In a recent article I wrote for this site, I talked about dealing with those people who are sure they’re fine. That can be a tough situation, but there’s a whole other kind of “I don’t need help” call that I think is even more difficult to navigate. You see, some people for one reason or another don’t just not want your help, they’re actually angry at you for even being there.
I ran a call to a middle-class neighborhood residence on Thanksgiving last year. It was dispatched as “Unconscious,” and on the way we got enough information to know that this was a young guy who was visiting his parents for Thanksgiving, and who had gone into a really heavy state of sleep. So heavy that when he rolled off the bed and hit his head, he didn’t even wake up. We were advised that he was taking Xanax, and one of the side-effects of Xanax is possible drowsiness, but this level of unresponsiveness was a little bit past “drowsy.”
When we arrive, we walk into a bedroom and see…nothing.
“He’s behind the bed!” the dad yells from the hallway.
We peak over the bed, and there he is, facedown and contorted up, wedged between the bed and the wall.
“Check his breathing,” the Captain murmurs as he begins to open the med-bag.
Leaning close to the kid I can hear respiration and can feel it on my face. Smell it, too. Definitely breathing.
“He’s breathing, but shallow, probably because of his position. Shall we move him?”
We each grab a body part and move him out into the center of the room. He moans and moves a bit as we move him, but goes flat out again as soon as we lay him down.
“Let’s get him on some O’s,” I hear from over my shoulder.
I pull a non-rebreather out of the packaging and hook it up to the oxygen bottle that’s already been primed for me, then apply it to the patient’s face. He doesn’t like that.
Sitting up groggily he yanks the mask off his face and asks what’s going on.
“You were pretty unresponsive there, for a while,” the captains says to him, checking his pupils (which are currently small pinpoints).
“I wass nnnapping,” he slurs.
Now we have a paramedic from the ambulance in the room, already briefed by the parents, who asks what’s been going on, pointing out that the heavy sleeping, The grogginess and slurred speech seem to indicated something is wrong.
“I’mmm sleeeepy,” he manages to get out.
“Well, your behavior is not quite what we’d expect from someone who is just sleepy.”
He really doesn’t like this.
“Well! I didnn’t knnnow…that..that…that therrre was a right wayyy to be slleeppy!”
“Calm down, buddy…” the medic says.
“NO! See, you’rrre starting to piss me off herrre! Herrre’s what’s going on…” his speech is improving a bit as his new found anger cuts through the haze “You all are in this house…telling me how to be ****** sleepy!….and I don’t aprrrrreciate it….So all five of you ******** can just take a flying **** out the ******* window….cause I swear if I find out where you live….”
How about that?! This guy just doesn’t like us at all. It’s not just, “I’m ok, thanks.” It’s more like “I will hurt you if you touch me.” I consider myself an emotionally tough guy, but it stings a bit when you reach out with compassion and get met with anger. You can see why the medics who have been on the job for a long time seem more likely to be rather unconcerned regardless of the situation (almost to the point of being dispassionate). Apathy is hard to offend. If you don’t care about someone that much, nothing short of a physical assault is really going to hurt you. But if you put yourself out there emotionally-if you try to feel some empathy for someone who’s having a rough day and you do your best to have concern for them and help them-and they reject you, it feels like pretty much any other relationship where you get something nice pushed back in your face. Far safer to not care that much in the first place.
These patients can sometimes be managed by utilizing whatever family or caretakers are around, because they’re probably used to dealing with their moods and will know what steps to take to redirect or dispense with their negative emotions. The tough ones, for me, are the patients like in my story above: the drug abusers. You never know if it’s the drug itself that sparks their rage at you, or their fear of being judged that makes them carry a chip on their shoulder. Either way, I haven’t had good luck dealing with them. In the end, I find it honestly hard to find compassion for someone who’s doing these things to themselves.
And I’ll openly admit this is a thing I need to work on. My feeling is, all patients should be shown respect, empathy, and compassion. Not because they’ve earned it or necessarily deserve it, but because it’s the right thing to do. If they reject it and get ticked off at you, there may not be a lot you can do about it; in my jurisdiction we’re supposed to call law enforcement in to manage these patients because typically they aren’t in a competent mental state where they can refuse treatment. But you can’t carry that with you. Bad calls are going to happen-calls that piss you off, that rub you the wrong way. The worst thing you can do is get jaded and cynical. The actions of a few angry patients can easily color your view of all the patients you’ll be helping in the future. Next thing you know you’re being gruff and snide with any patient you suspect is a drug addict. It’s not worth going down that road. Those “old dogs” you sometimes see who treat their patients with empty and uncaring eyes weren’t always that way.
The reason I (and many others) got into this business was to help people; to use that natural compassion we feel as human beings to make other’s lives better. What a shame it would be if in pursuit of that goal we lost all the empathy that motivated us in the first place.