They only moved here a month ago, she says. It’s quite dark outside and you can’t tell it’s foggy unless you catch a glimpse of the misty haze in the glow of the passing small town streetlights. From another part of the state, they loved the topography of the bluffs that line the mighty Mississippi in our driftless region. The coulees stretch fingers up among the gentle swells of the bluffs, and in the warmer months the surface of the water is glassy and rippling, in turns. They knew exactly where they wanted to move when they retired, and just under a month ago they made my region of Wisconsin their permanent home. When she speaks of the views she enjoys from their new home, her face lights up and she beams. The joy is incongruous in its juxtaposition next to the ecchymosis evident on her eyelid and surrounding tissues which occlude her vision on one side.
The Badgers played awhile back and lost the game to the Gators in the last 4 seconds. She and her hubby haven’t really met anyone here yet, so they enjoyed a couple beers at home. Unused to the unfamiliar home, she stumbled in the dusk afterward and lost her footing. A retired healthcare provider, she chalked up her subsequent pain and stiffness as just a result of tumbling down some stairs. Time went by, the sun rose, she began to admit that it was more than pain and stiffness. Listening to her history of the events, I’m struck by her strength. The paperwork accompanying her lists a fracture as well as an anteriorly displaced shoulder dislocation – in the same upper extremity as the ecchymosis. A reduction attempted was unsuccessful due to some myoclonus and trismus evidenced after administration of etomidate. I’m currently transporting her to a larger facility for further care.
As so often happens in the back of my ambulance, the paperwork is forgotten and the patient care report is neglected as a human connection is formed. I read each patient and if they wish to close their eyes and rest during an interfacility transport, I respect that. On those transports, my report is 90% complete before we arrive at our receiving facility. Some patients are nervous about the reason behind the need for transferring to the larger facilities, some are really sick and I’m busy with managing their medical presentations throughout the transport. But some, like this wonderful lady on this drizzly foggy night, are just warm and naturally want to connect with their care provider.
She tells me a little bit about her life, that’s how I learn of the retirement. She is no stranger to the environment of medicine, and she uses “our” language. We frankly discuss the trismus, we both evaluate her hypotension and work to find a semi-comfortable position for the upper extremity that’s now so painful. She rates her pain an honest high score, but says she can handle it. She doesn’t like her hypotension and neither do I. We discuss the hypotension as perhaps transient and lingering due to the medications she was given prior to the expected shoulder reduction: Fentanyl, 4 doses of 50mcgs each, Etomidate, Ketamine. She states Ketamine helped her pain not at all. Ketamine would be my medication of choice right now, I tell her, due to its analgesia without systemic effects to blood pressure etc. She nods and says she agrees but in the ER it did nothing. We discuss pressors, discuss the possible surgery ahead, the rebound hypertension when all the ER meds wear off. She states frankly that she has no symptoms, and I can measure none objectively either – other than her blood pressure. I give her a 500cc fluid bolus and the systolic comes up where I’d like it. She grins and says it’s probably the bumps in the road more than the bolus. We tried to position her with head down and feet elevated during the bolus but that is too painful with the still dislocated shoulder. She is grateful it’s displaced anteriorly rather than posteriorly – we both shake our heads at the rough ride of the ambulance with a shoulder displaced to the posterior. It is certainly easier to protect a shoulder displaced anterior, in this environment.
The ride through the wet velvet black night rolls on. She begins to tell me of her love of sewing, how this is going to put a damper in the wedding gown she’s making for her daughter. I tell her my mother-in-law loves to sew, too. I tell her of the large quilting machine that sews designs onto quilts and my patient knows the name of it right off the top of her head.
My patient tells me she went back to school when she was in her late 30s. I tell her I’m currently in nursing school and just turned 40. She is encouraging about changing life directions no matter your age. We discuss education for a while, noting the similarities in our choices. She tells me then about her childhood some. Her mother taught her German, despite her grandfather’s wishes that his grandchildren never know German. I cock my head and she explains. Her grandparents emigrated here in the late 1920s. They never spoke German in public because of the negative opinions held by many at the time regarding Germans. She tells me her uncle married a Jewish girl, who ultimately did not survive the concentration camps. He, wracked with grief, stepped in front of a train. The family was afraid to appear too German here in America, even to the point of abandoning their native language. The isolation and loss of culture, coupled with a new country and personal grief must’ve been profound. This personal account of the horrors most of us have only been exposed to through a history book or class is striking. I listen with respect as she tells family tales, the ambulance parting the fog on the road like a knife in the darkness.
We approach our destination. The monitor takes another blood pressure and we watch for the results. Better. I take the mic off the hook and give report. Arriving, we make our way to the team waiting to take over her care from here. I shake the wrong hand, her good hand, and thank her for her encouragement and sharing her life with me, the lessons she’s had along the way. She smiles that smile with the one eye out of sight under the truly impressive ecchymosis – and tells me it was good to find a friend in this new part of the state she’s made her home.
My partner is new but quick, and he’s gone by now with our cot, off to strip it and remake the linens. I walk down the familiar hall with my boots the only sound echoing. The lights shine off the floor and I’m reminded for the hundredth time how no matter the day, the weather, the circumstances – the human connection is surprisingly often unimpeded by situation. People in the most dire straits, or with pain levels that have to be significant, are calmed by being heard, knowing they matter. A thank you from a patient sustains and uplifts us through an entire shift.
Perhaps the walls we tend to put up to do the job aren’t helpful at all. Perhaps the walls we put up only serve to isolate us from the human connection we were born to have. No man is an island, isn’t that what John Donne said? (although, as a child I heard the adults say that once and wondered for days after why there was no mayonnaise in Ireland.)
The trust our patients put in us, the hours we give up to be there for them – those are no small things. I’ve said it before and it still holds true for me – the front row seat to the human experience never grows old.
“Sometimes our light goes out, but is blown again into instant flame by an encounter with another human being.” – Albert Schweitzer