Trying to sleep tonight, I found myself instead thinking of Jerry Maguire. Perhaps not ironically, the beginning where he couldn't sleep and instead wrote the mission statement that would haunt him for the remainder of the movie. Less obviously, I was thinking of the conversation Jerry and Ron had outside the stadium where Jerry tells him that his problem is not that he gets no love or no coin, but that he has no heart. Ron replies quite explitively that he is "all heart...." and they part as Ron says "I don't want to be friends no more" That exchange made me think of what paramedics are missing, and why.
We are afflicted with the same absence of heart. While we are so wrapped up in who is trying to take our skills away or our pay or our respect, we fail to see that we lost our collective heart long ago. And, in a business so centered in caring as ours, he who lacks heart lacks identity and, ultimately, soul.
Jerry spends the entire movie recovering from a crisis of conscience he suffered after two slices of bad pizza. By a similar turn, paramedics have spent the better part of a half-century trying to emerge from the shadows of ambiguity crafted for them by the forgers of EMS. Our founders formed a grand vision of how pre-hospital care should be delivered in this country, but only the vaguest notion of how to meld that system into a complex healthcare framework that grows and changes daily with time and science. While our nation is governed by a living Constitution, paramedic
practice is still largely defined by a forty-five year old White Paper that is as dead as the victims who spawned it. Most notably missing from this document and those that followed is the fundamental part: how the highly skilled, throughly educated clinicians at its core will be integrated and regarded in the healthcare system.
I've spent alot of time recently looking at North Carolina General Statute 55B. As a matter of fact, it stares at me even now from an electronic sticky note on my desktop. In order to form my own business, I had to understand how this minor, relatively obscure piece of legislation applied to me...in the negative. For the unknowing, NCGS 55B was passed into law in 1969 and is titled "The Professional Corporation Act". This law outlines in Article 2, paragraph 6 the requirements for being considered a "professional", who may render a "professional service" and the specific job titles that are considered "professionals" The main requirement is "the obtaining of a license from a licenseing board." Some of these licensced professionals, as designated by their own statutes are architects, chiropractors, foresters and individuals noted in the "Nursing Practice Act, with regard to
registered nurses" Nowhere in 55B are paramedics explicitly or implicitly mentioned. As a matter of fact, NCGS 131E which outlines EMS rules, expressly refers to paramedics as being "credentialled" rather than licensed, thus by definition excluding paramedics from the professional designation and the myriad of privileges and responsibilities bestowed therein. Whether this verbage was meant to be an intentional exclusion makes for good academic debate, but leaves the larger issue unresolved.
It truly doesn't matter whether or not we can intubate, or if we're allowed to carry and use a certain medication, or even choose what hospital will receive our patient if the greater issue of lacking professional identity is ignored at the very fundamental root of our inception and organization.
Now is the time to stop squabbling about skills or worrying about how much crap will fit in your pockets or complaining that we don't make as much money as nurses. This is the time for a gut check. The time to decide if you really want to be a professional or just shout about being one, thus removing all doubt that you aren't.
Jerry Maguire has his living room moment in, well, the living room. Ours needs to be in each one of our ambulances, aircraft, hospitals and ultimately, the halls of congress.
ACHILLES' BRAIN
Greek mythology is full of lore that remains metaphorically as relavent today as when it was current; so much so that its cultural referencing is probably second only to the Bible, and maybe Harry Potter depending on who you ask. Many of the great heroes and fools are used so often that they have their own adjectives: hurculean, sisyphean and so forth. Every pretty face we see could launch a thousand ship, and one pretty face in particular, Pandora, brings out the problem with this lazy language. She was made by Zeus as a punishment to man, invested with horribly lovely gifts from every god so that her wonder took hold of gods and men alike when they saw her. And while it is true that she was filled with the curiosty that unleased innumerable sorrows upon the earth, she is also the giver of hope, the most forgotten gift of her nature. Without the whole story, she, the gods and the rest of mankind are little more than shadows.
Another, better example is Achilles and his tender heel. He is oft remembered for the single point of vulnerability on his body, and as frequently forgotten for being the most tragic of heroes of the Trojan War. Achilles was a conflicted chieftain who wrought vengence on his sworn enemy only to relent to the slain man's father and halt the fighting so he could be mourned. He travelled between rage and remorse not from indecision, but from compassion even in the face of his own fated mortality. There was a place in Achilles' heart, not his heel, that was softer still and more vulnerable to the things he couldn't fight because he could not imagine them in the first place.
In all of us is something, simply called gumption, that keeps our forward momentum through soft grass and briars alike. But deeper is a soft part that we let no one see because we do not see it ourselves. This dark place is held behind a lock whose key we do not have and do not know. It is only undone by another and when opened, like Pandora's box, unleashes sorrow we cannot conquer because we did not know it was possible.
Caring for the sick and injured can be like this. Choosing to heal often means choosing to hurt some of the time as you share another's pain and grief for a short time. This is part of the job and part of the bargain. What none of us sign up for are the atrocities that derail rational thought and threaten in a flash to push us from competent to fetal, or worse. We never know what we will encounter that will open that lid, because it is different for everyone. For some, it is simple and grotesque as a mangled body. For others, it is more visceral, like the bite marks left on a small body by the one trusted to care for her. Whatever the trigger, what separates the good from the great is the knowledge that no matter what you just saw, you have to push forward regardless of the mark that it will leave on you.
A favorite quote of mine is "Everything worth knowing leaves bruises". In the dark places, the bruises are deeper and last longer, and they leave an enduring soreness of spirit which is not easily forgotten. But they also toughen the skin they wound, helping us to heal and to keep healing those who cannot do what we do because they do not see as we see.
Greek mythology is full of lore that remains metaphorically as relavent today as when it was current; so much so that its cultural referencing is probably second only to the Bible, and maybe Harry Potter depending on who you ask. Many of the great heroes and fools are used so often that they have their own adjectives: hurculean, sisyphean and so forth. Every pretty face we see could launch a thousand ship, and one pretty face in particular, Pandora, brings out the problem with this lazy language. She was made by Zeus as a punishment to man, invested with horribly lovely gifts from every god so that her wonder took hold of gods and men alike when they saw her. And while it is true that she was filled with the curiosty that unleased innumerable sorrows upon the earth, she is also the giver of hope, the most forgotten gift of her nature. Without the whole story, she, the gods and the rest of mankind are little more than shadows.
Another, better example is Achilles and his tender heel. He is oft remembered for the single point of vulnerability on his body, and as frequently forgotten for being the most tragic of heroes of the Trojan War. Achilles was a conflicted chieftain who wrought vengence on his sworn enemy only to relent to the slain man's father and halt the fighting so he could be mourned. He travelled between rage and remorse not from indecision, but from compassion even in the face of his own fated mortality. There was a place in Achilles' heart, not his heel, that was softer still and more vulnerable to the things he couldn't fight because he could not imagine them in the first place.
In all of us is something, simply called gumption, that keeps our forward momentum through soft grass and briars alike. But deeper is a soft part that we let no one see because we do not see it ourselves. This dark place is held behind a lock whose key we do not have and do not know. It is only undone by another and when opened, like Pandora's box, unleashes sorrow we cannot conquer because we did not know it was possible.
Caring for the sick and injured can be like this. Choosing to heal often means choosing to hurt some of the time as you share another's pain and grief for a short time. This is part of the job and part of the bargain. What none of us sign up for are the atrocities that derail rational thought and threaten in a flash to push us from competent to fetal, or worse. We never know what we will encounter that will open that lid, because it is different for everyone. For some, it is simple and grotesque as a mangled body. For others, it is more visceral, like the bite marks left on a small body by the one trusted to care for her. Whatever the trigger, what separates the good from the great is the knowledge that no matter what you just saw, you have to push forward regardless of the mark that it will leave on you.
A favorite quote of mine is "Everything worth knowing leaves bruises". In the dark places, the bruises are deeper and last longer, and they leave an enduring soreness of spirit which is not easily forgotten. But they also toughen the skin they wound, helping us to heal and to keep healing those who cannot do what we do because they do not see as we see.
HANDS OF FATE
"Cradled by the hands of fate the faith that sometimes wraps around too tight - so tight" Train "Free"
A Google search of "hands quotes" returns about 20 million results, most of which refer to things we hold in our hands. We can hold our future, love, another's heart, fear, a weapon...the list is endless. But what of the hands themselves? In the lines and creases and veins live the words of each of our stories; words that cannot lie or embelish or hide the deeds that bore them. These are the words, more than the ones we speak, that speak what we are.
Like many, my hands are vital to what I do to live and for a living. Without their strenght and sensitivity, I could no more be a paramedic than I could fly without mechanical wings. But my livelihood is only the smallest fragment of what my, or your, hands know.
More of what I've learned can be attributed to putting my hands where they didn't belong rather than where they did, and that's OK because, right or wrong, they have been in some pretty amazing places, and some equally dark ones. But I am defined by these places and the marks they have left on my hands. There are scars from a childhood accident I don't remember and more recent ones I remember all too well. My fingers know of unzipping a dress and helping it to the floor; they know of zipping countless body bags and lifting them away. My hands have reached into my son's crib to lift him from his nap; and a dozen other cribs to carry away those who will not wake. My cold hands have found warmth in many places, just and unjust; and have spread their own warmth of better days to those in need. My hand has cut the cord, cut ties, shook hands over a promise and acted to break one. My fingertips hold memories my brain has pushed away, only revelaing these reminded places when they find them again, reminding me that the words are on my skin, in my veins and on every other hand that I touch.
A good friend of mine always talks about the details in everything we do. She believes, as I do, that the most important intricacies are found in the places most people don't care to look. Often these places are the hands, ours and others. Many would say that scarred and calloused hands are imperect and need to be fixed. For them, I am sorry for it these hands that fix things, and it is in these places, this character, these words, that human perfection lies.
Do good things, learn something, and be safe.
"Cradled by the hands of fate the faith that sometimes wraps around too tight - so tight" Train "Free"
A Google search of "hands quotes" returns about 20 million results, most of which refer to things we hold in our hands. We can hold our future, love, another's heart, fear, a weapon...the list is endless. But what of the hands themselves? In the lines and creases and veins live the words of each of our stories; words that cannot lie or embelish or hide the deeds that bore them. These are the words, more than the ones we speak, that speak what we are.
Like many, my hands are vital to what I do to live and for a living. Without their strenght and sensitivity, I could no more be a paramedic than I could fly without mechanical wings. But my livelihood is only the smallest fragment of what my, or your, hands know.
More of what I've learned can be attributed to putting my hands where they didn't belong rather than where they did, and that's OK because, right or wrong, they have been in some pretty amazing places, and some equally dark ones. But I am defined by these places and the marks they have left on my hands. There are scars from a childhood accident I don't remember and more recent ones I remember all too well. My fingers know of unzipping a dress and helping it to the floor; they know of zipping countless body bags and lifting them away. My hands have reached into my son's crib to lift him from his nap; and a dozen other cribs to carry away those who will not wake. My cold hands have found warmth in many places, just and unjust; and have spread their own warmth of better days to those in need. My hand has cut the cord, cut ties, shook hands over a promise and acted to break one. My fingertips hold memories my brain has pushed away, only revelaing these reminded places when they find them again, reminding me that the words are on my skin, in my veins and on every other hand that I touch.
A good friend of mine always talks about the details in everything we do. She believes, as I do, that the most important intricacies are found in the places most people don't care to look. Often these places are the hands, ours and others. Many would say that scarred and calloused hands are imperect and need to be fixed. For them, I am sorry for it these hands that fix things, and it is in these places, this character, these words, that human perfection lies.
Do good things, learn something, and be safe.
CLARITY
Coming out of paramedic school, I was unwittingly handicapped by two unfortunate notions; #1-I knew everything and, #2-I really could save them all. #2 rather depends on #1, and #1 is always the first to go. I have a very clear memory of the day both notions died, and it remains one of the most transformative days in my career, if not my life.
Less than six months had passed since graduation to this beautiful, sunny autumn day when we were dispatched to a medical alarm activation. Well over 90% of this type of call results from an accidental activation, so it is fair to say that even exuberance of youth could not help me find much urgency. My partner and I approached the scene with local first responders in front of us. As we turned down the long driveway to the reported address, the dispatcher calls to tell us that infant CPR is in progress at that location.
Oh, there's my urgency. And my stomach.
Let me stop here for a moment to say that this would not be my first time doing CPR on a baby and, I'm sad to say, would not be my last. But this would be the first time I was the only paramedic.
I leapt from the ambulance and ran for the front door, passing the first responders in their church clothes gathering equipment from their truck. Bursting through the door, I saw something I would not realize the sadness of for many years. A man of about 30 performing CPR, incorrectly I would add, on his lifeless baby boy. From the baby's dusky torso ran wires to a monitoring device which connected to a help center very much like the medical alert buttons we've all seen on TV. This one; however, was not for an aging grandmother trying to keep her independence, but for a six week old baby at risk for SIDS. I asked the father what happened while scooping his child from the table in a single fluid motion and carried him like a football towards the ambulance. I passed the first responders standing on the porch holding I believe every bag, case and gadget from their truck. Without breaking stride, I yelled at one of them to come drive and bounded into the back of the
ambulance where my partner was waiting.
All the specifics escape me of that trip to the hospital except the sun streaming in the windows of the truck to illuminate the absolute horror in front of me.
The hospital staff worked as diligently and unfortunately, as vainly as we had, and it was done. A few minutes later I was sitting on the bumper of my truck trying to organize the thoughts in my head to put on the run report when I heard the ER doors being knocked off the hinges from the inside by the father of the now deceased infant. His anger, certainly misdirected, was justified and sought only a target. Being the 22 year old kid who had held his child for the last time made me the natural choice, and even through the arrogance of youth I saw that. In the moments between the unhinging and a superbly executed tackle by hospital security, I found clarity.
Webster's defines clarity as "the quality or state of being clear", and everyone seeks clarity in their own fashion. Many find clarity of purpose through intense self-purification, while others look for God through the 'clarity' given them by
mind-altering drugs. Conversely, those in the grip of addiction may find their way out through lucid periods often referred to as moments of clarity.
My own clarity came from knowing I was about to take a punch meant for Death himself, and knowing that the man I was only an hour before would have hit back. There is really no way to quantify how much I grew in that awful spin of the clock, but it was enough to know that whatever was about to happen, it wasn't about me at all.
This moment of clarity allowed me to let go of the aforementioned ideas and find two new ones which I carry with me still today. #1-the majority of learning lies in front of me rather than behind, and 2- in terms of saving lives, the L's will always outnumber the W's. Sometimes people just die and, at particularly grisly times, they are babies and it is my job not to interrupt or intervene but to learn and grow and, sometimes, to take it on the chin. Since that day I have held quite a few babies in the moments preceding and following their deaths, and I'm continually amazed how well I remember a face I only saw once for an hour.
American businessman Thomas Leonard said "Clarity affords focus", and I believe it is our job to focus not on the loss, but the wisdom gained from understanding your place in the natural order.
Then, all will be clear.
Do good things with the week to come, learn something new and be safe.
Coming out of paramedic school, I was unwittingly handicapped by two unfortunate notions; #1-I knew everything and, #2-I really could save them all. #2 rather depends on #1, and #1 is always the first to go. I have a very clear memory of the day both notions died, and it remains one of the most transformative days in my career, if not my life.
Less than six months had passed since graduation to this beautiful, sunny autumn day when we were dispatched to a medical alarm activation. Well over 90% of this type of call results from an accidental activation, so it is fair to say that even exuberance of youth could not help me find much urgency. My partner and I approached the scene with local first responders in front of us. As we turned down the long driveway to the reported address, the dispatcher calls to tell us that infant CPR is in progress at that location.
Oh, there's my urgency. And my stomach.
Let me stop here for a moment to say that this would not be my first time doing CPR on a baby and, I'm sad to say, would not be my last. But this would be the first time I was the only paramedic.
I leapt from the ambulance and ran for the front door, passing the first responders in their church clothes gathering equipment from their truck. Bursting through the door, I saw something I would not realize the sadness of for many years. A man of about 30 performing CPR, incorrectly I would add, on his lifeless baby boy. From the baby's dusky torso ran wires to a monitoring device which connected to a help center very much like the medical alert buttons we've all seen on TV. This one; however, was not for an aging grandmother trying to keep her independence, but for a six week old baby at risk for SIDS. I asked the father what happened while scooping his child from the table in a single fluid motion and carried him like a football towards the ambulance. I passed the first responders standing on the porch holding I believe every bag, case and gadget from their truck. Without breaking stride, I yelled at one of them to come drive and bounded into the back of the
ambulance where my partner was waiting.
All the specifics escape me of that trip to the hospital except the sun streaming in the windows of the truck to illuminate the absolute horror in front of me.
The hospital staff worked as diligently and unfortunately, as vainly as we had, and it was done. A few minutes later I was sitting on the bumper of my truck trying to organize the thoughts in my head to put on the run report when I heard the ER doors being knocked off the hinges from the inside by the father of the now deceased infant. His anger, certainly misdirected, was justified and sought only a target. Being the 22 year old kid who had held his child for the last time made me the natural choice, and even through the arrogance of youth I saw that. In the moments between the unhinging and a superbly executed tackle by hospital security, I found clarity.
Webster's defines clarity as "the quality or state of being clear", and everyone seeks clarity in their own fashion. Many find clarity of purpose through intense self-purification, while others look for God through the 'clarity' given them by
mind-altering drugs. Conversely, those in the grip of addiction may find their way out through lucid periods often referred to as moments of clarity.
My own clarity came from knowing I was about to take a punch meant for Death himself, and knowing that the man I was only an hour before would have hit back. There is really no way to quantify how much I grew in that awful spin of the clock, but it was enough to know that whatever was about to happen, it wasn't about me at all.
This moment of clarity allowed me to let go of the aforementioned ideas and find two new ones which I carry with me still today. #1-the majority of learning lies in front of me rather than behind, and 2- in terms of saving lives, the L's will always outnumber the W's. Sometimes people just die and, at particularly grisly times, they are babies and it is my job not to interrupt or intervene but to learn and grow and, sometimes, to take it on the chin. Since that day I have held quite a few babies in the moments preceding and following their deaths, and I'm continually amazed how well I remember a face I only saw once for an hour.
American businessman Thomas Leonard said "Clarity affords focus", and I believe it is our job to focus not on the loss, but the wisdom gained from understanding your place in the natural order.
Then, all will be clear.
Do good things with the week to come, learn something new and be safe.
There Will Be Three
The day sticks in my head because of what Kimberly and I each brought home. I had carried a rip-roaring headache from work; she, a pregnancy test. Headaches are common here; pregnancy tests…not so much. Of course, she mentions it in the offhanded fashion of someone who has to make a phone call before dinner; “I need to take a test.” My throbbing head searched for the adjectives to make this a complete sentence. Test….what kind of test? First time in my life I had test anxiety for a test that wasn’t even mine. Then, I realized it sort of was mine. She explained her missed period, we did the math and she went to pee. Emerging a few minutes later wearing a smile I’d never seen, she said “You have the magic stuff”. Thus we began the long journey of parenthood.
The next few weeks were pretty normal. Of course, she had to give up some things like alcohol (no big deal), Advil (a little worse) and caffeine (now it’s getting serious). Kimberly went through the misery of finding a new OB, which is an experience I don’t think most men really appreciate. Speaking strictly as a husband, I know I’d like to limit the number of people with that kind of knowledge of my wife, so I can only imagine how it must be to actively recruit another person, likely as not a man, to mess around in your business. What’s worse, it took more than one try to find a good doctor with a good office. But she did and is very pleased with her new physician.
After the search came the patient wait until the first appointment, which was scheduled for what was estimated as her 10th week. We had originally been told that this visit would be mostly about collecting information and history, blood & urine and establishing a due date, so I didn’t go. Knowing her appointment was at 2:45, I waited patiently at work for the call letting me know everything went OK. The call I actually got at about 3:30 was a little more cryptic:
“Hey, I’m still at the doctor’s office”
“Oh. Is everything OK?”
“Yeah. Can you meet me for dinner when I’m done here?”
“Yes. You sure everything is alright?”
“Oh, yes. Everything is good. It’s just taking a little longer”
With that and an agreement on dinner, we hung up. Fifteen minutes later she called back.
“Hey, can you come home now?” I knew it….something was wrong.
“Yes, what for?”
“They did an ultrasound today. I want to show you the pictures”
“Ok. I’ll come now.”
On the way home, I was finally wrapping my head around the idea of having a baby. I’d known since we took the test that we were going to be parents, but with only a urine-soaked stick as the talisman of our impending parenthood, you can understand how the idea was still a little abstract to me. But driving down the interstate, the thought of holding my baby very soon started coming home, and I smiled all the way to the front door. As I got out of the car, Kimberly stood at the door rushing me along. I walked in and, without even a kiss; she pulled me by the hand to the computer where she had loaded the CD from the doctor’s office. The first picture on the screen was a simple baby ultrasound; nothing particularly special about it except that it was my baby and the picture was titled “Berrier Twins”
Twins? That better mean there are two pictures.
That isn’t what it means. It is only by the grace of God that my head didn’t twist off my neck, seeing how I spun it between her and the screen non-stop for at least five minutes, alternately saying “What?!” and “Oh God!”. I spent the next half hour or so staring at one of eleven pictures of two non-descript little blobs that had, with hands too tiny to see with the naked eye, turned my life completely upside down.
This had, as you might guess, changed everything. Kimberly’s age combined with twins now made her high-risk; setting in motion a whole new set of doctor visits. This meant more ultrasounds, more tests and more ways she had to take care of herself to make sure she and the babies stayed healthy. And, let’s not forget…we’re now having babIES… two of everything.
And, we started telling everyone. This is by far the funniest part. We broke the news to most everyone in the same way. “Hey, we’re pregnant” At this point, everyone said congratulations or something like that. Many even anticipated what we’d say when we revealed we had news. Then, we’d chase it, “With twins”. Laughter, almost across the board. People actually found it amusing that we were having two babies. And, I have to admit; once I regained consciousness I did too. After that, though, it was really kind of cool to think about having twins. I found it took considerably less time to absorb the idea of two babies than it did to accept the arrival of one.
In the meantime, I started a new job at one of the bigger hospitals in our part of the world. The orientation process required me to spend some time in different areas of the hospital, including the Neonatal Intensive Care Unit (NICU). I had a little anxiety about an being an expectant father of twins in a place with so much misery, but I figured I could learn a lot, so I’d make the best of it. What I found out rather quickly was that a lot of twins end up there just because they tend to be born a little early and need time to “feed and grown” as one of the nurses put it. Some weren’t all that sick; others were tiny, barely a pound and fighting for every ounce. As we rounded, my preceptor refused to tell me one story, saying instead that I really didn’t need to hear about it. “The story”, as it turns out, was about a twin in the unit (less than 600 grams) whose sister was born into a toilet at 24 weeks and didn’t make it. She was right…I didn’t need to hear about it. I left the NICU honestly not caring if we had a boy or girl, only that whatever it was, it was healthy.
The next countdown was to Kimberly’s next ultrasound on July 17. I was again unable to join her but got home shortly before she did. I met her at the door and quipped “There are three, aren’t there?” She said “No, we’re back to one healthy baby.” I didn’t know before then that I could fit both feet in my mouth at the same time.
As you can see in the picture, baby # 2 never developed past the 10th week; a common occurrence known as a “vanishing twin”. But the remaining baby was growing fast and well, making it very hard for us to be sad. I think Kimberly said it best with “we have as many babies as we’re supposed to have”; and that’s alright with me.
Most recently, we visited a genetic counselor for additional screening. Mainly they were looking for chromosomal abnormalities like Down’s syndrome. We still don’t know the sex, but the testing went fine and we’re happy to say that Baby Berrier is right where s/he should be. The pictures are incredible, but they really don’t do justice to the live ultrasound and the cartwheels the baby was doing while we watched.
Thanks again for all the congratulations as we begin our roller-coaster ride of parenthood. Keep watching here for more news and updates with the weekly blog, and as always, thanks for reading.
Do good things with the week to come, learn something new and be safe.
Things that go bump in the night...
Principal Vernon (Paul Gleason)talks in “The Breakfast Club” about “the thought that wakes me up in the middle of the night”; and that’s what I’d like to hear for this week’s blog. What scares you? I’m not talking about spiders or snakes or Democrats…I mean the real stuff. I’m just going to ask and see if anybody has the guts to answer. To be fair, I’ll start with mine.
Most everyone knows that my wife and I are expecting (if you didn’t know…surprise!). What many of you don’t know is that we are no longer having twins. At the doctor this week we found that the second baby did not develop. The first baby is growing like a champ, though, so we are still very excited and can’t wait to meet him or her. Everyone tells me I’ll fall in love with the baby as soon as it is born, and I’m so anxious to feel that, but therein also lies my fear…to love something so much when so much can still go wrong. I’m afraid that my body could not withstand having that much love torn out of me.
So there….I’ve taken the first step, so let’s see if you’ll follow. Post a comment here or on the MySpace page. If you’d rather keep it private, send me an email. Thanks for playing along.
Do good things with the week to come, learn something new and be safe.
The Unfallen Sky.
There is probably no greater self-proclamation of professional prowess among paramedics than the mastery of airway management—specifically endotracheal intubation. One of the greatest compliments you could pay a medic is to say he could “tube anyone” and mean it. By the same token, nothing will tear at the fabric of his confidence faster than failing to intubate, even once. Even outside their own ranks; everyone has an opinion of EMS and their ability or failure to pass a tube. Whether it’s the wide-eyed EMT student who latches onto intubation as a lifelong dream, or the grouchy ER nurse who swears that all the paramedics want to do is to intubate people…even though they aren’t any good at it. What escapes almost everyone, including paramedics themselves, is the irrefutable link between this relatively simple skill and the confidence it takes to perform it.
Despite what the grizzled EMS veterans will say, intubation is a fairly easy procedure that, if anything, we have complicated by insisting that we can do it anywhere and trying to prove it. The fact is that a mediocre instructor could teach an eight year-old how to intubate and most of the other paramedic skills in a weekend (A student recently told me “that would be one cool eight year-old”). What makes intubation so prized and contested is the guaranteed acuity of the situation that necessitates it. In the EMS realm, if someone needs a tube, it is because they die without it. Enter the confidence factor.
Because EMS is such an egocentric profession, confidence among the practitioners is usually a given. But, the confidence inherent to the practice of intubation is necessary, because without it the battle is lost before it begins. It is important that you believe you can intubate every single patient that needs it in order to be successful. You won’t get them all, but you must believe you will or you won’t get any.
I remembered this nearly too late this week. During orientation at my new job, I rotated through the operating room to grease the rusty gears of my own intubation skills. From the start I was paired with an incredible nurse anesthetist who gave me all the room I needed to stand after a very long time of sitting by the sidelines. The first patient we saw was a big guy…no neck and a huge tongue. At this point, I hadn’t told anyone that this would be my first tube in a long, long time. Somehow, as I was putting the laryngoscope together didn’t seem like the right time. Drugs were pushed, the patient slept and I went to work.
Money.
Within seconds, I saw the cords, passed the tube and found my long-forgotten swagger. I hung around for a few minutes before excusing myself to search for the next victory in a day that was now certain to be full of them. However, crossing the threshold of the room left me with the uneasy feeling that things were going too well, too soon.
My next patient was with the same anesthetist, and it looked like a cake walk. During the pre-anesthesia screening, we decided together that this patient, a jolly man in his 60’s had an easy airway. Short teeth, big mouth and a solid chin—no problem. Same as before, everything went smoothly until I put the scope in his mouth and saw…nothing.
Well, nothing but tongue and epiglottis. The biggest epiglottis in history. Seriously…somebody call Guinness. I looked some more, being mindful of teeth that were short and stubby in the holding room but had somehow grown in the sterile air of the OR to the size of grave markers. The patient’s oxygen saturation began to fall, taking with it my confidence, and the anesthetist asked “Want me to have a look”? Please.
I took a little pleasure in seeing him struggle for about 4 seconds before placing the tube, but the damage was done. I stuck around for the duration of the surgery, partially to watch the procedure but mostly to give my wounded ego time to heal.
As we walked from the recovery room back to the OR, I admitted to the anesthetist that my confidence had been shaken. He casually remarked “You won’t get them all” and lead me to our next patient which he handed over to me without a second thought.
Allen Neuharth, the founder of USA Today, once wrote “I quit being afraid when my first venture failed and the sky didn't fall down. “ I was reminded of those words throughout the rest of my day in the OR, which was perfect both in intubations and experience. I left feeling on top of the world, not only because I had done well, but because I recognized the value of doing badly. And between “well” and “badly” is confidence, because without the confidence in success, there can be nothing learned from failure.
Too often, people mistake confidence for arrogance. And, while there is an abundance of the latter in modern EMS, most of the accused are guilty only of believing that they are the best hope for the survival of every patient they treat. The difference between confidence and arrogance is the humility of knowing your own fallibility. None of us can save them all, but it’s the guts to try that sets the best apart from those happy with being good enough.
Anyone who is good at what they do gets that way by believing they can be great, and accepting that they must be human.
Three shining examples of confidence and conviction made news this week with their passing.
Jesse Helms, ever a stalwart of conservative values in the 20th Century died on the 4th of July. Like him or not, you could always count on Jesse to tell it like it was, or at least like it was in his
mind. The only upside to Helms’s death is that, should the liberal Barack Obama win the White House, we will be able to power Raleigh, NC from the static electricity generated by Jesse spinning in his grave.
Also from the right side of the aisle passed this week Tony Snow, conservative commentator and
former spokesperson for the Bush administration. Once again, whether or not you agreed with him or not, Snow’s candor won over people from both sides of the fence. Ed Henry, the very reporter from CNN told by Snow at a press conference to “zip it”, wrote that he believed “life is too short to get yourself all worked up about one tense exchange, one awkward moment or one misstep.” We should all be so wise.
Finally, Dr. Michael Debakey, THE pioneer of cardiac surgery died at the age of 99. Ironically, he
owed the last few years of his life to a life-saving aortic surgery that he himself developed several decades ago. Early in his career (he graduated from medical school in 1932) he commented that “If a patient came in with a heart attack, it was up to God.” Dr. Debakey was never satisfied with that, and spent his career of more than six decades giving the Almighty the best help he could. He performed over 60,000 surgeries, developed hundreds of medical devices and listed celebrities and heads of state among his patient list, though never giving special treatment. “Once you incise the skin”, he said, “you find they are all very similar.” Without question, no one will say that about you, Doc.
No big news to report this week about mother and babies. All is well. We have appointments in the next couple of weeks, so I hope to post new pictures soon.
Do good things with the week to come, learn something new and be safe.
There is probably no greater self-proclamation of professional prowess among paramedics than the mastery of airway management—specifically endotracheal intubation. One of the greatest compliments you could pay a medic is to say he could “tube anyone” and mean it. By the same token, nothing will tear at the fabric of his confidence faster than failing to intubate, even once. Even outside their own ranks; everyone has an opinion of EMS and their ability or failure to pass a tube. Whether it’s the wide-eyed EMT student who latches onto intubation as a lifelong dream, or the grouchy ER nurse who swears that all the paramedics want to do is to intubate people…even though they aren’t any good at it. What escapes almost everyone, including paramedics themselves, is the irrefutable link between this relatively simple skill and the confidence it takes to perform it.
Despite what the grizzled EMS veterans will say, intubation is a fairly easy procedure that, if anything, we have complicated by insisting that we can do it anywhere and trying to prove it. The fact is that a mediocre instructor could teach an eight year-old how to intubate and most of the other paramedic skills in a weekend (A student recently told me “that would be one cool eight year-old”). What makes intubation so prized and contested is the guaranteed acuity of the situation that necessitates it. In the EMS realm, if someone needs a tube, it is because they die without it. Enter the confidence factor.
Because EMS is such an egocentric profession, confidence among the practitioners is usually a given. But, the confidence inherent to the practice of intubation is necessary, because without it the battle is lost before it begins. It is important that you believe you can intubate every single patient that needs it in order to be successful. You won’t get them all, but you must believe you will or you won’t get any.
I remembered this nearly too late this week. During orientation at my new job, I rotated through the operating room to grease the rusty gears of my own intubation skills. From the start I was paired with an incredible nurse anesthetist who gave me all the room I needed to stand after a very long time of sitting by the sidelines. The first patient we saw was a big guy…no neck and a huge tongue. At this point, I hadn’t told anyone that this would be my first tube in a long, long time. Somehow, as I was putting the laryngoscope together didn’t seem like the right time. Drugs were pushed, the patient slept and I went to work.
Money.
Within seconds, I saw the cords, passed the tube and found my long-forgotten swagger. I hung around for a few minutes before excusing myself to search for the next victory in a day that was now certain to be full of them. However, crossing the threshold of the room left me with the uneasy feeling that things were going too well, too soon.
My next patient was with the same anesthetist, and it looked like a cake walk. During the pre-anesthesia screening, we decided together that this patient, a jolly man in his 60’s had an easy airway. Short teeth, big mouth and a solid chin—no problem. Same as before, everything went smoothly until I put the scope in his mouth and saw…nothing.
Well, nothing but tongue and epiglottis. The biggest epiglottis in history. Seriously…somebody call Guinness. I looked some more, being mindful of teeth that were short and stubby in the holding room but had somehow grown in the sterile air of the OR to the size of grave markers. The patient’s oxygen saturation began to fall, taking with it my confidence, and the anesthetist asked “Want me to have a look”? Please.
I took a little pleasure in seeing him struggle for about 4 seconds before placing the tube, but the damage was done. I stuck around for the duration of the surgery, partially to watch the procedure but mostly to give my wounded ego time to heal.
As we walked from the recovery room back to the OR, I admitted to the anesthetist that my confidence had been shaken. He casually remarked “You won’t get them all” and lead me to our next patient which he handed over to me without a second thought.
Allen Neuharth, the founder of USA Today, once wrote “I quit being afraid when my first venture failed and the sky didn't fall down. “ I was reminded of those words throughout the rest of my day in the OR, which was perfect both in intubations and experience. I left feeling on top of the world, not only because I had done well, but because I recognized the value of doing badly. And between “well” and “badly” is confidence, because without the confidence in success, there can be nothing learned from failure.
Too often, people mistake confidence for arrogance. And, while there is an abundance of the latter in modern EMS, most of the accused are guilty only of believing that they are the best hope for the survival of every patient they treat. The difference between confidence and arrogance is the humility of knowing your own fallibility. None of us can save them all, but it’s the guts to try that sets the best apart from those happy with being good enough.
Anyone who is good at what they do gets that way by believing they can be great, and accepting that they must be human.
Three shining examples of confidence and conviction made news this week with their passing.
Jesse Helms, ever a stalwart of conservative values in the 20th Century died on the 4th of July. Like him or not, you could always count on Jesse to tell it like it was, or at least like it was in his
mind. The only upside to Helms’s death is that, should the liberal Barack Obama win the White House, we will be able to power Raleigh, NC from the static electricity generated by Jesse spinning in his grave.Also from the right side of the aisle passed this week Tony Snow, conservative commentator and
former spokesperson for the Bush administration. Once again, whether or not you agreed with him or not, Snow’s candor won over people from both sides of the fence. Ed Henry, the very reporter from CNN told by Snow at a press conference to “zip it”, wrote that he believed “life is too short to get yourself all worked up about one tense exchange, one awkward moment or one misstep.” We should all be so wise.Finally, Dr. Michael Debakey, THE pioneer of cardiac surgery died at the age of 99. Ironically, he
owed the last few years of his life to a life-saving aortic surgery that he himself developed several decades ago. Early in his career (he graduated from medical school in 1932) he commented that “If a patient came in with a heart attack, it was up to God.” Dr. Debakey was never satisfied with that, and spent his career of more than six decades giving the Almighty the best help he could. He performed over 60,000 surgeries, developed hundreds of medical devices and listed celebrities and heads of state among his patient list, though never giving special treatment. “Once you incise the skin”, he said, “you find they are all very similar.” Without question, no one will say that about you, Doc.No big news to report this week about mother and babies. All is well. We have appointments in the next couple of weeks, so I hope to post new pictures soon.
Do good things with the week to come, learn something new and be safe.
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