Partners

      I'm not a big fan of prime-time EMS dramas. When they stray from "gritty realism" toward vacuous story lines favoring voodoo medicine, they make me say bad things to my TV. None of my home appliances deserve such treatment.

   There is one element of EMS that I think shows such as Saved and Third Watch have portrayed accurately: our mutually dependent, sometimes volatile relationships with partners. Does any aspect of our profession have a bigger impact on job satisfaction? I don't think so.

   Partners can make a busy day exhilarating or a slow shift interminable. Their mere presence fosters serenity or provokes IBS. They can be conscientious, contentious, sociable, unapproachable, pragmatic or enigmatic. The only constant about partners is that they're ours until shift change or hand-to-hand combat--whichever occurs first.

   I feel fortunate to have worked beside many considerate, supportive, perceptive peers. I've also encountered a few wackos who were one psych evaluation away from the medic wing at the cracker factory. I'm thinking of the guy who barked like a schnauzer at pedestrians as we responded to alarms, and the one who used two hand puppets as squeaky-voiced surrogates to admonish noncompliant patients:

   Left Hand: Mike didn't take his blood pressure medicine today.

   Right Hand: Really? Why not?

   Left Hand: Because Mike's a bad boy!

   Partnerships begin with an awkward phase that lasts anywhere from 10 minutes to, well, until you get your next new partner. During that interval we're seeking compatibility and compromise; specifically, is my partner willing and able to meet my needs? That sounds selfish, but when coworkers assume roles that highlight each other's strengths and compensate for weaknesses, everyone wins.

   I had a rocky start with IVs. After missing three during one shift as a new medic, I decided I was a threat to public safety and should limit my community-oriented activities to lemonade stands. Fortunately, my next call allowed me to showcase my intubation skills while my more experienced partner started a difficult line. One successful invasive procedure boosted my confidence in all of my competencies, and encouraged me to swap roles on our next two jobs (both cardiac arrests). My partner cooperated, just as I had when he preferred to drive.

   I've heard people liken partners to spouses. I disagree. EMS objectives are mostly short-term--stabilization of illness and injury en route to definitive care--rather than lifelong quests for fulfillment shared with significant others. Also, there's an element of risk in the essential services that most of us don't endure at home. Stress associated with that risk can lead to intense loyalty and an us-against-the-world mentality among partners that many couples never know.

   Some EMS agencies require partners to rotate. Why interfere with partnerships that are working? That's like replacing Mick Jagger with Donny Osmond on the Stones' next tour. If there are concerns about business being compromised by personal relationships, I can only say I've witnessed more pros than cons when colleagues form close friendships.

   I prefer partners who bring a "we" mentality to work. Each of us is entitled to:

   Vigilance: Once when I was working a code as a new medic, I grabbed Lasix instead of lidocaine. I don't know why--maybe because both start with the same letter. Perhaps I would have discovered my error before pushing the Lasix. We'll never know because my partner stopped me before I implemented a novel cardiac arrest algorithm. (Somebody please wake me at the Home for Feeble Medics if the 2020 version of ACLS adds "Early Lasix" to the Chain of Survival.) Division of labor during difficult calls doesn't allow us to double-check everything, but it's good to have another set of eyes. Ears, too--like when a belligerent, intoxicated patient boasts he's a mercenary and an ex-con (my benevolent intervention of the week).

   Conscientiousness: Many of us supplement subsistence-level EMS wages with other income-producing activities, but we can only concentrate on one job at a time. I don't want my partner preoccupied with stock portfolios or sales calls when we should be in medic mode.

   Consideration: If I'm paying the price for fusing Thai and Korean cuisine the night before, can we go easy on the jalapeños today? I promise to do the same for you. Also, music of any genre played loudly enough to induce tinnitus isn't entertaining--it's diabolical.

   I think we seek different qualities in partners as we gain experience and self-sufficiency. Early in my career I hung with the crazies because comic relief calmed my nerves. Later, as call volume became my antidote to awkwardness, I sought partners who practiced at a higher level, systematically vectoring patient interviews toward working diagnoses that were almost always correct, or at least close. Even as my career winds down, I remain determined to learn from anyone who screws up less than I do.

   Polished practitioners leave lasting impressions. The best partner I ever had, an EMT from the mean streets of Brooklyn, taught me that EMS shouldn't be a choice between BLS and ALS, but rather a continuum of care. We worked so well together, I doubt patients suspected our levels of certification differed. Even today, that partner and I are two halves of the same whole.

   Maybe that's why I married her.

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