The Dichotomy of Crazy

Crazy presents itself in many forms. My own particular brand of crazy is a bizarre form of serially monogamous relationships despite my intense fear of commitment. I’m fully aware of the oxymoronic nature of myself, but self-psychoanalysis is for another time all together. I find it much more entertaining to ponder the craziness found in others than attempt to interpret and treat the psycho within. Through what I consider to be deep thought (I’m blond, it hurts, you know), I’ve come to the conclusion that the crazy I’ve encountered on the job is split into a fairly distinct dichotomy: Good (or at least not a danger to the world and its populace) Crazy and Bad Crazy.

Good Crazies and I get along very well, perhaps due to the “it takes one to know one” theory. Good Crazies and I can see eye to eye and get to the hospital without physical restraints, threats of/attempts at bodily harm, or the sudden inescapable desire to unbuckle oneself from the seatbelts on the stretcher and fling oneself out of the back of the ambulance at 55 miles per hour on the highway. We may even share a laugh, a common interest in books/music/serial killers, or a personal epiphany into the insight of mankind. People of the Good Crazy variety tend to see me, decked out in pigtails, with big blue eyes and girl-next-door freckles, as the kind and loving creature I try to portray my image to be, and immediately assess that I am not only far from a threat, but willing and able to help them. Good Crazies get my personal specialty, 50cc of love: hand holding and head patting as necessary.

Examples of Good Crazy:

Alzheimer’s Patient Who Seems To Have Developed Tourette Syndrome: This patient is almost always a delight for me. You just can’t be mad at them. You can be annoyed with the nursing home staff for calling 911 and reporting that the patient has an altered mental status, despite the fact that their normal mental status is indistinguishable from an altered one, but not at the patient. Furthermore, every time they drop the F-Bomb, it gives me the giggles like nitrous oxide. There’s just nothing like a 200 year old lady swearing like a sailor. I realize how hard this must be the patient’s family members, but if I spend much time analyzing the true misfortune of my patients, I’ll spend the rest of my life munching on serotonin reuptake inhibitors.

Mentally Handicapped, But Incorrigibly Happy Kid: I walk into the room and this kid (or technically adult as the case may be, but they always strike me as kids) just BEAMS at me with a smile that could replace the sun. I introduce myself and ask if we can be friends, and they always want to be my friend. People who want my friendship may be appealing from a person with all their mental faculties, but people who have been dealt a seriously shitty hand and have a sunny outlook are impossible not to adore. I realize that perhaps they’re incapable of knowing the nature of their illness, but I can’t force myself to care. They actually want to be my friend for no reason (perhaps this requires another self-psychoanalysis in the future, but I digress)!

The Happy Drunk: While it is obnoxious to continuously take people to an emergency room when they are clearly not having an emergency, it’s apparently unavoidable. If I must transport a drunk, I infinitely prefer The Happy Drunk, which is not to be mistaken with The Drunk That Vomited Red Wine On Me And Now I Can’t Even Smell It Anymore Without Feeling Nauseous. They may take for freakin’ ever to load into the ambulance because they feel the need to say goodbye to everyone on first response and stumble around incessantly, but they don’t throw punches or insult public safety personnel. They even laugh at their own slurring, inability to speak a clear sentence, and hiccups. The Happy Drunk is occasionally homeless, and this is his or her primary escape from the harsh reality of the world, for which I can’t really blame them. I suppose The Happy Drunk takes me back to my days in college, where I didn’t realize my EMS training had begun by taking care of my friends who frequently morphed into The Happy Drunk. In fact, I have been The Happy Drunk, just never in an ambulance.

The Schizophrenic Lady Who Puts Lipstick All Around Her Eye Like Petey The Dog, Or Other Harmless Aberrant Behavior: Bystanders only called 911 because this patient is clearly off her rocker, and they have no clue what to do. Think about it: you see someone with blatant atypical behavior, but do you really know if they’ll go off on you if you ask about it? Bystanders don’t see this patient normally, because they tend to be tucked safely away in the care of family members or mental institutions. They see someone painting their face in hot pink and babbling incoherently and have no idea what to make of it. When I show up, I compliment the color and let her know if she missed a spot. In retort, we have a peaceful ride conversing about the nice Martian she met last week.

Bad Crazy, on the other hand, is the total opposite, and even worse, they see right through my docile appearance. Bad Crazies know I’m not totally sane (who in EMS is, anyway?), and they thrive on it. They love to pick fights, force us into physically restraining them (without even acknowledging how handy I am with soft restraints! Jerks!), or make grand accusations of our intentions/races/religions/sexual preferences/possibilities of demonic nature or possession. Bad Crazies will NOT accept even my most compelling charm, which quite frankly, annoys the crap out of me. Well, that and sometimes they try to hurt me, which sucks for obvious reasons.

Examples of Bad Crazy:

The Patient Who Makes Really Ineffective Suicide Attempts Regularly: This patient either has the IQ of a fencepost or is really searching for attention, not an end to their existence as they know it. This patient only falls into the Bad Crazy category because they’re hurting the people who care about them, albeit emotionally. Cutting your finger, taking a dose of an over the counter medication that is less than the recommended dose, jumping out of a window on the first floor of a building, banging your head onto a concrete wall (but not hard enough to leave a mark), stabbing yourself in the leg with a pencil, refusing to take your vitamins, taking your prescribed medications when and as you are instructed (seriously), scratching your forearm with a dull knife, or staring at the sun will probably not kill you. These patients typically need either a stage complete with spotlights or Darwinian intervention. Better luck next time.

The Paranoid Schizophrenic Conspiracist: These people are very mentally ill, usually with a multitude of psychiatric disorders, and typically have experienced such awful things in life that their mind literally surrendered. These people know for a fact that myself, my crew, and all first responders and police officers are all minions to those orchestrating an elaborate scheme to “get” them. Granted, it doesn’t help my case that the patient was full body tackled by a police officer to get under my care in the first place, but you simply cannot run half naked, at top speed, through the back yards of a middle-upper class neighborhood; people frown on that kind of thing. Logic is of no use with these patients. My oxygen is really noxious gas, my lancet for checking glucose levels is actually a poison dart, and my blood pressure cuff is a cleverly disguised torture device. These patients are highly unpredictable and are so intensely fearful that they honestly believe I can and will hurt them. They interpret my attempt at a calm voice as a ruse and my ambulance as an embodiment of the evil that is set to destroy them. I can’t entirely blame them…if you were actually looking at a hallucination of “El Diablo,” how can you not believe higher powers are looking to destroy you? After all,
seeing is believing, right?

The Dimwitted Criminal: This particular type of patient exists largely to make me feel of superior intellect. This patient dons stylish house arrest anklet, yet led the highway patrol on a high speed chase for no apparent reason, hit the car of a passerby at an off ramp, took off on foot, got bit in the leg by a dog from the canine unit, and fails to see the irony in the fact that I forgot to put my phone on vibrate and The Clash’s “I Fought the Law, and the Law Won” rings from the pocket at my right breast. Nicely done, Dimwitted Criminal, you may have just won yourself a stay at the big house! I see the biggest injustice as the fact that these delinquents always seem to procreate; can the spawn of those responsible for keeping prison recidivism rates exceptionally high really stand a chance at success in life?

The Mean Drunk: I despise The Mean Drunk. The Mean Drunk has poured alcohol down his throat in whatever form he/she can find every waking minute of every day, regardless of the fact that the juice makes them grow horns and spit fire. The Mean Drunk knows that he or she is a raging asshole under the influence, and probably wouldn’t be such a dick if he/she quit drinking mouthwash every day, but just doesn’t care. The Mean Drunk is full of threats of violence, and occasionally acts them out. He/she flails about, swinging fists and feet, yelling threats and insults, spitting and refusing to cooperate. Really, Mean Drunk, I’m practically Aryan in appearance; it just doesn’t make much sense to call me the N-word. Also, please keep your HIV, Hepatitis, TB, or other communicable disease laced saliva to yourself. On occasion, The Mean Drunk picks me out of all the people available as his victim, which never fails to baffle me; aside from an emaciated teenaged fireman, I am likely the smallest person on a scene, and I wear my hair in pigtails regularly…PIGTAILS! “I’m gonna rearrange your pretty little face!” Yeah, Mean Drunk, you said that last week, and guess what! Face. Still. In. Tact. Seriously, Mean Drunk, this whole slowly killing your liver ordeal is for the birds; just aspirate your vomit and die already. Perhaps the most disturbing thing of all is that these people don’t actually scare me anymore. Sure, I’ll be more alert, keeping my arms constantly prepared to block a swing or ready to use four point restraints, but I’m no longer afraid. When I was a new EMT, these people scared the crap out of me; these days, I just think these patients are probably why we don’t use paralyzing drugs in my system.

I’ve barely covered the tip of the craziness ice burg in the emergency setting, but I can’t be bothered to write a novella on the experience. Besides, most of it is depressing. The comic book version of myself lifts The Good Crazies effortlessly and compassionately, delivering them to hospitals capable of curing their incurable problems. She protects the world from the Bad Crazies with speed, strength, and intelligence. Of course, the superhero within is a fantasy, so I’ll settle with not being dumbfounded and doing the best I can in whatever situation I find my patients and myself in.

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