Take Notice of Nice

The end of the program is right around the corner, and I’m out doing field observations with one of my students. We are in pursuit of the last few of the 70 ALS contacts required to complete the field internship. As usually seems the case when students get close, the ratio of BLS to ALS calls leans disproportionately to the left.

Such is the case today, as our first three calls are all routine transfers with no opportunities for ALS interventions. We have just returned to quarters and are walking into the kitchen when we get turned around and dispatched for another transfer. But this call also features abdominal pain, so that’s a roll of the dice in the world of ALS vs. BLS. We’ll have to wait and see how this shakes out.

We find our patient in a room right next to the nursing station. The RN doing the handoff report introduces us to Aubrey, who’s 92. The student takes the report and asks a couple of additional questions as we get Aubrey ready to head out to the rig. It seems like everyone on staff is there to see her off and wish her well. Lots of hugs all around tells me Aubrey is a well-loved member of this extended-care facility. As we weave through three hallways, Aubrey smiles and waves at everyone we pass, acquiring two more hugs before we reach the front door.

Once in the rig, the driver, a young fellow in his early 20s, is in the side jump seat, BP cuff in hand. As the gurney clicks into place, he takes the patient’s arm and begins to wrap the cuff. In response Aubrey reaches out, pinches his cheek and says, “My, my, my, you are quite the little looker, aren’t you?” Freezes the boy on the spot. The other three of us are falling apart watching this exchange, so just for sport I ask, “It’s because he looks so similar to Brad Pitt, isn’t it?” “No,” she replies. “He doesn’t look at all like Brad Pitt.” Truth is, he doesn’t, but I was just being stupid and got caught at it.

Our driver seizes the opportunity to escape and head up front, and we continue to work with Aubrey. As it turns out, Aubrey is putting her abdominal pain at 8 of 10. After having five babies and spending just shy of a century on the planet, we are unanimous that she meets the quals to rate pain accurately. She’s a really tough stick, and IV attempt No. 1 is a no-go. The student apologizes, and Aubrey quickly pitches in, “Oh, that’s no big deal. You just need to try again.”

As the student preps the next site, I look at Aubrey and say, “Hey, Aubrey, when’s the last time somebody told you what an incredibly nice person you are?”

“I’ll bet you say that to all the girls,” comes her reply.

“No, Aubrey, actually I don’t. Only to the nice ones. And you’re truly a sweetheart. Patients like you make this job much more enjoyable.”

With that, the Aubrey smile we’ve enjoyed since the moment we met her again lights up her face, and my student rolls out a care plan, first addressing her pain issues and then providing a pair of 250-cc fluid boluses when her skin turgor indicates she’s dehydrated. Aubrey confirms that she hasn’t been eating or drinking much since her belly started bothering her a couple of days ago. Good catch by the student.

Throughout the rest of the call, we continue to visit and keep an eye on Aubrey as the saline boluses drip and the pain medications put her in a more relaxed and comfortable state of mind. Upon arrival at the ED, I listen to the student’s handoff report, and the transfer of care goes seamlessly. As we pick up the last of our stuff, I walk over and take Aubrey’s hand and say, “Thanks again, Aubrey, for being such an incredibly nice person.”

“Thanks for noticing,” she says with a wink and a smile.

For the rest of the shift we talk about what a special patient Aubrey was, and how those types patients often fill a provider’s day with human sunshine. That was certainly what happened in our case.

On those occasions when you run across one of those truly nice patients, don’t just notice it; act upon it. Nothing really comes of just thinking about someone’s niceness. Make it meaningful by taking a few moments to let that person know. Just as they may make your day, so you may well make theirs.

Until next month…

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.