Breaking the Rules

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The call comes in for an elderly female who fell down during the night. My watch says 9:15 a.m. Home aides often arrive at work in the morning to find their elderly charges have fallen down during the night. They’re required to leave the patient untouched and to call 911.


When we get to the tiny studio apartment in the Nostrand Houses, Pernilla Greene is sitting on the floor beside her bed with her legs splayed out in front of her, like a child playing with jacks. She’s wearing a battered yellow wedding band, and the walls of the room are lined with photos of her and her husband, both as a young couple in Trinidad as well as down the decades as they age. There are no pictures of children.


I ask the home aide, “No kids?”


She shakes her head. “No.”


Mrs. Greene sits on the floor blinking at us.


“How long have you been with her?” I ask the aide.


“Five years.” She leans over and in a West Indian accent shouts in Mrs. Greene’s ear: “Miss Pernilla! The ambulance people is here. How you feelin’?”


Mrs. Greene doesn’t register the outrageous decibel level. She simply says, “I feel fine. How ’bout you?”


“How old is she?” I ask the aide.


“One hundred.”


There’s a plastic bouquet of flowers on her nightstand wrapped with a ribbon stamped with a gold 100, and a plaque from the mayor’s office. “Holy cow,” I say.


A quick physical examination of Mrs. Greene reveals no injuries, and according to the home aide she has no medical problems. Does she need to go to the hospital? Probably not. But she’s over 65, so we can’t allow her to RMA – refuse medical assistance – so easily. EMTs used to let elderly people RMA themselves, but unrevealed (or unrecalled) medical histories resulting later in heart attacks, strokes, and lawsuits put an end to that. Now, if a patient is over 65, we need to call our medical doctor and have him speak with the patient on the phone to determine if they’re fit to RMA.


But no doctor who cares about his medical license is going to let a 100-year-old woman RMA. I sigh and help Mrs. Greene off the floor. She has smooth copper skin and white hair twisted into four large braids. Perfect opal earrings dangle from her plump earlobes. If there’s a fountain of youth, surely she’s found it.


My partner Bronson dials telemetry and reads Mrs. Greene’s vital signs to Dr. Byrd then passes the phone to Mrs. Greene. Though I can hear the doctor loud and clear from across the room, she says, “What? What?” We need to call a lieutenant over.


Now seated in a kitchen chair, Mrs. Greene starts to do her exercises. Arms go up and down, legs go in and out. “Me exercisin’,” she says, proudly.


The home aide grins. “Oh she’s a spunky one.” She screams into Mrs. Greene’s ear, “Ain’t you, Miss Pernilla?”


Mrs. Greene nods and keeps lifting her arms.


Lieutenant Pratt arrives and wants to determine if Mrs. Greene is alert and oriented to person, place, and time. She knows who she is and where she is, but not the year. In the case of a 100-year-old woman living in a room on the eighth floor of a housing project, it’s a trick question.


Mrs. Greene answers, “1904.”


“That’s her birth-date,” I inform the lieutenant.


Mrs. Greene also thinks it is winter. Understandable; it’s chilly and gray outside. I’m annoyed with the lieutenant for not even trying.


“She has to go to the hospital,” he says. No one is going to RMA a 100-year-old.


I sigh and manage a “Yes, sir,” but with regret.


Later in the week, another call comes in for an elderly woman in an apartment building on Avenue U. Anjana Vamrapittri’s visiting nurse called 911 because her blood pressure, controlled by hypertension medication, had dropped too low. Mrs. V is Indian by way of British Guyana and speaks in a heavy Caribbean accent. The fact that she has no teeth makes it even harder to understand her. Her waist-length gray braid flicks as she animatedly tries to make herself understood. The visiting nurse has gone, but Rena, one of Mrs. V’s 11 children, a middle-aged woman in sensible shoes, is there to translate. She says her mother is 89 and does not wish to go to the hospital. She has an appointment with her doctor tomorrow morning and will be fine until then.


We have the same dilemma as before. What if her blood pressure drops too low and she falls down and gets injured? Bad for Mrs. V, bad for the FDNY.


“My brothers and sisters all run businesses in the neighborhood,” Rena says. “Gas station, laundromat, liquor store. We’re all around, popping in and out. She won’t be alone.”


Indeed, the house is filled with the signs of a large and active family. Pictures of Mrs. V’s numerous children and grandchildren adorn the walls, all smiling, except for one son, who’s apparently incarcerated. His laminated prison ID photo hangs next to Ganesh and a blue god with 16 arms. According to the state penitentiary, his release date is 2008.


Mrs. V’s husband comes in wearing a gas station uniform. “What’s going on?” he asks, alarmed.


I explain the situation and inquire about his wife’s appointment tomorrow.


Mrs. V is tired of us being here. She flicks her hand. “Vamoose. Vamoose.”


“Okay, Mrs. V,” I say, “we’re going to try and vamoose this.” I finish my chart in preparation for the report I will give Dr. Byrd. This time, Bronson and I ask Mrs. V what year it is.


She thinks a moment. “1998,” she says. “Two-thousand-and-four,” we say, and make her repeat it. “Two-thousand-and-four.”


Coaching is highly inappropriate, and we know it. But we can see her family all around her, smell the curry bubbling on the stove, and witness the hustle and bustle of this household. Dr. Byrd can’t. We have to get her to memorize the year. Bronson and I do a little tap dance routine and, vaudeville-style, point to her and shout, “Month-?”


“1998!” she shouts gleefully, and claps her hands.


Bronson points to the prison photo of the incarcerated son. “It’s a 10-year sentence.”


“Good enough, Mrs. V,” I sigh. I call Dr. Byrd, give him the patient’s information, then pass the phone to Mrs. V and cross my fingers.


She takes the phone and shouts, “1998!” then rambles on in her indecipherable accent. I give it a minute, then take the phone back.


“Call a lieutenant,” Dr. Byrd snaps.


The lieutenant takes awhile to come, and in the meantime we make Mrs. V repeat “2004” over and over again until it seems she’s got it. Then the doorbell rings.


“2004!” Mrs. V shouts, the minute Lieutenant Pratt enters. I slap my hand to my forehead.


The lieutenant glares at me. He interviews Mrs. V, her family, and secures the RMA. Turning on his heel to go, he whispers to me, “Coach a patient again and I’ll write you up.”


As we get ready to leave, Mrs. V asks if we’d like some curry. “Thank you,” I say, shouldering the oxygen bag, “but we really have to vamoose.”



Ms. Klopsis is an emergency medical technician for the FDNY.This column details her observations and experiences on the job. Some names and identifying details have been changed to protect the privacy of patients.


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