It’s so strange to me that, even though I’ve been on vacation, thinking about some of the calls I’ve had over my career has actually numbed my desire to write as much. I think that there is a self-protective aspect to this, but it is is somewhat frustrating because I know that I want to write. One of the great people I’ve met on twitter, Natalie Harris ( @ParamedicNat1 ), calls her PTSD her “word-stealing demon.” I think that I’ve felt similarly in my experience as well.
I am going to get back on the horse and write though. I wanted to do this to commemorate my very first day working in the ER, which was my transition to working on the ambulance. In fact, my career almost ended before it even began.
July 4, 1993. An eternity ago.
I had just received my EMT certificate and was trying to figure out my next steps. I decided to volunteer at local Level 1 trauma center in the ER. And like any fool who doesn’t know better, the 4th of July seemed like a great day to show up for the first time.
I really had no idea what I was doing at all. I didn’t know where anything was. And I was really shy, which made it even a bit more uncomfortable. I had been in the department for about an hour when the radio call came in that the paramedics were bringing a major trauma in. The nurse who was helping orient me gave me a quick run-down of what to expect, told me where to stand, and said, “Just watch. You don’t have to do anything. Just observe.” This seemed to be a great idea in my mind, so while other people were prepping the resuscitation room, I found a wall, and tried to make myself as small as possible.
A few minutes later, you could hear the commotion as the medics were unloading their patient and rolling in. I was in no way prepared for what I saw. (As I go back and write these stories down, especially the one’s from when I was brand new, I think the defining words are “clueless” and “terrified.” That defines my first couple years!)
These two medics and a firefighter rolled into the trauma room. The patient’s head was wrapped in towels and soaked in blood. Someone was trying to ventilate the patient. Someone else was trying to do compressions on the person. The other medic started to give a report:
“Patients were in a minivan going south on the freeway when a Ferrari or Lamborghini came the opposite direction on the freeway in excess of 120 miles per hour, hit the center divide, went airborne and came down in front of the minivan. The driver of the minivan was critical and enroute to another trauma center. There were kids who were injured enroute to the other trauma center, too. This patient is the driver’s elderly mother, who was caught outside the van when it rolled after impacting the sports car. She has head injury and just coded.
Oh, and by the way, the husband was in the car behind the minivan. He and the passengers in his car will be here in a few minutes. Other family went to the other hospital. They were all going to a fireworks show in a family caravan.”
The doctors began resuscitation of the patient. I really couldn’t see that much, and because I wasn’t really participating, it was almost like watching a movie. Then the yelling started. A security officer came into the room and told us that the family was outside demanding to know what was going on. One of the nurses spotted someone in scrubs not doing anything and latched on to me.
“Hey. You. What are you doing? Nothing? Good. Go talk to the family.”
“But this is my first day! I don’t know what I’m doing or what to say!”
“That doesn’t matter. Just talk to them. The social worker will be here in a second. Just stall them. You have to do it. We don’t have anyone else who can.”
I mustered up what tiny amount of courage I had and walked out the side door of the department. It was obvious who I needed to talk to, and I just prayed that the fear wouldn’t be visible in my face, because I truly did want to help.
“Are you the family of the patient that the paramedics just brought in? My name is Tim, and….”
The doors to the ER flew open. All of us turned to look. One of the most awful things I had ever seen, especially knowing the family was watching, rolled out those doors.
The patient was now intubated, but her head wasn’t covered, and you could see the massive trauma and disfigurement. And instead of CPR, the patient now had a clamshell thoracotomy and someone was literally riding the gurney doing internal cardiac massage. It only took a few seconds to rush the patient past us and head to an OR, but the damage had been done.
My voice failed. I turned to look back at the family. They were focused on the retreating view of the gurney, and then they turned to me with shock, horror, and fear in their eyes and started to wail. It’s a sound I’ll never get used to, and one that shakes me to the core each time. It’s the sound of the deepest level of a broken heart, of a grief too powerful for words.
I couldn’t think of anything to say. I took the man by the shoulders and tried to get him to focus on me. Honestly, I don’t know if I was successful. I tried hard to get him to look at me, and to say that I would get him information. I think the “conversation” only lasted about thirty seconds, and then from opposite ends of the hallway, a social worker and a chaplin showed up. I introduced them to the gentleman, and then made my own retreat.
I don’t know where I went. I wandered the halls of the hospital until I found an empty waiting area. I guess I had been sitting there for about an hour before the chaplin found me. I was just staring at a plant and the wall, trying to process the the overwhelming visual and emotional experience I had just survived.
Thank God for that chaplin! (See what I did there! Haha) In all seriousness though, I think my career might have ended before it began, were it not for him and his compassion. I know he say down and talked to me about what had happened. I know he told me that I did alright, considering I didn’t do that much, other than try to show up and offer comfort. And he told me that if I ever needed to talk, he was around.
I’ve heard recently how the words we say to patients, or about patients, can mean so much to them. I’ve also heard it said that what we say in those moments might not be remembered, but how we make a person feel… that will be remembered forever. In my case it’s absolutely true. I hope we remember that this chaplin looked after a new kid, who ended up having a remarkable career, and it was because of him, in large part, that the career continued.
I wish I could go back and thank him. He deserves it. I think about him often, especially as my life continues to bring me across all sorts of broken people, many of them other medical professionals who are a bit “broken”, just as I have been.
Intentionality in my words and availability hopefully offer as much compassion and healing as that chaplin did for me. I hope we all look at each other that way as co-workers, providers/caregivers, and as humans.