Tuesday, November 30, 2010

Burnout : It's Real and It Hurts

When thinking about a worthy subject for my next post, I found that is fitting that I talk about something that not only I've been through (more than once), but something that the blog itself helps me with. Just another coping mechanism, I reckon.

For those of you who haven't known me for long, or at all, I am an absolute workaholic. On average, I pull 40-50 hours of overtime per bi-weekly pay period and sometimes way more (upwards to 80-90 hours). Working in a high run volume 911 service, those kind of hours can take it's toll on you very quickly and when you'd least expect it.

My first REAL run of being burnt came in 2008. I was making $17/hr at my current employer and was working 16 hour days for sometimes 14-15 days straight without an off day. If my memory serves me correctly, this was the year that I grossed well over $90,000. Yeah.... I was killing myself and I didn't even know it.

I would have long strings of bad runs, but I'd shrug them off like most of us do. I'd have nights of making 16-18 runs a night, getting off late and having to be back at work 6 hours later. I felt like I was superhuman at times. Boy was I wrong.

After 7 months and some change of relentless professional self-mutilation, I became bitter. I was angry at the world and had I been the owner of a puppy at the time, I wouldn't have wanted to be him. Anger turned into depression. Depression led to alcohol. Alcohol led to more and more pain and self-pity.

After bad break ups, more drinking, less caring about my work and my own well-being, I decided to make a change. Something I had never done before and like many other stubborn ass guys that I know, never dreamed of doing. I talked about my problems. Turning to the only person that I knew would understand, my preceptor, mentor and friend throughout my career, Joe, probably saved my career. Not to mention with the self-destructive behavior I was throwing down, maybe my life.

He suggested a few things that had helped him get through tough times in EMS. Working out, finding a hobby, read a book, build a model airplane... the usual stuff that normal folks do in that thing that we EMS folks have little of, "spare time".

"You need to stop working so much fuckin' overtime, dude. That's your issue." he said.

No shit, Sherlock. Like I didn't already know that.

Sad thing was, it was the truth. It was that simple. Stop working so much, have some time for yourself and relax. I hadn't had 2 days off in a row to sit on my couch in my boxers, watch TV and do absolutely nothing but chill out, collect my thoughts and catch up on sleep.

I know this sounds elementary, and it really was for me, but sometimes that's all it takes. Drop back five yards and punt.

Soon after this conversation, I found another thing that still to this day helps keep me sane. Social media and networking.

Twitter has helped me make so many connections all over the world, make great friends and assimilate a TON of knowledge from so many great pre-hospital providers from every edge of the globe. It really helps to see people being so passionate about the profession that deep down you love and want to succeed in. The folks on there that write blogs (most of which blow this heap of crap out of the water) are UNBELIEVABLY intelligent, articulate and passionate about the career and it shows in their writing. The Chronicles of EMS and EMS 2.0 movement has inspired me to want to be more involved with my career path and be a contributor to the future of OUR profession.

For me, it comes down to not working myself into a zombie-esque state and putting my time, thoughts and energy into making things better for the future of EMS. Simple? Yes. Does that mean I don't have my moments of anger, depression, etc? No. Everyone has that. But, knowing that I'm doing the right thing for myself and my chosen career helps keep things on a manageable platform.

That's how I've kept myself sane during the hard times. How about you?


Sunday, October 31, 2010

Common Paramedic Student Mistakes

As a fairly seasoned Paramedic in my service, I get the opportunity to teach new Paramedics and Paramedic graduates on a regular basis. I really enjoy helping the future heroes of our profession and every now and then, I get to make fun of them a little bit. This is about one of those times.

Before I get to the story, understand that I did like any good instructor or educator would. I complimented them, told them everything they did right and then verbally kicked them in the nuts. After making them see what they did wrong and how 'WE' were going to fix it, I complimented them again and away we went. This particular person went on to become a great Paramedic with our service and I'm proud to have a little part in their education.

However, I see ALOT of Paramedic graduates and even fairly new Paramedics make this same mistake. If you're reading this and fall into this category, read carefully and understand the story I'm about to tell. It'll help. Scouts honor.

We were dispatched to a 'shortness of breath' on a 74 year old female. Upon arrival, the patient is in very mild respiratory distress. She is cool and diaphoretic and says 'I just can't get a good, deep breath!'. My newb jumped in, placed her on oxygen, obtained baseline vitals and placed her on the EKG monitor.

"INFERIOR MI", he exclaimed.

"Ok, you want to explain that to everyone who didn't hear you in a 5 block radius who doesn't know what you just said? I would suggest speaking a little softer while doing that."

"Sorry." he murmured before rattling off what he had said meant to the patient, who looked like she had shat herself after his outburst.

We loaded her up onto the cot, moved her to the med unit and whisked her away to the closest STEMI center. On the way, I could tell he was fairly nervous. It was his first anginal equivalent MI and you could see he was scared. His hands were shaking and looked like someone had filled his gloves with water before he put them on from the sweat. He had given asprin in the house, got a BP and was working on an IV. She was a tad hypotensive so, luckily, he didn't go slamming NTG at her face immediately.

But the IV, he couldn't get it. Once.... missed. Twice....missed. After the third miss, I offered my services and quickly secured an 18g in her right forearm. He looked crushed. He looked as if I had kicked his little paramedical puppy. His face turned red and he started slamming things around as he was cleaning up his mess. Luckily, we weren't far from the hospital and quickly rushed the patient into the ED bed, gave our report and went back outside of a tobacco conference.

"So... How do you think you did?" I asked.

"Fucked up. I'm a moron. I never should have said that on scene and should have gotten that IV!".

"Listen, stop right there. Come down off the cross and stop pouting. You adapt, you overcome. So what you couldn't get an IV? It happens. Some of the best Paramedics in the world miss IV's. This one isn't your first miss and it won't even be close to your last. All you can do is learn from every run you make and better yourself in every way possible."

See... I can be diplomatic :)

He kept on with the pouting and the 'I fuckin' suck' comments for about the next hour until we secured for shift. Afterward, we sat around the table and had a man to man talk. I packed a dip and gave him the best advice I had ever gotten.

"Brother, let me tell you this. 20% of Paramedicine is getting to do Paramedical cool stuff. The tubes, the IVs, the drugs....all of that is a fifth of what it takes to be a Paramedic. The rest of the job is using your brain, knowing when to do what, and making the best possible decision for your patient. Using your brain is much more important than hitting every IV."

He nodded his head in agreement.

"But, she needed an IV. I was so nervous, I couldn't get it. What if you weren't there?" he came back.

"You would have done the best you could with what you had. That falls into the 'other 80%' too, hoss. Adapt and overcome. Don't let something like that frustrate you to the point that you can't function. Then, you're no good to anyone."

He smiled and shook his head.

"Speaking of being nervous, have I ever told you my 'Duck On a Pond' analogy?" I asked.

"No... But I'm sure I'm going to hear it after that, eh?"

"Damn right. It's applicable here. Let's say you're at a pond and you spot a duck chilling on the water. As you watch it, it's looks as if nothing could phase it. It's just floating along without a care in the world beyond 'I wonder if this fat kid is going to give me some bread'. But that's on the surface....."

"What in the Sam Hell are you getting at, dude? I'm like a duck?"

"No." I said. "On the surface, the duck looks cool, collected and relaxed. It's just floating around the pond. But, under the surface, that damn thing is kicking it's legs 200mph to get to where it's going. It's all over the place and it's moving a mile a minute. THAT is how you need to be! When you're in front of a patient, you should be calm and cool. Like Fonzie, if you will. At the same time, your mind needs to be going at light-speed. You have to think 10 steps ahead of yourself. You have to take in alot of information quickly, assimilate it and interpret what it means for your patient. Your brains needs to be working like the ducks legs....under the surface."

His face went from anger and frustration to the look of someone who'd just had an epiphany. "I see what you're saying. Honestly, it would probably make everything a little be easier too, eh? If I don't freak the patient out, I'd be able to develop a better rapport, they'd have more faith in my decisions and the whole run will go smoother."

"Nailed it." I was stoked. Now if he could actually pull it off, I'd hang my hat on the analogy.

The moral of the story is, to all of you young Paramedics and aspiring hero graduates, chill out. You're not going to be perfect. All you can do is use every mistake or negative situation as a learning experience. Missing an IV here and there doesn't make you a horrible Paramedic. Missing a vital piece of the assessment puzzle that results in a poor patient outcome does.

Be a duck on a pond.

Wednesday, October 27, 2010

Who is....

After much thought and deliberation about how I wanted this thing to go, I thought 'what better way to start out than to start out spilling my guts?". People ask all the time 'what made you get into EMS?' or 'how'd you get your start?'. Well, fair warning, all of the following is very true. Very un-#likeparamedicdan, if you will.

I graduated from high school in 2001. The school I attended was a 'magnet school', meaning that it specialized in a specific trade or occupation set. Some specialized in architecture, aeronautical, construction, vehicle repair... pretty much everything. I, of course, went to the one with 'Public Safety' program. Initially, I was a fire goober. Everything was fire department this, fire truck that with a little football and females mixed in.

While college hunting my senior year, I found an in-state college that had a 'College of Justice and Safety' that encompassed Fire, Law Enforcement and Emergency Medical Care. I was instantly sold. 150 miles away from home, an amazing football coach, and known nationally as one of the top party schools. Of course, I dove into college life with both feet and three quarter a hip.
After being accepted to the very prestigious and astute (note the sarcasm) Eastern Kentucky University, while scheduling classes, my academic advisor asked me 'Are you planning on working while you're in school?'. 'Well, fuck no. I'll be busy with..you know...school stuff'. He cracked a smile that I can still see in my head today. 'Ben, you're gonna need a job. Mommy and Daddy won't pay for everything forever'. I didn't want to hear that..at all.

Once he shot down all of my very well thought out and ever so awesome reasons why I shouldn't work while in school, he suggested to take an EMT class. 'It's credit hours for one class. Do well, get a certification you can use, have a good GPA. It's a win, all the way around'. The only thing I knew about EMS or being an EMT was a good way to get hired on to the Fire Department and I DID NOT want to ride on the ambulance. Old people, foul smells and dirty homeless guys just weren't for me.

Well........ Not everything works out like we think it will. Turns out, I fell in love with EMS during EMT class. I thrived... I loved it.... I needed more. I couldn't get enough. Everything was so new and interesting. Who knew this whole 'medicine' thing could be so cool? I did so well in class, in fact, that my instructor (who had never done such a thing) got me my first job in an outlying county after I got my EMT certification.

I worked in the outlying county for several months thereafter and soon, of course, decided to take a Paramedic course. Luckily enough, the "College of Justice and Safety" included a Bachelor's Degree program in Emergency Medical Care. Boom. I was IN! Much like the party life, I dug in. However, like I said before nothing seems to work out like we think it will.

In March of 2003, I came home for the weekend from school to visit with my family. Little did I know that this weekend would change my life, forever.

This is one of those things that happen in your life that, no matter what, you will always remember every little detail from the event. I remember everything. My family and I had finished dinner and my mother was cutting my hair. (She's a hairdresser) My step-dad called into work that day because he hadn't felt well all week with flu-like symptoms. As my mom was finishing up, my step-dad (Phillip), came into the room where we were and said "Honey, I really feel bad." My mom, being like many moms, suggested that he 'take one of those antibiotics in there with some Tylenol Flu and go lay down'. Three minutes later, I was on the phone with 911.

He was leaned over the bathroom sink splashing water on his face. I put my hand on his back to ask if he was 'ok'. When I touched his skin I thought 'Oh, shit. He's cool and REAL clammy'. I told the 911 call-taker (who happened to be a high school friend of mine) that I thought he may have been having an allergic reaction to the antibiotic. No sooner than I got the statement out, he hit the floor.

Mom and my sister came running in. I threw the phone at them and screamed "TELL HIM I'M STARTING CPR".

I had never done CPR on a real person yet. I opened his airway, gave him breaths. Nothing. No pulse. As I started compressions, my mother began to scream. My sister began to cry. All I could say was 'Come on buddy. Come on, Phillip'. The squad unit arrived in what seemed like an eternity, but I wasn't stopping. I kept on pushing. Kept on pushing. Nothing.

My step-dad was 33 years old. My first real cardiac arrest was the man who had raised me from the age of 9.

That's enough for now.....

- Grinder

Thursday, October 7, 2010

Welcome, baby birds.

What? It's real? The Grinder FINALLY set up a blog? Hmm... This could be bad.

Indeed, kids. I've bitten the bullet and taken time out of my busy life saving and beer partaking schedule to finally (after almost 2 years) set up my own little wall of the internet to spray paint profanity and ignorance onto. Hopefully, this won't be something that dies off and I will actually update it regularly. You're excited, admit it.

So....... Why set up a blog?

Over the last few years, everyone and their brother has set up one of these damn things. Some are good, interesting and informative. Others are much like the people who write them.... boring, dry and overwhelmingly useless. I've just decided that I need a place to vent, rant, tell stories (or lies), stroke my own ego or whatever I feel. I guess 140 characters just weren't enough anymore. Chances are, it'll still be entertaining.

Don't get me wrong, there's a TON of REALLY good blogs available for paroozing and maybe, eventually, I'll get around to putting some links on here for anyone who may accidentally stumble upon this page looking for something useful.

Anyways, this is where it begins. Rome wasn't built in a day, so try to contain your excitement. The fun has just begun.