One of the great paradoxes of human thought is the idea, “Be careful what you wish for; it might come true.”
We tend to associate the warning with great wealth or fame, but I think is has application in the EMS realm as well.
We often begin our careers with a flurry of training and activity. We attend classes and complete homework assignments. We study for tests.
We go on ride-alongs and fill out job applications. We interview and join organizations. Often there is a field internship and a probationary period.
As quickly as it all started, one day we look in the mirror and we’ve arrived. We iron our new uniform, place our new stethoscope in our cargo pants (It was a gift from mom after all) and arrive at the station ready to work. At this moment, it’s only natural to want to test our mettle.
I get it.
At the outset of our careers, we typically refer to them as “good calls,” the calls where our skills and training are brought to bear. We want to know what it’s like to be in the middle of the chaos. We want to feel the thrill of life and death hanging in the balance.
The calls I used to wish for
Stay around in this industry long enough and chaos and tragedy will find its way to your doorstep.
I don’t say this to admonish you. I was no different when I began my career.
I used to wish for challenging cardiac arrest presentations until the day a family called for their two-month-old infant who had stopped breathing in his crib. I don’t wish for challenging cardiac arrest scenarios anymore.
I used to wish for metal crushing car accidents and complex extrications until a group of four teenage girls pulled out in front of a van on a two-lane highway. The impact ripped the vehicle in half.
I don’t wish for car accidents anymore.
I used to wish that I could be a part of a large MCI that would make the national news and be remembered for years to come. Then two students at Columbine High School showed up one morning with guns and bombs. I was sipping my morning coffee at a street corner post a few miles away.
I don’t wish for MCIs anymore.
I used to wish for a prehospital delivery. I wanted to say that I had delivered a baby on my own.
Then a mother of five deep into her labor called 911 in a rural area 90 minutes from the closest hospital. Her meconium stained child was flaccid and struggled to breathe unassisted.
I don’t wish for prehospital deliveries anymore.
The price of experience
It’s worth remembering that when we wish for “good calls” and the opportunity to test ourselves, we are also wishing for fear and tragedy and pain and misery and grief and sorrow.
Often, in our wishes, we picture ourselves rendering care, but we fail to envision the screams of pain, the tears of family members and the horrible consequences of lives forever ruined.
I don’t want to discount the value of experience. I’m glad that I’ve responded to challenging calls and that I know what it’s like to rise to the occasion. There is a certain sense of satisfaction when the best within us rises to the occasion, even when the occasion happens to be the worst of human experience.
But there is a price.
Some things once seen cannot be unseen. Some moments once lived cannot be unlived. And there are few truly experienced providers who don’t carry a list of moments that they would gladly unlive if such a thing were possible.
Instead or wishing for “good calls,” I’ve started wishing for preparedness. Each time I feel that I’d like to be challenged, I express the feeling as a desire to be ready for the worst that life can throw at me. I know with certainty that time will always bring another challenging call.
I’m in no hurry to face the next one. But I do want to be ready when it comes.
The power of preparation
Human tragedy is certain, but being prepared for it is optional. That part is entirely within our control.
If you feel like you might want to experience a difficult cardiac arrest, recheck your monitor or AED. Review your CPR, PALS and ACLS guidelines and know that time will bring you more than you desire.
If you feel like you want to be called to a “good” car wreck, practice the best routes to your local trauma centers and look through your trauma gear.
Consider techniques for rapid patient extraction, rapid trauma assessment and critical airway management. And know that a significant vehicle accident will inevitably find you in good time.
If you wonder what it’s like to be a part of a major MCI, read up on some of the large-scale events that have happened in your region in the past. Consider what went well and what went poorly.
Think about how you would respond to a similar event. Participate in regional MCI trainings. If you retire never having used any of those skills, count yourself among the lucky.
If you’d like to be the caregiver who holds a new life as it enters this world, pull out your OB kit and refresh your memory on everything that is inside. Remember your protocols for obstetrical emergencies and understand when and how you should intervene.
Review the APGAR score and post-delivery care of a newborn. And know that the opportunity will probably find you eventually.
We can never know when our worst call will occur. We can’t decide when we will respond to the next child in distress or extrication needed. We have no control over the order or severity in which calls are distributed to us.
But we can control our own preparations.
If you remain in this industry for long enough, life will bring you more than enough tragedy. That is simply the nature of human existence.
Be patient, be willing and be prepared.
