Little People

It’s about midnight, and you arrive with an engine at the Beverly Convalescent Center, where you’ve been called after a fall.

Everything about the facility seems clean, but its atmosphere instantly evokes in you a familiar inclination to be elsewhere. Maybe it’s that vague biologic odor. Or the bland pumpkin hue of the long hallway that greets you as you enter. It could be the similarly pastel color of the shiny, hard floor, its pattern apparently designed to camouflage spilled pudding. Or the fragmented vocal sounds and the occasional hiss of a ventilator emanating from the open doorways on either side of you as you search for someone vertical.

That’s probably what frustrates you most of all about this place: there’s an emergency here, and they’ve called you. There’s only one entrance. But your arrival always seems so completely unanticipated.

Finally, in a room on your right, you encounter two uniformed medical people hovering over a form on the floor. One of them rises to greet you. She introduces herself as Sara, a CNA, and identifies the 80-ish old looking guy on the floor as Mr. Levy. She says she was doing her rounds and noticed him lying there, evidently asleep. He was arousable, but unable to rise. So she remained with him, called for help, and cautioned him not to move.

She follows her history of the event with what sounds like a pretty organized review of his past medical history. But Arnie, the medic on your crew, kind of shoves her out of the way. Hands on his hips, he towers over the old man and begins questioning him in a loud voice, obviously discounting everything the CNA has just told him. She seems offended by that, but she turns to a member of the fire crew and dutifully finishes her report. Then she disappears.

On your next shift, your supervisor notifies you there’s a complaint from the nursing home about your rudeness. Arnie contends that histories from CNAs are unreliable, and rants about the facility never being ready when he responds there.

Q. I have to agree with Arnie on both counts. For one thing, we can never find a nurse at BCC, and the staff turnover there is so high we don’t trust any of the CNAs. How can you not feel like you’re on your own when you go there?

A. I realize how important employee turnover is. But our culture tends not to value the elderly, nor the people who care for them, and least of all the people who lead them. I worry about us being part of that problem, sometimes. How would you like to work in an environment where you had to contend routinely with outright disrespect from outside agencies?  No matter who you are, you wouldn’t tolerate much of that.

Q. I disagree. A CNA’s job is just a bottom-rung medical position, and it may be a tough thing to do for a living. But some people just can’t get anything better. And let’s face it, They’re not medical geniuses. We may have to deal with that reality, but we certainly shouldn’t have to accept the responsibility for it. Should we?

A. I have to say that often when I’ve allowed myself to profile people I didn’t know, I found I was making a really bad mistake. I probably wouldn’t be happy as a CNA, if I could even do the job (which I doubt). But I have known some CNAs who were much better people than I was.

In our economy, having lots of money can mean access to great medicine. But if you live in a nursing home, you’re on Medicaid and you’re alone, God help you. I know someone who’s been a CNA for 30 years. She raised two kids all by herself, and put them through school. She doesn’t have a degree, and she’ll probably never work in a CCU. But she’s the best nurse I’ve ever met (and I’ve known some great nurses). Like so many other CNAs, she routinely spends her own meager wages to buy bathrobes, slippers, jewelry and the like, for patients who are admitted to her facility with nothing at all. I can only imagine how embarrassed and ashamed I would be to see a medic ignore her turnover report, or worse yet, shove her out of the way.

Medicine depends on an organization of roles and responsibilities. But we can’t allow ourselves to confuse that with a hierarchy of people. Hierarchies always presuppose that some people are less valuable than others. And any EMT knows better than that.

Thom Dick has been involved in EMS for 41 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 the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.