After EMS: Self-Defense

This article is part of an ongoing series from Mike Rubin. In this series, he’ll reflect on his career and share practical retirement advice for emergency medical personnel. Catch up on articles you missed.

When I started this series 18 months ago, retirement was my biggest challenge. Being an ex-paramedic was…ordinary. There were no clinical challenges, no collegial connections, no new stories to tell. Endless leisure time—my thirty-something fantasy—didn’t age well. Being able to mow the lawn whenever I wished wasn’t all that special.

Now, growing old is my chief complaint. Changes in health—some sudden—have cost me my independence, at least for now. Maybe I can help you keep yours.

I just finished a hospital stay where I stopped behaving like a paramedic (mostly) and tried to be an unremarkable patient. It wasn’t easy. After 30 years in EMS, it’s hard to pretend you know nothing about medicine. But when it’s your turn to swap sides, it’s better to embrace ignorance than act like you’ve had some training. Patients get no points from staff for time served in the field.

I don’t blame hospitals for that. With so many half-truths circulating on social media about science, it’s common for people to misunderstand risks. It would be better if the sick knew enough to ask all the right questions, but even that wouldn’t leave us surrounded by friendly fellow-caregivers. If you’re retired, you’re not in that club anymore. You probably don’t deserve to be. Policies and procedures invented after you saw your last patient aren’t necessarily compatible with old expertise. Perhaps you’ve been an outstanding EMS provider, but when you’re bedridden, you won’t be asked your opinion on how to treat you.

It’s hard to rely on strangers to care for us seniors. Often they don’t, yet blind trust is what the system expects. That can turn out badly for patients of all ages, but the elderly have a special disadvantage: frailty. It takes energy to monitor one’s own care and question it when necessary. Younger, stronger healthcare providers would prefer we act our ages and humbly follow directions.

Here’s a question for retirees: How many times have you gotten less help than you needed, really needed, from caregivers who mean well but don’t seem to understand how much seniors lose just by aging? I’m talking about compromises to health, companionship, familiar surroundings, mobility, employment, security, and respect—each a key contributor to quality of life.

What are we supposed to do about that?

Start by thinking defensively. Try to ignore the negative connotation of that word. Sometimes there’s a good reason to get defensive. For me, it’s feeling vulnerable. Hospitals are target-rich environments for the helpless.

After only one prior hospitalization since the age of seven, I was unprepared to deal with the consequences of questions I didn’t ask this time. I tolerated pain, fear, humiliation and indifference, including requests for written consent to two procedures I hadn’t even discussed with the surgeon. Frustration on both sides turned the patient-provider connection into something adversarial. How ridiculous.

With medicine changing faster than I can follow, perhaps I should settle for knowing the basics and observing my care quietly, even secretly. I’ll have to try that next time.

Do I have a choice?

Mike’s Exit Poll #18: What makes a good patient?

I thought I was one—cooperative, appreciative, compliant, clean—until I had a misunderstanding with a nurse about taking my own nightly eye medication.

The hospital had ordered the wrong drops for me. By the time I’d noticed, it was too late to replace them in time for my next dose. I thought I’d solve the problem by self-administering the correct prescribed meds I’d brought with me.

When I told my nurse what I’d done, more employees responded to my room than if I’d called a code. Things got unpleasant because I’d broken a rule against self-medication within the facility. Maybe I was 50% responsible for the silly argument that followed, and lost whatever chance I’d had to be Patient of the Month, but my eyes require daily treatment for end-stage glaucoma. Getting defensive felt necessary to avoid further injury.

What makes a good patient is similar to what makes a good medic: Be nice, know why you’re there, respect the rules, and settle for less than you expected.

Mike Rubin is a retired paramedic and the author of Life Support, a collection of EMS stories. Contact Mike at mgr22@prodigy.net.