Same Old Same Old

Are you bored?

The old woman on your cot is Catherine Oswald.

She was Chatty Cathy when you first disrupted the hypoglycemic stupor that prompted her family’s call, but now, absorbed in a world unseen to you and focused on the plain wall opposite you both, she is silent.

Ms. Oswald is gracile and frail. Her thin skin is the color of china, embellished with a subtle lattice of blue veins so small you can barely imagine them transporting blood or anything else. Resting lightly on your pillow, her head acknowledges the sway and pitch of your ambulance en route to a community hospital. You can’t think of a thing to say. So you find yourself staring out your rear windows, listening to the thump-thumping sounds of the tires and the occasional complaints of the suspension system.

Another diabetic. Scene size-up. BSI. ABCs. O2. Draw blood, D50 and transport. Lately you’re seeing two of these a day, and the work that once seemed so important to you as a new medic has become routine. Monotonous. Unimportant and pointless.

Q. I remember during my first year as an EMT, and again as a new medic, every call seemed exciting and interesting. Some of them still do, but I think the repetition is starting to get to me. Could I be burning out after only three years?

A. I know just how you feel. I think each of us reaches plateaus. For me there was one just before I got into P school, and another one about three years after I graduated. Then several smaller ones, probably related to partners I worked with, or the political nonsense that always seems to get in the way of taking good care of people.

Q. I’m really worried about this whole notion of burnout. Already I’ve known several good medics who simply gave it up and walked away from EMS altogether. Is a career in this business simply unsustainable?

A. It certainly is for some. But make no mistake; all of us who are honest will admit we’ve grappled with the notion of burnout from time to time. We’re all people, and we all lose our balance, sometimes. I’m convinced it takes talent to do this.

To some extent, your talent is validated by a license or a certificate awarded by others. But your license is just a starting point. It merely gives you permission to cultivate, develop and nourish your talent for the rest of your life.

A person in hypoglycemic crisis can never be just a diabetic, any more than a drunk can be just a drunk. There are people throughout the world who are suffering from traumas and medical conditions neither of us has ever imagined. I think you have to discipline yourself to wonder about stuff, learn from it, and understand a bigger reality of it today than you could ever have grasped a year ago. And it’s never about you or your career. It’s about easing the misery of strangers. And that has to be OK with you.

Q. Nice. But how do you do it? What steps do you take as a new medic, and how do you start this business of nourishing your talent?

A. I wish I had all the answers, but nobody does. One thing’s certain: I don’t think you have to wait until you graduate from anywhere. Seek out people you admire as caregivers, and ask them these kinds of questions. Seize any opportunity to partner with them. Learn how they think, watch them do physical exams, and ask them what they look for and wonder about.

Do that, and read. Fortunately, some of the people we admire have quietly written great books about their own journeys. I would recommend two. One is Gesundheit! by Patch Adams. Better still is Mountains Beyond Mountains by Tracy Kidder, which details the ongoing life and work of Paul Farmer, MD, in Haiti. Drs. Adams and Farmer are perfect examples of people who practice mostly western medicine, but have managed to transcend the boundaries of politics, pharmaceutical companies and even their own limitations. They clearly practice at a whole other level above most of us.

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