Guest Editorial: Three Little Words

The interventionalist sat on a chair in the corner of the room, holding my test results in his hand, long legs crossed and foot swinging. He was high-speed, low-drag—you know the type, short on patience but sharp in ability. When he realized I was fluent in speaking medicine, he visibly loosened up, answering my questions with blunt precision and a side of dry humor I appreciated. He gave me his recommendations, discussed (and dismissed) options, and threw numbers at me. When he was satisfied we agreed on a plan, he left the room with purpose. 

I watched the swing of the curtain as it closed behind him. It’s amazing the illusion of privacy that swath of ugly fabric gives. He’d had all my attention, and now the sounds of the ICU trickled back in and reminded me where I was. 

I had just agreed to have an urgent diagnostic cardiac catheterization done.

I know how PCI works; I’ve seen it done plenty of times. I was directly involved in developing a prehospital activation program. It saves lives. I am a believer.

I also realize I have no true idea what’s about to happen to me.

Part of our job is to advocate for a system with which we don’t always have firsthand experience. Depending on where we work or went to school, our education and experience exposes us to many different facets of healthcare. From the cadaver lab to the cath lab, everyone does their time in scrubs. 

Navigating the hospital environment is like being on safari. This world is foreign to you. You’re used to a stretcher and some gear, transferring to another stretcher with better lighting, then getting out again. Now you’re ducking around IV poles and wires while listening to the chirps of alarms coming from seemingly everywhere, peering around corners or through windows into ORs, ICUs, and morgues. Clinical rotations and interfacility transfers give you an appreciation of the world outside prehospital care. You learn all sorts of things, from how to scrub in to central-line maintenance, what the alarms mean, and how to maneuver patients on vents for procedures.

It doesn’t teach you what it feels like.

Unknown Territory

Only minutes had passed since the interventionalist left, but it felt like ages. I was sitting cross-legged on the bed, my IV lines fanned out in both directions. Providers as patients are an interesting breed, a cross-section of just enough knowledge to be a pain in the ass, control issues, and stubbornness. I try pretty hard to be low maintenance. I’d gone through a lot of tests and treatments in the last day and been forgiving and cooperative. This is all stuff I know how to make easier. IVs, EKGs, multiple blood draws, moves to and from stretchers—piece of cake. Except now I was going into unknown territory.

My husband was on his way back from the other side of the state. In Alaska that meant a three-hour flight. He wasn’t going to make it in time. I’d been dealing with this issue alone for 24 hours. I sat there staring at that beige nonsense of a curtain, frozen as all the possible outcomes played out in my head, followed by what that could mean for my family. My confidence evaporated. I picked up my phone and sent him a text. Just three little words.

I am afraid.

Staring at the screen, the enormity of those words struck me. I’m not supposed to be afraid, not of this. We are the heroes, the faithful, the clergy, the purveyors of calm, the bringers of order to the chaos. When the elephant squats on your chest in the middle of the night or you find yourself tangled in the metal that was your car, we’re the ones who wipe the cold sweat from your face, stop the bleeding, and prepare you to enter the systems that will hopefully save your life. 

Yet this wasn’t an anonymous patient anymore, this was me, and I was scared. A primal, amorphous black fear of all the feelings I didn’t know and things that might happen. I couldn’t speak, and stupid tears fell unchecked as I let it roll through me. I was a panicked mess, and it took me a while to calm down again. 

The procedure went very well, and I can now say I know what it feels like. What I was left with, besides a small scar on my wrist, is this:

If someone of my background, in the presence of capable help and with a full understanding of my treatment, could become that frightened, then what does that mean for the average patient faced with catastrophic illness or injury that requires (any) treatment?

It means we must remember that for every person there is a first. It’s a reminder that these things we do so easily each day, these simple procedures and tests, may be utterly foreign to the person on that stretcher. The blood pressure cuff can hurt if you haven’t had it done before; the squiggles on the screen could mean a fatal event if you don’t know how to read them. 

So when that patient resists, instinctively pulling away or becoming suddenly uncooperative, when their conversation is guarded or they become argumentative, take time to consider: Maybe it’s nothing more than fear. 

Ask them three little words: “Are you afraid?”

Take the time to explain, answer their questions whenever you can. Involve them, give them choice; even the illusion of some control can help calm the panic that might be seeping in. Even the smallest of interventions can bring the unknown with it. 

Take it from me, the unknown is a pretty scary place. 

Tracey Loscar, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska.