Dyspnea, Orthopnea, Eupnea

I had to take a Medical Terminology class to fulfill the requirements for my degree. I thought it was kind of silly and somewhat of a waste of time, but, hey, I can’t argue with an easy A.

My class was online. However, we had to call the instructor once per week to read medical words from a vocabulary list she’d emailed to us. When I called her for the first time, she went off on this huge tangent about how she has all this experience in the medical field, but she never specifically discussed what job(s) she held.

One day, I called her to complete this assignment. I was reading down the list, not thinking much of it.

“Hypoglycemia,” I’d announce.

“Good.”

“Humerus.”

“Good.”

“Dyspnea.”

“Um….try that again.”

 

I was kind of surprised. I didn’t think I’d mispronounced anything.

“Disp-nee-uh,” I tried a little slower.

“No. Minus 5 points. It’s pronounced dis-pee-nee-uh. You need to pronounce the ‘P’. Next.”

Huh?

“Um…ok…orthopnea.” (Orth-op-nee-uh)

“Again, pronounce the ‘P’. Minus Five again. Orth-o-pee-nee-uh. Next.”

“………….Eupnea.”

“Pronounce. The. P. Ee-you-pee-nya.”

“Interesting,” I said, carefully choosing my words. “I’ve never heard it pronounced like that before.”

“Well, when you’re in the business for a long time, you pick up on these things.”

“I see.”

 

Maybe I–and everyone I’ve ever worked with or been exposed to in the medical field–is wrong? But I’m willing to bet you all (y’all, yous guys, etc.) pronounce it the same as I do, despite the differences in our colloquialisms. That’s just me though. Feel free to correct me if I’m wrong. Because she definitely did. 15 points worth of it, actually.

Pinning

It all began with a plain piece of 8.5 x 11 paper. A little more than two years ago, a lump sat decidedly in my throat as I nervously opened an envelope from a school. My eyes searched that simple sheet of paper, finding the only words that mattered: “Congratulations! We are pleased to inform you that you have been accepted into our nursing program.” That summer seemed to crawl by as I anxiously awaited the beginning of my nursing career.

On a late spring evening in 2014, I sported a traditional white scrub dress and goofy-looking cap, as my mother pinned the hard-earned nursing school pin to my chest. I stood before my family, my closest friends, and my classmates as I lit my candle and recited the Nightingale Pledge. I promised to be the best nurse I could be, and to serve my patients above all.

The two years in between were the most difficult I’ve ever endured, and were fraught with more challenges than I’d ever imagined. There were unfair, condescending professors. There was the one instructor who looked me dead in the eye and said, “EMS is for people who aren’t smart enough to get through nursing school.” There were cut-throat classmates. There were absurd policies, forcing students to choose between missing a family member’s funeral or paying $850 to make up their schoolwork privately. There was the ever-looming threat of failure, made all too real by the steady loss of 62% of my classmates. Some friendships drifted apart–some probably irreparably so. There were brutal shifts on the ambulance. There were calls and incidents that shook me to my core and made me question things I was so ignorantly secure in. There was the loss of my only living grandparent–a loss that was unexpected, and occurred with a simultaneously shocking speed and a heartbreaking slowness. There was my father’s diagnosis of cancer. There were plenty of all-nighters, tears, and swearing I could not take another day in this program.

If that dark picture entirely described my two years of nursing school, there’s no way I would have made it. The nursing cap and pins on my bookshelf would never be there. There were people who gave me strength to give it just one more day, to try just one more time. There were professors who pulled me aside and told me I was going to be a great nurse. There were classmates who would vent with me, give me incredible words of wisdom, and drive to Chipotle for dinner while blasting music at an unreasonable level. There were instructors who tried to fight unfair policies that put students in unreasonable positions.  There were new friendships that were forged under the hot stress of school, and older friendships that were strengthened. There were shifts at work that were filled with camaraderie and fun, and were absolutely vital to keeping my sanity. The calls and incidents that had caused me so much pain are sewn into the fiber of my being, making me stronger and wiser than before. And there were calls that reminded me why I love taking care of people so much. The loss of my grandmother brought my family even closer. My father’s illness is allowing me to reorganize my priorities, to think less selfishly. I’m learning to look for the things I can change and help with. And, I’m learning to accept that some things are out of my control. Above all, the love, support, and compassion I’ve received has absolutely astounded me. All I can do is say “Thank you,” although words could never adequately express what these selfless kindnesses have done for me, and what they continue to do.

My nursing pin is a celebration of all that has happened, all I have pushed through, and everyone who was there along the way. It is for the bad as much as it is for the good.

And now, for better and worse, on to the next…

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.”

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!

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.

An Eraser-Free Exam

Everyone takes tests differently, using different strategies and tactics. When I take an exam, I try not to change an answer after I put it down on paper, unless I realize I read the question wrong. In fact, I rarely go back and review my exam for this reason…I always psych myself out. And, usually, this strategy works out well for me.

One friend, however, does the exact opposite. She essentially takes the test twice. She goes back, reads through her answers, panics, and changes like half of them. When the tests are returned to us, she finds that her score would easily be 10 points higher if she hadn’t changed her answers.

“You’ve got to stop doing that. You know this stuff. Just trust that you do, finish your test, and turn it in. Be done with it,” I tell her.

“I know. I’m trying. I just get so panicked when I’m taking the test!” She says, nervously drumming her fingers on the desk.

Our teacher is going around, passing out exams to each of us. She also hands us a simple calculator and a pencil. She comes around to our row, and methodically sets down a paper exam on the desk. Then comes the calculator. Finally, she passes a pencil to my friend. And, without any warning, smoothly pulls out a pair of scissors and cuts the eraser clean off the top of it. She winks at my friend, and carries on as if nothing ever happened.

My friend and I exchanged glances, with wide eyes and shocked smiles. Did that really just happen?

But, hey, it worked out. My friend got a 90 on that exam.

Teachers can be pretty cool, even if their methods seem a little crazy at first.

I Took The Red Pill

I went through a box of old pictures today, and took that trip down memory lane to happier and simpler times. There was one of my second grade friends and I sitting on a brick wall in the park, sticking out Kool-Aid technicolor tongues. Another featuring my eight-year-old sister and I, horrifically sunburnt, carefully sculpting our sand castle–no, impenetrable sand fortess–on a July day at the beach. Fast forward several years, and there I am at 15 with a sports medal around my neck, a boyfriend’s arm around my waist; laughing at something I can’t remember. Towards the bottom of the box, there’s one of  me squinting into the camera, with a 6-year-old toothy grin pushing dimples onto my freckled cheeks.

I know I’m looking back at myself in these pictures, yet I feel like an entirely different person. And I can’t help but wonder…Would these girls in these pictures still feel like such strangers to me if I had made other choices? Would they feel more like memories, and less like different lives? Would they be proud to see the young woman they would go on to become? The young woman that became an EMT?

Maybe, if I hadn’t been an EMT, I never would have left the sports I’d loved. Instead of fighting my way through a community college nursing program, maybe I would be a college athlete now at some university. Perhaps, I’d be majoring in English, pursuing my life-long dream of becoming a writer.

On my breaks, maybe I’d come home and work at the grocery store, or a diner. I’d watch the clock as I worked, counting down the hours until I could go spend the evening with my friends. Instead of having friendships consisting mostly of adults, all of my companions would be stressed, idealistic kids my own age. Instead of trying to find the words to say when hearing about divorces, children, and financial issues; my friends and I would groan about our papers due next week. We’d excitedly share the news of that internship we worked so hard for. We’d look forward to graduating, gazing through dreamy veils at the perceived freedoms of adulthood.

Maybe, if I hadn’t been an EMT, I’d meet some great guy. Instead of constantly apologozing for and juggling my hectic schedule, maybe I’d actually have time to spend getting to know him. Maybe I’d have days to go out and evenings to stay in.  Maybe I’d have someone to say, “I love you” to before I hung up the phone. Instead of hearing, “I can’t do this anymore. We’re done,” maybe I’d hear “I love you” back.

Maybe, if I hadn’t been an EMT, I’d never read the obituary section of the newspaper. I’d pull over for the flashing lights of an ambulance, briefly wonder what happened, and then continue back on my way without giving it another thought. Instead of hearing the screams and cries of those involved echo inside my head when watching the evening news; the stories would only cause sighs of dismay and temporary grief, before drifting back to the dusty corners of my mind, soon to be forgotten.

But, maybe not. I will never know. Sometimes, I look into the pictures of my younger self and think, “God, the things you’re going to see. The things you’re going to hear. The things you’re going to do. If I told you, would you believe me?”

Three years ago, I made the decision to go into the emergency medical services. Unknowingly, I chose a life that would never be “normal” again. Sure, I could quit and change to a regular 9-to-5 job; but the experiences I’ve had will never leave me. Funny thing is, I don’t think I’d ever want them to.

I chose an experience, a brotherhood, a life like nothing else. It wasn’t expected or planned. But despite its occasional ugliness, I fell in love with this field. There’s no turning back now. I will never know what it’s like to have the “traditional college experience.” I’ll never know what it’s like to fumble my way into adulthood hand-in-hand with peers of my age. I will never know what it’s like to have a college sweetheart. I will never read the paper or watch the news the same way again. But, I will live my life knowing I made some small difference in my corner of the world. I will know, as tough as it can be, I did what I absolutely loved.  I will know a great many things about life, mankind, and the human spirit that most people will never understand.

It’s true…some days, I look back at my younger self and say, “What on earth did I get you into?” But I know, I wouldn’t trade this for anything.

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(Image credit)

Healing Is Not A Linear Process

I’ve learned plenty of things as an EMT. I’ve learned what the top and bottom numbers of a blood pressure mean. I’ve learned how to splint a fractured bone. I’ve learned the proper way to talk on the radio. I’ve learned how to start an intravenous line. I’ve learned that real life is nothing like the textbook. In the textbook, you see calm, cooperative patients, neatly packaged in controlled, well-lit environments. Ask anyone who’s ever run an EMS call, and they’ll tell you the real world is nothing like that. But, there’s a quieter, more subtle difference between the textbook and reality; one that might not be realized right away. Once you experience it, however, you’ll never forget it.

You see, there are no pictures in the textbooks of EMT’s lost in thought, laying wide awake at night. There are no images of paramedics waking up with nightmares. There are no illustrations of providers crying, or torturing themselves with “Why?” and “What if?” These things are mentioned, though. But in real life, you only hear about it quiet whispers, if at all.

I’m willing to bet that most EMT’s and paramedics who truly love their work, and have some time under their belt, have had at least one call that stays with them. It could be a nasty trauma. It could be a medical call that got out of your control. It could be subtle details in an otherwise routine call that trigger something else. We don’t talk about it too much, though. Maybe we’re afraid, or we think we’re alone. Maybe we’re embarrassed. Maybe talking about it just isn’t helpful for some.

Everyone deals with their demons differently. Go do whatever you need to do to help yourself. Talk about it. Meditate. Write. Lift some weights. Paint. Run until you can’t feel your legs anymore. Shoot some targets. Spend time with loved ones. Play with your dog. Do whatever it is you need to so you can help yourself.

But, what if you’ve done that? What if you’ve done everything you can think of?

This is the other thing I’ve learned in EMS: healing is not a linear process. There are good days, and there are bad. You reach your peaks, and you think everything is fine…and the next day, you wake up to find yourself in a trough again. It doesn’t mean you are broken. All of your work is not undone when you find yourself hurting again. The ups and downs of your progress aren’t as important as the direction: forward. You may be down today, but you are further forward than you were yesterday. A straight line may be the quickest way to get from “unwell” to “well.” But there’s a reason why it’s called the “healing process” and not the “healing race.” There will be days where you will soar, and there will be days that you will falter.

Trust me when I say that you will have good days. You will have calls that make you smile, fill you with pride, and lift you up. These troubles that bother you so much now, will one day serve to strengthen and teach you; not haunt you. We all have those calls that we will never forget, but I promise you, they will not always cause this kind of pain that worries you right now.

 

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.

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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.