The Paramedic Face

“You don’t take anything seriously, do you?”

That observation was made to me during a resuscitation not long ago. The comment was delivered with a smile and a chuckle, but the joke that occasioned it had the intended effect. People relaxed and focused on the job at hand rather than what was at stake.

That’s what I do.

Pediatric calls, cardiac arrests, multiple casualty incidents, anywhere feces are flung by spinning blades…people seem to look to me to take the leadership role, even when there are those present who are much higher on the medical pecking order. It’s not a role I actively seek, but it seems to be one I fill quite often. And then those same people make the observation that perhaps I don’t approach the responsibility with the proper degree of gravitas…

They want me to put on The Paramedic Face. The one that is confident, but serious. Competent, but compassionate. Perhaps from watching ER, Third Watch and the like, people are conditioned to think that leadership in crisis situations involves people barking terse, clipped orders:

“Okay, I need a CBC, lytes, chest film and a thoracotomy tray STAT! Let’s move, people!”

Riiiiiggghhhhttt….

I’m more likely to ask for something than order it. I’m more likely to say “Thank you” and offer encouragement than I am to bark at people to hurry up. I make eye contact with people and give specific instructions. I use the word “we” a lot. I’m more Tony Dungy than Mike Ditka.

That’s just the way I roll, people. Sorry it doesn’t make for good television. Barking orders doesn’t inspire good performance, it just makes people tight. It increases the pressure in an already pressure-packed situation. Shouting at people to work faster just makes them work slower. Smooth is better than fast any day, and smooth is fast all by itself. It seems counterintuitive, but slowing down can make things happen more quickly and efficiently.

So when someone is struggling to get an IV on the sick, crashing kid…I may throw in a tension breaker.

“Good news, everybody…(long pause and wait for the expectant looks)…I just saved a buncha money on my car insurance by switching to Geico!”

It’s that spotlight that cuts through the fog of panic. Everyone can go about their tasks with a clearer head. But while everyone else is chuckling, I’m working on that intraosseous line. I’m preparing to secure that airway. Thinking, planning, assessing…

Never mistake the smile on my face for a lack of appreciation for the gravity of the situation. I have always thought of Patch Adams as a bit of a quack, but the man did realize the value of humor – for the patients, staff, everybody. If you can make a sick patient laugh, you have Done Some Healing.

If you can make yourself laugh, you’ve added another layer of armor to keep your soul from getting scarred. Like Matt G said in his blog, sometimes you just have to thumb your nose at The Reaper.

You know who my medical role model was? It wasn’t Johnny and Roy.

It was Hawkeye Pierce. He was the most brilliant, gifted and committed surgeon in the MASH 4077th, and he never stopped cracking wise. Plus, he nailed every nurse in the outfit. He was a swordsman without peer. Hawkeye Pierce was my hero in more ways than one.

I have never found an employer who would allow me to set up a still in the ambulance station, but I’m still looking.

Once upon a time, I treated my best buddy’s wife when she had a heart attack. He was a paramedic, she was an ER nurse/EMT, we worked together frequently. My buddy and I had similar leadership styles. We didn’t shout or bark orders, but we asked for something to be done, it got done. Right the hell then. It didn’t occur to people to question us.

But on her worst day, I was the one to respond in the ambulance to my buddy’s wife. Of all the medics she could have gotten, the only one she would have preferred over me was her own husband. You could see the relief in her eyes.

That relief was replaced by fear she realized from my expression just how sick she was.

AD, I wasn’t scared until I saw you put on your Paramedic Face. That’s when I thought I might die.

I didn’t panic. I didn’t shout. I did everything I was supposed to do, and frankly the only person who noticed my change in demeanor was the patient. But when I Took Charge – capital letters – she knew it was bad. And the fear made her condition worse.

So when you find me joking around and being a bit silly during a bad call, it’s not because I don’t take this stuff seriously.

It’s because I do.

Ambulance Driver