The Narratives We Don't Tell

What every day was like as an EMT in the form of a patient care narrative. Not based on any patients in particular, but many many of them collectively.

We arrived to find a 68 y/o female patient alert and oriented x3 with 102/89 BP. Patient has bilateral above knee amputations and an amputated left wrist. Patient smoking cigarettes against medical advice. Before transferring patient to stretcher via bizarre, underarm heimlich maneuver lift (very scientific) we (2x emts) sat with her on the front porch and accepted her offer of a cigarette.

Patient reports having drank a tea in her youth made from the dried feces of cattle. Consensus among her caregivers we've spoken to thus far is that there's a 50/50 chance this is bullshit. patient claims to have run a casino out of her basement in Detroit in her early twenties before her husband became a violent alcoholic. Ex-husband confirms this, though drinking problem was left out of the question at the time asked to avoid hitting a nerve.

Patient reports irresponsible adult children have left her with her destructive grandson in her care. She isn't sure how to care for a child when she only has one limb, but the 8 y/o boy appears to know how to cook. Patient says she knew he steals her money, but that some appears to be returning to her in the form of groceries, though her guess is it's only about 30% of the total amount taken. She reports "He might as well stay in his room and play with his butthole all day." 2x EMTs snicker at this, but only because the boy is always rude and calling them lazy and not because homosexuality is a negative trait.

Patient transferred to dialysis appointment and given pork rinds en route to prevent her from getting cranky. 1x EMT will miss them at lunchtime. Patient transferred to the care of the local dialysis clinic nurse who always looks pleasant despite the constant unnatural redness of her eyes.

We arrived on scene to find a 75 y/o female patient with a left above knee amputation, a right below knee amputation, alert and oriented x3 and in an otherwise empty apartment. Patient transferred to stretcher by sheet drag lift. Patient cried en route and said that her daughter would need her brought to a hotel after dialysis. Pt reports that her daughter can't pay for their house anymore because she's spending all her money on men. Patient also in 10/10  pain on the Wong Baker pain scale due to chronic sacral ulcer that she can't transfer weight off of due to her lower extremity amputations.

1x EMT attempts to offload weight from sacral ulcer by balancing patient on one hip. Success is partial, but for the short duration of the trip, appears to be sufficient. Patient remanded into dialysis center care for treatment, signed for by attending R.N.

2x EMTS get lunch and coffee at a nearby gas station. Nearby megachurch stands among countless section 8 housing projects. Almost 100% welfare recipient population. Megachurch is spotless, well groomed and features a fully equipped gymnasium, multiple chapels, a three story office building and has it's own local television broadcast. The sign reports that wealth is closeness to God. 1x EMT is certain that if he lived here, that sign would piss him off. The other EMT disagrees. A nasty argument ensues over whether the community would be better served by that megachurch or a Planned Parenthood.

2x EMTs agree to move on to their next appointment in silence.

We arrived on scene to find a 56 y/o male patient alert and oriented x3 with bilateral above knee amputations. Patient transferred to stretcher from wheelchair via hair-raisingly precarious walking across a piece of polished wood on stumps maneuver (patient insisted, not 2x EMTs idea). Patient satisfied his thrill-seeking and we began the transport to dialysis.

Patient claims that he almost left his wife for another woman once. Patient was in love with her, before all of this, back when they were all young and healthy. She killed herself 8 years later because of an underdiagnosed depression problem and some medications that mixed badly. He reports he was lucky that he stayed with his wife. 1x EMT tells him that he really dodged a bullet with that one. His wife is his primary caretaker and a pretty good cook.

Patient proceeds to tell 1x EMT how he assaulted the EMTs coworker the day before, both verbally and physically. Patient reports that he called him various homophobic epithets and slapped him across the face. Upon inquiry about why the patient had reacted so violently, patient states that the other guy wasn't his usual crew. Obviously it worked because we were back and not him. Despite this obviously being a bad way to handle conflict on behalf of the patient, 1x EMT feels proud on some level that he is a part of this patient's life.

Patient arrives at appointment and is transferred to care of R.N. after a much less precarious sheet drag lift despite numerous angry protests from patient. He says a polite enough goodbye after the situation is over.

1x EMT drinks a bunch of water. He's been drinking water all day long, and has polished off most of a gallon he bought at Walmart at 2AM after their first patient. He has a big test coming up, he says. He's studying hard. Can't have his urine be too concentrated. He's done this before and it works, but you have to do it just right or you'll have to retake the test.

1x EMT is skeptical, so the other explains in more detail. The first phase of the test is for specific gravity and temperature. Since it's your natural urine, it'll pass the temp test and if you take creatine powder, it raises the specific gravity of your urine to within test limits, even if you're diluting like mad with water. That leaves the urine looking suspiciously like water, so you take a B vitamin supplement too which gives your pee a yellowed appearance, if not slightly neon green, but luckily that's within the range of acceptable colors.

The second test is gas chromatography, which the dilution hopefully takes care of. The trick is, you don't use the urine at the beginning of the stream or the end to avoid solutes that might be floating or sunk to the bottom of your bladder. Just the stuff in the middle. You can pass so easy that way, 1x EMT explains.

1x EMT is nonplussed, but nonetheless wishes him luck. Passing this test is really the only chance he has of escaping this morbid job. At least there's a chance.

Author's Note

Nonspecific goals for improvement, but open to any ideas.

Reviews

[Bob]

It seemed dry, and almost clinical after the first reading, but when I read it again and really looked at the scenes it was almost horrifying, gripping. I really liked the way the language of the job described the anguish of the people.

I think to make it a little stronger you could start the sentences with something less profession specific, but that is only the opinion of someone who has never dealt with those things.

I am not sure how to rate this, but I will try.

[Great Aunt Astri]

You could have been a fly on the wall.
I love the way you observe and report this story. Good technique!

[MichaelJHyde]

This was really good... zero crap. I loved how you changed the use of the language, but managed to contain the emotion and humanity of the characters.

This was a refreshing break from the first person specific that I've seen so much.

well done. look forward to more of your stories.