Tuesday, October 23, 2007

Bad Day

A good friend of mine, also a Paramedic, commented to me the other day that he would "rather be pumping gas" than doing the job that he is doing. I feel his pain.

Frustration with this job tends to peak and trough from day to day. Though we work at different services, our feelings about where and what we do are often similar, and to be honest there are times that I too feel like I would rather be doing something as straightforward and bullshit-free as pumping gas. It is on the other side of the fence, but sometimes you have to admit: the grass is pretty green.

Gas pumpers know what to expect from their job each day. Get dressed in the uniform, come in to work, and you will be pumping gas to people who do not respect you and will treat you like garbage. So far, sounds fairly similar. The difference here is that as a gas pumper, you know and expect this reality. A gas pumper has no delusions that someone will recognize a job well done, that one tank is truly different from another, or if his disposition matters from day to day. The game plan is clear: this job is close to the bottom rung and there is no real hope of anyone believing otherwise.

Though it doesn't seem all that green over there, consider coming into work with higher expectations, but the same reality. Build up a job in your head so that you believe that it matters. Believe that hard work will pay off, that determination will lead to success and tangible benefit. ...An environment where excellence is placed on a pedestal because without excellence the job cannot properly be done. Put extra work into the job so that you believe you are capable of more than what is normally expected, present yourself as a professional deserving of respect and believe it.

...And then have someone spit in your face. Not actually spit in your face, although that has happened as well, but in a manner much more insidious. Crumple up your hard written run form. Toss your opinion to the side. Smirk when you look for a zebra, laugh when you think you may have found one. Look right through you as you as you attempt to give a report. Interrupt. Criticize harshly with incorrect information, and then carry on as if nothing happened when the truth is brought to light. Suggest that a protocol is a "guideline" when you bring up detail, and call it "protocol" when you bring up leniency. Punish good behavior and reward bad. Screw up your paycheck and expect you to suck it up with a smile. Call it a symptom of being "new" when you work hard, when you do things right. When you give a shit. Suggest that experience is a substitution for perseverance. Leave for you a mess in the ambulance, a pile of laziness and open sharps. Talk a big game about "patient care" and then behave like a police officer on scene. Listen without listening. Talk without listening. Care more about the blood than the mechanism, more about the glory than the truth. Put a premium on transfers and a damper on medicine. Believe that education does not matter. Insist that privilege be given and not earned. Hire an 18 year old with no experience to do the same job.

It is painful to look around and see people who used to be like me. People who were once excited with this job, who looked at it as if it were a branch of medicine and not a path to a paycheck. People who let the above paragraph become them. It would be unfair to say that everyone is like this, but I can write with absolute certainty that the percentage is far too high.

It is enough to suck a person in. Like a black hole of overwhelming gravity, the could-be realities of this work are hard to avoid as we spin around the edge from day to day.

I love this job. But I'm glad I'm getting the hell out.

Tuesday, October 9, 2007

Potato Chips

Called for the allergic reaction, I am greeted at the door by a small child. He looks at me sheepishly, kicking his right leg nervously and looking at the ground. He hands me a scrunched up piece of paper and without making eye contact says "mommy told me to give you this."

I unfold the note and read it at the doorstep.

I tell the child to lead me to his mommy, and he does. Around the corner and up the stairs we find a woman sitting on the floor in the bathroom. Her face is extremely swollen, puffy and bloated. She has a thin body, but her head looks as if it belongs to someone else entirely. Looking up at me from the floor she is alert and anxious, wheezing with each breath.

I drop the red bag on the floor and pull out the yellow pack. Without words we we are at work, my partner is setting up the oxygen equipment. I draw up the epinephrine and push it into the woman's arm.

Her relief is almost immediate.


On the way to the hospital, priority two, the woman looks at me with a profoundly thinner face. She is still thanking me, thanking me, thanking me. Her lung sounds are full and clear, skin with a little redness but otherwise in good condition.

Potato chips. She had never eaten that brand before, and likely never will again.

"I shouldn't be eating those greasy things anyways," she says.

Tuesday, October 2, 2007

Tuesdays and Thursdays

The calls keep rolling in, and as I gain experience with this job and start to begin to feel like I can perhaps have an inking of comfort with what I do, I have been subjecting myself every other day to a completely different experience: school.

Tuesdays and Thursdays are school days. I am on campus all day, in the lecture hall and the lab studying Chemistry and Physics. The material is foreign to me with it's dizzying array of equations, formulae, and mathematical logic- starkly different from the Monday, Wednesdays, and Fridays I spend in the fronts and backs of ambulances. The two efforts seem to require different parts of my brain. Half of the days I think how I have been trained, with what information I have gleaned from experience on the subjects of signs and symptoms. The other days, I have to warp and contort myself around concepts that I have never seen before, about math that I barely recollect in orientations that I struggle to comprehend. I hate the math. I have never been very good at it, and to do well in these subjects means to grind my way through mountains of practice problems, gritting my teeth as I calculate, erase, and re-calculate solutions.

Mastery is coming with time, but the work is harder because of my distaste for it. It took a lot of effort to learn what I know as a paramedic also, but the struggle was eased by my interest. I always kept my medic book open a little longer than required, spurred onward by a thirst for the knowledge. With this science I am taking, though, I am always glad to have finished: slamming the book covers closed with a definite thump. It is a hoop to jump through, and as of late I am becoming more entwined with the idea that I am being tested not on my scientific ability, but on my determination. This work comes easy for some, but for most of us I have come to believe that it is simply a matter of pressing forward, putting the work in even when it is nothing other than horrible drudgery. Those that rise from the dust of this pre-medical schedule do so because they are hardened warriors: eyes fixed towards a goal, mouth hardened, hands calloused. "Throw at us what you will," they say. "We're coming anyways."

My days in the ambulance test me as well, but I have come to find the time as a relief. I am glad to have this experience, this window into medicine that shines enough light into the tunnel so that I can do for a little while longer without sight of the end. The challenges I face as a Paramedic are exciting, tasty glimpses into a bounty that lays ahead. They are tantalizing, and with each patient I leave in the hands of a higher level of care my determination grows. I still groan when it comes time to do my schoolwork, my stomach aches and I loathe every minute, but I will not give up.

My eyes are fixed.