I'm nervous on the way to every single call.
Our response time to a patient with chest pain is in excess of 10 minutes. I ride along in the back of the fire ambulance, nervously contemplating various treatment modalities. Chest pain patients usually get treatments based on the acronym MONA: meaning Morphine, Oxygen, Nitro, and Aspirin. ...But that is after my assessment. I need to understand the patient's story, the onset of the pain and the patient's previous history. OPQRST. SAMPLE. I remember the differences between right and left sided heart failure. Check lung sounds. Check for distal edema. Do a 12 lead ECG. IV, Monitor, O2.
We arrive on scene and the patient doesnt have chest pain. He fell out of his wheelchair and his left leg hurts. Whoops.
There is no way to plan for this, no way to decide ahead of time what to do. Every patient is different, and the dispatch system leaves us with only the most vague descriptions. I am going to have to become good enough at this so that I dont have to plan, so that when I walk into a house and see a patient I am able to immediately react-- treat based on presentation and previous experience. I need to be fluid with my knowledge, ready with my treatments. Everything must already be on the tip of my tongue.
I am getting better at it. My preceptors say that I ask all the right questions, just that I ask them in a somewhat jumbled and disorganized manner. I ask things as I remember them. Sometimes it takes 5 minutes into a call before listening to lung sounds occurs to me. I learned early in class that the lungs should be first, but I'm busy processing. Busy looking at my patient and trying to understand which path I should go down.
Experienced medics have told me that I need to develop a system, an initial process that I run through for every single patient. Mental status, Airway, Breathing, Circulation. They're right there on the national registry sheets, but difficult to transform into real life. Do I really listen to lung sounds first on the patient who hurt his leg? I havnt been, but I should. Medics say that once I have this system, I will never miss anything important. I can focus on details while my hands go through the motions of the basics. Nothing, they say, gets overlooked.
I spend days at the fire house trying to come up with a system. This isnt something I can read in a book, not something another medic can tell me how to do. I no longer have instructors at the front of the classroom with laser pointers and powerpoint presentations. These days, my only teachers are those laying on the stretcher, in distress and asking me for help.
I do my best to keep my mind open despite my nervousness and the work I have to do. Every patient teaches me a different lesson.