Reflect on a time when you challenged a belief or idea. What prompted you to act? Would you make the same decision again?
The best way to learn is through blood, sweat, and a little bit of vomit. Prior to my relatively new experiences in EMS I always believed that the classroom was where you learned and the real world is where you apply your skills. 150 hours of Emergency Medical Technician class left me feeling confident, until my first call at least.
* * *
A two-toned beep came from my hip. I coiled my stethoscope around my neck and within seconds, I was being led to the ambulance by a paramedic. I stepped into the back of the truck and was unprepared for the putrid odor of bleach billowing from the open door. The only redeeming quality of the smell was the knowledge that the ambulance had been cleaned recently. The ambulance turned the corner onto a street adjacent to the hospital; the lights and sirens flashed and blared as soon as we had left hospital premises. Having no knowledge of what this call was I turned to look toward the center console (I sat in a rear-facing seat in the back of the truck) and saw the dispatch report of “88 YO F, NV” meaning our patient was an 88-year-old woman with nausea and vomiting. After deciphering this fantastic news I went over all of the likely causes of these symptoms that I could remember, upper GI bleed, lower GI bleed, appendicitis, food poisoning, and peritonitis.
Arrival on scene proceeded as expected, a frantic husband led us to their bedroom and introduced the woman laying fetal with a small bowl next to her mouth as Mary (this name has been changed to comply with HIPAA standards and to protect the privacy of the patient). As the paramedic and head EMT attempted to obtain a list of medications and any other pertinent information about the patient, I was tasked with taking the blood pressure of this woman. I walked around the bed to Mary’s side, confident because I had taken blood pressures dozens of times in class. My confidence quickly subsided and transformed into mild embarrassment as I struggled for several minutes attempting to perform a task that should really take less than one minute. Something that I wasn’t taught in class was how to auscultate a brachial pulse (a key component in determining blood pressure) while distressed groans are being projected right by my head. After several minutes of embarrassment and judgmental stares from my partners, I was finally able to measure a blood pressure that I was confident in.
Being that this was my first call ever, my two experienced partners performed the initial assessment of the patient as I observed. Immediately the head EMT takes the bowl from under Mary’s mouth and gestures me over to it. “What do you think this woman has?” he asked me.
“Being that her vital signs are normal, my best guess is food poisoning?” I unsurely responded. He pointed into the bowl.
“There’s blood in her vomit, that means she has an upper GI bleed,” he said shaking the bowl uncomfortably close to my face. After the suspected cause of the problem had been discovered, the paramedic decided that rapid transportation to the hospital was in order. After delivering the patient to the Emergency Department my first call at Norwalk hospital was complete.
* * *
Despite finishing at the top of my EMT class, I had never felt more like a deer in headlights than during my first call in the ambulance. My preconceived notion that the classroom is a place to learn and the world is where you apply your skills had completely misguided. After the multitude of difficulties I faced and the diagnosis that I had missed during this call, I realized that my time of learning had only just begun. The experiences I had during this call had taught me new skills and valuable information that could never be taught in a classroom, almost anything can be learned from as long as you’re open-minded and observant. However, this experience did not serve as a disparagement of classroom training, it served as a wake-up call to observe and learn from everything you can because the patients tend not to read the textbook.