Tuesday, November 21, 2006

Singing and Dancing on the Ambulance

Because the TV shows need action, most people believe that ambulance work is fast-paced, gory, and anxiety producing. The truth is the great majority of ambulance calls are like the work most people do - the calls are not an "emergency" in the truest sense, there is no blood on the floor, and everything gets done in a calm, focused manner. But, as people in all professions do, ambulance people sometimes get pleasant surprises while doing their job. I'd like to describe one of these to you.

I was called to a restaurant where an older woman was already being cared for by a paramedic who had arrived in another vehicle. Her husband was speaking for her because her condition was rather poor. The paramedic already had started an IV and cardiac monitoring had been initiated. After fitting her with an oxygen mask, I helped move the woman to the ambulance where the paramedic finished the monitoring setup. My patient was not responding well to stimuli, and I was concerned for her. The paramedic then administered a medication that accellerated her cardiovascular system, and, in combination with the oxygen, she "woke up" as her vital signs returned to almost normal. All this occurred at a measured, careful pace, and we reacted to her recovery with relief. But this was not the pleasant surprise.

After the woman opened her eyes, she looked at me and smiled a beautiful smile. Her eyes were bright and filled with life. But she was not what she once was - Alzhiemer's disease had taken her memories and much of her comprehension, as it has for many of our patients. Yet the core of her being was still there in that smile and brightness of visage, and she began to sing a lovely melody to us as we went on our way to the hospital. The words to her song were long passed from her memory, but the familiar melody remained as did her wonderful voice. La, la, la, la - in a pure soprano that any choirmaster would applaud, and sung in a range that most 30-year-old's would die for. As we sped down the freeway, she sang and sang, and smiled and smiled, and told us how nice we were. And we looked from her to each other and we thought that it doesn't get any better than this. Later she sang in the emergency room and drew an appreciative crowd. I tucked her into her hospital bed and said goodbye to her and her loving husband.

Later that day I returned home and related the story to my wife. She reminded me that several years ago I had taken a brain-damaged patient on a long ride to the hospital. This patient's condition made her verbally abusive, and I was really getting the full treatment from her. Then I asked her what she was doing for Christmas, and, getting a positive reaction, I asked her if she knew any Christmas songs. That did it. For 20 minutes my driver was serenaded by my patient and I singing every Christmas song that she knew - and she knew a lot of them by heart. Christmas started early for me that year.

Then there was the day I went to a supermarket to see about an elderly woman who had fallen but was apparently not injured. There she was, sitting on a chair and not reacting to those around her. Her companion informed us that she had Alzheimer's. We needed to transport her to the hospital where they might determine why she had collapsed, but she would not budge from the chair. Then it came to me - I approached her directly and asked her if she would dance with me. Immediately she came to life, and when I asked her if I could hold her she readily agreed. I reached under her arms and helped her to her feet, at which time she began to hum a lilting waltz. So we waltzed carefully around, maybe two turns, at which time we arrived at my gurney. I thanked her for the dance and asked her to sit down, which she did with a flair. The trip to the hospital was most pleasant for the two of us, and for the paramedic who had watched my effective new patient care technique with some amazement.

Not all ambulance work is so surprising or rewarding as it was on these calls. And some Alzhiemer's patients have been injured too much to respond to any normal stimulus. But the things these ladies loved the most were the last to leave their memory, and they were able to experience joy in the most unusual circumstances. And so was I.

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