Saturday, September 13, 2008

Growing Old

Had a few runs lately with ancient patients.

Here's an interesting thing about being a paramedic, unique in most of the medical field in fact. We are routinely invited into peoples homes.
Doctors and nurses most often see patients "at work". But we go out and pick them up with whatever malady or injury they have. Medics also are trained to pay attention to detail. The first thing on our mental checklist is scene safety, because if we get hurt, who helps the patients and us? So we take note of our surroundings, pay attention to things that a casual observer might miss. (although when PD is on scene, we may not look as closely, because they do it for us!)

Still, you can tell buckets about a person within the first few steps onto their property. Is the house in good condition? Yard tidy or unkempt? First thing through the door we are noticing not only appearance, but smell and temperature as well. You'd be amazed what we can learn from someone by the smells we get.

Do they live alone or with others? Are there animals we need to be aware of? (this becomes very important after you've had an overprotective Chihuahua furiously attacking your boots as you try not to squish it while moving their master.

The elderly population that we serve are for the most part delightful, and remarkably around here they mostly call when they are actually sick or injured. I did some ride time on other places where even in my short time I got to know a few of the "frequent fliers" who really needed just an ear to hear them every once and awhile.

But the more I serve, the more I learn, and the more I am shaped by my experiences. We have a few nursing homes in our community. I have not had many good experiences in nursing homes. Now, in their defense, they are usually understaffed and overworked, and I would work almost anyplace else before I worked there, so I give the staff credit, especially the good ones.

But time after time when we pick someone up, there is a bad or sad story behind the patient. We get their 'papers' when we leave, with health and social histories and such. So reading through them gives us an idea of what life is like in there. One patient plays cards about every day, but is also incontinent most every day. Another spends the day in a wheelchair, being moved around from time to time before being put back in bed for the night. Yet another might wander the halls aimlessly, trying doors and seeing where they can get. Escape attempts? The staff is overwhelmed with baths, medications, feedings, cleaning up messes and such that they seem to have little time to just sit and hear the stories that must invariably come. Families visit rarely if at all. Not that they do not care, but they are busy living their lives as well. Some families visit weekly for an hour or two. Rare is the daily visitor that spends much of the day.

And since the rooms are their "homes" We get a Readers Digest picture of their lives. Pictures and trinkets most valuable after a lifetime lived. Pictures of kids and grand kids, old pictures of their time in the military, or college days or on the farm, etc. etc. Lifetimes of stories and memories. And then we come and pick them up off the bed or the floor, covered in blood, feces, urine and whatnot. Get them on the cot and in the rig and check them over. Carefully and tenderly, as they are mostly quite fragile and/or quite hurt. IV access is limited most often to spidery, narrow veins that burst like water balloons sometimes at the pressure of the advancing catheter. Or veins that twist and turn and bifurcate and are valvey, unsuitable for IV's really, but we take what we can get.

Once and a while they are lucid and mostly pleasant. But some cannot communicate with anything but their eyes. And the eyes are usually haunted or vacant. Devoid of hope, will, life, whatever the spark is that makes us human.

One recently looked at me pleadingly. Could not speak. Was barely able to focus. But the eyes, when they did focus were asking me to do something. The trouble was, I did not know what he wanted. "Help Me" is a very gray area sometimes with people.

When I first found Shoba, here eyes said "Help Me", and I knew she meant "help me live" Ive had other animals doing wildlife rehabilitation whose eyes clearly said "help me, put me out of my pain and suffering"

And I've seen both looks in the eyes of patients as well. Of course, my profession is to sustain life when possible and comfort when it's not, and euthanizing people is not legal. But I wonder, if near the end of my life I am lifted from my bed in the morning, washed up by someone else, moved around by someone else, fed, cleaned, and put to bed by someone else, what sort of quality my life has at that point.

Our society is so scared of and distanced from death that we seem to deny the inevitable to the point of forced suffering. I know that part of the reason I went into emergency medicine was to face my own fears about death, wage my own personal battle with it. For I was once scared silly by it as well. But in my experiences, I have learned that there are indeed things worse than death. Suffering and pain. Despair and hopelessness. It brings into focus the ways I do NOT want to die. And there are times when I hear about the death of a patient I had last week or last month when I think that maybe it wasn't such a bad thing that they died. Life is a blessing. No doubt. But a dignified death is too. None of us gets out of here alive. Or at least alive as we now experience it. So what needs to be done to provide a little dignity for the end of a life well lived?

More Later

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