Sunday, June 17, 2012

Good and Bad: Paramedic Edition



Remember all my work stories?  I used to gross you guys out on a regular basis.  Blood and guts.  Gunshot wounds to the head with teeth coming out the back of someone's skull.  Crazies threatening to slice off their breasts with a razor blade.  Vomit on my boots.  Just another day at the office.

The funny paramedic proverbs;

"They're not dead til they're warm and dead."

"Air goes in and out.  Blood goes round and round.  Any variation on this is a problem."

"If you hear hoofbeats, think horses, not zebras."

"CPR is just pumping and blowing."

"S/he was circling the drain."

"Protocols don't save lives.  Primary surveys save lives."

"If by the end of the primary survey you don't know what the hell is wrong with your patient, they are SICK. They need a surgeon, not a paramedic.  Get the hell out of there as fast as you can."

Anyways, in some ways I was well suited to my job, and in other ways I wasn't.  No matter what kind of job I have, this seems to be the case (and I don't think it is much of a stretch to say it likely applies to all of us.  Except maybe the Bloggess, who is 100% well suited to being hysterical).  Here is a list of some of my strengths as a paramedic;
~memory: I have strong recall of pathology details, physiology, anatomy, names, exceptions, and algorithms involved in protocols.  Even the hard to remember exceptions and small details stick in my mind.
~methodical: I rarely miss steps, take shortcuts, or forget things; nearly every call is run in a similar sequence so that suited the way my mind works and helped me feel in control of the situation with regards to the gathering of information, diagnosing, and developing a treatment and transport plan.
~thoroughness: by the time I brought a patient to the emergency department, I knew LOTS about them, and I used to get teased about my paperwork because all the lines and boxes were filled in, even if it was just with the shorthand symbol for "nothing."  This was partially to cover my butt; if you don't write it down it didn't get done (or you can't prove it did), and partially for good patient care.  The more you know about a patient the better the chance you can give tailored care for their needs, situation, and idiosyncracies.  Also it is easier to miss small details or hidden health problems if you have less information about a patient.
~medical terminology: a few times I was asked by medical staff if I had another job as well (such as nurse or respiratory tech) because my description of a person's medical history used the correct medical terminology and considered diagnostic details.  This is a side bonus of being a linguistic type of person.
~easy going: I was easy to work with, flexible, kind, and generous.  I see people as equals regardless of age or status in life and for the most part people respond well to that.  It makes them feel good that I see them for who they are, rather than what they do.  Knowing my protocols, physiology, and pathology as well as I did made me a great partner on the road because I could anticipate what my coworkers needed or wanted, what equipment we might need, or what questions to ask, and pull out things and hand them over before they asked.  Every day I worked was with a new partner so flexibility and an easy going nature were assets.  I mean, I worked lots with the same people but seriously we had hundreds of colleagues rotate through our station so I worked with TONS of people.  Lots of them expressed that they enjoyed working with me.
~compassion: I connected well with most patients and felt compassion for nearly all of them.  I know this ability to empathize was my greatest asset as a paramedic.

Now here are some of my weaknesses;
~self confidence: one of our jobs was to come up with a 'differential diagnosis'~ a working theory as to what is 'wrong' health wise with the patient you are caring for.  This can be difficult in complex cases, or non classic presentations (ie, painless heart attack).  Generally by the end of the primary survey, or first five minutes of assessment and questioning with a patient, you have a pretty good idea what's going on.  Complex cases require a bit more sleuth work.  My differentials were almost always right, but I nearly always kept them to myself because I was afraid I was wrong.  Always.
~assertiveness: I was NO good at bossing around my colleagues.  I'm terribly afraid of offending people and it makes being assertive very difficult for me.  Part of our job as paramedics is TO BE assertive when we are 'attending' (vs. driving), particularly in MCIs (Mass Casualty Incidents), or in multi agency scenarios involving firefighters, hydro, police, etc.  I was no good at it.  If everyone on scene was younger than me or had less experience, I WAS good at it, but that is so rare that it essentially meant I sucked at assertiveness.  A few times I remember being good at it, but it took concerted effort and there had to be a really good reason for it.  Like one time a sixteen year old patient was in a car crash and wound up in the river, and I was worried she may have broken her back.  Keeping her calm was paramount because when she panicked, she thrashed around.  Not good for a broken back.  Her mom arrived at the hospital when we were transferring her from our cot to the hospital bed and she started screaming and shaking and saying "OH MY BABY!"  Which got my patient all panicky again.  It had taken me so much work to keep this girl calm and now her mom walks on the scenario and fucks it all up.  Understandably, but still.  I turned around, held my hand up, and said, "I'm sorry, I know you are upset and I know you love your daughter.  But you MUST either leave or calm down.  Your daughter must lie still until we X-ray her back, and you being upset makes her move."
She looked me in the eye, hated me for a second, and then knew I was right, swallowed her pride, and turned and walked away.  Five minutes later she was back and calm.
That was an unusual day, for me.  Many, many times I let people (namely, colleagues) plow over me, my call, or my patient and didn't say a word.  I'm not a dog eat dog person; I treat people fairly and expect the same in return.  I generally don't know what to do when people don't treat me with courtesy.  The ambulance service in particular and health care in general is dog eat dog.
~speed: being both methodical and working part time made me slow.  Not suuuuuuuuper slow and I could hoof it in an emergency, but slower than the majority of my coworkers.  This had no bearing on health outcomes but I'm sure it drove my coworkers nuts.  Efficiency comes with practice, which I had less of than most of the people I worked with.
 Why did I have less?  Because I had kids.  I had kids and I chose to work less in order to be with them as much as possible while they were small.  Most BC paramedics are not good at balancing work and life; the system is set up to make overwork seem incredibly normal and it is very easy to work more than 40 hours per week and hardly notice.  I noticed.  Hence, I was slow.

All in all, I had tons of fun in 10 years and I learned SO much.  About life, about myself, about conflict, human behavior, reactions to stress, and how hilarious that job can be if you don't take yourself too seriously.  It wasn't perfect and neither am I, but I still managed to save a life or two.  And be a small part of hundreds of other lives in a remarkably intimate and astonishingly fascinating way.  I felt like a witness to so many significant moments in people's lives, and that was incredible.  So cool.

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