Presumptive Innocence

   The woman in front of you is trembling, wobbly, distrustful.

   Plain and small, she's perched in the middle of a big gurney in an exam room where the PD left her earlier tonight. Another medic crew had responded to her home when she experienced a severe migraine and, out of medicine, she was afraid she was going to have a seizure. She couldn't bear the financial consequences of transport by ambulance and the cops were nice enough to bring her here. The doc has eased her fears about seizures and given her some sample pain meds. Now she needs a ride home, she can't afford a cab, she has no family, and the ED staff is deliberating what to do with her.

   She's a picture of disarray and years of defeat. Her hair is frizzy but clean. The collar is twisted on her faded old paisley dress, its top button undone and the second one gone. She's missing two of her upper incisors, and the survivors are leaning into the empty spaces like tired old friends. Even the gold band on her wedding finger is plain, worn and ordinary. Your partner, Herb, takes a seat on an exam stool and rolls it closer. He rests his forearms on the railing of her gurney.

   "You look like you've had a pretty long day," he says, and he waits for her response.

   It's 3:18 in the morning, and you've been up all night. The last thing you want to do is wait around so Herb can visit with some street person whose problems you can't possibly solve. But you barely have time to wander out to the desk when Herb comes up behind you.

   "Come on," he says. "Let's take this lady home. It's on our way."

   So you walk her out to the ambulance and help her into the passenger's seat. Herb takes the wheel, and soon you're on your way—not far out of your way, actually. He stops at the curb in front of a small wood-frame house in a quiet old neighborhood, and you help her out of the cab. Herb follows the lady up three concrete steps to the front door, where a bare lightbulb keeps vigil. You watch as she hugs him briefly, then disappears inside and closes the door. Herb says he'll handle the paperwork.

   Q. Herb does this all the time. There's never any paperwork, and I know I'm going to get into trouble over it one of these days. I was taught that if it wasn't documented, it didn't happen. This seems dishonest to me.

   A. Aesop was quoted 2,500 years ago saying that no act of kindness, no matter how small, is ever wasted. Somebody, possibly Mark Twain, suggested much more recently that it's better to apologize than to ask permission. There's a recession these days, and people are suffering. Herb didn't take anything that wasn't his; he's just doing what I suspect lots of us are doing all over the world right now. He's finding ways to help people.

   Q. But this lady's a seeker. She took advantage of the crew that responded to her home, the cop who took her to the hospital, the ED physician, and now us —to get pain meds. I think we're facilitating her habit.

   A. Your story doesn't suggest this lady's a drug seeker. It describes someone who had a migraine headache and thought it might lead to a seizure. Sounds like she was scared and alone, that's all. Anybody who's ever suffered from a migraine would understand what an awful experience a headache can really be. When you're poor—really poor—you simply don't have the options that are available to most people.

   Q. I think you're being gullible. Big-city EMS is a whole different kind of thing; you get lied to day after day. You have to be on your guard all the time.

   A. Or what? You may be too kind once in a while? Lying is just one way people handle stress. True, it's also a common strategy for addicts to secure the objects of their addictions. But to do what we do, you need exceptional intelligence, creativity, a sense of humor, and the natural inclination to care about people you don't know, who are having the worst days of their lives.

   None of those things are exempted by the size of your system.

   EMS Reruns addresses dilemmas in EMS. If you think of an example, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail Nancy.Perry@cygnusb2b.com.

   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 Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.