May 5, 2007 Whoa Nelly! I'm NOT ready.

I've found myself in a state of something but I don't know what to call it.

It started with hearing that I passed the didactic portion of school...with a respectable cushion even. An absence of excitement...and something oddly similar to disappointment. It was a friend from school who described it best because she was feeling the same way: it felt as if I had cheated the system...that somehow the tests which were meant to prevent some of us from making it had failed. I had squeaked through.

Maybe part of it had to do with the fact that we had 'lost' some of our friends throughout the course and our successes seemed so random instead of being based on merit. I felt as if the wrong person had been elimintated. I felt guilty for not being as good a student as others were: why had I, someone who barely studied, made it this far when others who studied hard and often had not.

There was a brief moment of joy though...when I was paid a high compliment from our coordinator. And in the rest of my moments when I'm scared and worried and without any confidence, I try to remember her words.

I began my hospital rotation right after the exam. I was terrified that first shift just like I had been that first day of EMT school. Not knowing who would be there, and what they'd be like...positive that I was going to screw up worse then anyone before me. Certain to disappoint everyone that had supported me thus far.

But I survived. And in fact had a very enjoyable time with an excellent preceptor! Summing up what Emily refers to as an 'ah-ha' moment in my hospital experience:

The best example I can give is one patient who was brought in...geriatric male...was found by a staff member in the community he lives in when he didn't show up for dinner. Became more and more alert as the shift wore on but doesn't remember anything that happened before the hospital. He was funny, and pleasant from the get go even if you couldn't quite make out what he was saying all the time. One of the leads unclipped from his monitor in the wee hours and an alarm was going off. Poor guy was wide awake. I went in to shut off the alarm so this he would finally get some sleep and he smiled and called me a genious for 'fixing' it.

The enormity of your role as a medical professional, outside of your education and skill set, is demonstrated in the smallest things. My patient was not well enough to get up to pee. My preceptor was busy. So a first for me was assisting this man in going to the bathroom while still protecting his dignity. That's when I realized the significance of our role to protect and advocate for the patient because our encounters with them will be when they are often the most vulnerable. In some strange way, it was while holding the bottle as he peed, that I felt the most humbled, and very honoured to be in a position to help however I could.

Moving on to our next stage of practicum with the transfer service I didn't feel the nerves quite the same. Perhaps because I was too busy rushing to be on time after sleeping in by mistake. This stage was accompanied by an excellent preceptor as well. A fellow who handled everything superbly laying out exactly how it would all happen throughout the week. His partner was equally as awesome.

We had a notable call with one patient which really impacted me and marked my entire experience. A patient who was quickly deteriorating before my eyes...we have the DNR in hand, knowing the limits of the care we are allowed to provide. After handing over care to the hospital we discuss the call and the possibilities which the signs and symptoms we saw might indicate...and how that DNR might come into play soon enough. I realized this was an area I had never contemplated before: more often I have been worried about not providing the right care...this made me think about not being ALLOWED to provide the care that may affect a patient's chance of survival. In truth I really wasn't okay with it. That reality is still being digested. Will I be able to just sit back and let someone die? I don't have much choice do I.

It was a couple days into this stage when I heard the final details of my ambulance practicum. I had gotten my first pick! Yet another situation where I should have felt excitement, but instead felt panic and dread.

Now I've begun my final practicum portion...on car. And with this has come the intense desire to just stop...and quit. In less then 24 hours of arriving at the base I felt as lost and sick as I had the very first time I was away at camp. Despite everyone being nice enough, I felt like I couldn't be in more wrong of a place then I was there.

While waiting to prep a patient for medivac I was hanging around the emerg waiting room. My preceptor was talking with an aquaintance who was waiting for someone else. I watched as the RN came in and went to a woman sitting on the far side of the room, Turns out this is the wife of the patient that was going to be flown out.

The RN told her that we would be flying him out to Edmonton. The wife was confused but still calm because she didn't know what had happened in the trauma room..."Why are you flying him out? What's wrong with him?" Her husband had driven himself in to emerg because he was just 'not feeling well'. The RN told her "He's having a heart attack and we need to get him to Edmonton as soon as we have him stabilized."

I couldn't hear much from where I was standing, but I could see enough from the wife's reaction to know what was happening. And then she looked over the RN's shoulder at me...straight in my eyes and I watched as it all came together in her head. I had seen her husband in the room...I had seen that grey pallor we are told about. And as she looked at me and I kept as neutral a face as I could I was once again reminded of just what I was getting myself into here.

I feel like I learned nothing the past 6 months, and like I'm the stupidest person out there. I feel like whatever common sense I might have in my normal everyday life...leaves me stranded the minute I put on my uniform. I can't even do the simplest thing or answer the most obvious question. I feel certain I will quickly crash and burn in the coming tour.

With tours of 7 on/ 7off...and being on call 24 hours when I'm out there...without any friends to debrief to in my down time...without any downtime to debrief at all...I can see the perfect environment for all my fears and self-doubt to fully manifest themselves. I dread heading up again next week...whatever passion and excitement I had even a couple weeks ago has completely vanished and I have nothing to draw on for energy to just push through. I've lost all interest in even wanting to try and make an impression.

All I feel is tired...and the urge to walk away. Why does it seem like I'm the only one who feels this way?


medic969 said...

I must say that it makes me sad to hear you think about quitting. And part of me is shocked that you have never had that scared feeling before, that "I cant believe i am doing this" feeling.

I have told you before that I think you are right for this job and I will continue to support you as much as I can.

I have had that "holy crap, this is not right" feeling many times. The first time was when I was 14 and was about to be the head umpire for a kids baseball game. Here is a 14 y/o, who is suppose to ensure that all the kids are having fun and understanding the rules but as anyone who has participated in minor league sports knows, dealing with the kids is the easy part. Its the adults that need to be shot. I made a questionable call, and of course the heat was on from the parents. It was unrelenting, and by the end of the game i had tears falling from under my mask. I had stayed my ground, finished the season and in the end, it was the coach of one of the teams that ended up giving me my first job when the season was done. I did not even have an interview. He said that it was because of what he say at that game that he knew I would be good for his "team" at work. That job served me 7 good years until I was done college.

The next time I truly felt that feeling again was on my way to my first EMT job. Here is a born and raised "city slicker" traveling up to Wabasca-Desmarias, 1.5 hours north east of Slave. I am traveling in my Z24 Cavalier, up a muddy reserve road thinking to myself "where the h*** am i going". I already am missing my mom, friends, and homemade cookies. Then I show up. I find out that I have 2 hours to get a tour of the area by the other EMT who is there because he is leaving for his 3 days off since he has worked 21 days straight waiting for me to get hired. So there I am left in a lonely cold apartment with nobody, just a radio that will go off when a call comes in, and I will meet the local EMR with the ambulance. Now I want to be sick. I have never been so scared of both where I was and my skills in my life. We never did a call in 3 days thank god, but I think that just contributed to the diarrhea as I just sat and worried for 3 days. 1 month later we had a 4 patient rollover, all ejected and I got the critical patient. As I approached, I tunneled in on the dust and dirt around his mouth and the snoring resps. As I bent over, I felt like I was stroking out. Then I said "Hi, my name is Rob and I am here to help." Just as I had done in all my scenarios. The rest of my survey and interventions just rolled and flowed from my body. I even delegated to bystanders exactly what I wanted them to do. I felt great. I could not believe that I just done that call. I was on top of the world and new that this was my calling. Then sued for that call 2 years later. I remember being on the stand, testifying as to my actions, second guessing everything I had done even though I knew I was right. I was cleared of any wrong doing and all was good again.

Then came paramedicine. I had no ALS experience but I took the challenge. I made it through, not tops of the class but not the bottom. I got offered a job during practicum, was about to get married and bought a place in Stony Plain. Life was fabulous. Then ACP came along. I failed the scenarios because of what I still see as a technicality. They say I failed on 4 items. I appealed and won on 3 of 4. So now I am stupid again and wonder what the h*** am I doing. I even got to assist a classmate with his very first intubation. It took 4 attempts and even though I was his classmate, he would not let me try because i was "just an EMT". That was hard. After the 3rd ACP attempt I got R0500969.

2 years later I am asked to help out with some teaching. "It wont be hard, just some lecturing for an EMT class", I believe I was told. And yet again, that retarded feeling starts again as I nervously attempt to explain what I had been taught so well by some very brilliant people in this industry ( Peter Symons, Shari Lutz, Joe Acker.... this is long and distinguished. I was sweaty palms and quivering voice. I made it through that year and the next 5, even taking on REDS for the paramedics. Every year, no matter who it is, I get that "i don't feel smart" feeling and every year it all works out.

Oh ya, and then there is that small moment in my life that really scared me. The words "I am pregnant". then the words "its twins". After the year long blackout, I wake up and find that life is still good despite that fact that kids come with less instructions than a toaster.

The point of all this gibberish is one to get laughing again and forget your worries. and 2, to remind you that its ok to be scared. Practicum is scary, but it is also a chance for you to hone your skills. In a short period of time, you will find yourself getting more and more comfortable and life will be good again. At least until the next "life moment"!

I will see you in a couple of weeks for practicum visit. Keep your chin up.

Mastabattas said...

QUOTE(medic969 @ May 9 2007, 10:39 PM)"part of me is shocked that you have never had that scared feeling before"

You would think this would all be a breeze for me...confronting these fears and worries. I have a couple of ultimate wild cards of life in my back pocket and still these little things stop me dead in my tracks.

Not once since the day I first found the the day I was diagnosed with breast cancer and given my treatment options...the countless scares I've had since then and now as I approach that coveted 1 year remission mark, have I felt an ounce of the fear that I feel now just thinking about practicum.

But you did succeed in one thing...I the bit about being pregnant with twins. One of those moments you wish you could be a fly on the wall.

It will be nice to have a familiar friendly face out there...something to look forward to.

hugemedic said...

Heidi, this is the first time I have read your blog buddy, I'm sorry you went through your period of doubt, and that I wasn't there to pick you up and brush you off. The fortitude you showed by taking the leap in this grand new venue and the guts it takes to look cool when all hits the have it my friend, you have the guts, smarts and motivation to be the best of us.

Even today when dealing with my employer I question why I do this gig, and it's the little things with patients that brings me back every time. It's not the management I do this for, it's for my community and myself.

Keep pluggin at it, you are everything we hoped you'd be, and more!