The Lesson

     EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     You and your partner, Jeff, respond to the private residence of Bill and Yoko Zimmerman, an elderly couple who live not far from your suburban station. Jeff is a six-year paramedic who normally works in the busiest downtown part of your response area. He's not a bad guy, but he seems a little rough around the edges. He has a habit of talking about how things are in "the city," as though that's someplace far away, and the fact that you ain't there means you ain't diddly.

     Mr. Z awakened from a nap this afternoon with nonpleuritic chest pain, and, even from across the room, he looks pretty sick. The vitals taken by the engine company don't look good, either. Only trouble is, Mrs. Z wants you to take her husband to a hospital 13 miles away, because that's where his doctor practices. In rush-hour traffic, that will take about 45 minutes, but she's adamant about it, and Bill nods his assent. Your partner reads the firefighter's vitals, defers the physical exam, waves off the ECG, and, without a word to the patient or his wife, elects to begin loading. Actually, he leaves the mechanics of that task to everyone else while he gets on the phone to an ED about two miles away.

     When Mrs. Z hears the name of the closer hospital, she immediately tries to interrupt him. Without a pause in his phone conversation, your partner grabs her wrist with one hand and twists her arm, forcing her backward and obviously hurting her. That escalates everything, and the elderly couple become tearful and angry. With a dismayed look at your partner, the fire captain intervenes, and you join him. But the damage is done. Despite your best efforts, the Zimmermans order you all to leave their home.

     Q. You're astonished, and you let your partner know it. But he seems completely unfazed, as though the call's outcome seems about right to him. You're sure this needs to be reported as an instance of outrageous behavior that is certain to produce a complaint, or something worse. You don't want to get in this guy's face, because you have to finish the shift with him. What should you do?
     A. Well, maybe you have to finish the shift with him and maybe you don't. Being an EMT means advocating for people. Your partner has just demonstrated that he is a Martian. You don't need to get in his face. Just pick up the mic and call for a meeting with a supervisor. Keep your emotions under control and tell the supervisor what happened. Provide details about the engine company and the patient.

     Q. What if your partner objects to your concerns?
     A. Inform him that, in your opinion, he just exhibited the sensitivity of a fecal pellet, jeopardized the physical well-being of two citizens and exposed you to personal legal risk. Remind him that you have the right to consult a supervisor any time.

     Q. What makes some of us act this way?
     A. There's so much we just don't know, but read the headlines. There is a force of evil in this world, both conscious and purposeful. Like gravity, it's not something you think about much. When you experience it day after day, you underestimate it, take it for granted, forget it. Some believe it's just a myth, but if you spend just a few years in EMS, it seems plenty real. You grapple with it often, up close and personally. It universally targets the people and the ideals we value most, and makes them seem unimportant and irrelevant. It hides in the hearts of heroes and muddies the aspirations of leaders. And it fosters the illusion in good people that they're insignificant and their worthiest pursuits don't matter.

     I think it's what keeps addicts addicted, convinces loving spouses of 20 years that they just can't last any longer, and prompts talented caregivers to do things that are cynical, judgmental and mean. Deep in our souls, it can rust away the goodness and the gifts we were born to share with others.

     But look around you. There are 20-year caregivers everywhere who obviously haven't allowed that to happen to them. They are kind, perceptive and gentle and still seem to see the dignity in others and persist in serving them well. They have learned and relearned what we should never forget, and that's this: EMS will never be about us. But over the span of a lifetime, even when we can't see how, our best efforts absolutely do matter, sometimes long after we forget all about them.