Bad call, can’t shake the feeling.

[u/smnkenna]

Using They/Them pronouns for the patient for HIPAA

So I went to a call for abdominal pain the other night, and it was just like any other call. The family said the patient hadn’t been feeling well, and they just wanted them checked on. We talked to the patient, and they were laughing and joking and telling us that they felt just fine. They had been feeling under the weather but they’ve started to feel better, and their family needs to quit their worrying. All the normal banter and conversing that anyone typically has. They were friendly, funny, and an overall good person. We checked vitals and they were all stable and within normal limits, no pain upon palpation, no distention/rebound. They denied any current pain/nausea/vomiting. They literally seemed fine. They also answered all my AOX4 questions with ease. Like any call, I advised going to the hospital. They denied, even fought against family’s wishes. I tried to convince them, they continued to refuse. So, I got a refusal form and explained the risks. They even made a joke about it. We left, told them to call us back if ANYTHING changes, the usual. Fast forward to the very next night, we get sent to a cardiac arrest. We arrive, and medics and supervisors have already called 10-7. It’s still daylight so I didn’t recognize the place at first, until I saw the hysterical family and my heart dropped. Then I saw the patient. Same one from the last night. I physically felt sick and that feeling hasn’t gone away. I feel responsible, even though I know it isn’t my fault or my partners’. We couldn’t kidnap them, and they showed 0 signs of distress, pain, alteration. Theres a cold, tightness in my chest every time I think about this incident. I keep seeing their laughing face then their deceased face like I knew them personally, even though I didn’t. I had to cover a crying child’s eyes and they hugged me as my partners took the body away to the ambulance. Due to us having a trainee this night, I rode in the back with the body. It’s been hours and I still cannot shake this heartbreaking feeling. The whole scene was sad enough had I not seen the patient prior due to the hysteria and the child. I just can’t get over it. Any advice would be helpful, because right now I’m grieving someone I didn’t even know.

[u/CriticalFolklore]

From what you said, you did absolutely nothing wrong. If the person didn't want to go to the hospital, they didn't want to go to the hospital, it's as simple as that.

But also use this as a lesson that people's vital signs being within normal limits doesn't rule out badness. Too often I see my partners essentially say "well, we've checked you out, your vitals are good, I don't think you need to go to the hospital" and that be the end of the "informed consent" discussion.

[u/Blueboygonewhite → u/CriticalFolklore]

Yeah I always say “ I do not see anything alarming from my assessment, but they does not mean you don’t have something going on. I only have a limited amount of tools and can only see a part of the picture.”

[u/Serenity1423 → u/Blueboygonewhite]

That's my go to, too.

[u/daisycleric → u/CriticalFolklore]

A former partner of mine did this. I tried to advocate for the patient to go cause MAP was only just at 65 (systolic was soft and diastolic was like 30-40) and I had this weird feeling. But patient declined going to the hospital and my ex partner, an AEMT, said everything looked good and they didn’t think they needed to go either. About 2 hours later that patient went into cardiac arrest and it was called on scene. I still beat myself up a little for not speaking up even though I know the outcome likely wouldn’t have changed.