Frequent Fliers - an observation

Epi-do

Epi-do

I see dead people
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We all do it. You hear a familiar address, or show up on a scene and see a familiar face (and it isn't any of the other first responders that are there). You can't help but cringe a little (or maybe a lot...) inside. It's your "favorite" patient...the one that somehow always seems to know when you are on shift...the infamous "frequent flier."

In doing this job for almost 12 years, I have come to realize all frequent fliers are not created equal. In fact, I have found there are at least 4 different types, if not more.

  1. the LEGITIMATE patient
    These are the patients that you develop a relationship with over time. Life has dealt them a pretty crappy hand, and they have true medical issues that necessitate calling 911...repeatedly. The do as much as they can for themselves, and have additional resources, such as friends and family, that help out as much as they can. They typically only call when they have exhausted all other resources. You almost always transport these patients.​
  2. the LONELY patient
    Another patient that you often tend to develop a relationship with. These patients are typically elderly, but not always. They call 911 for every single ache or pain they may have. They usually either have no family/friends nearby, or the ones they do have won't give them the time of day. Often times, they aren't having a "true" emergency, but rather, want some human contact. Sometimes you transport these patients, other times you don't.​
  3. the TOLERABLE patient
    These patients are the ones that call for just about any reason at all. Most of the time, they probably don't truly need an ambulance. Part of the issue is that they are simply uneducated about the issue of the day. Other times, they call because they think 911 is the number to Yellow Cab. Yes, they play the system, trying to get ahead. However, at the same time, they do take some ownership (however small it may be) of their situation and how they got there.​
  4. the NOT-SO-TOLERABLE patient
    OK, so I had to figure out a relatively unoffensive "title" for this group. They know the reason they are calling is BS, but they don't care. They need a ride to the other side of town and claim to not have any cash for a cab, gas for one of the 6 cars in the drive, or anything else that could interfere with whatever it is they are wanting to do once they get to their destination. You take them into the ER to be triaged, and they are promptly booted to the waiting room. From there, they walk out the ER doors and head to their actual intended destination.

    The ones that aren't looking for a ride across town, are convinced that whatever problem they are having is caused directly or indirectly by you, or anyone else that either implies or outright tells them they need to take some responsibility for their problems and do something to help themselves before anyone else can help them.​

We've all had to deal with each type of frequent flier at one time or another. Some of them it is easy to feel compassion and empathy for. Others...not so much. We learn to interact with each one in a variety of different ways. At the end of the day though, each one teaches us something, whether it is an "I hope I never..." type of lesson or something about the resilience and perseverance of the human spirit. Yes, frequent fliers can be the most trying patients we have to interact with, but it is important to remember the lessons you walk away with (no matter how small) each time you interact with one of them.
 
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Even some of the legitimate ones can be trying. We run on one girl all the time who's always in terrible pain by the time she calls us. No family. She's terminal, younger than I am, and generally a very sad case. She says a lot of very hurtful and personal things when she knows one of us (hooray for frequent fliers in small towns), is generally nasty when she doesn't, screams and cusses a lot, and throws things on especially bad nights. Best of all, she lives about as far from a hospital as you can get. The volume goes down with pain relief, but not the intensity or nastiness.

I get that she's in an emotional place that nobody should ever have to go, and I really do feel awful for her. She has plenty of good reasons to hate the medical establishment. I always try to be pleasant and provide the best care I can. But I still cringe whenever that address comes in. Of course, because I'm new and one of the more patient people at my service, I know who's going to get to deal with her most of the time...
 
This was a good thread.

I hear you. Seaglass was very observant about why people act as they do.

Other thoughts about "frequent fliers"?
 
While not yet "in" the medical field yet, most of the patients that I dealt with during my ride alongs certainly fit the frequent flier description, even though they weren't so familiar to me. I can honestly say that the crew that I was running with was glad that I was along, because it allowed the patient someone new to interact with, and for the most part, that's what it seemed like the patient wanted all along. Whether the call was legit or not so much, the common thread was that the patients just wanted someone to listen to them, to validate them, in a sense. Sure, a patient with a painful, chronic condition knows about everything that is happening to their body, they've likely told their family and their doctors, and by this point in time, they probably don't want to hear about it anymore. As a child, when you fell and scraped your knee, we wanted to let someone know that it hurt, and the pain was somewhat relieved by having someone who cared for us tell us that they knew that it hurt, and that they were going to take care of you. In my opinion, this is what a majority of these patients want. Someone to say, "Hey, it's cool. I know you're hurting and I'm going to do my best to take care of you," even it's for only a short period of time during transport. Of course, there's the opposite end of the spectrum, the folks who just want to use you as an emotional punching bag. While less cool, I would still say that it's tolerable, because even though we get to see a person at their very worst, it's usually in less than thirty minute intervals.
 
What about the not so tolerable real patient. I had until recently (patient passed away) a dialysis patient who weighed 500+lb who we took to dialysis every week 3 days a week they would always send 2 crews for this patient. Bed confined with a very extensive history. However he would always be very rude to the crews, anyone we would get him back to the nursing home he would demand his food from the nurses and wouldnt let us take him into his room until they brought him the food.
 
Hunter said:
What about the not so tolerable real patient. I had until recently (patient passed away) a dialysis patient who weighed 500+lb who we took to dialysis every week 3 days a week they would always send 2 crews for this patient. Bed confined with a very extensive history. However he would always be very rude to the crews, anyone we would get him back to the nursing home he would demand his food from the nurses and wouldnt let us take him into his room until they brought him the food.
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We have a few like that. They are extremely verbally abusive, rude and generally unfriendly and extremely sick. We have a few address that are flagged for an automatic PD response with EMS for safety of the crew. The police all are pretty understanding and friendly but I understand why they get frustrated, they aren't our personal security guards and on top of that they have to deal with an extremely undesirable personality.

I do agree with your other definitions, the lonely ones can be heart jerkers too. I'm always down for cookies and a chat but I don't like running code to do it. My life isn't worth a yummy, fresh, homemade cookie.

I'm still meeting all the frequent flyers in the system I work in and I've worked here for 6 months. We have quite a few of them although two of the main ones just actually died.
 
We have a couple very rude patients just like every other service. My response? Kill em with kindness. Nothing pisses off a very angry/rude person then when you are overly nice to them. They want a reaction, I'm not giving it to them. Yeah it's annoying when you're transporting them for the 15th time that day, but in 30 min I'll be clearing the hospital with a PB&J and an apple. They get a ride, I get free food, in the end we all win.
 
My favorites from these 4 categories.

1). A pretty young girl with recurring bouts of SVT. Very nice, pleasant girl. Try the Vagals and stuff once we hit the road, never works. Get a line in, she usually converts on the first round of Adenosine. My favorite frequent flier. Very nice person, easy on the eyes, great conversation during the ride in.

2). This ones a tie.
First is "Sue"(name change to protect the innocent). Has a drinking problem. Drinks, gets depressed, gets lonely, calls 911 to get a ride "for treatment". Never goes into any kind of rehab or treatment. Just wants someone to talk to. Deep down probably a nice person, but annoying because she always gets lonely around 0300hrs.
Second is "lou"(name also changed). Another lonely boy, This one buys alot of crack, he don't smoke crack though. He buys crack to trade to the hookers for "company". The genre of hooker don't matter, Black, White, Female, Male, Whatever. When his money for the month runs out, and he can't afford to buy any crack, he gets lonely, depressed, suicidal, and calls us. Also, he always gets lonely around 0300hrs. His money usually runs out in the first 7-10 days of the month, so we get to see him a handful of time a month.

3). Don't really have a 3

4). Another tie.
First is "Joe"(name change again). Usually about 0400hrs "Joe" gets stressed. He gets stressed several times a month, when he gets stressed, he gets "belly pains". Of course he always wants to go "downtown", about 30 miles each way, past 3 other hospitals. Because "His Peoples be near there".

Second we'll call "Joe"(name thing). He gets his monthly appointment at the VA to get his prescriptions. Per our rules, we can't transport to the VA. The VA is right around the corner from one of our ERs. He always calls right before shift change, with a minor BS complaint, will meet us at the end of his driveway with his suitcase in hand, and want to go to the ER downtown. From his house about a 45 mile ride each way, also past 3 other ERs, at the time he calls it is usually peak traffic time. he'll get to the ER, get sent out to triage, walk out the door and around the corner to the VA clinic. After his appointment he'll go to his sisters house for a few days, to visit, and she'll drive him home.

I don't mind the 1s and 2s, the 2 guys at number 4 get to me. Per our rules, we transport everyone with a complaint, to the hospital of their choice. Some people get used to this and abuse the system, using us as a taxi cab. This could all be solved by letting the Medic decide the hospital choice to the closest appropriate facility.
 
I don't eat or drink food from clients unless it comes from a sealed can or bottle and then I quietly wipe it off. If they ask, I say "Can't be sure how clean those Safeway warehouses are".
 
Mad Max said:
While not yet "in" the medical field yet, most of the patients that I dealt with during my ride alongs certainly fit the frequent flier description, even though they weren't so familiar to me. I can honestly say that the crew that I was running with was glad that I was along, because it allowed the patient someone new to interact with, and for the most part, that's what it seemed like the patient wanted all along. Whether the call was legit or not so much, the common thread was that the patients just wanted someone to listen to them, to validate them, in a sense. Sure, a patient with a painful, chronic condition knows about everything that is happening to their body, they've likely told their family and their doctors, and by this point in time, they probably don't want to hear about it anymore. As a child, when you fell and scraped your knee, we wanted to let someone know that it hurt, and the pain was somewhat relieved by having someone who cared for us tell us that they knew that it hurt, and that they were going to take care of you. In my opinion, this is what a majority of these patients want. Someone to say, "Hey, it's cool. I know you're hurting and I'm going to do my best to take care of you," even it's for only a short period of time during transport. Of course, there's the opposite end of the spectrum, the folks who just want to use you as an emotional punching bag. While less cool, I would still say that it's tolerable, because even though we get to see a person at their very worst, it's usually in less than thirty minute intervals.
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This is very incisive. I'm blown away you picked up this sort of wisdom during your ride-along time.

Other thoughts:

1. People who are sick and infirm and hurting have a pretty good excuse for being jerks.

2. Being lonely can be as bad as being sick.

3. When you think about it, trying to judge whether someone's situation is "bad enough" to qualify as an excuse for being a **** doesn't seem to change anything -- and who qualified you to make that judgment?

4. In the end, no matter what, it's your job to be nice, and try to make their day better. Maybe eventually someone will fix the world and there will be better avenues than 911 to do that. In the mean time, you play the hand that dispatch deals you.
 
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