It happened again. My partner, a relatively inexperienced EMT, asked the question we’ve all asked at one point or another: “So, if you’ve had this for a week, what made it an emergency at 3 a.m.?
Bless his sparky little rookie heart. He still actually believes that ambulances are for, well you know, emergency calls. He wanted to know why our 50-year-old patient had been self-medicating her sore ankle with booze and Vicodin for the past six days, instead of going to the ER when the injury happened. He was understandably curious as to why someone would call an ambulance for chronic gout, especially when we had to maneuver our stretcher past four perfectly functioning cars in the driveway and a handful of able-bodied relatives in the living room to even reach the patient. I knew why.
But my poor partner, still clinging to the faint shred of hope that at least some of our patients may actually be, well … sick, just had to know. Call it morbid curiosity. Call it misplaced optimism. Call it whatever you like; but if you don’t think you’re going to like the answer, it’s probably best not to even ask the question. That’s a lesson my rookie friend has yet to learn.
When the patient told us that she was running low on her Vicodin, and had been out of her gout medicine for a week and that ambulance rides and narcotics administered in the ER were free, I think I saw the last shred of his idealism boil out of his ears like indignant steam from a teakettle. It was actually kind of cute, in an “Aaaawwww, they grow up so fast!” kind of way.
My reaction? I just shrugged and spoke the words I always do in such situations: “Watch your head when you climb in the truck, Ma’am. And what hospital are we going to this evening?”
I’ll also confess that I breathed a quick prayer of thanks that, in our system, such calls can be turfed to the EMT-B partner on the crew. It’s nice being an ambulance driver occasionally. And while I was providing her a safe and sedate $800 ride to the ER so she could save the $8 price tag for a month’s supply of allopurinol and colchicine — I was struck by the idea of other patient assessment questions that we really shouldn’t ask (unless we’re really ready to hear the answer):
''Have you given him any Tylenol?’'
Of course, they haven’t given him any Tylenol. If they had given him any Tylenol by the time the ambulance arrived, the patient may no longer have a fever, and then what use would an ambulance be? Don’t even ask the question and you’ll never have to ponder how some nursing home personnel ever made it out of school.
''How much have you had to drink?’'
You know darned well how much they had to drink — two beers. I mean, take a good look. I know the reek of ketoaldehydes on his breath, the vomit stain on his shirt front and the fact that he’s wearing Burger King ''Home of the Whopper’’ boxers outside his pants might lead you to believe he’s perhaps imbibed ''tee many martoonis,’' but doesn’t he have an honest face? Who are we to disbelieve? Two beers can do that to a person … if each of them came in a keg.
''How fast are we going?’'
Honestly, do you really want to know? Suffice it to say that if a) you are over 40, and b) your partner is younger than 25, and c) said partner plans his vacation around Speed Week in Daytona, the answer is not one you want to hear. I asked this question once, in an old gas-burner Ford ambulance on a dark country road. My partner looked down at the speedometer, shrugged and said, ''Beats me. The speedo goes to 85 and I’ve got it wrapped all the way back around to 10.’'
In those situations, it’s best to just close your eyes, tighten your seatbelt, and pray that your service implements an Allsafe program soon. And perhaps ask your partner to rock you a bit when you get to the call, to break the suction on the seat.
''So, how many of these did you take?’'
Well, doesn’t it say right there on the bottle? I know that, objectively, the fact that you find the patient licking the dust from inside their Vicodin bottle, even though the prescription was refilled less than a week ago, should have lasted them roughly until the implosion of our sun. But surely there must be some other explanation. If you can wake them up from their stupor long enough to hold a conversation, they’ll tell you they’re still in extreme pain. Or that their pain specialist doesn’t understand them. Or their shiftless nephew stole them all. Or the evil Vicodin Fairy came and took them all back. But they certainly wouldn’t take more than 1 tablet, q 12 hours, PRN for pain. That would be unethical, immoral and maybe even fattening.
''So, what did the poop look like?’'
Yeah, I know this is a germane question. You want to know if it was melena, or hematochezia or just plain old bloody-streaked poop from chronic hemorrhoids. But invariably, they’ll apologetically tell you they already flushed the toilet, and if they don’t, do you really want to open the Cool Whip container they so helpfully provided? Better to just get some orthostatic vital signs and let the ER doctor find out what’s behind Lid #3. Or if you must know, have your partner open it.
''Do you feel anything out of the ordinary down there?’'
Yes, I suppose if the guy complains of groin pain, we’d need to know if the patient has an incarcerated inguinal hernia, if for no other reason than to recognize the need for pain relief and the need for a surgeon. But what do you do if they tell you they’re not sure? Because then, you’re honor-bound to examine the area in question, and possibly even palpate it. Aside from directly violating EMS Rule #1 (Handle no one’s junk but your own), it can also lead to a number of nasty surprises, like the aforementioned hernia, or testicular torsions, or genital warts. Or maybe even the partially absorbed skeleton of his unborn twin. Ignorance is bliss, folks.
''How do you spell that?’'
Better to just get a patient’s first name, then copy the rest from the face sheet after the ER clerk signs ‘em in. That way, you never have to endure the exasperated eye roll because you didn’t know that Chopaquelethia Da’Nae Desdemonaretha Smithe has a silent ''e’’ at the end.
''Does anyone have a handcuff key?’'
Context is everything here. If it’s the prisoner who desperately needs IV access, by all means, ask the cop to release the cuffs. But if it’s an unconscious man wearing nipple clamps and a leather corset, still handcuffed to the frightened hooker who called 911, some cop is going to have just the type of key needed to free them both. And when that happens, it ruins a perfectly good war story.
''Can you show me your teeth?’'
If you’re checking for facial droop in a potential CVA patient, a better way is to simply ask the patient to smile. Otherwise, you’ll forever be the butt of jokes when the elderly patient obediently points to the bedside table where she keeps her dentures soaking in a water glass.
And the number one question you’re better off not asking:
''How did that get in there?’'
While I understand that we all possess a certain curiosity as to how a Fabergé egg can wind up stuck in someone’s rectum, is it worth the mental picture that the truth will conjure, or the aggravation of being lied to? Just accept at face value that some people paint their houses in the nude, leave paintbrushes sticking out of paint cans, and then fall backward off the stepladder onto that can. Seriously, it could happen to anybody.
Ever asked a question that you wished you hadn’t heard the answer to? Chime in with your comments! I’d hate to know I’m the only one in the market for brain bleach!
This article, originally published December 26, 2008, has been updated
