I’m proud to say that our mobile integrated health program, the Birmingham Fire and Rescue C.A.R.E.S. program, turned three years old last month.
As I reviewed the spreadsheets of data accumulated, I couldn’t help but reflect upon certain moments along the way. Moments that didn’t lead to quantifiable positive outcomes, but that will stick with me forever.
Simple acts of community paramedicine: Mr. Williams
Mr. Williams had given up. He was an alcoholic and his clothes were always soiled from his shoulder blades down to the backsides of his knees.
His apartment wasn’t any better.
Only after speaking to him on the staircase outside the front door for a couple of days, did he trust me enough to let me in.
When I saw what was in there, I almost wished he hadn’t.
I had to wade through empty beer cans piled up to my knees to get to the kitchen. It was the middle of June—hot. He had no power or running water and the windows had all been painted shut.
The stale-sour air was hard to breathe, but I was able to stay inside long enough to clear a path to his front door in case of a fire. Using a shovel, I filled three garbage bags with beer cans.
Later that day, I brought him a set of fresh clothes and a bag of groceries from a local food pantry. He drank two cans of peaches before I’d even put down the bag.
At the end, he shook my hand and twisted his mouth into the closest thing to a smile he’d ever let me see. “Thank you. Bless you,” he said.
Two weeks later, he was found dead inside his apartment.
Community resources: Ms. Betty and Tony
Ms. Betty was Tony’s mother. And like most mothers, she refused to give up on her son.
Tony was 22 years old. He had no job or insurance.
Recently, Tony had started going to the emergency room for frequent seizures. Each time he was discharged, he was given instructions to follow up with a doctor he didn’t have along with a prescription for medications he couldn’t afford.
Ms. Betty paid for what she could and she prayed for what she couldn’t. As the weeks went on, she found herself praying for more and more.
There was only one free clinic where Tony could go. It was open one day of the week for four hours. First come, first served.
We paid the neighbor $5 for gas money to take him there and for the first time in his adult life, Tony was seen by a doctor outside of an emergency room.
He was given a three-month supply of his seizure medicine and a little card showing him when to come back for his follow-up appointment.
On her porch the next day, Ms. Betty squeezed the breath out of me with a long thankful hug. It was the happiest I’d ever seen her.
Not long after, Tony was arrested for a failure to appear. He got 30 days in the county jail. His medicine was still at home on the mantle.
A chaplain’s kindness: Ms. Champion
Ms. Champion could no longer get out of bed.
Her world had become hours of daytime television blaring over the hum of an oxygen concentrator.
On her nightstand was enough medicine to stock a small pharmacy.
On the wall was a calendar marked full with appointments. Tuesday was the primary care physician, Thursday the pulmonologist, next week the nephrologist.
She knew the world of medicine had nothing left to offer. But when we arrived, she humored us long enough to take her blood pressure. Then we would talk.
Or really, she and my partner Brian would talk.
Brian is a fellow firefighter and he is also our department’s chaplain. He carries with him a kindness, which knows no end.
Ms. Champion was one of his first patients. Over the few weeks we knew her, she and Brian formed a bond over a shared faith that there were better things ahead.
Most of her days were still spent in bed watching television. But at least during her final weeks on this earth, Brian’s visits gave her a reason to turn it off for a little while.
Celebrate the little victories in MIH
As we strive to prove the worth of mobile integrated healthcare and community paramedicine, it is easy to get wrapped up on the outcomes—readmissions avoided, ED visits decreased, dollars saved.
But we shouldn’t overlook the importance of those little moments of shared human connection. The smiles, the hugs, the tears, both happy and sad.
These are the moments that matter most to our patients.
And in the end, it’s the patients who will determine the outcomes.
