A Funeral Procession?

Being assigned - willingly - to a double-basic EMT ambulance for a commercial provider, I often find myself being a transfer shuttle. I'm okay with that; after 15 years there isn't a whole lot that I haven't done at least once before, so catching hospital discharges and hospice transfers with a sprinkle of BLS emergencies is just fine with me. Today, though, I found one of my transfers seemed more macabre than simply a ride to another facility.

Mind you, in the past month that I've been back in the company's system status management plan, at least 50%, maybe more, of my patient encounters have been transfers from a home or a hospital to a hospice care center. There are a lot of great places for patients who are in the final transition of their lives in our area. Today, the routine is somber as usual, but there was an unusually high number of family members present at our patient's bedside. They were kind and very helpful in removing the boxes - yes, boxes - of flowers from the room, and even went so far as to help move furniture so we could get better access to their loved one. 

Once our patient was transferred and secured to the stretcher, the journey began. Due to the attention being paid to the patient by the family, we did the best we could to keep them involved in the move, including loading every one of them onto the elevator while I quickly descended a stairway to meet them on the ground floor. One of the children accompanied my partner in the back as we pulled out of our parking space...and three cars pulled in line behind me.

Like most transfers to hospice, this one was considered fragile, and we proceeded as if our patient were made of glass. Our slow procession wound its way to the facility at speeds that would make a snail qualify for the Indy 500. At one point, the cars behind me turned on their hazards, and a thought popped into my head: is this a funeral procession? By all accounts, it probably could have been, considering our destination. With this thought, instead of moving quickly, I maintained my pace in order to ensure the family could stay with me.

After arriving and helping the staff gently transfer the patient, my partner and I took our leave. We were stopped and thanked by each family member for treating their loved one as tenderly as they would have. Between my thoughts while driving and their obvious gratitude at our simple efforts, I couldn't help but feel sad for our patient and the family. In reality, it was most likely one of the last trips their loved one will ever take.

End-of-Life Decisions

Nothing like a hug from someone you don't know to bring you to the brink of tears. That's pretty much how I'm feeling right now: torn, angry, sad.  

I've just been visited by a sweet woman who wanted to borrow some equipment from the loan cupboard. The encounter started off pleasantly, as she was looking for a walker and wheelchair for a family member. Always trying to provide the best service possible, I started talking with her about the File of Life emergency information cards we offer. During the brief overview of the form, she must have noticed the "Advanced Directives" section, because she began talking about her end-of-life wishes. While preparing to provide information on how she could make her wishes known, she told me "oh, I know about them, but my doctor refuses to sign them. She believes they're only for people who are dying."

My frustration must have been evident, because she mentioned "I'm a nurse, and I know what it's like to see the effects of trying to bring someone back." She mentioned that her physician insinuated her thoughts were "selfish," and my frustration grew. This woman was adamant that she wanted specific actions taken (or not taken), yet her physician was refusing to go along with her requests because "she doesn't believe in them." In that moment, I realized that despite our best efforts in educating the public, we're still at the mercy of others, usually those who have much more medical education than we do. I mentioned going the route of medical identification jewelry, and she stated that she owned a pendant but didn't wear it. I suggested that in light of the discussion we were having that she re-consider it, as in New York State the options for EMS crews to follow are limited. 

I cannot count the number of times I've encountered family members who were shaken by needing to execute the duties of a Healthcare Proxy, or worse yet, get angry because Healthcare Proxy documents and living wills aren't recognized as legal advanced directives in pre-hospital settings in New York. The conversations with a physician and family members, when made in advance, don't make end-of-life decisions any easier. But knowing the wishes of the patient beforehand can make these encounters a little less stressful on everyone involved. Additionally, it's usually not physicians who are walking through the door into these situations. With all respect due her station, this physician's refusal to discuss and acknowledge a patient's express wishes was certainly distressing for a veteran EMT.

We chatted for a few more minutes, then after I had lifted her wheelchair and walker into the car, she asked "Can I give you a hug? Is that okay?" It caught me completely off-guard, because I didn't think that I'd done anything spectacular besides offer some advice and help with loading some equipment. But apparently, that alone was enough to warrant this spontaneous moment of human emotion from someone I'd met for the first time only a few minutes earlier. I can only hope that she takes the information I provided her with and tries again to convince her physician to follow the wishes of the patient.