Candle Power

   My first boss south of the Mason-Dixon Line was a paramedic named Debbie. On a July morning in 2007, I discovered what a gifted caregiver she is.

   We were less than an hour into an orientation spin around my new employer's entertainment complex. It was the kind of clear, dry Tennessee dawn that makes a recovering New Yorker realize he's not getting his minimum daily requirement of hydrocarbons. I was driving the TrailBlazer, trying not to miss any turns while gawking at horses recycling the local greenery. After 54 years of asphalt, I was ready for this.

   Our leisurely patrol of the perimeter was interrupted by a call for a male, unknown, on a turnpike bordering our property. Less than a minute later, we found our 50-ish patient sitting on a sidewalk bench. He was wearing soiled, casual clothes and carried only a trench coat--an odd accessory on this warm, sunny day. Debbie, who beat me to the patient's side, learned that "John" had walked away from a downtown halfway house with all his possessions the night before. He was tired, hungry and having second thoughts about seeking sympathy in the suburbs.

   I was certain I knew what would happen next because I'd seen it many times: "eviction" of the needy from one block to another. Those cases, usually accompanied by No patient found dispositions, should have been coded No compassion found. Debbie didn't settle for that. Not only did she arrange transportation for John back to his room; she bought him breakfast while waiting for the taxi. There were no protocols to cover any of this. It was as good an example as I've ever seen of service shining through the haze of policy.

   It isn't always possible for us to be so charitable with time (and, in Debbie's case, money). The realities of emergent care and short transports often interdict our efforts to do more listening and less auscultating. Even if we extend ourselves beyond personal preferences and pedantic protocols, our patients' prognoses don't necessarily change. John, for example, was going to be just as dependent on municipal healthcare after his cab ride as he was before. Are we compromising productivity by allocating time and technicians to social services? What about all the other Johns out there? How would we fit their needs into a typical workday?

   Perhaps I'm overthinking this. From the time we encountered John until we waved good-bye to him, there were no other alarms. If, instead of offering him assistance, Debbie had simply instructed John to "Move along," I suppose we would have continued my tour of the grounds--not exactly a mission-critical assignment--and forfeited our chance to improve the quality of one life for one day. We didn't have to "cure" John to make a difference.

   Being opportunistic about helping others, despite our dissatisfaction with the status quo, must be what Confucius had in mind when he said, "It is better to light one candle than to curse the darkness." Consider how that philosophy might lead to small but worthwhile adjuncts to prehospital procedures:

• En-route conversations with passengers instead of partners. Patients and their families can't help but feel unwelcome during lengthy cab-cabin accounts of yesterday's cool calls.
• More aggressive pain management, even if it helps only for a little while. I understand the concern about administering potentially dangerous meds, but can we stop the excuses about drug seekers and paperwork?
• Extra blankets and pillows to truly achieve the oft-quoted "position of comfort." At shift change, I've often inherited ambulances without a single pillow or blanket. We compromise patients' comfort by operating that way, and we lose a couple of pretty good tools for stabilizing or splinting extremities.
• "In-flight" entertainment selection delegated by drivers to patients. A choice of music is one way to return a little control to customers during transport.
• Shared destination decisions when logistics permit. Passengers' preferences don't necessarily compromise protocols or policy.
• Hands held--not just palpated, pricked or cannulated. A little empathy probably helps stable patients more than that third set of vitals.

   Such courtesies often compete not with lifesaving resources, but rather with apathy and inconvenience. It can be discouraging to repeatedly encounter chronic illnesses with intractable causes. But patients like John also present fresh opportunities to make tiny improvements in the human condition. I have to remind myself of that at least once a week.

   None of us wakes up every day wanting to do this job. Fatigue, injuries and even boredom threaten to divert our focus from comprehensive care to personal problems. Instinct and experience might guide us through messy trauma, rapid triage and other challenging scenarios, but private agendas have a way of competing with patients for our attention during low-acuity cases--a target-rich environment in my world. If I put aside my clipboard and concentrate on the little things that matter, I might just find a few less-emergent but much-appreciated medical services I can offer my patients.

   The holidays are near--what better time to light a candle?

   Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.