This is the post that I mentioned briefly the other day. This happened a while back and I wrote it up and let it sit for a while. Everything happened as I wrote it, if I tried to embellish it, I couldn’t. Any quotes are as I remembered them at the time. I’ve in this line of work for a while, but I’ve never run into a patient like this before.

Herewith, the story.

We were dispatched to a call for a “Cardiac Disorder” early in the morning. Elderly woman with “tachycardia”, no other details. We were last to the party, FD and BLS arriving first.

The address is a very fancy combined hotel and condominium complex. The condominiums start around one million and go up from there.

As we walked down the hall to her apartment the fire fighters were leaving. The LT, who I used to work with, greeted me and said, “Good luck.” Knowing him as I do this made me a bit leery. I soon found out why.

Inside the apartment was the BLS crew, the on duty concierge, and herself. The patient that is. Lying on her bed under her very expensive comforter, wearing a very expensive terry robe, giving orders to the new EMT trying to assess her.

“I can’t have my blood pressure taken with a blood pressure cuff that has touched other people.” So, we took a linen dinner napkin and wrapped it around her arm to get the BP. White linen if you want to know and I know you do.

“I just want you to take my vital signs and check my EKG, but you have to use electrodes that don’t stick very well because I’m allergic to the adhesive.” My partner assured her that our lowest price electrodes did not stick too well, but I think that one was over her head.

The monitor showed a very nice SVT at about 200 BPM, which would explain her complaint of dizziness. We informed her of this and she agreed that it would be good to go to the hospital.

She then made a point to tell us that she had written a letter to our boss about how nice the last crew that took her to the hospital had been. More on this later.

Going to the hospital would seem to be a pretty straightforward thing, but not for this patient.

First, Bob, the long suffering concierge, had to make sure that her suit case was zipped shut and she gave him explicit directions on how it needed to be zipped. Apparently the words “please” and “thank you” were not in her vocabulary.

Then the home O2 had to be shut off. She gave me explicit instructions on how to turn off a D tank. They were wrong and would result in the tank being drained dry, but she was insistent that I leave the valve on and turn the flow meter to 1LPM. I tried to explain to her that this was incorrect, but her 20 years of being a hypochondriac* trumped my experience. So, the tank will be dry when she gets home, which will give her another thing to add to the inevitable complaint.

Then she had to pick out an outfit to come home in. My partner offered to do it but no, he obviously didn’t know how to put a dress on a hanger. She selected a very nice print dress and complimentary black sweater. Which had to go onto a hanger and in a garment bag. Then shoes to match, which she wore.

Then the purse, with the medical record in it. “Because the one in the computer is wrong, but they won’t change it.” However she refused to allow us to actually see the record.

Just in case you’re wondering, our plan was to start an IV and give her some Adenosine since the rhythm was narrow, regular, and looked like Atrial Tach. Only she’s allergic to the plastic in the IV catheters and insisted we use a Butterfly needle. Which we don’t carry and have never needed. I know at this point AD would suggest that we light her up like a Christmas tree and believe me, I was tempted. Still, it probably wouldn’t have been the most prudent thing to do, all things considered. It sure would have been fun, though.

So now, we have the dress (with sweater), the suitcase, and the purse. And the slowly draining D tank quietly hissing away in the background. She finally agreed to get on the atretcher. She’s checked on Bob’s zipping of the suitcase, the dress is properly placed in it’s garment bag, the purse is on her lap. Oh, attached to the suitcase is a large zip lock bag with… more zip lock bags in it. And a tag with one of her last names and her medical record number on it. More on that later too.

As we started to the ambulance, luggage in tow, she stopped us. “Last time I was at the hospital I got terribly dehydrated and almost died. Bob, there are two bottles of Evian Water on the counter, get them and put them in the black cloth bag on the chair. Be careful that they don’t break, they did the last time. THOSE PEOPLE were so careless.“

At this point, I turned to Bob and asked him how much they paid him. “Not enough.” was the expected answer, accompanied by a resigned shrug.

As we got to the door herself said, “Bob, we MUST use the service elevator, I don’t want to go through the lobby.” Bob nodded and said yes. At this point I was thinking a trip down the elevator SHAFT would be better, but it was not to be. Fortunately, the service elevator entrance is right next to the main entrance so there was no additional distance to be traveled.

BTW, her heart rate was still banging away at 200 BPM.

In the ambulance we decided to defer the 12 Lead and just give her O2 and a gentle ride to the hospital. Which we could do only after we showed her that the nasal cannula was indeed non Latex.

I also warned, uh, I mean notified the hospital, that we were coming in. Just by my description they knew who it was. I think that they drew straws to see who would have to treat her and the junior nurses and residents lost.

We got to the hospital where she started her act even before we got her off the stretcher onto the hospital bed.

Oh, the neat touch was when my partner hung her dress on the IV hanger in the treatment area.

Oh, she of course wanted her belongings placed in specific places within the treatment room.

I chatted with the very cute (I wasn’t that annoyed and distracted) resident who was going to do the initial evaluation. “She probably won’t want me to see her because I’m so young and African-American.“, she said. “Probably, but don’t let that stop you, I’m sure she’ll find other things to complain about.” was my reassuring reply.

The upside was that it was a pretty short written report. Since she refused all ALS, I noted that in the narrative. Other than that it was demographics, a lot of “Unknowns” for the PMH, Meds, and Allergies, and we were done.

When the relief crew came in we related the tale and it turned out that another crew from our station had taken her a couple of weeks ago. That nice letter that the lady told us she wrote was in fact a complaint. Why? Because the BLS crew refused to collect a sample of her vomit and bring it to the hospital. Which is what the zip lock bags were for. I’m sure the complaint against my partner and me will be more detailed.

I really feel bad for Bob the concierge. He has to deal with her every night. They can’t pay him enough, but I’m sure she tips him at least a dollar a year. Maybe.

I’m off the next few days, but when I come back I expect to find a note from a supervisor requesting an incident report.

* Eventually, even hypochondriacs get sick.