The Argument

It’s 1130, so you were supposed to be off duty four hours ago. But one of the oncoming crew members did what she always does: showed up at 0729, while you were 10 minutes into a late call. Your patient chose a destination halfway to Kansas, right in the middle of rush hour. He probably could have driven there, too. But no-o-o-o, he had insurance. So, he wanted an ambulance. Yours.

Now you’re late for the end of an argument with your significant other. The issues aren’t new; they include your schedule, your finances and (by some coincidence) a recent decline in your normally sunny disposition. You might have wrapped that up yesterday. Instead, you had to interrupt it so you could get to work on time. That went over like a fart in a Honda, on top of which you were late anyway. The offgoing crew let you have it for that, because they’d been up all night. After they got through with you, your supervisor hopped on your back. And now, as you’re headed for the driveway, your pager says your relief for tomorrow just called out sick. The scheduler’s asking you to work tonight.

That would be overtime, but it’s risky; you’re supposed to take an ACLS refresher in the morning, and you need that cert. Not to mention that you haven’t yet told your spouse about the ACLS class in the first place. And now you’re going to have to discuss some very important issues without the benefit of sleep.

I don’t know what to do. Sometimes it’s like I’m immersed up to my chin in a giant cesspool full of speedboats. I feel tired all the time, and sometimes I’m finding it hard to care about other people’s problems. I used to be a really good medic. Now I’m not so sure. Am I burning out?

Burnout’s kind of like what happens when you’re driving down a road and ignore a turn. Remember what it was like to be fresh out of EMT class or medic school? You had expectations, right? Of course, and some of them didn’t exactly match the realities you encountered along the way. We all have to learn how to steer, to manage our balance in a hundred ways. Sounds like that’s what you need right now: balance, and maybe some rest. In the meantime, try not to beat yourself up. (And never discuss anything important without the benefit of sleep.)

That sounds good, but where do I start? It seems like I’m getting stretched in so many ways.

Set some priorities for yourself. Relationships come first, of course, and family outranks everybody. That’s not a popular notion in medicine, where we dedicate ourselves to strangers. But it’s absolutely essential to first address the needs of the people to whom you’ve made your lifelong commitments. That argument--you need to finish that, and by finish I don’t mean win. I mean achieve some understanding. (That necessitates listening and talking.) I don’t think we can do EMS without the support of someone at home who loves and supports us.

I understand the importance of family. But something’s gotta give here, and I need to earn a living somehow. This is what I do. I shouldn’t have to apologize for working; I should apologize for not working. As part of EMS, I have to work long hours, I have to maintain some certs, and I have to make sure my service area is covered.

Each of us has our own way of achieving and maintaining balance in our lives. You know how important balance is in chemistry, in physics, in physiology, in the environment and in walking to the bathroom. Well, it’s important in our minds and hearts too. You do own a share of the responsibility for your EMS system, but nobody owns it all. Keep a good grip on your ego, protect your humility, insist on your ethics, nourish your sense of humor, care about others, and treasure your relationships like diamonds. If everybody did that stuff (and got some sleep), their EMS systems would run just fine.

Sometimes that means saying no, like when a supervisor calls and asks you to work an extra shift after you’ve made a prior commitment. And sometimes, when you’ve made life hard on a colleague by barely getting to work on time, it means apologizing. Perhaps even in front of others.

Donuts wouldn’t hurt.