Just a Little Pinch?

     When I started in EMS, the hardest part of my job was interviewing patients. I'm not sure why. Perhaps it's because I'm a closet introvert—you know, the kind who discreetly dreads large social gatherings. (Memo to anyone whose wedding, confirmation, communion, anniversary or bar mitzvah I've ever attended: No, no—yours was different.)

     Maybe my discomfort had more to do with the limits of intimacy in polite company. You must admit, asking complete strangers about their bowel habits is an unnatural act. At least we should discuss the weather first.

     Whatever the reason, my awkwardness produced the audio equivalent of "Kodak moments" many times during those first few years of contrived conversations with patients. Some I recall due to acute, wish-I-were-a-houseplant embarrassment, others because of how long it took me to get a clue. I present my gaffes here for your amusement with one condition: If we ever work together, pretend you've never read this.

     "Don't worry about the bill—your insurance should cover it." Translation: I have no idea whether the cost of this ED visit will prevent your least-favorite child from going to college.

     "Are you sure you're not pregnant?" Asked and answered the first time. Yes, patients lie, but that doesn't justify playing district attorney. (I was going to say it doesn't justify playing Perry Mason, but the blank stares among the barely legal members of our profession might be mistaken for absence seizures.)

     "Breathe normally." If the patient could do that, I'd still be watching Honeymooners reruns at headquarters.

     "Uh oh…" All I meant is that I had dropped the lancet. Between my legs. Clearly, the patient misunderstood my distress and, based on his expression, was taking a mental inventory of advance directives.

     "OK, OK, we'll bring the dog." See Spot ride near the stretcher. See the EMTs offload the stretcher. See Spot run.

     "I haven't done one of these in a while." Thank you for sharing that, my patient must have been thinking. Now, if you'd be a good little EMT and find someone who knows how to attach that contraption to my leg, I might stop screaming long enough to express my gratitude.

     "Just a little pinch…" I'm pinching myself right now. No, it doesn't feel like a 16-gauge needle.

     "You don't really want to go to the hospital, do you?" OK, I admit I never actually said that. I just think it a lot. I mean, a lot.

     To the family of an asystolic patient: "There's nothing more we can do. And I have another call coming in." This is a good example of what can happen when you make an engineer a medic. Logic: A+. Sensitivity: F-.

     "Ready? One, two, three…" Here's how this works: One, the patient's autonomic nervous system warns of a threat that looks suspiciously like an 18-gauge angiocath. Two, the adrenal glands release catecholamines that are supposed to help the target run away from IVs. Three, being too civilized to indulge in such primitive defenses as clawing and biting, the patient settles for vasoconstriction as a way of not bleeding too much. How considerate of me to expedite this stress response. Now could someone please hand me a 20-gauge instead?

     "She's (he's) the best we've got." When I said this to a patient about my partner, I don't think I was doing him/her a favor. Most of us would rather sing in the shower than try out for American Idol.

     "Are you having any respiratory distress?" Wait, there's more: "Does it feel like chest pain?" "Do you have black, tarry stool?" And my all-time favorite, "Is this the way you normally are?"

     "What a coincidence! I just treated your neighbor for that." I think this might be an example of what Forrest Gump meant when he said "Stupid is as stupid does." At least ol' Forrest didn't have to worry about HIPAA.

     "Can't you hold it until we get to the hospital?" The preferred answer was yes, but we usually had enough receptacles to deal with no. "How long?" would have caused violation of the commandment about not bearing false witness against nurses.

     "Would you like to listen to my heart?" The kid had an ear infection.

     Any acknowledgment of budget cutbacks during difficult fiscal quarters. Even if the patient were the principal stockholder in my company, I don't think I should volunteer that we're down to one half-filled D cylinder, our drugs have expired, and we're driving with the engine light on.

     "Have you ever been diagnosed with pericardial tamponade?" Huh?

     "What's the worst that can happen (if you let us take you to the hospital)?" Well, I suppose we could sideswipe a parked car en route, summon a supervisor to the scene, then wait 90 minutes to transfer the patient to another rig.

     "Looks like you have another little one on the way. When are you due?" She wasn't.

     I think I've gotten much better at making small talk. Maybe it's all those years of meeting and treating strangers. Or because I watch The Weather Channel before I go to work. All I know is that I'm much more comfortable conversing with patients now. We don't scare each other as much. As for cocktail parties…just point me to the bar.

     Mike Rubin, BS, NREMT-P, is an EMS educator and consultant based in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.