Wednesday, December 8, 2010

On paying Attention

 The tones dropped and I pulled myself from the desk chair and headed for the truck in the driveway. As I grabbed the door handle, the address was given as 2 houses down, "possible stroke". I thought for a second about walking over but decided to take the truck so I had all my gear if I needed it.
 So I drove down, left my truck in front of the house, leaving the driveway open, and the blue light flashing to mark the location for the incoming crews. We would have a BLS first response truck with ALS backup on automatic dispatch as is pre-plan for a stroke call.
 I walked up to the front door and greeted the wife "Hi Mary, whats going on today?" Mary was calm, but concerned "I don't know, he is definitely not himself, he's wobbly, has slurred speech, and I think he may have had a small stroke." She went on "be gentle when you approach him, he's acting real strangely."
 I've known Bill for around 20 years. He's my neighbor and although we don't spend  lot of time together, we have been friendly and share a common hobby. In years past we would share the occasional evening or two. He's watched all the kids grow up in the neighborhood and could always be counted on to set them straight when their parents weren't around to do it. I liked Bill and he, I think, liked me. Lately his health has deteriorated and he has been losing the battle with his diabetes and the related effects. I know Bill can be a rough guy with strangers. He tends to have a harsh tone about him and can sometimes appear nasty. But if you know him, then you also know that he is just a teddy bear and can usually be disarmed by a good laugh and a sincere smile. He does not suffer the insincere well at all, and you really do not want to get him pissed off.
 I walked into the bedroom where Bill was laying on the bed with his lowers legs hanging off to the side. He half sat up when I walked in and looked me over... hard. "Who the F--k are you and what are you doing in my house!?"  "Bill, it's me, UU, don't you remember me?"
 "No, why are you here, what do you want? Never mind, just get out!"
 "Bill, we're here because Mary called us and she is worried about you. She says you are not well and she wanted us to see if we could help you. Do you mind if I ask you some questions about how you are feeling?"
 Bill looked over to his wife who was now standing in the doorway, then back at me, then back at her, and I could see him softening just a bit. "Well, ok, but make it quick."
 While our conversation is going on I instinctively scanned the room for any hints of other things going on. Med bottles, liquor bottles, bloody tissues, what ever might clue me into other issues. It's a habit I have, and in the course of my survey, my eyes fell on a handgun laying on the dresser just two steps from where the patient was. It appeared to be a .38 police special, Detective model, 2" barrel, Smith and Wesson, I think. From the angle it was laying at, I could see the bullet noses peaking out of the front of the cylinder. I knew in his working days as a long haul trucker Bill had always carried a small .38 in a waist band holster. He was big on personal protection.
 The gun didn't bother me, but it's proximity to an altered patient did give me some concern. It was in reach and I could easily have picked it up, but I knew this would most likely set Bill off. So I stepped in between Bill and his gun as I casually moved in to start my assessment. I asked him the usual stuff about when he ate last, what he ate, whether he had any pain, etc. I also asked when he last checked his Glucose level. (It turned out that this put us on the right track.) Shortly the medic came in and I waited until he stepped up next to me before I gave him all my info. Then I said, "if you're OK here, I'll go out and get the guys moving on a stair chair and gurney, OK?" The medic nodded. I knew George well, he had been a fill-in instructor in my CFR class years ago and I have worked many job s with him. I liked him because he was always consistent and predictable, and you always knew what you could do to help him. He never made assumptions and always went beyond the first treatable condition to make sure there wasn't anything else. He was good.
 So I stood up, and backed up slightly and waited for George to ask Bill his first question. When Bill began to answer, I turned to Mary and quietly asked her if she could take the weapon out of the room as I casually nodded toward the pistol. She looked at me, then at the gun, realized I was providing a visual shield for her to pick it up, so she gently took it, turned and stepped out of the room as she gave me that "Ooops, sorry!" expression.
 We packed up Bill, got a sugar count (25), and got him in the ALS rig for some dextrose and a quick trip to the E/D. All was well and he was back home that night.
 Two days later I ran into George at the auto repair shop in town where he was getting his car fixed. After the usual "hellos" I asked him how Bill treated him on the way into the hospital. "Man that guy is one mean, tough cuss!" "Once we got his sugar up, he wanted us to stop the rig and let him out on the side of the road". I told him a little of Bill's history, his long haul trucking job, they years he spent as a Professional Bull Rider on the National circuit, and how he really was a nice, sweet old guy. "By the way, I was really impressed on how you didn't make a big deal about the loaded hand gun in the room. A lot of Medics would have freaked out over that. You were very cool."
 George's mouth dropped "Loaded hand gun!?" "Why didn't you say something?"
 I was taken aback. "George, you didn't see it? You didn't scan the room like you taught me? Didn't you always say 'Observe the environment just the same way you observe the patient'?" I explained that saying something out loud would have created a situation that we didn't need. I knew the patient could not get access to the weapon as long as I stood in position, and he couldn't see it either. We got it out of the room before the patient was moved and eliminated the risk.
 I couldn't resist, I read just a little of the riot act to George about "complacency" and "sloppy work that might get him hurt someday". He could see I was enjoying it, and he knew he deserved it, so he let me go on without protest. When I finished, he simply looked at his shoes and said "Thanks for the wake-up call, I guess I was getting a little sloppy."
 We both learned something from that job. George was reminded of his own lesson, and I had it hammered into my head that you never make assumptions, even if it's familiar surroundings.
 "Scene safety", we hear that and repeat it a million times, but how often do we really practice it?

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