An Early Morning Puzzle
by Chris Beucher, Flight Paramedic, Paramedic Preceptor, Pre-hospital Educator
by
It's 02:30 in the morning... I'm tired. It's been a busy nineteen and a half
hours of a twenty-four hour shift. Just as my exhausted head hits my cold
underused pillow...the horrible familiar tones of the fire department in our
response area screams over the scanner that we forgot to turn off just prior to
going to bed. "P-L-E-A-S-E let it be a fire call" I say to my pillow. "PLEASE”!!
"Engine Seven medical aid". My partner and I jump out of bed shouting expletives
as we pull on our jumpsuits. Soon after our pagers light up like Roman candles.
"Med-three priority two on an illness". “Illness”. "I'm ill”!! "You don't
see me calling an ambulance at two-thirty in the morning". "This better be
good".
We arrive on scene at a large apartment complex. Since I used to live there
I’m familiar with the numbering of the apartments. We arrive at # 73. It's
upstairs so we have to carry our equipment up the cement steps. Half way up we
pass a young man smoking a cigarette leaning against the guard rail. We exchange
nothing but a glance as we squeeze by. I knock on the door. Just then that same
young man says "Oh, you guys must be here for me". Frustrated I say "You could
have told us that before we lugged all this equipment up these stairs". He
shrugs is shoulders. I cancel the fire department as they walk up to the scene
looking like zombies in turnouts. Trying to maintain some restraint and
professionalism I calmly ask the guy "So. What are we here for"? He replies
"Well..umm.I can't have a bowel movement". So I ask him the string of the usual
questions: Abdominal pain? Nausea? Vomiting? Fever? Diet? Have you
tried stool softeners? Other symptoms? Etc. Etc. No to all the assessment
questions. Then I ask "When was your last BM"? His reply bewildered me.."This
morning". I think to myself I haven't taken a #@&% since yesterday morning. Regardless he wants
to go to the hospital so we load him onto the gurney (he prefers to lie on his
side) and we begin transport to the ED...
Enroute he strikes up small talk. He tells me he's new to the area and he
doesn't have any friends that could have driven him to the hospital. He also
tells me how lonely he is and that he is looking forward to meeting someone in
this town. His vital signs are all stable and his physical exam was
unremarkable. Diffuse abdominal palpation reveals no grimace or report of
pain. I tried to put his signs, symptoms, and his complaint together to help me
form some sort of diagnosis but, I felt I was missing a piece of the
puzzle. We transported him to the ED without intervention.
At the hospital we turn him over to the triage nurse who has just downed her
third Starbucks Latte. Shortly there-after we are called out to another response
near the hospital for a fall.
We transport the elderly fall victim to the same hospital that we just left.
While there I asked the registration clerk if she had a billing sheet on our
last patient. She replied “There is one but it’s in the patients file and he
just went to surgery”. My jaw hit the floor. I went over the call in my head.
What could I have missed? I needed to ask the nurse what happened but I was
almost to embarrassed because I had just BLS’d a surgical patient to the
hospital. But, I swallowed my pride and asked the nurse what his admit diagnosis
was. (This was before HIPAA) She laughed and said “Well, umm..He was
obstructed”. She laughed again and showed me the X-ray. The patient had a 10
inch.. “Toy” lodged up his rectum. Ahh..the final piece of the puzzle..
