My Alzheimers

Of all the patient's I see, I can't tolerate drunks. I'm not talking about the happy drunk or the quiet drunk who doesn't bother anyone or gets themselves in trouble. I' talking about the angry or belligerent drunk who's behavior and actions have required my services. I have a zero tolerance policy for drunks--if you mouth off once you get a warning, again and it's chemical sedation. You threaten violence or come into physical contact with me or my partner, you've just bought yourself a tube and a very unpleasant experience. Woe be upon the drunk that finds themselves in the back of my bus.

Next to drunks, I have a hard time with Alzheimer's patients. I understand that they have a legitimate medical condition that has reverted them to an earlier point in their life, or causes them confusion, or severe dementia. However, just as often, I see family and care staff use Alzheimer's to defend a patient's behavior and actions during the patient's most lucid periods.

My partner and I were sent to Auburn a few shifts ago, which after doing the transfer math, I realized was a 6 hour round trip. Irritated by this, but resigned to the fact that I'm doing my job, I awaited the page for the assignment. Upon receiving said page, my irritation went into full blown contempt as I read it: COMBATIVE ALZHEIMERS PATIENT. A 3 hour trip with a combative psych patient did not seem like fun to me. Begrudgingly, I did my job and we placed ourselves in route and a few minutes later, on scene. The hospital, known for sending a high percentage of psych patients, is also home to some of the most irritating and burnt out nurses I've ever had the displeasure of working with. The nurse at the desk points to an ER room and says "she's in there, here's her paperwork." Without a further word, he turns is back and continues his crossword (or whatever it was he was doing).

I fling a disbelieving look at my partner before I ask the nurse, "so what's the deal with this patient?"

The nurse gives me a heavy sigh, "family tried checking her into a care facility earlier today, she became anxious and didn't want to be checked in. So family brought her here for a psych eval."

As if on cue, the family approaches me (smelling of alcohol, to top things off) and asks me "you're going to put her on that?" indicating my gurney. "She's gonna get combative. You're gonna have to give her something."

I stop the conversation at this point and turn to the nurse. "I'm hearing two things here, that's she's anxious or combative. Which is it?" I ask the question as I glance over at a very sweet looking short, elderly woman in a flowered sweater and blue wind breaker.

ETOH smelling son answers, "well, she can get combative."

"So she's actually been physically violent before?" I clarify.

"Well no, but your gonna to have a heck of a time with her if you don't give her something to settle her down."

Again I turn to the nurse as the ER doc walks up. "I carry Versed, Ativan, or Inapsine and she's going to get something before we leave."

This settles the issue as the doc writes a quick order for Inapsine. The patient gets her shot, we load her on the cot, and then we get going. For the first hour, everything goes smoothly. The patient is in a happy place, even though I'm ready to upchuck due to the winding road we're on, and I'm writing my chart. The patient and I make small talk, and once she says to me "you're cute."

"Thanks. My wife likes to think so," I answer. The patient quiets then and I move to the airway seat to check in with my partner. I then hear the patient's seatbelt unclick itself and fall to the ambulance floor. I remind the patient that the seat belts have to stay on for her safety, I secure her again, then return to the airway seat. A few minutes later, this happens again. I go through the routine again. This repeats twice more before I move to the bench next to the patient, then the mysteriously unfastening seatbelt settles down.

Shortly after, the patient tells me again "you're cute" and her hand finds its way to my left knee. Now, I should say at this point that the patient knows exactly what she is doing--I had watched her twice unfasten her seatbelt purposely, she was aware of her surroundings, and knew where she was going and why. In short, she was lucid. So casually I readjusted her arm to take a blood pressure, then placed her arm back at her side. I return to me chart and a few minutes later I hear it again "you're cute." The hand returns to my left leg, a little higher up this time. This time I readjust my position on the bench seat out of arms length of the patient.

We're about an hour from our destination at this time and I decide its time for more sedation. A little more inapsine and the patient was docile and hands-to-herself for the remainder of the trip. At the hospital, we turn the patient over and I get an "I love you" from patient, then my partner and I pack up the ambulance for the return 3 hour trip, thankful this is now behind me.

The point I'm trying to make is that I've been in EMS for 6 years, not a career by any stretch of the imagination, but long enough to understand when a patient is operating under their own free will. My problem with Alzheimer's patients are those that act and behave inappropriately under their own free will. And what happened with this patient? Chemical sedation. Inappropriate behavior is the same no matter what the age group and I shouldn't be at the receiving end of it no matter the circumstances.