The Grass Is Always Greener…

About four-and-a-half years ago now, I nervously sat on the smooth, gray bench seat. The smell of Cavi-wipes and plastic saturated the stuffy air. Our pediatric patient slept comfortably in his car seat while Mom dabbed tears away with a washcloth my preceptor had fished out of our linen cabinet. He consoled her throughout this 90-minute trip, reassuring her that all would be well. And I sat there, almost too stunned and nervous to speak. My brain was a mash of nervousness, empathy, and excitement. I was finally riding along on my very first ambulance ride—and I was hooked.

Not too long ago, I sprawled out on that smooth, gray bench seat. The air hung heavy with the metallic smell of blood. The patient was forced into a dreamless sleep with medications, and I wondered if he would ever wake up. Having nothing else left to do on this 90-minute ride, I dabbed a moistened washcloth at the dried blood and vomit at the corners of his mouth. The paramedic and I chatted quietly, discussing the patient’s health, vital signs, medication dosing, ventilator settings…and what places might be open for a quick bite at this hour. My mind buzzed with hunger, fatigue, and a curiosity about our unfortunate patient. I didn’t realize it at the moment, but I was on my last call as a full-fledged member of this department.

I found myself in the backs of those trucks. I knew so little then…about medicine, about my future, about life, about myself. I worked alongside some of the most incredible firefighters, EMT’s, paramedics, and human beings. I made some amazing friends. Sure, I’ve cried, considered throwing in the towel, and been angry with coworkers, with this department, with this profession. But I always came back for more. I truly felt at home in that brick building, in that red truck. Those people I worked with? Broke bread with, laughed with, argued with, cried with, goofed off with, learned with, grew with? They’re my family. God, or whatever is out there, did not see fit to provide me with any biological male siblings. But I was blessed with 40 brothers, and I wouldn’t trade that for anything.

And yet…it feels like I am.

Within the past month or so, I have accepted a position as an ER nurse. The job hunt for new grad nurses is excruciating in my corner of the world. To be offered any job—especially an ER job—was completely mind-blowing. So, even though it was far away from home, I had to take it. I packed up my few belongings and moved out of my parents’ house for the first time. I found myself in an apartment in the heart of a small town in a different state. I know nothing and nobody for an hour in any direction. I work a full-time job, with a bigger paycheck that has chunks removed from it for important and adult sounding things like “403b.” I wear scrubs in styles and colors of my choosing, and I don’t have to put on those God awful white clogs anymore.

But my new rotating schedule forbids me to work my regular nights in that ambulance that I grew up in. It is getting harder and harder for me to justify spending so much time and money to drive all the way back home to work on an ambulance for a day, and then drive all the way back to my apartment.

“We knew this day was coming,” A lieutenant told me. “Why don’t we bump you down to per diem status?”

And it was in that statement that I realized that no, I can’t have it all. I am slowly being peeled away from the department and field I loved so much. Going to per diem status may not seem like much. But it means giving up my regular schedule. It means giving up my time with those people I love, doing what I love.

Suddenly, I find myself asking, “Is this really what you want to do?” The decision is somewhat already made for me…I am an ER nurse now. I live in another state. I have been doggedly pursuing this for years. I worked so hard for this. Yet I find myself missing the confidence of being in a truck. I miss the synchronization of working with a good partner. I miss EMS, and the home and family that taught me so much.

“We really are a family,” The weathered nurses tell me at the nurses’ station. I smile and nod while my heart breaks a little. They very well may be a family…but my EMS family is going to be pretty hard to compete with.

Poetic Juxtaposition in a Small Town

Working in a small town provides a glimpse at some truly beautiful, near-poetic things. There are the smiles and friendly waves of townspeople as you walk around downtown in your uniform. There’s the warm food, donated by generous local restaurants that volunteered to open in the middle of cold, brutal nights; provided to the victims and responders of a local tragedy. There are the “Thank you” cards that are proudly and thoughtfully tacked to the station cork boards. There’s that pristine hour after clearing an end-of-shift call, where new morning sun filters through the mist, and reflects softly off still ponds. There’s the privilege of being allowed inside of those small, sleepy townhouses and cabins; the same ones that seep curly plumes of sweet woodsmoke into crisp morning air. There’s the sanctity of caring for the people we see every day; those we grew up with and know well, and those who are familiar strangers.

That familiarity–that close-knit bond unique to those who work and live in a small town–can provide for the most inspiring, speechless joy; and unfortunately brilliant sorrow. Sometimes, you are called into those small, sleepy townhouses and cabins, and you witness and participate in the recovery of not just an illness, but a life that weaves frequently into yours within this little town. Other times, you are called around the stoves’ hearths that seep those curly plumes of sweet woodsmoke, and you are asked, demanded, begged to fix something that cannot be fixed; cure something that cannot be cured. Then, that particular thread of life is missing from the usual, comfortable tapestry of every day.

It’s hard to tell a family, “I’m sorry, but she’s passed away.” It’s hard to stop pushing on the chest of someone you’d known, either close or from afar. It’s hard when a family member cries into your uniform as you try to console them with a hug. It’s hard when they watch you pick up the trash, pack up the equipment; and leave them with their sorrow, the whirlwind of funeral directors and arrangements, and the shell of their loved one. What’s harder is when you can’t put the call to the back of your mind, filed away somewhere along with the other codes and unfortunate calls you’d been a part of–when you are forced to face the aftermath of what you couldn’t help. When you are required to attend this person’s funeral.

I was uncomfortable as we waited for the services to start. I kept my head down, chin tucked against the lump in my throat. Part of me hoped I wouldn’t be recognized by the survived who were there on that day my partner and I were called to try. I prayed I wouldn’t be asked once again by a distraught family member, “Why didn’t you save her?” Because it was too late. Because the odds were astronomical. Because it was her time. Because I couldn’t. I would never say those out loud. They wouldn’t alleviate the pain. What’s more, it doesn’t answer question they really want answered: Why did she have to go now?

I focused so intently on trying to find comfort in this awkward, sad situation; trying to be both present and invisible. I was focused so intently, I almost didn’t recognize the man who had taken the seat beside me. He turned and chatted with a friend and coworker of mine. Then, my shoulder was tapped.

“Do you remember that code a while back?” My friend started. I squinted my eyes and thought as he described the house, the room, the circumstances. It all flooded back to me, back from the corner of my mind where the code that resulted in this funeral should be. I nodded. “This is him. This was your patient.”

I looked into those bright, sea-glass green eyes. The last time I looked into them, I was breathing for him. He was cool, gray, limp. Now, his handshake was strong and warm. There was such a life about him. Every blink, every smile, every word out of his mouth seemed so completely miraculous and wonderful. I wanted to talk to him all day, if for no other reason that to truly be in awe of life and every little thing we take for granted.

We sat next to each other during the ceremony. I sat beside a man whose life I helped save, whose thread I helped preserve; while mourning the loss of a life I couldn’t save, the newest uneasy void in our local community’s tapestry. The juxtaposition was beautifully, inspiringly, sadly, uniquely poetic; leaving me with a deeper, greater appreciation for my life and work in this small town.

Let Them Say Goodbye

“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.”

Words of Wisdom in the Back of a Truck

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.”

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.