Anal Medics: Don't Be A-freud

I had a Contemporary Civilization professor who fancied himself a Freudian. This was in the early ’70s, when it was still fashionable to do so. As an engineering student trying to maintain consciousness during a seemingly interminable psych lecture, I probably wasn’t paying much attention—until my instructor addressed anal retentiveness. He might as well have been profiling me.

Freud theorized that infants progress from oral to anal stages characterized by obsession with bowel control. As I recall (I must have stayed awake for some of that class), anal-retentive children wait until they’re maxed out on encouragement before letting nature take over. I may have acted that way as a 1-year-old. I don’t remember. I was very young at the time. What I do know is I have traits considered anal by family, friends and even editors.

I think being anal makes me a better caregiver. I’m determined to convince the rest of you that anal medics, though we may be mocked, have a purpose in EMS no less consequential than any combination of airway, breathing and circulation you favor.

My dictionary defines anal behavior as orderly, stingy, stubborn, etc. No doubt etc. was inserted by some lazy writer with anal envy. I’ll come back to that. I think I’ve outgrown stingy; no longer do I deny friends postage stamps, as I did in college because “they’re mine.” As for stubborn, some might claim I’m not, but only if they’re confusing me with someone else. That leaves orderly. Guilty as charged. I crave order. I’ll fight for order. If you’re between me and order, you’re going down—well, only if I can do that without getting messy. (When you’re anal, neatness counts.)

Order is a good thing in EMS. Order begins even before you report to work. Order means someone you’ll relieve has checked supplies and equipment on your ambulance, has removed patient detritus and restocked whatever’s missing, has finished the shift’s paperwork and left the ready room neat, if not pristine. It’s not fair for all that work to be delegated to one person, but that’s a cross anal-itics often bear without complaint—assuming our noble efforts to remediate others don’t count as complaints.

I used to work with a world-class anal medic. Let’s call him Al (guess if you must, but that’s not even close to his real name). Al’s coworkers considered him quirky and a bit of a nuisance. He’d find expired angiocaths before anyone else knew plastic had a half-life. He’d empty sharps containers while there was still room at the top. He’d check BP cuffs for off-center gauges. When you rode with Al, you knew you had enough of everything—2x2s, 3x3s, 2.3x3.2s—to handle at least a dozen calls without resupplying. Al’s bosses and partners made fun of him, but when Al was off, there was a preparation gap that occasionally deprived Al’s colleagues of very useful items—electrodes or charged batteries, for example. During after-hours titration of liquid refreshment, everyone agreed Al was indispensable…and a pain in the butt.

I think we need more Als in EMS, which is why I’d like to go back to that dictionary definition of anal and replace etc. with organized, conscientious and thorough. (Is it too late to add humble?) To earn those adjectives, I offer this occupational checklist. I call it Six Degrees of Preparation:

• Personal equipment. Is my uniform clean? Do I have my stuff (whatever I normally carry)? Does it work?

• Company equipment. Is my vehicle stocked? Will it start? Does it need fuel, fluid or air? Are there any issues with medical equipment? Are batteries charged?

• Continuing education. How’s my recertification progressing? Do I need to register for any upcoming classes or exams?

• Health. Am I well enough to work safely and effectively today?

• Attitude. Do I still care enough to treat patients the way I’d like to be treated, regardless of presenting problem, demographics or proximity to the end of my shift?