I’m back to work after being a stay-home mom for a while to take care of the two youngest in our house. This year the youngest started school, and I started working for a paid EMS service two days a week. I work two 12 hour shifts – that’s really all I need. My agency responds to emergencies, as well as doing inter-facility transports. I worked yesterday and we did a couple of emergencies and then a bunch of transports, some to nursing homes and some to residences. I prefer the latter - the patients at least don’t have to be in the hospital on Thanksgiving.

One of our transports back home was a hospice patient being returned home to “convalesce” (read: die at home). She was on oxygen, and was deemed to be stable, so it was a BLS transport, which meant I rode in the back and my partner (a paramedic) drove. I typically don’t mind the transports, because the patients are pretty interesting to talk to and I try to make them feel better if they are a little down. The patient and I tend to have a little bit of fun.

On this run, about a fifteen-minute ride, the patient began to complain of having trouble breathing, but as I was monitoring her she was breathing at the same rate and with the same labored breathing that she had in the hospital. I got her to calm down and just sit back and relax and I told her we were taking her home. She did fine on the ride and when we got to the house we had to wait a few minutes for her family to get there.
As we were waiting, the patient told me she was feeling strange. This sent a shiver down my spine. When I asked her to describe what she was feeling, she said she couldn’t - but that it was different and she didn’t like it. I checked her vitals again, and they hadn’t changed at all so there was nothing we could do. I just tried to assure her that everything was going to be fine and that she was home. I told her that we were going to get her inside and into her own bed and that she maybe just a little anxious about getting home and being in her own bed and surroundings.

We took the patient into the house and got her all set in her room and we double-checked with her daughter to make sure they were OK with us leaving. The daughter thanked us and said that they would be fine. I got the signature that I needed for the billing form, and I went out to help my partner get the rig back in order. As I walked up to my partner I told him that I hated doing this type of transport.

He asked why, and I explained that I was afraid the patient wasn’t going to make it back home. She was truly looking like she was just to the point of “this is it…I’ve had enough.” My partner (compassionate soul that he is) proceeded to tell me nonchalantly that yup - he has had a patient die in the rig on him on the way home from the hospital and that there is nothing you can do about it. I just shook my head…thanks, pardner. I still hate these types of transports, because you know they are near the end and you just don’t know when it’s going to happen. The rest of the day went more or less smoothly.

I do love this job. I like to think that I’m helping keep the spirits up on the patients that are in some of these nursing homes. I try my best and I will continue to do so. To anyone new in this field I would say to just try and make the patients feel like they matter, regardless of the situation, and that they are not just a job to you. Make them smile when you can and don’t take anything too personally. This is a great job, and if you can make a patient feel good and smile then that’s all that should really matter.

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Comment by Kimberly A Bownas on November 30, 2008 at 9:36am
Thanks Anne, I am fine with trying to make them feel comfortable and all, I just don't want it to happen in my rig as we are taking them home. That would be tough to handle. But I love my job and I am glad that I can make the patient feel better for a little while....
Comment by anne potter on November 30, 2008 at 12:01am
I have to say even though you hate that part of the job those pt's look at you as being their hero because you are the one taking them home to die..Most people who go home to die can not wait to be within their homes.. Plus on top of that Kim you want them to feel good while their in your rig...Only special people can do what you do... You are the last important piece of their life.. You got them home....
Comment by Kimberly A Bownas on November 29, 2008 at 10:28pm
thanks Kali that means a lot.
Comment by Joe Stoltz on November 28, 2008 at 7:03pm
Great post, Kim. You know, I have taken many people on their "last ride" to the hospital. In some cases we all knew it, while in others it came as a surprise to me. Since we generally don't do transports from the hospital back home, I don't think I've ever been in the situation you describe. I have known people who were terminally ill and very close to death; generally they have come to accept their situation and are even looking forward to peace. For many it has been a long, hard fight and they are tired of fighting.

I have had numerous occasions when we've been called to verify a death. After confirming this fact, I sit with the family and gather infor for the PCR just as if the deceased were still alive. I ask questions about what career he/she had, and look at photographs with them. I also ask if any funeral arrangements have been made, and encourage them to call relatives/friends.

Basically, all we can try to do is to help people in their time of need. Sometimes the people are the next of kin, but the job is no less important.
Comment by Jenny Holderby on November 28, 2008 at 3:03am
One of the reasons I don't work as an EMT is that I don't deal well with "illness". Its one thing to function on an accident scene where you KNOW that you can stop blood or use and AED or dig someone out of a vehicle & get them somewhere to be cared for and a completley different issue walking into a situation where a person has been ill, under a doctor's care and you can't actually DO anything about their condition unless it becomes an emergency. All you can do is to comfort them and give them the compassion they deserve.

My daughter works in health care as a Certified Nursing Assistant while she is studying for her nursing license. She worked in a state run psychiatric facility for several years where there was often a lot of action and occassional trauma. Now she works in a Nursing home/convalescent/rehab facility. On some of her shifts she is on the Hospice floor. These people are only being made comfortable while waiting to die. There is no treatment to make them well again, that has all been done prior to admission to this place. Many of these patients have Do Not Resuscitate orders. It is often hard for a health care provider to not react to a patient dying but the whole point of them being there is to enable them to die with as much dignity as possible. My daughter has a lot of religious faith that I believe helps her do this job. When she first started working there, it was very difficult for her emotionally to deal with the aspect of death. In her prior job(s) the point of health care was to help people live, not die. Death is infact a FACT of life.

I have seen death many times. In different situations I deal with it better than other people seem to. Yet some situations I handle it better than in other circumstance. It is never a comfortable or plesant to deal with.

EMS is kind of like fighting fire. Sometimes, you are fighting a losing battle from the beginning and there is nothing you can do to change it, no matter how hard you try.
Other times everything goes as it should & you come away patting yourself on the back happy that you made a difference. Lets hope we all have more of the later.
Comment by Jim Seargent on November 27, 2008 at 10:13pm
I don't deal well with the emotional part of other people dying. Those like you who do are a breed apart. If you want someone to give the everlasting pep talk about how "You're going to make it", I'm your man. To deal with the whole "we both know you're going to die" thing however, you had better get the pros. All I can say is to treat them with the compassion that you would like in the last act of your life's play.
Comment by Jay Nicholson on November 27, 2008 at 3:20pm
My son is planning on going into the ministry. This last summer he had an opportunity to do an internship with a large church. His most rewarding part of that, much to his surprise, was hospital visits. He's hoping now to become a hospital chaplain. ( Hopefully a FD chaplain also ;) ).
In the long run, how we treat the dying is probably more important to us than it is to them. If we convey our fear unto them, not only does it make for a bummer call, but I believe increases the likelihood of us suffering from PTSS.

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