Archive for September, 2013

Self-care in Emergency Medicine

I recently read this post on Tumblr and found it very insightful. The truth is I sometimes find myself too wrapped up in EMS and have a little trouble disconnecting. I know, it’s surprising to me as well. But I think we have all been there, we are in the middle of a nice day off and when someone asks a question about how work has been we launch into a 10 minute story. We go to the book store and somehow we find ourselves in the medical section instead of the new fiction. That is not always bad, but sometimes it does us good to find something different to occupy our minds with.

For me, my oxygen mask is sometimes music, sometimes it’s books, which sometimes aren’t even the good ones, just cheap little thrills to pass some time. Movies, my family, yeah they sometimes drive me nuts but still. Sometimes it’s a walk in the park with good music on my earphones….yeah I like that one, I think I will do this one right now.

Here’s the link and post:

Link: http://blaumau5.tumblr.com/post/61711146326/self-care-in-emergency-medicine-yes-it-is-ok-to-be

Self-care in Emergency Medicine: Yes, it is ok to be nice to yourself.

Self-care. It’s a biggie for those in professions that address the needs of others. Not that I’m going to write solely about 9/11 today, but I have to admit that this year’s anniversary really affected me differently. It prompted me to think long and hard about maintaining my emotional health while caring for others for a living.

Most of you readers are probably strangers. To give you some background information and context, I’m an EMT on a 911 ambulance in a rural area. Much of our service area is poverty stricken, and we see horrific traffic accidents on highways boasting speed limits of 75. One morning you may have to dig a hoarder in cardiac arrest out of their toxic wasteland of a home, and by nightfall you’re wrestling with a gaunt meth addict. Other times you just end up checking grandma’s blood pressure and leave with Snickerdoodle cookies.

I didn’t get into EMS until my late twenties, as I was finishing my undergraduate degree. With that said, I’ve approached my job from a different perspective than that of many in the profession. I didn’t get my certification as a naïve teenager, and I have a well-rounded liberal arts education in the social sciences to go with it. It has greatly benefited me and made me a more compassionate provider, but at the same time I think it makes some aspects of the job more emotionally taxing. I’m generally quite good at handling the stresses of the job, but sometimes I am disheartened by the awful things I see. Sometimes I feel overly sensitive to things that probably wouldn’t bother other people, and in contrast I’m unfazed by situations that would send most people into a panic. It’s a little like living in a parallel universe that the rest of the world sees but doesn’t fully understand.

When the anniversary of 9/11 arrived this year, I felt differently about taking time to remember it. During the 12 years that have spanned between then and now, I have generally just gone about my business and moved on. I was a teenager at the time it occurred, so I remember the attack very clearly. In 2006 I visited Ground Zero to pay my respects in person. I just felt like it was something I really needed to do. This year, I felt that revisiting the media coverage from that day was also something I just ‘needed to do.’ I saw it almost as a masochistic duty. I’m older, wiser, and now that I’ve been a first responder for a while I’ve seen a lot of horrific things firsthand. I wanted to know how I would react after gaining those experiences.

While at work that day I queued up as many 9/11 videos as possible on my iPhone. What I really didn’t expect was the overwhelming sense of dread and sadness that I felt while viewing them. It was almost like something was pulling me downward and draining any trace of well-being from my body. I felt tense and depressed and anxious. I felt like I had experienced the whole day all over again, and this time it seemed realer than real. The sounds of emergency vehicles in the videos, which I am now intimately familiar with, elicited a near panic response from me. I could picture myself there as if I had responded as an EMT, triaging patients and trying to make sense of the chaos, wondering how much worse the situation was going to get. It felt like I was helplessly watching something unfold that I desperately needed to respond to.

Eventually I just had enough of it. I was in such a heightened state of anxiety and alertness that I literally could not relax without filling my head with something mindless and unrelated. I had to turn off the documentaries and news clips in exchange for cartoons on Nickelodeon, which I generally don’t watch anymore.

The next day I thought about it and wondered why on earth I willingly made myself miserable. This isn’t something entirely out of the ordinary for me though: at times I feel obligated to experience negative emotions. Then I remembered something I had recently read in a book about the effects of trauma exposure on workers in fields such as mine: we tend to experience guilt about how good our lives are in comparison to our patients. People who routinely work with clients or patients that are in much greater distress than themselves often try to downplay the positive things in their lives, in an effort to not flaunt them around those in terrible situations. (Such as domestic violence victims, the homeless, the terminally ill, etc.) The happily married counselor may be reluctant to talk about his children around a battered woman in the shelter where he works, or a fit paramedic may not feel comfortable sharing information about her last hiking trip when treating a paraplegic.

I realized that this is exactly what I do from time to time. I feel so guilty that others have gone through something horrendous that I feel obligated to share their grief. I’m not entirely sure why sometimes, because my life is far from perfect. I have plenty of emotional scars from fighting my own battles. When faced with large scale disasters though, which I have only experienced peripherally, I tend to fall all over myself trying to help and empathize.

Sometimes I wonder where the dividing line is between being a compassionate, soulful human being and being slightly insane.

Either way, being mindful of this tendency is the best thing I can do as a first responder. It’s also a good idea for anyone who has witnessed traumatic events involving others, which is essentially everyone at some point in their life.

I do, however, feel fortunate that I still have this much compassion and empathy for others. It can be difficult to not hate everyone when you see people at their worst on the regular. I’ve been a public servant for almost 6 years, even though less than two of those have been in EMS. Some days I just don’t even want to have contact with human beings because I am so tired of their trivial crap. I just want to nap on the couch with my cats and eat dark chocolate.

I think the field has made me more self-aware though. I suppose you could say that’s the moral of this story. I’m more conscious of the fact that I absolutely must engage in self-care or I’ll burn out, and I really don’t want to ever burn out of emergency medicine. Part of that is in the interest of my own career, and part of that is for the sake of my patients. (So much for trying to have a mostly internal locus of control.) There are a lot of other providers whom I know experience the same things, but don’t talk about them necessarily.

So here’s to making sure the conversation of self-care continues.

During undergrad, my clinical psychology professor used a great analogy. You know how airline attendants always say, ‘In the event of a crash, put on your own oxygen mask before assisting others?’ It’s the same principle. If you help others first – and then pass out – you’re rendered useless. Then you can’t help anyone.

My metaphorical “oxygen mask” is playing in a rad brass band, gardening, reading, writing, taking photos on road trips, and making sure I surround myself with positive people. I don’t really watch much news outside of staying current on major international happenings, because let’s face it – I don’t need to hear about the 20th rape that’s been reported locally this year. I see assault victims in person enough.

Instead I read about people doing nice things on Buzzfeed and Upworthy, and I scour Youtube for the funniest sketch comedy I can find. I make fart jokes. I speak in funny voices to my friends, just for the sake of being ridiculous and quirky. I’m not afraid to spend a little more for a quality meal at a nicer restaurant, when I can afford it.

I laugh at myself.

I daydream.

What’s your oxygen mask?

Advertisements

What we live for.

I recently read this and it resonates with me. I think many in EMS can understand what Bertrand Russell is talking about. Many in EMS know how precious life is, how important love is, because we see how quickly it can all be taken away. How quickly life can change.

Many of us in EMS search for understanding. We search for knowledge. And lastly, many of us do this job because we know it’s necessary. It’s important because there is so much pain and danger in the world some are needed to hold the line.

Here’s the prologue:

The Prologue to Bertrand Russell’s Autobiography

What I Have Lived For

Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither, in a wayward course, over a great ocean of anguish, reaching to the very verge of despair.

I have sought love, first, because it brings ecstasy – ecstasy so great that I would often have sacrificed all the rest of life for a few hours of this joy. I have sought it, next, because it relieves loneliness–that terrible loneliness in which one shivering consciousness looks over the rim of the world into the cold unfathomable lifeless abyss. I have sought it finally, because in the union of love I have seen, in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined. This is what I sought, and though it might seem too good for human life, this is what–at last–I have found.

With equal passion I have sought knowledge. I have wished to understand the hearts of men. I have wished to know why the stars shine. And I have tried to apprehend the Pythagorean power by which number holds sway above the flux. A little of this, but not much, I have achieved.

Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer.

This has been my life. I have found it worth living, and would gladly live it again if the chance were offered me.

-Bertrand Russell

Retiring medics email

It’s sad but true that we are all on a time limit. Be it in an ems career or in life. So few of the patients I deal with see life is about to throw them a curve ball when it slams into them. I remember one patient who was about to sign the papers for a new vehicle suddenly had extreme weakness and called the ambulance. We arrive and find a man having classic signs of a stroke. His family was probably waiting for him at home to drive up in a new car and now there is something new and evil present in their life.

Few of us reach the end of our careers and can look back at life well lived, work well done. I came upon this email from a retiring medic. I found many of these points talk directly to me. I am reproducing them now with a link to the original post at the bottom:

A retiring medics last stand

Although I post a lot of religious/my life stuff on here, this was an email I received from a retiring medic. 30 years on the job and this was his “goodbye”. I only know who he is because I was in a position that made me travel to every station and talk to almost every paramedic we have.
Great piece of writing. Cheers!

“I’m another one of those retiring medics (I started back when Karma Chameleon was on the radio and Ghostbusters was at the theater and you had to find a payphone if you wanted to make a call outside your house) but please don’t give me a gold watch, a radio sign-off, or a going away breakfast. Just let me have your ear for a minute and I’ll share with you some things I’ve learned that lead to an EMS state of nirvana:


1. Get a life. You have got to have a non- work related hobby (collecting EMS patches doesn’t count).

2. Be nice. It just makes life a lot easier and always keeps restaurant staff from spitting in your drink. I still can’t figure out why the Yankees don’t get it.

3. Get a good partner. This applies to home too, but it really makes a difference who is sitting beside you in the cab all day. I mean, you have to listen to them more than your spouse; so make sure they don’t just yak endlessly about absolutely nothing, unless of course you also like to do that.

4. Corollary to the above point: Always have your partner’s back. And I don’t mean a knife in the back. You’re a team.

5. Enjoy what you do. If you don’t want to be in the back of the truck taking care of patients, might I suggest you find what you do want to do and do it? Unhappy medics hurt themselves, their patients, and those of us unfortunate enough to get stuck riding with them for months on end…..long, long months.

6. Do sweat the small stuff. Sometimes it’s the small stuff that makes the difference in what we do. What not to sweat is the unimportant stuff; the trick is choosing the unimportant things correctly.

7. It’s not about the money. Don’t get me wrong, it is about the money in that we all work to put food on the table; but be an investment broker or an EMS medical director if you want that new Ferrari for your next birthday. Just don’t work yourself into a crispy state trying to make up for the income deficit.

8. It’s about the patient, not you. We are not served; we serve.

9. Stay under the radar. Best for admin to not even know who you are. (As in “Robert who is retiring?”)

10. Smile. There is never any shortage of things to laugh about at EMS. Some are even HIPPA compliant.

11. Be your own best crispy meter. When you’re feeling a little on the fried side, use your vacation time.

12. Be humble. The medic who thinks he’s the best medic in the world, never is. Continue to grow as a medic for your whole career.

I still enjoy being a medic and know I’ll miss it, but 30 years is long enough.
I’ll be up in the mountains, waist deep in a trout stream, feel free to stop by, but don’t spook the fish, and please don’t talk about any “good” calls as, back in the day, we came to work and we gave everything we had on a call, but then you went home and thought about other things.”

Link: http://awb318.tumblr.com/post/61682064191/a-retiring-medics-last-stand

Why I’m in EMS

I’ve been asked why or how I got into EMS. I got into EMS because…..

Well that’s not an easy question to answer. Part of it had to do with being able to help others. My brother had asthma as a child and on a few times he almost didn’t make it to the ER. I’m sure that had an impact on me wanting to help others. In fact to this day my absolute favorite type of call is asthma and anaphylaxis. I love pushing epi and moments later seeing the relief rushing to their face as they take a breath and it goes in through a slightly clearer airway.

Part of it is because it looked like a cool job. I remember the first time a paramedic pulled up to my brother and started coaching his breathing while he got his equipment ready. Calm in a sea of chaos is the only way I describe cool now.

Part of it began as penance. I, like most people in their youth, was not always a saint and after many years of examining myself have found I wanted to pay for some of my mistakes. Some of the people I hurt. I gave a lot of myself to EMS. At first it felt like penance, slowly my flirting with EMS became a full fledged love affair. Once it gets into your blood it’s hard to shake off. I’m sure it’s like this for many careers. My father is a welder, done it for so many years now he associates with it. It’s a part of him. I’ve seen it in firefighters too. There’s a police officer who was shot 9 times by a criminal who’s life he had saved years back. After multiple surgeries, rehab and a ton of hard work he came back to the field. On a tactical training we were both taking part of I asked him why he came back especially after all that. He said, “it’s a part of me.”

That’s me with EMS now, slowly, sometimes painfully, but finally, “it’s a part of me.”

Washington DC Whistleblower

I wrote this for tumblr last week:

It feels very sad to me that we have to have whistleblowers in EMS. This has happened in my area where in some instances it was very minor infractions (the lack of tourniquets comes to mind) in others it was very extreme (child sex offenders operating on the ambulances). No matter what the item was however, the whistleblower had to do what he felt necessary while at the same time being completely secret about his identity. I have great respect for those that are bold enough to say what they deem is necessary and the courage to do it in public. The ability to face your accuser has always been a very important aspect of the judicial system after all. Unfortunately we have very few real protections from a biased attack when we do it in public.

If I was being accused of something I would want to face my accuser. Is this not the way we can more closely align justice? Is this not how we figure out if there is a true crime, problem or fault? I know we have rules for HIPAA and they are there to protect the patient’s rights. Sometimes, however, I think we narrow in on the small topic and forget the bigger picture. I am reminded of a story I heard of a Christian college that had a student drown in a river when a dam was released who then punished his friend, who was out with him, for swimming on a Sunday.

The minor infraction is punished severely while the bigger issue is disregarded.

In Washington, DC a paramedic has written a letter to the city council detailing a call that went bad and was a direct link to low paramedic numbers for the city. He makes a point that two engine companies closer to the call could not respond with paramedics because they didn’t have any on shift. He has been reprimanded and, according to the JEMS article, it sounds like if the privacy officer is involved. So, he is getting reprimanded for maybe revealing a patient’s information, but the information that may have saved a life is disregarded.

I am not saying I know the entire story, but it always sounds suspicious to me when someone gets reprimanded when calling out a company for something.

Here’s the link to the story from JEMS: http://m.jems.com/article/news/dc-paramedic-disciplined-over-letter-cit

Hello

On my followers

I want to tell all of you that follow my little blog thank you. I want you all to know that I do not consider myself worthy.

I have always liked to write and I have loved EMS since I began. With writing its a love and hate relationship. When I get what I was trying to say across I love it, when I look back at my writing and critique it I hate it. I am going to try to stay on a more consistent schedule with my original content. Time constraints always get the best of me. Well that and my easily distracted mind.

I am going to try to post all original content on Saturdays, but by that I mean things I comment on or create. No reblogs without comment, no pictures that aren’t mine. On Mondays I’m going to try to post a longer essay on something EMS related. Be it treatment, commentary or anything I generally am asked about.

I would like to start having giveaways and maybe even contests but I still am not ready. I’m hoping by the first quarter of next year I will have more scheduled time.

I hope you are all doing well out there, stay safe and remember that no matter where we are from, at the end of the day, whether we like it or not, we are part of a massive, multicultural, worldwide, and yes at times crazy family.

Ouremssite

Donkey Ambulance

No this isn’t a funny post about an ambulance provider, or an ambulance for donkeys. In some parts of the world where emergency medical care is almost nonexistent cheap alternatives have to be developed. One such device is what they are calling a Donkey Ambulance. It is basically a device that helps transport people on top of a donkey. It looks to be marketed for pregnant females and is already being tested in Afghanistan.

It amazes me that there are such huge differences between healthcare. I possibly have a complaint against me because in the pouring rain I tracked some mud into a persons house. This after I carried his screaming elderly wife out of there, she had a chronic pain condition that was made worse by a fall, treated her, gave her pain medications on the way to the hospital and even kept her dry as me and my partner got soaked. While people in other countries have to rely on a 100 dollar donkey ambulance to transport their pregnant wives over mountains. 

Wow.

Here’s the link. http://www.bbc.co.uk/news/uk-24141922