Friday, November 9, 2007

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.


Jean said...

Terrific post.I'd rather have your attitude. Believe me, you don't go unnoticed by those who also walk softly and still get the job done.
Esp when you roll into the ER - staff knows right away "the mouths". they ae not thought well of.Keep up your good work.

Brendan said...

Holy @#$% you're a a great writer.


RevMedic said...

Excellent post! Very insightful and full of some thought and discussion-provoking ideas. Thank you.

Summer said...

Awesome post! As a preschool teacher of children with significant special needs I have pretty frequent contact with the local paramedics. Attitude is everything, especially when it involves a little one whose history is so complex and whose parents are not always able to be there right away. I have no respect for someone who enters with the belief that respect comes from swagger, command, and superiority. Those that I respect and truly appreciate for beng able to give my little ones what I can not are the ones who instantly drop down to their level, who consider that others have valuable information, and who recognize that being gentle and compassionate are not weaknesses but rather the greatest strengths of all. Thank you for recognizing this as well. You have insight that few in the medical community possess, and I am quite sure your patients benefit from it greatly.

Andrea said...

This is a great post ! I forwarded it to my other EMT friends, who all concur with your views. Ironically, the same day that I forwarded your post, we had a call for a very difficult patient that almost became combative with me. You can find it here if you are interested.

Keep up the great work, I enjoy reading your blog and learning from your experiences !

Anonymous said...

CLAP! CLAP! CLAP! CLAP! CLAP! Been a medic in different capacities over 10+ years. It is SO NICE that new medics are able to identify and isolate themselves from this age-old tradition of "EMS cops". The first lesson I learned that I was NOT a cop was in Paterson, N.J. I had a gal one day who freaked out on the way to the ER because some rigs fell out of her pocket when I asked her to get her ID out. She FLIPPED. I was being precepted and I was staring at the sharps box. My preceptor winked. I handed her the SHARPS BOX and told her "please dont confuse us with the police, we're not here to cause you trouble". We had several 'bullies' like the ones your described on ours and neighboring services. I hated working with guys and some gals with that attitude. One day we had a call in the Pink Building. A shabby project with the reminiscence of the luxuries that used to be afforded to the visitors of "Hotel Pink". The enormous chandillier (sp)was still in the lobby with a mural on the concave ceiing. We were there on some type of altered mental status *AMS* and we were getting the info from the cops when my partner wanted to go get the stair chair (it was an AMA till the last minute). I was riding with one of the meanest, nastiest, "EMS provider" that would chip a notch in his belt if he broke an arm restraining smeone. He played cop so many times that the only other people that liked working with him were the other "EMS cops". Crap, most services including ours went to body armour after one medic was stabbed. I took the shift because his regular partner had a car wreck coming in and it was split so I only had 6 hours with this jerk........... the cops asked me how long to took to get a stretcher? I though, CRAP, I already have all the info and this patient already has smoked 2 cigarettes (well, we all did, this was 15 years ago, I've quit since then) I asked for one of the cops to go with me to find him. We lit our thrid smoke and took a walk though of the easiest path to the bus (the unit). we got down 2 floors and heard a weird sound; a sound like an animal that had been hit on the side of the road. We rounded the stairs, CRAP, it was my temp. partner! A week later when he gained the ability to write on the chalk board (after they wired his mouth shut, put 2 chest tubes in, intubated him for 4 days, put an icp monitor in his head, wired ribs and his orbit and many other things)... we found out that it was the brother of one of the patients he helped the police do an unnessary exam by cutting out his pockets and letting the drugs fall on the ground (we were technically not 'activated' at this time (the man was not even under arrest, he just walked up to the cops and said "want me to see if he is bleeding from where he fell on his leg? It looks swollen"). Back to finding him......... I was like S**IT. Turned out the "alledged subject" had an air tight alabi and after the reconstructive surgery our ego shattered 'EMS cop' picked up a medic job where he was recouperating at his parents place near Utica, NY. No arrest on his attacker because of the alabi. I LOVE THAT YOU CHOOSE THIS SUBJECT 'BABY MEDIC' it is a good thing worth talking about. My first year taking PRN shifts in the "country" for some rural/urban E.M.S. they just get their revenge on the "Rural EMS cops" by keying their vehicles and slashing their tires at Wal-Mart (not kidding ya, saw it twice). I have since lost those zippered up paratrooper EMS boots I bought the week I was hired in Bergen/Passaic Counties of NJ and I Love the look of polo shirts NOT in blue (and stethascopes say "not a cop" too!). Thanks for putting some light on that subject and dont let it get lost. I have not stepped foot on a bus in awhile so keep us guys aprised of what is going on to curb this behavior. PS I was giggling inside when 'EMS cop' was heaving in pain with every stair-step because he was a bully to his co-workers as well too!