There

Once upon a time I decided that I wanted to become an EMT. So I did. It took me about 3 months and 5 phone calls to figure out what I needed to do, and in December 2001 I was officially certified. The training was a lot of fun, and very fascinating to me. I kept my textbook because I still find it interesting reading, and also because it was expensive, but mostly because I think it’s cool to have a book on my shelf that says Prehospital Emergency Care and displays a picture of a helicopter, fire truck, and ambulance all at the same scene.

The thing about emergency medical care (and probably every profession) is that there is a lot more to the daily operations than just the textbook procedures. It’s really good to know how to take a blood pressure, and know what it means. It’s certainly important to learn how to appropriately perform CPR. And it’s pretty much absolutely essential to memorize the indications for administering epinephrine. But when the 911 call comes in, it turns out that there is a lot more to responding than just the medicine. And so, my EMT instructor gave us what he called “practical advice for life” as part of every class. The stuff that’s not in the textbook, but is important to know. And he wasn’t kidding either. I didn’t realize important the practical advice for life was until I failed my first practical exam by losing “style points.” I didn’t even know that style points existed. But in his class they did, and they counted for a lot.

I walked into my exam room where the instructor explained that my patient had been the victim of a drive by shooting and received 2 gunshot wounds: one in the leg and one in the stomach. I somewhat dismissively said “Well that sounds like a bad day.” He gave me a chance to redeem myself, but I didn’t know that I needed redeeming, so when he asked “What?” I said with equal flippancy “That sounds kind of uncomfortable.” And right there I failed. Before I even approached the scene, or assessed the wounds, or controlled the bleeding, or administered oxygen, or made a decision about transportation (all of which I could have done perfectly). I failed the exam because I had disregarded the advice that one of the most important things an emergency responder can do for patients is validate them. Instead I had minimized the problem to a “bad day” and “kind of uncomfortable.”

Once I realized that style points did in fact exist, I did a lot better in the class. Most of the practical advice for life was not profound. Much of it was very entertaining. Although it has been years since I’ve really been anywhere near the emergency scene, I still recall the top 3 pieces of practical advice.

1)Always carry a pen.

2)Babies can be very slippery when they are first born. If you drop the baby…pick it up.

3)Never ever ever ever say “oops” or “uh-oh.” No matter what you do, no matter how badly you mess up, no matter what is going on, a patient should never hear you say anything that indicates something has gone afoul. It doesn't matter if the problem is painfully obvious. Even if you’re carrying a hiker down a mountain trail on a backboard and you drop him, and he goes tumbling down the mountainside- Never say “oops.” Instead say “there.”

I’m not sure why “there” is the word of choice, but it is.

I have generally been very pleased with my doctor. He has been very helpful, usually has good bedside manner, and I would recommend him to anyone that asked me about him. His medical training, although exponentially more thorough than my little foray into first aid, evidently did not include practical advice for life. I’m officially past my due date, and am exhibiting no signs of impending labor, so he sent me for an ultrasound to check on the growth of our baby. When the ultrasound tech handed him her report he offered a very surprised, and not reassuring, “Oh my!” This is not quite the same as “oops,” but not much better. Apparently, despite having very average sized parents, our baby is huge: potentially large enough to significantly complicate delivery. We are now scheduled for the soonest available induction. All of this information would perhaps have been much more welcome if it had been preceded by “there.”

New Job

I have taken up babysitting. This is also frequently referred to as substitute teaching. Substitute teaching is in no way similar to real teaching except that it occurs on a school campus.

Benefits

1. I don’t have to work every day. This is really convenient on days that I am sick.
2. I have no before or after school responsibilities. No bus duty, no lunchroom duty, no metal detector duty, no staff meetings, no lesson plans to submit, no papers to grade. When the kids leave, I leave.
   
3. I get to have a new specialty every day. In addition to History I have now “taught” Accounting, Chemistry, Psychology, Keyboarding, Economics, English, Algebra, Public Speaking, and Basketball. I do not think the PE teacher realized I was pregnant when she called me, but it was a week that I was feeling pretty good, so I went ahead and did it.
4. By far the most significant: No irate parents.

Drawbacks

1. It’s really really really boring. Sometimes the most difficult thing I have to do all day is stay awake. Having been a teacher I understand the wisdom in providing a self-directed assignment for the kids to work on, but as a substitute I sometimes wish I had more to do than take attendance and hand out worksheets.
2. The kids aren’t mine. Instead of knowing who just got a new haircut, and who’s trying out for the play, and who has been looking for an after school job, and who always writes in green pen, and who just moved in; I just have a list of names. The politely say “here” at the appropriate moment during attendance, and that’s about all I get out of them.
3. No lesson plans. It doesn’t matter if I have an awesome idea for teaching the stock market crash, or if I know a really great activity to introduce Pavlov’s theories. My job is to follow the provided lesson outline which is usually to take attendance, and hand out the worksheet. Or take attendance and start the video. Or take attendance and tell the kids what chapter to read in their textbooks.

The job is different, and the kids are also significantly different. Rural farming community kids in no way resemble their inner city counterparts. They are remarkably submissive. They come into class and sit down without being asked, and they follow directions without argument. I wondered how far this compliance would go, and one day I told them that I needed them to line up in alphabetical order by the second letter of their middle name. They did it incredibly quickly. Nobody asked “why?” None of them said, “This is stupid.” The whole class just jumped up and started asking each other how to spell their middle names. It made me laugh. Then I divided them into teams for basketball.

Dr. Visit

I have somehow become entirely conditioned to believe that visiting the doctor will make me feel better. I'm not sure how this happened. As I reflect on my experience with doctors I realize that such belief has received very little positive reinforcement. This is in no way a negative commentary on doctors. I know that their medical expertise and advice have led to my eventual recovery on multiple occasions. But, while it has never happened, I have come to believe that a trip to a doctor’s office will result in the immediate cessation of ailment.

My doctor has told me that he has done everything he can for me, that it is normal (and somehow healthy) for me to feel awful, and that pregnancy is supposed to be uncomfortable. Even still, when I am feeling particularly miserable, I find myself looking at the calendar and counting the days until my next doctor appointment and, despite my knowledge to the contrary, believing that it is a magical day on which I will suddenly feel better.

While not a single trip to an obstetrician has been able to fulfill my irrational belief, last month’s visit was at least somewhat vindicating. As we were sitting in the waiting room I mentioned to the Texan that our baby had the hiccups. He apparently had never heard of this before, and insisted that it couldn’t be true. Later, while the doctor was listening to the baby’s heartbeat he mentioned that the baby had hiccups. And while I still felt just as nauseated as I had when we arrived, I was thoroughly delighted to declare a professionally endorsed “I told you so.”