Baby Medic asks in his most recent post Routine about the frustrations of the mundane in EMS:
I would like to know how those who have been doing this job for a long time are able to withstand the mundane. Do they no longer live for the exciting calls? Are they content to relax in the routine, or have they a way to find interest in the subtleties that I may perhaps miss in my eagerness for something new?
Am I missing something?
I've been in EMS now since 1989, a medic since 1993, and a full-time medic since 1995. Here's my take:
I do share the frustration of the mundane to a degree. I have had days where I am doing multiple codes and months where I never touch my laregnyscope. I'll do back to back trauma room calls, and then not have another trauma for three weeks. I'll do ten ALS calls in a row, but none of them more advanced then simple IV, 02, monitor, and transport non-priority.
I guess I manage through the dry spells because for me it has never been primarily about the medicine. I have come to enjoy and appreciate the challenges of the medicine and, as much as anyone, I relish an opportunity to solve a medical puzzle or perform a difference-making skill. But the fact is we are somewhat limited in our diagnostic abilities. We can venture guesses, but often without labs, x-rays and imaging tests, etc, we can't really tell what's going on, and often not knowing, keeps us from taking a stab at treatment(And we really should never be stabbing at treatment unless the situation is quite dire).
Recently I had another patient who's internal defib was going off. The last time it had happened, he had hypomagnesium. I carry magnesium, but there is no way for me to tell that this is why it is happening again, although I can guess it might be. I have amiodarone ready if he goes into a v-tack and starts getting shocked repeatedly as well as some versed to ease the jolts, but his defib never goes off again and we have a nice easy ride in with pleasant conversation.
Working primarily now in a town with a huge elderly population I am constantly faced with the CHF/COPD/Pneumonia conundrum. Some cases are clear cut, but in many in order to determine what is really going on, I need an X-ray and a BNP test. The doctors have that at the ED and I don't so my care is far from definitive. I'll withhold the Lasix, and give them NTG if I feel I have to do something.
The challenge for me then when I am not medically challenged is trying to do the part I can do as well as possible. Yesterday we had a stroke patient, and I judged myself on how well I was able to get the full story of the patient's norm, what happened, etc, collecting all the clues to present to the doctor. The call went okay, but there were some frustrations. I couldn't get a good medical history because the man was visiting relatives and not at his home where his medicine was kept. I had radio problems and so couldn't give a patch to the hospital, and then in transferring the patient over to the hospital's bed, the tape on his IV got caught on his pants and ripped the IV out when we moved him over. Oh, well.
I've had a number of IVs get pulled out in this way over the years. Now whenever I bring a patient to the trauma room, I always wrap kling around the IV site to protect it because they are notorious from yanking out IVs as they try to help you transfer the patient over. I am going to start working on a new method of better securing my lines on all patients and see how long I can go before I get another one yanked out in transfer.
What I like about the routine of the job is the chance to try to do calls perfectly. Even the simplest calls are hard to do perfectly, but I try. I grade myself in many categories from courtesy to the patient, family and staff, efficiency of time, proper gathering of history, getting the patient into a johnny if necessary and putting their removed shirt and jacket in a plastic clothes bag, full assessment, doing a 12-lead, gaining IV access, getting the blood sugar, dotting all the i's and crossing all the t's, limiting time on scene, completing all care by arrival at the hospital, as well as writing my trip card, and cleaning the back as I go, so that when my partner returns the stretcher, there is little to do, but change the sheets. And of course, saying goodbye and wishing the patient well.
If I can do weeks of simple calls as close to perfectly as possible, then when I get the big bad one, I might do it just a little better than I otherwise would have.
For me, though, the biggest thing that keeps me sane through the mundane is the people, the human contact and the stories. That's why I got into this in the first place. If I can come through a day with one good story or moment I can tell about when I get home, then I am happy.
For me yesterday, it was at a retirement home where our patient, a woman with a skin tear on her leg, sat watching the Red Sox game on TV -- unbenownst to her it was a cable rerun of the game the night before. It was now the seventh inning and the pitcher for the Oakland A's had a no-hitter going with one out in the 7th with David "Big Papi" Ortiz up for the Red Sox. We were trying to get her on our stretcher, but she wanted to see how Big Papi was going to do. "I know the way its going, he's going to make an out, but I just want to see him bat," she said.
"He's going to lash a single up the middle," I said.
Sure enough the next pitch, Big Papi broke up the no-hitter with a single up the middle to the woman's great delight.
"You should be a fortune-teller," the woman said.
"No, no, I'm just a paramedic," I said, pleased I had my story for the day.
