How I see it isn’t how you might see it – September 2015
My partner passed the endotracheal tube into the patient’s mouth and down into the trachea. The route to his lungs was now clear and we could breathe for him freely. This was good. Very good. My partner looked up at me in a lather of perspiration. I nodded grinning almost maniacally with shared celebration. We actually high fived each other, certainly not something I have done a lot of at callouts. As we looked around, the family of the patient immediately broke into hugging and their own version of high fives. They more than shared our enthusiasm and celebration.
In return, my partner and I stared at them aghast. We both broke immediately into a stream of gestures all designed to quash any such celebration. The family did not speak English making this a real challenge. Why would we want to celebrate so obviously and visibly yet desperately not allow the family to also do so?
It is onerous on all paramedics to remain vigilant to the mismatch between their own emotions and those of the people involved in any callout. A cardiac arrest resuscitation is likely to be very exciting to many paramedics. Practised skills to perform, being tested for real in human drama and the prospect of making a real difference ensures this.
From the family members point of view though the events are horrifying. They are welling with a range of agonising emotions and will offer almost anything to be allowed escape somehow. Even from a bystander point of view, their stereotyped expectations honed from so many television dramas load up in advance what they expect to witness. In either case, the paramedic and all others are starting out from very different places.
Paramedics need to not only be aware of this, but always act driven by this knowledge.
It isn’t uncommon to hear ambos chatting to each other at callouts about all manner of unrelated events. Sometimes it can be like old friends catching up which might be just what it actually is to them. However business as usual isn’t that at all for the family and patient. Even guarded whispering can be a risk if misinterpreted.
At times even when you are totally focussed on the callout, you can still find yourself in a different mind space to the patient. You nonchalantly inform them they need an injection and to go to hospital just as you have so many times before. All they hear is a painful therapy and the terrible news that it is worse than thought since they have to go to hospital. You feel all is under control, they feel the world is starting to spin out of control.
I recall once sitting across from a patient who was sitting on the floor. He was in a poor way with great difficulty breathing from his asthma. I sat down before him and prepared to insert an IV into his arm to allow me to inject him with necessary medication. As I pulled the IV out I noted that my partner had handed me a ‘long 14’. This needle is almost as big as an IV can get. We joke that it is a small sword and should even make a swooshing sound as you withdraw it from its plastic ‘scabbard’. Of course it doesn’t really but this makes the point of how big the needle actually looks.
Anyway as I held it up to insert it I found myself focussed, captivated, on its size. I held it up before my eyes impressed by the ‘weapon’. A moment later my eyes changed focus from the needle to the patient. His face was about the same distance as mine from the needle only on the other side. He seemed almost to have forgotten that he was struggling to breathe. Whilst my gaze was in awe, his was one of horror. He stammered between gasps “What …are you…going….to do….with… that?”
Yeh okay, we weren’t on the same page with this.
But what caused that desperate mismatch between our high five being okay but not the family? My partner had been battling with a difficult intubation attempt for several minutes. A short patient neck, a big chest and an airway badly soiled with stomach content was making a procedure that looked easy, actually very difficult. My partner resorted to several options to help pass the tube and was finally rewarded with success.
His struggle and our need to pass the tube led us both to celebrate as he finally confirmed its correct placement in the airway. We were entitled to feel a little elated. The operation was a success. The trouble was the patient was in cardiac arrest. I was still pumping on his chest and the patient was still without heartbeat. This was our celebration but did little to change the desperate circumstances for the patient and family. Inadvertently we had told them the patient was alive and all was well. Why else would we be so celebratory?
The patient died. It was our job to help prepare them for that but we, albeit for only a moment, forgot. There was nothing here for them to celebrate. This needed to be seen as they saw it, not as we saw it.
Jeff Kenneally – www.prehemt.com