Unprofessionalism in Education

We’re gonna play a little game today. Yep. You and me. I’m going to write a quote here that took place at school the other day, and you’re going to guess who said it. Okay? Great!

“So Elise emails me this question the other night, asking me about complications of placenta abruptio. (laughs) Seriously? How do you not know this? Like, really? How about bleeding out, Elise? That’s gonna be a pretty big problem pretty quick if you don’t see what’s so wrong with having placenta abruptio. I can’t believe she asked me that.”

You probably have a decent picture in your head. Some mouthy nursing student (similar to ones I’ve previously posted about here and here) that has nothing better to do with her time than put down the others, most likely because she’s insecure herself. But you’d be wrong.

That quote was from one of our teachers.

That really grinds my gears. I am somewhat shy, but I used to be much much worse. Speaking from experience, shy people can get incredibly uncomfortable about asking questions in a public forum (ie, a classroom.) Why? Because we’re afraid everyone’s going to think we’re stupid. At least that was my fear. So emailing a question is a nice, private way of learning while successfully avoiding judgement. Right?

Wrong, apparently. I guess now it’s okay to make a mockery of a student by name–who fully intended to speak with you privately–and flaunt it to other students. I’m proud to say that none of the students in this room so much as chuckled. No one said anything. We all just stared at her, occasionally exchanged glances with others, and waited for her to finish her rant. When she was done, there was an instantaneous understanding amongst all the students in the room. We could never feel comfortable asking her questions without fear of her making fun of it to other students. Creating an environment that discourages questions from being asked is to essentially kill off the possibility of gaining a full and comfortable understanding of subject material. Inquiries are at the heart of learning. And now, everyone is afraid to ask. Super.

I’m completely disappointed and continuously discouraged every time something like this happens. To any of you educators out there, I am begging you…please never do something like this to your students. Ever.

Quote of the Day

My professor during my maternity lecture:

“Let me just tell you now that I really don’t recommend Googling ‘nipple pinch test.’ I had a very specific result in mind…and it certainly wasn’t what came up.”

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.

Quality of Life

“…This patient is a DNR,” The nurse mentioned in her report.

The newbie beside me gasped and whispered, “A DNR?? How awful! I can’t believe that.”

The nurse and I exchanged looks for barely a fraction of a second, before the nurse stated gravely, “Let me tell you what’s he’s been through, and maybe then you’ll understand.”

Let me begin by saying that I–and most EMS providers I know–are pro-DNR. I didn’t have to be in EMS too long before I started to truly understand why people wish to be DNR’s. “Quality over quantity,” many people say, focusing on the quality of life rather than the length. It seems many of us fear the chance of being “saved,” only to be in a permanent vegetative state, or disabled secondary to an anoxic brain injury.

Now, this patient we had received report on, in addition to an extensive medical history, had been suffering from severe brain damage for many years now. He now had the estimated cognitive ability of an infant.

I will admit to you that I’ve never really been comfortable with the mentally challenged. That might make me a bad person…it’s certainly not a trait I’m proud of. I think that those who do work with them are amazing, wonderful, gifted people. But I’ve always felt uncomfortable, awkward, nervous, and unsure around them. It’s almost a fear, for lack of a better term. I guess I just don’t know what to do, or how to act. So you could imagine my stress and uncertainty when I spent time with some mentally challenged individuals, such as the patient mentioned at the beginning of this post.

I know many (yeah, ok, myself included) would see a severely handicapped, mentally challenged individual like that, shake their heads, fill with pity, and wonder about that person’s quality of life. Maybe you don’t. You’re probably a better person than me. But that’s what that nurse did. It’s what I know at least a few others have done. And it’s what I did.

As I watched others interact with this patient, my fears, discomforts, and worries about being around the mentally challenged just slipped away. They played with him, chatted with him, playfully teased him about flirting with his “girlfriend” (one of the nurses), and touched his shoulders or hair. And you know what? I didn’t see suffering in his eyes. I didn’t see misery. I didn’t see a tortured soul, trapped in his body. I saw playfulness. I saw a smile in his eyes and on his lips. I heard his laughter. He was surrounded by caretakers who loved him and genuinely cared for him. Seeing him as a joyful, content human being forever changed the way I see the mentally challenged, as well as eased my discomfort and fears. I can confidently say that, to him, he had a great quality of life.

Overall, yes, I still support DNR’s. But for the first time, I saw the other side of the story. Is it where I’d like to picture myself? No. But that man, despite all of his medical issues, was happy, and he loved his life the way it was.

Just interesting food for thought, I think.

Fake Confidence is Still Confidence

“How are your IV’s coming?” My EMT-I partner asked me, as we responded to a call.

“Ugh. Terrible. I can’t hit the broad side of a barn now. Haven’t gotten one in forever.”

“Ohh, that’s okay, we all get ruts,” The paramedic called out from the back.

“No. This is more than a rut. I learned on one catheter, and then we used another type during clinical, and those have two completely different finesses to them. Now that we use the first catheter type here, I can’t seem to get the hang of it again.”

“You’ll figure it out again. You’ve just got it in your head now that you can’t do it. Cut that out. You gotta have confidence,” The I-tech said.

“Fake it til ya make it?” I asked.

“Hey, fake confidence is still confidence,” He replied. “You’re gonna get this one. Trust me, when the pressure’s really on, and the guy really needs a line, you will somehow find a way.”

Not long afterwards, the medic and I found ourselves on either side of the patient, bouncing down the road to the landing zone. Alcohol swab in hand, I searched up on down her cold, sweaty arm for something, anything, that I could stick. This was my first patient who, without a doubt, needed an IV. I traced my fingers down her arm, poking and tapping where I hoped to find veins. I was starting to get worried when…oh, Perfect!  I could feel that spongy rebound under my fingertips in the crook of her arm. If I looked at it at just the right angle, I could almost make out a tiny raised section of the vein, making it that much easier to go for. I watched for a steady straight-away in the road, painted the vein with the alcohol wipe, and uncapped the needle. As discreetly as possible, I took a deep breath to both steady my nerves and strengthen my courage. I raised my voice and said to our deteriorating patient, “Okay! Big pinch in your arm, ready? One, two, three!”

A smile tried to edge its way onto my face as I watched the flash chamber fill with blood. I couldn’t believe it…when it actually really mattered, I got it! Knowing I wasn’t done yet, I leveled out, and advanced the catheter. I heard the click of the needle into the safety cap, and knew I was in. It flushed beautifully, and was secured with a tegaderm and (probably too much) tape. I even made the stupid little chevron out of tape. I worked to keep myself from visibly shaking from the excitement. No one was coaching me through, or watching over my shoulder, or setting up any of my equipment. For the first time, I got it done all by myself–and when it counted for something, too.

When we watched the helicopter take off with our patient inside, there was something extra satisfying knowing they were using the line that I had started. Those medications could help preserve the patient’s life.

I turned to an ear-to-ear grin on my partner’s face. “What did I tell you? When you need to get it, you’ll get it! Right? Right???”

“Fake confidence is still confidence!” I replied, a huge smile stretching across my face.

The medic clapped my back, saying, “Hey, congratulations on doing your job.”

“Would you hush? Let me enjoy my glow.”

“Well, glow and clean up the back. You and the medic trashed that place,” The EMT-I interrupted. “Then we’re getting a celebratory coffee. Good job, kid. Well done.”

ECASA es su casa?

In nursing school, we have to make up medication cards for the medications that our patients are on. On these cards are things like dosage ranges, mechanism of action, indications, contraindications, side effects, and many other things. They’re time consuming. And they can do some interesting things to friends’ overtired and overworked brains.

 

Fried Nursing Student: Hey, did you finish your med cards?

P2P: Eventually. I’m not drinking this much coffee because I got a good night’s sleep, we’ll put it that way. You?

FNS: Almost. There was one I couldn’t find anywhere. I looked through all my drug books, all my reference guides…nothing. I’m like freaking out right now. I hope I don’t get in trouble for this…

P2P: That’s really weird it wasn’t in any of  your books…I can’t see how they can fault you on that. What was the drug’s name?

FNS: E-casa.

P2P: Wow…yeah I’ve never heard of that. Like ever. Spell it for me?

FNS: E-C-A-S-A. E-casa.

P2P: Um…Enteric coated aspirin? ECASA?

FNS: …….seriously? Seriously? Wow…I can’t believe…….

P2P (handing over my coffee): Here. You need this more than I do.

 

Freshwater Sharks

One day, in my EMT class, our teacher went off on this scenario. He was talking about being on some rescue saving some guy in some lake in some town somewhere else. I think the point of the story was that you needed to think ahead and consider what resources you might need to call for in such an event. So he asked us what we’d need to consider before and while arriving on scene.

“Well, I’d want some sort of police protection. Or a hunter. Or fisherman,” This student said. We all sat quiet, waiting for his rationale. “Gotta watch out for those sharks, man. No sharks. Scene safety.” We all subtly looked at each other.

“…Okay. Uh…interesting thought. But it’s a lake,” The teacher replied cautiously.

“Yeah, and it’s a shark. I don’t mess around with those things. Too many teeth.”

The Death Fishbowl

Dead. Pushin’ up daisies. Curtains. Checked out. Deceased. Gone. Passed away.

People ask me how I handle dealing with death all the time. Usually I just tell them that patients don’t die all that often. But it brings about an interesting point. We in EMS see death more often than the general population. When I think back on my experienes, there’s a certain “fish-bowliness” to it.  It’s looking in and sympathizing with the family, without necessarily getting your heart wet with the sadness of the event. With practice, I’ve been able to separate the family’s tragedy from my own life. Maybe I’ve done it too well. I found myself believing that death and sadness happens “out there,” outside the station.

It’s going to happen to each and every one of us. Me. You. The goldfish. The potted plant on my kitchen windowsill (although, given my gardening skills, that death might happen sooner than later.) One day, it will all be gone. Yet that thought doesn’t pervade throughout our daily consciousness. It doesn’t sit forefront in our minds. That’s probably a good thing. If my ultimate demise was constantly on my mind, I doubt there would be a whole lot of skydiving, Rocky Mountain climbing, or riding bulls named Blue Manchu. For me anyway, I think there’d be a lot of fear, sadness, and freaking out, with a couple of reckless activities thrown in there. So I, like most people, live with thoughts of death tucked away in the back of my mind.

Then, something happens that shatters the worn falsehoods you’ve wrapped yourself in, keeping you emotionally safe. Where death doesn’t just happen to the goldfish or the potted plant. It happens to people–and not just the people in our ambulance coverage zones.  The red lights of the ambulance don’t penetrate the darkness of that unknown “Great Beyond.” The brick walls of the station don’t keep death from reaching for those inside.

I was fortunate to have gone several years without losing someone dear. Maybe that, in combination with seeing death happening to others, allowed for me to forget that death happens to everyone. Even those I see all the time; fixtures in my life that I’d taken for granted. Even those I work with. Even those I care about.

It’s an interesting and uncomfortable roller coaster. It’s a learning curve–an important one at that. I find myself wanting to spend more time with the people I love. I find myself giving out more hugs, and telling people how important they are to me. It’s unsettling to have that naive, protective bubble removed. I’m no longer on the outside of the fishbowl. Instead, I’m swimming in it.

Burn Out is Kind of Like Love

Burn out is kind of like love. When people get all sappy and starry-eyed and start shedding cooties all over the place, they sigh, stare off into middle distance and dreamily say cliche and exclusive-sounding things like, “When you’re in love, you just know.” Well, guess what? When you’re burnt, you also just know. 

I feared burn out. I feared that I wouldn’t be able to recognize it. I expected it to sweep over me, take me and break me before I really had a firm grip on what was going on. Surprisingly, that’s not what happened at all. As much as I wanted to deny it, there was no arguing with it. When our tones went off, the pulling anticipation in my stomach would break into dread and annoyance, not the elated excitement I was used to. On my way to the truck, I fought to hide my frustration and aggrevation, instead of my enthusiasm and eagerness. To be honest, I wasn’t doing a very good job of it either, particularly around the station. I had a few concerned, “Are you okay?”s, but mostly I got some bewildered stares. I’m not a mean person. Get to know me, and you’ll find I’m one of the most empathetic people you’ll meet. But lately, as one friend and coworker coldly–but rightly–pointed out, I’ve been a bitch. The people I work with deserved better than that, as did my patients. I was burning out.

I didn’t want to believe it at first. I’d only really been in EMS two years, in what most would consider a relatively low call volume system. While I’ve heard that the average career lasts only five years, I thought I was far too early in my career to be getting burnt. Regardless, I knew it through and through. I was burning.

As for what did it…I think it was just one too many calls at 2 a.m. on my nights off to run a BLS transfer. One too many rides with verbally abusive patients. One too many runs where I felt like I didn’t make any difference at all.  For me, a good shift means that I’ve run calls with either my brain or heart involved–if both were involved, even better. There were too many shifts were neither were used. Combine that with the physical exhaustion from working far too many hours and the emotional ache of a personal life that was imploding, and you have yourself one over-cooked little EMT.

So that’s my excuse for falling off the face of the earth for the past several weeks. I needed a break from EMS in general, and everything that reminded me of it…..which is pretty hard to do when you fall into the trap of making it your life.

Now, I’m a little more rested. I’m learning to say “No” to covering extra shifts I’m too emotionally or physically tired to work. I’m learning to stick up for myself, and start to build the stronger, improved me. And piece by piece, I’m rediscovering the little reasons that caused me to fall in love with EMS in the first place.

I’m Not So Perfect After All

I hit another landmark down my journey to becoming a fully competent practitioner.  It was inevitable, although I’m not sure I recognized that initially. It wasn’t a proud moment; in fact, it was close to just the opposite.

Empathy is my strongest skill set. I take pride in it. I’m pretty good at removing myself from a situation and trying to imagine what the patient is going through. I’d almost say that I’m cocky about it. Some paramedics can get blood from a stone. Some can fall down a flight of stairs and intubate 3 people by accident on the way down. I can connect with almost any patient. Well, so I thought.

Several months ago, I transported a young woman who was emotionally in a tough place. She was smart, pretty, polite. She had an interesting sense of style, and was embarrassed to be seen without her make up. On the surface, she looked like your typical adolescent kid…just beginning to try figuring out who she is. Still trying to find the place she fits in. But I guess she was like a lot of young adults, myself included. She was losing hope over figuring herself out, over finding where she truly belongs. I’m not sure she realized the permanence of what she was contemplating…That she was thinking of walking out of the movie only 15 minutes in, or closing a book after only 2 chapters. But when you’re only just starting out, it’s awfully hard to contemplate things bigger than yourself: who, where, and how you are now. It’s hard to contemplate things bigger than right now at any age.

We talked about things…school, boys, friends, arguments, likes, dislikes. Plans for the future, memories of the past. Mainly superficial stuff, but she occasionally opened up and allowed us to examine a little deeper. When the transport was over, we left her in capable hands, trusting that “The System” would get her the help she needed.

Not long ago, my partner and I showed up at the hospital for a transfer. The ED nurse gave us a report before we walked into the pt’s room. I flipped through the paperwork, when something grabbed my attention: the patient’s name. It was the same girl.

Maybe I was blinded by an arrogance I didn’t know had developed. Maybe my newness and ignorance kept me from even considering this possibility. Whichever it was, I felt a little blindsided.

I’d had repeat patient’s before. Every ambulance corps has their frequent flyers. So I’m not sure why this is so different. Maybe I actually expected this patient to get better. On some level, I liked to believe that I’d made a difference in this patient’s life. In my mind, I probably made out my impact to be much larger than it actually was. I really wanted her to get better, and I must have really expected her to get better too. When she didn’t, I was a little shocked. I felt a little like I had failed her. Obviously that’s not the case; this is no one’s fault, and certainly not mine. Although I worked to not show it, I was upset with her for reasons I couldn’t place.

I suppose I was frustrated that all of our efforts in the medical field hadn’t—and weren’t—helping her. And I had no idea how to fix that. And, to be truthful, dealing with this new understanding made it hard for me to reach out and connect with my patient on the same level I did before. I was wrongfully angry with her, and found myself trying hard to be there for her the way I did originally had. Why was this so hard for me? Why was it so easy to be compassionate the first time, and so trying the second? Maybe this empathy I’d given to patients wasn’t as genuine as I believed. That notion itself just rocks my world. It makes me feel worse than a bad EMT…it makes me feel like a terrible person.

Nobody has a 100% success rate. EMT’s with a talent for IV’s will eventually blow a line. Paramedics with a knack for intubation won’t get every tricky tube. I empathize and develop a relationship with patients, and I suppose it was only a matter of time until I didn’t, or couldn’t. I just hope that this landmark isn’t any more significant than that.