You Can’t Give Away What You Don’t Have

Imagine we were walking down the beach together on a sunny day and I suddenly looked at you and said, “Would you like an apple?”

If you were hungry, your initial reaction might be, “Yes, I’d love one.” But you might also be a bit perplexed. I mean, what if I clearly didn’t have an apple? Somewhere in your mind you’d wonder where the apple was. Did I have one stashed in a pocket? Do I know a good fruit stand near-by? Your next offering might be an awkward sounding question. “Uh … do you have an apple, Steve?” or perhaps, “Where is it?”

When it comes to physical objects the implication is clear. I can’t give you something that I don’t have. It’s not physically possible. Nothing could be more obvious. And that brings us to an interesting point about some of our more non-tangible assets like compassion, patience, kindness and good patient care.

You see, when writing about things like kindness, compassion and patient rapport I’m as guilty as the next guy of falling into “tips and tricks” mode. In the past I’ve written articles about how to speak and behave in ways that help build patient rapport. I’ve listed tips for making the patient feel welcome and comfortable and I’ve extolled the virtues of good listening, kind interactions and compassionate care. But I, like many other EMS authors, have overlooked one simple truth.

None of it  really works if you don’t feel it.

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Beware of “Almost Good Enough”

This article was written in partnership with Greg Friese at Everyday EMS Tips. Greg and I decided to both write on the topic, “You don’t have to settle.” You can find Greg’s contribution here. If you’re an EMS blogger we’d like to invite you to write your own post on this topic. Send me an e-mail an we’ll add your link as well.

What makes you afraid?

When we were kids we were afraid of things like the boogie man, monsters in our closets and thunder storms. As we become adults we got over most of those fears. We recognized them for the irrational and false beliefs that they were and we grow up. You might even say that letting go of these irrational fears is a part of becoming an adult.

Of course, that doesn’t mean that our fears went away. It also doesn’t mean that our big people, grown-up fears are any more rational than our childhood fears were. Just as certainly as kids will be afraid of thunder and dark closets at night, the grown-up boogie man is failure.

Adults fear failure. We take comfort in the security and predictability of success. As a result, we tend to look toward endeavors where success is a near certainty. Playing the game well within the boundaries of our ability is a great way of warding off the fear monster. We get to chose our goals and our challenges. Out on the outer edges of our abilities lies the dark closet where the possibility of failure lies in wait.

I know what you’re thinking. OK, now Steve is going to give us the old, “Let go of your fears and aim for high goals” speech. We’ll not quite. Yes, I think there’s great benefit in letting go of the fear of failure. But I’d like to go a step farther. I think that there is a much scarier boogie man than failure. I’d like to give you something even more worrisome to fear. A monster that is responsible for far more human grief, failed ambitions and shattered dreams than failure. If you’re going to walk around with a gut full of irrational fear, fear this:

Fear almost good enough.

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I Spy

Sometimes it’s all just a matter of what you focus on.

My children like to play a game called “I Spy” while we’re driving around in the car. You probably remember the game as well. One person selects a random object. Something you’re sure the other folks in the car won’t guess. Then you let everyone know what color it is.

“I spy, with my little eye, something … blue.”

And the guessing game begins. There are different strategies to keeping the guessing game going. You can select a common colored item and try to hide your object in the sea of white, blue or gray items. You can also pick something more obscure and force your guessers to use their powers of observation.

I’ve noticed an interesting phenomenon when we chose the second option. It’s trickier than it apperas. “I spy something purple.” This one should be easy.  There’s just not that much purple to pick from. Find the purple thing … win. Next player.

Purple … purple. “Uh, the insigina on the radio?”

“Nope.”

“Huummm. Mommys hair clip?”

“Nope.”

“The digital readout on the thermometer? Your sister’s swim goggles? The letters on my t-shirt?”

“No, No and nooooo.”

Wait, where did all this purple stuff come from? This one was supposed to be a gimmie.

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Connections

Sure you communicate with your patient, but do you make connections? The difference may sound like semantics … but it’s not. The difference is extraordinary.

Do you remember James Burke? He was the plucky, dry humored narrator of the 1970s BBC TV series “Connections”.  James would begin each episode with some historical event like the invention of the catapult and show how it was related to the way we make billiard balls or some other impossible sounding connection. His message was simple and profound. The big idea was that we are interconnected in ways that are complex and impossible to predict. Reality doesn’t flow forward in a perfect linear timeline.  An intricate web of human connections drive history and innovation forward.

Without one minor connection another crucial event becomes impossible. Alter one seemingly insignificant event and you change the course of history.

There is something vital in the way we are interconnected. When we connect, we change each other in ways that we can’t predict. If we simply communicate with our patients and coworkers but never reach out across that gap and connect with them, our work can become dull and routine. On the other side of the gap the patient / caregiver / human relationship is far more fulfilling.

If that sounds worthwhile, let me give you a few tips for making conscious connections with your patient.

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Get to Vs. Have to

Between my blog, Twitter and my EMT class, I have the opportunity to talk to a lot of new EMTs and EMT students. It’s fun to take part in the early energy of learning emergency services. Working with EMT students is an opportunity to vicariously relive the excitement and confusion of the first cardiac arrest or major accident scene.

One thing I’ve noticed as we porgress into our chosen field is what I call the “get to - have to” shift. New EMTs get to do things. “I get to ride along for 8 hours today.” “I got to hold c-spine on scene.” “I get to do all the patient assessments today.” “I get to be the attendant next shift.” “I get my first partner assignment at the end of the week.”

Somewhere along the way we shift. We’re still doing the same job. We’re still running the same calls but somehow, someone convinced us that we don’t have a choice. We may even chose to believe that these things aren’t fun anymore. Perhaps they’re not even worth doing.

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Is What We Do A Science Or An Art?

It’s both. And that can create quite a problem sometimes. OK … often.

Some EMTs are scientists. They see medicine in very linear, protocol driven flow charts. If the chief complaint is X then check Y and administer Z. They like statistics. They talk about efficacy percentages and risk-benefit calculations. If they can analyze the data … they can find truth. Within the beautiful geometry of research they can discover the perfect algorithm of care and believe that, by doing so, the patient will be served.

When it works, science based medicine is a beautiful thing. The problem is … well … it doesn’t always work. We are treating humans. Humans are an anomaly. They are the rouge element in the scientific plan. Human beings are the perfectly imperfect wild card in an otherwise flawless equation.

Some EMTs and paramedics are true artists. They approach each new clinical presentation with a haphazard mix of established treatment and gut instinct. There decision making process may hinge on such variables as the weather, the last EMS magazine article they read and which doctor is on duty at the base hospital. They tell jokes. They inspire movements. They throw together treatments like Jackson Pollock splashing paint on a canvas. They write deviation from protocol addendum’s. They surprise people with their knowledge and, in many cases, they give outstanding care.

And the scientists ring their hands in frustration.

This causes some problems:

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Who’s Going To Let Me?

      … Who’s Going To Stop Me?

I should have expected it. It was to be expected. After two recent posts suggesting people take some drastic actions, I’m responding to a wave of, “but we just can’t” feedback. … Let me ask you something.

Why are you waiting for permission to be awesome?

But we just can’t Steve. If we did this thing you’re suggesting it would be immoral, it would be illegal, it would be unethical. Nobody does that here. I’d be the only one. People think differently where we live. You just don’t understand. That would go against the grain. That’s not the way I’m made.

Sometimes in life we have to ask for permission. That’s just the way life works. There are barriers preventing us from going to far. Part of life is playing by the rules. Your protocols are an example. Your policies and procedures are another.

We are obligated to follow the law of the land. But I find it interesting how often we use these constructs as excuses for why we can’t do anything drastic or unusual. None of these things are preventing you from being better. None of them are keeping you from standing up for yourself, your patient, your profession or your God given right to be remarkable. Stop pretending that someone or something is keeping you from being everything you want to be.

Stop waiting for permission. Especially if you’re taking a stand on what you believe. Gandi didn’t wait for permission to hike to the sea and make salt. Rosa Parks don’t ask for permission to sit in the front of the bus. They simply acted on their convictions. They chose to live lives worth living … their way. And you can too. No more excuses. No more waiting. If you needed permission, I give you permission. Tell them I said it was OK. Go live a life worth living. Go be awesome. Tell me how it goes.

Stop Whining

Yes, I’m talking about you.

We are talking about you being more satisfied with your work right? We’re talking about you being better at what you do and accomplishing more and getting more of the stuff you want and less of the stuff you don’t want in your career right?

Perhaps I should have mentioned this earlier. There is one little essential detail to the whole equation. You have to stop that annoying habit of whining about stuff. How do I know you’re a whiner? Because, for the most part, we’re all whiners. We all do it. Sure there are different degrees of whiners. Some folks are world class, champion whiners and some folks are merely amateur whiners who only dabble in the complaining arts on the side.

I’m looking out for you here when I say this, really. It’s time to stop. Why, you ask, should you give up your beloved complaining? Well, there are a whole bunch for reasons. Here’s the big one. You’re never going to reach your real potential as long as you’re stuck in the destructive habit of whining about stuff. It puts you in the totally wrong mindset.

Here are a few of the reasons you need to put a pacifier in it.

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What Makes A Great Partner?

Everyone has their own idea of what makes a shift a good shift. Each of us carries our own magic recipe. Perhaps a little trauma with a dash of cardiac thrown in. Add a choice rig from the fleet and a dispatcher who still remembers the last burrito run you made for her. Sprinkle liberally with just the right amount of down time and voila!

Wait. We’re missing the most essential ingredient. A great shift can never be a great shift without a great partner. That’s the best thing about EMS, all the awesome characters you get to work along side. Some would say that when your mixing your recipe for a great shift, your partner isn’t the most important factor, it’s the only factor. I tend to agree.

Think about it. You could give me the worst shift schedule and the crummiest rig in the fleet. Make me run the worst calls that come. Hold me over late. But if you give me the right partner, we’re going to have some fun. There’s just no stopping us.

The inverse is true as well. Put me in the best medic unit on a prime shift. Dispatch me to the most cherry-picked calls and send me in early when I’m done. But if my partner’s some serious, stick-in-the-mud who couldn’t find fun if you stapled it to his forehead, guess what? It’s going to suck. There’s just no nice way to put it. The partner makes all the difference.

So I got to thinking … no really. What makes an awesome partner? Here’s my list.

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Unconventional Thoughts On Emergency Services

 

Once in a while it really hits people that they don’t have to experience the world in the way they have been told to.”
-Alan Keightley

You chose an unusual career path. it would be a shame to think about it in an ordinary way. Here are some thoughts to ponder about your chosen career path.

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