Friday, November 30, 2007

Sailing Rough Waters

This is a complicated job.

There is a lot to pay attention to. Nuances that must be noticed in proper respect, concurrent details that need to be handled adeptly and smoothly. There is a significant amount of academic knowledge necessary, coupled with a standard of dexterity and physical skill that must be mastered for proper control. There is a social aspect as well: a smooth tone of voice and calm demeanor that experienced medics develop, employed judiciously to an extremely diverse population of patients. The role is one of leadership, of proper resource control and group dynamics. Coupled with a constantly changing work environment, it is important to learn how to adapt quickly, ride the waves and keep the course true.

These challenges were patently obvious to me as a medic student, as I'm sure they are to anyone experiencing this job for the first time. To be faced with these responsibilities all at once is an incredibly frightening prospect, one that is handled to varying degrees of success by those that make the attempt. It is a difficult thing to face all that must be done, to do so under the stress of a medical emergency and the ultimate knowledge that the buck stops at you.

The other side of the coin comes with slowly encroaching senses of calm and competence. I have been on my own for almost 6 months now, and though my body occasionally runs cold with fear at the presentation of something unknown, I have slowly been finding a groove in which I am capable of running. Most of the calls we run are routine, and I am starting to handle them in an almost lethargic manner, robotic in my repeated assessment and treatment. I am calm on scene, expressionless in a practiced manner of unsurprise and experience. I ask the same questions, run though the same routines, and expect little else. The routine has become just that, and I dare say with this limited experience: easy.

It is a sharp change from my first few months as a paramedic student riding 3rd on foreign ambulances, unsteady and nervous as I wobbled my way through repeated assessments under watchful instructor eyes. I remember taking manual blood pressures, placing the scope in my ears and feeling grateful for a few more seconds to think about what I was going to do next while the needle turned downward through the numbers. I was on edge all the time, nervous and thinking a mile a minute. I had to be, I was being watched and assesed. Criticized and reviewed.

I wonder sometimes, running these lethargic calls of routine low priority, if despite my nerves and mistakes back then, perhaps I was a bit more thorough. When you are a student, chest pain is never muscular in origin. Cold symptoms are zebras in hiding, and tucked deep behind every omission was the critical point. Students are exhaustive in their approach, over-the-top in a way that now might generate a smirk from a more experienced provider. It is newb-ish to remain unsatisfied in the face of the routine, while the rugged and seasoned medic is tranquil as he sits with the same patient, content in all that he has supposedly assimilated.

...But has he really?

I have come to grips with the immensity of this job by riding the waves from peak to peak. I keep the course smooth by handling rough waters with a steady hand, calm as I approach a patient wholesale: sick or not sick. Still, I wonder if sometimes the student might have it right, his boat riding wildly over all over the place, jostling and twisting unsteadily while at the same time experiencing everything that the patient has to offer. My demeanor is much more low-key these days, and as I coolly peruse the patient and his host of complaints I feel like I look more experienced. Thinking back, though, I have found myself now omitting things that I might have stressed when I was back in school. I roll my eyes at complaints more, blow more things off than I used to.

The assumption is that my experience and knowledge thus far has afforded me the ability to understand patient presentation so well that it is no longer conscious thought. ...That I am able to assimilate a host of factors at once in rapid succession, assemble them together, and come to the correct decisions without much fanfare. This is the standard that they set in medic school, and the goal of my repeated trainings and research.

I want to remind myself, though, that a calm demeanor does not mean that I have reached the point. I still make mistakes. I still miss obvious things from time to time. Despite the fact that I am starting to feel more competent on scene, I need to remain fervent in my efforts and unsatisfied in my assessment. I have not been around long enough to be calm, and I should probably sacrifice myself to a few more smirks if it means that I am more thorough in the end.

Call me new, but I want to get this right.


Ken said...

Exactly how I feel.

Stacey said...

Wow. Thanks for that post.
I am in the exact same place right now. It feels really good to know I am not the only one who feels this way.

paul said...

This reminds me of my first job out of nursing school some eight years ago. Trust your training! Good luck.