The Death of Compassion?

Rabbit and Rubber Band and I spend the day running calls to people who didn't really need ALS but could have benefitted from it greatly.

The 24 year old male who was retching from food poisoning. Rubber Band didn't want me to put him on the cot because he doesn't like to change the sheets.

The 47 year old male with back spasms, elevated pulse rate and mild chest pain. I asked if I could do a 12 lead and Rubber Band said, "We never do those." I then ask if I can at least do a 3 lead for a rhythm strip. I'm thinking I want to have some kind of look at this guy's heart. He's got a pulse of 94, a blood pressure of 180/98, he's overweight and he's got back pain of 10/10.

"Nope. We'll be at the hospital in 5 minutes."

Which we are and we wait for 10 minutes. I could have had 3-4 sets of serial 12 leads on this guy and seen what kind of response his heart was doing to all this stress but no.

We leave the hospital but don't put ourselves back on serviced for about 30 minutes. Rabbit doesn't like running calls, apparently. Neither does Rubber Band.

Here's the one that really set me off, though.

We get called across town for a 19 year old male with a shoulder injury from playing football. We take a crosstown highway to get there. Apparently, we're not the only unit in the city who's slow to go back in service. This call sends us deep into another Medic's area. On the way, I notice a minivan following very closely behind us. I'm sitting in the back of the ambulance facing out the back so I can see very well. The minivan tailgates us the whole way (about 5-7 minutes of driving) to the reported address and pulls right up to us when we get out.

"What the hell is this lady doing?" says Rabbit

"He's in here! He's in here! We called you a half an hour ago!" says the woman getting out of the minivan.

It seems she chose to follow us for 5 minutes instead of driving 5 minutes to the nearest hospital. Brilliant!

I go to the back of the minivan and am met with a young man who's covered in mud, in obvious pain and presents with one shoulder about 4 inches lower than the other. I help him walk to our ambulance and get a firm shake of the head from Rubber band when I go to put him on the stretcher. I situate him on the bench seat but once we start moving, his shoulder keeps bumping the backrest and he screams each time. I dislocated my shoulder when I was 18 and again at 32. It's no fun.

I finally override Rubber Band's disapproval and move the kid to the cot and strap him in.

Start an IV?

No

Push some Morphine for the pain?

No, we'd have to get medical direction and we're almost to the hospital, according to Rubber Band.

Well "almost to the hospital" is a 5 minute drive at high speed over the worst potholes in the city. Each scream of pain from this kid elicits a more annoyed look from Rubber Band. Rabbit's driving so, I can't see what her reaction is.

At the hospital, we're 4th in line and the kid is screaming and hollering the entire time. Rabbit tells him he needs to be quiet.

We finally get him a room and Rabbit closes the door on his screams and rolls her eyes as she walks away.

I'm ready to kill someone.

Before we leave the hospital, I walk up to the cab, where Rabbit and Rubber Band are sitting.

"Why didn't we push Morphine?" I ask.

"We'd had to call Medical Direction. Besides it's only indicated for fractures of the extremities." Says Rabbit.

"He had an obviously dislocated shoulder." I reply.

"You can't know that without an Xray." Rabbit shoots back.

"Then how do you determine a fracture in the field?" I ask.

"Look, we were almost to the hospital." She says with exasperation in her voice.

Fine. I get into the back and look up our protocols on Morphine Sulfate while we drive back to our station.

"Isolated injuries requiring pain relief " is what I find in the list of indications from our protocols. That means we can administer it without medical direction.

I've got a healthy kid with no contraindications for Morphine, who's also got an isolated injury and pain that's a 10/10. Why didn't we push the morphine?

Is it because I wasn't aggressive enough with my preceptors? Should I have insisted and told them to go to hell? How would that have looked at grading time? My preceptor holds my grade in the palm of her hand.

Is it because Rabbit and Rubber Band didn't want to deal with the hassle and paperwork of dealing with Morphine administration?

Is it because Rabbit and Rubber Band been on this job long enough that they've lost compassion?

Is it because I need a new preceptor?

--maddog