I’m an old guy who works as a firefighter in one small town and as an ER doctor in another even smaller one.
Sometimes I find myself leading a team of people in an emotionally charged environment and every once in a while someone says to me later, “I like the way that went.”
Leading By Example
When that happens, I am always grateful for the big-city paramedics who led by example when I was a young man working on an ambulance.
Today, as a medical director, I’m asked to review a cardiac arrest run where the facility and the family are unhappy. It brings to mind a call I ran many years ago when the patient also died. Even so, it’s one of the runs I feel the best about after all this time.
As a fairly new medic, I was excited to be running the show that day, with an EMT-basic partner and a BLS engine company who trusted me more than I really deserved.
The call was for a fainting spell, and she was supine on her living room floor. We moved the furniture, spread out our gear and started chest compressions. There was a lot to be done.
To this day I have a book on my shelf from my own paramedic class: Streetsense, Communication, Safety, and Control. In his introduction, Jim Page said that, “Usually, the street is where we first realize that our official training and preparation was inadequate. We yearn for the mental discipline and perspective to put conflicting demands and influences in their proper places.”
Kate Dernocoeur taught me in the rest of her book that my job was always to consider the larger picture. Thanks to her I came to think of my role as a conductor, listening for the melody and coordinating the many instruments that contribute to a scene.
Conducting the Call
So, I waved my mental conductor’s wand that day. There was a gurney to be retrieved, an intubation to be performed next to the sofa, shocks to be delivered on the floor, drugs to be pushed and a base station contact to be made. Thankfully someone had already shown me by then that the identified patient is rarely our only “patient.” Maybe this middle-aged woman, who didn’t look like she would survive, was not even our most important one.
I backed away from the fray and motioned to her son. We’ve all seen the desperation he had in his eyes that day. I told him what I’d heard one of the older medics say to families, “Do you understand what’s happening here?” This was followed by a full pause.
“Her heart is not beating on its own. We are breathing for her and helping her blood to circulate.”
Another full pause.
“This is very scary. She’s as critical as it is possible to be.” Then as now I try to be measured in my delivery, but there’s always a tightness in my chest when I pronounce these words.
I wasn’t prepared for what he told me through the tears. They’d been arguing loudly, yelling at one another when she went down. He’d said something terrible to her.
And so, in the middle of the controlled chaos, we stopped the show. I have no idea how I came up with what I told him.
“There have been people who survive what your mother is going through. When they come back they sometimes remember everything that has been done and said. I want you to tell your mother what’s on your heart right now. She won’t be able to talk back to you, but she will hear you.”
Breaking the Rules
We were breaking the rules when we set down the backboard with her lifeless body in the entryway of her home. Only one of us stayed to do the chest compressions and squeeze the bag while the rest watched from a respectful distance as he apologized and said his sobbing goodbyes.
There are many competing priorities to be balanced in life, just as there are on a complicated EMS scene. An old adage about healthy relationships says that, “You can be right, OR, you can be married.”
I think we would all agree that at the end of the day, our job is to make a situation better when we leave than it was when we arrived. I must constantly challenge myself to accomplish that.
Editor’s Note: This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
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