Precursor to Kindness

   You're sitting on a bus bench examining the ugliest man you've ever seen in your life.

   He's hunch-backed, and his shoulders are round and poorly defined. His head is disproportionately huge, and his nose is badger-like. The latter is so long you imagine it could incorporate an articulating joint, the better to sniff around corners. It's asymmetrical, and its end is pointed. You can't decide which is worse, the odor of his breath or that of the rest of his body. His teeth are oversized, the color of brown mustard, and irregular. They're dwarfed by swollen red gums that look like they could start bleeding any time.

   He's unshaven, and his hair is long, matted and tangled, like sloppy strands of yarn. The surface of his face is rough and deeply pocked, suggesting years of poor hygiene and many past infections of the kind that generally result from such care. Just for grins, he has a disconjugate gaze--the product of a lazy right eye that stares past your left shoulder when you make contact with the other one. But he's docile. Timid. And just for a moment, he seems familiar. You get a feeling you've seen that face somewhere else.

Q. Some people really are so ugly, it's hard to look at them. I don't want to be arrogant or mean; it's not like they've done anything wrong, and sometimes they're actually very nice. So why do I have such a hard time making eye contact with some of them, or touching them--focusing instead on getting them to the hospital and finishing my calls?

   A. There's a reason why we call this work, eh?

   It may sound funny, I know, but try thinking of patients as Muppets. Guess what was the most popular TV show in history. Not M*A*S*H, not Baywatch and not I Love Lucy. It was Sesame Street with the Muppets! Think about it. Jim Henson, with that big brain of his, realized what it's so easy for us to forget: that beauty most often comes in the plainest brown wrappers.

Q. Muppets? MUPPETS? I'm really serious about this. We're not just playing a game, here. This is medicine. What a condescending thing to say.

   A. No, please, I'm not kidding. There's nothing condescending about any system that helps you to accept people the way they are--asymmetrical, pudgy, cantankerous, rich or poor, elegant or unsophisticated, odoriferous, leaky, cranky, quiet or just plain not like you. The ability to embrace differences in people is essential to medicine, always and everywhere, and I think it's an inevitable precursor to kindness. I believe one big reason for the Muppets' enduring popularity is that show was all about accepting others as they are. Many of the characters were less than perfect, symmetrical or even "normal," and that's what welcomed them into people's living rooms. (Come on. A pig doing stand-up with a frog? And who wouldn't love Fozzie Bear?) I'm just saying it worked for me. In fact, I think it helps me to absolutely love my crews. (Sorry, guys!)

Q. Well, I don't know. Doesn't this just seem a little out there?

   A. Trust me, when you're taking care of somebody you'd rather not deal with, this is a valuable strategy that works again and again, to the point of actually helping you like people you might otherwise not be able to tolerate.

Q. Maybe. It just seemed a little goofy when you first mentioned it.

   A. I think I understand how you feel, and how it must seem like I'm making light of what you do every day, or of other people's tragedies. I'm not, I promise. But even humor's a good tool in this important business of ours. When you consider your practice as your life's work, maybe a little humor isn't a bad thing. When EMS is easy, it's real easy. When it's hard, it's real hard. Somehow, we need to keep our balance--not just in our work, but in the rest of our lives. Have you ever had to work with a partner whose life was completely devoid of humor? People like that can make a 24-hour shift last about a week.

   The world is full of people who have no source of joy in their lives, and sooner or later, they all call 9-1-1. You wouldn't want to laugh at 'em.

   But privately, at least, you have to be able to smile.

   Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.