Things I've Learned in 8 years...

This is a work post I've been thinking about for years. But I'm not sure where exactly it will go when it gets going, so I'm not sure to warn you about content or not. I don't think so, but then things that seem *normal* and non traumatic to me after 8 years as a paramedic are often shocking to others. But it's an interesting thing to contemplate some off grid things I've learned in this job, that I didn't expect were true.

One of the biggest things I've learned is that it isn't often that we save lives. We deal with death, tragedy, grave illness, and everyday hurts, but most frequently, a person marches towards death with an unstoppable character, like an individual tsunami or a meteor impact: we are witness to it, but powerless to stop it. We are well trained, apply all our tricks, drugs, artificial pumpings and blowings (colloquial for CPR), needles, IVs, oxygen, investigative assessment skills, high quality teamwork, paramedic prayers (uttered by most, and often along the lines of 'SHIT,' 'DAMMIT,' 'FUCK,' or 'Oh, GOD,' but really in spirit are, 'HELP GOD, PLEASE!'), and emotional supportiveness, but the vast majority of the time, if someone is dying, we can't stop it. I've learned that I am small. I'm in awe.

I have also learned that people are not compartmentalized into parts. You cannot simply treat a person's physical symptoms and have done your job with any measure of completeness. It's barely even possible to treat people this way. People have emotions and souls and families and lives that are inextricably tangled up with their physical selves. Fixing an unstable injury while extricating someone from a car is meaningless if you don't make eye contact or reassure the person attached to that injury. Nobody teaches you this in school.

Nobody teaches you, either, how difficult it might be to make this type of connection with someone who was drunk behind the wheel of their car, and hit someone while driving, but who is themselves still trapped and injured and afraid...but it's still essential.

Since the beginning of my career it has been repeated to and by me, and become more and more evident, that alcohol is job security for emergency services. Without alcohol, much of what we see and treat would not exist. It does not take an alcoholic disease for it to be evident how destructive this liquid can be: the destruction is self afflicted, and runs the gamut from MOST assaults, MANY domestic disturbances and/or violent situations, many traffic accidents, falls, drownings, broken limbs, head injuries, deaths, neglect of children, and unnecessary tragedies. A Friday night party, one too many drinks, underestimation of how much is too much, people across the social stratosphere cause destruction with alcohol.

I'm no saint. I propose no solution. But this is what I've learned.

Aggression can be a conscious buildup of anger, or it can be a symptom of a medical condition.

Vomit is overwhelmingly disgusting, no matter its origin or cause.

Preserving peoples' dignity is a huge component of my job, and takes enormous skill and compassion in some cases, because nakedness and feces and out of control emotions are so commonplace, and so easily strip someone of their dignity if not handled well by those who witness it. People in need are highly sensitive to the deconstruction of their dignity, more so than in everyday life.

Drugs are not scary. Dark alleys are not scary. Aggressive people are not scary. Mentally ill people are not scary. Skid row is not scary. Prostitutes are not scary. Blood, guts, tears, and screaming is not scary. People are people, wherever they live, whatever they do, and they generally operate the same as you and I. Compassion, eye contact, kindness, and a strong foundation of common sense and boundaries (ie, trust your gut, yell if you need to, get out while you can) serves you well in a 4,000 square foot house or the back alley behind the mall.

What is scary? Poverty. How people get trapped by their own self definitions more than any other factor. Hatred. Complacent medicine. Bullying coworkers. Loneliness. Women who starve to death in Canada, a wealthy country, which is tossing food in the garbage like fish guts and with social assistance for hungry people, but where a woman can starve to death of anorexia. Also, I never got used to the maximum security prison in the town where I work. Prison is scary. For similar reasons, so are nursing homes.

People have an incredible capacity to heal. I saw a man once stuck in the rotating planer at the sawmill, his arm was in pieces and I thought for sure he would die, but in the end not only did he survive, but his arm did, too. They managed to piece it back together in surgery, and he was able to work again within a year. I've met survivors of Rwanda, the depression, the Holocaust, Residential schools, horrific childhoods, and terrible tragedies, who have healed.

Sometimes, silence is a gift.

People really are poor enough to necessitate burning their own furniture in the winter, in Canada, sometimes.

Poverty has nothing to do with money. It's about emotional pain, lack of resources, drug addiction, alcoholism, emotional trauma, lack of education, lack of healthy community, and lack of an ability to see that life could be any different in any way.

Sometimes, it is just as difficult to die as it is at other times to live. LIFE marches on, and the Universe/God/Fate/Providence has something else in store for a life, sometimes. I once met a man who slashed his wrists and survived. A few months later he drove his car off a cliff, landed on train tracks, and was struck by a train traveling over 80 kilometers an hour. He was looking up through the sunroof of his car, broken limbs, still alive.

It's not your day to die. Dude, stop trying and start figuring out what it is you're alive for.

Death can be really, really funny. I mean, you have to have a somewhat dark sense of humor to cope with a job like mine, but some of the most hilarious moments I have encountered in life have been juxtaposed with death. How can I explain this? It sounds so insensitive. But really, it feels more appropriate a response somehow, because it is celebratory of life.

The only place death is consistently never funny is the cancer clinic. Another place that never loses its fearful quality, for me.

Most laypeople don't like to think or talk about death. In an abstract way, they're fascinated with it: in massive catastrophes on television, set in Pakistan or Texas or Southern Russia, or in statistical form: Many Thousands Die in Darfur. But "I did CPR yesterday." Or "last night I saw three dead bodies." Not so much. I mean, it is a bit weird. What does one say in response? "Uh-huh. Were they stinky ones?" See? Death can be funny.

But paramedics march towards death. Alongside us, firefighters and police officers. Every 3 or 4 years we lose 2 or more paramedics to the hazards of the job (last week 2 paramedics died on Vancouver Island). Firefighters and police officers, too. Most of the people I work with love to face this primal need for flight in the face of danger, and to fight it instead. This is pretty darn cool. Like working as a skydiver or something.

Disposable bedpans make great snack bins for popcorn. Urine containers make great iced tea pitchers.

The handiest paramedic tools are the simplest: large elastic bands, six inches across and about a foot long, with velcro on them. Multiple, multiple uses: hold broken limbs in a splinted position. Affix a pillow splint to a foot/ankle injury. Hold legs together on a spine board. Tie down the wrists of combative overdoses or head injuries. Hold sandbags or ice packs in place. Splint pelvic fractures. Improvise a rapid infuser by wrapping it around an IV bag very tightly. Improvise a clipboard holder, IV ready pack, Saline bag holder, Yankaur suction tip ready pack holder, lunch bag, coffee sleeve, pressure bandage, or garbage can. I love those things. We call them "Zap Straps," or "Zaps."

Other useful tools: pillows and blankets. Heavy duty vinyl gloves (my favorites are green and have long cuffs that go halfway up the arms). "Sam Splints," a flexible piece of mesh wire wrapped in a thin blue foam: also multiple uses! Mainly for splinting any limb, and holding the head in place when strapped to a spine board. Also good as a coffee cup holder.

=)

The most useful tool is my own brain, and my two hands. I can do more with questions and a physical exam than I can do with any of the expensive gadgets in my ambulance or jump kit.

Fancy drugs and protocols rarely save lives: a good, thorough primary survey saves lives. [Primary survey: rapid initial assessment of airway, breathing, and circulation and rapid head to toe check for injuries or major signs of disease. Takes 2 minutes, max.]

Related tidbit, learned from an ALS paramedic of 25 years: "If by the end of your primary survey you have no idea what's wrong with your patient, and they are unconscious, get the *F* in the ambulance and get out of there. Your patient needs a doctor, not a paramedic or a protocol."

Any call with Search and Rescue is a hell of a lot of fun!

Babies compensate really well and then crash hard and fast.

Related tidbit: when newborns vomit blood, check the mother's nipples. She likely needs lactation advice, not a helicopter ride for gastrointestinal bleeding in the infant! (Seen it!)

Driving fast with lights and sirens is really, really fun.

Kneeling on one's stethescope will bend its arm so you can't hear properly on one side.

Vital signs are meaningless without context and a continuum showing changes over time. I've seen a Bp of nothing on nothing in a talking patient. Of course, he died shortly thereafter, but he WAS talking to me when I arrived! That call was very memorable. It's amazing how rapidly a human being moves from a dynamic presence in the room, to an inanimate object once they die. Like, amazing. We're generally aware of each others' presence in a room, and recognize each other as human, but once someone has died their body rapidly becomes something markedly non alive. Significant, but inanimate.

I'm not doing it justice, but maybe you'll get it anyways.

I think that's it for now, but I'm sure I'll have addendums. I have learned a ton of weird and wacky lessons in this job! But mostly, how medicine can be so boring and life so interesting, all at once!