Enablement

You’re enjoying breakfast when you get toned with a volunteer engine company for a fall in a neighboring district. You both groan as you recognize the address at 623 Morning Glory Way.

Shannon Cary is a 50-year-old, 5'2", 300-lb. orthopedic train wreck. She has bilateral knee replacements and surgical fusions at every level. She lives with neuralgia and paresthesias 24 hours a day, and has a doting husband who’s a third her size (well, almost). Medics have made 9-1-1 responses to Shannon’s home seven times in seven weeks for falls. In addition, the engine company gets frequent public assist calls when she needs help getting to her bedside commode. That usually happens on weekdays, when her husband—and those volunteers—are at work.

Today you find Shannon lying on the wood floor next to her bed. She’s unhurt, so you use a MegaMover to lift her. Once she’s vertical, she’s as good as she gets. Her husband is worried about an upcoming appointment with her surgeon. He shows you a sturdy folding ramp he’s purchased to get her oversized wheelchair out of the house, but he’s afraid he won’t be able to control the chair’s weight by himself once she’s in it.

Mr. Cary seems highly distraught, so you get him off by himself for a few moments, and he starts sobbing. He works 66 hours a week, he says, and he calls his wife numerous times during the day. She has so many emergencies, he’s in danger of losing his job (and their little manufactured home). His wife won’t hear of going to a hospital, due to financial worries.

We’re just a small-town ambulance service, and we cover this adjoining town because they don’t have a service of their own. We have plenty of other people to worry about, but this lady’s needs are overwhelming us. We care about her, but sometimes it seems like we’re helping to sustain her problem.

It appears you’re right about sustaining her problem. Thanks to the many effects of a recession, we’re all struggling with added responsibilities.

We know all of that. But how do we get her (and ourselves) out of this fix?

It seems you’re in a better position to communicate with this couple than just about anybody. I think it may be a good idea, either next time they call you or during a return visit to check this lady’s welfare, to sit down with both of them and tell them how ominous it is when an adult falls. Our bodies are elegantly engineered to keep that from happening. Seven falls is an awful lot in seven weeks.

We’ve been down that road more than once. The discussion always evolves into talk about skilled nursing facilities, and they always slam the door on it. They’ve apparently explored their options, and they simply don’t have access to the necessary financial resources.

I’d be willing to bet that every reader of this journal understands and respects the importance of this couple’s financial worries. (We’re EMSers, fergoshsakes.) I don’t believe in using threats to coerce people into accepting therapy. But if their big worry is primarily financial, you might take some logical advantage of it. Like it or not, this lady is headed for an inevitable, catastrophic injury that will trigger a lengthy hospital stay. By acting on her own behalf before that happens, she gets to exercise some power of choice over her situation.

We’ve already spent hours at this address, arguing every approach we could think of. So has the fire chief. We get nowhere with these folks. We’ve done everything but tell them we can’t afford to be here several times a week so they can continue to postpone the inevitable.

I can think of one more option. Based on the information presented here, I think it would be a good idea to enlist the help of one of this lady’s docs—if possible, the primary care provider. If the PCP doesn’t return your calls, stop by his or her office. It may not help, but if the lady knows and trusts her PCP, the doc could be a powerful ally. This lady really needs some help, and so do you. In fact, it would be a great idea for a representative from the fire department to join you.

If that doesn’t help, the doc may still have access to one or two resources you don’t.

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.