The Trust Factor
Tara D.
I'm on the back hill slide of my career. I've got far more years behind me in the rearview mirror than I do staring down the barrel of the windshield so some generational misunderstandings are going to happen. For example, if your shift starts at 0700, you should be checking off your until by 0630. At least that's how I was raised up on the job and personally I take offense to anyone showing up any later than that to relieve someone who's already put in 48 hours and is just praying for shift change to come sooner rather than later. So please tell me why the new kids walk in at 0655 wearing gym shorts and Crocs? I'll never understand showing up to work not wearing your uniform but the more time goes by, the more commonplace it is for your relief to walk in five minutes before their shift starts wearing whatever they rolled out of bed in wondering why you've got an attitude when doing the truck hand-off report: Them: "is it missing anything?"
Me: "probably." **And then I leave.**
These kids know more about A&P than my generation was ever taught. They can explain the pharmacokinetics of any drug and the body systems right down to the cellular level. Their base education was far more extensive than that of my generation so clinically, they're wiping the floor with us. Don't believe me? Just ask em! They're more than happy to tell you how great they are and why they don't need any advice or guidance from you. Us Old Heads are mostly deemed irrelevant until that teachable moment inevitably comes around. You'll know it when you see it. Just look for the sheer look of terror on the new kid's face. But even then, the moment after we've saved them from themselves, we're ushered back into the background while they tell us why their way of doing things is actually the only way of doing things. I think the majority of us are used to it. We shadow alongside them quietly waiting for them to tag us in and the moment they start to actually drown is the moment we tag ourselves in and clean up the mess hoping that the lesson wasn't lost in the aftermath. But one glaring gap in their skill set continues to baffle me; they don't know how to talk to people.
For a generation that has never known a world without contact, connection, and instant access to people, these kids have no idea how to conversationally gather pertinent history, symptoms, context clues, assessment AND CONSENT from patients, family members, bystanders, or other crew members. I think if they could text their assessment questions in they'd be fine but to actually have a conversation with someone, a stranger, is completely foreign to them as is the ability to care, or to at least emote it, if they can't actually do the work of actually caring.
Maslov made it pretty easy to understand that human beings need to be cared for, especially when that human being is turned into a big dumb animal by fear, pain, illness, or injury. Given that our entire profession is built upon caring for people when they're not at their best, in under less than ideal circumstances, wouldn't it be reasonable to assume that anyone called to this job would be someone who cared about people? Because it sure isn't the money or career advancement opportunities that are drawing them in!
It's understandable that during the early days, the rookie phase, that someone might stumble for the words or stutter in their flow when practicing the finesse of speed dating sponsored by Medicare as compared to someone with a decade or more under their belt. The rookie is still trying to complete his SAMPLE history while the Old Head just got invited to Thanksgiving dinner. The conversational aspect of this scenario is a skill that comes with practice, time, and a million different contacts with a million different patients. You start learning who will respond to what and adapt accordingly. Unless you have nothing to base your assessment on, which in that case, you either approach it like a training scenario or clam-up and wait for an adultier adult to make location. I finally had this play out beginning to end on enough of a consistent basis that I was able to explain it all to my greener counterpart when, for the fourth time in a row, a patient spoke to me and not him. The fifth encounter was the straw that broke the camel's back when a mother handed me her sick baby, rather than handing the baby to guy all up in Mama's business!
This kid could run circles around me. He can explain the why on anything, even when I don't care to know. "That's fascinating and I'm so glad you shared that with me but could we address the shit-show that's currently circling down our drain or nah?" He's so smart that it irritates me. Especially when he wants to teach me something he thinks I don't know. Most of the time I let him, like a mother let's their child dress themselves for church. It always ends the same: he's wearing a tutu, a tiara and cowboy boots while lecturing me the benefits of prophylactically sedating patients who "might" become agitated, while I'm standing by holding a BVM waiting for the other shoe to drop. Sure. I could tell him why that's a terrible idea OR I could wait for the terrible idea to illustrate itself and let him ventilate himself into a solid understanding of why we don't do that.
I'd spent many shifts banging my head against the wall trying to defend my generation and our way of doing things only to be countered at every turn and before long, I didn't like the new guy I wanted to like so badly. He was so smart with so much potential but his ego was holding him back and after sky-rocketing into an In-Charge position in the field, his ego was going to get him and others hurt. I tried to tamper it down by being the gentle maternal figure, the cautious but affirming cheerleader/Big Sister, even the crunchy salty old head that bit a little harder than necessary to make the lesson stick, but none of that worked until a patient's daughter turned to him and said "I want her back here with my mom, not you. You may know what you're talking about but you should talk less and listen more. I don't need to know how smart you are. You do. I only need to know that you care and you don't. She does."
He and I were both taken back by that statement because nothing had happened to suggest any potential conflict between the two of them, let alone involving the patient. I had consciously made the decision to fade to the back and let my partner take center stage and was very deliberately staying as far off to the side as possible, but even then, the fact that my partner was bored and bothered by the call and everything else involved with it. I smiled and made eye contact and addressed the patient directly, even though I could tell that dementia had long since taken its toll and the daughter was going to be doing the answering for the patient. I gently held her hand and explained everything to her before we did it and on the way to the hospital I held her hand rather than writing my run report. The entire call took under an hour but it had an impact that lasted a lot longer, and in fact, years later, is still at play, all because he set his ego aside and climbed into the box with a question and a genuine desire to learn: "How do you do that? How do you make people trust you like that?" Here's the answer I gave him and have given anyone else who has ever asked me some variation of that same question. I'm sharing it with you all because we seem to have lost the art of caring in this profession and it is my hope that maybe this will bring back a revival of caring, compassion and kindness. Otherwise, what's the point in any of this?
"I'm sure you've heard it said a thousand times over to treat people how you would want your loved one to be treated and it's true. The problem is that that concept has no meaning when you're young like you are. You can't conceive the notion that there will come a day where the person you love more than anything in the world will be strapped into that stretcher and you're going to be facing this scenario from the other side of the call but it's true. That day will come and when it does it will humble you. Only then will you realize that nothing else in here, in this truck, in this situation matters except the humans involved in it. They don't understand the jargon and lingo we use, so instead they'll search our face for interpretation. They'll weigh the severity of the situation by the sound of our voice and by the urgency with which we move. Their eyes will be focused on every movement of our hands, our feet, our equipment, searching for some hint as to how good or how bad things really are. They'll lose site of their loved ones because by necessity we will step into the forefront and the familiarity of their home will be replaced with foreign surroundings full of strangers and though everyone is talking about you, no one is talking to you, and you're left there internally screaming for someone to notice the scared sick person wadded up into a ball of blankets and belts. You wanna be the best of the best? Then get really good at noticing what most people overlook. Slow down and look down at the person in the center of everything. Ask their name. Tell them yours. Hold their hand. Ask them questions even if they can't answer you. Explain everything to them even if they won't understand it. Offer them reassurance even if it looks bleak. When the room reads panic, make sure your face, your words, your tone, and your tempo read calm and control. Give them choices when you can. Offer them a blanket even if it's not cold and get a warm one out of the blanket warmer at the ER as soon as you get there. If you're not sure where to start, ask them about their grandchildren, that's always a safe bet, just talk to them regardless of what you're talking about. Just that act alone will make them feel seen and cared for and sometimes the distraction will benefit you just as much as it does them. They don't give a shit how smart we are. They won't remember how skilled you were, but they'll remember how you made them feel and that'll be the last thing you leave with them so make sure you leave them feeling like you cared, especially when you didn't."
