The Midlife Medic: Pony Up

One of the questions I’m asked about my decision to relocate to Alaska from New Jersey is “Why?” It’s been a year and a day since I got on the plane for Anchorage. Very few knew I was going, and I was missing the funeral of my friend and mentor, Walter Drivet, to do it. As Walter was being carried out to the mournful thrum of bagpipes along lines of pristine white gloves raised in crisp salute, I was staring at the fog-shrouded Chugach Mountains and wondering what the hell I was doing. My friends, my career—everything I knew was back on the other side of the continent. My job was secure, my mortgage being paid—why would I risk all of that? I mourned for my friend alone, terrified of what might happen to my life because I said yes.

I was even more afraid of what would happen to my life if I said no. As I stared blankly at a landscape as gray as I felt, my thoughts went back to an earlier time when I felt equally as lost. I was a 20-year-old kid and had no idea what I was doing.

I squinted against the scene lights as I lugged the equipment, dutifully following my preceptor to the side door of the truck. Walter stepped back, and I peered in. A tall, thin man struggled on the backboard, his back arching as the EMTs worked to secure and suction him. The profile was wrong—from where I was looking, the shape of his head did not make sense. I heard the words “shotgun” and “face.” The guy groaned and gurgled as they suctioned and manipulated the macerated flesh around his mouth.

In a small way I was relieved at how bad it looked—there was no way a student should try to manage that. I looked at Walter, the red lights reflecting off his bald head. Without missing a beat, he indicated the captain’s chair and said, “Go on, get in there.” I remember laughing incredulously and staring at him. I think I asked him if he was crazy or possibly hypoglycemic. His face grew serious, and he said to me, “You don’t get to pick the patient, you get to manage them. Now pony up and get in there—that kid needs an airway.”

Pony up. Put up enough money to stay in the game. Invest yourself, knowing that ultimately it’s a game of chance and you won’t know what the return will be. In the years since, I have used that same phrase to other people who were lacking confidence and afraid to commit to a decision or action. It brings me back to that critical moment where Walter taught me that it wasn’t the act, but the decision to act that was important. He is part and parcel of all my success as a paramedic and the reason I continue in the field today. There are plenty of instructors out there, but true mentors are rare and a thing of professional beauty. Appreciate them and endeavor to be one. There is some small thing you know or have done that will help a new provider find their feet—be willing to put your hand out and help them.

That kid, the one with no face? He got an airway.

A generation later I sat on the bench seat, quietly coaching my student through an intubation on a patient with significant respiratory burns. I watched the fear turned to focus, then to confidence. In that moment I was just a small part of Walter’s legacy, his gift to those who will come next.

Edwidge Danticat wrote, “In the Haitian vodou tradition, it is believed by some that the souls of the newly dead slip into rivers and streams and remain there, under the water, for a year and a day.” He says they can then be lured out again. “The spirits can also hover over mountain ranges, or in grottoes, or caves, where familiar voices echo our own when we call out their names.”¹ I can think of no place with more mountains than where I am right now.

Your years may weigh on you at times, your experience may steal your sleep and rob you of your peace on the odd night, but it is in the twilight where these moments are. Take the chance on the student, encourage the young provider, help them learn their craft and apply it with critical thinking, compassion and humor. Remind them that they do not get to pick their patient, they get to manage them—and that you have their back.

Watch the fear turn to focus when you tell them to get in there and pony up.

It has been a year and a day.

Walter Drivet—EOW 08/28/2015

Reference

1. Danticat E. A Year and a Day. The New Yorker, 2011 Jan 17; newyorker.com/magazine/2011/01/17/a-year-and-a-day.

Tracey Loscar, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, AK. Her adventures started on the East Coast, where she spent the last 27 years serving as a paramedic, educator and supervisor in Newark, NJ. She is also a member of the EMS World editorial advisory board. Contact her at taloscar@gmail.com or www.taloscar.com.