Ok, so everyone knows an ER nurse that claims a dude came in with the aquarium bulb shoved up his ass, and they had to do emergency surgery in the trauma bay to remove the bulb, so it didn’t break. Yeah, maybe, but that is not a common thing for people present to the ER. We all hear about things shoved in places they do not belong as well as just absurd things.

That is not to say that strange shit doesn’t wander into the ER. I remember the dark days before I became a nurse. I remember one crazy, full moon, a night where I ran my ass off as a paramedic. We were dropping off a patient from a car accident at St. Vincent’s in Billings, MT, when Chuck (an excellent flight nurse) said, “Why are you killing yourself?” “Sure, we have crazy people, but at least it is in a nice climate-controlled building.” Chuck, you are fucking correct, sir. Those words made me think that it was time to start becoming a nurse. Acceptance to nursing school was not an overnight thing and was one of the most dizzying, intricate, pain in the ass, psychotic things I have ever done (and I was on tanks in the Army).

It would be several years of me becoming politically and educationally savvy before I landed on the doorstep of nursing school and was allowed in.

Before I got there, I was still subjected to about three years of the oddest calls and abuse. Why recount these tales? Because everyone deals with crap like this, and yet we allow it to happen, why? It negatively impacts our profession as well as ancillary professions, and wow, people can be like this shit?

So in the field, we had what is known as the “frequent flyer.” We have them ER’s, psych units, detox units, etc. As the name implies, we see them on a very regular basis. Honestly, in the pre-hospital environment, we saw some of these people more than we saw our own families. Not figuratively, but literally. Let’s talk about Joe (not real name). Joe lived on a local reservation and ventured to our fair city when he had money (and sometimes when he didn’t). Joe was a frequent, frequent flyer. There was a six month period where I sometimes ran a call where Joe was the victim 3 and 4 times a day. No, I am not exaggerating, I literally would drop the man at one hospital and 3 hours later he would be back downtown, and calling again. His MO was to call and say he was having a seizure (of which he had never been diagnosed) and wait for the medics. The 911 comm center got a tad wise to him and started sending PD first, as it is a misuse of the 911 system to call for an emergency that doesn’t exist. So he would hand the quarter to a passerby and have them call it. Passerby did and of course, out the door on a call we would go. At the end of about a 6 month period Joe racked up almost 80,000 wing wangs in charges. Holy misuse of the system. He had some unusual quirks. He was doing a fabulous acting job one night when we rolled up. We were trying to assess him, and of course, his “seizure” was making this difficult. My partner said, “Dammit Joe, stop moving so I can get your blood pressure.” All of a sudden, the arm with the blood pressure cuff on it became perfectly still. I remember we still transported him, but his story was in the wind, and everyone knew. Joe was taken less seriously, and there was even a protocol established that we could decide to cancel on him either PD, Fire Company, or we did a cursory assessment and found him to be the baseline of his health.

Joe then “upped” his game. He started calling with chest pain. THAT is an entirely different and potentially life-threatening symptom. We got that call and rolled up to see Joe. Joe was in his usual state (very intoxicated, but I will get to that). My partner, who is one of the best damn medics I have to know, leans over him while he is in pain and says, “Joe, this is not a good symptom to claim.” “If you insist this is real or if it is real, just know that you will have your shirt removed, I am going to start, an IV on you and I am going to give you some drugs that if you are not having chest pain or heart issues, is going to make you sick.” Funny, all of a sudden, he was fine and accepted the kind offer of the PD to take him to detox. Yeah, unconventional but effective.

The bottom line in this story is that the ambulance and local fire service ate those costs. In the end, Joes’ inability to bay for over 350 runs in 6 months raised the value of your healthcare. He didn’t pay his bills, and he was having issues.
The sad part of this story was Joe. He had been a college professor and had taught for 25 years on a decent salary before he started hitting the bottle (massively). He would come to town because it was illegal to possess alcohol on the reservation that let him drink alcohol designed for consumption. When he didn’t have money, he drank Lysol. Yep, that stuff you clean floors with. You could tell because he had lemony fresh breath (and a BAC of over 600). Yes, 600. He lived in that range and was coherent. His substance use killed his career, marriage, relationships with family, and I am sure eventually him (this is 20 years ago, so I am not too sure). The weird in this is, we have no real way to help an addict like Joe because those programs are tough to get into, have low tolerance with relapses, and offer a cursory level of rehab (it is cost-prohibitive to expand that rehab).

Yeah, the worst was one of the charity rehabs would not tolerate relapse and would kick out a patient and ban them. Yeah, that is the least supportive way. Yes, we want the addict to cease this behavior, but honestly, missteps are taken, and the correct and supportive measure is to help the patient find the way back to sobriety, learn from their mistakes, and move forward. I am pretty sure Joe never made it past his first relapse. We all know he was crying for help in a system that was unable to care for him. He was also using the wrong system, as we had the least means to help him. I am sure that Joe has long since died and that his demise was painful sober or drunk. For all of the angst about running calls on him all the time, it is sad to think as I have matured, what a fucking waste that was.

We have to realize in everything that when we are unable to recognize the real problem.

Be the kind of person your mom and dog hope you are.