I asked her if our patient was normally this combative and she said he wasn't. I told her I was uncomfortable taking him in our ambulance unless everyone was clear that I might need to use restraints, and/or they gave him a sedative before we left. So I went to talk to the nurse and she seemed confused as the patient had never been that way with her. As soon as she and I walked back into the room, the patient saw the nurse, and turned into a very calm man, smiling and making borderline suggestive comments, and there was actually a spark and a gleam in his eye. 3 minutes ago, he was angry and combative and now he's on the prowl with the admittedly quite attractive nurse.
The patient's history suggested that his altered mental status worsened significantly after his MI, so now I knew that I had a normally calm, but confused patient and something about the CNA and the gown had set him off. My partner and I loaded him to our stretcher and cocooned him a bit in the sheets just in case and set off through the hallways of Great Big Hospital. As we walked, our patient was making random observations and comments which I initially ignored, but then began to listen to. A lot of what he was saying made no sense until it hit me. Our patient, Mr. Smith (not his real name of course) was actually a former Marine Corps infantryman and right this very minute in his mind, we were in a combat zone. His unit had just been hit hard by enemy fire and he and all of his buddies were wounded badly. The reason he was so upset was that someone (presumably a Medic) had snatched him away from his buddies to treat his wounds and he was concerned about the rest of his unit. As soon as I figured this out, and started to tailor my conversation to suit his reality, he started to calm down quite a bit.
By the time I had him in the back of our ambulance, I had the whole story, and I had assured SGT Smith, that me and my partner were indeed military medics and we were assigned to take him to a facility where he could be properly treated and more importantly the remainder of the medics in our group had been sent to take care of the rest of his sqad. He relaxed more and then asked me where I was taking him to get fixed up. He was concerned that the drive to Philadelphia might be a very long one and he wasn't sure he could make it. I asked him if he had ever been to Georgia (not really, but it's a southern state and it works for the story) and he lit up like a kid at christmas and said "Son, I was BORN in Georgia." I asked him where and he said "Eatonton
, I was born in Eatonton Georgia." And I said, well SGT Smith, I'm taking you to a military hospital in Warner Robins. Then with a sly grin, SGT Smith said "are you SURE you can't take me to Eatonton?"
No sir, I said, I have my orders and you know how the Corps is about orders. We're going to Warner Robins and that's the end of it. He laughed and said, "Son, I knew you couldn't, but I had to try. You just carry out your orders and I'm sure I'll be fine". With that, my formerly confused, angry, combative patient closed his eyes and napped for the rest of our 20 minute ride to his nursing home.
When we got there and unloaded him, he recognized the nurses and aides on his ward, and seemed quite content to be there. Now whether he knew he was in the nursing home, or thought they all worked in a military hospital in Warner Robins, GA, I'll never know, but at least he was calm and peaceful and no one had to drug or restrain him.
Some days I love my job.