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Stinky People
EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. Send ideas c/o Nancy.Perry@cygnusb2b.com.
You've responded with your partner, Linda, to a downtown mall for a "man down with seizures," and you recognize Leon as soon as you pull up. Leon, that's his EMS name. Crews call him that because he looks and talks like bearded rocker Leon Russell-except for his few crooked, brown, broken, bare-rooted teeth and the numerous scars on his face and hands.
This guy stinks. You know he's human, and you know he owns your certs, but you're outdoors, and six feet away from him the odor of concentrated urine nearly knocks you off your feet. You know how hard it's going to be to get that smell out of the ambulance, and even for a good caregiver, this one's hard to respect. You've "experienced" him before, and last time you had to decontaminate yourselves and your equipment for scabies. You catch yourself wanting to call in an engine and ask them to pull a hard line.
| Q. | You're only human. How do you give this guy your best medicine? After all, he lives this way as a result of his own choices. |
| A. | The key to treating him well is to honestly respect him-see beyond his appearance to the soul of the person within. Regardless of what may seem obvious at the time of a response, none of us really know why some people live the way they do. |
| Q. | It's easy to pontificate. But how do you honestly respect people like Leon? |
| A. | Not easy, is it? Maybe it would be easier if we had been homeless ourselves. In that case, we'd know some of the basic truths about living on the street, namely: Most folks who live there don't do so by choice, and none of us is really qualified to judge what's inside them. Some people are simply too lazy to work, but for many, life is hardly ever that simple. According to one experienced shelter worker in a big metropolitan city, as many as 80% of homeless people are mentally ill. Many of them (and many others) are addicts as well. Still others simply do not possess the social skills they need to survive in the workaday world. Once you get on the street, it's nearly impossible to break away without help. Employers won't hire you unless you look and act presentable, and they won't keep you unless you stay that way. To look presentable, you need regular access to shower and laundry facilities, you need to eat, you need transportation, you need decent clothing and shoes, and you need a safe place to sleep. All of that costs money, and if you're not working, you don't have access to money. It's a vicious circle. Most cities don't provide shower or laundry facilities for the homeless. So if you're homeless, you tend to wear things until they fall apart-smelly or not. Not only that, but if you have spare clothing, you generally have to carry it everywhere you go. For one thing, that's a burden. For another, it can be taken away from you. You soon learn to tolerate bad smells. |
| Q. | What if you work in a system that routinely assigns its least-experienced EMTs and paramedics to downtown areas, so they're exposed to a steady diet of homeless people? For those of us who face that reality every shift, it's easy to get cynical and burned out. Once that happens to you, respecting others can be a real chore. |
| A. | EMTs aren't machines, and even if they were, they would need maintenance. The worst thing about cynicism is, it goes home with us and becomes part of who we are. Don't let yourself stay in any system that routinely exposes its newest people to its most unlivable circumstances. There's a fine line between the clinical skepticism we all rely on daily and the kind of cynicism that eventually destroys us and alienates us from our families. It's not unusual for even the best caregivers to get cynical when all they ever see is people whose lives make no sense and dilemmas that nobody else can tolerate. The solution to that was invented a long time ago. It was called balance. Other people can affect your balance. Only you can control it. |
