I was one shit hot paramedic.
All you had to do was ask me.
I was smart; no question about that. So smart that I was accepted to paramedic school (p-school) due to some really high test scores, despite being a year or so short of the required amount of field experience. I started school when I was 21, basically the earliest you can drive an ambulance in Colorado due to insurance requirements, and was one cocky 22 year old by the time I graduated and went on the job. I think I graduated number 2 from my class- on test scores at least.
Since most of the men reading this have probably been 22 by now, and most of the women have had to deal with 22 year old guys, you can probably see where this story is going.
(spoiler) For those of you that want to skip to the end, the short version is that brains and ego alone can’t ever compensate for real experience.
Oh yeah, and Soylent Green is people. And Snape killed Dumbledor. And Tony Soprano got whacked. They said like 3 times that it all just goes black, and it went black; seems pretty darn obvious.
So there I was: 22 years old, filled with my own confidence, and ready to change the face of emergency medicine. A few months after graduating p-school I started my first full time paramedic job working for a company called Foothills Ambulance out of Golden, Colorado. Foothills wasn’t what you’d call a very professional organization. Our headquarters was basically a condemned shack with a few bunks and enough parking space outside for a couple ambulances. I’m not kidding about the condemned part- the only reason it wasn’t to down was because the fire inspector knew better than to stick his head inside the door.
The working conditions weren’t much better. We were expected to work at least 60+ hours a week and weren’t paid overtime. Illegally. The owner made it clear that if we ratted her out she’d drop everyone to minimum wage and 40 hours a week. Heck, one time the drain cracked, dumping water and refuse into the crawl space below the small kitchen, and we only noticed when the smell finally started freaking people out. Management’s answer? Buy some lye and make one of us crawl in there ourselves and spread it around. Why did we put up with this? Foothills was one of the only companies in the area (nearly everyplace was a private company, not a municipal department) that would let every rig run 911 calls. Nearly everyplace else required years on transfer cars running back and forth between nursing homes before you gained enough seniority to use those lights and sirens.
As far as I know, these days all that’s left of Foothills are a few t-shirts buried in rag piles. Even our noble “headquarters” is probably long gone.
I managed to get a job there thanks to my roommate who was working for them as an EMT. I was totally psyched- there I was, fresh out of school, and I’d be running real emergency calls. So psyched I managed to sleep through my alarm the first day and showed up 40 minutes late for orientation. Not the best start, and it probably didn’t get better.
Most places start you off as a third-rider/candidate working under a senior medic called a Field Training Officer. You spend a few weeks learning your way around, the department’s protocols, and having your skills evaluated. (Except Jersey City- when I worked there it was 3 shifts and you were on your own; getting lost with lights and sirens running is always tons of fun).
I started to learn pretty quickly that my lack of experience was a bit of a liability. I was far from polished, but good enough I probably wouldn’t kill anyone. Actually, as a medic you really have to screw up to kill someone directly- it’s more along the lines of not effectively preventing them from expiring that’s the problem. Eventually I muddled through the program and was handed the keys to my very own ambulance, with my very own EMT partner. A really cute one. With red hair.
I’d like to blame the next part on her for distracting me, but alas, it was my own stupid ego.
The day started slow; I think we maybe just did a transfer or two. After dark we finally got our first call.
I was excited. I was pumped. My very first call as a solo paramedic on a paid ambulance (I was also volunteering somewhere else at the time). We were dispatched to a local trailer park, one of the nice ones, for an elderly patient with altered mental status. This can mean pretty much anything from a drunk to a room-temperature body (you’re not real responsive at room temperature, unless the room is 98.6 degrees). More often than not, at that time and with that kind of call, it’s some sort of medical issue.
We rolled up and I let my partner lead. We often let the lesser-trained EMTs run calls as training experiences. Personally, I was trying to show off to a cute girl. We walked up the stairs into the trailer and were met by a neighbor, also an older woman, who showed us to her friend sitting in the living room, not very responsive. Up to now all was good in ambulance-land.
It didn’t last.
There are a lot of things that can make someone act weird. This patient was staring off into space, and wasn’t very cooperative. She’d fight everything we’d try to do. Sure, it could be a head injury, drug interaction, hypothermia, or dozens of other medical problems, but in this case the odds were strongly in favor of hypoglycemia- low blood sugar. Mostly because she was diabetic. And might not have eaten recently, according to her friend.
Here’s where things went wrong. For some reason I got it into my head that I HAD to put her in my ambulance and take her to the hospital. Sure, I could have started an IV on scene and given her some glucose (sugar) to wake her up right away, but I just got it into my thick skull that I had to get her in the ambulance and treat her on the way into the ER.
In both EMT and paramedic school your very first class is on medical/legal issues. One of the most important you cover is consent. Basically, the law says you have to actually get someone’s permission to treat them before you touch them. Poking needles into people who don’t want them is some obscure thing called “assault”. There’s also things like “unlawful restraint”, and “kidnapping”. Now if a patient isn’t mentally competent, or under 18, you have something called “implied consent” and can do what’s needed. Even a drunk is considered incompetent and you can tie their asses to a backboard if you have to in order to treat them.
In this case, the patient clearly couldn’t make decisions and I was totally justified in putting her in the back of the rig and driving off. So I did. Even when she started fighting. Even when this 70+ year old woman with low blood sugar started becoming a serious challenge to me and cute red haired partner. Seriously, never get into a wrestling match with grandma.
We struggled and wrestled this poor old lady into the back of the rig, her fighting every step of the way. Her friend wasn’t too thrilled with us either. It wasn’t pretty. We finally got her settled back there and I started a line (IV), and injected an amp of D-50 (50 mg of dextrose, a simple sugar). Cute red haired partner was now rattled and exasperated, and started driving us to the hospital.
Since D-50 takes all of 1-2 minutes to kick in, tops, I had a good 15 minutes or so of an angry lady in the back of the rig wondering why the hell I didn’t just give her the sugar on scene, make her eat some food, and let her manage this disease she’d had for years all on her own. I’ve sco ed a few women in my day, but this was a burning look of hatred that’s still seared in my brain 13 years later.
No, I didn’t technically kidnap someone. Legally I had implied consent, but I suspect a good lawyer could prove my actions weren’t reasonable for someone with my level of training. I should have given the sugar on scene, and assuming it worked could have asked the patient what they wanted next. Instead, for whatever reason, I dragged her to the hospital and saddled her with both an ambulance bill and ER bill she didn’t really need.
I screwed up. Needless to say, things never went anywhere with cute red haired EMT. And I’m darn lucky I just got reprimanded by my supervisor and the patient never made a formal complaint.
I knew all the textbook answers, and thought that was more than good enough. I was trying to prove that despite my age and lack of experience, my enormous brain could compensate. Well, something was enormous, and it wasn’t my brain or any body parts.
I learned the hard way (and my patient the harder way) that while experience doesn’t always make you an expert, you can’t be an expert without experience.
I eventually got there, and avoided any more kidnappings, but a few more years in the field before going to p-school would have made all the difference.