Real Strength

Sometimes it is easy to forget what color our uniform is. It is a lighter shade, of a different material, and carries different insignia. We wear pants that have pockets in very different places, designed that way to accommodate the starkly different gear we must carry and use. On my leg is not a baton and leather gloves but rather a small penlight and a pair of trauma shears. My gloves are baby blue and nitrile.

We dress differently from police officers because we are not to be confused with them. Though our occupations may both be loosely considered of the "public service" department, our duties and skills are enough so that our work may be thought of as mutually exclusive. We do not arrest, bully, or enforce. We have very little to do with the law other than those we must abide by, and our concern of illegal activity truly ends at that which may be considered medically relevant. We work side by side with them, help each other out when we can: but we are not police officers.

And yet our identities are so often confused, even amongst ourselves. I overheard a crew the other day, laughing and bragging between themselves about the manner in which they physically confronted an abusive patient. The man was drunk and violent, spitting venom to the best of his faculties and swinging his arms in a whiskey-induced rage. The crew was proud to say that they handled him swiftly and with the efficiency of a trained force. One EMT grabbed the left arm while the other grabbed the right, and the man was quickly removed from his footing and brought down hard onto his back. He was restrained with a knee in his chest as the ambulance crew tied him down and sniped with comments of their own. The man was antagonizing the crew, and they were proud to say that they didn't take any shit. He got one chance and then down he went, they said.

The story is exhilarating. Fun to tell and fun to listen to, it brings to mind a sense of the "street tough" mentality that many urban EMS'ers aspire to. The story goes that we must be tough, we must remain firm and hard in the face of antagonism. To be compassionate is to be weak, and to give too many chances invites further insult. Subscribers to this attitude wear their choices for all to see. Sleeves are rolled up high and at the bicep. There is often an EMS badge, and leather gloves tucked into the back pocket ready for use. They walk differently, talk differently, and - as it must be - think differently about what this job is about.

But we are not police officers. Though I am hardly on my own an authority on the standard of our practice, I think many would concede the point that our approach is on the outset markedly softer. We don't demand answers but request them. Often we will listen instead of talk. We work hard on our facial expressions so that they do not falter even at the most ridiculous scenario, at the most embarrassing confession. We are worthy of trust because we are steadfast in our compassion, free from judgment, and always, always willing to help. Such is the purpose we serve.

The attitude of the quasi police officer EMS worker is one of boisterous ego. These people are proud to admit that they do not take attitude from their patients, that they elicit their answers by demand and exude an authority of medical necessity. They are the bosses of their ambulances, and will do with their patients what they like. The patient is in their care, and must submit in the name of proper medical care. I have watched this happen. Patients getting bullied around in the back of ambulances, forced with the power of supposed medical urgency and relegated to submit to unnecessary brutish and judgmental attitude. These patients sit on the stretcher, scared and submissive. The EMS worker sits on the bench, proud of his job and convinced of his importance.

Strength does not derive from the volume of our voices. Authority does not come from the issuance of a demand. Our "street cred" will not be determined by our ability to tackle a patient to the ground. No, real strength, real ability is much less flashy. It happens quietly, in conversation between a medical professional and a frightened patient. It happens when a provider will sacrifice for the benefit of those in need. When he fights off his frustration, quells his qualms with the unpleasant.

As often as I have witnessed brutish behavior in the backs of ambulances, I have also seen incredible feats of strength in quiet and uncelebrated patient assessments. Providers willing to forgo their immediate ego for the greater good, listen to an entire story and speak calmly despite an escalating situation. People willing to elicit transports to the hospital by leveraging their own humility, admitting to a lack of knowledge and ability in order to make clear the importance of seeing a doctor. People who sacrifice everything that they have so that the patient will get the best chance at what is available.

This is real strength. Though it may go unnoticed by so many, hidden and overwhelmed by the stories and tales told by the loud and flashy, it is important to know that those who are very good at this job are often also very quiet. Mildly they will accept their victories and walk without a word past the opportunity to boast.

Self assured and confident in the knowledge of their own success, they wait for their next call.