Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”
So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to result in an unwanted pickle or two until things get straightened out. I’m thinking now of O’Flaherty, a patient I came to know more than thirty years ago, working on a busy (and brand-new) Mobile Intensive Care Unit in an Eastern Pennsylvania city. Every so often, we were summoned to one restaurant or another for “man down, possible heart attack” and frequently found O’Flaherty on the floor somewhere near the cash register, clutching his chest and gasping for breath.
On the cardiac monitor he was “normal sinus” but so short of breath and so wracked with substernal pain was O’Flaherty that we had to treat and transport. each and every time. Usually within an hour of arrival at the emergency room, O’Flaherty was signed out and on his way home by foot — he lived three blocks from the hospital. Often, it was “against medical advice.” This went on for the better part of two or three years until, one evening, we were dispatched to O’Flaherty’s home address for “unresponsive patient, 70 year old male” and found our friend in cardiac arrest. We began CPR, got an intravenous line started and pushed sodium bicarb and epinephrine, intubated O’Flarerty’s airway, and had him at the emergency room in short order, but there was no walk home that night. O’Flaherty left the hospital in a hearse.
Looking back from the vantage point of impending old age, as well as looking ahead toward medicine’s future, I often ponder O’Flaherty. He beat the check for years and probably had a good laugh over it. We got a little comic relief (have I mentioned that he usually wore safari clothes?) in a profession fraught with tragedy, and the hospital eventually received a hefty bequest from the city’s least ostentatious, though perhaps most eccentric, millionaire — O’Flaherty himself. No one thought it possible. Eating free on and off for years, was O’Flaherty salting away funds for donation to a much-valued neighborhood institution?
There was no charge for the ambulance service in those days. O’Flaherty knew that, and he knew how to stagger his gastronomic adventures to spread them evenly over all four work groups and various city restaurants. Just when you forgot about O’Flaherty, he’d show up again — was he training us? Possibly. His gasping and clutching were very convincing — did he have a theater background? Maybe. And what can we conclude from O’Flaherty’s ultimate demise? No such thing as a free lunch? For the cynics among us.
I’ll never know many of the answers, I know that much. But isn’t this a big part of being flexible? For what’s on the health care horizon right now, I think it’s called a “leap of faith.” Wait and see. Work and hope for the best. You may be pleasantly surprised. And remember, it’s only ketchup.
Rob Burnside is a retired firefighter and paramedic.