Tuesday, July 12, 2011

clang! pow! thunk!

When another job appears on the screen, the student paramedic riding in the back of the truck stuffs his head through the hatch.
‘Anything good?’ he says.
I’ve been wincing so much this shift I’m developing a twitch. The student means well, but carries himself awkwardly, like a kid in dressing-up clothes pretending to smoke with a pencil. When he speaks to the patients it’s such a disaster I half expect to see comic book sounds in the air. Clang! Pow! Thunk!
To the alcoholic: ‘How many units of alcohol do you drink a day?’
‘What do you mean? Units?’
‘Well how much do you drink, then?’
‘How much do you drink?’
‘Obviously not as much as you.’
To the woman who took an overdose:
‘What made you take the pills, then?’
‘My husband of thirty years decided he doesn’t want me anymore. He’s moved in with the lodger.’
‘Where does she live?’
‘In the room across the hall.’
‘Oh. So are you moving out, then?’
To the old woman who just wants to die at home.
‘Let me do your blood pressure.’
‘I’m not going to hospital. I will not go to that place again. I would rather die here in my chair and be done. I’m ninety one, for goodness sake. What’s the point of dragging things out? I’ve had my time. I’ve enjoyed it – I’ve had a lovely marriage, three beautiful children, and I simply think it’s time for me to move on. All I do is sit in this chair staring out of the window. Where’s the life in that? Ouch! That cuff’s rather tight again.’
‘Well if you’d only stop talking for a moment I might be able to hear.’


Three o’clock in the morning. Six years of shift work heavy inside me like the fossilised remains of something. I can feel it sitting there, as scuffed and cold as the moon that drifts up over the sea. I climb into the cab with a cup of tea, look for my book, click on the overhead light, settle back for a five minute read.
The door opens.
‘Do we have a traction splint on the vehicle? Did you check that earlier?’
‘A traction splint. I need to have a look at one to get it signed off in my book.’
‘Look – I, erm – I really don’t want to be getting any kit out right now.’
‘But I need to get it signed off.’
‘It’s three o’clock in the fucking morning.’
‘It’s got to be done.’
‘Some other time, mate. The day time.’
‘I’ll ask Frank.’
He closes the door again.
‘Good luck with that,’ I say to myself, then settle down lower – much, much lower – so low it’s apparent to anyone, even to me, that I am now more chair than man.


tpals said...

:) A fun change to the usual. Do you carry a bottle of tact you can inject him with?

Wayne Conrad said...

Spence, Does it make you wonder what you were like when you were green? I sometimes have those "was I like that?" moments, but I can't remember. It's possible I was never aware of them.

Spence said...

Thanks Tpals. I def think he could do with an injection of something!

Hi Wayne. I do think I was pretty hopeless when I started. It always takes a little while to build up experience and confidence, and that counts for so much in this job. But I have to say I think it helped I was a bit older when I started, though. This guy seems so young! (OMG - I've actually reached the point where I say stuff like that... :/ )

Cheers for the comments!

Gentrie said...

As long as you are not saying that and he's like 45 or something I think you are good! Although I cringe whenever I say things like that about "kids" I work with. You're an old soul Spence......

Spence said...

I know what you mean, and you do have to watch yourself with this stuff. But I have to say that not all the younger people at work are like that. It's just this particular one doesn't seem to have much tact!

jacksofbuxton said...

Nothing wrong with being keen Spence,although I'm sure it must have been quite grating at the time.

I wonder if you and Frank see any similarity to yourselves as young,go get 'em type newbies?

Having said that,if I had an apprentice like that I'd be fairly certain that a "quiet chat" might be the order of the day.

Spence said...

I suppose I'm just too grumpy and thin-skinned that time of the morning. Bah! I need to find a job where I don't have to work nights... ;/

family affairs said...

He has a lot to learn Lx

Spence said...

I've been thinking about this a fair bit since, L, and I've come to a couple of conclusions!

1. The para training lays such emphasis on ticking off a long list of skills and competencies, it runs the risk of narrowing your focus and losing sight of the patient. I think a more holistic approach would be better, one that puts communication and softer skills higher up. But then again, I suppose that's maybe a side of it you can't easily teach - something that just improves over time.

2. Working nights makes me cranky!

Becca said...

Non-snarky question:

Have you given him feedback on this? He's not going to suddenly develop tact overnight, but if he thinks before (or even after) he speaks he might learn a bit faster and it might mitigate some of what he says. It's also probably much easier for him to hear and take on board as a student than after he's qualified.

Spence said...

Absolutely, Becca - I should've given some feedback.

I must admit I've felt pretty uneasy about this post, but I've left it up as I think it says as much about my state of mind as the student's.

To add a little context - I only heard him say two of those things, the other I heard from someone else. So not really a fair conflation.

At the time I thought the post illustrated a kind of work blindness - forgetting the patient in a rush to get the facts down, the procedure done. But now that I've caught up on my sleep and feel a little more grounded, I can see that it was really a trigger of other things.

I'm a technician (EMT in the US), a particular grade of ambulance worker who attends every kind of incident, but lacks the training to cannulate, intubate and give certain drugs. Here in the UK - certainly in the trust I work for - the role is increasingly redundant. The trust wants paramedics who've gone through university, both for the degree-level qualification, and for the savings they make in the funding of that training. There's definitely a feeling here that technicians should either retrain or leave - I don't think I'm being paranoid. So no doubt at least part of my antipathy to the student paramedic was a feeling of resentment: why should I be signing off competencies when management are eager to see me leave? Not the student's fault, of course, but part of the environment.

Another factor is the growing feeling that I've reached my limit. In the four years or so of writing this blog, I hope I've managed to get across some sense of the stresses we face - the grindingly depressing jobs, the long hours, the early hours, the boredom and the excitement. I don't know how much longer I can pitch up to these jobs - and I'm certain that shakiness is manifesting itself in a certain amount of crabiness, especially in the early hours.

I'll carry on writing out some of these things, but there's a clock ticking now!

Thanks for your comment, Becca. I like non-snarky questions. They're the most provocative. xx

Journey-woman said...

Personally, I think it was a wonderful post....the stresses you face aren't just from the calls! Being patient focused is a good thing and something that can be taught more by action than word...young people today (I worked in a high school so I feel qualified to say this) are not as sensitive to face to face situations as our generation mainly due to the technical devices etc. Many times I have asked young people if they realize the effect their words have on people and am astounded to find out they don't....even tone doesn't mean much to them...Spence you have a teachable opportunity don't let it pass!!!!! That's my lecture for the day.

Spence said...

Thanks JW. I think you're right about stress - it's as much about the environment, the politics and the personal stuff as the nuts and bolts of the job itself. They feed in to each other, and make it worse.

I think I'm just going through a difficult patch at the moment. I need to find a new way of thinking about work - or find something else!

Anonymous said...

aw hang on in there, can't you give him/her a "slap" (as in NCIS - gibbs and Danozo)
don't let it get you down.
Big hugs and best wishes.

Spence said...

Thanks Lollipop. I've not seen NCIS, but I can imagine that set up. I'm increasingly like some embattled, grizzled older cop. Next thing you know I'll be chucking my badge and gun on the Captain's desk... :/ x

Anonymous said...

I joined the Ambulance Service as a Student Paramedic back in 2006, going the university route, and with absolutely zero experience. The existing staff at the first ambulance station I pitched up at were *deeply* unimpressed to have a student paramedic who'd never even been inside an ambulance prior to the first placement. They all wanted to know when I'd passed the Ambulance Technician course, and when I told them I was going the university route and it was unnecessary then you'd think I'd just coiled one out in front of them.

The existing Amb Techs felt threatened, as they could see the writing on the wall over the shape of things to come, and the existing paramedics didn't much like it either. Why should new paramedics just parachute in after two years training without going through the traditional route they'd all done?
Fifteen people started my Paramedic Science university course, and there are eight working as State Registered paramedics today. I'm not one of them, just didn't make the grade, found out I'm not cut out to do that line of work. I'm still in touch with some of them and they all comment on how the job is changing, and not for the better. Single crewed fast cars or single paramedic crewed with a 'driver' is the shape of things to come. Ambulance Techs are 'encouraged' to pass the paramedic course, or think about leaving. So its not just your area, Spence, its happening all over the country.

Mrs M said...

It's a good post, an important issue. So much of care is about how you speak to people, what you decide not to say as much as what you do. I've been on the receiving end of some shocking statements in the midwifery care I received; so I'm damn sure I'm never going to tell a teenager mother her baby's life is ruined before it's started, or a labouring woman that she's not in pain.

But there probably are still midwives and students out there who will.

I'm old-ish for a student midwife; staring down the barrel of my 40s. There are 18 year olds on my course and I'm full of admiration for them because there's no way I could have done this job at 18.

Spence, your student sounds like he could just do with a bit of a talk about empathy and that how to engage brain before putting mouth in gear.

But then you're an ex English teacher like me, aren't you? And we're fussy buggers when it comes to communication.

Spence said...

Hi Anon. Thanks for the comment.

I don't have any beef with the university para course. There are people at work I really respect who came in that way. But I think it's a shame that the uni route has completely replaced the more work-based route, esp. as pre-hospital care is such a practical field. Nothing wrong in doing a degree in it, but I think they should still keep up the IHCD / intensive course route, as that leads to paras who are just as effective in the field.

The change over to response cars is a symptom of the continuing obsession with response times, putting that above clinical outcomes. Another regrettable development!

What are you doing now, Anon? Stil in the health field, or something completely different?

Hi Mrs M. Thanks for that.

I don't think you can over-emphasise the importance of good communication - esp. at scenes where people are distressed. You can accomplish huge amounts just by putting people at ease and making them see you are listening, taking them seriously, treating them with respect etc.

But you're right - there are plenty of younger people doing the job who do have the ability to talk to people. A skill worth cultivating.

I think being an ex-teacher has helped me in lots of ways. One of them is in walking on scene with an authoratative air, even if I don't actually have a clue. I did that in teaching more times than I care to admit!

Congrats with the midwifery course. An excellent thing to do. How many babies have you delivered this year? A few more than my two, I expect... ;0) x

Katie said...

Wow. "More chair than man." I love your writing. I have been reading for several months and find that if I visit your blog, I linger for at least an hour. Your writing is so enjoyable; a capturing of humanity.

Spence said...

Thanks so much, Katie. I appreciate it. I suppose that's my aim, really - to take snapshots of these people and situations - brief impressions, but hopefully with the humanity still intact. Anyway - glad you like them! :)