Tuesday, June 2, 2009

On Being Scared

I've been spending weekends as a part time instructor at the local community college, teaching paramedic students about things I've only recently myself become passingly competent.

It's a difficult thing, to stand up there in front of the class and insist that they make decisions about spaces of gray between the black and the white. It is a wide complex tachycardia, the blood pressure is borderline and the symptoms are murky. It is a constellation of potentially unrelated complaints, presenting in unison as if on purpose to deceive. They sit there and scratch their heads, squint at the data with all their might as if the answer will present itself by force.

The next step is always to explain that there will be cases that don't fit the book. In fact, most of them wont, and the choices these students are going to make will have to be well reasoned ones, based not on algorithm or memorized protocol, but rather the larger picture of genuine comprehension. The answer isn't always to give a drug or to shock, but maybe to sit back and wait. ...Give a little bit of fluid and observe. I tell them that there is often more than one right answer, and despite the fact that the paramedic exams are largely multiple choice, working in the real world is much more often about filling in the blank.

The students stare back at me in horror, and I smile. That is precisely the right reaction.

I think it is important that all paramedics look up from their work from time to time and be terrified. There is so much out there that we don't know, a whole world that bustles around us whether we heed it or not. We are charged with making critical decisions for sick patients based on incomplete information and limited experience. It is my opinion that if you're not scared, you're not doing it right.

"I will have no man in my boat," said Starbuck, "who is not afraid of the whale." By this, he seemed to mean, not only that the most reliable and useful courage was that which arises from the fair estimation of the encountered peril, but that an utterly fearless man is a far more dangerous comrade than a coward."

Herman Mellivle, Moby Dick


Adders said...

I'm a second year paramedic student, and what you're saying about filling in the blanks is completely true. In first year, it was always "if this then do that". Now, they introduce "clinical judgement" to us... Our lecturer said nothing is black and white any more, and "welcome to the grey".

And you're completely right. It is terrifying!

Adam Thompson, EMT-P said...

I always say that it is fear that makes me keep reading and researching. It is that fear of not knowing what might be going on with a patient, or not knowing a treatment that might help. Great quote!

This is FL_Medic from emtcity by the way.

Scott T said...

haha yeah Adders, I know what you mean, all of a sudden it's clinical judgement and the instructors can't agree on the right or wrong way.

NJ EMS said...

We NJ EMS love your page...I feel you on the filling in the blanks part.