitted to Medicine. I know that she was discharged the next day after social work arranged a home health aide to keep an eye on her until her husband came home again two days later, and there were some other services that were arranged for as well.
Hm. I'm not sure.
You were compassionate though, so I give you mad props for that.
You did right, G.G. If it were MY ambulance crew, I'd have had them apologizing to you in front of the hospital CEO at noon in the cafeteria, begging you for your forgiveness, and pleading that I didn't cut off any body parts.
Or something like that. :)
EMS ain't always about saving lives. Most o' the time, it's about being nice to folks and helping in ways they don't teach you in paramedic school. Probably the same for nurses, too.
Very difficult to tell, sometimes, whether somebody is just venting, or is truly going to refuse to cooperate/kvetch to supervisors, etc. When in doubt, counter his bluff. You can always call it a "simple misunderstanding" later. Most of the EMT's in my city genuinely want to assist in any circumstance. Sounds like your guy thought he was Nicholas Gage in "Bringing Out The Dead".
I compliment you on getting that done. I've dealt with something similar, and we ended up calling adult protective services, because we couldn't get the spouse admitted...
Likewise, I had a parent who had a young child that we had big issues trying to get taken care of so the parent could be admitted..
EMS abuser or not, we need more nurses like you in the EDs, GG.
What a beautiful story. Well done!
Very nice story, thanks for sharing it.
There might have been other ways to deal with the situation, but you did a really good thing, and you should be proud.
As a nurse, and a former ambulance driver, I guess I wonder if these EMS guys were going to get bitched out by their manager for running a call they wouldn't get re-imbursed for. The manager of my old ambulance company wouldn't have allowed us to run a call like this. I do agree that this lady needed to be with her husband.
("EMS abuser"... heh heh. Wish I had thought of that one.)
Yes, you're a vicious, evil EMS abuser. You should be beaten severely with wet a wet noodle until totally chastised.
BTW: I think they're looking for good nurses here in Manitowoc, WI. First week's coffee on me?
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