Monday, February 08, 2010

Internal Momentum

What drives you?

I was asked that question recently by someone I used to deal with pretty regularly. A nurse that I’ve known for nearly twenty years. She is still licensed as a Paramedic in addition to having her nursing credentials. And she is one of the biggest pain-in-the-ass people that I have ever known simply because she’s so incredibly energetic. And she wanted to know why I do what I do.

I had to think about it for a while. After all, I really hadn’t considered what it is that moves me forward in a long time. We all have something that keeps us going and that makes us want to get up and live each day. At least most of us do, or should.

Once I really took some time and considered her question, I was able to come up with an answer. And – the answer I found surprised me somewhat, but in considering it further I came to understand what it is that moves me each day.

Simply said, what moves me forward is the love I have for those who love me. And it really is that simple.

There are many, many people who love me. These people care about me, my life, my family, and the work I do. These many people who love me do so in spite of myself and my sometimes unintended efforts to sabotage that. They care every day. And I don’t do enough to acknowledge that. I need to do more.

This is a start.

Further, she asked me why I keep getting up every day to go to the job that I have and why I like my work as much as I do. When she asked me that, I had to laugh because it is an easy question to answer.

I figured out that I enjoy interacting with the people that I see every day that I work. The people that I work with and the patients that I see – even the obnoxious ones  - even the difficult and dangerous ones – make it worth doing. It’s not always about the skills that I use or the knowledge that I get to apply in whatever situation I find myself in. The most important thing about my job – probably the most important thing that I do – is exercise compassion and caring in taking care of whomever I have in my charge.

That doesn’t necessarily mean being “soft” – that is normally not appropriate when dealing with most of the people I see. It’s often about being honest. Being considerate. Answering questions when they’re asked. Explaining what’s going on. Providing intervention that is appropriate for the complaint and the condition. Making sure that the patient isn’t harmed further.

All of these things are incredibly important as well as necessary. But there is one thing that most of the time needs to be done, and it goes an incredibly long way. And it’s simple.

Be nice.

As I said, it goes a long way. And if you think about it, what is that patient going to remember most? Are they going to remember that you treated them with Oxygen, IV fluids, cardiac monitoring, and medications if they’re appropriate? Are they going to remember that you performed a thorough assessment on them asking them many questions that ED nurses are going to also ask once the patient arrives there? They may. But that’s not where I’m going with this.

The one thing that any patient will remember, more than anything else, is whether or not you treated them with respect and dignity during the trip. They will also remember if you were polite. And they will appreciate it.

I had an experience recently that brought this home to me. It did so in a positive way, but it still made me realize how important these things truly are. An 89 year-old female with a myriad of medical problems. She was recently an in-patient at one of the Boston hospitals being treated for dehydration. When we arrived at her home, she was complaining of nausea, vomiting and diarrhea that had been going on for two days prior to this encounter.

We found her sitting on her bed, fully dressed, alert and oriented appropriately and able to answer questions and follow instructions. She was slightly pale but she was dry and warm. She had extreme kyphosis – I have no idea what her height was prior to her back becoming humped, but she also was very small. She didn’t weigh more than 90 pounds.

I introduced myself and started asking her questions trying to figure out what was going on. As soon as I saw her and her surroundings I knew that I had to be careful with her. She actually appeared to be rather affluent; after all, the place where she lives is an exclusive complex of condominiums that sit in two very tall buildings. She also had a home care companion that was actually really helpful to us – a pleasant surprise, to be sure. But it was also apparent to me that this patient was acutely aware of what was going on. She was able to give me a considerable amount of information herself.

Would I have behaved any differently if this patient were suffering from dementia or some other cognitive impairment? Maybe a little; if anything I would have probably needed to exercise even more patience than normal.

She was also complaining of some discomfort to her chest, which she told me was going on for most of the day prior to our arrival. Denied difficulty breathing or dizziness. Vital signs were actually not horrible – the only thing that was different was her blood pressure which she told me was higher than it normally would be. The cardiac monitor showed a sinus rhythm and a 12-lead ECG showed some abnormality with the anterior chest leads. Not a huge issue, but she had some T wave abnormality that may or may not have been her baseline. Her blood glucose level was at 148, which wasn’t terribly unusual. And her Oxygen levels were near 100% on room air.

Transport was totally uneventful. I gave her 4 baby aspirin during the ride to the hospital. IV access was not possible because her vasculature was incredibly brittle. Even though she was Oxygenating well, I did give her some supplemental Oxygen during the trip in.

What was most significant about this transport wasn’t the things I did to treat her. It was the interaction she and I had. She was actually rather interesting to talk to, and it was, strangely, pleasant.

When I turned her over to the attending physician at the ED, she squeezed my hand, thanked me, and said, “this was very nice. I appreciated being taken care of by someone who has such a good sense of humor. And you’re very diplomatic, too.”

That made me smile. And it is stuff like this that drives me.


Susie Hemingway said...

What a great post!
I could relate to the first part so well and it made me think carefully about why I get up and continue a long daily battle - it is all about loving someone more than yourself and yes how true about the trust they have placed in you to do your v best for them. Something that comes from courage you seem to find from somewhere, when it's most needed.
You may enjoy my poem "All Is Love" that relates to this I feel.

The second part of your post made me think carefully of the many medics that have arrived here at our home over the last few years and YES you are so right the ones I clearly remember are the guys or lovely ladies who were so tender and careful and took time to listen to the needs of the patient and his carer. Those little comforting remarks and gentle gestures to one who is already frightened about movement with badly damaged bones. Very often the confidence shown by those attending also helped greatly restores normallacy and calm once again. What a skill that is.

And I know for sure that all we need in times such a these, is a most caring person such as you to arrive at our door.
Many thanks for all you do for your patients daily - what would we all do without people such as you.

TOTWTYTR said...

For years I've been reading studies that show that nice, but less competent doctors are sued less often than nasty, but very competent doctors. Which to us might seem odd, but "bedside manner" goes a long way with patients.

There's a lesson in that for EMS providers. If you're good at what you do and polite while you're doing it, you'll have a long career and spend little time writing incident reports.