Dealing With It Part 2

I can’t recall a SINGLE incident or situation that put me under stress, I seem to remember them as periods of time.

I’ve blogged about this before, but my biggest storessor is mistakes. I despise gross mistakes and if you know me well, you know that I am a perfectionist. So when I make a mistake, I tend to beat myself up a little bit. It seems fitting that situations that have made me physically ill from stress were errors. Most of the time those mistakes were minor, but me being me, that’s how I work.

I recall a situation as an EMT-Basic where my partner and I picked up a patient a nursing home. This was one of those less scrupulous nursing homes where they shipped people out as they were just about to die in order to keep their good numbers high.

So we picked up this gentleman, who was pretty close to guppy breathing, he was cyanotic, clammy, and just generally didn’t look good. In hindsight as a Paramedic, that guy would have bought a tube and some IV fluids right off the bat, and probably before we even left the facility. But being a Basic EMT I didn’t quite know that stuff yet. I had been an EMT for 2 years at that point but lacked the necessary knowledge or experience in order to make that determination (which was probably the source of my anxiety).

So we get this guy loaded (on the high flow O2) and I’m going through my assessment when it dawns on me that “hey this guy is CTD.” So I call up to my partner, who kicks it into high gear. The only thought in my head was “oh my God what did I just do?” Again, another stressor.

So at this point, I’m walking through what I saw the guys at the fire department do when we’re coming in hot to a hospital: Call.

Let me tell you something: when you are in a panic, trying to do everything, that encoding radio is a pain.

So we’re screaming in, and it was a straight shot to the ED from the nursing home, and my radio report sounded absolutely horrible. I almost laugh today at the jumble of words that came out of my mouth taking to that doctor. But, being the calm in the eye of the storm, that doctor got a panicked Basic EMT to focus for a brief second on a dying patient and got me to finally do one thing I had been trying to do all along: bag this guy.

Which worked, rapidly. Mental status, skin color, and all that improved Made me more than happy. I felt like I had done a fair job considering I was fairly inexperienced.

What got me really worried was when the nurses started combing through the guy’s medical records and located the one piece of paper that I had somehow missed in the packet: the freakin’ DNR. The one thing that could have hung me up in the whole fiasco.

I was pretty upset about that, because to me it was a huge freakin’ error. I had provided life sustaining care to someone who didn’t want it. It was tantamount to kidnapping. This had me really worried, and of course I made no mention of it to my partner (and I didn’t know if she would be any help anyways). It kept me up the rest of the night, but I had to say something to someone so I called a long time friend who reassured me that there should be no issue from it, and that I should review the laws and protocols surrounding DNR’s.

It helped a little, but I don’t think I stopped being anxious about it for a week or so afterwards.

So how was I dealing with it?

1) I remembered what the ultimate purpose was, which was taking care of this person. Regardless of ultimate status, a DNR does not mean “Do Not Treat.” I learned later that I didn’t have to go to great lengths to find a DNR, just that I made a reasonable attempt.

2) In this situation, breaking it down was where I got more anxious. I started noticing the mistakes I had made. However, it did let me find ways to prevent such an error from occurring again, such as asking to see the form, or be more careful about when I went through the record packet. It turns a negative moment into a learning situation.

3) I didn’t say something right away, but I eventually outed the mistake to someone I trusted, and got good feedback as a result. Not that I didn’t trust my partner (which I did, and still do) just that I needed a more seasoned ear.

4) After the talk with my buddy, I was able to let it go, and move on with new knowledge and a bit more confidence.

You can learn from stress, you just have to put the right spin on it.

  • Started to write a comment here, and it kept going, and going, and going, and turned itself into a blog post. So thanks for that, I think.

    Basically, it’s about how/when/why to ask whether a patient has a DNR.
    How do you decide whether to ask? How do you ask? Have you ever had a bad reaction to the question itself?

    And absolutely, you can learn from stress, from mistakes. I think it’s part of our job! The major part, at the beginning.

  • Started to write a comment here, and it kept going, and going, and going, and turned itself into a blog post. So thanks for that, I think.

    Basically, it’s about how/when/why to ask whether a patient has a DNR.
    How do you decide whether to ask? How do you ask? Have you ever had a bad reaction to the question itself?

    And absolutely, you can learn from stress, from mistakes. I think it’s part of our job! The major part, at the beginning.