“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.”

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!

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

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

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

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

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

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

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

It was a peculiar moment of knowing and not knowing.

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

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

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

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

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

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

“You must only use one pair of gloves throughout the duration of a call.”

I’m looking around the inside of the ambulance for a little plaque or a sign that says this. I already checked the protocol book…it’s not there either. I’m willing to bet a week’s pay that such a rule does not exist. So then why do people act like it does?

Let’s get specific here. Someone calls 911. You show up in your shiny truck with your partner. Turns out, the guy’s not feeling super well. In fact, he looks almost as icky as he feels. Poor dude. Better get him to the hospital and see if we can make him feel a little better. So you do your on scene assessment (and, assuming you’re doing it right, you’re touching your patient), load him onto the stretcher, put him in the truck, and help your partner get some things accomplished in the back.

After a few minutes, you look at your partner and say, “Ready to go? Need me for anything else?”

And he’ll say, “No thanks, buddy, I got it now. We can get going.”

“Righty-oh,” I hope you don’t say, and then get in the front of the ambulance and drive.

With your freaking gloves on.

The very same gloves that were just all over Mr Sicky back there. You pretty much just rubbed your patient’s body all over that steering wheel. And if you did something more invasive? Like check his BGL? Or start an IV? Or intubate? Or suction? Then his blood/saliva/vomit is all over that steering wheel too.

I don’t know anyone who ordinarily drives (non-emergency, like between calls) with gloves on. So, if you are in that category of people who puts your gloves on when arriving on scene, then doesn’t take them off until you’ve transported the patient to the hospital…then you just inadvertently exposed yourself, your partner, and anybody who drives that truck, to the very things that you wore gloves to protect yourself from.

Maybe I’m crazy. That kind of thing just drives me nuts. Take the gloves off–And throw them away!–when you get up front to drive. If you can use some sort of hand-sanitizing product after taking off the gloves, even better.

In the meantime, I’ll keep looking for where that sign is…

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)

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.

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.

Like most of the best things in my life, I came into EMS completely unintentionally.

Prior to EMS, I had a particular fondness for swimming. At 17, I was preparing to start my 10th season of competitive swimming, and my fourth season of 10-&-under coaching, when I got a phone call from my head coach. Enrollment was down for the upcoming season, and it looked like I won’t be coaching the little kids after all.

Well. That greatly opened up my summer schedule.

To most people, that would hardly be a bad thing. But I had spent my adolescence as one of those annoying over-achievers that burnt the candle at both ends. In high school, I spent my afternoons, evenings, and weekends darting around to my 13 extra-curricular activities. If I had down time, I was in a panic, trying to remember what project, assignment, meeting, practice, rehearsal, game, meet, or activity I was supposed to be doing. I couldn’t relax during my “time off.” It actually made me more anxious.

So I began my job hunt. Unfortunately, it seemed that every attempt to find a local job ended in “Thanks, but no thanks.” Each small store already had their seasonal adolescent workers hired. Not giving up yet, I figured if I couldn’t get paid to do work, well, maybe I could volunteer. Seeing how I was starting college in the fall for my biology/pre-med degree, I decided I’d give the hospital a call and see how I could volunteer there.

“Sorry,” I was told. My heart started to sink. “We only take volunteers in the ER if they’re EMT students.”

EMT student, huh? That sounds kind of fun. I could learn more about healthcare, get some practice actually treating patients, and ride around in an ambulance. There’s no harm in at least seeing what it’s about, right? And if it’ll be a gateway to get me to work at the hospital–even better!

I set up a meeting with a fire department officer later that week. He had a paramedic take me to do a truck check on one of the ambulances. I sat on the bench seat, and listened intently to his explanation of the equipment, what EMT’s can do, and the EMS culture. I was awestruck.

By the end of that hour, I was so completely in love with EMS. I don’t know what did it, but sitting in that truck just felt right. I didn’t want to leave.

It didn’t matter how much I had to learn. It didn’t matter how long it would take. It didn’t matter that I had no idea how I was going to deal with things like guts, gore, and death. I would figure all of it out in time. For the first time in my life, I knew I could do something. I mean, just knew it. On the days I had my doubts, there was always this determined little whisper in the back of my mind that said that I could get through this.

That night, I researched EMS blogs, almost desperate to find someone’s story or opinion that would take this dreamy glow off of my newest and strongest aspiration. As it turns out, it only deepened my love for the field. The next day, I was enrolled in a local First Responder class, and began my EMS apprenticeship at the fire department.

And the rest, as they say, is history.

Why on earth is the healthcare provider education system so hell bent on burning people out before they’ve even got their license in hand?

At least that’s the way it seems. Maybe it’s just a regional thing. Maybe all the schools in my area are teaching using similar techniques, and all the teachers subscribe to a similar mindset. Or maybe I’ve officially lost my mind (I am certainly not ruling that out).

This post is going to mostly be about nursing school, because that’s what I’ve experienced. But, any new-grad paramedic I know has talked about similar problems.

For any of you that actually read my rambling, babbling, nonsensical drawl, you know that I am unhappy in nursing school. Yes, I do feel absolutely miserable. Every week, I find myself up in the wee hours of the morning on the verge of a mental meltdown. Every drive to school is filled with anxiety, and every drive home is filled with discouragement. It feels almost like a trap some days. The further into the program I get, the worse I feel, but the more obligated I feel to finish it. At my worst, I find myself panicky, physically sick, unable to sleep, and waking up with horribly graphic and disturbing nightmares. Sometimes I start wondering why I ever decided to go into nursing. In my stress, I start to look for other careers I could do. Maybe I’ll find my calling in something else. In the past, I’ve considered going to paramedic school. Currently, I have some wild aspiration to go into law enforcement…which I’m sure would be greatly discouraged by anyone who actually knows me. I have to stop and wonder if these aspirations are real, or if I’m just looking into them because it’s something other than what I’m going through right now.

I’m in an associate’s degree program, so it’s only 2 years long. Most paramedic programs are about that long as well. It’s a short amount of time in which to learn a lot of important things. It’s not like earning a typical degree…after we get out of school, our decisions could greatly impact the lives of others. The stakes are very high, and it’s incredibly important to learn as much as we can in the short time that we have. Maybe these programs are just too short to be reasonable. I find that students in these shorter healthcare degrees/certification programs are just so stressed out and inundated with schoolwork that they find themselves discouraged or disliking the career they are about to enter. It’s heartbreaking to work so hard towards something, and then to be almost directed to hate it.

Maybe I just don’t love my potential career enough. Maybe I’m not dedicated enough. And like I mentioned before, maybe it’s purely a regional thing. Regardless, something should change here. Maybe it’s just me. Or maybe it’s the healthcare system. Or perhaps something in between.

Are any of you having problems similar to this? Or did I really just plain old lose my mind.

Although the calendar had just flipped over to September, the weather still remained unforgivingly hot and humid. It was my first week of college, and my first week out in the big bad world all by myself. I knew absolutely nobody in this city, and I was hours away from anything remotely familiar. So far, I was making the best of it. I was excited and ready to prove to the world that I could do grown up things. Because, obviously, at the age of 17, I was pretty much a full-fledged adult.

On my list of grown-up things to do was to go and take my computer-based test for my First Responder ticket. I’d taken the class back home during the summer, seeing as I wasn’t quite old enough to take my Basic course. All that was left between me and my first EMS provider license was a computer test.

Being a college freshman in a city, I had no car. I had already taken a taxi once before that week, and that was a disastrous decision. It’s just too intimate a setting. Call me crazy, but there’s something unsettling about being trapped behind plexi glass, in a locked vehicle, being driven by a stranger listening to tympanic membrane-rupturingly loud music, that occasionally tries to scream-ask me questions like, “DO YOU LIKE SAND CASTLES, SWEETHAHT?” Also, the posted sign that says “There is a $50 fee for vomiting in the back seat” is there for a reason. They didn’t just opt to put that there one day. It actually happened. Right exactly where I’m sitting, most likely, seeing as there’s really nowhere else to go.

Long story short, I hate taxis, and try to avoid them. Which leaves me with the bus system. I had spent the entire long, sticky, swelteringly hot night before the exam peeling apart the bus schedule brochures I found in the lobby of my residence hall. It all seemed to be working out perfectly. I had enough time after my chemistry class to walk over to the bus stop, take the bus to the center, test, and be back in time for dinner.

I couldn’t sleep at all. Well…partly because it never got below 102 degrees in my dorm room that night. But even if the temperature had dipped to a more sleep-conducive level, my excitement and nerves still would have prevented me from getting much rest.

After my chemistry class the next day, I swung by my dorm room to drop off my books, pick up my exam entrance ticket, and triple-check that I had all the appropriate forms of ID. In what was one of the two acts of kindness my roommate had displayed all semester long, she left me the last apple we had left (we really needed to go grocery shopping) with a note that said, “Good luck!” After slinging my purse over my shoulder, I grabbed the apple and set off into the stupid hot afternoon sun towards the bus stop.

The thing about bus schedule maps is that they don’t give you nearly as good of an idea about distances as you’d assume. They also don’t account for the additional travel time needed for an anxious, sleep deprived girl who’s well on her way to heat exhaustion. Nor do they give any indication of changes in elevation–suprise, cities aren’t perfectly flat.

I thought doing something other than walking would help calm my nerves, so I ate my apple on the way….really fast. Before I reached the end of the first block, my now cramping stomach was filled with butterflies and golden delicious apple. I get super queasy when I’m hot, nervous, or tired. I happened to be all three, so I spent most of my walk trying not to wretch, and/or die in the 105 degree heat. Later that day, I would consult Google maps to find that I’d walked about 1.5 miles to get to the stupid bus stop–while apparently passing several other bus stops that would’ve taken me to the exact same place.

When I finally arrived, I stood in the baking sun, absolutely pouring with sweat, waiting for the bus. I felt dizzy, realizing that I hadn’t had anything to drink all day. The sizzling waves of heat floated above the pavement, making me question if that was normal, or if I was about to pass out. I was unapologetically mouth-breathing, and trying really hard to make my retching as discreet as possible. I checked my watch, and saw that the bus was probably about 15 minutes late. I was sick, tired, a little lost, and alone in a city where I didn’t know a single person to come help me. A part of me wanted to cry, give up, and go back to the dorm. The other people waiting for the bus shuffled away from the crazy-looking chick with the sweaty eyeliner running down her face. Except for one brave individual, who decided to get sociable with me. Probably out of pity.

“So where are you going today?”

“To take my first responder test…” I panted. She gave me a quizzical look. “It’s like an EMT, only you can’t do as much.”

“You look like you need an EMT yourself. You want me to call you an ambulance?”

“Nope. Definitely not. Thanks.”

By the time the bus did show up, I almost forgot why I was there. I was just so overjoyed that I was about to get on something with air conditioning. When I stepped onto the bus, I fumbled around, looking for my student ID (which provided free bus fare). The bus driver chuckled and said, “You aren’t from around here at all, are you?”

“Nope,” I said sheepishly. “Actually, maybe you could help me. I’ve never taken the bus before. Obviously. Can you let me know when we get to this destination?”

Surprisingly, he happily obliged. The woman I chatted to at the bus station told the driver, “She’s going to take her EMT test.”

I shuffled my way to the back of the bus and clung on to the overhead bar for dear life. The tall towers of downtown started to shrink away into dilapidated buildings with rusty metal bars over the windows. Angry looking people hung out on stoops and street corners, glaring at those who walked past. Abandoned cars with broken windows lined the streets. The lights of police cruisers glittered down a side street. I couldn’t be 100% sure, having never really seen them in real life before, but the signs and walls of buildings seemed to be full of pock-marks and bullet holes. My heart pounded away in my chest. Oh, God, where am I going? What am I doing? I’m not ready for this at all.

When we finally arrived at my stop, the bus driver called out, “Miss? Your test center stop!” I made my way off the bus, and stopped to thank him before leaving. He yelled out to the rest of the bus, “WISH THE KID GOOD LUCK! SHE’S GOING TO TAKE HER EMT TEST!” To my surprise, the bus erupted with loud cheers and well wishes. I smiled and scurried off the bus. It certainly made me smile…but now I had that overwhelming terror build up inside me. I was about to go take the test that justified all my hard work all summer, and all the craziness of getting to this testing center, which was apparently in the bad part of town.

A week later, much healthier, and many degrees cooler, I received a letter from home. Sitting on my bed, I opened it up.

“Probie To Pracitioner, Congratulations on passing the National Registry of Emergency Medical Technicians First Responder…”

I beamed. Yep. Definitely worth it.