In the Navy

When I first started working as an EMT, I had just got certified and was working for my local volly fire department during a summer home from college. We got called to the "Better Spaces" home, an 'assisted living' community for people suffering with Alzheimer's. I think most of you remember your time in this position, you didn't really know what you were doing: you had your training to guide your actions, but no experience.

I'm running lead on this call for a 86 y/o male with a fever. I've got the Chief, who is decidedly hands-off for this one, and another college-aged firefighter, not trained in EMS, except that he picked up the art of taking vitals somewhere along the line. We do first-response, and the Hudson ambulance service reports a delay in the time of arrival of their rig. In fact, when I start talking with the guy, he's appears fairly healthy and we find him in the dining room (how the staff found out he had a fever in the middle of dinner, I will never know) sitting calmly at a table.

I introduce myself and start the routine I was taught in class.

"Hi, I'm a EMT with the fire department, how're you doin'?" I ask.

"Oh, I'm good! I'm feeling pretty well, and I'm just sitting here eating dinner.... what do you want?"

"Well, we were called here for you because you have a fever."

"Ah. I see," A puzzled look on his face, "I really feel fine. All of this is probably not necessary."

"Well, my partner here is going to check you blood pressure and pulse if you don't mind."

"..."

"You alright?" I ask as he seems to have momentarily blanked out. He blinks and I ask about the vitals again.

"What...... oh. Yeah, sure, whatever you need. Why're you guys here?"

I feel like I may have answered this question already, but.... seeing as we're in a home for Alzheimer's patients.... "Well, the staff called us because you have a fever, apparently. I'm going to take your temperature now, OK?"

"Sure," he replies, and I stick a probe in his ear: 100.2 F. Geez, I don't know what all the hubbub is about. Well, with baseline vitals unremarkable, EMT-Basic training states to begin OPQRST, and obtain a SAMPLE history.

"When did your fever start?"

"I have a fever?"

"Ummm, yeah." A staff member fills in the blank that they routinely take temperatures every evening before bed. I see. "And when did you take his temperature?" I ask the staff member. Blank stare answers that question. Right then, so proceeding right along...

"Does anything make it better or worse?"

"Make what better or worse?" asks my patient.

"Your fever."

"What fever?"

'Oh, Lord' I think. I look over at my Chief, who is happily engaged in conversation with a young blond nurse in a flowery frock. Firefighter partner has started wandering around looking at the artwork in the dining room.

"Have you felt sick recently?"

"Nope, I'm healthy as a horse!"

Skipping the rest of the history of the illness, I remember I need SAMPLE and AVPU.

"Do you know your name?"

"Sure, I'm Jim."

"Do you know where you are?"

"I'm at home."

"Do you know the day of the week?"

"Yeah, today is Sunday."

'Well, that's not right,' thinks I, seeing as it was Wednesday.

"What's the date?"

"Oh, It's October 14th, 1943. Speaking of dates, I had a cute, little one last night...." he smiles and winks, "yep, got me some shore leave for the weekend and had a little hook-up, if you know what I mean!"

I'm speechless for a moment... I start to open my mouth and I shut it. "What do you do?" I ask, stalling.... somehow I know asking for his allergies and past oral intake, etc., won't get me too far.

"I'm a hand on an ocean going tug," he replies, "we're in port for a week, so I thought I'd look up some gals that I know."

The grin on his face is contagious and tragic all at the same time. I can't even begin to relate to the patient. Here is a man who has lived his whole life, and now, nearing the end, the doors of his memories for the past 70 years are shut. The only memories accessible to him at this moment places him the morning after a one-night-stand he once had, with a person who now probably has grandchildren of her own, and yet, it seems like it was just yesterday. In a sense, the reality he's living at this moment is almost better than the reality that actually exists. The triumphant attitude of a virile young man facing the adventures of youth has to be far superior to that of a frail, elderly gentleman, stuck confined to four thin walls with locks to keep you inside - the smell of urine and sponge baths always prevalent. Is this the way the brain keeps us sane, in response to conditions that would surely drive us insane? Is this the way a body, barely able to respond to the demands of life, much less the enjoyment and full expectations of it, cope with the disappointment of a machine worn well beyond the limits of its construction? Alzheimer's is a terrible disease, I've been told, robbing its sufferers from their faculties. And yet, this smiling, talkative soul in front of me, older than my own grandparents, is enjoying life just as fondly as he ever could.

We chat a little more about things and wait for the ambulance to show up. When they arrive, the medic doesn't bother asking for a report from me. In and out. Jim is loaded onto the stretcher for another unnecessary ride to the hospital that Medicare or his insurance company will have to pay for. The assisted-living community I learn later has no medical resources, so for any ailment, no matter how small, 911 is dialed and EMS is summoned to transport its residents to the ER.

I've seen enough of this home to know that most of those who live here aren't nearly as active as my patient today was. Many go through the day barely aware of their surroundings. I've taken calls here where the patient, after falling down in their room, with copious bleeding from certainly painful injury to their arm or to a leg, can barely comprehend the simplest questions, or even tell us if there's any pain at all.... the only indicator yelling or screaming when a site is touched or pressed upon, or maybe not. Yet.... what is happening in their minds? As the world progresses and time continues around them, what reality and what present are they interacting with? Is it possible that they're in a better place? As a patient is picked up, bandaged, and carried to the ambulance, are they vividly reliving their time on shore leave?...smiling, winking, laughing, and enjoying the art of living.