Sickness is a great leveller and affects the wealthy and poor alike. Consequently I got to meet some very interesting people during my time as an ambo.
Many of our patients were not so acutely ill and were therefore open to conversation during the trip to hospital.
This was especially true for many of the routine patients who were often just going back to a clinic for the day for some rehabilitation or an x-ray or similar outpatient procedure.
It was a fantastic opportunity to hone my communication skills by chatting to them, putting them at ease and helping pass the time during the trip. I found it particularly easy asking them questions as I have a natural and inquisitive personality and a genuine interest in what other people have done in their lives.
An interesting male patient I once transported to the head injury clinic told me about a unfortunate but humorous event that led him to rehab. He was a truck driver who had received a head injury when he rolled his truck twelve months previous.
He was hospitalised, treated and discharged but said that certain strange things started manifesting themselves some time after he was discharged from hospital.
According to his account he had trouble judging distances whilst driving his car and often braked too late when approaching intersections, which meant he ended up halfway through the intersection before stopping. The crunch (sic) came however one weekend when he was at home working on his racing car. He and his wife both owned and raced hot rod vehicles.
He told me that this particular day he was sitting in the drivers’ seat of his hot rod, in its garage and was revving and tuning the motor when he suddenly started hallucinating. The mirage was so real he swore he was actually at the drag strip and could even see the crowds, other vehicles and himself at the start line ready to race.
Revving his motor, the start lights turn red, then orange, then green so he put his foot down and drove out the end of his garage! That’s when he came back to reality and realised that maybe he wasn’t fully cured afterall.
I was taking him into the concussion clinic, which was a rehab day clinic for head injury patients.
Illness has no respect of ethnicities either and with my City having the largest Polynesian content outside the Pacific Islands we were often called to some of their homes in the Southern Suburbs for various medical problems, often involving respiratory complaints.
It was not uncommon to see the parents, grandparents and children of a Polynesian family all living in a two or three bedroom house. I recall attending one such residence in the early hours of a morning and having to carefully step over three children who were fast asleep on mattresses on the lounge floor. This was their bedroom at nighttime.
Their walls were often adorned with holy pictures surrounded by the familiar flower-bound leis. Most European families place their elderly parents in rest homes but I found Pacific Island people always gave them the best room in their own house. They were also always extremely grateful for our help and always polite and co-operative as patients.
I found that the cultural differences did however sometimes hinder our treatment of patients from this culture.
In my experience Pacific Island people have a set hierarchical structure, which demanded respect for people with authority such as ambulance officers. They would tend to nod or agree with everything you said even if they didn’t quite understand what you were asking.
One example was when I transported an elderly Samoan patient who was accompanied by a younger female relative. The older man spoke little English so the relative did the translating for me. I wanted to know if the treatment was working so I asked the relative to ask the patient if the oxygen we had administered was helping with his breathing, which she duly did in their native language.
I sat there waiting for the answer but she said nothing. So I proceeded to ask her “well what did he say” to which she replied, “yes it was helping”. Then I suddenly realised that she had taken what I said literally. I had only asked her to enquire about our treatment, which she did but I failed to ask her to then tell me the answer!
Another culturally related issue I encountered with Pacific Island patients was that when they were feeling ill sometimes they would just lie down and close their eyes. This gave the impression that they had collapsed and some well-meaning person would call an ambulance.
The solution was always the same and it was simply to get all the concerned relatives to leave the room so it was just the patient and ourselves left. We would then explain in a reassuring manner that they were now alone and often the patient would open their eyes and start talking to us.
It was as if they just wanted to block out everything that was happening around them and this was their way of coping.
Another different cultural practice I encountered was with some Asian races. I went to a few jobs where the patient had collapsed and the concerned and well-intentioned relatives were propping the patient up and rubbing them all over their body with their hands. The trouble was in these instances both these patients had low blood pressure, which is why they collapsed in the first place and appeared so pale and sweaty. Sitting them up was the worse thing to do and it took some convincing to get them to leave the poor patient alone so we could lie them down.
Cultural differences caused communication problems at the hospital as well. A friend who worked in the emergency department told me about a female Somalian patient that was bought in by her husband and was actually quite sick. I think she had some vaginal bleeding and so needed urgent medical attention. Now I’m not sure whether it was a religious or cultural thing but her husband didn’t want anyone inspecting or talking to his wife and so he answered any questions that were directed to her.
He became quite obstructive towards the medical staff, particularly when the patient was taken to the resus room and the male doctors were involved in her treatment. Apparently the hospital had to get the security officers to remove him from the room because in his belief only he was allowed to answer for her or examine her.
Medicine also has its societal taboos and I remember transporting the first “AIDS” patient I had ever seen.
The more politically correct terminology these days is HIV positive but back then societies understanding and acceptance of this virus was limited and there was still a lot of paranoia surrounding the controversial disease.
I had had little training about it and was basically told that it was much less infective than other more common nasties like Hepatitis, but like the rest of society I was still relatively uneducated and probably over cautious.
I picked the patient up from Auckland hospital ambulance bay and was transferring him to the Mercy hospital hospice unit. The patient was bought down from the ward and appeared very pale, gaunt and anorexic. The poor chap looked terrible and had sores on his mouth and face and was coughing frequently. Initially I had no idea what his medical problem was and had only been told he was a medical transfer.
A relative was with him. Suspecting that he was an AIDS patient, I quickly scanned the notes and asked the female relative if the patient was HIV positive. She became very defensive and asked me why I wanted to know. I explained diplomatically that since the patient was coughing I was concerned at the risk of contamination. She reluctantly admitted that he was, so in my naivety I asked him if it was ok and placed a surgeons mask on his face for the short trip. He really didn’t seem to care and it gave me peace of mind so it worked well.
Our ambulances carried Personal protection packs for jobs involving gross contamination. The kit contained paper overalls, a plastic apron, gloves and mask with a face shield. I only ever used this once. The job was an arranged admission to hospital and the patient an elderly bed-ridden man suffering dehydration.
On arrival at the premises, his slightly demented wife who was still wearing her nightie, even though it was the afternoon, greeted my work partner and me. The patient had been suffering from diahorrea for the last three days and there was ample evidence of it throughout the one bedroom unit. A urinal was full of the liquid waste and there were stains on her nightie, all over the patients’ pyjamas and all over their sheets. Needless to say the smell was slightly overwhelming!
They were a very friendly couple though and didn’t seem to mind that we were all geared up in our white sterile looking overalls and gloves. I wrapped him in a blanket and we popped him off to hospital.