My non-traditional journey to medical school involved a seven-year stint working as an EMT and paramedic. Serving patients in Northern New York and the Greater Boston area was a privilege since I was tasked with caring for the most acutely ill and injured patients. Initially, I felt a lot of pressure having this responsibility because my actions could mean life or death for these patients. This was particularly true for one of my first emergency calls as a paramedic. My partner and I were responding mutual aid to an adjacent town for a child in respiratory distress. During the response, I heard the words “juvenile” and “not breathing” on the police radio. I felt a sense of urgency as this was likely a sick pediatric patient. My EMT partner and I met the other town’s ambulance in front of an unkept residence. We found a toddler named “Aiden” lying on the stretcher in the ambulance. I placed him on the heart monitor and checked for a pulse. There was no pulse and a flat line indicating asystole ran across the screen. Seeing Aiden lifeless on the stretcher with his eyes staring blankly into space caused my heart to sink.
The reason I did not immediately freeze in that moment was that I had prepared to care for Aiden well before the 911 call was even placed. Throughout my adolescence, I had heard about the various traumas that healthcare workers encounter on the job. My mentors had told me that gruesome traumatic injuries, children in distress, and deaths were enough to incapacitate a provider in the moment and cause them to leave the profession due to the mental toll. Ever since the day I earned my EMT certification, I would constantly reflect on those potential situations. How would I react to patient suffering? What would I do in the face of death? There was a central question that always persisted in my mind: was I willing to always help the patient despite those difficult circumstances? Being mentally prepared for uncertainty and the worst-case-scenario made handling those situations more manageable. Preparation also meant enhancing my clinical repertoire. When I took my first ACLS course at age 18, many questioned my motives. Why was I taking a $200 course that had minimal applicability to an EMT like me? For me, it was all about exposure. Why wait until I was a year older and in paramedic school to learn about advanced life support and algorithms when I could start at that moment? The more time that I spent going through ACLS medications, managing mannequin airways, or identifying rhythms would make me a better provider when it came to those stressful moments that mattered the most. For many patients who I cared for as an EMT and paramedic, being mentally and clinically prepared was the difference between survival and death.
When it comes to managing a critically ill patient like Aiden, healthcare providers often need to pay just as much attention to their team as they do towards the patient. It is an ironic concept considering how we strive for patient-centered approaches in healthcare. During that call though, I remember the mayhem on scene. EMTs rushing through ineffective CPR, police officers yelling, and screaming bystanders surrounded Aiden when I arrived on scene. Seeing how dire the situation was, I took the initiative as team leader and coached the team to perform high-quality CPR. This is where connecting with everyone proved vital. Utilizing closed-loop communication to delegate tasks and receive feedback from the various first responders provided the order we needed to care for Aiden. During the 30-minute transport to the emergency department, I continued to direct and encourage the team even though Aiden’s condition did not improve. In addition to CPR, we administered multiple medications, placed an endotracheal tube, and considered reversible causes for his cardiac arrest. What made the cardiac arrest run like a well-oiled machine was the mutual respect and openness that myself and the other EMTs shared that day.
Despite our efforts, Aiden was pronounced dead at the hospital due to viral meningitis. Before that call, I had often looked at death indifferently and even nihilistically. I viewed it as a universal destiny for all of humanity that affected both the old and young. Aiden’s case changed me though. Before leaving the hospital on that summer afternoon, I had a newfound desire to help the next patient despite death’s inevitability. Medicine was no longer a job, but rather a cherished vocation. The mantra “so that others may live” has propelled me through this journey in medicine. Reflecting on the call, pursuing additional continuing education, and harnessing a desire to help the next patient fueled this motivation. Two years later, I used the lessons learned from Aiden’s case to help resuscitate a young girl named “Charlotte” who presented similarly. I believe that it is a consistent desire for self-improvement and the ability to embrace hardship amid difficult circumstances that makes the most effective clinicians.