November

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.

Growing up in EMS: Lesson #53

“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.

Another Day In The Life

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?

Newbie A Newbie: What To Bring For Your First Shift

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 On The Ambulance…

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?

 

Awkward Report

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.

Angels

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.

Rant: Snoozing Partners

I can’t stand it when my partner* falls asleep on the long rides back home.

There, I’ve said it. I feel kind of guilty about it, but I’m writing it nonetheless.

It’s not uncommon for us to go on runs where the drive alone–one way–is 75 minutes. The drive can be incredibly boring. Combine that with a long shift, and a very late hour, it’s easy to see how one can get tired.

Now, I know we’ve all been there. You finally reach that point where the only things caffeine does is make your hands tremble, and your stomach rumble like an angry grizzly bear using a chainsaw in an earthquake. You would give absolutely anything to get comfy and curl up in bed, or any other remotely horizontal surface. Your eyes are bloodshot. Your eyeliner is running into the bags  under your eyes, or your 5 o’clock shadow is coming in nicely ahead of schedule at 3 a.m. (Or, maybe both. Who am I to judge?) In general, you just feel awful. The notion of sweet, sweet sleep is never far from your mind. When you start making up the cot and communicating with your partner in a series of grunts, gestures, and looks, you know that you’re both getting to that point, and can’t wait to get back to the station for the relief crew.

I get in to drive, and my partner climbs in the passenger seat. Not 10 minutes down the road, I hear him snort and snuffle. A quick glance over confirms that he did, indeed, fall asleep. I spend the rest of my drive silent and frustrated that he gets to sleep and I don’t. I can’t turn the radio on to distract myself from fatigue, because he’s asleep. Obviously, this also means I have no one to talk to.

It’s petty and stupid, I know. But being super exhausted when this all goes on doesn’t exactly bestow me with the patience of a saint. And we all have those little things that irk us. Right?

Ranting over.

*Actually, several partners, not just one.

EMS Week 2013: Knowing and Not Knowing

About three years ago, I carefully stepped down this short hallway, not all too certain what to expect. The hallway opened into a small, practically empty room. A dusty mammoth of a photocopier sat in the corner beside stacks of office paper. A few framed photographs adorned the otherwise blank white walls. The new summer sunlight streamed through a small window near the ceiling. An open door in front of me led into an even smaller room, lined with cluttered desks. To my right was an open door with a sign saying “PERSONNEL ONLY”.  I froze up, awkwardly standing in the middle of this room in a place I clearly didn’t belong.  What was I doing here anyway? Just as I turned to look at the now very alluring front door behind me, a voice asked, “Can I help you?”

I snapped my head back from over my shoulder, suddenly very aware of how out of place I seemed. I swallowed. A man with salt & pepper hair stood in the doorway, a quizzical but friendly expression on his face? Was he always there? How did I miss him before? He must think I’m crazy for just wandering into this station.

“Uh…hi. My name is Probie To Practitioner. I’m here to uh…see if maybe I could…work on an ambulance?” It was more of a question than a request. The words felt strange coming out of my mouth, and even stranger to my ear. You? On an ambulance? You’re afraid of your own shadow. You’re afraid of talking to this man here. And you’re trying to do what??

He grinned broadly at me. “Ohh, you’re the one who called earlier! Come on in! Let’s show you around, see how you feel, and go from there. Alright?”

“Hey, wanna show her around a little? Show her the ambulance or something?” This gentleman asked a short paramedic, with tired circles under his eyes and a welcoming half-smile on his face. The paramedic agreed, stepping into the doorway, and making a motion for me to follow him. He walked through the door that said “PERSONNEL ONLY”.

This was where I hesitated. I stopped, mid-step, and mentally told myself “No, you’re not ‘personnel’.” I spent a moment internally arguing this point. I just felt odd, barging into the personal space of a place filled with prestige, courage, and tradition. It wasn’t something I was a part of. I realized how stupid I would look, awkwardly posed outside the door, and how much more stupid I would sound trying to explain my reasoning to the paramedic. Quickly, I hurried through the door, catching up with him.

I followed out into the bay, smelling of cool concrete, metal, and rubber. The rest of that afternoon would be spent with an awed smile on my face, feeling like I was half in a dream, going through an ambulance check with this paramedic.

It was a peculiar moment of knowing and not knowing.

At the time, I didn’t know that this station would become my second home. I didn’t realize I’d walk these carpets thin. I didn’t know how many roaring laughs and gravely whispered conversations would reverberate off these walls. I didn’t know I’d be spending countless hours here. I didn’t know that the cool smells of the bay would become so relaxing and cleansing to me.

I didn’t realize that the paramedic who showed me an ambulance for the first time would go on to be my mentor, and one of my dearest friends. I didn’t realize that these same people I had held in my mind as heroes, would one day be held in my heart as family. Some would move. Some would leave. Some would die. Some would come and stay, others would come and go. I didn’t know how much they would do for me.

I didn’t realize the lengths to which I’d go when I was here. I didn’t realize what this job would ask, demand, and take from me. I didn’t realize how much of myself I’d give to this field, this lifestyle. I didn’t know how EMS would bend me, push me, and teach me. I didn’t know how much it would make me grow. I didn’t know how many lives I would touch, or to what extent.

Despite all that I didn’t know, I somehow knew one thing: I belonged here. It may not have been a conscious thought; even if it was, I’m sure it would have been drowned out with all the other thoughts of self-doubt and disbelief. But I felt it. I felt it in my heart, and in every fiber of my being.

EMS Week 2013. We have one mission. We are one team.

And I am beyond honored to be a part of yours.

I Guess We’ll Find Out

I’ve officially passed in my last final. The backseat of my car still has my duffel bag full of extra scrubs. A dozen or so textbooks and study guides are still sitting on the kitchen table. A few beat up notebooks full of lecture notes are still loaded into my backpack. My laptop is still loaded up with old PowerPoints. And my brain is still guilt-tripping me for indulging in fun things. But, slowly, it’s starting to dawn on me that the year has come to an end.

I’m still reflecting over everything that’s happened. Obviously, I’ve learned a lot about physiology and nursing care. But, as cliche as it may sound, I’ve learned so much about myself, and I’ve grown into a much stronger person.

At the beginning of the year, I found myself crying. Like, a lot. There were two main reasons for this: academic work, and social challenges.

For the most part, school has just been something I’ve been fairly good at. Some people can learn in a classroom, and others can’t. I could, and without too much difficulty. For the first time in my life, I’ve had to really really work at something academically. I couldn’t breeze into the lecture hall on exam day and crank out a decent test score. I spent hours upon hours of studying, hoping to get a grade that would somewhat reflect all the work I’d been putting in.

Like I’ve ranted about so many times before, many of the students were just plain mean. As a pretty sociable person, I’d always been able to make at least one friend wherever I was. But for much of that first semester, I was struggling to even find people to be friendly with. Nursing school was far more cutthroat than I’d anticipated. It ranged from petty name-calling, to blatant verbal attacks. I’m a pretty sensitive person…and suddenly, there was all of this stress and drama, and I had no one to lean on. Well…no one to lean on but myself. But I didn’t realize that at the time.

Many all-nighters, tears, and near-breakdowns later, and I find myself almost finished with this year. One day, right before lecture started up, a few students asked the professor about an assignment that they felt was being graded unfairly. I’ll spare you the boring details, but it basically boiled down to a discrepancy in the rubric. I attempted to help explain the confusion to the professor. As I was the last one who had spoken, the teacher looked directly at me, and, in front of a lecture hall full of students, said this:

“You know, it’s a nurse’s ability to look at the tiny details and draw conclusions. It sounds to me like you’re unable to do this. I don’t know, but I’m not sure how you’re going to make it in the real world without that skill.”

The entire classroom went silent. The professor probably felt attacked, which was totally unintentional. A few months earlier, I would have probably teared up right there, and bowed my head in an ashamed silence, panicked self-doubts running through my head. But, for some unquantifiable, unnameable reason, the past few months had built me into a stronger person. I’m not sure how or when it happened, but it all culminated in that moment. The moment when a crooked half-smile pushed onto my mouth, and I evenly said:

“I guess we’ll find out.”

Somehow, my skin had gotten thicker. My doubts, while still there, were quieter. The process by which this happened was painful. It was exhausting. It was draining. Worse, it wasn’t just that way for me, but for anyone who knew me. Anyone who I trusted enough to share the details of my crippling doubts. To many, I boldly declared that I wanted out of this school; this program that I worked so hard to get into. I came up with a thousand reasons why I didn’t belong, why I couldn’t do it, why I’d never be good enough. I lunged at these opportunities to work in another field, quickly polished them up, held them high and said, “No, this is what I really want to do. I’d much rather do this. I’m going to quit nursing school and do this instead.” But these confidants, they knew me better. They calmed me down. They smoothed out my ruffled feathers. They pulled me into their strong shoulders and let me cry. They listened to me rant about all the “mistreatments” I’d been “enduring,” and spew out self-pitying statements. And, they gave me some little thing to hold onto. They gave me a little push, a little spark, to keep me going just a little bit further. Just when I’d swear I was through and wouldn’t budge one more inch, they’d convince me to take one more baby step. Soon (probably not soon enough for them), I was taking these steps by myself. I’d tell a story or two about school when they asked, but not much more. I learned to rely on myself. I learned to motivate myself, believe in myself, and get through this on my own. And I can’t thank those people enough for what they’ve done. You know who you are.

To all of you who stayed with me throughout this crazy year, to all of you who posted an encouraging word, to all of you who liked or shared one of these posts, and to all of you who contacted me privately…thank you. You’ve helped me grow, strengthen, and change in ways I’m not sure I could ever truly explain. You guys are the best.

As I decompress over the next few days and start to soak in my newfound freedom, I’m sure I’ll come up with more self-examining posts. It’s been a hell of a ride so far, and I haven’t beaten this dead horse nearly enough.

So, again, thank you.