Flying Frequently

I'm sitting in the kitchen of a Frequent Flier and wondering what to say.
My main job is for a suburban service now. We're slower, but the patients tend to be sicker because they take their medicine, visit their doctors, take better care of themselves and thus, when they finally need 911, it tends to be because they are very sick.
This patient is the exception.
There is nothing remotely sick about him, at least not physically.
In my last job at a busy urban 911 system, Frequent Fliers were as common as streetlights.
They were an accepted part of the landscape. Only when they decompensated and became real players -- say, calling once or twice a day, every day, for a month or more at a time -- did they warrant comment.
But when they do get under your skin, well, there's NOTHING worse in EMS.
Some guys can handle taking the same Frequent Fliers shift after shift without a problem.
For others, it's sometimes enough to make them contemplate leaving the field entirely.
I'm usually in the former camp, but often in the latter -- much more so lately.
So now I'm in the kitchen of a guy who's called for nine nights in a row, each time complaining that his uclers are bleeding.
But he always has a twist to his main hemorrhagical complaint -- the ulcers are acting up AND a local gang has caused a rash on his forearm, or the ulcers are acting up AND the federal government has him under surveillance.
He's been rotating among the three nearest hospitals because each has identified him for what he is almost immediately.
Typically he's discharged and on his way home within a couple hours, depending on how much time and personnel the overworked EDs have to devote to a patient who darkens their door daily with a slew of bogus and bizarre complaints.
Tonight he is asking to go to a hospital 20 miles away. On a rainy Friday night. In a town with a single ambulance.
I have to measure my words.
These are not good times for telling it like is in EMS.
It's best if you don't think too much, don't worry about the system or allocation of limited resources or wasting public money on public nuisances.
The best thing for my career is to just forget the abuse this particular patient is heaping on the system, forget the tens of thousands of taxpayer dollars wasted on the meaningless carousel of transports, ED evaluations and ambulance rides back home this patient has created in order to exorcise his personal demons, and ESPECIALLY to not consider for a moment the possible patients we won't get to help while we are performing yet another fruitless transport -- the father of four who suddenly goes into cardiac arrest, or the 72-year-old CHFer woken from sleep by the suffocating presence of lungs filling with fluid.
Thankfully this nightmare scenario hasn't happened. But it's only a matter of time, I think.
But telling him so won't do any good and may in fact cause me significant grief.
So as much as I'd like to tell this patient exactly what I think of what he's doing, instead I smile.
We can't go to that hospital 20-miles away, I say. We are, though, more than happy to bring to the hospital of your choice in The Big City, about 5-miles away.
He is appeased, and within minutes we're on our way to the hospital once again, both of us certain in the knowledge that this won't be the last time this particular patient will make this particular trip in this particular ambulance.