Half Full of Hope

On the first day of paramedic school, our instructor asked us why we were there. My classmates implicitly categorized themselves as inquisitive (“I want to learn more”), ambitious (“I want to do more”) or practical (“I want to make more”).

I wanted to be more—a medic whose bold and decisive interventions would yield dramatic outcomes through mechanisms I didn’t fully understand, like comatose diabetics waking up during IV boluses from blue boxes, or frantic asthmatics breathing easier after each puff of nebulized meta-something. I’d seen such results many times during my first two years on the streets. Yes, I was overlooking the value of sound BLS, but I coveted mastery of on-scene sorcery that seemed to raise the dead, or at least make them a little less so.

Jim Garside can relate. One year ago the Suffolk County police officer and critical care EMT (an advanced level of certification unique to New York) was leaving a Long Island restaurant after an all-day ACLS refresher with fellow officers and EMS providers Angela Ferrara and Joe D’Alessandro when he heard the sound of an engine revving at the edge of the darkened parking lot. The off-duty trio walked toward a 2004 Mazda with blue-white smoke billowing from its tailpipe. “It didn’t make sense the car would just be sitting there at full throttle,” remembers Garside.

The driver—we’ll call him Dante—was slumped behind the steering wheel with his right foot planted on the accelerator. The needle in Dante’s arm left no doubt as to the cause of his predicament.

“He wasn’t breathing,” says Garside, who, with Ferrara and D’Alessandro, detected a pulse, repositioned the airway and began ventilating the 23-year-old heroin user. Dante abruptly regained consciousness and asked if transport to a hospital was necessary. Yes, the officers explained, necessary and preferable to the eventual destination, which would be jail. “I don’t think he realized how lucky he was to still be alive,” Garside says of Dante, who was discharged the same day.

Garside feels any outcome where the patient walks away is positive and might even make a difference long-term. “He gets another chance—maybe to go to rehab, maybe to just take better care of himself,” figures the veteran of 19 years in law enforcement and 27 in EMS.

I’m not so optimistic when I encounter those like Dante, with self-inflicted conditions. Sometimes I feel the strain on my goodwill. I’m tempted to lecture the Dantes of the world about the harm they do to their bodies (and ours), but unsolicited advice about risky lifestyles is often inappropriate and usually futile. I remind myself I have two choices: embrace a duty to help others—including those who can’t or won’t help themselves—or find another line of work. Imposing my exasperation on customers and colleagues shouldn’t be an option.

“You have to accept a level of frustration about people who make bad healthcare choices,” advises Garside. “It’s not just drug overdoses; uncontrolled diabetes, morbid obesity, seizure patients who don’t take their meds—you just have to do what you can for them and not dwell on why they’re that way.”

I think most of us want to do that—to be more than mere observers of the human condition. Anyone can settle for a strictly reactive role; no training, no experience, no commitment is required.

When decades of caregiving leave us feeling indifferent, discouraged, cynical or even hopeless, the best among us will remember whatever reasons we had for joining EMS. Then redemption is never more than one call away.

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In October Garside responded to a North Shore storefront where other officers and EMS providers were already packaging a 24-year-old “on the nod”—in and out of consciousness. It was Dante—a year older but apparently no wiser. Same drug, same outcome. Garside, who had to remind Dante to breathe on the way to the hospital, thinks “regulars” sometimes have to fail a few times before they succeed.

“There’s a magnet on my refrigerator,” he says, “with pictures of faces showing different moods: happy, sad, frustrated, disgusted. There are at least 20 of them. You can slide a frame over the face that stands for the mood you’re in.

“When I got that magnet 10 years ago, I put the frame over hopeful. I haven’t moved it since.”

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