It's Christmas eve. We get called to one of the local nursing homes for rib pain. The room number sounds familiar. The nurse hands me the paperwork. "Mr. Ryder," she says. "He says he needs more Percocets. He's requesting transport."
Mr. Ryder is a tattooed biker, an emaciated COPDer with a long white beard. Almost sixty, he can't weigh more than a hundred pounds. He sits in his wheel chair, wearing his motorcycle jacket and oxygen cannula.
"I'm in real bad pain," he tells me in his whisper of a voice. "Fifteen on the scale." He nods as if to say it is the truth.
"Well, we'll take you down to the hospital and maybe they can help you."
It seems he fell a couple weeks ago and cracked a rib.
I have taken him to the hospital at least ten times over the years. The night medics have taken him more. Nearly every time it is self-dispatched. He agitates the nurses until they call his doctor who after several calls relents and tells the nurses to go ahead and call an ambulance just to get him to stop pestering them. He gets pneumonia a lot and complains of the chest pain. It is always real bad, he says. He goes to the hospital and gets sent back a couple hours later. He is rarely admitted.
While I don't like to categorize patients in this way, he does fall into the "pain in the ass" category.
I see him nearly everytime we go into the nursing home. He is always sitting out in his wheelchair in the main TV area. He sees me and his eyes light up. I say "Hey Jimmy! How'ya doing?" as I push the stretcher past going for someone else on the wing.
He lights up and says, "Not too bad, hanging in there."
That's the jist of our relationship.
Today in the ambulance, I have an EMT student do vitals as we start toward the hospital. I'm not going to do anything for the patient -- no IV, no monitor -- just keep him on his normal 2 liters of oxygen. His color is good and he doesn't appear in any distress. He, in fact, seems rather lively.
The patient looks up at the EMT student and says, "This guy over here, me and him go back a long way."
"He's taken care of you before?" she says.
"Yeah." He nods at me and then says, "He's probably one of my best friends in the world."
I melt a little inside at his words. It also makes me terribly sad. I think of all his biker buddies -- Hoss and Mongo and Big Steve -- and wonder if they are partying at the Iron Hog without him tonight or if maybe they are all either in the ground or solitary in nursing homes themselves.
He looks up at me now, his eyes locking on mine. "I'm in real bad pain," he whispers urgently. "Fifteen on the scale."
It's hard when folks have that mixture of manipulation and genuine need.