Why Some Make It in EMS and Some Don’t
Is your work a lifelong source of joy, or is it destroying your life?
It’s almost midnight on a Sunday in 2001. A late-model sedan glides through a neighborhood called Dictionary Hill in a sleeping California town. Emergency service workers know this as a violent place. Their activity attracts crowds here, and crowds always increase the complexity and danger of EMS work. So especially at night, crews routinely switch off their warning equipment before they arrive here.
The sedan comes to a stop in the intersection of Jacoby Road and Sangamon Avenue. Its curbside door opens abruptly, and 18-year-old Lashana Latrice Newman is propelled into the street. She clambers to her feet and shouts angrily at someone in the car. Then she pleads, and a single gunshot interrupts her. She lurches backward, drops and settles like a pile of rags. The vehicle vanishes, its tires complaining in the distance.
Two hours later the town breathes softly. Its taverns and bars discharge their lingering occupants, and a scant gilt glimmer of a moon descends in a black sky that envelops them all in shadow. One of the patrons lives at the corner of Jacoby and Sangamon. He parks at the unlit curb in front of a home and notices something in the intersection. He recoils when he discovers the girl’s remains, fumbles for his cell phone before dialing three digits. In the next hour residents will tell medics and deputies they’d heard screaming and a popping noise. As locals, they’re familiar with both of those sounds. A few will say they’d thought about calling but opted not to get involved.
Despite her young age, Lashana’s been a full-time hooker for five years. Paramedic Shelley Mankowitz recognizes her, not only from this neighborhood but also from other calls she’s answered in neighboring towns. Shelley’s hands search deftly for the discarded girl’s life and find instead the still, sad signs she’s seen so many times.
Lashana’s body exhibits the peculiar absence of color you see in dark-skinned people after their blood drains away; the mucous membranes in her mouth and around her eyes are pearl-colored and pasty. There’s a single, round wound in her precordial chest. Her pupils, freed from the duties once assigned to them, are now midsize, fixed, vacant and unseeing. Her corneas are dry. A deathly stiffness has gripped her joints, and Shelley rolls the small, boardlike body onto its side so she can examine its back. A few ounces of blood saturate the ornate embroidery on the front side of its V-necked blouse and the brassiere it barely conceals. A cardiogram confirms what the seasoned caregiver has known since the moment she arrived: Lashana is dead. Shelley calls for a pronouncement, and her manner is casual.
“Medic 256 has a death on scene,” she says. “An 18-year-old female, single GSW...”
Returning to quarters, the medic reflects on her own daughter, asleep at home. Melanie is about Lashana’s age, and for a moment Shelley wants to hold her. They won’t see one another in the morning, because Melanie will be at school by the time Shelley gets home. That’s too bad, because their last verbal contact was contentious and mutually disrespectful. In the midst of it, neither of them would have wanted an embrace.
The crew handles four more responses prior to their morning shift change. Driving home, Shelley thinks about the hooker. She pulls over to call her daughter and dials the number, but there’s no answer. She leaves a message, asking if they can meet for lunch.
“I love you, honey,” she says, and she means it. At home she showers, pulls the curtains, slides under the covers and tosses for an hour before drifting into a fitful sleep. She dreams, first about Lashana and then about Melanie. She sleeps for two hours before the phone rings.
It’s Melanie. They fight. Shelley hangs up and cries for half an hour. The phone rings again, and this time it’s the on-duty supervisor. A deputy has some questions about a homicide, and Shelley needs to report to headquarters for a meeting at 1. The supervisor hints that her documentation isn’t perfect, and Shelley fights with him too.
Ancient Dynamics
Any EMT of two years would instantly recognize the ancient dynamics and unchanging realities of this call, including:
- The complete lack of value attached by a great many people to a great many others;
- The power of some people to vend the childhood, dignity and sanctity of others for profit;
- The relentless conflict between the urgencies of strangers and the constant needs of one’s own family members; and
- The unceasing, unalterable necessity to subordinate one’s physical needs for rest, nutrition and personal comfort to the requirements of the work.
Some of us seem to cope with those frustrations, shift after shift and year after year, and still lead balanced and happy lives. Others aren’t so lucky, succumbing to depression, divorce, substance abuse, caregiver fatigue leading to burnout, and a chronic general sense of depletion. Why is that?
It’s possible, as 38-year California medic Les Federoff believes, that some of us are attracted to EMS with expectations we can never realize here. Others, despite the most realistic expectations, suffer from runs of bad luck, involving awful calls, busy shifts, sleeplessness, difficult partners, poor leaders, insufferable interagency politics, interpersonal challenges at home, the death of a loved one (including a pet) and the risk of a career-ending illness or injury. A few more undergo life changes that alter their personal priorities—for instance, a desire to go to medical school or having a couple of kids.
That’s a long list, and two popular Facebook pages contain abundant testimony from hundreds of EMS providers who generally validate it.1,2
There’s a distinct difference in emergency medicine between critical stress and chronic stress. Critical stress is the kind that arises during and following the kinds of calls that would overwhelm any of us, like 9/11, the 2015 Paris massacre and the Aurora theater shootings in 2012. Fortunately those don’t occur often during the career of a nonmilitary caregiver.
Chronic stress is the day-to-day variety Shelley Mankowitz confronts in the preceding story. Numerous recent articles, both online and in print, describe and discuss the nature of chronic stress.3–7 A related article in this month’s issue of EMS World offers as many useful, practical coping tools and strategies for busy medics as possible.
It’s is intended to be the best advice I can think of or that has been shared with me by smart medics with whom I have had the privilege of working. It’s free, so you know what it’s worth and how easily you could ignore it. Its scope is limited to encompass nonmilitary EMS.
Find related content from Thom at www.emsworld.com/12246923 and www.emsworld.com/12246929.
Footnotes
1. 911 Peer Support Group, https://www.facebook.com/groups/828274287220637/.
2. Code Green Campaign, https://www.facebook.com/thecodegreencampaign/?fref=ts.
3. Everline T. Banged Up & Burned Out. Drexel University Research Magazine (Exel), www.exelmagazine.org/article/banged-up-burned-out/.
4. Meyer T. Paramedics Say Cleveland EMS Crippled. WKYC, https://www.wkyc.com/news/investigations/investigator-i-paramedics-say-cleveland-ems-crippled_20160330094537246/109787619.
5. Newland C, et al. Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide. J Emerg Med Serv, 2015 Oct.
6. Leap E. Suffering and Burnout in the ER. Huffington Post, https://www.huffingtonpost.com/edwin-leap-md/suffering-and-burnout-in-_b_8448704.html.
7. Krischke MM. Suffering from Compassion Fatigue, Burnout or Both? What A Nurse Can Do. Nursing News, https://www.nursezone.com/Nursing-News-Events/more-news/Suffering-from-Compassion-Fatigue-Burnout-or-Both-What-a-Nurse-Can-Do_41375.aspx.
Thom Dick has been a passionate advocate of sick people and the safety of their field caregivers since 1970. He has written hundreds of articles and three books on those subjects, including the People Care books. You can reach Thom via Facebook or at boxcar414@comcast.net. Thom is also a member of the EMS World editorial advisory board.
