Cure sometimes, treat often, comfort always
The memorable calls from a patient perspective identify the disparity in what EMS providers think is a job well done, and what patients think
My partner and I got an “attaboy” from my employer a few weeks back. With it came an official commendation in my personnel file, and a $25 gift certificate. My employer is pretty good about handing these things out for what they deem going above and beyond the call of duty.
It was a welcome and not infrequent bit of positive feedback from my employer, who understands the importance of such things. I’ve gotten them before, and I’ll get them again. What was unusual about it was the channels through which it percolated back down to me. No one called my immediate supervisor or my area operations manager. No phone call was made, no email or letter was sent.
The commendation came from one of our senior administrators, one of those guys with a single-digit employee number who wears a suit at corporate headquarters 120 miles away – a guy I’ve barely met. As it turns out, one of the patient’s family members duck hunted with him, and mentioned it one morning over sunrise in the marsh. He wasn’t at the call, but he remembered being impressed with how much his mother went on and on about how nice her EMTs were.
Frankly, I don’t even remember the call. It took my partner, a man with savant-level memory recall of details, names and addresses to remind me of the circumstances of the call and, even now, the details are vague. I doubt I’d recognize the patient on the street. Names and faces fade from memory after another shift or two; what remains in my memory is the diagnosis, not the person. I don’t remember Mrs. Theriot or Mr. Thibodeaux, I remember the lady in respiratory failure or the old man north of town with septic shock.
The personal element to compassion in EMS
When you make it a point to be as nice and comforting as possible to every patient, it’s hard to pick one call out of the crowd. And even though I may try – because there’s a personal element to compassion – I simply can’t remember them all.
Oh, but they remember me.
Well, maybe not me, but rather the large man who calmed their fears, took care to ask their name and offer his own – though they likely won’t remember it – and not only assured them everything would be OK, but actually made them believe it. You know, big guy, tousled hair, mid-forties; partner’s a little older, going bald. Knows just when to crack a joke or hold a hand. Tell that guy I appreciate what he did.
And so, our senior administrator, knowing the importance of such things, looked up the call, found out who the crew was, and fired off an official commendation, even though the call had happened months before.
We often forget in this profession how profoundly even the smallest of gestures can affect our patients and their families. For us, it was just another call, but for them, we were key players in a defining moment of their lives. And, almost invariably, every one of those attaboys I’ve received had nothing to do with the technical skills and knowledge I employed in treating my patient. They were almost always for how nice I was.
And therein lies the disparity in what we think is a job well done, and what our patients think is one.
What stands out to patients beyond medical care
The 500-pounder wedged in the doorway that I intubated on the first attempt in the dark hallway whilst the other crew did CPR on the half of him that still lay in the bedroom? I heard nary a peep from on high, got nothing but a fist-bump from the other medic I backed up.
The tomahawk intubation on the failing asthma patient with her head jammed in the corner? I got nothing more than an astonished look from my partner, who had never seen such a thing.
The WPW patient with orthodromic AV reentry tachycardia where I made the right call and cardioverted instead of administering antiarrhythmics? The grunt I got from the ED physician might have resembled “good job,” but it never reached the ears of my supervisor.
For the successful IV sticks en route to the ED on the patients who sighed and warned me, “You’re not gonna get that. They always have to stick me a bunch of times, and never in a moving ambulance,” the praise and gratitude never extended beyond the confines of the patient compartment of my ambulance. They thanked me personally, and that’s enough, but nobody else ever heard about it.
What impressed people enough to write a letter, send an email, make a phone call, or mention it to a senior vice-president between flights of teal one fall morning?
Things like standing in the rain, getting soaked as I held an umbrella over the frail little woman we loaded into my rig.
Things like the HIV-positive man covered in blood, who was grateful that I made a short detour to drop off his Yorkshire Terrier at his home on the way to the hospital.
Things like the code I ran on the woman younger than I, the one I failed to resuscitate. What they remembered was the death notification, and the hug and reassurance I offered to a heartbroken sister who was torturing herself over what else she might have done. They didn’t even notice how sweat-soaked I was. The 45 minutes I spent working up that sweat wasn’t what stood out to them. The 15 minutes I spent after we stopped did.
The patient for which I received this most recent attaboy? It wasn’t the 150 mcg of fentanyl I administered before I even moved her off the floor. It wasn’t the upside-down KED I used to splint her broken hip, in which I had to explain to my partner what I was doing. It wasn’t even the remaining doses of fentanyl I administered en route to the ED to keep her pain at bay.
What impressed her was how nice he was, “The big guy, I forget his name, but he said his people were from Monroe and he used to train retrievers before he became a paramedic, and we had the nicest conversation all the way to the hospital, and I sure wish I could thank that young man … ”
And you did, Ma’am. In a roundabout way, months after the fact, after your name had faded in my memory, you reminded me that what is important to my patients isn’t lifesaving care, but something we have known in health care since Hippocrates:
“Cure sometimes, treat often, comfort always.”
Making a difference isn’t so hard, if you look at it that way, nor are the opportunities so infrequent.