The Patient-Provider Experience: Remembering Compassion

Have you ever been a patient in an ambulance, before or after becoming an EMS provider? Have you witnessed a loved one become a patient? How did it alter your perception of patient care? EMS World’s newest series, “The Patient-Provider Experience,” shares the stories of both patients and providers who have been impacted by their respective experiences with EMS—on or off the cot—and how these experiences changed the way they provide care.

The Patient

You’re going about your normal routine, and then everything goes dark. You know you’re lying on the floor, but you can’t actually feel it because your fatigued muscles have left you numb. You hear your mother gently yet fervently saying your name in efforts to wake you while the EMTs soothingly speak to you in that calm and collected tone of theirs, asking, What’s your name? What year is it? Who is the president? As you lie motionless, your eyes drift to the left and meet a pair of large black boots.

You shift your gaze upward to find they belong to a police officer towering above you. There are beeps, gravelly static, and muffled voices of dispatchers emitting from his scanner radio after he reports the status of this call. You’re annoyed the EMTs are trying to make you speak, wishing they would stop telling you to keep your eyes open when you close them, too exhausted to care about anything other than sleep. They ask if you can move. You try. You shake your head no.

They transfer your limp body onto a stretcher before you feel the hard thud of each step down a flight of stairs; outside, you open your eyes enough to see the stars passing over you and suddenly feel self-conscious about neighbors watching as you’re lifted into the ambulance. The air inside is icy and smells strongly of plastic and antiseptics. One EMT sticks two small plastic objects up your nostrils, blowing cold air, making you scrunch your nose; you think they’re oxygen tubes.

“How’re you feelin’ so far, dear?” You don’t answer, but you’re touched by the kindness in the voice; how they use your name or a term of endearment each time they address you. You hear the sirens ringing above you and think they’re for someone else while you fade in and out. As the EMTs unload you from the back of the ambulance and wheel you into the ER, you try to smile and mutter a thank you, even though you probably sound like a toddler forming her first sentence. They smile in response but look at each other, glints in their eyes, and you think they are mocking you for some reason. Then again, nothing seems to have reason when you’ve just suffered a seizure.

The Provider

After a series of tonic-clonic seizures led to a diagnosis of generalized epilepsy and prescribed medication that stabilized the episodes, I didn’t think I’d ever have to ride in an ambulance again.

But years later, I would—except I wouldn’t be the one on the stretcher.

I never thought I’d be sitting in a classroom working to achieve my EMT certification, but it’s an experience I’m very grateful for. The clinical knowledge I gained about my condition and EMS providers’ management of it helped me understand my past experiences—like learning why EMTs had to ask me so many orientation questions when I was in the postictal state (or that ‘oxygen tubes’ are called nasal cannulas).

All I had known prior to my EMT education was a 17-year-old girl’s post-seizure fear and confusion produced simply by a lack of knowledge about her circumstances. While I’ve only spent time in the field participating in ride-alongs, my education and editorial work with providers in the industry have enriched my understanding of the patient-provider interaction. Knowing what I know now about the EMS professional’s perspective during the patient care process, I’m much more empathetic in hindsight about crucial parts of the patient assessment that sometimes bothered me. I feel a deeper appreciation for the respect, professionalism, and compassion they demonstrated caring for me while also tending to my distressed mother and leery dog.

On my most recent ride-along, we were dispatched to a call for possible heat exposure—unsurprising, for the oppressive heat that day had resulted in multiple calls for heat-related issues. Upon entering the patient’s residence, we met a young girl crying and speaking on the phone in Spanish. She paused her conversation and said to us, “She’s upstairs,” before sobbing into the phone again. We made our way to the top of the staircase, where we found a teenage boy kneeling calmly beside his unconscious mother on the floor. He explained how she passed out cold upon seeing a turtle he had caught and brought home as a pet. Surely, we thought, there was more to this than being frightened by a turtle.

She awoke a few minutes later in response to hearing her name and her son’s gentle shaking of her shoulders. After coming out of her stupor, she sat up abruptly against the wall, eyes darting back and forth between her children and the three uniformed strangers inside her home. Allowing her son to translate for her, she agreed to answer some history questions, attempting to control her tears and wringing her hands as she explained how she’d pleaded for him to get rid of the tortuga before screeching and falling unconscious. It was determined that the cause of the patient’s syncope was legitimate fear of the turtle.

The absurdity of this prompted the EMTs to ask more clarifying questions to ensure there were no other medical events preceding this one (“Do you have some kind of PTSD with turtles?”). They couldn’t help letting out some laughs as I stifled my own, suddenly remembering how I felt when I’d awoken to similar scenes years before—opening my eyes to fuzzy faces above me; the disorientation, embarrassment, even. As funny as it was, my empathy for her quelled the desire to laugh, afraid it would make her more uncomfortable. To be clear, I don’t think the EMTs were out of line or disrespectful—they were overall very professional and friendly with the family, and I think anyone with a sense of humor might have laughed in this scenario. I simply had a different reaction based on my own experiences as a patient.

I don’t know if my suspicion of being discreetly laughed at was orchestrated by my altered level of consciousness, but even if it wasn’t, I can empathize. Humor is vital in a profession that calls for the regular witnessing and managing of traumatic events. I get it. I don’t feel retrospective embarrassment like I once did. But having acquired this new understanding of the provider’s standpoint, coupled with my experience as the patient, I can say how valuable it is to remember that the patient doesn’t know what you know.

Patients are often uninformed, and providers must keep that in mind to ensure the best experience for their patients. That’s what the profession is about—caring for the sick and injured. Just as situational awareness is key to your safety, active awareness of the patient’s emotional state is key to their comfort. From what I’ve observed so far, the practice of this principle hasn’t fallen short. I’ve seen kindness, compassion, resilience, and a strong sense of humanity exhibited by EMS personnel and firefighters.

If you find yourself in this category, keep doing what you’re doing. It matters. If you’ve found yourself hardened by years of arduous field work that have made patients more like anonymous assignments than human beings, try taking a step back and really put yourself or even your mother or best friend in their position. Does that humanize them again, changing the way you care for them? Do you still have the passion for patient care that brought you into the field in the first place?

This is my thank you letter to the providers who have graciously cared for me and countless others, and a gentle reminder that patients notice and remember more than you might think. Everything you do in your time with them makes a difference, for better or worse. For the times patients couldn’t or didn’t tell you when they wanted to, I’ll tell you now—your kind words, smiles, and empathy go a very long way.

Valerie Amato, NREMT is assistant editor of EMS World. Reach her at vamato@emworld.com.