Breathe

You ever had a call where you wished you could have done more?  Where after a call you can’t help but have this nagging feeling that just doesn’t leave you?  Where you feel bad inside, guilty, like you owed your patient something, something more than what you have given.  But deep inside you knew you did what you could at the time, that your decisions weren’t incorrect, it just could have been better.  Yet despite knowing this, you can’t get rid of that horrible feeling inside.

I absolutely hate that feeling.

There’s a call quite a while back that stands out in my head.  We were dispatched to an elderly lady, who was having shortness of breath (SOB).  When we got there, she was clearly having SOB, but she was also having discomfort in her chest.  She had a nasal cannula on, but I found out that the O2 she had was out.  So I asked my partner to swap it.  All that time I see her eyes, pleading, fear filled.  I remember she got super distraught when I started inquiring a bit more about the situation; I was trying to figure out if the SOB was causing the chest pain or if the chest pain started before the SOB.  She squeezed my arms, saying she can’t breath, she can’t breath.  I tried to calm her down by talking to her, but she was panicking and wasn’t answering my questions properly.  It must’ve only been 30 seconds (although it felt way longer) since I introduced myself when I asked my partner to put a normal face mask on.  She still says she can’t breath.  I don’t know if she was staring death in the face or not, all I know was that she stared at me like I was the only one there that could save her and I wasn’t doing enough.  To her, help had come, but help is not helping her.  

Her lungs were tight on auscultation, and decreased on one side.  It was difficult to hear clearly.  We got her onto the cot switched to a NRB (non-rebreather) mask and into the ambulance quickly.  En route, I decided to assist her breathing using a BVM (bag valve mask) because she clearly was not getting better and needed assistance.  I talked her through being assisted to breath.  She resisted the BVM initially, it took quite a bit of encouragement and coaching before she realized it was helping her.  I could tell she was getting tired and I did my best to keep her awake and breathing.

I continued bagging her into the hospital until we transfered her over to a bed and the nurses hooked her over to a BiPAP (bilevel positive airway pressure) machine.  The patient was exhausted from the efforts of trying to breath.  I later found out she had a collapsed lung on one side (spontaneous pneumothorax), I also noticed she had a masectomy.  It’s clear that she’s gone through a lot in the past, and I wished she didn’t have to go through what was going on now.  

After the call, I thought I could have done better to calm those frightened eyes.  It’s not that I didn’t give her oxygen, but I should have given it to her earlier instead of asking a few more questions.  With the slight delay I made, I emotionally tormented her.  When she called 911, she expected someone to come in, and alleviate her breathing ASAP.  When I showed up, I didn’t look after her emotional needs as much as I should have.  I asked her questions that were pertinent, but perhaps not at the right time.  In her mind she was probably thinking, “I’m dying, I can’t breath!  Stop asking me questions and help me breath!”  I don’t think I can forget the way she gripped my arms, those big frightened eyes, the soft airy whisper of  I…can’t…breath.  It rips at my heart.

I took that call, which was one of my first more serious SOB calls, as a lesson.  One that I will never forget.  It’s one thing to feel bad about a call, but another to learn from it.  Each patient, each call, is a lesson. On each call you go on, your patient is sharing a part of their life, with you.  It is only up to you to take this gift and make it a part of you, so you can benefit the next patient in a similar situation.  

The next serious SOB call I ran, it was smooth and worked like a charm.  After the call, I remember leaving the ER thanking her, thanking that one patient that had pulled at my heart strings and made me a better paramedic.

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Comments
16 Responses to “Breathe”
  1. Bella says:

    It’s a very touching story. Thanks for sharing! You make each patient and each call a lesson to be a better paramedic. That is wonderful! I hope you will never lose the willingness to be a better paramedic. 😉

  2. Vanja says:

    Is there a risk of “pushing” any of the O2 inside the pleural space since she had a collapsed lung?

    • PocketMedic says:

      Yeah I’d be worried about a tension pneumo but her sats were in the 80s and her LOC was decreasing (nodding off)

      Sent from iphone

    • Kevin says:

      There is a risk but when someone isn’t oxygenating the benefits >>> the risks. Thanks for sharing your story Michelle. I’m glad there are paramedics like you out there who care so much. 🙂

  3. Ken Abramsen says:

    “She had a nasal cannula on, but I found out that the O2 she had was out. So I told my partner to swap it.” Hmmm, not trying to be an ass here, I really like your concept of this blog, however, this is one of the quotes that …irk me…As a 21 year Paramedic, and envision us working TOGETHER. I have never TOLD my partner to do anything, it is just as easy to ask as it is to order or tell. You and I would have had an eye opening conversation after this call. At 1 year on the job you need the help and support of your more experienced partner, and this is not going to happen with this attitude.
    “The next serious SOB call I ran” Again, it seems like you are trying to give the impression that this is a one Paramedic show, and nothing is farther from the truth. The standard rule of thumb is that it takes about 3 years in a high call volume area to become competent as a practicing PCP, I relied HEAVILY on my partners (whenever possible) for roughly that long. Be very careful, I believe your intentions are good, but watch out for hubris, especially in this job, it will bite you hard.

    • PocketMedic says:

      Hi Ken,

      I appreciate your comment. The style I write my blog I tend to write in a one person format due to reasons where I don’t want to portray my partners in ways they may not want and I don’t always ask for permission from each partner before writing in here. In reality at work, we always work as a team and by no ways do I run my calls as a “one person show”. That’s not what it’s about, it’s about taking care of the patient. Perhaps the wording of my blog can place bias depending on how one reads it. I do change things in my blog to also protect confidentiality, it is also one reason why I write mostly in a one person format/view.

      As for asking my partner to swap the nasal cannula (as I mentioned it is one of the first serious SOB calls I’ve ran), this call was during my precepting shift. So essentially my partner and preceptors don’t do anything until I tell them to. This is a rule set so my preceptor knows what I’m thinking and not having my partner do everything as in a normal partnered call would.

      But yes I do agree with you, when working, there is no such thing as the typical “driver & attendant” I expect my partner to look out for me and to run calls together as a team. I always appreciate feedback ideas on decision making. I believe good partners know how to “read each other” and know the second step without having to be asked.

      Hopefully that clarifies some things for you.

      Cheers.

      • Ken says:

        Hey Pocket! Kudos on posting my reply, wasn’t sure if you would ^^ As a preceptor, I am passing familiar with the format of having a student. Sounds like you a had a good Preceptor, and they are worth a lot to new Paramedics! All I hope for you to take from what I have said is to always remember to be civil with your partner-du-jour, you are a team, and remember they are there as a second set of eyes and hands and brain. There are few things funnier than watching a new Paramedic floundering with an experienced frequent- flyer that knows how to push your buttons. I am sure that you do this, but showing your experienced partner a little respect by asking instead of telling, will carry you a long way in your career. I worked in Vancouver for 15 years +/- I have seen all kinds come and go, the best talk little and listen lots.

      • PocketMedic says:

        Hi Ken

        I always welcome positive and negative feedback, how else does one grow and improve?

        I had awesome preceptors whom I learned a ton from. I’ve learned at school to always ask for things plus a please and a thank you goes a long way. You just reminded me i have to pay attention to the little wordings when writing lol!

        I’m sure I’ll run into you sometime on the streets.

        Cheers

        Sent from iphone

    • Kevin says:

      Hey Ken

      The partner dynamics that I learned in the PCP program was that the person in the passenger seat is the attendant who directly takes care of the patient, and the driver does everything else. The driver is there to help assist you with the mechanics of the call like setting up oxygen, taking vitals, grabbing the cot, gathering patient meds, and most importantly monitoring the scene for your safety. If you have a good partner you shouldn’t have to even ask them to setup oxygen as they would be anticipating your needs and the patient’s needs. But if they did not anticipate something (e.g. didnt realize you wanted oxygen), you then would ask them to grab it for you.

      I’m not implying the driver is inferior to you, as you still work as a team and take suggestions from them and bounce ideas off them. It just means one person is free to focus 100% of their attention on caring for the patient. It sounds like you work for BCAS and I’d love to hear your suggestions as to how you work on calls with your partner. I’m not a paramedic anymore but I plan to return to it in the future and welcome any new ideas for how to be a better medic. This is just how they teach the dynamics in school, and how my preceptors taught me to run calls.

      Cheers!

      • Kevin says:

        Oh wow…Ken, I should have read more closely. It sounds like you were just getting on about ‘asking’ vs ‘telling’ your partner to do something for you. If so, 100% agree with you! And also 100% understand where PocketMedic was coming from on her call with preceptors who want direction. Ooops! 🙂

      • PocketMedic says:

        Lol. I agree 100% with what you said earlier though K 🙂 haha it was all a slight misunderstanding btwn all of us lol

        Look forward to having u back in the service

        Sent from iphone

  4. EMR in training, ACP is in Janurary. Im sitting here outside my class to do my final scenario, and all I can think about is if I am really cut out to do this. Am I really the idiot in training everyone wants to see running at them with high hopes, while they’re in a moment of despair. It takes courage and guts to be able to handle things like this. I only hope that I can do the same.

    Thank you, for becoming a paramedic.

    • PocketMedic says:

      Hope your last scenario went well. You wont know until you try. All I have to say is that it’s an awesome job. Good luck!

  5. Christian SChlegel says:

    I really enjoy reading your blogs because they are real life stories, you make it very interesting and because I’ve always had a big huge interest into the human body functions and Emergency Paramedicine myself. Please keep posting 🙂

    • PocketMedic says:

      Thanks Christian for your wonderful comment, life has gotten really busy for me, but when I have some down time, I will try and continue posting on this blog 🙂

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  • Courage is the discovery that you may not win, and trying when you know you can lose. -Tom Krause
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