Administration and Leadership, Columns

Dealing with the ‘Deja Vu’ of Repeat Patients

Issue 2 and Volume 41.

I’ve never really cared for the month of February. The two months of winter prior to this point usually leave me so somnolent from the colorless outdoors and captive cold that I can’t even pronounce a word like somnolent, much less recall what it means. Add to this the knowledge there will be two more months of this drawn-out pattern of predictable weather and I’m drawn to any omen that could mercifully hasten the arrival of an early spring— including the unsubstantiated ritual regarding a fat mammal that’s forced to reveal himself in the midst of hibernation. And no, I’m not talking about your supervisor.

Speaking of groundhogs, every February I try to make a point of ritualistically watching the movie Groundhog Day, whose character Phil Connors, played by Bill Murray, portrays a weatherman covering Groundhog Day and is cursed to repeat the same day over and over and over and over again. At first glance I found the film to be clever and humorous, but not much more. It wasn’t until my 145th viewing that I realized I’d vastly underestimated the movie’s many virtues and similarities applicable to my own profession as a prehospital care provider— specifically regarding the déjà vu part.

Déjà vu is French for “already seen.” In EMS, déjà vu stands for “dispatched emergencies judged as validly unjustified.”

Now I’m not speaking of those poor individuals whose chronic past medical history requires frequent EMS stabilization and ambulance transports to appropriate medical facilities, despite their best efforts to stay vigilant in their own care. I get that. But what of those patients determined to not fulfill their wellness potential—those who have no intention of changing their harmful lifestyle despite the limitless times they rewind 9-1-1?

Some such forms of EMS déjà vu include:

Déjà blue: Patient ran out of Rx home O2—again.

Déjà loo: Patient fell off toilet—again.

Déjà brew: Patient abusing ETOH—again.

Déjà flu: Patient has a mild fever and cough—again.

Déjà goo glu: Patient needs oral glucose —again.

Déjà sue: Patient threatens medical litigation—again.

Déjà boo boo: Patient with … well, you know—again.

Déjà spew: Patient with nausea and vomiting—again.

Déjà stew: Patient believes medical community is oppressive—again.

Déjà poo: Leading to déjà eeeewwwwwww.

In the movie, Phil struggles to deal with a storyline that remains unchanged despite his self-centered efforts to keep it from resetting itself, and so it goes day after day until he hopelessly concludes: Today will always be tomorrow. Disheartened, he loses not only his compassion for others, but for himself and life in general.

Though not as dramatic as the film, EMS often finds itself running through a time loop of a particular patient’s self-imposed neglect of their physical or mental well-being. When reverberated enough times, it can leave a responder resentful of not only the patient, but of EMS as a whole for creating such a hopelessly unbreakable closed circuit.

We have a patient in our system whom we’ve run on at least 150 times over the past several years. Despite building a community-based paramedicine paradigm around him, he continues to abuse and neglect his diabetic health needs. In fact, we’ve run on him so many times we can guess within a few milligrams of his glucometer reading based on his behavior.

His emergencies are true, but usually require restraining him secondary to his hypoglycemic combativeness, which, of course, usually occurs during the wee hours of the night. Our crews have remained professional and benevolent in caring for his needs. But recently, cracks in crew morale are beginning to reveal themselves.

At one point in the movie, Phil finds compassion for an ailing homeless man and attempts to rescue him, but the man ends up dying at the end of each recurring day anyway. Once Phil eventually resigns himself that he can’t save him, he begins a transformation of acceptance of his limitations, thereby freeing himself to focus his attention on whom he can help.

Despite EMS’ best efforts to treat, guide and educate, there will be those occasional patients who will never experience a breakthrough of embracing self care. We should recognize we can’t allow a patient’s inability to pull themselves out of their own hole to overshadow our own psychological well-being of purpose as we serve the majority of patients who truly do struggle to survive. And that’s no déjà moo (bull).

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