Fixing Problems

Sometimes being a paramedic wears thin, and I develop the urge to tell people what I think of them. By people, I mean dispatchers, firefighters, partners, coworkers, supervisors, nurses, physicians, other drivers, bystanders, random neighborhood dogs, patients, 911 callers, people in charge of making the roads generally smooth, people in charge of road signs, people in charge of radio song selection, family members, restaurant employees… The list of people who should loudly and proudly be told what I think of them is long and illustrious. These situations come up most often when I am hungry, tired, or have been working too much overtime.* Don’t worry, I have a plan for the speak-my-mind urge. I have a note page on my phone with a whole bunch of reminders for me to read when I have a bad day. It is a dorky thing to do, I know, but I sometimes need to remind myself that “EMS is not a hard job. Roofing is a hard job. Don’t volunteer to go back to roofing.” Another one reminds me that my daughter thinks being a paramedic is heroic and reminds me to act like she is watching me when I am on a call. I have ten or fifteen affirmations like that. I just read through them when I feel the nearly-bottomless well of patience that I have for my fellow man start to run out. The reminders have saved me from showing my ass more than once.

One says: “You can’t fix anything. Don’t try.” I think it is my favorite affirmation reminder, which is weird because it is pretty negative and apathetic. It feels like failure and submission. But I know what I meant when I wrote that note.

I know that I meant that system-wide, EMS related things that irritate me can’t be fixed. At least, the solutions don’t come from my partner and me in the front of an ambulance. Every conversation about how things would be different if I were in charge may as well be whispered into the wind. Nobody cares about my personal opinion of post locations, response times, EMD, and protocols. Nobody cares what I think about the overall skill level of EMS as a whole, or of my system itself. Certainly nobody in other agencies cares what I think of their systems, policies, customs, and employees. I was a captain in my agency and nobody cared then, either. They certainly don’t want my opinion now that I am a paramedic. I don’t think people really care what the Chief thinks, when you get right down to it.

That’s because an EMS system, especially a large one, is like an oil tanker. Steering inputs take a long time to take effect. Deciding to turn the wheel or advance the throttles can have huge consequences that extend outside of the ship itself. Systemic changes, then, are the results of discussion among groups of stakeholders over long periods of time. I can be involved in that, but it is unlikely that I can either personally initiate that process or have a measurable impact in it.  

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There are things that I can fix, though. I do try to fix those. That is where the importance of the reminder note lies.

Fear. Pain. Worry. Grief. Loneliness. Cold. Discomfort. Those are things that I can fix. I can concentrate on fixing those on every call, for each patient, on an individual level. Lessening pain and fear are easy for me to do for a patient. Setting a patient at ease, smiling, giving them a blanket, and administering analgesia costs me almost nothing. It is what I am paid to do. And I can ameliorate those problems that my patient is having without going to several city council meetings first.

By attacking the problems that I can solve, I am actually helping to “steer the EMS oil tanker.” My actions help to set the expectations among my patients, peers, and other stakeholders in regard to how my EMS system performs. Concentrating on the core EMS functions result in the systemic problems taking care of themselves, through cultural improvements over time. I can also help “steer the tanker” by giving newer paramedics and EMTs all the help and support I can give them – like someone gave to me once. We can talk about ECGs, pathophysiology, EMS hacks that make the job easier, how to start difficult IVs, the best route to the next call, and those kinds of things. It is like gently pulling on the oil tanker’s steering wheel. (If oil tankers don’t have big wooden wheels with knobs on the end like a pirate ship, I will be sad.) I get more out of talking to my partners about what was going on with the last patient  than I do talking about why supervisor so-and-so shouldn’t have ever been promoted.

If modern supertankers don't have steering wheels that look like this one, I will be thoroughly disappointed.
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I decided to not worry about the EMS system until my work is done, fixing the patient-related things that need my immediate attention. Chiefs and medical directors are paid extra to worry about stuff like hiring practices, response times, and financial stability. Let them worry about that crap. I will focus on the next patient I see.

Why would I volunteer to worry for free when other people are being paid to worry? Instead, my note reminds me to concentrate on the problems that I have the responsibility and authority to manage on my own. That’s why "You can’t fix anything. Don’t try” is one of my favorite notes.

*It's funny: Call volume, call type, and such things that we think make a good/bad call have little effect on my attitude.  My attitude revolves around how full my belly is, how sleepy I am, and how much overtime I have worked in the last month.  A call that enrages me when I am hungry (hangry) is a funny call when my belly is full.  That leads me to believe that call volume is less important than having enough time between calls to eat...