My old partner and I had a code word for patients that take blood thinners. We are both medics, and we both like to just put the patient in the truck and sort our call out without screaming bystanders. Often, we would both be in the back, who ever was teching the call would be doing the patient care stuff, and the other would be looking through scraps of patient info and med bottles finding clues. If a patient happened to be taking a blood thinner, the detective partner would say, ‘Signal 30.’ Which in our service means going back to base to de-con. The other would then prepare the inevitable 4x4s needed to clean up after the iv. I always passed the 4x4s and went right for a towel.
I suck at tamponading.
The most dangerous part of EMS to me is getting dirty. Blood, puke and other body fluids are gross to walk around wearing. I have partially disrobed in the trauma room before, and I’ve been greeted with stares from some of the baby doctors. I always choose the clothes under my work clothes with care. Do I want my coworkers to see me in this? No skanky tank tops under the work shirt for me. Sometimes a girl just needs to be able to strip off a layer that is speckled with blood and grey matter.
There are a few moments during a nausea/vomiting call that scare me more than any other unsafe scene you could throw my way. Gun shots ringing around me? The crisis patient grabs a knife? Pulling the dirty needle out of a heroin od’s arm? I feel nothing. Make me be bottom while stairchairing a green, gagging patient and I quiver in fear. I find myself trying to make small talk, with the patient’s family, police, the landscaping while I avoid putting the straps on stretcher. Its a very vulnerable spot to be in, leaning forward in front of the patient, cursing the Gods of EMS for giving you a cot with those pathetic short straps on one side and the needlessly long ones on the other side, just waiting to see your arm covered in some one’s idea of a good midnight snack.
The worst is when the things that are coming out of a patient still hold some resemblance to the things that went in. I can no longer eat Spaghetti-Os for that reason. Ramen Noodles are just going back on my list of okay foods next month, and show me Campbells Chicken Noodle Soup and I will puke all over you.
Just because foods are liquid based doesn’t mean you don’t have to chew them people!
One night we picked up a handcuffed, combative patient. He had an above the elbow amputation on his right arm, and we were talking to pd about the safest way to restrain him for the transport. He had been drinking for hours and told a friend he took the ubiquitous “handful of pills,” so he needed to go. After watching him try to knock some sense into himself against the window in the back of the cop car, I finally just said, ‘Alright, we’ll just 4-point him.” Dear patient, who somehow heard this, started waving his amputated limb and screaming “3 POINT MOTHERFU*@ER!” Once we pulled ourselve together and got him, my partner, and an officer loaded into the back, we took off. My partner dials C-Med, and as she’s giving her report, I hear her say, ‘Are you going to vomit!?’ She hung up the mic, and I saw her, through the rearview, jump up on the bench and take the bag with her. The police officer was not as fast or puke avoidance savvy. It wasn’t my tech.
Which means it was my cleanup.
Some people say they’re going to puke and they make these cute little gagging noises, and spit a bit into a convienence bag. Some people say they’re going to puke and then spew forth vile from the depths of hell with force enough to knock out the back windows. The people that really worry me however, are the ones that say nothing at all. They have a few fingers pressed to their lips, their skin is transparent. Their eyes are half closed and you can see them willing themselves not to let go of their lunch. The stuff that comes out of those patients always makes me want to ask if its just corpses and feces in their diet, or if they also eat other things….
A friend of mine got injured in a fire tonight. Some smoke inhalation, a little heated airway trauma for your Friday night. Its nothing major-in the sense that he’s not tubed in the ICU-but major in that whole, friend injured kind of way. I have the greatest fire friends, I truly do, but this one friend in particular had said something to me about 8 hours before his injury, we were bidding each other the standard pre-shift safe wishes. He said, ‘I won’t get hurt- I promise.’ You’re thinking the same thing I am, I’m sure. And its kind of heartbreaking….to me at least.
I told you I was going to see you tonight…
He’s a new-ish friend. We’ve been coworkers for my entire EMS career, but have only recently started to talk. We’ve worked together a few times now, and on one shift in particular we spent all night running calls and just talking. The calls were simple, we both missed lines-me because my partner made me nervous, him because his patient evidently was part alligator-we teased each other and had easy banter with our patients. It was just one of those shifts that went well. Just a good vibe all around. He started the shift not unlike I start my shift with new basics. With The Rules. Mine are simple and mainly revolve around you-new basic-not killing me-mother of a 2 year old-with your driving. His however were a bit more detailed:
1. No protocols on the overnight. We do what our patients need and we’ll sort the rest out later.
2. We get dispatch a coffee at midnight. This is how things used to be done, it may be brown nosing, but we’re bridging the ever expanding gap between road crews and comms.
3. Lower the bar, you’ll be less disappointed.
In between calls we talked about the usual stuff that people talk about at 3am. He talked a lot about the psyche of people in our particular line of work. The theme seemed to be that we’re inherently selfless and selfish at the same time.
That’s an interesting way to look at things, selfless and selfish. He said that we have a need to feel what we feel when we’re helping someone else. We crave that pat on the back that comes from a job well done. We can, and do, function without the accolades that the job merits, but he was right. I often look at my looming EMS day as getting on stage. The lights flashing, the family and first responders holding their breath until I walk through the door. Me. For a trauma or medical 911 phone call, I am the star of the show. That’s the feeling I crave, the selfish part of what I do.
This feeling has come to live in me at all times. I perform all of life this way. Like my medic instructor said, ‘You have to be like a duck. Calm above the surface, paddling your ass off under water.’ Try throwing something my way that messes with me. Its a unique perspective to have. Broke? Car trouble? Failing marriage? I’ve held dead babies.
I get why firefighters do their thing. I do. Its personal gratification. Its a bigger, more obvious job well done feeling at the end of the day. But I hate it. I hate it so much. Let shit burn to the ground. Seriously. I really don’t care if your entire life is inside that house. Why not just surround and drown? Ok. Maybe if there are kids, or elderly people inside, do what you can. And by all means, throw up the ladder and let an able-bodied adult climb down. But don’t go in!
I married a firefighter. He wasn’t on a department when we married, but I knew it was his ambition, and sure enough, 7 days after my son was born, he started a fire job. I resented it. I thought-without actually putting it together-that it was selfish and selfless.
If you DIE, in a god damn FIRE, what do I tell your son!? ‘Here’s the better part of half a million kiddo. Daddy died trying to save some kid’s dog. Consequently THAT kid’s dad wouldn’t go in after the dog himself. And he’s fine.’
Fires are rare. Especially in areas with large amounts of new construction.
We are trained to do it safely.
We protect life first, property second.
All shit. All complete shit to me. If my home were burning, and my child was safe-which he would be because I would crawl over hot coals to ensure his safety-I would demand that no one went inside. Let it go. Baby pictures? Family heirlooms? The last letter gramps wrote gram before he was killed on Omaha Beach? Fuck it. What is more important than life? People think, ‘it’ll be ok, the fire department will come, they’ll save our home.’ Fuck your home, those are men and women walking into your ‘unsafe disposal of smoking materials’ fire. That’s someone’s most favorite person in the whole world. Let’s risk their lives so that your mother’s wedding china can live to see another holiday.
Its not just about assigning value to things we choose to protect though. Here is what I was told. Here’s what starts the mending of my heart. It came to me, via text, from another guy who was at that particular fire. He sent it after I met them at the hospital, watched them wheel in my new friend, sucking on an updraft and sounding like a 70 pack year smoker, after I professed my anger.
I know you’re pissed and I get it, that’s a rotten thing to have happen to a friend. We don’t like it either, he is like family to us. Try not to be too hard on him he takes a lot of pride in his job like we all do. Despite how we may talk from time to time we are not all cowboys, and speaking for he and I at least, we don’t think of this as an extreme sport with a paycheck we take the risks seriously, and do what we can to do things safely. Sometimes bad things happen on the job, but that’s true of all public safety jobs
He’s right. Sometime bad things happen on the job. According to the US Fire Administration, in 2010 there were 85 line of duty deaths in the US. Bad things. A small number I suppose, but here’s a large number to think about: 1. One firefighter, your firefighter, killed protecting someone else’s life. Someone else’s property. Bad things.
I’m blocked folks. I see so much every where I look. I’m full of as many emotions as someone like me is capable of right now. And yet nothing. There is nothing in here that is coming out in any cohesive fashion. I’m writing about my writers block for crying out loud. I’m walking around in the world as if I’m new here. All of a sudden, I’ve created a situation where I’m discovering that I’m a person in addition to being a mother, and a medic. I feel every step toward figuring out who I would have become had I not spent my early 20s starting my family is a step away from my little guy. How is that fair? Does my identity have to hinge on being a mother? And if the answer is yes, yes it does, what’s wrong with me that yes is not the obvious answer? Who am I? What the hell am I doing? Its 0220. What the fuck is my problem?
One of my favorite basics has had a few calls lately, on a double basic truck, where the unspoken implication was that a medic would have been helpful. They went lights and sirens, he describes the patient presentations as pretty serious. It was more than one call and so I finally broached the subject of calling for ALS. Now, keep in mind that I adore this basic, we have amazing, thought provoking conversations, I totally respect him and I think that he’s going to be the kind of medic that I would want taking care of my son if needed. His response to calling for ALS was, “fuck ALS” and my heart shattered a bit. Here I am, riding high off the fact that I am the end all be all in the pre-hospital arena, and a basic with a lead foot that can make it 10 miles in 13 minutes makes me obsolete.
Why is that basic making me obsolete?
Because I (not me of course, but my peers) have so degraded him with my paragod complex, that he would sacrifice 4 minutes of a higher level of patient care so as not to spend the next 6 months getting shit every time I see him. Do you blame him? Its a tough call to make. What’s best for my patient vs what’s only a little less good for my patient and keeps my self esteem and working environment intact.
As medics we have a responsibility to address the low performers that are dragging us down. You cannot tell me how bad the basics around you are and then bang out when you get split and put with one. How do they learn? Us. They learn from us. We are given more responsibility for a reason. With that responsibility to our patients, comes responsibility to our coworkers who are putting in their time to become our peers.
This all being said however, let’s have the conversation that’s being murmured and not really acknowledged. What is the best way to make a basic and more, a whole fleet of basics, people that you would be happy to work with? What do you say when a basic screws up that helps them learn, and doesn’t destroy their desire to learn from you? First of all, we need to agree as medics, that basics don’t make patient care decisions. That is not their job. I’ve said it before. It is no ones place-basic or medic-to dub a call complete crap. Its just not. If you think what you do in the field is 80% BS, then go be a tech in a cath lab. Every patient is serious, no one will care about your clinical ability of course, but you’ll spend your day helping people that even you must feel ‘deserve’ your attention. We serve the populations we serve for a reason, and that reason is not the issue here.
So a basic spends 14 minutes on scene, gets loaded up 2 miles from the highway and then calls for ALS. Maybe they did a CYA call in which case when dispatch asked them if they wanted to meet me just off the highway (a mile away from the hospital) they would have said, ‘No, its ok, we’ll just go to the hospital.’ It wasn’t a CYA call however, because they agreed to meet me a mile before the hospital. They thought they needed me.
The call was a call that I would have teched over my basic partner had we first responded, it was difficulty breathing, but this was not the situation where I do my cmed report and demand a bed and respiratory waiting on my arrival. In fact, I would have given a basic in medic school ample scene time to do an assessment and decide on a treatment plan, ‘play medic’ if you will. It was a run of the mill ALS call. A dozen basics would have BLS’d it in no problem. What do I say to those basics when we turn over patient care?
Here are some options:
“Hey, jackass, thanks for wasting my time.”
“Glad I was in the back of your truck with granny there while that kid was coding up by the school.”
“So, why did you call ALS?”
Let’s say it together folks, the only way to approach this situation, is to hear them out. To seek to understand what their thought process is. Isn’t that one of the rules for good communication anyway? Look first to understand, then to be understood. I didn’t actually do that in this case, my tendency was to just clear quickly so they would know what a small deal I made of the call. I was remiss in this situation, it was a learning opportunity that I sacrificed. Even I have to fight the behavior to think less of a crew that uses such thinly stretched resources when it didn’t change the patient outcome at all.
Here’s another one for you. I did a call recently, a trauma code with 3 basics. I screwed up big time, couldn’t tube, no access, no drugs, it was a mess. Two basics in the back and I couldn’t get anything done. Totally my fault. What was not my fault however was that third basic not listening to my directions and holding the whole game up. We were in a geographical situation where my truck was far from the patient, and by the time we realized it could get closer-there was an alleyway we could use-they showed up and put their truck where we needed the truck. I had this basic running, getting the things from my truck that I didn’t bring to the patient because I was planning on extricating quickly, I had no idea I would get another truck. She was incapable of listening before moving, and because of this, she ended up running a half mile with gear, instead of just listening closely and making one trip. She also never thought to move my truck closer to hers-I don’t fault her for this, but the initiative would have been appreciated. Then she threw us around on the drive, while I repeatedly told her to slow down and take it easy, and after 3 or 4 times, I realized that my bottom was still coming up off the captains chair with every bump we hit as I’m trying to tube. Then, and this may be the most aggregious of errors, she lied to me about the total call time. I yelled up front, ‘when you call out, ask for and wait for a total call time.’ She said, ‘what?’ And I repeated myself, giving her the exact phrase to say and exactly what to do-as if she’s never done it before, which, for all I know, she hasn’t. I walked into the trauma room, was asked for the total call time, and looked at her, she shrugged her shoulders, turned bright red, and said, ‘uhm, 10 minutes?’
The actual total call time was 28 minutes.
When we transferred patient care, I walked out to the ambulance bay last, and noticed that my basic was getting into their truck to help clean up. I pulled her out and pulled her aside. I explained to her the things that I did wrong, or just failed to do in general, the ways that I messed up being the senior tech. Then I told her the good things that she did; consistent cpr, good bls airway management, and moving quickly. Then I told her what the other basic did wrong. In this explanation I included that we were going to let her do the lions share of the cleaning, and do it alone. She seemed taken back, we work together a lot and she knows I’m not an inconsiderate medic, if I make a mess, I help clean it. I told her that its punitive cleaning. If you’re a basic, in the back of a truck, cleaning up after a veritable shit show all alone, then you should know that it means you screwed up. And not screwed up patient care wise, those screw ups are mine and mine alone, but you didn’t listen to my directions. You didn’t follow through when I asked something of you, and not because you couldn’t, but because you were careless.
Now we have the, ‘Why did you call ALS?’ conversation vs punitive cleaning to teach a basic what we expect from them. They seem to be perpendicular schools of thought. You can’t believe in one and believe in the other, they’re opposites, they’re completely different ways to teach. But the thing is, I do believe in both. I believe that we need to take care of road problems on the road, with whatever we can use in the situation, and at the same time we need to talk freely about being better, and ways to learn from every call. Ideally, I would have seen the punitive cleaning through to the end, and then taken her aside and talked about what went wrong. I didn’t. And that’s my fault, yet again, for letting the learning portion of the game pass un-utilized.
You, my friend, have not made it yet. I know how you feel. I remember that twinge, that cringing inside. I remember feeling sick and heart sick. You need to hear some things, and I think I’m the one to tell you.
When you were a basic, and you looked at those few medics as if they were super human and all knowing, you weren’t completely off. No one is all knowing, obviously, but they knew the important stuff, they knew the heart of the job, and you will too.
You knew, as a basic, that you had the potential to be good. As a medic, you just need to find the courage to let yourself be good, the faith in your skills required to steady your hands, and the peace of mind to let your instincts run the show. Don’t ever ignore that queasy feeling you get sometimes. Don’t be too scared to listen to it.
Stop letting that voice in, ‘they know you’re faking it….’ You’re not faking, you’re learning, you’re putting your feet firmly on the ground and taking one step at a time. There’s nothing wrong with that. You are beating yourself up in ways that will affect the quality of the rest of your life. You are destroying your self esteem, and for about 8 months, you will pay dearly for this. People only treat you poorly if you treat yourself poorly.
Stay attached. There is nothing wrong with caring about your patients. Put them in a corner of your heart and take them all with you every day. Feel compassion for every single person that you treat, if for no other reason than the fact that you may be the first or last to give them that gift.
Be generous with your praise. There are people around you that are harder on themself than you are on yourself. People deserve to hear when they are doing well, and some people may look at you the way you looked at those medics before you-you could change a career path with a few words, just like long ago your path was changed.
Remember every day that it’s an honor to hold this title. Each and every single day of your career, there are people in the world that respect you just for punching in. And as much as people are lucky that you’re responding to their emergency, you are lucky for the experience.
One day you’ll have a zen moment while getting tossed around in the back on a priority 1 trip to the hospital. Time will slow down and your thoughts will be clear. Your patient will be dying, you’ll have no help, and you’ll have to make a decision. It will be easy. It will come to you in that exact moment. You will know what to do, and you will be right. In the sense that if that person never called 911, they would have died, you saved their life. You saved their life. Don’t let that moment pass by. It will define you, and all your moments from then on. Feel overwhelmed by the emotions you feel about that call. That day will fundamentally change you, and you’ll finally feel like you’ve figured it out.
Every night at work, almost without fail, between 3 and 4am, I experience a little crisis of sanity that I like to call, ‘hitting the wall.’ If its an appropriate situation, I will look my partner dead on and say to him or her, ‘I have hit the wall’ in a very serious tone of voice. If I have a good partner, they will understand this phrase to mean that they should tread carefully. When a person has hit the wall, all rational thought goes right out the window. Decision making abilities are clouded. Personal thresholds for stress and anger are lowered to the barely human levels.
Last week, during my wall time I hallucinated. Literally hallucinated. I was not asleep, but I saw things that were not there and laughed at words that were not said. Uncontrollably laughed as a matter of fact.
It has been said recently by a close friend that I am playing with fire. I recognize this to be true. I have made some personal decisions in my life over the last month or so that I might not have made if not for my new found wall time. In the bleary haze that takes place before the sun comes up, I have trouble seeing myself as being 27 and unhappy with life. It doesn’t make sense. What is it about the night that helped me come to that realization? I don’t know. Maybe its just being tired and trying to reconcile my current life with that exhaustion. Maybe its an early life crisis. Maybe its the calls that I do, the people I see at night that remind me that the 60 years I have left are short ones, and not meant to be wasted. Maybe its the feeling of constantly waiting for the other shoe to drop-which isn’t exclusively an overnight feeling.
Sleep deprivation heightens the senses….briefly…..before it shuts them all down.
Either way, I’ve come to crave wall time. The recklessness that comes from being tired and blurting out words that fall under the ‘best left unsaid’ heading. They’re the things I’ve meant to say all along, but I needed the carelessness that comes from no sleep to spit out. I feel like a more real Angela. I feel like I am who I am meant to be. I feel happy to be a round peg trying to shape a square hole.
I would trust you with my life.
Is that the implication when someone calls 911 and lets you into their home in an emergency? Yes it most surely is. It’s a careless implication however, it’s not born of personal knowledge, or any sort of trust that has to do with something besides the fact that you happen to be wearing a uniform and carrying a bag full of magical tools to help their loved one.
What about when a comrade says it? A fellow provider. A pal. Someone that knows your work. You have seen their steady hands intubate a baby. Someone whom you’ve looked at to ask to get a med and they’ve already drawn it up and cleaned the med port. When that person tells you that they would put their life in your hands, what does that feel like?
It feels like coming home.
It feels like those months of destroying myself over a bad call have been erased, forgiven by the God of EMS. It feels like the bleariness and total self-destruction that was life during medic school was worth it. It feels like I’ve become respectable. No longer trying to prove bare competence, but walking around under an umbrella of excellence. It’s a bit of strength in your step. Some confidence in the arsenal for the next bad call; maybe I’ll be thinking, ’wow, that was a tough one,’ and not, ’oh man, I’m fired.’
This is not an easy job. There are not concrete milestones to success. Every day is new, every patient is different, each situation challenges a different part of us. You can be a supervisor, an FTO, a ‘senior medic’, and still screw up. In an office, there is always that one person that knows it all; the go-to person. In EMS, it’s not quite so simple. There are days when the ‘go-to person’ has no idea what was wrong with the patient. It’s not black and white. I’m not going to get to the point where I know what every call is going to be. Such is the nature of the beast I suppose. Success, while in another field may be a promotion or a raise, in EMS means inspiring confidence amongst peers. It’s also about embracing the helpless feeling that comes from finally deciding to stop beating myself up. Not because I don’t care anymore, but because I know that I care enough. I know that I am walking around, doing my best, and sometimes, my best isn’t enough. That’s not my fault. I’m not mediocre, a patient’s life doesn’t hinge in the balance, waiting for me, or the next medic to see if they will live or not. I’m as good as that next medic, but sometimes the cards fall where the fates mean them to regardless of intervention.
It is what it is. It’s what I love.