The Hardest Thing I Do

This story happened quite a while ago, but I is similar to situations that happen way too frequently. I responded to an unresponsive party on a train. Dispatch reported that the party may be a cardiac arrest. The train, which was full of other passengers, was stopped in the station waiting for us to deal with the issue. I boarded the train to find a 20-something male snoring and smelling strongly of alcohol. (He was not a cardiac arrest.) His skin signs were fine, there was no apparent trauma, and both his respiratory status and pulse were normal. I made the choice to wake him up and get him off the train; that way the dozens of other inconvenienced people could go on about their lives.

It took more work than I expected to wake this gentleman up.  Neither voice nor shoulder shake worked. I had to press the base of the SCM* to even get a grimace and a withdrawal. The man groaned and twisted toward his side, like a tired hotel guest who wanted to sleep in.  “Come on, dude. Up and at ‘em. We got to get off the train,” I said as I gave him a little more SCM pressure. That was enough for the man to get his feet under him and walk off the train.

I sat him on a bench to complete my exam and work up. The pain at his clavicle, along with moving a little bit, woke the man up a little more. Now he wanted to be aggressive and belligerent. He stood, though I asked that he not, balled his fists, and explained that he was going to kick my ass. The man began to shuffle toward me in an ataxic fighter’s stance.

This is not a person that puts me in an excessive amount of danger, in most cases. There is always a chance of getting hurt, I suppose, but my main concern at this point was the hassle his behavior was causing. I began to slowly back off, circle, try to talk him down, and get him into a position so I could finish my job.

He hocked up a big ball of mucus, spit it at me, and threw a giant, arcing haymaker that missed.

Do you know the call I’m talking about? Ever run a similar one? How about another example?

My partner and I responded to a downtown club during out-crowd on a weekend recently. We found a different 20-something male who was intoxicated and had received an ass kicking. I’m sure it wasn’t deserved, though. He had a laceration extending the length of his left eyebrow, smelled strongly of alcohol, and was shouting profane threats at the bouncers, police, my partner, and me.

I have a theory that men like this feel a subconscious need to regain face. This is especially true if they lost a fight in front of a girl. I think there is enough lizard brain peeking through the alcoholic haze to make a decision: Against whom should I regain face? The bouncer? Nope, already lost that battle once. The cops? Nope, not unless there is a female officer. Police are mean. The medics? Unarmed, here to help, softer than the cops. Yep, he’s going to decide to regain face against the medics.

I never understand why people direct their anger at me. I didn’t beat them up. I didn’t arrest them. In the end, it is just that I’m just the safest target for their impotent rage. They never run away, either. Just stand there and shout how they aren’t going to any damn hospital.

This genius was unhappy at my decision to take him to the hospital and decided that he had a right to my name, right at that moment. My identification badge was clipped to my chest pocket. He snatched it off my shirt and gave me a shove.

Have you run that guy?

As a final example, check out this video from YouTube.** It makes my guts tighten up. I have been there and I hate it.

Powerful waves of frustration and anger roll over me. None of this is my fault! Everything about this situation is due to someone else’s decisions! I shouldn't be treated this way!

In most settings, spitting on another full-grown man isn’t a safe action. There are unpleasant consequences. Snatching a man’s possessions and shoving him is not safe. Consequences. My uniform is what renders those actions safe. That, and my decision to walk away when I feel the tide of frustration and anger welling up. 

Contrary to the approach of a lot of EMS safety training, I walk away to protect the other guy’s safety, not mine. I have an unbroken seventeen-year streak of not engaging in my baser instincts that I’m trying to protect. I walk away, take deep breaths, imagine that my daughter was watching me, work at the gym until I want to puke, drink too much, bitch to my peers, complain to my wife, bike, jog, and all of the other better options than administering 80 kilograms of brutacaine to a patient deserving of a dose. They are better options (mostly), but not especially satisfying ones.

Sometimes the hardest thing I do at work is not do what I want to do.

*Sternocleidomastoid (SCM) pressure is a good way to apply humane painful stimulus to a patient. It looks better than a sternal rub, doesn’t bruise, and so on. The SCM inserts at the medial end of the clavicle, on a tubercle. Right as it connects to the clavicle, it bifurcates. Press straight down (toward the patient’s toes) with one finger. Don’t press into the airway, or into a carotid pulse; just press downward onto the clavicle at the bony bulge where the SCM inserts.

**If my video embedding skills suck, click this link: https://www.youtube.com/watch?v=UOX3fXSoNJk