Stuff I Wish They`d Taught Me in Class Part 7: It`s All About The Little Things

As paramedics we sometimes forget about the phrase, "BLS before ALS." With the rapidly morphing medical field, medics find themselves doing more and more ALS interventions rather than BLS. All too often, patients are looked at in reference to their chief complaints or vital signs versus the actual human beings they are.

"Wow! You shoulda seen the STEMI I had yesterday!" Or, "I had a bad hypotensive yesterday. I've never seen a BP lower than 60 before!"

We tend to de-humanize patients to help fend off rampant emotions we get when we see fellow human beings, young and old, in the throes of immense suffering. This is easier and more often done by very well-seasoned EMTs and medics who have more to focus on such as getting a line started; checking an ECG, medication dosages, medical consults; and so on. But as medics we tend to sometimes forget our roots. As an EMT, who is third person on an ambulance, after vitals are assessed, sometimes there isn't anything to do other than sit and look pretty. That's when we get to see how something as simple as patient interaction goes such a long way. It's the little things we do, like blowing up a glove and turning it into a balloon animal for a kid that makes the experience 20 times better for all involved.

As an EMT, I volunteered at a local service and rode third person. Through class, and even through the first few months of volunteering, I didn't know how to truly interact with patients. I was good for about three questions: "So … have any kids or grand kids?" "What do/did you do for a living?" "Is this your first ride in an ambulance?"

After that I was good for smiling sheepishly and staring at the darkened stains on the bench seat. I'd offer an awkward smile every few moments and pat the patient on the arm with a latex-shrouded hand. I had no idea how to truly interact with the person! At the same time, I didn't think I had to. In those days, I didn't understand that a kind word and a squeeze of a hand could sometimes be more beneficial than any medication in a drug box or any procedure could ever do.

My very first cardiac arrest taught me how important it was. I happened to be fourth person on the box that day and I was the low man on the totem pole. I got stuck at the head in the airway seat. I was bagging the patient while the medic was trying to get everything set up. The patient went from alert and oriented to unresponsive and not breathing faster than we could say in unison, "Oh, crap!"

As I bagged, I noticed the patient's cheeks going from a nasty grey to a bright pink. His eyes fluttered open and he sucked in a huge breath of air.

"Hi!" It was the first thing I could think of saying. The patient's family member was riding shotgun and kept asking, "Is he talking?! Is he talking?!"

I looked down at the patient and he looked up at me with big blue eyes. Tears stared running down his cheeks and I reached over, wiping the tears from his face with my ungloved hand. It all happened so fast I didn't even get a chance to put on my gloves.

I leaned in close so I could be heard above the noise and I looked into his eyes, my voice confident.

"You're going to be just fine. Just hang in there with me."

I reached over, holding his hand in mine as I kept my eyes on his. I mentally searched for something to talk about. I was more shocked the patient was alive than anything else. He gave me something to talk about.

"Am I gonna die?" he asked.

"No! We're gonna get you to the hospital where they're gonna fix you right up," I answered. "You'll be playing with your grandkids in no time!"

From that point, conversation flowed freely. He talked about his grandchildren, how much he loved them and if something happened to him, how much he'd miss them. When we dropped him off at the emergency room, the family and ER staff gushed over the care he received from us, how quickly and safely our driver got us to the ED, how quickly the medic was to start CPR and get a shock going within seconds, how the one EMT was right on with his compression rates and so forth.

I stood off to the side. All I did was just talk to the patient. I had bagged for maybe a minute, tops, but after that, I just sat on my duff and talked. I couldn't understand why people were treating me like I had done something spectacular.

On the ride back to the barn, I asked the medic, "Why did they act like I did something big? I was just a very little fish in a gigantic pond that was this call."

The medic smiled, patted me on the shoulder and said, "Kid, some days it's all about the little things. You helped that patient more than I ever could. Just because you didn't do a line, shock him, or do any major medical procedure doesn't mean you didn't help. You gave him the support he needed to help him feel as if he was truly going to make it. Half the battle in these bad calls is to make the patient believe they're going to live. If the patient thinks they're going to die, well...sometimes it turns into a self-fulfilling prophesy."

That day, I learned one of the big secrets to the job: it's the little things. I can start any IV I want, push any med, or make the greatest consult ever heard, but in the long run it's about just being there for your patient, remembering there's a human being on that stretcher, not just a set of numbers and a medical problem that needs fixing. Sometimes, all the help we need to deliver is a hug and to wipe away the tears.

Truly...some days, it's all about the little things.

Shao Trommashere completed paramedic class in 2007 after working as an EMT since 2002 in the Northeast corner of the United States. She also has a blog called Looking Through A Pair of Pink Handled Trauma Shears.