A Few More Weeks

His name is Richard.

For the past ten years, he’s lived in a nursing home in a town near Boston, not too far from where he grew up. In his 60s, he’s still mentally intact, and except for the incontinence that forces him to wear a diaper, he outwardly appears well. But wending through his brain is a host of malignant tumors that will soon kill him. “The doctors” give him less than six months.

Today, we’re bringing him to see his neurologist, in an outpatient clinic for one of the large Boston hospitals. As usual, it’s been scheduled right in the middle of rush hour, so we poke along slowly through the heavy traffic and chat. I’m driving today, with a relatively new partner in back.

Richard tells us about his time in the military, running maintenance on the early WWII radar stations that would ping back from a flock of seagulls just as fast as an enemy bomber. “Seagulls are all we ever got,” he confides to us. He has a wry sense of humor and the physical carriage of someone who has been through the wringer and remains standing, even if his tanks are now mostly running on empty.

He bitterly and inconsolably describes to us how much he hates his current living situation. He spent years living on two of the facility’s other floors, and was happy — the staff were kind and competent, and he got the care he needed. Recently they relocated him to his current floor, and he can’t say enough bad things about it. The nurses are negligent and dismissive, he is ignored and manhandled — he suspects he may have run afoul of the administrator who manages the facility. I ask why he doesn’t go elsewhere; he says he wants to stay close to his doctors here. “There must be a dozen other places at least as close,” I don’t say.

When we arrive on the floor, the receptionist calls ahead inside, and then informs us that Richard won’t need to be seen today. The appointment should have been cancelled, she tells us, since he was already seen recently on other business; he can instead be rescheduled for six weeks from now. Richard throws up his hands and shakes his head, exclaiming how he knew it all along; we all wonder aloud why it couldn’t have been confirmed ahead of time over the phone.

Back into the traffic, which has only gotten thicker. I try to ease us around the potholes and I fade the radio back into the patient compartment, giving Richard some classic Beatles. He rocks out hard.

We deliver him back to his room, shake hands and head out again. As we make up the stretcher, I find myself wondering whether this nice guy, who doesn’t ask anybody for anything except his basic needs of survival, really has to die somewhere he hates.

On a notice stuck to a corkboard, I find the number for the network’s ombudsman, an impartial representative designated to act as a patient advocate for resident complaints like this one. Standing outside in the rained-on mulch, I call their office, describing Richard’s situation and asking if he can’t be transferred, if only to another floor. They promise to speak with him when they round on this building early next week.

We drive back towards the city.

It’s several weeks before I can check on him again. I do visit his room several days later, but he’s asleep, and I hate to wake him. His diaper is obviously soiled.

Three weeks after we transported him to the doctor’s appointment that never happened, I bring in Davis, one of our regular dialysis patients, who happens to share the room with Richard. A different name is on the door now, and I ask Davis hopefully if his roommate has been transferred elsewhere.

“He passed away,” he tells us, and wheels himself inside.

Copy, Roger Roger

I took my original EMT class in Northern California, where I was taught by a firefighter/paramedic from Santa Clara County. My first job was with the 911 service from the adjacent county, where I worked for half a year before picking up roots and crossing the country to the Boston area; I’ve now worked here for several years.

Working in EMS on the two coasts has revealed some differences in equipment, protocols, and system operations, but one of the first things I noticed was the changes in lingo. This business may be similar across our big wide nation, but some of the words we use do differ; people will likely understand what you mean if you use the wrong one, but you’ll get some funny looks. Some examples:

West — Your ambulance is a rig
East — We drive a truck

West — The patient lies on a gurney
East — The patient lies on a stretcher

West — Trauma patients get c-spined
East — Trauma patients get backboarded

West — A mixed Paramedic/Basic crew is “1-and-1
East — A mixed crew is “PB

West — Traveling with lights and sirens is called Code 3. Incidentally, Code 2 is urgent but with the flow of traffic, and Code 4 is “all’s well.” Firefighters flash you four fingers as you drive up to cancel you…
East — Lights and sirens is Priority 1, a hot transport, or simply a response.

West — Patients who don’t want transport sign an AMA (Against Medical Advice)
East — Patients sign a refusal

West — When arriving on location, you are on scene; when leaving, you are transporting
East — When arriving, you are either on scene or going out; when transporting, you might be occupied

West — You call to alert the receiving hospital with a patch
East — You call in an entry note (short for “notification”)

West — EMT-Bs are usually EMTs
East — They’re more often called Basics, or just BLS

West — Working as a dedicated unit for a special event is a standby
East — You’re working a detail

West — Continuing education is CEUs
East — You take con ed

West — Your certification is a cert, card, or license
East — You earn your ticket

West — When acknowledging radio traffic, you copy
East — Traffic is received

West — Patients are ideally AOx4
East — Patients are at best, usually AOx3, with “event” omitted

These are certainly not representative of the entirety of the two edges of the US mainland, but just a couple regions where I’ve hung my own shingle. Anyone else want to share? What’s in the local dictionary in your area?