Done In, Fed Up, Burned Out

It’s midnight. You’ve been running calls since 0800, and you reached your maximum fun level hours ago.

The man on your cot smells like a brewery. He’s toxic, jagged and dark. You found him leaning against a tree in a park after he crashed his 40-year-old Chevy pickup into one of those concrete barriers they use to keep dumb-ass drunks from driving into fountains.

There are no seat belts in what’s left of the truck. The steering wheel is broken, and the steel steering column is bent upward and to the left. The cops offer him an ultimatum: he goes to the hospital with you or with them, in cuffs or not. Then they disappear. (Thanks, guys.)

The man recoils from your touch. He won’t let you remove his Levi's jacket or look at his chest. He won’t tolerate a collar, he won’t lie down on a board, and he won’t let you engage your buckle straps.

When you try to explain your concern about his mechanism of injury, he suggests you have sex with yourself. His tone is menacing, and there’s no mistake: the suggestion was actually sort of a command. When he does acknowledge you at all, he glowers. His eyes are dark, and you can’t tell if his pupils are widely dilated or if his irises are the color of his mood. He’s missing half of his visible teeth, but he still manages to bite the ends of his words off and propel them at you past the clenched survivors.

You give up trying to communicate, and transport him in a semi-sitting position to University Hospital. There, he smoothly expands the scope of his spite to encompass all seven members of a trauma team. (About equally, in fact.)

Twenty minutes later, a young resident comes out to your ambulance and invites you to examine the imprint of a steering column in the middle of the man’s chest. You’ve already explained why you skipped the IVs and C-spine, but he asks you about them as well.

Q. You’re right about my MFL. After ten years, I feel like I’ve seen enough stupid, nasty drunks to last 10 careers. In fact, the next time I try to help somebody and they treat me like crap, I’m going to dish out some of my own. Know what I mean?

A. Can’t say I blame you, not a bit. But you’ve been around long enough to know there are plenty of people who won’t ever think like you do, who will never appreciate your help, and who will go on living their lives any way they choose. They’ll never care about anybody else. Let 'em destroy your life, and they win.

Q. Actually, it’s bigger than them. I’m at the end of my rope, and I feel like I have nothing left. I’m tired of the certs, I’ve had enough CE, I’m sick of the long hours and low pay, and I’ve had too many bosses who thought they knew more about my job than I do. And if one more young doc challenges my medicine, I’m sure I’ll have my partner drive me home and I’ll never come back. I know I’m fried, but I can’t afford to quit. What do I do now?

A. There’s an awful lot I don’t know. People much smarter than I am have taught me to believe the answer really is pretty simple. I think it depends on what you see when you look in the mirror. If you’ve never been happy as a medic, I would do something else—whatever that means. Plenty of wonderful people can’t do this. But if you’ve ever loved being a medic, please don’t give up.

Most of us have been brought up to see burnout as a terminal event—like a wall you hit if you stay long enough, and your career ends at that wall. I think every one of us who tells the truth will admit we’ve grappled with burnout, maybe more than once. I think burnout is a dynamic, not a terminal event. I think it’s an imbalance issue. You’ve studied physiology, right? You understand that all life depends on balance.

I could never do this topic justice in a column article, even if I were knowledgeable enough. But I know your system is not the only system in the world. Your ambulance is not the only ambulance. And you’re not the only person who’s ever grappled with burnout. Please, please don’t give up. Find someone you know and trust, who’s been around a long time. Sit down with them, and take time to discuss this with them.

Thom Dick has been involved in EMS for more than 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 the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.

Thom is the author of People Care: Perspectives & Practices for Professional Caregivers. The recently released 2nd edition of this classic text includes seven new features: Death notification skills; suicide intervention strategies; safe procedures for defusing and, when necessary, restraining violent people; cases intended to illustrate the lessons of People Care; and strategies for reconceptualizing burnout and managing it as a balance issue. Click here to order.