The Breakdown (And The People Who Helped)

My mind was swirling with a nauseating soup of questions and uncertainties. I felt this sickening pull in my stomach. Yet, it was all muted. I was manipulating red hot emotions through thick welder’s gloves. I couldn’t name it, I couldn’t identify it, but I knew it didn’t sit well with me. I quietly engaged in superficial and meaningless conversation with my partner as we backed into the ambulance bay. I was just politely filling in the silence, while simultaneously trying to figure out what was happening to me internally.

Numb, I climbed out of the ambulance, paperwork in hand. I returned the other crews’ greetings, and headed into the kitchen to grab a glass of water. An officer nonchalantly followed me into the kitchen, and quietly asked, “Are you okay?”

I looked at him, confused. “I don’t really know. I think so,” I mumbled. He patiently waited, watching my face as my eyes nervously shifted around the room. How could I not even know what was going on inside of my own head? I sighed, “I know I’m going to need one of the quieter rooms to write this report. There are phone calls that need to be made about this one.”

His eyes widened, almost imperceptibly, before nodding once. He set me up with a computer in a room away from the commotion of the common area. “If you need anything…let me know. I don’t care what it is…someone to talk to–”

“No,” I fiercely interrupted. “No, I’m fine. I don’t know what my problem is. I’m probably just tired or something.”

“I’ve seen you tired. That’s not it,” He said, looking me dead in the eyes. I broke his gaze, fidgeting with my paperwork. He knew me too well. His tone softened, “If you need anything. Someone to talk to…food…music…I don’t care what. Whatever you need, let me know, and we’ll get it squared away.”

He left me to take care of what I needed to. I didn’t realize it at the time, but he was already working on helping me–even before I properly understood myself. Those strange, detached feelings continued to stir in my head as I went through the familiar monotony of creating the report. And out of nowhere, I just started to cry.

What is wrong with you? I asked myself, disgusted. There was nothing on that call that should elicit that response. I’d run plenty of calls just like that one. This wasn’t some horrendous, gory trauma. This wasn’t a call where the patient was rapidly deteriorating before my eyes. This wasn’t about playing catch-up, or not being able to do a single thing right. Why this time? Why this patient? Why now? Why are you reacting like this? How can you see people horribly mangled and not bat an eye, and then lose it over something like this??? What is the matter with you?

My narrative was getting incredibly long and unruly. While blinking away tears, I wrote about every, single, last, detail I could possibly remember. About halfway through, I just propped my elbows on the table, and rested my head in my hands. I was giving up on holding it together, and figuring out why I couldn’t.

My phone buzzed against the table. Taking a deep, steadying breath, I tried to compose myself and answer it as evenly as possible.

“You sound like hell. What happened to you?” The chief officer on the other end of the line asked. Apparently it’s pretty hard to shake the sound of an unexpected melt down from your voice. Particularly at 1:30 in the morning. I stammered, dismissed, and evaded. He was having none of it. Finally, I got him to hang up. I figured I’d won.

By 2 a.m., there were three of the highest ranking officers at my department were sitting in that room with me–in their pajamas, no less. I offered smiles, thanked them, and tried to dismiss them. But they stayed with me for more than an hour. They told me stories of their distressing calls from back in the day, and the seemingly inexplicable breakdowns.

“That call, for whatever reason, touched you. And it’s okay to be sad. It’s okay to be angry. It’s okay to be confused. It’s the strangest, smallest details of a call sometimes that just hits you. It doesn’t have to be these obviously traumatic calls,” One told me.

I was given heartfelt compliments. I was given reassurance that this call didn’t make me weak or stupid. It didn’t mean the end of my career if I didn’t want it to be. They gave me their personal cell phone numbers, and was given instructions to call them whenever I needed to. They gave me hugs. But most importantly, they gave me their time–even in the dead of night. They gave me confidence, compassion, and understanding.

I don’t know many high-ranking managers that would go to the lengths that these individuals did. They went above and beyond. It’s something I will never forget, and will always be grateful of. Managers or officers, especially those that go out of their way to take care of their own…I can’t thank you enough.

Little Tape Chevrons

My IV skills are slowly but surely developing. Everyone who’s new at starting an IV gets so excited about getting flash, that there’s kind of that “Oh crap…well now what do I do?” moment after you withdraw the needle. I’m starting to nail more and more IV sticks, so the “OH MY GOD, I GOT IT!! YAY! Oh, wait, I’m not done?” feeling isn’t quite as strong. I’m actually thinking ahead a little bit more before just diving right in. That includes focusing on the less glamorous parts of starting the IV. Such as, oh, properly occluding the vein as you attach the extension set, so the patient doesn’t bleed out freaking everywhere.

"Uh...well, I think his blood pressure was high enough to handle this..."

“Uh…well, I think his blood pressure was high enough to handle this…”

(Image credit)*

 

I don’t really have that down 100% either, but I’m getting better at it.

The other big piece is securing the line in place. I tend to be pretty decent at that. One day, a paramedic showed me something I hadn’t been taught in class–the chevron. It looked pretty neat and handy. I liked that you could secure it more firmly in place if the loop of the chevron was pointed distally. And, if you pointed the loop proximally, you could pull the edge of the catheter off of the inside of the vein wall just enough so that it flows better. Pretty sweet, huh?

Oh, except that I saw it done in the nice, quiet, controlled environment of the hospital with a cooperative patient. And that the tape had already been ripped for me.

The next time I started an IV, I gleefully thought to myself, “I’m going to make my preceptor so proud! I’m going to surprise him with this cool little chevron trick! He’s going to just beam with pride!”

Oh, you ignorant, ignorant AEMT.

First off, I had an EMT-B tear my tape for me. I’ll be the first to admit that when I was a Basic, and a medic asked me to tear him tape, I never really knew exactly what he was looking for. How long? How wide? Well, turns out this Basic did exactly what I used to do…just take off huge hunks of the 1″ tape, stick it against the cabinet, and assume I’d figure it out. The paramedic preceptor I was with was busy sticking on EKG leads, so I went ahead and tried to quickly whip together my chevron. I was hoping he’d look back at me after he was done, and grin at my cleverness (even though he’s been in the business forever).

Have you ever tried to make a neat little chevron using 1″ tape while bouncing down the road? Because it comes highly NOT recommended.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

(Image credit)

And this is what mine looks like.

And this is what mine looks like.

(Original image credit…I just added some Paintbrush magic.)

This is the newbie, frustrated, stubborn, bouncing-around-in-the-back-of-an-ambulance version.

When I finally smoothed down the last crinkled piece of tape, I looked up at my paramedic preceptor. He was watching me from the captain’s char, with that sad, “aw…that’s so cute,” patronizing, “good effort, kiddo” smile on his face, complete with the “your earnest innocence is so endearing” raised eyebrows. I returned the look, and sheepishly smiled.

After we transferred care of the ball-of-tape-with-the-patient-trapped-inside, the paramedic chuckled and patted my shoulder.

“So, next time?” He started, stifling a good-hearted, bemused giggle. “You tear the 1″ tape in half. And uh…chevrons are…well…”

“A textbook thing?” I offered.

“Kind of. Yeah. Not so easy or practical in real life, huh?”

I shook my head, smiling just a little.

“It’s okay…at least that line isn’t going anywhere. For, like, the rest of that patient’s life.”

*By the way, it’s not real blood in that picture. Promise.

Is EMS A Team Sport?

I don’t have a designated partner, but I do have a small group of people that I usually work with. I know how they like things set up, what things they like to do, what they don’t like to do, where their strengths are, etc. And I know how I fit in with that, and we manage to get an awful lot done without saying too much to each other. I love calls like that. They just flow so seamlessly.

The vast majority of these familiar partners have years of experience on me. Maybe I unknowingly take comfort in that. I tech my fair share of calls and actively participate. I don’t sit on my haunches and wait for direction. If I see something that needs doing, I do it. Their experience and my eagerness blends very nicely together. I like to think I’m a good partner.

One day, I had a brand spanking new partner. I don’t know if he was shy, or having an off day, or just really didn’t know what to do. I prefer to do most of my interventions in the ambulance, if I can. So after we moved the patient into the truck, my partner stood awkwardly in the truck with me for about a minute before heading up front to drive. We were ridiculously close to our destination, so I had even less time to do everything that I wanted to do. I felt completely disorganized! There was no flow to what I was doing. I scrambled around the ambulance, remembering, “Oh, I should try this!” or “Ooh, I really need to get one of these,” all while frantically peering out the window and racing against how much time I had left.

A good partner can make everything smoother, as I’m sure you know. But what about a not-so-great partner? Is EMS really a team sport? Does having a player out of the game really impact things that much? Should it? Maybe that whole incident I described speaks poorly of my skills as an EMT. Maybe I should be perfectly capable of handling everything as evenly and smoothly alone (or with an “eh” partner) as I do with partners who I’m comfortable with. Maybe I’m inadvertently relying too much on my partner…more on feeding off of their energy, so to speak, than actually relying on their skill set.

I don’t know. What do you people think?

Instead of asking, “Why?”

You don’t have to be an EMT to experience tragedy. Although, we tend to bear witness to it more often. We are professionals at maintaining a level of calmness in the face of crisis. We were called to help, to fix, to save, to salvage; not to participate. We protect our bodies with gloves. We protect our psyches with adrenaline and “it’s not my emergency.”

After the adrenaline subsides and the call is over, you’re left with the aftermath. Sometimes the stories can’t be stripped off with your gloves, or the memories thrown away with the syringe wrappers. Sometimes they stay with you. In this messy and hectic career, you’re bound to get some of the shards of people’s lives embedded in your skin. It doesn’t necessarily have to be something massive and catastrophic. Your partner on that call may not even remember it today. These stories stay with everyone for different reasons.

Eventually in your career, you will find yourself carrying around a few faces, names, dates, or addresses forever. And they will not all be war stories you will flaunt or boast.

With many of these stories comes a simple and powerful question: “Why?” It’s a big impenetrable wall between you and (what you assume will be) peace. If you ever find the answer, it may not be good enough to excuse or explain what happened. More often than not, though, the answer will never come. It will never be clear.  “Why” will haunt your dreams and shadow your days. You will bludgeon yourself with it over and over in dizzying circles, searching for answers that may never come, only to find yourself exactly where you started–if not even worse off. You will kill yourself with “why”.

I try to make peace with my “why’s.” In fact, I try not to ask the question at all. Instead of asking, “Why?” I try to say “Thank you.” Thank you for giving me the chance to help you. Thank you for letting me learn from this, and using it to help my patients in the future. Thank you for asking me to be there to do the best I could at that time with those resources. Thank you for allowing me to look at what I have.

I have a warm bed. I have a roof over my head–and a fairly nice one at that. I live in a safe community. I work at a job I love, and one that challenges me every day. I work with awesome coworkers that I care very much for. They make me laugh and grow, support me, challenge me, and encourage me. Although I complain about it, I’m well on my way to a great and exciting career as a nurse/paramedic. I have a knack for writing. I have a blog that people read, and has allowed me to make connections and friends I never would have dreamed of. I have a wonderful family that cares about and for me. I have friends that love me. As for the things I do not have: I have tomorrows to earn and attain them. I am not perfect, but I am better, and I am enough.

Paramedic or RN?

Well, here we are again, internet friends. Back to the soul searching and looking for advice from my favorite anonymous third party!

Firstly, if you’ve been following my whining about nursing school, you know I’ve been dealing with several really mean individuals. I’m happy to report that most of them will not be in my class this coming semester. Yay! There’s something to be said about karma, I suppose. Well, that and hard work.

During my Christmas break from school, I picked up more hours at my department. Going back and being able to do something I love…that all by itself makes me happier. Plus, trying out my new ALS skills has been really exciting too. Anyway, with all of these additional hours, I’ve obviously been to area hospitals more often, and to the local nursing homes as well. It just seems to remind me more and more that EMS is where I belong.

That, combined with some major screw ups at my school (losing my tuition, for instance) is making me rethink the whole nursing thing. I’m planning on applying to transfer…the problem is, should I transfer into another nursing program? Stick with it? Bridge to paramedic later? Or scrap it, become a paramedic, and bridge to RN eventually? It seems like the RN-first path means I’ll have lots of years doing things I hate in order to get where I really want to be (pre-hospital medicine, although ER would be fine too). Paramedicine, however, means putting my time and energy into a field I love.

I understand the RN position would be more financially stable, and I would have the opportunity to change specialties and get out of the emergency scene if it gets to be too much for me. But the idea of being a paramedic still pulls at me. So, here we are. Paramedic? Or RN?

 

Overheard at the Station

Cop: Hey, how’s nursing school?

P2P: Good. To be honest, some days I’m sitting in class, staring at my pencil, and considering giving myself a lobotomy with it because that would be more fun and less painful…but, overall, no, it’s not too bad.

Cop: Yeesh. Well, I’d rather have a bottle in front of me than a frontal lobotomy. Good luck to you.

Time For Soul Searching?

I think I’ve finally had enough, and some soul-searching might be in order.

Recently, my grandma unexpectedly got very sick very fast, and was placed on hospice for a short while before she passed away. For about two weeks, any moment not spent in school was spent driving back and forth to distance major medical centers or her residence, spending what time I could with her. Her wishes were to be buried in her hometown in New York. When she finally passed, we had to travel for the funeral. In the middle of all this, I had a major paper due. My teachers were aware of what was going on, and granted me an extension on that paper. Certainly not something I asked for, but I was very grateful when it was offered to me.

When I came back to class, one girl had the stones to tell me, “I can’t believe you used a death in the family as an excuse. Must be nice to have family emergencies to give you even more time to get work done. Instead of just pushing through it like the rest of us.”

Once the urge to kick her in the head subsided, I felt hurt. Most of the drives home from school feel that way too. Which translates into commutes to school that are filled with anxiety and dread. Comments like the one I made above are made just about every day. I thought we were in college here. I thought the bullying was supposed to be over by now.

As hard as I try not to be, I’m a sensitive person. I’m much better at letting things roll off my back now than I used to be, but the right comments at the right time still get to me. So I vent to my friends who currently are nurses up at our little ER.

The popular response? “Yeah, nurses eat their young. That’s kind of normal. But in a year and a half, you’ll at least be making good money.”

That’s what I have to look forward to? A pay check? Let me be abundantly clear. Being paid is not and will never be enough compensation for daily emotional abuse. At least the patients who are mean are sick. Well, sometimes. Regardless, they won’t be in my care forever. But, I will have to be around mean coworkers all the time. And I don’t know that I can do that.

The school work is hard. But I know I can do it. I’ve been more proud of how much I’ve accomplished and pushed through this semester than I’ve ever been before in my life. It’s the fear that my working career will be just like my academic career–full of mean people who will say and do anything to cut you down. I don’t expect to be coddled and held and adored all the time. I don’t belong to that annoying mindset that I deserve a pat on the head and unabated praise for taking a poop every day. Although I’d like someone to joke around with, I’d be perfectly fine with neutrality.

Yes, I understand the world is full of mean people. But there are lots of really nice, caring, and wonderful people in the world too. Usually, I’ve found it’s a good mix, even leaning towards the good more so than the bad–at least in my small corners of the world. I’m talking about entering an environment daily that is nothing but cruel. And yes, I know, not all nurses are these awful and mean people. But it seems that that has become acceptable and normal; like kind coworkers are an exception. Therein lies the problem.

So do I keep on with nursing school, and hope that in a year-and-a-half, my career and coworkers will not seem as bleak and terrible as they’ve been made out to be? Or do I cut myself off from all the negativity now, and pursue something else? If I do that…then what else would I do?

Any insight? Support? Slaps in the face? Shaking in of common sense? Suggestions? Any and all of the above would be appreciated.

Lessons From The Other Side Of The Stretcher

As soon as I heard the dispatch information, I knew it wasn’t going to be good. An hour later, I would be walking into the ER in my uniform…not as an EMT, but as family.

I hate this. The discomfort, the hurt, the helplessness doesn’t sit well with me.  I hardly have time to digest one lesson, one emotion, one bit of information; before new lessons, emotions, and questions are thrown at me. I’m learning and discovering things I never wished to discover, and it’s all happening so quickly.

For one thing, I’m learning how unaware we as healthcare providers can be about our actions and statements. Our hospital is a small community facility where everyone know each other. I sat in a chair holding my grandma’s hand in the trauma bay, trying to absorb all the information given to me. One nurse stood entering information into a computer-on-wheels. Suddenly, another nurse (who, truthfully, I was never particularly fond of) threw the door and curtain open and stormed across the room, cursing and grumbling about how Pyxis had locked up, and now she had to go get flushes out of the trauma room cabinets. I looked over at her, somewhat incredulously. She caught my expression and snapped, “What?” Before storming out of the room, flushes in hand. It felt as though the gravity of the situation didn’t matter at all. It felt like a bit of a smack in the face. Of course I know my grandma wasn’t the only thing on any of the nurses’ minds. But when your world starts to cave in, you unintentionally expect everyone else’s to cave in too.

Speaking of caving in, I felt so incredibly alone. At the time, we couldn’t get in touch with any of the rest of my family. So it was me and my very sick family member alone in the room, along with a nurse or two. The conversations that were held were mainly to obtain consent to perform procedures that could help or end my loved one’s life. I wanted a pause button that I knew wouldn’t appear. I wanted to get rid of all the emotions swirling around inside me. I wanted to abandon the fear I had, and the terrified thought that cycled through my brain, “I’m 20…I can’t be making decisions of this magnitude.” The cup of water and box of tissues the nurses (who I work with and respect greatly) gave me just wasn’t enough. I wanted someone else to be there with me. I wanted to talk to someone about what was going on, that didn’t involve snap decisions and courses of action.  I wanted a hug. I just didn’t want to be alone.

I learned that the EMT’s and paramedics I’ve worked with are like a family to me. Some of my coworkers came up to check on me. I cried when I saw them, and received loving, warm hugs, which they knew was exactly what I needed. All the times I’ve said, “I’d trust these guys with my loved one’s lives” finally came to fruition. And I’m proud to report they did not let me down. Both the 911 call and interfacility transfer were run with proficiency, smoothness, and compassion. And I cannot thank them enough for that.

I’ve also learned that I fear I might not have spent enough time with my grandma, and that maybe I didn’t value the time I did have as much as I should have. Regret, sorrow, and remorse pull at my stomach whenever I think about that.

Finally, I rediscovered this more than I learned it…I love my grandma very much.

Competence and Fear

I found this post by “Hot Lights & Cold Steel” a while back, and it’s kind of stuck with me ever since. You should go check it out for yourself, but I’ll summarize briefly for the point of this post. Basically, there are four levels of an EMS provider: unconsciously incompetent, consciously incompetent, consciously competent, and unconsciously competent. In the first, you don’t realize what you don’t know. In the second, you are aware of all that you don’t know, and almost overwhelmed by it. In the third, you can provide great patient care when you are focusing and thinking about everything you’re doing. In the fourth stage, you provide great patient care without having to think every little detail through…it just comes naturally.

Well, a piece of me wonders if this theory involves some oscillation. I do remember being in awe of how little I actually knew. I realized that my knowledge base was so small…and the things I thought I knew really only consisted of superficial knowledge. It was daunting. As time went on, I ran more calls, saw more things, and learned more from others. I began running calls with confidence. There was a fluidity to my movements, a steady process to everything. I was calm. As a EMT-B, I knew what I needed to do, and was able to do it.

Now, if all goes according to plan, I’ll be a licensed AEMT within a month. That terrifies me. Honestly, I didn’t feel that my program really adequately educated us. But, to be fair, I know that’s only part of the problem. That fear still remains, whispering poisonous thoughts, catalyzing my moments of discouragement. Although I try very hard not to show it, my methods and my thoughts all seem to be similar in nature and feel to those I had when I first started running calls: disjointed and somewhat anxiety filled.  Maybe that’s because of my broadening and deepening knowledge base. Maybe it’s because I don’t get to tech as often as I used to. Maybe it’s because I’m starting to realize the much greater responsibility I have to my patients as an ALS provider. Maybe it’s all of the above, plus so much more. Regardless, I feel that my thoughts are uncoordinated and clumsy again. Maybe not to the extent that they were when I first started EMS. But, deep down, I do worry. What will it take to earn that confidence back? Was that original confidence deserved in the first place?

Maybe these are good, healthy concerns to have. Maybe this will help me become a better provider. But for now, it’s a little scary.

The Flashers

Aha! That title certainly got your attention, didn’t it?

Anyway, this is another local greeting phenomenon more commonly observed in whackers (newbies, probies, FNG’s, etc.).

You’re driving along in the ambulance, responding to some 911 call. The lights are going, but you’re not flying anywhere really. Just cruising along, minding your own business, chatting with your partner about what the call might be like and what you should do for lunch later. Cars are obligingly pulling over (not really stopping, but at least slowing down) in the opposite lane of traffic. Things are alright. There’s a car approaching with the red fire half-plate. You and your partner raise your fingers in the courteous three-fingered wave as the car gets closer.

All of the sudden, BLAM! The car seems to have exploded into a flashing, glowing, retina-burning display of red and white lights. Shocked, you and your partner blink several times, attempting to clear the purple spots from your vision. If your vision clears in time, you’ll note that the guy never made an attempt at pulling over.

“What in the hell was that? Did a stoplight just fall out of the sky and explode on that car, or what?” Your partner asks, rubbing his eyes.

I never did quite understand that. Yeah, I mean, I get the whole “We’re part of the same gang” thing. Kind of a new spin on “flashing your colors” I guess. But the three-fingered wave should suffice. That’s a good, solid, brief interaction where nobody gets hurt. Why throw the lights in the mix too? Did you think that maybe, if you showed you were “one of us” you wouldn’t have to pull over? It’ll take like 4 seconds, I swear. You’ll get to where you’re going at the exact same time.

While we’re having this discussion, why do you have so many lights? Are the grills lights AND dash light AND visor lights AND mirror lights AND roof-top light bar (that was meant for a truck, but you drive a sedan, so it hangs over the sides by a couple inches) really necessary? If you’re responding to a call, and the jerk driving in front of you won’t pull over for your dash light, what makes you think they’re going to pull over if you add an additional 173 lbs of lights? It’s…it’s too much. I appreciate your enthusiasm, really, I do. But you’re going a teensy bit crazy there. Relax a little. Save your month’s paycheck for food or rent instead of more light equipment.

Don’t even get me started on the personal vehicles that “blat” or “whoop” their sirens at you in addition to the light show.

Long story short (Newbies, I’m talking to you), don’t be that guy. Don’t light everything up like a Christmas tree on the Fourth of July every time you see an emergency vehicle. It’s shocking, if not scary. And maybe even dangerous. And, frankly, kind of confusing. And then jerks like me will write blog posts about it. So stop it.