The Midlife Medic: Status Virginicus

The year is 1987, and I’m styling with my big hair and white canvas jumpsuit, wearing an EMT patch that’s still stiff on my sleeve. En route to the hospital with an adult male patient, I am alone in the back—a place where I’ve not yet logged a lot of solo time.

Without warning his eyes roll back, and he stiffens. His arms and legs flail violently, he rolls to the side; the gurney straps keep him from flipping off the stretcher and onto my lap. I call out his name—no response. My partner starts asking whether or not she needs to pull over. 

I can’t answer her—I’m too busy climbing to the highest point of the ambulance. I start calculating our road speed and wonder which door will be best to throw myself out of should he come off that stretcher and try to remove my arms or eat my brains. 

Then it all stops. He lies on the stretcher quietly, awkwardly limp and snoring, a small amount of foam around his lips. Now I’m the one shaking. What in the hell just happened?

If you answered, “He had a grand mal seizure,” you would be correct. If you laughed because I did not recognize it right away, that’s OK, I laugh at it too—now. At the time, however, I was an 18-year-old kid who had never seen a seizure before.

I was status virginicus—plenty of book knowledge but not enough personal experience to put a physical presentation with a list of symptoms I could recite cold. Back then all I had was a book definition to tell me what a seizure was.

There’s a wild card in even the most robust clinical education, and that’s the patient. You cannot hew to a series of benchmarks with a deadline if you base them in specific patient categories.

EMS dogma dictates that the patient you need to see will be the least likely case to occur during your entire rotation. Until you can actually get your hands and eyes on one, you must rely on other methods to learn about patient presentations. 

The information age has gone a long way to help mediate this gap. The Internet and its instant access to infinite information allows current providers to review not just realistic signs and symptoms but real case presentations where they can see and hear visual and auditory cues that will allow them to put an accurate clinical picture together. Simulation technology today is amazing and gets more realistic every year. That missing piece, the hands-on, gives students the ability to integrate patterns into recognizable presentations in a safe learning environment.

Even with these advantages, every provider must still face their first. Whether it’s a grand mal seizure or a pediatric cardiac arrest, there comes the moment when they need to put all that practice into application.
Intuition allows us to understand things without conscious reasoning, but only if we’ve seen or experienced something similar in the past. For those with previous experience in a particular scenario, it can become easy to forget just how profound an impact a significant “first” can have on any provider—even when it goes well and has a positive outcome.

Experienced providers may have to spell out clearly what they see to help get everyone on the right track. Often putting a name to it is all that’s needed to keep everyone functioning. Making it recognizable (and now memorable) will help the less-experienced team members come on board.

Not long ago my crew was called for a pediatric cardiac arrest. The case was clinically complex and emotionally taxing. All members of the team performed well, and the patient was ultimately delivered with pulses to the flight team. It went just about as well as I’ve seen such a case go. 

In the back of the truck, with the sound of the rotors still overhead as the helicopter took off, I looked at the paramedic who was starting to sort through the mess on the bench. She was pale, her lips pressed together. I asked her if she was OK.

She burst into tears. “Please tell me I didn’t kill that little boy!” 

I immediately reassured her that she did not kill him, and we went on to debrief for quite some time. Inside, I was taken aback. While it was a sad case, I was satisfied with everyone’s performance and even proud of how well the younger staff had done. Yet here she was, convinced that one small error she’d made had impacted this child’s resuscitation. 

It was her first.

I have seen way too many children die. It never gets easy, but it becomes recognizable, and you can learn to accept your role and function to the best of your ability. She had seen precisely one.

Something that is routine to you may be devastating to the person sitting next to you in the truck. When they appear lost or seem like they’re not keeping up, remember that everyone has a first.

Be gentle. 

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