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Patient Care

Everyday Grief

      To say you're tired would make the obvious seem silly. You've been to bed at least five times in the past 10 hours, and you probably have one hour of sleep to show for it. You're already more than an hour late getting off duty. Now, returning from a trauma center in somebody else's district, you're stuck in traffic that's slowed to a crawl. There's a tangle just ahead of you, and like it or not, you're going to be first on scene.

   Your partner parks the ambulance, calls for help and initiates traffic control while you grab some gear and motion the involved parties off the roadway. One of them is a guy with three kids, all standing next to a new Escalade. He appears to be at fault, but he's adamant: He doesn't want to leave his fancy car. Your "nice" reserves are about used up, but you marshal just enough to get him and the kids off the roadbed and away from the action without escalating things.

   It turns out, only one of the kids is his; he's just carpooling the rest to school. He wants to leave the scene, and he just about does before the first-arriving cop changes his mind. He keeps it unpleasant, nonetheless, and he's soon calling you unfortunate names in front of those kids.

   Q. I'm really getting tired of arguing with these kinds of people. When we do our best to get them out of some of the situations they cause, why don't they listen? They get angry. They argue. They act out. And if that's not enough, they lie 'til they die!

   A. I think I know exactly how you feel. I have been wondering for some time now why those very behaviors seem so familiar in various contexts. I've noticed they're similar to Elisabeth Kubler-Ross' stages of grief. The first five, as I recall, are denial, anger, bargaining, depression and acceptance. Thanks to my EMS sister, educator Twink Dalton, I learned long ago that when people are stressed enough, they may actually be willing to hear you--but they simply can't. Twink can talk all day about how, when the brain's limbic system is excessively stimulated, people's physical senses are simply filtered out. It may be one of the reasons why we don't feel pain at the time of injury. I think it explains a lot of other behaviors, too, when people are in crisis.

   Q. Must be nice to have all that knowledge, but what good does it do me when I'm trying to block a busy freeway in the middle of rush hour and I need to get some fool and his kids off the road before an impatient commuter drives through our scene and runs somebody down?

   A. Sorry. My reason for bringing it up is, maybe it's easier to tolerate a behavior when you know somebody can't help it. For instance, I've taken lying personally way too often. ("I'm not having chest pain" comes to mind.) But I don't get so upset anymore when I know someone is dealing with big-time stress. Of course, lying is also one of the ways addicts support their addictions. ("I didn't have nuthin' to drink.")

   Q. Whatever the reasons, when I'm confronted by situations like the one described, obstinate people drive me crazy. How can I be patient and act the part of a professional without losing my temper?

   A. I think plenty of us ask that same question. We all have that limbic system. Our brains are made like onions, with the smartest parts in the outermost layers and the emotional parts situated in those primitive, innermost tissues. But if you think back to some of the angriest conversations you've had in your life, chances are the right words didn't come easily until afterward. During those arguments, you stuttered, you muttered and you sounded foolish instead. Right?

   It's physically impossible for most of us to be good thinkers when we're really upset about something. And for you, good thinking is first, last and always your most important ability. You have to preserve and protect the ongoing function of that tool.

   I don't think you have any choice.

   Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at

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