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Saturday, April 26, 2014

Me, Rescue? Part Deux, or Why Lawyers Care More About People

Yesterday was my eight-hour shift at the local fire department, for ambulance ride-alongs, scenarios, et cetera.  I showed up bright and early at 8 a.m. (which beat the heck out of the 6 a.m. at the local ER the preceding day), ready and willing to help out and learn even more.  Here's how the day went down, in no particular order, with my perceptions and opinions:

I met the few firefighters/paramedics/one EMT who were on that shift, and to a man they were helpful and patient with  me (others arrived later who were not so helpful, but I digress).  The chief and deputy chief, whom I had met last year at my agility and fitness test, also made a point of greeting me, which I appreciated because let's face it, I was nervous.

The two most helpful paramedics let me observe the restocking of ambulances, explaining everything as they went along.  I was impressed by their patience and thoroughness, as well as with the modern equipment in such a rural area.
Some of the engines


It was a slow morning, but I hung out with the young ones while they worked out (I was reviewing my index cards for the coming midterm since it didn't even occur to me to bring workout clothes), and couldn't stop myself from cautioning them to be safe while lifting, etc., like the mother I am not -- old enough to be, though, so I think they forgave me.  I also snapped some photos of the older vehicles.




I attended the debriefing of the previous day with these fellows and the fire chief, which was enlightening, in that I was working in the ER yesterday when some members of this crew brought in a patient.  They also do a drill each morning wherein someone picks three or four street names from a box of slips, and they each (including me this time) find the street on a map of the district.  I think this is an excellent drill.  They also pick a medication from a box of medications, and quiz each other on its indications, contraindications, etc.  Then we (they) practiced math equations converting pounds to kilos and then calculating the dosages of the various medications that paramedics can give. I was honestly impressed by their abilities, and their willingness to explain things to me - EMTs don't give medications without consulting the advising medical practitioner first, and some we don't give at all.

When the shift captain arrived, I watched the fellows run through a scenario involving an intubation - also enlightening.

I had planned to eat lunch with the crew, since I didn't want to miss an opportunity if a call came in.  I didn't bring lunch from home, which turned out to be a mistake because they ordered from a really vile local Mexican restaurant, and my taco salad sans chips turned out of be a leaf or two of week-old lettuce,  maybe  four ounces of fatty chicken and a HUGE dollop of questionable sour cream.  I ditched the sour cream and added a bag of lettuce drizzled with my own cilantro-lime vinegar that I had brought for an afternoon snack, thank Bob.  The up-side?  I lost 2 pounds yesterday.

A call did come in, to transfer someone from a local facility to the next town over, and I rode in the ambulance with the two most helpful firefighters/medics/EMTs of the bunch, helped wheel the person into and out of the ambulance, and then helped clean up the gurney before heading back to the main station.  Not as stressful as a trauma or other emergency call, but I took what I could get, and it turned out to be only one of two calls that day anyway.  I also saw one of my favorite fellow students in the ER, but he was busy so we didn't chat.

Can you tell I'm just adding random photos now to break up the narrative?


I also saw one of the volunteers in the fire station (apparently they wander in and out at will) who had taught me my AHA Healthcare Provider CPR class, and my regular CPR class.  He's a nice guy, and it was good to see him again.  Finally, I was able to watch a paramedic complete his report, and watch the crew try out a new piece of equipment which facilitates an intubation by use of a little camera inside the throat.  Nifty.

No, this isn't it but I can't remember the
name of the device and can't find a picture on Google. 

This crew is a very tight-knit group - at least the paramedics among them.  They didn't seem particularly chummy with the EMT or the student firefighter, but only one of them was outright condescending toward them/me.  I imagine they need to be close since they do 24-hour shifts together, count on each other in life-threatening situations, and are about the same age.  It was a good dynamic for them overall.

These a-holes had a pretty good dynamic, too.


So I stayed up later than I wanted to last night, weighing what I had seen and heard yesterday and the day before in the ER, against what I want my contribution to be as a volunteer.  After sleeping on it, here's what I know:

1)  Only one of the crew members seemed to honestly care about the people he served, i.e., the public in addition to his firehouse clan.  I don't mean only one would give the proper and appropriate treatment - I'm sure they would all do that.  I mean I watched him interact not just with a patient but with other care providers outside the fire station, and I was really knocked out by his compassion, and the courtesy and professionalism with which he treated everyone.    Now, I considered whether it was his kind treatment of ME that led me to this impression, but he didn't really treat me any better than two others did, and I did observe some other crew members interact with other people not on their crew, so no, I'm singling him out because he truly was remarkable, especially for someone so young.

2)  I don't know what makes the others seem so jaded at such a tender age, and frankly it hurts my heart to see it.  They seem more concerned with getting sued and with making their own jobs easier than with how their patients may be feeling or what their patients are going through.  Maybe they think it's not necessary, or maybe it's too stressful a job to have to worry about your patients' mental attitude when you're busy trying to save their lives.   I'd like to think it's possible to provide necessary care, and to CARE, or at least fake it in front of the patient if it's too much of an emotional investment for you.

Having spent my entire career as a paralegal in a large, metropolitan area, for big litigation firms and small,  this anti-litigation mind-set mystifies me.  Sure, some people are sue-happy, but they aren't for long because it takes a lot of time and a lot of money to bring and maintain a civil suit.  There are mechanisms in place, at least in Nevada, to keep frivolous suits from coming to court.  I mean what other profession has a screening panel process before you can even file a suit against a practitioner, like the doctors have in Nevada?    So it bothers me to see this archaic mind-set still being perpetuated, especially among those so young who could do so much more good.  Now that I think of it, I see this antiquated attitude quite a bit around these parts - there are people around here who still think the McDonald's scalding coffee suit was a joke.   Any of you reading this who agree with them need to read the facts about that case.

3)  I heard a remark in the ER yesterday during that shift, that also bothered me, and by bothered I mean really pissed me off.  There seems to be an opinion among some care providers,  be they paramedics or hospital personnel, that Obamacare is the reason their numbers are up because people are now >gasp< seeking treatment for medical emergencies where before they couldn't afford it because they didn't have insurance.  The opinion seems to be that these people "don't really need to be here" but are causing more work because they now have coverage.    Those of you who know me can only imagine the smoke coming out of my ears when I heard this, and it took every ounce of self-control I had not to jump in (or on) with both feet.  Here's what I wanted to say:  "Wow, you know I don't think any of these folks have YOUR medical training, so perhaps they don't really know what constitutes an emergency in YOUR minds, only that they are not feeling as they normally do, that they are suffering and they want that suffering to stop."  My only regret now is that I didn't say it.

Incidentally, Marvin paid me what I think was a compliment on Thursday.  He told me that he didn't think I'd ever be satisfied as an EMT, and that I should at least go for paramedic.

Which leads me to my final point:

4)  I have worked with a lot of people, from all walks of life, in the legal profession in a big city.  Sure, some were jaded but when I consider the overall numbers, I can count on one hand the cynics and nay-sayers, over a thirty-year period.  Everyone else genuinely cared about their clients and wanted to help them, or wanted to uphold the Constitution, or to hold someone or something accountable for their wrongful acts for the benefit of all citizens.  The legal profession is a noble one, and the overwhelming majority of the people I know who entered it care about people and how the law affects people in everyday life.  I know I did.

I thought the medical profession was the same.  But I see that, at least in this little corner of the world as I have seen it, I was wrong.  And that makes me sad.