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.”