Before leaving field work as a flight paramedic to return to graduate school for a creative writing MFA, I had been fortunate to log twelve, experience rich years in emergency medicine; from land ambulance, to air rescue, to remote third world clinic environments. Those dozen years yielded a set of universal truths for coping in the often intense and sometimes heartbreaking environments I found myself in.
Broken down into fifteen golden rules, some are hilarious, gross, and crude, while others are serious, simple, and exactingly accurate. And a few are so emotionally resonating, they still cause me to well up.
So, here they are, the things I’ve learned, and what I’ve found most important to pass on.
- There will be the occasional glorious fuck up and the insanely awkward, embarrassing situation (reference #10). Responding to life threatening emergencies, as a career, cannot involve anything but complicated problems. For those of you who find that statement exciting, that’s fine, though consider the counteracting aside, “When you hear hooves, think horses not zebras”. Which is meant to say, common things happen commonly. Other things happen, but less so.
- If you drop the baby, pick it up. It happens. What are you going to do, leave it there?
- Air goes in and out, blood goes round and round, any variation on this is usually a bad thing. Simple, you’d think. I cannot tell you how many times I have walked into a hospital room with nurses and supposed doctors performing CPR, initiating a central line, preparing to shock a cardiac rhythm, only to turn on my snark to full effect and ask “Um, yeah, who would be doing the breathing”. Thus, the reason for the term ‘pulmonary’ in cardiopulmonary resuscitation. They may have an absolutely beautiful underlying sinus rhythm, but if they aren’t breathing, I can guarantee they won’t have one for long.
- What may seem like a big, fat waste of an ambulance ride to you, may be experienced as nothing less than a monumental event in someones life. Patience, restraint, empathy, and the willingness to view someones current situation through their frame of reference are vastly more important skill sets than your stellar success rate at placing an external jugular IV, or your impressive command of cardiac electrophysiology.
- If the sick kid is quiet, get scared. Fast. You have to see it to believe it, but if you compare adults and children in how they move from moderately sick to critically ill, adults take a very slow, somewhat predictable descent into dangerous territory. Kids on the other hand, will coast, and coast, and coast, then rapidly crash and burn. No warning, just a very severe tipping point. The tell tale sign is the sick child who has been whiny and crying, suddenly going strangely quiet and self absorbed. If you are seeing that, you are already behind the eight ball.
- All bleeding stops…eventually. Well, it does.
- One thing you can be assured of. No matter how many years of paramedic preparation you have, be it community college, undergrad or grad school, there will still be those charming people who ask why you wanted to become an ambulance driver. And if you are required to have your Standard First Aid.
- You can’t cure stupid. Learning this early on is an excellent predictor of a long and rewarding career.
- Neither can you cure addiction. Your job is to support, treat, and advocate. Not rescue, lecture, or save.
- When a pregnant woman says “The baby is coming”, you would be well advised to believe her. And a cautionary tale from personal experience — when your partner, who is driving and is overly brake friendly, rapidly and without warning stops at a red, that is never a good time for you to go in for a closer look at how fast she’s dilating. Trust me, you will carry that little gem of a memory, and taste, for life, thank you very much.
- If it’s wet and sticky and not yours, leave it alone. Need I say more?
- Whatever that higher power thing is, know this: He / She has an infuriating habit of protecting the biggest assholes and drunkest drivers.
- Emergency medicine is extended periods of intense boredom, interrupted by occasional moments of sheer terror, joyful exuberance, heart wrenching pain, and transcendent humanity. In no particular order or frequency.
- Learn to juggle the above. Sounds easy, you say? Try going from consoling young parents who found their first born dead in his crib, to delivering twins at the side of an eight lane highway. In the span of 11 minutes.
- Finally, when a patient looks into your eyes and says, I think I ‘m dying, he or she is probably right. The most important lesson you will ever learn is when to, a) Pull out all the stops and do everything in your power to halt that active process from occurring. Or, b) To understand when the most heroic and profound thing you can offer someone is your compassion and humanity. In equal measure. Not often, but occasionally it will be your job to to bring them as far as you can, and then gently let them go. In either case, begin by looking into their eyes, taking their hand, and assuring them you will be there as long as they need you.