Compassion in EMS, curious about your thoughts...

[DwayneEMTP]

Hi all,

I wrote the below post in my blog and was curious about your thoughts. The idea from it actually came from a discussion of FB. Some saying that compassion, and/or "hand holding" is part of EMS, like me, and others saying that it can be, but that it's not necessary to do good medicine.

Anyway, the below isn't directly regarding that, but it's what got the ball rolling in my head..

From, www.chasing-my-life.com

Let’s talk about the spirit of EMS for a minute…

June 4, 2013by Dwayne

Let’s talk about wankers first. (wackers, wannabes, Ricky Rescues, whatever). I’ll start. They hurt my heart. Truly. And they also, without knowing it, hurt their own hearts as well. And probably worse, they hurt the spirit of EMS very much.

I believe that there is an amazing spirit that lives at the very heart of EMS. If we listen to it, it can make EMS the most amazingly rewarding career that I can imagine. If we don’t, then we can sometimes end up being just another wanker that’s been given a truck with lights and a siren. And I’m not a big fan of the wankers. They just don’t ‘get it.’

We’ve worked hard for the privilege of being “the” person that people call when they are terrified. The person called when they, or someone that they love, are hurt, or ill, or sometimes just mentally or emotionally lost. Yet somehow there seems to be a huge segment of the EMS population that has decided to whine about that. To complain about the fact that they’ve been asked to actually perform in the role that they’ve worked towards and applied for. They’ve decided that to be cool you have to show how detached you are from compassion and simple human decency.

Fortunately, I believe that most of us don’t fit into that category. And most that do don’t want to, they are just not strong enough yet to go against their buddies that choose to act cool instead of being competent.

Let me lay out a few guidelines regarding our EMS spirit, yours and mine. If you’ve transported an old person and later referred to them as a ‘lizard’ or ‘gomer’, you’re a wanker. If you’ve bragged about how much you love the sound of breaking ribs during CPR, you’re a wanker. If you’ve ever explained to someone how you’d love to give your most recent suicide attempt (real or pretended) better instructions so that they can be successful in the future, you’re a wanker.

If you’ve ever chosen to leave a patient’s spirit in worse shape than when you found it, in any way, you’re a wanker.

Those gomers and lizards have lived a long time, and have accomplished things that you can’t possibly imagine. They’ve lived through a world war, some of them more than one, and multiple depressions, including the Great One. They’ve watched their friends, brothers, sisters, and too often, their children die. They’ve been humiliated as their driver’s licenses have been taken from them, again as their bladders and bowels began to betray them, and in many, many cases they were forcefully removed from their homes and placed in terrible institutions against their will, by the children that they raised.

They now live in a world that many of them don’t understand, are afraid, feel unwell, and are powerless. They deserve, and have unquestionably earned more than our county gives them, but at the very least they deserve our respect and very best care.

Those breaking ribs belong to a human being that is almost certainly in the last seconds of their life. Trillions and trillions of memories, loves, tears, laughter, all ending at that moment. The cracking sound that you’re so proud of will be heard, very often, by their families and loved ones. It’s that sound that they will involuntarily associate with the last memory of their mom, dad, or child, for the rest of their lives.

Sometimes these worn, tired, amazing people need help. They need a hero. So they call for an ambulance.

If you’re a wanker, unfortunately they sometimes get you instead. You laugh about the smell of their rooms, make jokes about their diapers, the way they talk, the way they chew, draw pictures of their sagging breasts. You drop them off at the hospital and then go to the bar later, strutting, wearing your EMS or firefighter t-shirt, accepting accolades for all of the amazingly heroic things that you did with your day, though no heroic things were done. Accept free drinks for being willing to put your life on the line during every shift!! Wanker bullshit at it’s finest.

If you’re a wanker, you have the opportunity on these calls to be a hero. But as there were no burning buildings, or bullets to dodge, no cameras around to put your face in the paper, you couldn’t be bothered. You had the ability to ‘see’ this tired old person. To get them to tell you their stories, and truly listen to them. To get them an extra blanket even if they didn’t need one, simply to show them that they were still important. More important, you had the opportunity to stand up for them after the call. To choose to promote their dignity instead of joining your buddies in crowing about their uselessness.

During each call we have a chance to make a difference in someone’s spirit, and therefore their life. After each call we have a chance to make a difference in EMS.

And please, if you’re a wanker, spare me the argument of, “I may say those things after a call, but that doesn’t effect my patient care!” Bullshit again. In fact, if I even have to explain this to you then you’ve likely deluded yourself so completely that I’m not sure that you’re reachable at this point.

Do our attempts to make a difference always work? No, almost never. Do they sometimes create drastic change? Yes. Do they ALWAYS make some positive difference in our patient, and just as important, in us? Yes, they do. Every, single, time. Is there ever a good reason NOT to try? One. If you’ve got a dozen plates spinning, trying to save a life, then perhaps you don’t have time for this type of compassion. But as soon as one of those plates is taken down? You’re out of excuses again. Besides, despite what you allow your family and girlfriend/boyfriend to believe, those are what? 1/10 of 1% of your calls?

Maybe your attempt at some positive thing does something, or maybe it doesn’t, or maybe it does but you won’t be there to see it at some later date. Any way you slice it, succeed or fail, making the attempt is just simply good medicine.

Language is powerful. Each time we use, or hear such terms as those above it should make us feel a bit ill. You know that feeling. When you’ve discovered that you pushed the wrong drug, or the wrong dose? Or delivered a medication before finding that you forgot to consider interactions with the other drugs they’re already taking? That ill feeling that you get when you know that you’ve done bad. That you were called to help, but hurt instead. Wanker or not, I’m confident that you know what I mean. I certainly know that feeling well.

I know that you went into this wanting to be a champion for those that can’t champion for themselves. I know, I truly believe, that you went into this to make a difference. I know that at the end of the day that you want to lay your head down knowing that someone’s life is better because you were a part of it when they were in trouble.

Please. Listen to your EMS spirit. Take a minute on every call and actually see your patients beyond their pathologies. Treat their bodies, but heal their minds and spirits. If you’re not doing so then you’re missing a vital part of the medical arts. It costs nothing but an additional bit of your focus. It takes no additional time. But the rewards are monumental.

Leave the wankers to do what wankers will do. But today, choose not to participate. Will the world change because you’ve made a different decision? Yes, for this one person, their families, and friends, the world will be different. It should feel like a privilege to hold such power as to be able to be part of a stranger's memories for the rest of their lives. Those memories will be good or bad, either way those that carry them will be changed.

To the professionals in EMS that get the reason, and the need for such posts…I salute you. Thank you for watching out for my family and myself. For bringing the best of EMS to every home, and to every patient. I promise to continue to do, every day, the best I can to be considered your peer and to live up to your example.

To those of you that think that this is just a bunch of feel good rah, rah, bullshit. I thank you to, for the work that you do, though I’ll likely never consider you a professional. My wish for you is that you to take a minute to think, and go back to the days when you could be proud of the job that you do every day. When you do? Man, nothing would make me happier than to welcome you to the ranks of the brotherhood of professional EMS providers and scratch another name off of the wanker list.

To those of you that really don’t know what the hell this is all about? That’s ok… You will. And as you move forward maybe this will give you a bit of a compass to help guide your way. I hope so. I’ll keep an eye out for you down the road…

Have a great day all…

[Arctickat]

Wow, nicely done. I knew there was a reason I like you so much. Just to show that I "get it" I'll share my EMS week Facebook post on here since some of our brothers and sisters don't use the Crackbook.

I'm told it's EMS week, but what does it mean? We're your community paramedics. We do our jobs because we love what we do, we get the glory when we finish a tough call and know we did a good job, and the riches we earn are the satisfaction we feel knowing that we could be there when you needed us.

It doesn't matter what week it is; you have invited us into your home and into your life when you were in your most vulnerable state. We took the faith and trust you had in us very seriously. When you faltered we became your armour to protect you from further harm, we became your sword to drive away the sickness, we became the vanguard of your army of health care providers who fought for you until your health returned; we have done it thousands of times and we will do it thousands more.

EMS Week isn't a week for people to recognise and thank their paramedics, it's a week for us to renew our pledge to you. When you call for help, we will always be the warm light that appears in your darkest hour.

And at the end of EMS week:

Today marks the final day of EMS week in Canada. During the week paramedics across this nation have responded to your calls for help. They've shared their compassion when they lifted you off the floor and put you back into bed, they've shared your relief when they removed you from the mangled remains of your car, they've shared your joy when they revived your loved one, they've shared in your excitement when they helped to deliver your baby, and they shared your sorrow when those you love were beyond saving.

Some have gone home to their families and shared their happy stories, others have gone home and kept the heartaches to themselves to spare others from the pain they've witnessed. 4 of our dedicated brothers never made it back home at all and we weep with their families, friends, and co-workers.

Every other week will be no different. Across Canada we will respond to thousands of calls, for some we will rejoice, for some we will weep, but we will never do it in front of you because our priority is to care for the needs of our patient over those of ourselves. We will find a private place to deal with our pain so you don't have to see it, then, we will go out and help the next person in need.

We thank you for your support, your understanding, and your comments. We look forward to continuing to help you when you call the other 51 weeks in the year as well.

[DwayneEMTP]

I love that they are opposite sides of the same coin...

Nice Kat..thanks for sharing...

[Arctickat]

NP, the thing that bothered me all during EMS week was all the EMS organisations touting that people should "Thank a paramedic" for what they do. I think that's a load of crap. We do our jobs 51 other weeks of the year and don't go around asking for thanks. That's just pathetic. I consider it a week for medics to reflect on the service they provide and renew their commitment to their patients.

[island emt]

Thank You to both of you.

We had some folks that wanted us to do a story about small town rural EMS for EMS week. The reporter called and gave me his version of what he thought the story should be about.

I declined to partake in the charade of rah rah sis boom bah.

[chbare]

Just received a call. A close family member was taken to the hospital experiencing intractable pain. A couple of months ago this person was diagnosed with pancreatic cancer with hepatic mets. For what I assume are a variety of reasons this person did not tell anybody and instructed their doctor to not even tell the spouse. To say the least, it was a shock to hear about this and to try to take in the fact that any hour from now I will be loosing a family member. My mother is probably suffering the most.

There are no miracles, there is no hope and the most progressive, cutting edge science cannot reverse this situation. The one thing that my mother in particular is holding onto is the fact that the health care providers have treated the family and patient with nothing but compassion and respect. This family member is no longer in pain and the providers have taken time to discuss what is occurring and what is to be expected down to what to expect with the breathing, mottling and why their beloved one is so yellow in colour. Even though there are no miraculous recoveries when faced with this situation, health care providers are still able to touch people in profound and important ways that reverberate and resonate for years to follow.

These are often simple gestures of human dignity, respect and compassion. My situation is not unique; however, and I imagine many people have similar stories to tell. Thank you for such thoughtful and profound posts Dwayne.

[medicgirl05]

This was a great post. Thanks for sharing. It definetely makes me reflect on my own actions, which I need to do every now and then.

Last night I had a patient with chest pain, turned out to be a M.I. The best thing about the call was that while my partner went to get the stretcher closer the patient was scared and she hugged me. REALLY hugged me. After that I could see that she felt better. That hug that I felt awkward about in the moment did more for her, in my opinion, than any Nitro, ASA, or Morphine possibly could. It allowed her to relax and be comfortable with me. Too often I find myself treating the signs and symtpoms and forget there is a patient under there.

[Arctickat]

Shrug, it's kinda like the new onset dementia patient I had last week. He was upset because his family had sold a piece of farmland out from under him, however he actually sold it himself back in '69. They showed him the sale agreement and everything and he freaked out, saying they were all liars and against him. If he had a gun he'd kill himself right there. A very sad situation for the family and they couldn't control him, so they called 911.

When I arrived I sat down with him and chatted for about half an hour. Listened to him, spoke with him, and generally diffused the situation. By the time I was done he was agreeable to go to the hospital. He is still there awaiting placement in a nursing home. His dementia had first been noticed about 3 months ago, but this was the first violent outburst from him.

We walked with him to the ambulance and after he was loaded and we closed the doors i turned to his 80+ year old wife who was visibly shaken. She gave me a hug which I returned and thanked me. I consoled her for a bit and gave her another squeeze before we left her with her son.

Those are the calls I do this for, not the hot code or the gory crash scene.

One thing I will add to Dwayne's litany. If someone asks you what the worst call is that you've ever been on and you glorify yourself with the attention, spouting off some car accident or other situation with the most gory detail you can muster, you're a wanker. When I'm asked that question I

1. Choose not to respond.
2. Ask the person why they would want me to relive such a horrible event in my and so many other lives for their entertainment, or...I tell them:
3. The worst call I've ever been on was the morning after Christmas day. We were called at about 8am to a home to care for a 2 year old child, but when we arrived there was nothing to be done. She had died in her sleep hours earlier, alone in her room, with a small amount of bloody drool dried on the pillow. That family went to bed the night before after celebrating Christmas together and woke to find their little girl dead. Instead of those parents being able to watch their little girl play with all the toys that Santa had just given her, they had to watch her funeral.

Usually, the person who asked has a tear in an eye, or is embarrassed enough to have realised just how inappropriate that question was in the first place...one thing for sure...they never get the answer they're expecting. I have twins who are about to turn 3 years old....I can't count how many times I've thought about that call since they were born and had a chill run down my spine at the thought of it being one of them.

Chris, my thoughts are with you and your family. Be strong bud, your family member made the choice for reasons he thought were sound at the time.

Edited June 5, 2013 by Arctickat

[Mateo_1387]

I think a slew of wonderful things are being wrote here. I find the writings thus far to be eloquent and touching. Therefore, I must apologize for blundering this post with my half wit, straight to the point nonsense....

The EMS spirit expressed through compassion and mercy, are the truer marks of a professional. Something that really catches my eye is the reminder of a certain power we sort of hold while being invited to view the lives of so many people, especially those in vulnerable positions. I know we are trusted with this responsibility, though it is always good for me to be reminded of that position once in a while. I truly believe it takes a personal motivation to want to be a better practitioner and simply a better person. As I said before in the post recently about the poster frustrated with their partner and taking it out on that person, our actions are a choice we make as to what kind of person and practitioner we strive to be.

Now I'm going to take the rocky road and go against the general grain/direction of this thread and offer my spin.

As I sit and type this, I have reread my last sentence about actions and contemplated a few different things. Most of my thoughts left me feeling like a shithead, and it may be rightfully so. I haven't quite figured it out in my head, but my thoughts are along these lines...

I had a patient recently that is still on my mind. To give you the quick and dirty it was an elderly female with alteration in mental status. Initially no response to painful stimuli. Upon starting an IV we get a response from her. She says "ouch, take that out" then goes back to not responding while trying to talk to her (now that she is finally talking). I used a trapezius muscle squeeze to illicit another response from her. She would talk and come back with short and seemingly snide remarks. I admit, it made me a bit frustrated. I did a few more squeezes during the call, and continued to engage talking with her to illicit responses. I find no glory in trying to make her talk, rather I wanted to figure out what was going on with her current mental decline. Did she take something? Is she hurting? Ya know, the usual things that help with our field diagnosis....

To get to the point, I feel like the crappiest paramedic alive right now. I have no malicious intent for doing what I did. I felt it prudent that talking to her was important and since I know she can respond I continued to engage her. Point blank, I was frustrated too. In my mind, I also seem to be associating my actions (squeezes and talking) as being a manifestation of my frustration. I do not think my bad feelings would be there if I was not frustrated. Did I commit battery? I feel like I may have, wanting to cut up my cert card and attach myself to an ass kicking machine. At the same time would she be getting the timely and necessary care she needed without eliciting a response and acquiring information? I doubt it, though it doesn't make me feel any better.

The point I'm trying to reach is that meeting our patients with compassion, respect, mercy, and a desire to "gift them with our advocacy" are wonderful things, though other influences such as frustration, fear, anger, and those other lovely emotions we possess are capable of leaking out of that professional EMS spirit cape we all wear. That is the human element we all face, IMO. I do not think the EMS spirit is a bunch of rah rah feel good bullshit, but rather an important part of who we are as EMS professionals. As an introspective person who has an introspective race car track without a finish line in my head, its hard to think I'm the sum of the not so great things I feel I have done, in an EMS spirit kind of perspective. I do not think I agree that just because one can have certain negative feelings about interactions we have with our clients means that we succumb to the whacker level, at least not until the point is reached where we let those feelings guide our EMS spirit. Some folks (whackers) get their kicks off by sharing and probably exaggerating their feelings (and at the expense of others), though I guess I just live with it in my head.

______________

A separate point I want to address that has been discussed in this thread is the "thank a paramedic" and "we don't need no thanks" parts. So they promote the idea of saying thanks to EMS folks during EMS appreciation week and it is pathetic?

It seems to me that appreciation would be healthy. It promotes people to say thanks which in turn makes them feel good. At the same time a stranger that takes the initiative to do something good, oftentimes for a stranger, makes me feel not only appreciated, but contributes to the idea the world is not as bad as we often perceive it. Where is the harm?

Now, I will say that the facebook posts I see about "we get up at 3 am to save your sorry tails, so thank us" is bullshit. That is pathetic. As I previously talked about that, what is the harm in genuine appreciation?

[DwayneEMTP]

Man, Matty, on your first point. What an excellent, and overlooked, at least by me, point. I'd once had to be pushed out of the ambulance by my partner before beating the shit out of a drunk. Upon examining a man in jail who'd sverely beaten his wife (I'd also treated her), who'd also been beaten by the police, I declared him sound to stay in jail despite his being pretty banged up and screaming of a headache.

My post certainly did imply that if the less desireable human elements seep into your care that you are less than a professional provider. That was terribly hypocritical of me and I'm grateful for your pointing it out. Or perhaps if those things do seep into your care then you're not yet a complete professional? But can you open yourself up to giving love and compassion to your patients without also opening yourself up to anger and frustration? Intuitively I'd think no...but I don't know. Being that unprofessional person for me is rare, a couple of times that I'm ashamed of in my career, but man, how I hate him when he shows up.

My post more should have reflected a professional's constant desire to reach that ideal, without implying that they do so always...

I'll have to give that some thought and make some changes...Thanks Brother.