6.03.2008

Things I've Learned

I've learned a lot on the ambulance that has translated into my daily life. Hell, it probably goes the other way around as well. But in the parking lot of Walmart today, it sort of dawned on me that I should write about them. I don't know who to thank, but I'm grateful for everything I learn and continue to learn.

1.Take Some Time.

You have to take some time to listen. Sometimes, what you hear when you listen gives you clues about what a person is really thinking or feeling (a la "Jill Tracy" from that episode of Scrubs). Sometimes listening is all a person needs to make them feel better. I've found that with geriatric patients, "loneliness" is often their chief complaint, whether they'll admit it or not.

In my real life, I've learned to be more patient as well. Today in the parking lot I was approached by a man collecting money for his church's ministry which is helping put drug addicts in programs. It was legit, and I listened to his spiel. When he was done, I thanked him for what they were doing and said that I didn't have anything I could contribute. He was simply happy that I had taken 15 seconds out of my life to listen to him and take him seriously. It made him feel good, it made me feel good.

2.Everybody Lies.

Okay, so this one isn't as optimistic. I also learned this from House, but didn't really believe him until I got exposure as well. Regardless.
Patients do not tell you the truth. They omit things, they flat out lie, they tell half-truths, etc. I don't think I've ever had a patient be 100% up front and honest about their stuff. People lie for different reasons, and if you can find out why, it can help a lot.

People lie because they are embarrassed. Diarrhea is not something people like to admit they have. Neither is herpes. Letting them know that you're not going to think what they have to say is weird or gross helps a lot.

People lie because they don't want to be treated differently. HIV+ patients often don't admit that they are because they don't want to be thought of as a lesser person. Once again, the whole "I'm a medical professional and I need to know this information so I can take better care of you and protect myself" thing works, along with gently letting them know that their answer won't change how you think of them.
People lie because "you didn't ask." This annoys me to no end. Oh, you're 12 weeks pregnant? Thanks for telling me right as we arrive to the hospital. Glad you didn't need any meds. I've learned to ask the "right" questions. My preceptors told me to ask "story questions," ones that have to be answered with detail, not just "yes" or "no." Lies of omission are the worst, though.

And the last reason I feel like getting into on why people lie is because they are trying to be considerate. On the ambulance, this is white-lies-gone-bad. Yes, my dress looks pretty even though you think it's repulsive. Yes, my new haircut is great. But when I ask you if you're finding any relief from the nitro I just gave you, don't say you are just because you want me to feel like I'm doing you some good. When I ask if you're dizzy after falling and hitting your head, don't say you aren't just because it's 3am and you feel bad that someone called the ambulance. This is my job, this is what I do. You call, we haul. I'll never forget a pregnant patient we had who had lacerated an artery in her right arm while working in the packing plant. I applied pressure and held it over her head the entire way to the hospital. The EMT in charge of that call would ask if she felt better and she'd nod and try to take her hand from me. Finally, she says "I'm so sorry, your arms must be so tired from holding mine." Yeah, they were burning from pain, but I smiled and told her that this was my job, and she shouldn't worry about me.

3.Don't Treat the Machine, Treat the Patient.

You have got to touch your patient to know what's going on with them. For the love of God do not get every pulse from the Pulse Oximeter. Are their pulses equal? Bounding, thready, strong and equal will not show up on the Pulse Ox, just a number. So your patient is satting at 92. Is this normal for them? COPD? Elderly? Not all low readings require oxygen. Likewise, if they're satting at 100 but they're struggling to breathe, why the hell don't you put them on some oxygen?

In my daily life, this has helped too. Just because someone is smiling and saying they are fine doesn't mean that they are. Consider what they've been going through recently. Refer back to point 1 and take time to listen to what they're saying behind the smile.

4.Parents Are Crazy.

And rightfully so. Their child is hurt, sick, etc., and you have shown up to take care of them. Suddenly they look to you to be the one to take their child and become responsible for their wellbeing. But at the same time, they won't relinquish that duty. It's usually a power struggle all the way to the hospital, and sometimes the parents are the ones that need to be taken care of more than the child. Realizing this ahead of time can prepare you for the stress, and save you some of it.

On the other hand, some parents aren't crazy enough. Your child had a seizure for no apparent reason and you sort of just hand him over to us when we show up as you continue watching The Price Is Right? Something's not right here. Your kid was just involved in a high-speed collision, and when you arrive on scene you tell her to "stop crying about it." There are times when I want to take these parents and physically shake them. Then again, I often want to do that with the crazy ones too.

I don't think I have a real-life application for this, other than that I'm sure when I have kids I'll be the same way. But as my family always says when someone mentions me having children, "Not for a long time, God willing."

5.It's All About Respect.

Aretha Franklin wasn't kidding. Respect is something that I want as a medical professional, and it is something I give to my colleagues. Mom always told me that you catch more flies with honey than vinegar. I always wondered why you'd want to catch flies in the first place, but that's beside the point. My Partners, my patients, ER Nurses, Doctors, family members--you all get my respect. Yes, even you Favorite ER Nurse get my respect. I hope that in return I will have yours. But once you lose my respect (and it takes a lot to do so), it's probably not coming back anytime soon. But that doesn't mean common courtesy goes out the window; I will still be as polite as I can be; just because I don't respect you doesn't mean I want to piss you off.

Real life? Be nice to the people that serve your food, clean the buildings, and issue tickets. Don't assume one person to be more deserving of your respect than another. Perhaps this is just a personal belief, but I think that every human being has inherent worth and dignity. Every person is basically good, and by looking for the good in a person I can see what is respectable about them. Mom was right about the honey; I've caught a lot of flies thanks to it. But now I'm not really sure what to do with them. (Read: unexpected discounts, free food, verbal warnings [not tickets], and lots of favors that I can call in. I definitely know what to do with all that.)


Okay, so I've written a lot more than I had originally planned. I thought I'd spend one to two sentences on each point, but that's obviously not the case. I'm way too superfluous for my own good. So that's it for now, but I have a few more I'd like to post at a later date. So expect more of Sam's Ramblings on this.

I'd love to hear what you've learned from your life/job/interactions with other people. Leave me a comment or feel free to email me (whygomad@yahoo.com)

Take care out there,
Sam

21 comments:

Gertrude said...

I think this one is going to be a post of my own. Thanks for getting me thinking.

Medix311 said...

My paramedic preceptor always told me to learn something from every call, no matter how insignificant. One of the things I've learned about myself (which isn't necessarily positive) is that I have no tolerance for drunks--in the professional setting of EMS nor a personal setting.

This is such an interesting topic. Thanks for the thoughts.

Medix311 said...

P.S. Thanks for listing me on your blog. Much appreciated.

Chapati said...

This one got me thinking! Your blog is amazing by the way.

I think I've learnt never to become too used to or too reliant on people emotionally. As long as you remember that people are unpredictable, changeable, and that there can be many reasons for this, its much less likely you'll be hurt by what some-one else has said or done.

Now to apply it...

tracy said...

Sam,

Thank you so much for a most excellent entry, i really appreciate it and in a way i can't really explain, it is something i could really use this morning. i also think some of your very wise tips will be of great use to me when i f i n a l l y get to take the exams.
again, thank you, for everything,
tracy

tracy said...

Chapati,

Well put...i am a l w a y s managing to get my feelings hurt over the dumbest things, even over the 'net, if you can imagine. i really like what you wrote and can use your advice.
Thanks, tracy

david mcmahon said...

You're right - it IS all about respect.

Bernice said...

Phenominal blog. I will have to try for a more inteligent reply at a later date. There is not enough coffee in my system yet.

JD said...

Great Post

the one thing that sticks in my head was told to me by the son of the owner at my first job. His dad had told him and he passed it on to me.

What he said was "when you are the new guy keep your mouth shut. Watch what folks are doing before you change it because they may just have a reason you don't know for doing it that way. . ." A good piece of advice I have used at every new job since. . . That and a bit of respect gets you far.

Bernice said...

Okay, let's try this again.

My lesson is never get comfortable. Always assume the worst in the situation and be prepared for it. It is easier to have a potential game plan for the worst than to have to make one up on the fly. Every house has a danger, you just haven't found it yet.

And ALWAYS ALWAYS have an escape route.

Chapati said...

Tracy,

Glad I helped someone in someway in my first ever post on Sams blog! Its been a philosophy I've somehow naturally followed my whole life...until recently...and I can see now how damaging it can be to not! I'm hoping its not just simply a part of 'growing up'.

tracy said...

thanks again, Chapati, could i maybe come over to your biog sometime? thank you, tracy

Epijunky said...

Sam...

Girl... AWESOME post, as always :)

Since someone took my answer already (don't I sound a bit juvenile? :)) I'm going to go with this.

Never stop learning. Never turn down an opportunity to learn. Medicine is constantly changing.

Anonymous said...

Sam,

I like this post.

Drew

Momma said...

As someone who has ridden in the ambulance a few times myself, it's interesting to hear the other side of the story.

Good luck with your creative writing, by the way. I'm getting ready to enter an MFA program at American University. The world needs more art.

Peace - D
(found you through David)

Sandi McBride said...

My father is a small town Doctor and has been practicing medicine here for 47 years. He still takes as much as an hour with each patient because he says if you talk long enough to them, the truth will out and the diagnosis will be golden. How lucky your patients are that you are continuing to learn and learning not to judge...great post...great blog...

Merisi said...

I find it frankly amazing that it is possible to find a way to communicate what's really important to know, between patient and doctor/medical profession, after all.
Thank you for these thought provoking post, I got to read them thanks to David from Authorblog.

katydidnot said...

i am always the crazy patient.

Epijunky said...

Congrats on the post of the day dear... You deserve it :))

Epi

Beth said...

One of my fellow residents whom I love and adore taught me "Trust but verify."

As in, even though your teenage girl with abdominal pain says she's not sexually active, get the beta hCG.

It's a corollary to "Everybody lies" because you should want to try to trust everyone but verify what you can.

danny said...

Being taken seriously for 15 seconds does make a person feel good. And you know, vinegar literally attracts flies much more easily than honey. Anyway, you've got a nice list there. I bet a good many people will find (or have found) it useful.