Lessons in 911

The difference between theory and application punched me in the face when I was two weeks into working as a 911 emergency medical technician (EMT). “Start compressions, Julia,” my field training officer called as we hauled our unresponsive patient onto the gurney, and all at once, I found myself popping the cartilage of his sternum, fighting the panic in my stomach and wondering the entire time when the adults were going to take over.

No amount of studying could have prepared me for this. I’d practiced CPR dozens of times on plastic mannequins and thanks to my rigorous pre-med classes, could recite to you every biological pathway that was happening, and still I wasn’t ready for how cool his skin was beneath my gloves. I noticed the tiniest things – the stick-and-poke tattoos scattered across his arms, his freckles, how long his eyelashes were – minute details that composed a real, actual human being. His humanity floored me. Our patient was a composition of organs and cells, blood and physics, but he was also entirely human. After years of school, I could reasonably understand our patient’s physiology, but I was stunned by the emotional response that connected me to this man. It hit me like a sack of bricks that this was another complete human being with his own thoughts, emotions, and soul, now laid bare on our stretcher. Silent, motionless, and utterly dependent on our ability to understand what he couldn’t tell us.

As a student who had shadowed and volunteered in hospitals, I thought I had a fairly decent – if incomplete – understanding of medicine, of the meaning of service, of the world. I could have drawn you a perfectly symmetrical cyclohexane, or recited the thyroid hormone signaling pathway like some sort of ritualistic chant, and I thought that because I’d loved my anatomy classes and the TV show “Scrubs,” I was ready to serve in health care. I could not have been more wrong, and I am so grateful for it.

I began working in the wild and wonderful world of emergency medical services (EMS) in 2018. I entered EMS as a fresh college graduate, brain full of facts and figures but with no true experience in the “real world” of medicine. Two years is a tiny span of time, especially when many of my mentors have been in the game for decades, and I consider myself a baby EMT in terms of my skill and experience. And yet, these past two years have been filled with precious lessons that I could not have learned in any classroom – some painful, some absurd, but all essential to my growth as a medical provider and person.

In the short period of two years, I’ve been learning some pretty amazing things, like how to perfectly balance a bed pan under a butt, and how to convince combative patients not to punch me in the face. I’m learning how to backboard trauma victims in the middle of the highway and how to most efficiently devour a rotisserie chicken with my bare hands when we finally scrape together a lunch break. I’m learning how to work quickly, but calmly, finding a composed voice even when I’m so full of adrenaline that my brain feels like a hamster wheel about to spin off of its screws. I’m learning how to draw up medications despite shaking hands, and bind big wounds with gentle care, and find common ground through laughter, always looking for the humor in a tough situation. I’m learning how to fall asleep anywhere at anytime – catching naps during a fourteen hour shift is an art.

I’m learning how important it is to listen, to admit when I don’t have the words to comfort, and sometimes, to cry with the patient and sit with them in their pain. I’m learning how to treat patients in a way that honors their dignity, especially in situations when they feel helpless, because we are their first line of advocacy. I’m learning how to allow myself to deeply feel and grieve – how to be careful with my heart while still maintaining my empathy. I’m learning how beautiful it is to be part of a community of peers who give so deeply of themselves every day. We are united in our desire to serve others, and when we inevitably have those dark days, we take turns to build each other back up. I’m learning that the more I learn, the more I have yet to learn. This is a truth that humbles and excites me.

In EMS, I’ve seen things that have broken my heart completely open, and filled me with horror and sadness. But I’ve also had the privilege of experiencing the extraordinary: pulling completely unharmed people out of crushed cars, feeling a pulseless heart begin beating under my hands, holding a newborn baby boy, only minutes old, as he opened his eyes for the first time and looked at me with the purest gaze I’ve ever seen. Just as extraordinary is the trust that our patients place in us as we enter their homes, handle their painful wounds, hold their sick children, and bear witness to their lives and sometimes to their deaths. It is nothing short of an honor to be invited into the most intimate moments of peoples’ lives, and the opportunity to serve them with compassion and competence is a privilege that I do not take lightly.

Working in EMS is special. Nowhere else in the world will you witness such a diverse cross-section of life on a daily basis and in such an intimate environment. It is powerful and raw work. The pre-med education that I received at Washington University was outstanding, but I believe that my true medical education started my first day on the ambulance, when I had my very first patient and began learning how to genuinely connect with people from every background, in every stage of health. I learn something from every single patient and every single partner that I’ve had, and they have changed me for the better. EMS has profoundly shaped the person I am and the physician that I hope to become. It is a job for growing-up, for investing in the world around you, and for finding yourself through your care for others and pushing yourself beyond what and who you thought you were.