Stuff I Wish They`d Taught Me in Class Part 6: You Can`t Help Everyone

Mr. A. was a frequent flier who called 9-1-1 on a regular basis—at least once a day, if not multiple times. But, he wasn't the one doing the calling. It was a buddy or his girlfriend calling for the same thing: "He don' take his sugar shot," or, "He take his sugar shot, but he didn't eat, so he done fell out."

Each and every time we went, it was the same routine. We'd check his sugar, find out his BGM was higher than the Gross National Product of China or so low that the first four numbers after the decimal point would've been zero followed by a 1...if we were that lucky that day.

We would play our favorite game of Poke-and-Hope, trying to find one sliver of vein that wasn't covered in scar tissue so we could give him D50 and allow him to wake up in a manner that wasn't unlike a bull after being Tasered. He'd wake up swinging and kicking, ripping out his line, cussing us out for waking him up from his nap. If his sugar was high that day, he'd sit obstinantly in his bed, refusing to go to the hospital. The speech was the same every time: "Mr. A, if you don't go to the hospital with us, you know what's going to happen. By tomorrow or the next day, if you don't take your insulin or keep up on your sugar, we'll be back, because you'll be unresponsive. Do you want to go through that again?"

Mr. A would sit, sullenly staring at the wall, the ceiling, his belly-button...whatever he could to keep from making eye-contact. The results were always the same: a refusal. The times we'd arrive to find him unresponsive, we'd take him to the ED, but once he was awake, he'd sign himself or have his girlfriend sign him out against medical advice.

We tried everything we could to get him the medical care he desperately needed. It seemed as if he were absolutely unable to care for himself, and his roommates were not able to take care of him. It looked as though the only outcome for him was going to be transport to the local cemetery.

One evening when we were eating at a local restaurant, Mr. A and his family walked in with a few people we didn't recognize. We had been at his home so many times, we thought we knew all of the people who lived there by name and face. They waved politely at us, and Mr. A seemed as if he was doing pretty well. As they sat down, we watched him pull out a glucometer and a vial of insulin. Right before our eyes, we watched him check his blood sugar, jot something down, then, while looking at a piece of paper, he gave himself an insulin injection.

We were stunned. The man who could never even find his glucometer, was testing his sugar and taking his medication! From the looks of it, he was even recording his numbers. We shrugged our shoulders thinking that, finally, someone got through to him.

We didn't hear from Mr. A for almost a week. We started to pass by his house on the way back to the station after calls to make sure there were lights on and movement in the house. We'd wave when we saw him sitting on the front porch and he'd wave back.

Unfortunately, like clockwork, it started up again. After one particularly frustrating encounter, a woman who identified herself as his cousin pulled me off to the side: "Child," she started in a very motherly tone, "you're wastin' your breath. He ain't gonna listen to you. He does this. He's had the sugar these past 15 years, and he's making the choice not to do what he needs to do. Some days, for appearances, he'll choose to watch the sugar...if not, he gets lazy. He'll eat what he wants to eat, then give himself his medicine to fix it, or he won't. It's that simple."

I furrowed my brow, "But why..."

"Because he can act like he don't have it."

The message hit home. We all knew what he needed to do to keep these repeat visits from happening. He had to take care of himself, but when the cure is sometimes more frustrating than the disease, patients may ask themselves if it's worth it.

Sadly, many of our frequent fliers fall into this category. They have the means to take care of themselves, yet they refuse to do so. Why? There are many reasons: Being hospitalized brings in family they might not normally see to visit and take care of them; they want to act like they don't have a medical condition, so not taking the proper preventative action makes them feel as if they aren't really sick; or they just want to feel like someone cares for them.

Even worse, it could be the patient's way of getting out of an unsafe environment. They know the people in the ambulance will come and whisk them away from those who are abusing them and take them somewhere that, if only for a few hours, is safer than they feel at home. In any event, whatever makes these people feel the need to stop taking care of themselves is a disease in itself.

It's a hard thing to do, and I struggle with it regularly, but we mustn't be critical of these patients. It's easy to look at them and say things like, "Why do you keep calling us?" or "Why can't you just take care of yourself?" In the end, all it does is frustrate both us and the patient.

All we can really do is understand that this is the patient's decision and there isn't much we can say or do to change it. We should continue to refer patients to social services, see about getting in home health care or, if your region has it, getting them into elder care programs.

Now, if something doesn't seem right, your medic-sense is tingling, or you see a red flag every time you encounter a patient, don't hesitate to report your findings to an ED physician or nurse, and, if your state requires it, to the police if you have any suspicion of abuse. Frequent calls to the same location could be a sign of abuse, whether it's physical abuse or the care provider is witholding medication or medical care.

Mr. A eventually passed away. When we were called to his home for the last time, no one was surprised, yet it was upsetting. The one patient who seemed to need the most help was the one to push it away. Help those you can, but remember, you can't help everyone.

Have fun and be safe, my friends.

Shao Trommashere completed paramedic class in 2007 after working as an EMT since 2002 in the Northeast corner of the United States. She also has a blog called Looking Through A Pair of Pink Handled Trauma Shears.