Things I’m Good At:

1. Patient rapport. I just know how to talk to people. I can’t explain how or why, but I just instinctively know the right tack to take with people. My speech patterns and demeanor change with every patient. I can keep it real with a thug from the block and then, without missing a beat, walk across the hallway and have an erudite discussion with the white-collar professional about his abdominal symptoms – and each one of them will swear that he’s seen the Real Me. I wish I could explain how I do it, because then I’d be able to teach it to my students. I don’t know whether it’s the ability to read people or whether it’s all in my delivery, but I can get away with saying things to patients that no one else would dare. Like my mother once said, “If you can’t save ’em, at least you’ll convince them what a privilege it is to die while in your care.”

2. Airways. Any airways. All airways. I can fall down a flight of stairs and accidentally intubate five people on the way down. I am Ambu–dextrous – I can hold the mask seal of an Ambu bag with both hands and squeeze the bag under my arm without breaking a sweat. I’m confident administering paralytics (well, as comfortable as anyone can be when giving a drug that converts a compromised airway into none at all), yet I’m not too proud to drop an oral airway and BLS it if that is what’s necessary. Managing airways is my thang.

3. Calmness and choreography. I always tell my students that the choreography of a code is just as important as the skills and knowledge of the people working it. To choreograph the intricate ballet that is a resuscitation or a chaotic scene, the leader has to remain calm and thinking three dance steps ahead of everyone else. Sometimes it seems that everything else slows down while my mind tends to speed up. My decision making is almost languid.

Things I’m Not So Good At:

1. IV access. If I’m Supermedic at everything else, I am Clark Kent with an IV needle in my hand. Frightfully, shamefully, disgustingly average. Whenever I feel my ego growing out of control, all I need do is find the nearest fat lady who needs an IV right now. Four sticks later, I’m humble again, and the aides are pulling the bedsheets out of her ass. On the other hand, I’m really good at sticking kids. That whole patient rapport thing, I guess.

2. Understanding metabolic disorders. Not that they’re beyond my grasp, but I need to be better.

3. Disagreeing with someone when I *know* I’m right, without sounding condescending to that person. And yes, I do take time to reconsider the rightness of the position I’m defending. But when I *know* I’m right, it’s a struggle not to behave like an arrogant ass. Yeah, it’s shocking, I know. Me, an arrogant ass?

Things I REALLY Suck At:

1. Reasoning with drunks. Psych patients I can deal with. Despite my professed cynicism and world weariness, I’m an empathetic fellow. I’m like Bill Clinton, except that I really do feel their pain, and I’ve never tried the disappearing cigar trick. And I’m reasonably honest. And decidedly un-liberal. And a gun nut. Okay, let’s just scratch the whole Bill Clinton simile.

But while I can empathize to a certain extent with the anxious/depressed/mentally disturbed because I’m good at the aforementioned patient rapport, I can neither speak nor understand drunkese. Moreover, I have no desire to learn. Mugwug said it well in his blog:

I’ve found over time that I don’t actually talk to the problem children, drunk-ese is my second language, but my comprehension of it is limited severely by my characteristic apathy. Drunks tend to spin tales of woe filled with serpentine logic and non sequiturs that would leave me scratching my head for hours if I was actually listening. I simply nod, make the odd concerned noise and return to the point in the script where we left off before the drunk wandered down fantasy lane.

I’d rather just keep ’em paralyzed, put ’em on a vent and park ’em in a dark corner somewhere until they sober up and start speaking in anything but Jim Beam. But that would be unethical. Instead, I just get short and ill-tempered and entertain dark fantasies about punitive Foley catheters.

2. Empathizing with malingerers. I don’t even include drug seekers, at least initially, in this list. Withdrawal hurts, and I can understand to a certain extent the lengths that a seeker will go to for a fix. I believe that drug and alcohol use is ultimately a personal choice and not a disease, but then again I’ve never been addicted to anything. I may be full of shit. So I take the middle ground – I empathize, but I don’t necessarily feed the addiction.

But while a chronic pain patient who is out of his Lortabs may be stupid for not getting his prescription re-filled in a timely fashion, it doesn’t change the fact that he is still hurting. So I have no problems giving them a narcotic to tide them over until they can see their Doc. Doesn’t bother me in the slightest.

But if I see them continually for the same problem, they get lumped into the Malingerer category with all the other oxygen thieves who insist on using EMS and the ER as their personal 24-hour free clinic/pharmacy/confessional/medical advice/taxicab/group therapy.

My personal mantra to these people: “If you want sympathy, look between shit and syphilis in the dictionary.” I may have to treat them, but I’ll be damned if I’ll pretend to like it. And I let them know I don’t like it.

In a nice way, of course.