Anyway, Topia was driving that night on Route 202 in blinding rain and Nouisha was in the back with the patient, who was covered with a blanket. Big mistake. I, personally, always like to see psych patients’ hands at all times, so I can see if they’re masturbating, or reaching for a gun, a dirty syringe or a serrated machete that they are going to embed in my neck. Nouisha, over-tired and uninterested in her current situation, promptly fell asleep. Topia told me later she could hear Nouisha snoring and saw the back of her head drooping down in the rearview mirror. A clink of stretcher-strap buckle hitting the floor didn’t wake Nouisha up and, in seconds, the psych patient bolted upright and Nouisha, finally awake, screamed. She jumped into the driver’s compartment to get away from the psych patient, who pushed her head and knocked it against the passenger’s side window of the ambulance. Then he went after Topia. She slammed on the brakes, causing the heavy box-truck to skid in the rain and slide along the highway until it came to rest, sideways in a ditch.
Fortunately for Topia it was three in the morning and there weren’t many other cars on the road. Nouisha jumped out of the truck and the psych patient jumped in the back. Topia walked around the truck quietly, hoping to catch the psych patient as he exited the back of the ambulance. But he didn’t exit the ambulance; he was in the driver’s seat. Topia leapt back into the driver’s compartment and fought with the psych patient over the ambulance’s keys as he twisted her fingers, trying to gain control over the ambulance. He eventually fled into the nearby woods and was apprehended soon after by Pennsylvania State Troopers who responded to the scene. Topia got a broken finger. Nouisha got fired.
Qualcare is very protective of its biggest investment, its ambulances, and so you would think that Topia would have gotten rewarded for her selfless attempts to prevent this lunatic from escaping with a Qualcare truck. She was disciplined. You’d think that Mitch, my psychotic ex partner, would have been fired for his jubilant, effective, and deliberate destruction of Qualcare trucks, but I guess they couldn’t determine that the breakdowns were the cause of intentional acts, you know, without my information. Other employees, however, were not as immune from persecution. One EMT was disciplined for putting regular gasoline in a diesel truck, which the truck thought was poison and consequently died. Another employee got in quite a lot of trouble for shearing off the light-bar of unit 305, a brand new truck, on the overhang of a Wendy’s drive-thru. After that little snafu, no more drive-thrus, not because of the potentiality of damaging more trucks, the memo said, but because, if a crew were in line at a drive-thru and that crew received an emergency call, they would be trapped, ostensibly, in that line. I chuckled as I read that one. An emergency—us? Please.
The other big no-no at Qualcare is dropping patients. As medical professionals, it is our goal to help the sick and the injured, not make them that way. While the plan is “zero patient injuries”, things don’t always go according to plan. The following incident report contains my word-for-word account of the events of August 23rd, 2005, the day Buddy Wendt, a part-timer, and I took Gretchen Madeira to a doctor’s appointment.
“Whilst at Dr’s appt, Pt requested to utilize the lavatory. We requested a bedpan & were told none were available. My partner & I assisted Pt out of stretcher over to toilet, assisted her w/ removal of shorts & underwear. She said she was okay & we said for her to let us know when she was ready to be moved. As bathroom was quite small, we exited & stood by w/ door cracked open. Pt urinated & talked to us through door, then a crash was heard. We immediately entered lavatory & found Pt with a substantial amount of blood emanating from her nose. Pressure was applied & Pt was placed on stretcher. Pt’s lip was also injured. We asked the nurse for directions to closest hospital (Miquon County). Nurse gave directions & we proceeded to Miquon County’s ER. Nurse said she would call them to advise. As our NEXTELs were dead, I called dispatch on my cell, reported incident as we initiated transport & asked him to advise Miquon County’s ER. Upon our arrival, we were told no one had called in. Pt care was then transferred over to ER staff after a report was given by Mr. Wendt. I then called Springfield Rehab (Pt’s residence) to inform them of the situation. Pt. Injury occurred at approximately 14:40pm.”
After a week of nail-biting, hand-wringing, and Qualcare street supervisor Jake Stone calling me on the radio each day, bothering me for more information about the incident that would tilt the field in Qualcare’s favor, I picked up the pen and wrote some more.
“Continuation of Gretchen Madeira incident; Additional information. A female nurse (whose name I did not obtain) at the Dr’s office assisted us in getting the patient inside the lavatory, however, when it came time to help the Pt. with her shorts & underwear, I turned around & the female nurse had vanished. When the Pt was in the lavatory, Mr. Wendt & I were the only ones standing by the partially closed door. After the Pt fell, I had to go into a separate room to fetch the nurse, who had no idea what had happened. The Dr bent his head down & looked @ the Pt & said “Looks like you’ll be making a trip to the E.R.” This was the extent of his professional involvement in the incident. On the whole, I think it would not be unfair to characterize the staff’s (at the Dr’s office) attitude towards Mrs. Madeira as blasé. They were ill-equipped, unprepared & unable to accommodate the needs of a stretchered Pt—hallways were too narrow & lavatory was not fully accessible. The female nurse appeared more interested in repeated personal telephone calls received on her cell phone than she did in appropriately and fully caring for the patient in question.”
If there is one transport I think about more often than all others, it is this one. If there is one moment at Qualcare, frozen in place in my mind that I can flash back to at any time, and I do: it’s Gretchen, on the floor, slumped against that cold, tile wall, her shorts and underwear down around her ankles, crying. Blood everywhere. I have never felt guiltier, sicker, more irresponsible, more foolish and more alone in my entire life. I still, after almost a year, am sure that, one day, a certified letter from some vengeful, powerful, bloodthirsty law firm will find its way to my mailbox, and maybe I deserve it. Maybe I deserve to pay for what happened to Gretchen Madeira. I thought I did the right thing—she was complaining that she had to pee for at least an hour and a half, whining and holding her stomach. The doctor’s office was so far away from Springfield Rehab, and we had been waiting there for almost two hours—this woman had to go. I thought I did the right thing—what does that even mean really? Right for whom? Right procedurally? Even after my disciplinary meeting and remediation, I still don’t know what Qualcare’s procedure is for escorting a patient of the opposite gender alone in a bathroom. Ought I to have gone in there with her with the door closed and end up getting sued for sexual harassment? No, I don’t think so. Should I have let her go in her pants? No, that’s inhuman. Should I have made that cell-phone-obsessed nurse get off the goddamned phone and told her that she had to escort Gretchen to the bathroom? Probably.
Looking back on it with perspective as my partner instead of Buddy Wendt, I guess that would have been the thing to do, but I didn’t do it. Through the choices I made, or didn’t make, harm came to my patient. For my punishment, I got to see her blood pour out of her nose and mouth like a river, I got to see it spattered on the tiled bathroom wall, and that is something I suppose I will just have to compartmentalize and deal with, as surgeons deal with operating room mistakes, as police officers come to terms with shooting suspects who turn out to be unarmed. We are only human, all of us, and we are destined to fail and fuck up at times, sometimes in minor ways like breaking a light-bar, sometimes in major ways like breaking a patient. Our humanity is the sum total of whom we are as a species, and that’s not an excuse, but it’s the truth.
I hope Gretchen’s lawyers feel the same way.