“Huh, interesting,” I thought. I was being sent up to the ER to assist with a transfer to another, larger hospital. “Interesting, but not particularly rare or unusual.”

I’d seen this diagnosis numerous times. Hell, I’d seen this presentation for this diagnosis a couple times too. When asked if my assistance would be needed, the doctor sucked on the inside of his cheek thoughtfully, and finally said, “The patient will probably be alright. But, eh, it wouldn’t hurt to stack the deck.” And that’s how I became a second set of hands in the back of the truck. If you were superstitious, you might say I was sent with the intention of being more of a good luck charm than a second practitioner. If you weren’t, you might just say I was a poorly allocated resource.

Four-leaf clover or unnecessary weight in the back of the truck, I was happy to be going along on a transfer with a pretty sick patient. Even better, a pretty sick patient with an anticipated positive outcome. Sounded like I was going to go home that night content with the somewhat false knowledge that I helped a little bit today.

Our patient was a sweetheart. Polite, witty, intelligent, friendly, but definitely a bit nervous and frazzled. She had a dog that needed walking, a yoga class to get to, an upcoming vacation to pack for. This trip to the hospital was not planned in her tidy schedule. Her husband stood at the door, fidgeting with his jacket, occasionally taking a few paces forward and a few paces back.

We got her settled on our stretcher, and hooked her up to all of our equipment. Explanations were sprinkled with light jokes, which seemed to calm her somewhat. In short order, we were ready to load her into the ambulance and get on our merry way. I started for the door when I felt my partner pull back ever so lightly on the stretcher.

“Would you like to give her a kiss goodbye?” The paramedic offered gently and brightly. The husband sheepishly grinned, and shuffled over to his wife. He kissed her on the lips, then gently on the forehead. He smoothed back the stray, wavy locks that had sprung free from her braid.

“I’ll be over soon. I’m just going to go home, pack a few things, and call the boys. But I’ll be right there,” He promised.

“Take your time. Don’t worry. I won’t be going anywhere,” She dismissed with a smile and a squeeze of his hand.

It was a cute and tender exchange–one that softens my heart for a little whenever I see it. We whisked her away into the back of the ambulance and took off without much of another thought about it. After a few quiet minutes, her concern became evident.

“I never thought this could happen to me. I do everything right,” She said quietly, tears brimming in her eyes. The paramedic set down his paperwork, and fished around for the small box of cheap tissues. Our patient squeezed my hand lightly. I squeezed back.

I picked a line from my mental toolbox. I’d used it plenty of times before, and I meant it every single time.

“Hey. Look at me,” I started gently. When she lifted her eyes to meet mine, I offered a timid, crooked smile. I tried to let my eyes reflect the compassion and concern I had for this wonderful woman. “Do I look scared?” I ticked my head in the direction of the paramedic. “Does he look scared?”

“No.”

“Then it’s okay. We’re doing everything we can for you, and there is nothing about what’s going on right now that scares us, or is making us panic. You’re in great hands. We’re here to help.”

 

I will never use that line again.

 

She thought it over for a second, as a playful smile eased her worried brow. “So, when you guys start looking scared–then I should be scared?” She teased.

“Yes,” I laughed, “Then you can be scared.”

Her nervousness diminished some as she told us about her life. About how her childhood best friend grew up to be a nurse. About how she met her husband at the local lake one summer. About how she turned down his friend’s request for a date because she really wanted to date her future husband instead. About how she went on to be a teacher. About how she loves to make apple turnovers while singing, which she thought bothered her husband (although he never said anything). About how she loves going to yoga in the morning, and taking walks in the evenings. About her small house by the lake. About how the smell of daisies, pine, and pond water always seems to set things in perspective.

I could’ve listened to her forever. That might be my favorite thing about EMS–being granted the privilege to look through these snapshots of life with another person. But, soon enough, we arrived at our destination. We wove our stretcher through throngs of nurses, doctors, and families, we found our room assignment.

I turned to prepare our patient for the sheet transfer to the hospital bed. In a sickening, heart-dropping instant, everything had changed. That rare, potential complication that is listed when consent forms are signed…it was actually happening. It was no longer just words on paper. It was no longer something the doctors say to cover their ass. It was right there, and it was real. And there was nothing we could do about it.

The changes were subtle, but rapid. The next few minutes were a blur of gloved hands, quick assessments, urgent murmurs, and STAT tests. A frustrated doctor cursed in the hallway. Nurses were preparing to take our patient to other departments, other rooms; somehow heading simultaneously towards and away from hope. We all knew what the results were going to say, but we needed to see the physical, undeniable damage to permanently extinguish the ever-diminishing hope that maybe this won’t be so bad.

As we passed the stretcher to the staff, our patient grabbed my hand, nearly pulling me over from the momentum of the rolling gurney. Her glassy eyes searched my face. My eyes probably betrayed my fearful, worried interior that I tried to mask with a stoic, serious face.

Barely lucid, she mumbled, “I’m scared now.”

I squeezed her hand and swallowed hard. They took her away to care for her as best they could. Approximately ten minutes later, she was unconscious. She would never wake up again.

My crew and I cleaned the stretcher and ambulance, occasionally muttering something to reflect our disbelief. We stood in the ambulance bay, taking in the skyline of this foreign, distant place. On some street between here and home, is a husband driving over to check on his lovely wife of so many years. A bag is packed and sitting in the backseat. Maybe an apple turnover is sealed up in some Tupperware in there. Maybe a shirt from off the clothesline, saturated with the comforting scent of daisies, pine, and pond water. And as he sings softly along with the radio, he has no idea that he just kissed his wife goodbye for the last time.

We sighed. “I can’t believe…” We’d start. “It happened so fast…” We’d try. But in the end, we were left with nothing but the road noise and a quiet, sad shock.

“We can’t prevent everything. We can’t treat everything. Some things you just don’t see coming,” The paramedic said numbly. “But you can always let them say goodbye. You can always give them that minute. You just never know. It might be the last time.”

Working for an aeromedical transport team wasn’t always a goal of mine. It wasn’t something I’ve always wanted since I was little (although there is a picture of my 3-year-old self wearing a medic’s helmet and grinning broadly in a helicopter in a photo album somewhere). It wasn’t part of the reason I got into EMS. But my fascination and desire to earn my wings grew steadily over my short medical career.

The first time I ever saw a flight crew, they were coming to pick up our patient in the hospital. My preceptor tried not to smile when he saw the awestruck look on my face. They  were  calm, and collected. They walked with a swagger into our ER. They asked these questions with big, fancy words. And, okay, I’ll admit it, they looked so cool in those swanky flight suits. As they loaded up and prepared to head back to the helicopter, a nurse asked one of our paramedics if he could help carry some equipment back to the bird. He agreed, before handing a bag to me. He knew how badly I wanted to watch a helicopter take off, and that I’d never seen one before. I carried the bag with pride out to the helipad, and watched with total awe as they took off. When I got back to the ambulance, my preceptor chuckled at my obvious excitement. I told him I wanted to be just like them. Always supportive, he told me that one day I could be.

To this day, watching helicopters take off and land through my classroom’s window is a great tangible reminder as to why my butt is growing numb in those awful plastic seats. I can do this. I will do whatever it takes, and I will get there. It won’t matter how many all-nighters I pull, how many tears I shed, or how frustrated I get. I will get there, some day.

Just imagine my elation when my old preceptor handed me a ride-along application packet for a aeromedical critical care transport service. When I was accepted, I marked the date down on my calendar. It gave me something to look forward to, amongst the boring clinicals, personal problems, and seemingly impossible countdown until graduation. Soon, I would finally get to spend a few hours living the life I wanted so badly.

That day has come and past. The experience was a mixed bag.

I loved the crew I was with. Everyone was so friendly. There was such a camaraderie, and it was everything I could have hoped for. It just made me want to be a flight nurse or medic that much more. I was practically shaking with excitement went the helicopter was pulled out of the hangar. Everything inside me lit up with happiness as we lifted off.

The flight made me feel a little funny. I wasn’t exactly nauseous or dizzy. I just felt that familiar general strangeness I get whenever I fly in airplanes. It’s not uneasiness or sickness. Just this very subtle difference. When we landed, we piled into the back of an ambulance. It wasn’t anything like the ambulances back home, but it was oddly comforting to me nonetheless. I was standing in the ER, maybe a full three minutes after we’d landed, when it hit. I was overwhelmingly nauseous and dizzy. I leaned up against the wall, and tried to pay attention to what was going on. (I wasn’t allowed to engage in patient care–even to help lift–anyway, so I wasn’t missed terribly.) Now I started shaking with nerves. What was I going to do? Here I am, feeling absolutely awful, and I still have two more flights ahead of me? There’s no way…

Oddly, when we got back into the helicopter, I felt fine. The patient was hardly labor-intensive, to put it lightly. But the nausea and dizziness just evaporated. The flight was flawless. Again, maybe three minutes after we’d landed, I felt that disorientation, dizziness, and nausea creep back into my body. Nobody else seemed to notice, but then again, I wasn’t needed or asked to do anything. I continued to feel crummy for the flight back to the hangar. Although I started to feel better back at the hangar, my stomach didn’t fully recover for an hour or so afterwards.

There were so many things I loved about my opportunity to fly. But, it’s all dampened by this huge overwhelming fear: what if I can’t do this? What if I’m extremely prone to being airsick? This isn’t something that can be fixed with better grades, more studying, more experience, or more certifications. This is something I can’t control. To be stripped of this dream terrifies me. It has completely flipped everything around. It’s made me question and worry about so much. I hate to have this goal, this dream, this desire that has fueled so much, be completely snuffed out. All because of one glitch in my stupid body.

I’ve talked it over with a few people who have flown. Most have told me not to worry about it. I had literally scarfed down an entire Tupperware container of ravioli in three minutes before the mission because I could practically feel my blood sugar dropping. (I hadn’t eaten all day because I was so excited…don’t do that.) I had slept three hours the night before, worked the entire day before, and slept another three hours the night before that. It’s safe to say I was pretty sleep starved and running off of pure adrenaline, excitement, and caffeine. I’d also never flown in a helicopter like that.

I’ve been told that practically everyone feels airsick at some point in their flight career. That I’m willing to accept and take as it comes. My fear is that airsickness is my baseline, but I won’t really have any way of knowing right now. Is it possible that my sickness (which oddly only happened after I landed) was mostly due to the fatigue, overly full belly, and inexperience? If it turns out to be a more regular thing, is this something you can “train” yourself out of? Would frequently spending time in a small plane help accustom me to being in the air? Could medications be effective?

I’m so desperate for any answers that will tell me that my dream doesn’t have to disappear. I just want a glimmer of hope or good news that says I don’t have to give up and throw everything away. That is perhaps the most devastating part.

I’ve been told by many a good teacher that every interaction with a patient presents a learning opportunity. I really believe that’s true. Each individual allows you to refine your assessments, or practice interacting with people. But, I’m also learning that each patient has a chance to teach you something; give you something to think about.

I once had a very sick patient, going through some very challenging things physically, mentally, and socially. With everything going on and going wrong, one could only expect that he would throw his hands up and say, “Can I just have one thing go right? Can I just have one good day?” I’ve said that myself plenty of times over lesser events. I searched for words. I tried to verbalize my sympathy. I quietly noted aloud that all the gray, rainy days must be exhausting for him.

“But, you know,” He said calmly, looking away as if he were actually physically searching for words, “Even too much sunshine can get you burnt.”

The dull roar of road noise was the only thing that filled the silence as we absorbed his words. He sighed and nestled a little deeper into his pillow.

“Balance, dear. Life is about balance.”

Physically, the drive to Major Medical Center is a little easier when driving a car instead of an ambulance. There’s not nearly as much surface area for the wind to toss the vehicle around when I’m cruising down mountain roads in my car. The drive goes by a little faster when listening to loud music in the confines of my personal vehicle. Emotionally, however, this drive is a completely different story.

In the ambulance, I have protection. Occasionally, old memories start to stir in the back of my mind. But they’re easily buried beneath the more intense focus I have when driving this large vehicle. I can hide in the professionalism I put on with my uniform. I can drown it out when chatting with my partner. But in the car? I have none of those luxuries. It’s just me, the radio, and this long drive that does nothing but dig up old memories.

A year ago, almost to the day, I was making this same journey in this same small vehicle. The same jagged lines of mountains and valleys lay just beyond the metal guard rail. The same bare trees stood in the piles of dead, reddened leaves. The same enormous building sprawled out before me, patient windows glittering in the afternoon sun. The same road wound past the ambulance entrance, where I’d parked my truck many times before, and continued down to visitor parking. And an eerily similar sense of dread settled into my stomach when I put the car in park.

A year ago, I made that drive knowing that, once at my destination, I would play a part in making that ultimate decision for my grandmother: comfort measures only, or aggressive medical and physical therapies. I felt fleeting emotions in a numb, hollow space in my chest: fear, sorrow, grief, strength, anger. It was an awful experience I wouldn’t forget. I just didn’t realize that a year later, I’d be making this same journey.

This time, I’m driving up to go see my father. It was supposed to be a relatively simple surgery for a relatively simple problem. Instead of this quick, easy procedure and recovery, we were met with complications and phone calls, sleepless nights and unknowns, running nurses and worried doctors. A week-and-a-half later, time and progress feels as though it’s standing still.

Something about November, Major Medical Center, and my family. I hope with all my heart that we don’t have to make the same decision this year.

Please keep him in your thoughts. Thank you.

“You are way too young to be this bitter,” My partner said, shaking his head. We’d spent the better half of this drive to a nursing home venting about our separate love lives, or lack thereof. As he backed our truck up in the parking lot, I made that bold, broad, terminal statement that love is stupid. Or maybe I said it wasn’t real. Or that it was for the birds. Really, any of those described how I was feeling.

“Too young? Psh, too old to be this bitter. I know it’s childish and immature. I just can’t help it.”

We grabbed our gloves, our clipboard, and our stretcher. We stood up straighter, smiled, and stuffed those feelings into the backs of our minds–away from the professional exterior our patient deserved. Our patient was sitting in a chair beside her husband. They held hands, and watched the commotion of the floor with quiet, content smiles. My partner and I introduced ourselves to the couple.

“Well, Mrs. Smith*, your chariot awaits,” I said playfully, making a sweeping Vanna White gesture.

My partner offered his arm to support her for the few steps to the cot. Once we got her settled, her husband rose from his chair, slowly and unsteadily. He shuffled over to her, took her face in his hands, and brought her nose-to-nose.

“I’ll see you soon, beautiful,” He said, before planting a shaky, tender kiss on her forehead. She grinned back at him, looking back at him lovingly through her thick glasses.

We completed the run in the usual way, getting her to where she needed to be. My partner and I climbed into the cab of the truck, signed back in service, and hit the road.

“You see?” My partner nudged me. “That right there is why I believe in love. Yeah, getting your heart broken again and again sucks. But that? That lady and her husband? They’ve probably been married like 50 years or something crazy like that. Maybe more! But you could just see it. They got it right. Love is there. It’s possible.”

I’m pretty stubborn, but I have to admit that maybe he’s got a point. We get to bear witness to life and death, good and bad, hate and love; and everything in between. All in all, we’re exposed to some pretty powerful and inspirational things. There’s something to be said about that.

Nursing Assistant: Can you bring in the patient through the employee entrance? I’ll meet you on the other side. Just knock, and I’ll open the door.

P2P: No problem. We’ll scoot right over.

(20 seconds later…)*knockknockknock*

Nursing Assistant (surprised): Who is it?

P2P (also surprised): Uh…ambulance?

P2P’s Partner: Housekeeping! You want mint on your pillow?

You took the class. Studied hard. Stressed for the exams. Took your national/state exams. Convinced yourself you failed all of them and wept softly into a pint (of Ben & Jerry’s?). Found out you passed. And then landed a job as an EMT. Congratulations!!!

It’s been a pretty stressful past few months. I wish I could tell you the stress was over. Honestly, it’s not. It just takes on a different form–albeit, a more enjoyable form (at least I thought so). Soon, you’ll officially be taking your first step as an official EMT: your first day on the job. I don’t know about you, but I had no idea what to expect. But, I’ve come up with a list of things that are pretty important to have with you on your first day. Without further ado…

 

A WATCH – Don’t try and tell me that you can ballpark a pulse by simply feeling it. I’m calling you out on that right now. That may be true of some experienced EMS personnel, but it’s not true of you (yet). Also, you’re going to be recording times on the procedures you perform, the medications you give, and the vitals you take. Sure, some ambulances have clocks in them. I can honestly say I’ve never been in an ambulance where they worked correctly for more than a shift. Just trust me here, and go buy a watch.

You can get whatever you want, but I have some personal preferences for watches. Firstly, I use an analog watch. Watching the seconds count off on a digital watch is just way too confusing for me. It’s like somebody saying, “23, 39, 0, 62, 11″ when I’m trying to count. With an analog watch, I can count in my head and simply observe the time pass in segments. Also, I like a strap that I can disinfect and clean easily; namely rubber or plastic. Also, I prefer the band to be solid, as opposed to having links. You’d be surprised about the gross stuff that can collect in those nooks and crannies. I prefer my watch to be waterproof so I’m not constantly taking it off whenever I wash my hands. I also like one with a second hand that “ticks” instead of “sweeps”; I can’t accurately tell 15 seconds with a second hand that’s constantly moving (sweeps), versus one that ticks out every second. Lastly, I want something on my watch to glow–and not just because I’m like birds and small children when it comes to bright and shiny things. I work lots of night shifts, so I want either the numbers or the face of the watch to light up.

All that being said, I don’t buy crazy expensive watches. My favorite watch was $20, had all of features listed above, and I wore it every day until it broke after 2.5 years of wearing it. And, let me tell you, that thing took a beating. Figure out what works for you.

 

PENS – At least two, at a bare minimum. I go through pens like water. I’m constantly losing them, breaking them, or permanently lending them to someone. True story: I once found myself in the back of a rig on a call with no pens. Even my partner didn’t have one. So I wound up writing all my notes down in Sharpie. That was incredibly hard to read later on, and, frankly, pretty embarrassing. Don’t be that guy me. Always keep pens on you. No crazy colors either–a simple black or blue is good. Ballpoint pens are good, seeing how so many services use that carbon copy “Bear down because you’re making 7,238 copies” paperwork.

 

SOME CASH – Odds are, you’re going to get hungry. Or thirsty. Or under-caffeinated. Even if you’re one of those responsible people that packs snacks and a meal, unforeseen things happen. Your relief doesn’t show up on time…or at all. Your truck breaks down. You don’t have enough time to get all the way back to the station to grab your food. Besides, it’s amazing how overwhelmingly tempting it is to grab at least a little something when your partner decides to swing by Dunkins, or 7-Eleven, or Panda-Wok, or whatever. Keep a little cash on you…you never know when it’ll come in handy. Better to have it and not use it, than to not have it and need it.

 

PATIENCE – This one’s pretty simple, although it can be hard. EMS can be a pretty stressful field. Maybe it’s a call. Maybe it’s the weird hours. Maybe you don’t get along so well with your partner/preceptor. And, to add to that stress, you’re brand new! You’re still getting a feel for how things work. You’re getting to know your new coworkers. You’re getting used to being in a moving vehicle all the time. You’re trying to apply your textbook knowledge. You’re finding out that the real world and the classroom don’t always line up (You’ll probably first notice it when trying to take a blood pressure in the back of a truck. That was a shocker.) And, not for nothing, you’re doing it in a pretty high stakes environment. These are real people, with real lives. It doesn’t get much more overwhelming than that.

Remind yourself that you’re brand new. Your partner/preceptor’s actions and decisions are going to look so fluid and effortless. Meanwhile, you’re fumbling around, untangling the nasal cannula and praying that you put it on right. Trust me, your coworkers were once in your boots. It may  have been last year, or twenty years ago; but they were there. They were just as nervous, frustrated, and overwhelmed. All you need is time, experience, and the desire to learn.

The beautiful thing about being so new in your career is that you can pretty readily remember why you wanted to do this job. Remind yourself of that when you get down on yourself. Even the most seasoned paramedic with the entire alphabet after his name will have off days. You’re human, and you will make mistakes. What’s more, you’re a human who is trying something new. Expecting perfection is unrealistic. Cut yourself some slack, and commit yourself to learning.

 

SWALLOW YOUR PRIDE – Actually, this is the opposite of something to take with you. It’s something to leave at the door: your (excessive) pride. Like I already mentioned, you are going to make some mistakes. When your adrenaline takes over, and you start ventilating someone with a BVM at 60 breaths per minute, your preceptor is probably going to try to do something to correct you. He might not be super kind or subtle about it (If that happens, sorry. Maybe he’s having a bad day.) Don’t snap back. Don’t snarl, “I know what I’m doing!” When someone tries to teach you something, don’t wave them off–even if it’s something you already know. They’re trying to help you. They don’t know you, so they don’t know where to start. Most of all, ask questions. Don’t worry about sounding dumb.

While we’re on the subject, if you don’t know how to do something–say something. If I hand you a glucometer and say, “Can you grab a sugar for me?”, and you don’t know how to do it, tell me. That’s an easy fix. If you roll your eyes and say, “Uh, yeah,” and then spend 5 minutes unsuccessfully screwing around with the device just to prove you’re “not an idiot”…guess what? You’ve proven to me…well, I was going to say “that you are an idiot,” but that’s a little harsh. You’ve proven to me that you possess some traits that don’t come off very well when you’re brand new: lying, pride, and thinking you know it all.

Asking questions doesn’t make you stupid. It makes you seem receptive to learning. A desire to learn more about the field builds the foundation for other providers to trust you. It means that you care enough about what you’re doing to admit where your deficits are, and that you want to fix them. You care enough to want to be better. And that’s huge.

 

Alright, I’ve prattled on for long enough. Stay tuned for Newbie A Newbie: What To Bring For Your First Shift – Part II!

The other night, during a “Q” shift, my partner and I were chatting to pass the time. Somehow we came onto the idea of writing a massive series of books/articles/whatever, describing everything you could possibly want to know about EMS. So far, our collection includes:

The Newbie’s Guide To Surviving Long Shifts: You’re A Machine…A Slowly Rusting Machine

The Magic of Reverse 24′s: Sleep Is What?

Wait, What Day Is Today?

” ‘EMT-B’ Stands For ‘Empty My Trash, B****’ “, And Other Things Paramedics Regret Saying To Their Basics

“I Can See The Head!”, And Other Things You Don’t Want To Hear From The Front Seat

“Patching In” In 30 Seconds Or Less: Nobody Cares About The Patient’s Favorite Color

Body Mechanics For Dummies: I Pick People Up And Put Them Down

Coffee, Pens, and Time: Things You’ll Never Have Enough Of

Words And Phrases You Must Never, Ever Say

 

Any others?

 

P2P: Hey! So, this is Mr. So-and-so. He’s doing alright. Been hemodynamically stable for the whole trip.

Nurse Unsure: Good, good. How were his vital signs?

P2P: ….Yeah. Uh…yeah, those were good too.

 

So…there’s that.

It wasn’t until we were in the truck and moving that I really noticed it. Those eyes. They looked so, so much like my grandma’s. The same cool, celery green that turned that softly blued in low light. I was torn between wanting to stare at those eyes for the duration of this trip, and wanting to look anywhere else.

Those eyes remained closed, mostly. When they did open, they pulled at my heart, reminding me both of the happier memories and the harder good byes. Her gaze drifted around the truck, never really focusing on anything. I couldn’t help but wonder if my grandma did the same thing when she rested on that very same cot, taking this very same journey. I absentmindedly wriggled my hand into hers and lightly squeezed. She very gently squeezed back. We continued on in silence, lost in our own thoughts.

Her lips moved, forming words I couldn’t quite read or hear. Her gaze still hung around me, not at me. I leaned closer, struggling to hear over the road noise. I asked her to repeat herself. She spoke just a little louder, but not quite loud enough. I asked one more time. She squeezed my hand. Quietly, shakily, but certainly, she answered.

“I see angels.”

My heart thudded in my chest. I asked, “What?” more out of disbelief than not hearing her correctly. She repeated herself.

“I see angels.”

It was reassuring, and shaking. Comforting, and shocking. Instilling hope and unease. I’ve seen people die. I’ve heard a loving last testament, spoken with the hope it would be passed on to those who were held dear. But this, for some reason, came as more of a shock. I don’t know what I do or don’t believe in. Maybe that’s why I can’t figure out how this feels.

To this day, I don’t know what to make of it, or my feelings around it.