It’s hot, and she’s not dressed for it. Sweatshirt and sweatpants, tee shirt and socks with laced up tennies. She’s currently sitting in the rear of a squad car, guzzling on a bottle of Sprite that is sweating only slightly less than she is.
Passersby found her, she was down on the ground and it was pretty clear she’d fallen. Someone helped her up, but then she fell again. So they called it in, the nice officer who responded scoped out the clothing situation and her speech, and activated EMS non-emergent. Now we’re here, and I lead my student across the street from our parking spot towards the black and white. My partner updates MedComm that we are on location, and brings up the rear. On this initial evaluation we’ve got the cardiac monitor. The bag is feet away should we need anything.
The lady was assisted out of her sweatshirt by the officer prior to our arrival. Pink and white camouflage, it’s more at home in a rural environment than here in the city but I guess you never know where people hail from originally. Little bits of home from all over converge in any metropolis, and you get what you get. The only constant is that the kaleidoscope keeps moving, the bits and pieces keep on tumbling.
Her speech is softly rounded, not in the drawl of the southlands but in a gently slurred sort of way. Her facial features are a little slack, and in the first few minutes while my student assesses her, I wonder if she has some cognitive delays. Soon we have the first vitals, she’s hypotensive and my partner brings the cot right to her side. She’s still seated mostly on that rear seat with the door open, one leg in, and one leg out. Her cane is leopard print, and I grin at her style. Pink camo and leopard print – lady’s got flair.
Securely fastened to the cot, we wheel her to our truck and the automated system whirs her into the air conditioned truck. The doors kathunk shut behind us and we survey the situation. Then she says, in that soft speech, “I believe it’s a low volume issue, I’m dehydrated and forgot my cooling shirt at home.” I cock my head and evaluate her again. She tells me she has MS.
She tells me she used to be a nurse. Before the disease progressed.
The remainder of our contact is wonderful. She encourages my student thru the IV start, she matter of factly discusses her evening schedule of HCTZ and why it is taken then, the need to schedule it so far apart from her diuretics. She’s a smart lady. The day didn’t seem that hot when she set out to walk for a snack. She became over heated. My student informs me after we’re in station, later, that increased body temperature in an MS patient decreases the ability of the non-myelanated sheaths to conduct impulses. So with no one to help her out of the sweatshirt, and the increasing heat making her co ordination worse, she was on a downhill sled with no trees in sight.
We take good care of her, and after my student gives report at the receiving facility, we shake her hand and inform the young nurse taking care from us that this patient is a nurse. The patient softly corrects me, “WAS a nurse.” I think of how she welcomed my student, walked her through a failed IV and told her that learning takes time. I think of her gentle patience on scene, her grace in the face of adversity of a cruel disease.
I bend down, and softly say, “you taught me as much today as my nursing instructors. You are once a nurse, always a nurse. Thank you for today’s teachable moment.”
She didn’t say much, but her eyes shined a little brighter as a smile spread across her face. I walked down the hall and thought to myself, teachable moments, indeed.