MCRA Connections

Making Lemonade

People ask me, “What is the worst call you have ever worked?” As a road medic and trauma/corrections nurse, I’ve seen and done plenty of the things that most people do not see or do. When telling stories about blood, guts, and gore, people often conclude that these were horrific experiences and we must have been seriously traumatized by them. Sometimes, though, we are not adversely affected. On those occasions when we beat the bastard (death), or do the seemingly impossible, we are invigorated. Our capes wave in an invisible breeze, our emotional tanks top off, and we remember why we got into this crazy business in the first place.

A flight from Las Vegas to Detroit some years ago provides an example. When I heard the overhead plea for “any medical personnel” my heart sank, head dropped, and I mentally uttered, “Oh, Sh**.” I was not prepared, did not know the protocols [for in-air rescues], had no idea what equipment was available, and was clueless as to what type of emergency had presented. Those are my fear triggers. Did someone in first-class drop dead and I was going to have to run a code blindly?

I answered the call. It was serious enough to warrant communicating with the Mayo Clinic as medical control, pulling out the drug box, starting a line, and administering medications in bumpy air. I had to brace the patient on the floor to keep us both steady during landing and then turned her over, in improved condition, to a pair of medics who took her to the hospital.

When I review that call, I realize that it began and should have remained terrifying. The patient spoke poor English, communications with the Mayo Clinic doc were rough, and I had to share the radio in the cockpit with the pilot who was trying to divert to a new airport. The bumpy air meant poor conditions for poking ampules and skin with needles and produced an EKG that was almost unreadable. I was not sure what I was dealing with, which meant not sure of which protocol to use, or what to intelligently report to medical control.

The woman could have coded, and the airline’s drug box was poorly stocked. The landing, with neither of us strapped in, was difficult as I braced the patient on the floor and pushed my legs and back firmly against the first-class service area bulkhead to keep us from flying into the first-class cabin.

It was awesome; the most fun I had in a very long time. I got to be road medic and trauma nurse, had an audience of first-class passengers transfixed by what they saw, and an attentive flight attendant who acted as my partner, getting rid of sharps, and noting vitals and medications as administered. What could have been a negative, as my perception going in was a worst-case scenario for my personality (unpreparedness), completely flipped. I came away with two bottles of wine, grateful passengers and crew, and a story that renewed rather than drained.

Back home, my full-time job was at a Detroit Trauma Center, and we were always understaffed and overworked. I was a magnet, attracting the worst situations, and never had a “Q” (quiet) day. Sometimes we handled the impossible and lived to walk out the doors at the end of 12 (or 16) hours. Many times, we left completely drained, ready to ditch our uniforms and stand under our showers at home until we washed away the smell, pain, images, and failures. Other times, we high-fived each other on the way to the parking garage because we came out victorious; we conquered what could not possibly be done. We had raced each other to get lines on IV drug abusers and trauma victims who had no discernible veins. We bounded down the halls at super speed, making faces at each other, and sometimes whispering expletives, as we ran for equipment, sent blood tubes to the lab, or checked the pharmacy tube for meds that never came.

Trauma centers are unpredictable at best, and we hold no claims to controlling outside forces. A blackout that covered eight US states and Ontario, Canada in the sweltering, humid August of 2003 wiped out power and water. Local nursing homes assumed we had auxiliary power to support their patients (for several days of power outages). We did not. People at home without air conditioning thought that we would have our AC running. We did not.

The city water was contaminated. Some water in gallon jugs came from administration to each ER module, solely for the patients to take medications. There was no water for staff in my module the first day. People were angry, hot, miserable. Those with difficulty breathing longed for an air-conditioned room. Patients and their families were verbally abusive because the hospital was not prepared for a catastrophic emergency.

The staff could not take breaks, obtain water or coffee (a mortal sin), and ambulances backed up into the street. Many patients who came in by EMS, thinking it guaranteed them a bed, found themselves, because of the low priority of their complaints, shuffled into the waiting rooms. We double-bunked patients, throwing portable screens between them in the ER to offer some measure of privacy.

On one of those days, feeling hopeless, helpless, and at the end of my rope, I grabbed Bonnie, my ER tech/medic, and stepped into the ice room. We each vented for a minute, then broke out into song: “I’m not crazy, I’m just a little unwell…” [Matchbox Twenty]. For the next few days, every time we saw each other in the hall (away from patients), we started singing that same refrain, and it defused our stress to tolerable levels. We had no control over the situation and felt powerless until we realized that we could control our reactions to the situation.

We got silly, and it worked.

How can that be? How can the same experiences that cause negative feelings and burnout also result in positivity among those exposed to trauma? Although traditional psychology addresses pathology and negative outcomes, some researchers have found workers exhibiting compassion satisfaction during traumatic occupational stress, confounding the relationship between trauma and coping. Such a conundrum!

Something incredible can happen during the worst of circumstances as a responder. Sometimes we are victorious, and sometimes we grow. Sometimes positivity wins out over the black cloud that darkens the joy we find in our work. Sometimes we are invigorated by the feelings we get from caring, doing jobs well, and helping others. In the worst of circumstances as a responder (or receiver), sometimes we are triumphant.

When I was researching the problem of a lack of coping and resilience education in nursing for my doctoral study, the literature search surfaced many of the articles and outcomes with which we are all familiar. Bad things happen to emergency responders. The responders may experience anything from compassion fatigue to burnout to PTSD.

Journal articles abounded with negative outcomes and why we need to build resilience and integrate an effective response program, like CISM [and resilience in healthcare], into worker’s toolkits. Awareness, preparation, and education are wonderful things. They make the difference between standing alone in the dark, cold, rain or running at full-speed and tumbling joyfully down a grassy hill in the warm sunlight.

Although there was not much in the literature about the posttraumatic growth stemming from occupational trauma, it is beginning to surface. Mixing the ingredients of positive emotions, meaning making, and accomplishment in a bowl of mindfulness, we can find a calm center in the midst of chaos, those whirlwinds of emotional tornadoes.

We all know about transforming a negative situation into a positive; we talk about it during almost every CISM debriefing. Taking the foundation of reframing situations into positives can personally and professionally transform us. Twisting your spiral upward into positive perspectives does not mean becoming Cupcake Carol and mindlessly smiling all the time. It means you try to change your view.

Choosing to find a single piece of positivity in negative situations, to reframe what happened, can help form a path to seeing things differently. It takes effort. When I’m discussing bad calls with peers, sometimes we cry as we share what was painful to our hearts. Somewhere in the discussion, though, we find the sliver of hope and redemption.

It isn’t always easy, or possible, but sometimes, it reframes the view, the memory. It changes things. It changes fear and trepidation at 30,000 feet into one of the best calls I ever worked.

Submitted by: Jones, Sherry Lynn (2014). Making Lemonade: Posttraumatic Growth and Reframing. LifeNet, 27(2), 4, 18. Reprinted and adapted with permission.

And Something Fun!
The Monkees’ Pleasant Valley Sunday is the tune.

Another Trauma Junkie Sunday
(by Sherry Jones)

The EMS guys down the street
Are trying hard to learn their skills
Starting lines, use protocols for hearts and trauma, treat all ills

Another trauma junkie Sunday
Guns and knife clubs everywhere
Guts and gore get splashed all over me
And no one seems to care

See Medic Rick he’s learned a trick to get more stock from ER rooms
And EMTs share where to hide when all they see is doom and gloom

Another Trauma Junkie Sunday
There’s a full moon everywhere
Once the darkness falls the traumas bloom
Breaks and food are rare

Folks all warn me now
Go back to college soon and get a medical degree
My student loan is due, no chance of medical school
I need a financial fairy

La La La …

Another Trauma Junkie Sunday
Smell of Diesel everywhere
Another Trauma Junkie Sunday
Here in Paramedic Land

Another Trauma Junkie Sunday …

MCRA Connections

January 2019

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