The Little Picture

“Pay attention!”

I must have said that to my daughter dozens of times during her primary-school years, when her mind wandered instead of staying close to the rest of her. Nothing unusual about that; I’ve seen pulse checks last longer than most kids’ attention spans. When children do focus it’s usually on their terms, and only until something better comes along.

I wasn’t worried Becky might one day “overdose” on concentration—that she’d be so intent on completing a single task, she’d lose track of everything else going on around her. Only one person I know has a serious case of that disease:

My name is Mike, and I have tunnel vision.

There, I’ve said it. Those of you who used to ride with me probably already know. Just ask my wife. She’ll tell you about the time she was waving at me while we were treating an elderly supine male in a filthy apartment. At least I thought she was waving. Turns out she was swatting—gnats, enough of them to have carried the patient to the ambulance by themselves, she told me later. I was too busy taking vitals and wondering why no one was helping me. I swear I didn’t notice any life forms smaller than Helen.

Then there was the morning I asked her if she’d be making coffee—while I was holding a cup of it. No doubt I was thinking great thoughts at the time, but that didn’t discourage Helen from wondering aloud if I’d suffered any concussions she wasn’t aware of.

Tunnel vision is a tendency to miss something really important while fixating on something less important. The narrower the “tunnel,” the more you miss. If there were a Borg scale for tunnel vision, with “1” as a tunnel the size of your basic school corridor and “10” as the inside of an 8.5 endotracheal tube, I’d register about a “7”—say, the cramped sewer pipe that guy crawled through in The Shawshank Redemption. I can be very attentive. If you find me unresponsive, please don’t pronounce me until you’re sure I’m not just concentrating.

I pay too much attention to lots of things—like how I’m writing. I mean right now. My preoccupation with wordplay is an excellent example of one man’s focus on the little picture. Does little sound better than small? Was cramped a good adjective for a sewer pipe? Don’t worry, my editor and I will have it straightened out by the time you read this.

Sometimes tunnel vision really means tunnel vision, as in the underground kind. I’m remembering one of those otherworldly “man under” calls in the New York City subway system. I was so fascinated at being track-level, I forgot to ask whether the juice had been shut off until I was straddling the third rail.

When one has feet on either side of a lethal power source, a rhetorical question from a police officer about electrocution is not what you want to hear. I didn’t dare resume a position of comfort until a train worker stepped on the rail to prove it was safe. What a guy. I bet if he were a medic, he’d cardiovert himself just to show a patient it doesn’t hurt much.

It isn’t hard to spot medics with tunnel vision; they’re the ones on scene mumbling “just one more, one more” while pointing unsheathed angiocaths at patients’ exposed limbs. It’s probably best not to get in their way unless their IVs have already taken longer than a trip to the hospital would have, or no one can remember why an IV was ever needed.

I’m pretty sure medics with tunnel vision get lots of “what is your problem?” looks from partners. I wouldn’t know because tunnel vision prevents me from noticing. To those of you who enjoy rolling your eyes at someone else’s plight, let me just say…uh…I can’t remember what I was going to say. I’m still thinking about that tunnel-vision Borg scale, and whether a “10” should be a 14-gauge catheter instead of an ET tube. Just give me one more minute…

Tunnel vision isn’t all bad. Sufferers tend to conduct very thorough patient interviews—about childhood illnesses, recurring dreams, favorite colors—and can complete important tasks without being distracted by loud music or funnel clouds. It’s that short-term disconnect that occasionally compromises big-picture priorities, like survival.

The only hope for families with the tunnel-vision gene, I suppose, is for parents of afflicted children to employ a rather unconventional form of negative reinforcement:

“Pay less attention!”

Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.