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Patient Care

Another Angle: Chasing Perfection

Twenty-five years ago I was a paramedic student preparing for a training shift on a New York City ambulance. I’d been cleared for ALS the night before and was hoping for lots of chances to stick, bolus, and tube Brooklyn’s sick and injured.

I didn’t get past the “stick.” I missed all three of my IVs, two in colorful ways that suggested I shouldn’t handle anything sharper than needle-nose pliers. I felt worthless and ended my tour wishing I’d never heard of EMS.

Screwing up is supposed to be educational—and inevitable. I understand that in the part of my brain reserved for magical thinking. As for actual practice, I find nothing terribly constructive about most mistakes I’ve made.

One involved an extremely pregnant woman we transported with her 1-year-old son. At our destination I put the child on the rear-facing seat so I could help his mother manage those two big steps out the back. It was just going to be for a minute or so. That turned out to be more than enough time for the little boy to get antsy and fall about a foot to the floor.

There was much screaming and crying…from the kid too. He was fine, but mom thought I was the most terrible caregiver in the history of ambulance drivers. I know because she said so using language I couldn’t repeat without embarrassing my spellchecker.

Not long after, I had an episode with a length of pipe—or, more specifically, a diabetic on the other end of it. He was remodeling his bathroom when his insulin kicked in, scavenging just enough sugar from his circulation to make him combative. When he started swinging that pipe to keep me and my dextrose away, I was inexplicably intrigued by that challenge in a make-my-day kind of way. Had it not been for my partner, a broad-shouldered man who yanked me aside and told me to quit acting like I knew what I was doing, my EMS career might have been shorter than a Mississippi winter.

I’ve learned from my mistakes, but I still find some of them so dispiriting, it’s hard to even admit them here. Do we really need to talk about the time I insisted my partner and I rig ramps and ropes to maneuver a 400-pound respiratory patient to a stretcher by ourselves? Or my habit of securing IVs while standing untethered in moving ambulances? The last time I tried that, the driver hit a median and launched me from cabin to cab with enough energy to shear the top off a portable radio in the center pedestal. Or so I’m told.

I’ve spent a career obsessing over things that went wrong. Now that I’m deskbound and less of a danger to myself and others, I’d like to find the sweet spot between chasing perfection and embracing fallibility. Maybe then I’ll remember more about what went right.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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