Frustrating encounters with the bloody-minded patient!

By Thijs Gras

In this column our forthright and sometimes out-spoken Dutch correspondent, Thijs Gras, utters the unspeakable by reflecting on a particular group of patients – those bloody-minded individuals that all ambulance crews encounter from time-to-time – usually during a shift that is already driving you crazy. As Thijs observes: “While it’s not uncommon for an ambulance crew to come across patients covered in blood… it goes with the job… this thankfully small group of patients are the ones we must deal with that ‘suck the blood from under our nails’ – a Dutch expression referring to irritating people.

Thijs Gras


By far the largest cohort in this group of ‘bloody-minded’ patients are the drunken and intoxicated individuals. How haemorrhagingly irritating these charming people can be! Female patients (or their friends) who often suggest that: ‘Something has been put into my drink’ as an explanation for their rotten behaviour. But when you question them about their night’s alcohol intake you then have to wonder which of the ten shots they drank had actually been spiked! Some of these patients have lost their senses completely and would be quite embarrassed to see and hear what they had said to us or other people while vomiting and sometimes even opening up the sluice-gates at both ends! And we have to try to remain friendly while cleaning up their mess with a never-ending smile. I once had no option but to put a drunken girl with vomit all over her clothes, hair, mouth, face, arms and legs, in a body bag we use for dead bodies in order to prevent her from spreading her bodily waste all over our stretcher and inside our ambulance as it was a particularly hectic night and I knew we could not afford to return to the station to deep-clean the vehicle.

In Amsterdam we have a few GHB-addicts who pose a lot of problems for the emergency services. It takes the police a lot of effort to control these sad individuals, then we fly in with Midazolam to prepare them for the hospital, where they are welcomed with a ‘not again’ sigh from the ED team. While patients certainly elicit our sympathy, unfortunately we know them all too well and when we attend to them their chaotic behaviour can be both dangerous and stressful.

An especially annoying category is the pig-headed patient. Recently we were called to a drunken, pig-headed woman well into her fifties (a very dangerous combination). She had fallen from the stairs, sat outside and wanted us to bring her to her apartment on the third floor because she had to pee. One glance at her ankle was enough to see that it was broken. She could not stand on it; her foot and the rest of her leg went their own ways. We could almost feel the pain, but she obviously could not. “Bring me upstairs, you idiots! What the f…” What could we do but to grab her, put her on the stretcher, strap her in and bring her to the hospital? She was furious, called us some unrepeatable names and even tried to kick us with her broken leg; you can imagine what that looked like. Luckily for us she didn’t have a leg to stand on in this instance… quite literally!

With children all ambulance crews do their best to show more tenderness, but sometimes certain kids can cry and carry on with themselves for all the wrong reasons. They are after all just smaller humans and, as all ambulance crews know, when some humans find themselves in a distressing situation they can lash out and become overly dramatic. Such children can express a nagging, whining sort of crying, causing their parents to lose control and behave quite appallingly, leaving you and your colleagues feeling powerless. When parents are worried about their offspring and see them freaking out even the most usually calm people can become bloody-minded beyond belief!

But the group which drives me to distraction are those thoughtless people who think we deliver less quality care because we personally discriminate against them. As soon as something does not go their way, they shout: ‘You do not want to help me because I am…’ And you can fill in the blank with almost anything: Muslims, black people, Turks, Moroccans, gay, etc. Again, while all ambulance crews understand the concept that certain groups genuinely suffer racism and discrimination in their daily existences, we also sensibly recognise that we could never do our job if we based our clinical decision-making on such offensive and irrational factors. I became a paramedic to help people, not bully them!
I sometimes relax patients by telling them that I cannot stand blood. People look amazed when I say this, but then the tension in the situation is broken. But even more true is the fact that I cannot stand bloody-minded patients – and I’m sure that every ambulance crew across the planet knows exactly what I mean when I say this!

Tell Thijs what you think about this article by emailing him at: [email protected]


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