Angry People

Your regular partner, Scott, is away on his honeymoon, so you’re working with overtimers du jour. Today it’s Kerry Wilson. Kerry is normally a nice guy, but he has a storied history of anger issues. He’s prone to animated 80-decibel verbal outbursts when things don’t go his way, and his repertoire encompasses an impressive vocabulary of profanity which does not vary by his surroundings. (Nor does he limit it to one language.) On bad days, he throws things.

Your first call of the day is to a nursing home for a frail 90-year-old woman you encounter slumped in a wheelchair. Her pallor is striking even in the dim lighting in her room, and as you approach you note that her skin is cold and moist. There are several staff members watching as you and Kerry establish that she is awake, move her to the floor and apply an NRB. Your audience may not be medically astute, but they clearly think a lot of this lady, because as you move her they repeatedly reassure and encourage her. They call her Nana.

You find a thready carotid pulse of 88 with no peripherals, and large, jagged pupils. Her respirations are ataxic and shallow at 30 a minute, and you note faint, externally audible rales. Right on cue, Kerry lets the staff have it for not recognizing the patient’s shock status. He mutters loudly that the two of you had “better get her out of here; she’s lucky these f_____ idiots didn’t kill her.” 

One of the staff, perhaps a brand-new CNA, gasps audibly, says “Oh!” and starts to cry. The rest of the group ushers her out of the room, and you can hear them hushing her as she sobs quietly in the hallway. They’ve disappeared by the time you leave, and Kerry’s verbal exclamations don’t end until fully half an hour after you finish the transport.

Q. I felt awful about this call.  I’m just a new EMT, and Kerry’s a very experienced paramedic. When I mentioned the effect we had on the CNA, his response was, “Serves her right.” I would appreciate any advice you can give me.  

A. Everybody’s angry today. Our last three national elections were by far the nastiest ever. You can’t visit a blog without noticing how angry people are at complete strangers. Last year’s Grammy award went to a Neil Young song called "Angry World,” which featured some downright caustic guitar riffs. Even the most popular radio talk-show hosts (bottom-feeders all) attract the biggest audiences precisely because—yup—they’re angrier than ever, at anybody who disagrees with them. Everywhere you look, people are fighting wars, or at least thinking about it.  Total lack of respect and absence of personal control are definitely in vogue.

Kerry sounds like he’s reached his maximum fun level. He’s disrespectful toward colleagues, toward patients and toward you as well. It’s part of our jobs to deal with frustration. When we do, most of us seem to be able to control how and when we express ourselves. That’s easier if we try to appreciate the predicaments of others (and the jobs of those who work with us). I don’t think he’s going to get better on his own, nor will you be able to fix him.  I think you should offer him your honesty.

Q. Been there, done that.  He simply cited his years of experience, and asked me to keep my neophyte observations to myself.

A. In that case, it sounds like somebody with a little more responsibility than you needs to intervene. I would suggest describing this situation to a supervisor. Stick to the facts. Relate what you saw and heard happen, and simply ask for the supervisor’s advice in case it happens again.

Q. What about that CNA?  I’m sure she blames herself for this patient’s predicament. I know the patient’s condition didn’t allow for much conversation, but I wish I could at least have said something to her.

A. Actually, that’s a great instinct. Inexperience is not an offense, and a CNA’s job is no picnic. There’s nothing to keep you from going back to the facility, asking to speak to her, and telling her what you think. She may remember your kindness for years, and you never know, but she may become a fine caregiver someday.

A Greek slave named Aesop wrote a fable 2,500 years ago about a lion and a mouse.  His story included the following words: 

No act of kindness, no matter how small, is ever wasted.

Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS World Magazine’s editorial advisory board. E-mail boxcar_414@yahoo.com.