Lessons Learned as an Inner City Medic

I was raised in a small town in Southern Indiana. It’s the kind of place where you get in trouble before lunch and get a visit from your mother in the lunchroom to address your behavior. Everyone knows everyone, which usually translates to a phone call to your parents about what you were doing. You’d get home to the fifth degree questioning from your parents and you knew to come clean because someone had already reported you. Most families had a garden and you did your own landscaping. We never had all new things, but we always had enough food in our belly and clothes on our back.

In 2003, I took the leap and accepted a job as an Emergency Medical Technician (EMT) in Indianapolis. I was going from the local fire department and Emergency Department to the front-line in a totally new place. I don’t think that I expected that it would be all that different from what I was used to dealing with. After all, healthcare is healthcare, right? To say that I experienced some culture shock would be putting it very mildly. My comfort zone disappeared and I was constantly told that I talked “funny”. When I left Indianapolis to come to AUC, I had learned some very valuable lessons that are taught only by experience.

 

Lesson 1: Learn to speak the language.

My first lesson came early on in my career. I was on the ambulance after a week of orientation. I felt intimidated and very unprepared. I couldn’t find the addresses and navigating the city was very different from the country roads. When the run came in, the mobile data terminal (MDT) finally sent us to a location I felt confident I could find. After only one wrong turn I was feeling confident when we pulled up to the scene. My preceptor told me to initiate the interaction so I walked with a swagger into the alley. What could go wrong since I’d located the patient with only one wrong turn? A very agitated man, who smelled of urine and alcohol, was pacing in the alley with his friend lying unresponsive on the ground by the dumpster. I very quickly started my assessment and was repeatedly told the patient had “fell out”. As I stood there puzzled, I looked up at the two buildings and asked: “He fell out of what?” While my preceptor stood there laughing, we repeated the interchange before I finally asked what that meant. In Southern Indiana, you fall out of cars, windows, or down the stairs. In the city, to “fall out” means that he passed out or had a syncopal episode. I quickly discovered I didn’t speak the language. I had to learn about smoking squares (cigarettes), that a sweatshirt was a hoodie, and that being called a “cracker” was actually an insult.

I learned very quickly to say when I didn’t understand. After obtaining my paramedic license, one of the first runs I went on was in the Meadows. If you are not familiar with Indianapolis, the Meadows used to be the equivalent of the projects, an area well known for violence, crime, and poverty. It’s where I spent the first part of my career as a paramedic. We walked into the apartment to find a young man unresponsive on the floor. He was pale and diaphoretic but breathing and had a pulse. His brother was pacing and upset and was very insistent that he had a “fit” and he wouldn’t wake up now. I asked a handful of other questions as the brother got more and more agitated and upset. I started asking about health issues and medications. Medications often gave a better indicator of the patient’s history than the family could provide. It turns out that some people are happy to take whatever a physician prescribes and don’t necessarily care what it’s supposed to fix. My face must have been priceless when he responded with: “He takes peanut butter balls”. His brother repeated this several times and I asked if he had the bottle. He went to a different room and returned with a bottle of phenobarbital, a common medication for seizures.

Over the years I learned a whole new vocabulary and way of interacting. Patients would often laugh when the words came out with my slight southern accent. I learned that words like diaphoresis and dyspnea should never be part of a patient exam; it’s an uncomfortable thing to put a patient in a position where they have to tell you they don’t understand what you are asking. I learned quickly that if I used terms they understood, I got a better assessment of their condition. Using big words never made the patient feel comfortable. Being approachable and kind allowed them to realize I was there to help and we formed a much better working relationship.

Lesson 2: Try to see the big picture.

Perception is key when dealing with people. If you write someone and their complaints off as invalid, the patient usually picks up on your attitude. It’s not uncommon to find people who have consumed alcohol prior to an interaction with Emergency Medical Services (EMS). Not all people who drink are alcoholics. Not all homeless people are on drugs.

Let me tell you about a patient I met several times. Let’s just call him George. George is a veteran. He receives disability and a social security check. He suffers from PTSD and drinks away his pain. The very first time we met he was discovered breaking into a car and tried to run but only made it about thirty feet before the police showed up. He was intoxicated enough that he’d run out of his shoes. He was in handcuffs when we arrived for a checkout. He laughed and enjoyed talking to us and refused transport to the hospital. He was too intoxicated to be placed in the wagon (a van for transporting prisoners) so we took him for evaluation anyway.

The second time I met George, he was naked and bathing in a neighborhood swimming pool after hours. He’d set off the alarm and was removed from the pool by the police prior to our arrival. He had no injuries but was clearly intoxicated. His only question for me was whether or not he smelled better this time. With no option to send him home with someone, he went to the hospital to sober up.

The third time we interacted I found George bloody on the sidewalk. He’d been involved in an altercation. The blood had started to dry and I was initially not terribly concerned since George appeared to be the most sober I’d ever seen him. He again refused transport. During our interaction, George started screaming at an individual who showed up and was placed in handcuffs when he became aggressive. George begged for us not to take him to the hospital since it extended his time in custody. Having met George several times, I was inclined to agree to release him but my gut told me to ask a few more questions. After George calmed down, he finally admitted that the laceration at his hairline above his right eye was done by the other individual with a ten-inch saute knife. We took him to the hospital for evaluation.

I went back to check on him a few hours later. I’d seen him enough that I was curious about his condition. We had after all interacted enough that we were friends of a sort. I met George’s daughter sitting in his room. It turns out George has four children. He served in the military and married his wife after returning home. They had four children and his wife died leaving him to raise them alone. George had been a plumber, owned a home, and has 12 grandchildren. George was caring for his brother who was dying of cancer. After the death of his parents followed his brother’s death and the loss of his wife, George turned to alcohol. The family had tried to help but George refused. It turns out George also has several medals from his military service.

When I first met George, all I saw was a drunk. I was placing his value as a person based on what little I knew of him. I was wrong. Yes, he was a drunk. He was also a father, a grandfather, a loving brother, and a hero. I learned not to make assumptions about patients based on my experiences with them. I continued to transport George for several more years and we developed a good working relationship. If I had not met his daughter that night, I don’t know how the remainder of our interactions would have gone. George and his family taught me to look for the entire picture and not just judge someone based on a snapshot.

Lesson 3: Don’t make assumptions about people.

After several years, I was selected to be trained as the Back-Up District Lieutenant. Basically, if the supervisor needed a vacation day, I was trained to fill that position and perform the functions of the supervisor. It was the best of both worlds since I got to see both sides of EMS. I was responsible for monitoring staffing, ambulance coverage, and provide support to the ambulance crews. Some days were more exciting than others. Some days were boring as I was by myself in an SUV for a 12-hour shift.

One particular night, I was driving along a side street in the kind of neighborhood where you don’t want to be alone at night. My headlights revealed a person lying in the street. I flipped on the emergency lights and got out to check on him. He was covered in road rash and unresponsive. I called it in over the radio to dispatch and asked for an ambulance, the fire department, and the police since clearly this man’s injuries were no accident. As I was doing so, I realized that a crowd had started to gather. I returned to my vehicle to get my ALS bag (advanced life support) and a cervical collar to protect his neck. In a matter of minutes, I was surrounded by a mob of angry people. I was putting the cervical collar on and starting to feel very uncomfortable.

One of the first things an EMT or paramedic is taught is scene safety—we don’t enter unsafe places. The protocol is for the scene to be secured by police because if we go in and get injured, it creates more patients and delays care to the initial patient. I was always taught, and even taught other people, that scene safety is key. My safety comes first, then my partner, then the patient, and lastly bystanders. There were many places that we didn’t enter without a police officer since we don’t carry weapons and have no authority to compel anyone to do anything. I had accidentally placed myself into what was becoming a very intimidating and unsafe environment.

In hindsight, I think these individuals saw the patient lying on the ground in front of my SUV and assumed that I had run him down. I’m not sure what expression was on my face. I had placed the cervical collar on the patient and was attempting to do a quick assessment to see what other things needed to be addressed when a large shadow cast myself and the patient into darkness. As the screaming around me intensified I looked up to see a large black man, shaved head, covered in tattoos, and wearing leather chaps and a vest in between me and my vehicle. I recognized the markings on his vest as belonging to the Outlaws, a local biker gang with a house located not very far from my location. As I debated trying to retreat to my vehicle and not wanting to leave the patient, I noticed about three other men dressed as bikers coming forward. My heart was beating fast and I could feel the panic rising and bile gathering in my throat. The words that came out of his mouth I still remember to this day. “Do what you need to do. We got you, baby girl.” I was so relieved that I’m not sure to this day that I didn’t pee in my pants just a little. Those four gentlemen started herding the crowd back and I was able to start providing care to the patient. What felt like hours but was probably just minutes later, the fire trucks, ambulances, and police cars started arriving.

I never got to say thank you. I don’t even know any of their names. My previous interactions with the Outlaws had been a few 911 calls from their clubhouse. They often refused us entry into the building and would bring the patient out to the sidewalk. We were always told it was for our safety. I’ve never forgotten the fear that I felt that night. And I’ve never forgotten the safety that some really big biker guys provided me when I needed it most. My initial response was to believe the stereotype. Those gentlemen proved that stereotype wrong that night.

One of the first things I remember an old medic telling me has stuck with me to this day. He said that the patients don’t know if you’re a good medic or just a passable medic. They don’t know if you are doing what’s best for them. They won’t remember what you said to them a year from now. What people remember is how you make them feel. I remember the fear and knowing that if things continued to deteriorate that I was going to be in real trouble real fast. I will be eternally grateful for the kindness that was shown to me that night. I tried from that day forward to not make assumptions about people based on appearance.

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