I was a very shaky student.

Literally.

The very first third ride I did as a medic student was with a vollie department in the area… It was a call for chest pain, and I  was ridiculously geeked.  I remember sitting in the captain’s chair in the back of the squad, watching the rural landscape whiz by through the small side window feeling like I was ready to jump out of my skin.  I was ready to hit that run out of the park.  I made sure that I knew where everything was in the patient compartment, I mentally went over different rhythms and their treatments.  I thought of the different signs and symptoms that the patient might be exhibiting.  I thought about what I wanted to do first, and what I’d do after that, and what I’d do after that.  I did what I thought I was supposed to do on the way to a run.

And then we pulled up to the house.  I could feel my heart pounding in the center of my chest.  When I looked at my hands… They were shaking like I had just mainlined a few pots of coffee.  The kind the night shift at the local ER makes.  The stuff you can pave a road with.

Not the picture of calm.  Not by far.  When it was time to climb out of the back of the squad I tripped on the hook that catches the stretcher and damn near fell on my face.

It really was that bad.

I carried the monitor into the house and was instantly met with a scene I was completely unprepared for.  People, everywhere.  Medics, firefighters and equipment was scattered throughout the tiny living room.  A drug bag and an airway bag were open on the floor, and their stretcher was taking up what little space there was left.  I didn’t know where to go.  I felt like I was cemented in that very spot.  Unable to move.  I could have jumped in there… I should have.  A mixture of nerves and a somewhat chaotic scene prevented me from doing so.

So I stood there in the doorway feeling like a complete idiot.  I was supposed to be the one in there asking the questions… Getting things done.  Instead I let my own self confidence issues keep me from functioning. Hell, I was barely breathing, let alone acting the part of the calm, confident Paramedic that I knew I had in me.  Like the Medics I look up to and respect the most.

Those early third rides were a nightmare.   I couldn’t shake my insecurities.  I couldn’t shake the paralyzing fear that seemed to wrap itself around me like a wet blanket every time I stepped into someone’s home.  And I’d torture myself after every single run.

What the hell is wrong with you?  You know your stuff.  You need to get in there and do what you were trained to do.  You are never going to make it through this program if you can’t knock this crap off.

YOU ARE GOING TO FAIL.  AGAIN.

As time moved on I started to make small advances.  The lab portion of class became easier.  My “stage fright” when it came to testing out on skills all but disappeared.  I started doing my preceptor rides with squads from the private service that ran my school, with people that I knew.  That was probably the best thing that could have happened as my comfort level in the back of the squad was at a point where I didn’t feel like I was going to have a stroke every time I was with a patient.  I knew the back of these trucks, I had worked in them for awhile.  I knew the facilities we would go to.  I knew the crew members.  I felt like I was home; not just a guest in someone else’s house.

Even with the improved learning environment, I didn’t feel like I was being aggressive enough on calls.  I still wasn’t jumping in there like I should have.  I was more than willing to hang back and soak everything in for a minute before getting involved.  I knew what needed to be done, I just didn’t have the confidence to do it without being prompted by my preceptor.

**********

Fast forward to ten days before the end of class.

It was hot.  At least 95 degrees in the shade.  We couldn’t even count on the wind to offer any reprieve as every time it picked up it felt like we were in front of a blast furnace.  I had been lucky enough to score a 24 hour third ride with my favorite preceptor, Kozi, and his partner the lovely Miss S.

Dispatch had been running the stripes off of the side of our truck with back to back to back to back to back BLS runs.  11 hours into the shift and I hadn’t even gotten an IV started.

“Sit down, fill out your paperwork, and just relax.”  Kozi was ordering me to cool off.  We had just dropped off an ECF patient for a tube replacement and we were happy to be sitting in the almost icebox like air conditioning of the EMS room.  Still, our uniforms were all stuck to us, we were drenched in sweat and all three of us were possibly a little cranky.

Ugh.

I cracked open a fresh can of the finest Diet Pepsi and took a long swig while starting to jot down all of the patient’s information.

Name… Address… Phone number… Address…  I didn’t even get to “Chief Complaint” before the squad’s pager was going off.  Had I been holding it I’m fairly certain it would have been thrown across the room.

“Are you SERIOUS?  They can’t even let us sit for five minutes?”  I picked up my paperwork and cursed under my breath all the way out to the squad.

Yep, that’s right.  I had a full blown hissy fit.  I stopped just short of crossing my arms and stomping my feet like my daughter does.  I didn’t even bother to ask what the call was for, I just climbed into the back of the truck and sulked.

Kozi and Miss S followed shortly behind.  I could heard them chattering but didn’t pay much attention, instead I focused on the attitude adjustment I knew I was in need of.  I went to my happy place instead.

A hammock strung up between two palm trees, a great book to read… Nice quiet beach with powdery white sand… Waves washing up on the shore… Cold fruity drink in a glass with an umbrella in it… Some stunningly handsome tall dark and handsome man feeding me grapes… And —

*Insert obnoxiously loud siren and airhorn blaring here*

So much for my happy place on the beach… We had an emergency run.

I leaned forward into the cab of the truck and asked where we were going.

“It’s an unresponsive at Happy Hills Psych Hospital,” Miss S. replied.  She was busy watching the other drivers on the road while Kozi steered us around them.

I grabbed the airway bag and the Lifepak and put them on top of the stretcher.  I checked the portable tank to make sure we weren’t low on O2 and made sure that we had strips in the glucometer.  I spiked an iv bag and hung it up above the bench seat and shoved a handful of gloves in my pocket.  Satisfied that I had covered my bases I sat back in the captains chair and waited to get to the facility.  I found myself again watching the scenery fly by through the side window of the squad, our red and white lights bouncing off of mailboxes and windows.

Before I knew it Kozi was parking.  We were there.  ”Epi, can you throw the monitor and the airway bag on the st—”

I yelled back, “Already done.”

“Alright, Girl.  Think about what your treatment for this patient will be.  This is all you.”

I nodded, swallowed hard and pulled the foot end of the stretcher towards the doors of the facility where I could see a security guard and a very anxious nurse waiting for us.  She started talking before we were even to the door.  ”I have no idea what’s going on with him… He was fine a few hours ago, then he started refusing his medications, and now, nothing.”  She was walking fast enough that even I had a hard time keeping up with her.  I felt like I was dragging Miss S behind me with the stretcher.

The security guard let us through one set of doors into a foyer.  When the doors behind us closed he opened the second set of doors that led to the floor.  We repeated this ritual three more times before reaching the area our patient was in.  I could see a group of employees gathered outside of a door a distance down the hall.  Our escort nurse indicated that the patient was in that room.

I entered the room with Miss S.

Our patient was a 45yo male laying in his bed, out cold.  Honestly, it looked like he was sleeping.

“What’s his name?” I asked while grabbing a nonrebreather from the head of the stretcher.

“Franklin,” one of the CNA’s answered.

I rubbed Franklin’s chest hard with my gloved fist.  ”FRANKLIN!”

No response.

I put the NRB on him while Miss S checked his blood sugar.

“What is it,” I asked while slipping the elastic bands behind his ears.

“He’s good.  129.” She replied.

His color didn’t look bad, but I had been watching his chest for ten seconds and I hadn’t seen it move.  ”Yo, is he even breathing,” I asked no one in particular.  At that second Kozi walked in and asked the same thing.

“HEY!!!!  FRANKLIN!!!!!” I yelled a little louder and rubbed a little harder this time.  If he had chest hair before he didn’t when I was done.

Franklin took a breath and slowly opened his eyes, “Mmm whatsgoingon?”  His speech was slurred.

“Franklin, I’m Epi… You need to stay awake and talk to me for awhile.  What’s going on with you tonight?” I started patching him up and Miss S slipped the pulse ox probe on his finger.

“Yeah…. I think we need to get going.  Let’s move him over,” Kozi said while standing back and letting me work.

Franklin, for his part, closed his eyes and had another apneic period that ended with me yelling at him and giving him another wicked sternal rub.  ”I’mup… Immaurp.” He mumbled.

I looked at the BVM on the back of the stretcher and looked at Kozi.  He nodded towards the door.

**********

The mosquitoes were swarming around the lights from our truck and attacked us as soon as we were within twenty feet of the back doors.  My body was beginning to betray me… Sweat poured down my face, stinging my eyes.  I wiped my face on my shoulder and ignored my own tachycardia while helping load Franklin into the back of the squad.

Once inside with the door closed I started a line while Kozi and Miss S did a thorough once over on Franklin.

Okay, Medic…” Kozi started, “What’s the plan?”  He looked right at me.

Fuck, I don’t know. All I could do was sweat.  What I didn’t realize at the time was that everyone else was doing the same thing.

“I have no idea, Kozi,” I replied.

“Yes you do.  You know what you’re doing… what do you want to do?” He was staring at me now.  I could feel my HR slow somewhat.

“Well… ”  I started…

“Yes, Epi?”

“His airway… Maybe a nasal?”

“Sure.  Do it.”

I dropped a NPA.

I looked at the monitor, Franklin was RSR at a rate better than mine.  His BP was better than mine.  He was pinker than I was.  Other than the fact that he was prone to bits of apnea… His vitals were better than mine.

What else… what else… “And his sugar is good?”

“Yes,” Kozi said, wiping his forehead.

“And his pupils are good.”

Kozi nodded.

“Hell, I don’t know… Shouldn’t we just take him to the ER?”  I had no other ideas at that point.  The truth was that I didn’t know what the hell was going on with Franklin… He was pink, he was breathing and the ER was less than a mile away.  Taking him to the ER seemed like a great idea at that point.

“Exactly.  Let’s go.  Good job, Epi.”

At that point for some reason I chose to look at my hands.

They weren’t shaking.