In addition to responding to 9-1-1 calls, one of the necessary duties we perform in EMS is long distance transports. We pick up patients at skilled care facilities, hospitals, or even at their homes, and drive them to specialty care facilities for surgeries, procedures, rehabilitation, and sometimes just so they can be closer to their families. These trips can be just a few miles or a few hundred miles. There are times that I welcome a long distance transport so I can get off the streets for a few hours. That is, unless we get sent at the end of our shift and dinner will have to wait indefinitely. Or, the weather is bad and it will be a nerve-fraying experience. Hazardous duty pay should not just be for the military.
One such long distance transport occurred last winter. We were sent on a four hour journey to pick up a patient at their home and bring them back to a skilled care facility. The weather was iffy because of frozen fog (isn’t an ice cube frozen fog?). We were sent two hours before the end of our shift which meant I would get home just in time to go to bed and get up and go to work again. I drove on the way to get the patient, and sat in back of the ambulance on the way home. It should have taken four hours to get there, but because of the icy conditions, it took five. By the time we pulled up in front of the patient’s house, I had worked myself into a dither and was pretty cranky.
I backed into the driveway so we wouldn’t have as far to go to get the patient from the house to the truck. It would be my luck, I had decided, that this would be a 300+ pound patient that barely fit on the cot, and wheeling them down a driveway on a thin layer of ice posed all kinds of risks, not only for the patient, but for my partner and I, too. As we got the cot out of truck, I was fully anticipating that the patient would be some cantankerous person that would complain loudly for the next five hours about how uncomfortable they were, how bumpy the ride was, how hot or cold they were, and ask repeatedly if I had anything to drink in the back of the truck. If I should happen to mention with a little too much sarcasm that this particular “flight” does not offer a beverage service, I was sure this patient would write a complaint letter to the company and I would have to come up with an answer as to why I was treating grandpa with such disrespect. Bah-humbug.
The house was a quaint ranch-style home with a nice-sized two-stall garage. The house was probably built sometime in the late forties or early fifties. There was a FOR-SALE sign in the yard. As we maneuvered the cot up the porch and in the front door, I noticed that several neighbors were coming outside and gawking. Lookiloo’s, I figured, morbidly wanting to see if there was a ‘train wreck.’ As we walked into the house, I noticed several boxes stacked in neat piles. No pictures hung on the walls. The carpet was shag, straight out of the 1970’s. The walls were varying shades of greens and oranges – straight out of the 1970’s. A woman approached and introduced herself as the daughter of the patient. She had tears in her eyes.
This scene was not unfamiliar and it was never pleasant: Someone had reached the stage in life where they could no longer care for themselves and it was time to give up their independence. My heart already started aching, made worse by the tantrum I had thrown on the way there. My crabbiness was melting into melancholy.
The woman tearfully explained that her eighty-some year old father had really bad arthritis in his back and knees and was having a difficult time moving around. He had been sleeping in a recliner for the last several months because it was too difficult to get in and out of bed. He couldn’t shower or bathe himself any longer. He had fallen several times over the last few weeks trying to get in and out of the house. It was decided that it was time for him to move into a nursing home. They needed an ambulance to transport him because sitting in a car for that length of time would be excruciatingly painful. The daughter would follow us back. She handed me a check for over three thousand dollars because she already knew that insurance and Medicare were not going to cover this transport. I felt guilty taking her money.
The patient was in a bedroom sitting on the edge of the bed. I went back to introduce myself and my partner and see what we could do to help him get to the cot. He produced a quick, warm smile but the sadness in his eyes betrayed him. He politely extended his arthritic hand for a handshake. We chatted briefly and then I asked what I could do to help. With humility, the patient asked if I would allow him to walk to the ambulance.
I walked beside him as we slowly made our way into the living room, ready to intervene should he lose his balance. I told the daughter and my partner that Bill (not his real name) wished to walk to the ambulance instead of being carried out on the cot. I gave each a pointed look and they understood. My partner wrestled the cot out the door and went to the ambulance to wait. Bill stopped in the living room and gave the house one last loving look. His breathing became ragged as he struggled to keep his emotions in check. The daughter put an arm around her father’s shoulder and they both started crying.
How many memories must this house have? How incredibly difficult would it be to leave your home for the last time? How does a person come to terms with knowing they are no longer capable of caring for their own basic needs? I watched Bill and his daughter as they cried in utter agony as this new reality gripped them. I started sucking in several deep breaths and paced around the room to keep from crying myself. At that particular moment, I hated life and I hated myself.
One of the worst things about having a conscience is the price a person has to pay when they do or think something stupid and their conscience rears up and starts kicking the crap out of them. The last two hours of driving to get to this patient were spent cussing, and whining, and otherwise angry that I was risking my life to transport someone that probably could have been driven in a private vehicle. I had railed on to my partner about wasting EMS resources, abuse of the Medicare system, and how weak society had become in thinking an ambulance was needed for every little illness and discomfort. I felt ashamed and really, really stupid for being so judgmental.
After several despondent moments, Bill straightened up as best as he could, wiped his eyes, and with his voice shaking, said he was ready to go. His daughter helped him into a coat and stocking cap. As we walked out onto the front porch, at least a dozen neighbors had gathered in the front yard. The neighbors ranged in age from their early twenties to a few that appeared to be Bill’s age. A couple of the men approached and I got out of the way so they could help Bill down the porch steps. I noticed that several of the neighbors had tears in their eyes. The walk down the driveway was slow and the group of neighbors grew larger as more people came to offer words of encouragement and to say good-bye. This man was obviously well-liked.
Bill wasn’t the obese man that I had ashamedly assumed he would be, and with support from my partner and me, we were able to help him up the two steps and into the ambulance. As he gently lowered himself onto the cot, I noticed that he winched in pain. We got him as comfortable as was possible on an ambulance cot, and then I told my partner we were ready to go.
As we drove away, the throng of well-wishers waved and Bill gave a tearful wave back. My heart was up in my throat. I couldn’t even begin to imagine the emotional pain that he must be suffering at that moment.
I told Bill that this would be a bumpy ride and I offered to give him pain medications. He politely declined, which didn’t surprise me at all. Bill’s generation was proud, and willing to tough out their problems. I adjusted the heat in the patient compartment, dimmed the lights so he didn’t have to squint, and then settled in for the long drive home.
The ride was bumpy and with each dip in the road, I saw Bill grimace. But not once did he complain. I offered pain medications again, and he reluctantly agreed. I started an IV, pushed enough Morphine to dull the pain, and then settled back.
When Bill seemed to relax a little from the Morphine, he appeared to be eager to talk, so I asked him about his life: Where he was from originally, what kind of work he had done, how many kids, et cetera.
Bill was a World War II veteran and had even fought at the Battle of the Bulge. He married his high school sweetheart when he returned from the war and they had a son and a daughter. The son lived in the south and was on his way to visit. His daughter was a school teacher. He had worked as a laborer in his home town for 50 years and when he retired he had worked part time at a local hardware store until his arthritic knees had forced him to quit. He and his wife had built their own house 55 years ago. His wife had passed away 20 years ago after a long battle with cancer. He had done woodworking as a hobby and had taken great delight in making dozens of things for his five grandkids, but had been unable to pursue his hobby for the last five or six years. Bill proudly said that he had never had to borrow a dime in his entire life…that he had built a house and put two kids through college without setting foot in a bank. Again, I was not surprised. This was typical for his generation: Proud, hardworking, and responsible.
I had become so engaged in talking with Bill that the first three hours of the trip home breezed by. He was one of the most humble, charming, and charismatic patients that I had ever met, and once again my conscience was thumping me for being so audacious in assuming this was going to be a miserable long distance transport. I noticed that Bill’s eyes were getting heavy so I turned the lights off and stopped asking him questions. He drifted off to sleep.
When we arrived at the assisted living center, I gently woke Bill up and told him we were there. I could tell he was putting on a brave front when he asked if he could walk from the ambulance. Normally, I wouldn’t allow a patient that had been given Morphine to walk but I was not going to allow this man that had served his country and lived such a rich and full life to be robbed of his self-respect. We helped him out of the ambulance and assisted him inside. His daughter was already there and after taking care of some paperwork, I turned over care to the nursing staff. I shook Bill’s hand and wished him the best. He winked at me and thanked me for the pleasant conversation. But once again I noticed that he had tears in his eyes.
After getting home, I started thinking about what it would be like when I was Bill’s age. Would I handle losing my independence with the same grace and dignity that Bill had? Would I have a throng of well-wishers to see me off? What had I really done with my life that would warrant such respect? I had a lot yet to learn, I knew, and I was feeling very grateful that I had had the honor of meeting and taking care of Bill.