Flying Monkeys

EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. 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. We don't know everything, but we do know a lot of smart people. 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.

Mrs. St. Laurent is a 45-year-old woman who called you tonight complaining of moderate-intensity, colicky chest and upper abdominal pain. It seems anything but cardiac, but you've considered that anyway. The 12-lead is unremarkable. She's fat, female, 40 and fertile, with a history of worsening discomfort and some vomiting times 3 days. She denies any history of trauma, her vitals are within normal limits and she's not febrile. You're thinking gall bladder, and you probably should be.

At the neighborhood ED, you encounter a nurse you've known for years. Your interactions with her have always been cordial, but today she acts as though she's never met you. She essentially ignores your report, orders a CBC and labs and calls for the physician. She's obviously thinking cardiac. You're careful to state that the patient's last menstrual period was two weeks ago and she takes no meds, but the nurse appears burdened by your every word. For an instant, you imagine her in ruby slippers and a pointy black hat, and surrounded by flying monkeys. The image really fits, and you struggle not to smile.

Q. What's with her? Did you forget your deodorant today? Did you contract leprosy overnight? And what is it with your calls lately? There seems to be a question around every corner, and you've had three complaints in the past month. You're sure you're a good EMT, but in recent weeks you've been doubting yourself.

A. You may have forgotten your deodorant, and you may need to switch brands. You may even be a leper, but don't worry. They have pills for that nowadays. Don't give away your possessions, just yet.

First of all, questioning oneself is something every professional should do routinely. But don't get down on yourself. Everybody goes through runs of bad calls. It happens because you're not perfect, and the people you work for are all having the worst days of their lives. Put those two things together and you inevitably find yourself going through some good times and some bad times.

Q. What about the complaints? I don't usually get complaints, and our department head considers complaints during our performance appraisals.

A. You have a smart department head, especially if they consider compliments along with complaints. The complaints should be especially important to you personally. Each one is a chance to look at yourself through the eyes of an EMS expert. Sometimes they're simply not warranted (for instance, when the "expert" is in crisis), but they're always important. Complaints are part of a professional caregiver's "vital signs." If we're smart, we use them to make adjustments in our practice.

Q. What got that nurse so twisted up? You're sure you didn't say or do anything wrong. It's like she morphed into somebody else.

A. Even wonderful people go through bad times, including those who don't have tough jobs - and hers is a doozy. A busy ED is like a zoo with faulty latches on all the cages. You never know what's gonna break loose. But you can hop in that bolance and get away from stuff between calls. An ED nurse has to stay with the animals. More than that, sudden changes in people's demeanor always suggest personal catastrophes. And good nurses are like good EMTs in one special regard: They're sensitive. Sensitive people get hurt big-time, even by little things. Stop by a supermarket and get her one of those inexpensive mixed flower bouquets. You could ask one of the ED clerks to deliver it to her for you, so as not to make her feel awkward. As Aesop once said, no act of kindness is ever wasted. No matter how small.