Monday, September 8, 2008

Their Emergencies

I met a man and had a short conversation with him. He had a headache, ten out of ten, and couldn't talk about anything else but the pain. We were less than a mile from the hospital when he started mumbling incoherently and then went unresponsive. I found out a few hours later he had an acute subarachnoid hemorrhage, so massive that even the neurology folks stepped back in awe. He was forty years old, and alone in this country without family. For the rest of the day I brought patients into that same ER, placing far less sick people into their cots just a few doors down where this man lay, intubated and alone.


I transferred a lady out of the hospital a few days ago after a ten day admission for a swollen foot. She was pretty old and had a complicated medical history but was cheerful nonetheless. She laughed at some of my jokes and rested while I finished up the transfer paperwork. We fluffed her pillow at the nursing home before we left. Today I passed a number 8 endotracheal tube through her vocal cords and directed CPR even as her ribs cracked under the pressure. I couldn't get an IV and had to drill an IO into her tibia. Futile, though, as despite our sweat and effort the flat lines prevailed. She looked like a different lady than I had seen just a few days prior.


Raise your eyebrows if you like, but it makes me somewhat uncomfortable when through their stories, patients become people. A symptomatic tachycardia does not demand empathy. A clonic seizure can't crush a provider's spirit. Only people can do that. Only stories with which we can identify, only smiles and conversations can have that effect.

Prudence demands that we separate the disease from the person. Insult hits much harder than injury, and I think anyone who sees these kinds of things on a daily basis needs to put barriers between these patients and themselves. My paramedic instructor had a mantra that we were advised to live by, that these are "not our emergencies." I remember feeling that the concept was somewhat cold, uncaring, and against the grain of this medical field that I saw as powered through compassion.

Today, I understand its utility.


lucaf said...

In my mind "it's not your emergency" has a different meaning: your safety comes first. This is not a bad day like your patient's, this is what you do every day, so you owe it to yourself, your loved ones and your future patients that you keep your abilities in the best possible shape.

But the day "it's not your emergency" will become "patients are not real people" will be the time for you to move on to a different career.

Mastabattas said...

People ask me all the time, how I cope with the things I see (as if we see catastrophic events with every call). After explaining that most of the time the calls aren't even "real emergencies" I often explain to them that same adage "it's not MY emergency" which is what keeps me calm through the adrenaline rush; reminds me to step back and rely on my training; and allows me to see the person I am treating without being engulfed by emotions which will hinder my ability to the job they've called me to do.

Anonymous said...

"It's not my/your emergency" is something that I always have in my mind when things start to become overwhelming on an ambulance call or in the hospital. It helps me to take a step back and harness the calm and cool required for the situation. That way, if my patients can pick up on the fact that I am not frantic, it might help them to ease their own mind by knowing that somebody has (or appears to have) some sort of control over the situation. The same idea goes for dispatching - a calm voice on the phone can sometimes do wonders; And keeping that phrase in mind helps one to not clam up which in turn makes the job to go a little bit smoother.
In this field, we all have our emotional boundaries. Yet there are times when that boundary isn't strong enough- We are all human. There have been a situations that have tugged at my heartstrings. Sometimes it is hard to wrap our minds around the concept that we were just talking with our patient and days later, like BabyMedic, working his or her code. But it's the emotion that drives us to do our jobs with compassion. As soon as you lose the ability to do your job with compassion, that is when it's time to take a step back from the job.
BabyMedic- Keep up the great work and wonderful writing!