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My love-hate relationship with EMS

A full life weighs more than an empty one, but who I have become because of my EMS experience has made me a better friend and caregiver

A recent encounter with a salty EMR-firefighter who had learned all the wrong lessons from EMS, made me wonder why is it that some of us can find rejuvenation after burnout, and others can’t? Is it simply a matter of perspective and all it takes to improve your outlook is someone pointing out to you all the good things you’ve ignored?

Or is it that so many of us come into EMS already broken in some way, hoping that by healing others we can heal ourselves?

For some, that seems to work. For many others, though, it seems to build a callous over the broken edges, so that they may never knit together again.

A full life includes advocating for other caregivers through The Code Green Campaign (Image courtesy The Code Green Campaign)
A full life includes advocating for other caregivers through The Code Green Campaign (Image courtesy The Code Green Campaign)

For my part, I pray that it’s simply a matter of perspective. Otherwise, the years I’ve spent advocating for EMS seem pretty pointless.

I suppose that it’s simply a personal decision about what matters more to you — the things you hate about EMS, or the things you love about EMS. As another EMS Week — my 23rd — fades in my rearview mirror, I find that what I hate and what I love about EMS are inextricably linked, and my perspective about which one is more important is changing.

I hate that people call an ambulance for trivial reasons, but I love that I am expected to go.   
Anyone who has worked in EMS for more than five minutes has encountered a patient that called an ambulance for something that wasn’t strictly defined as an emergency. Whether it is ignorance or blatant abuse, it happens far more often than it should.

Much of it stems from two generations of citizens being constantly told — often by EMS itself — that the slightest twinge or sniffle might herald something serious and to call 911. And while blatant abuse and gaming the system for free medical care, a meal or a ride across town is still somewhat rare, most of us have encountered those patients.

Dealing with them gnaws at my job satisfaction like a rat gnaws at your electrical wiring, building a cozy little nest with the remnants of my idealism, a nest that threatens to one day burst into flame and destroy everything I hold dear.

But I also love the honor in the implicit compact between the people who call 911 and the people who respond; you call, we come. There is a beauty in the simplicity of it.

You call. We come.

Young, old, wealthy, poor, trivial or life-threatening, wealthy philanthropist or felonious meth dealer, in America it’s a pretty safe bet that when you call an ambulance, an ambulance will come.

The system isn’t perfect. It’s riddled with cracks and flaws, and often takes longer than it should. But the people within it make an earnest attempt to respond to your call for help, each and every time.

We don’t look at your neighborhood on a map and decide if your socioeconomic status or ethnicity is worthy of our care. When the car crash victim turns out to be the drunk driver who killed a family of three, we render the same care had the roles been reversed.

And many of us pay a tremendous emotional price for it. There’s an emotional burden in always being the good guys.

While many of us may try to ease that burden with bitching and complaining to our peers, or engaging in black humor that horrifies the occasional outsider who happens to overhear, when the tones drop, we put all that away and we respond.

You call. We come.

I take great pride in that. I condemn systems abuse as much as the next guy, but I honestly wonder if screening calls for appropriate utilization of 911 doesn’t chip away at the honor of my part in the compact.

You call, we come.

It doesn’t even occur to me not to respond. I’m not wired that way.

I hate that EMS has changed me, yet the man I was sorely needed to change.
Death holds no fear or fascination for me anymore. Car accidents, shootings, stabbings, blood and gore — they’re just meat. Because I’m good at compartmentalizing, people who don’t know me think I can be cold and uncaring.

And I suppose I can be. I worry about that myself sometimes. On a call a few years back, a horse in the roadway caused a multi-vehicle crash. As I lifted the shattered head of the first victim I triaged and her uninjured husband begged me to help her, I thought to myself, "Dead meat. Find the next patient."

And that’s exactly what I did.

I flash back to that call sometimes, and fear grips my heart in its leaden fist, as I wonder, "How much have I had to carve off of my soul to make that decision so automatically? And will I have any left to give to my daughter, my girlfriend and my friends?"

But when I think back on it, there wasn’t much to like about the person I used to be before EMS. He was cocky and arrogant. He was superficial. He was the quintessential class clown, hiding his pain behind a mask of humor.

He had been hurt so much as a child, that he held everyone at arm’s length. He loved no one, and dared let no one come close enough to love him.

The young paramedic I was used to avoid funerals. Funerals were events where people expressed uncomfortable emotions like grief and sorrow, things I’d rather avoid.

Now, I’ve learned that pain and sorrow are nothing to fear. I have borne witness to more pain and suffering, more grief, sorrow and death than most non-EMS people can ever fathom.

Each passing year teaches me to hold my loved ones close, and to treasure every moment. I’m a better man, a better father and a better boyfriend because of what EMS has taught me.

If I seem more weary and scarred these days, it’s only because my aches have been earned. A full life weighs more than an empty one.

I hate that EMS has taken so many of my friends, but they all died doing what they loved.
I’ve lost friends to helicopter and ambulance crashes. A few died by suicide.

Others left EMS after back injuries, patient assaults or burnout. They are still alive, but EMS changed them so drastically that they’re not the same people I once knew.

I advocate tirelessly for better ambulance design, more appropriate use of helicopter EMS and more stringent safety standards and practices. I do this because I don’t want to lose any more brothers and sisters in EMS — not even the ones I’ve yet to meet.

When I think about the friends I’ve lost, not a one of them would have chosen to die of old age in a nursing home. Old age, yes, but not in a nursing home.

To go into cardiac arrest right after they got ROSC on somebody else, that’s the way they’d have wanted to go. Or maybe they'd pick a massive stroke right during a night of passion with the supermodel you met when you saved her life … yep, in the ambulance.

I hate dealing with drunks, but drunks are endlessly entertaining.
Be it angry and belligerent, weepy and maudlin or rambling and incoherent, I’ve never been able to master any of the dialects of drunkese. I have been sexually propositioned, threatened with an ass kicking, and proposed marriage by more drunks than I can count — and often all three by the same drunk.

Dealing with drunk patients taxes every bit of professionalism, customer service skills and civility I can muster. I am ashamed to say that I have sometimes failed at it.

On the other hand, I have laughed uproariously with and at some of my drunk patients. Many of the most entertaining people in the back of my ambulance were there because they imbibed "tee many martoonis."

And for a writer, drunks are a gold mine of entertaining material. A wise man once said that no entertaining story ever begins with, "So there I was, eating a salad …"

Looking back on my career, it’s the perspective earned from 23 years in EMS that has taught me that for every gripe and complaint about what my job entails, there’s a "yeah, but" in my memories. So far, all those "buts" make everything else worth it.

Here’s hoping your collection of "yeah, buts" make everything else worth it as well.  

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