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Two weeks ago was the first real cold snap of the season.  It got butt-ass cold.  Cold like a well digger’s brass bra cold.  You know the cold that is so cold when you inhale through your nose and can feel the boogers freeze?  Or when you climb in your car and it creaks and crunches like an arthritic old man?  Cold like that.  The second day of the cold had a high of 7°F, but that was the high for the day.  When my shift started at 6 AM, it was much, much colder. 

Ever been in cow-freezing cold? I have - goose hunting in Wyoming...
Public domain, NOAA, via Wikimedia Commons

The city is generally good to the homeless on nights like that.  At night, most of the shelters toss out the rules and throw their doors open.  Most shelters normally don’t accept intoxicated people, but when it gets so dangerously cold outside they drop that rule.  "Come on in drunk, if you need to.  If you are a needle drug user, please try to keep it to that corner over there."  But not everyone gets into a shelter, and many shelters close first thing in the morning.  Everybody gets kicked out for the day.

My first call was right out of the garage.  A homeless man was forced to leave a shelter when it closed.  He had immediately developed chest pain.  I am not going to make any statement about his chest pain or the fortuitous timing of the pain.  The second call was for a different urban outdoorsman in a wheelchair inside a convenience store.  He had been hanging out inside the store and when he was asked to leave, dude had a seizure.  He only had socks on his feet – the hospital socks with the plastic tread on them.  I am not going to make a statement about the nature of his fortuitously timed seizure.  The third call was for a undomiciled lady who began to cause a scene in a coffee shop when she was asked to leave after hanging out for an hour or so.  There was really nothing wrong with her, except for being loudly and profoundly upset about having to be out in the cold.  She complained that she moved here for the legal weed, but didn't realize how cold it could get.

It was, all in all, a frustrating morning.  It was a waste of EMS resources.  It is not what I imagined when I began my EMS career.  (In my imagination, my job involves crawling through the broken window of an upside-down sorority bus with a laryngoscope and an ET tube during a nocturnal thunderstorm.  Lightning flashing, thunder roaring, that kind of hero thing.  My job is pretty badass inside my head.)  It is also a waste of hospital resources.  I pretty much guarantee that taking care of a cold bum with “chest pain” isn’t why the doctor got into med school.

You know the most frustrating part?  There is no answer to the problem.  I would have chest pain too, if I had to spend my day outdoors with a high of 7°.  Hell, I would jump in front of a bus if I had to, in order to get indoors.  What’s the answer?

I decided that it is okay that I don’t have the answer.  It is not my job to solve this problem.  My job is to make each patient’s day a little bit better.  When it is cow-freezing cold out, I can do that with a ride to the hospital.  I get paid hourly.  I don't get a bonus based on how many people I transport are actual, imminent emergency patients.  All I have to do is give someone a ride to the hospital, their situation is better than when I found them, and my job is done. 

Listen, schizophrenics stop taking their meds.  Women go back to physically abusive boyfriends.  Alcoholics continue to drink.  Homeless people are homeless.  These are complex problems that are multifactorial and difficult to solve.  It doesn’t help for me to get frustrated or angry about the situation.  I didn’t cause it and I can’t fix it.

I have to give credit – I usually hate it when my patient goes to the waiting room when we arrive at an emergency department.  But on this day there were hospitals sending me to the waiting room.  Once there, the triage nurse would ask whether the patient wanted to get checked in with a problem, or if the patient just wanted to sit in the waiting room until they were ready to leave.  The hospital had no problem if they sat in the waiting room quietly.  Several patients took advantage, without getting checked into a room for a full evaluation.  There is a balance there: You don’t want to turn the waiting room (where my family would wait) to turn into a shelter, but kicking people out will probably result in higher evaluation costs and uncollectible future toe removals.

Toes, twelve days post frostbite injury.
By Dr. S. Falz (CC-BY-SA-3.0), via Wikimedia Commons, with permission

The ED staff didn’t have answers for the problem either, so they just concentrated on helping people.  Focus on making the day of the person in front of you a little bit better.  Isn't that one of the main reasons you're in EMS?