A shift in review

We respond to a female fallen, with a nosebleed. Sitting there in her wheelchair is a profoundly mentally retarded woman. She is dirty disheveled. She doesn't respond to me verbally when I try to talk to her, just looks at me and rocks back and forth. The bleeding from her nose is stopped.
"She fell," the nurse tells me. She hands me paperwork and tries to run off. I'm already frustrated with her.

"How about giving me a report?" I'm barely covering the edge in my voice. The nurse repeats her previous statement.
"Any LOC?" She shakes her head. "How long ago?" 30 minutes, comes the distracted reply. For some reason she wants to run. I do a quick assessment and find no other injuries whatsoever. My patient is covered in old food, and smells like spoiled milk.

"So, you're telling me that this woman was sitting *IN* her chair, and without standing up, fell forward onto the floor, landing on her face, and the ONLY injury she managed to obtain is a bloody nose with an obvious fracture?" The nurse nods and runs off. I write it in my report as it was told to me. I don't buy it. No word on if the state is involved yet. My words might have made no difference.

................................

We're called to another home, for chest pain. There are two other ambulances there for other patient, but medics have initiated care already. She is in no acute distress, alert and oriented. As we get to the elevator, her daughter comes up to the stretcher. "This is all because she was out at Lace last night!" She must be kidding, Lace is a strip club, but I play along.
"I thought I recognized you there!" We laugh and the daughter grumbles, "I'm a grandmother myself, they'd probably kick me right out of there!" She looks no older than 50.

My partner is taking her in, and because she is lucid, he explains everything to he. He even explains all of her history, and tell her what it means. He tells her each and every one of her medications, and tells her what they are for. He is very patient with her many questions. "I like that about you," she tells him. "because you treat me like a real person."

The transport is an easy one, and as I turn to leave the ER she says, "Are you married?" I shook my head no.
"Haven't met a woman that could stand me yet," I said with a grin. She smiled. "I'll pray that you find one. You're such a nice young man." She smiled, and I know that her scary moment had been turned into something a little more positive, because she had a good crew.

.....................

Dispatch must be crazy. They're sending an all-male crew to go pick up a 14 year old female psych patient. I'm ready to refuse when my paperwork says that she is aggressive and violent, and I have a scrip for restraints. A 21 year old soldier wrestling a 14 year old girl alone in the back of an ambulance is just asking for a lawsuit or jail time, even if everything was by the book, and there were no dishonorable intentions. A female supervisor comes down with us instead.

The girl is quiet, reserved. She seems friendly enough. I can scarcely believe the stories on the paperwork...punching cars, threatening her family with a bat, sending nude photos to boys, walking out in the middle of traffic, and lie after lie. She sits there and listens to her Ipod until she pops in a stick of gum and I offer to throw out the wrapper.

Sometimes it only takes a small trigger to make a psych go off. It also takes an equally small trigger to get them to warm up to you. It's a delicate balance that in this case, paid off. From those few spoken words, she began to talk. About school, and getting kicked out. About her dreams of getting into medicine. About kid stuff, like climbing trees and decorating books with aluminum foil from gum wrappers, and snowboarding. She walked into the treatment facility of her own volition with a smile on her face. Only God and she know if any of the stories she told me and my supervisor were true, but if nothing else, the talking made a difference. And those little differences are why I do what I do.