Confessions of a Burn Out

DrakeBryan

Forum Ride Along
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I wrote this after a recent call, although now it seems a little melodramatic. I was hoping for some feedback on it, maybe somebody else out there shares this feeling i have. Please forgive any spelling or grammatical errors...

Its two thirty AM and in the last one awake, our double wide in the middle of smalltown USA is quiet except for the grating sound of the dying heater. At this point I’ve been awake for over 14 hours on something like 4 hours of sleep and I feel the pressure behind my eyes telling me to do the natural thing and go to sleep. Yet I sit knowing that the next call that drops is ours and the EMS gods are never kind, the second you put on your pj’s the harsh sounds of tones ring out from the base radio denying any sort of rest, at least for a little longer. I bide my time watching TV, staring at the subtitles since I muted it to preserve the silence. As I give in to the urge and start getting ready for bed the inevitable call sounds and in glad I didn’t change into my pjs yet. Instead of irritation I feel relief knowing that after this I can embrace the sweet darkness behind my eyelids at least until the next person decides to up and die on this town. The dispatcher speaks and lays out the reality that is going to be my life for at least the next hour. My partners awake and I respond to dispatch with a slight tone of sarcasm in my voice, my little attempt to undermine the seriousness of the dispatch center. It’s cold outside and fog has descended thick on this little town reducing the visibility to less than 50 feet, but it's inconsequential since there’s not a soul on the roads anyway. My partner hops in the truck wiping the sleep out her eyes and begins filling out the paperwork that seems to dominate our time in this field as I pull out onto the road. I neglect to turn on the lights because there’s nobody around to appreciate them and I certainly don’t need to see them again. It’s off to the low income trailer park where it seems majority of this towns lowlifes and junkies live. I blow past the officer on the way to the scene turning on my lights to let him know I’m taking this call at least a little seriously. As I drive past the rows of trailers I appreciate the minor irony of a permanent housing complex built of houses on wheels. The officers get into the trailer before me full of their self-important pomp and circumstance and I follow with my equipment in tow. I see a young girl holding back tears and I await the inevitable panic that follows when a person finds their loved one in a poor state, but to my surprise it doesn’t come. Following the trail of blood I find a man passed out on his bed and I hope he has a pulse, not out of concern for him entirely but for the fact that restocking the truck after a code is a pain in the *** and I’m tired. I politely ask the officer to get out of the way and he complies with a slight tone of condescendence because his importance has been reduced in the face of a medical emergency. The guy looks dead but has a strong pulse so we move him onto the floor and get to work, my adrenalines up because this is the first real call I’ve run in over two months and it seems I forgot how quickly a scene can get out of control as all the alpha males vie for the symbolic leadership role. The patient is moved to the floor and we get to work, he’s completely unresponsive but still breathing and we begin all the standard rule out procedures to figure out what’s going on. I draw up two mg of narcan in a needle that’s probably a little too big (since our stock doesn’t have the appropriate size… it’s on order or so I’m told) and proceed to inject the whole amount into his deltoid muscle silently swearing when it starts to run out of the new hole I’ve put in his body. No immediate effect but that doesn’t mean that it isn’t going to work and we move on to the next step, with the patient’s ABCs maintaining I pull out the IV kit and start my preparation. Handing the saline to nearest face in bunker gear I search for a vein, finding a nice juicy AC just waiting for me to penetrate it. I’m a little nervous as I line up the catheter with his vein, knowing I’ve been ish with IVs for the last couple of months, and I break the skin. I get a good flash but the catheter kinks and I know I’ve missed but I disconnect the needle to check anyways, no good it seems and I start my search anew. Second attempt goes in right above the first one and I doubt it’s because of my skill and chock it up more to luck at this point. The patient starts getting restless as the narcan blocks his opioid receptors from whatever substance he took before we got there and he starts fighting. Confused and still not fully conscious we have to restrain him to prevent the situation from deteriorating. My partner pulls the nose hose out and I can almost feel his relief, those things are super uncomfortable. With the situation seemingly under control we start with the same routine it seems I’ve done a thousand times and get the patient to the hospital. As I’m cleaning the gurney of the blood and stink of our previous occupant the thought occurs to me, I’m happy. Furthermore I’m having fun, which is closely followed by the self-deprecation that comes from the fact that it takes a twisted individual to find things like this fun. It’s a feeling I haven’t felt in a while, I’m burnt out or at least crispy on the edges from all the bs we see that it takes the real application of my knowledge to remind me why this job is rewarding at times, but I’m torn. I know my time in this field is limited, I don’t have the constitution to turn this plan B into a career nor would I want to. Yet I take pride in my performance, cognizant of the fact that it has little to do with the fact that we helped a stranger hold onto his addicted life for at least a little longer. His gratitude barely registers because I’m not doing this for him, or to help, I’m doing this because it’s a relatively easy job that gives me more down time than some other bs part time job while I’m in school and because I enjoy the work. Whatever my motivation or point of view on the field of EMS I know that when all is said and done I will be richer in character than if I’d never done it and from this I take solace. I respect the people that do this to truly help others and I appreciate that concept even though it is not one I share. Yet in this moment none of it matters because I did my job and I did it well and ill ride this wave until the next bout of crippling cynicism hits and I openly curse the people who call 911 for whatever reason I justify as bs the next time around… but tonight, right now, I can close my eyes and sleep contentedly knowing that in some way I’ve done some good in this world….
 

Veneficus

Forum Chief
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Doesn't look so bad to me

I strongly suggest you purchase and read this. Probably the best $15 you could spend right now for not only your career, but sanity.


http://www.amazon.com/dp/1602645655...http://medicalauthorchat.com/tag/fire-tender/

Moving right along...

I don't know what you are in school for, but if it is healthcare related, allow me to put some things into perspective?

Your feelings on EMS. They are actually rather common. Most people who sign up have this illusion (perpetuated by those in the field and on TV) that every call is filled with the life and death struggle of man vs. nature or the supernatural.

That is partially right. But it is not the life and death part but also man vs. himself and man vs. society.

There is nothing I love to see more in my professional life than a patient who is suffering from something that requires emergency surgery or presents with 3 or more organs actively failing. Age is not important, story is not important, just the time sensitive complex puzzle. (which usually ends in a protracted death, no matter what my role in helping is) Success is defined as varying levels of bad or at least less normal than when they started. A true "save" while extremely satisfying is very rare.

But some of the best moments in my career have been seemingly rather less dramiatic. I actually look forward to them and covet them more than a more dramatic save. They are the true measure of success

On a more personal level, medicine is about making people feel better. Many patients I see are so nervous they act like they are standing before god hoping they don't sound stupid or wasting my time with an insignificant problem.

In just a few sentences, I could tell you how they wound up where they are, and what their likely outcome is years in the future if they keep it up. But the reason they came is to feel better, if only for a moment. Not to be treated like dirt for their failings.

What makes them feel better? Sometimes it is relief of a symptom, sometimes assurance it will go away, or is not so serious. Sometimes it is just the hope that help is available.

In many societies, medicine is considered the highest level of learning and existance. That being the case, unless you are treating a doctor, the social/education circumstances of your patient are probably going to be lower than your own.

It is easy to be judgemental. The drunk, the drugie, the :censored::censored::censored::censored::censored:, the psycho, I have seen them all. I am not hollier than thou, I called them by title and showed them my disapproval accordingly. I think it is a phase we must all go through before truly coming to understand our part.

But here is the rub. They already know they are fallible and probably unworthy. They know they will continue to be. But they ask for help in the moment as a child looks for acceptance and comfort after being yelled at by their parents.

You are not immune from feelings, but you can choose how to perceive them.

Accept your patients for being mortal. For making mistakes and bad choices. Realize they may be making the best choice of a host of bad options in their life. They may be playing the hand they were dealt that is much worse than yours. They may have misplayed a hand better than yours. But that past doesn't matter at all. The chance to make another choice tomorrow is what matters. (it does not mean they will ever make the "right choice")

But now that you reached this revalation in your career, temporary or not. (and if you are continuing on in healthcare, you will have to come to terms with this.)

Burnout is not the end. It is the fork. You can choose to realize what medicine ( at any level) really is and means. You can go forward with this knowledge and perception, and will occasional make a misstep(especially when you are over worked or tired). You can choose to be the servant and comfort of your patients.

Or. You can choose to continue as you are. Doing what you are doing, and feeling the same.

Even if you leave medicine completely these choices do not change. You will either have compassion and mercy for the less fortunate or disapproval for the rest of your life.

The question is not whether or not you are burned out, the question is where you go from here.

Remember, it is much easier to "save" the unfortunate who will have even a slightly better life for many years than it is to bring back the dying at the end of their life. You may even find it more rewarding as you will be more successful more often.

The unconscious patient who you save may never know who you are. But the downcast wil tell all their friends and fmaily about the ones who helped them. You will bring credit to yourself, your peers, and gain personal satisfaction.

The titans of society expect you to be sucsessful when treating them, they are not grateful for what they perceive as expected. The lower levels of society expect nothing but benefit the most from simple things. Even if it is just a ride to the hospital.

Often when I do something small, like reassure a patient and treat what I percieve as insignificant with almost no effort; They return to their life with hope and feel better.

I wonder why anyone would pay me for this at all, not why I do it or how I will do it another day.
 

usalsfyre

You have my stapler
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That may be one of the better items I've ever read on the subject of burnout Vene...
 

Sasha

Forum Chief
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You're a good writer, maybe you should consider that instead of EMS.

Sent from LuLu using Tapatalk
 

Seaglass

Lesser Ambulance Ape
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Good, but would be a lot more readable with paragraph breaks.

You're a good writer, maybe you should consider that instead of EMS.

Sent from LuLu using Tapatalk

No reason you can't do both. Writing usually doesn't pay enough to live on.

Vene, I remember you talking about starting a blog awhile ago. Did you ever do it?
 

Sasha

Forum Chief
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Good, but would be a lot more readable with paragraph breaks.



No reason you can't do both. Writing usually doesn't pay enough to live on.

Vene, I remember you talking about starting a blog awhile ago. Did you ever do it?

With the feelings expressed there I would think it is not beneficial for him or his patients to stay

Sent from LuLu using Tapatalk
 

fast65

Doogie Howser FP-C
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That may be one of the better items I've ever read on the subject of burnout Vene...

+1

I actually found it to be quite inspiring, and it's given me a lot to think about on this slow work day.


Sent from my iPhone using Tapatalk
 

abckidsmom

Dances with Patients
3,380
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That may be one of the better items I've ever read oi n the subject of burnout Vene...

I guess I really do need to start that blog then, if this one is winning on that topic. I have been planning it for a while now.

I promise to use paragraphs.
 

Veneficus

Forum Chief
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sorry

Accepting the perspective of firetender, I do not blog.

To be honest, I am back here because there is a slowdown in my normally manic pace and this is the best opportunity I have to stay involved in the US when I am at school. (Even though if you read my facebook page the US medical education people consider me lower than dirt unless they need an ACLS or PALS class, or need my intervention to actually pass one when one of the regular instructors fail them, then my phone rings off the hook.)

I often comment here when I am multitasking, which in addition to my normally poor spelling and typing, usually leads to poor form and several mistakes. (even worse when I am sitting at a non QWERTY keyboard)

It also leads to a lot of redundancy in my posts, but I can't always go back and edit them in time.

So that is the nature of my beast.

(I try to use blank spaces so it is not a big block of text, and remember what you paid for it. :) )
 

mycrofft

Still crazy but elsewhere
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OP, how many drafts did you need for that?

Just asking.

I would talk to my superiors and maybe a professional who has worked with emergency workers before. If you are handling emotions you didn't expect like ennui and anger or disdain for your clients, then you will experience a feeling of being burnt out unless/until you know it is part of distancing ourselves and not feeling like we are going to be hurt too. Have a real life away from this, take time off, make friends unassociated with it.
 
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DrakeBryan

Forum Ride Along
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Paragraphs you say?

sorry about the paragraphs folks, i banged this out after the call and didnt
really think about readability... 1 draft was all it took with a little editing considering forum rules. Thank you all for the feedback and suggestions but take solace in the fact that my approach to this field is seperate from my personal feelings on it, at least for now. My care doesnt and hasnt changed because of my feelings. The second i feel like i want to my change my medicine due to my cynisism is the day i walk away from ems for i wont be an emt that doesnt act in the best interest of the patient.

My personal feelings mirror yours veneficus it seems, all the way from
appreciating the little moments of comfort to the disdain for the homeless alchoholic ive picked up for the 4th time in one shift and others like them. yet overall i dont take much personal satisfaction from these moments and for this reason i believe that when my license expires next is when i dont renew.

Many of my coworkers, men and women i respect... and some i dont, say things similair to your comments. Ive been around long enough to see past the flash and adrenaline to see the real work that goes on behind the lights and sirens; and it seems my empathy is not an infinite well but a finite substance that gets sapped every time i get in the truck.

Whatever you take from my little story i hope it means something... or maybe not and maybe all this is is my attempt to vent something i dont really understand yet. Ill keep trying to find the right motivation to be out here doing this work, i wont sit back and just let burnout take over. My feeling though still seems that i wont be around for much longer.

Once again i appreciate all your input... best of luck to you all in this work, i have the utmost respect for you. Stay safe out there -Kevin
 

firetender

Community Leader Emeritus
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This isn't a piece on burnout

The OP is quite clear on his relationship with EMS; it is a transitional job.

This will save him.

He doesn't have too many illusions. He's in a stage of exploration and he actually recognizes that what he's there for is to have a bit of a human experience while he's doing some good.

Burnout is about staying in the field long after you have lost your compassion; long after deciding it's not "fun" any more. He's not quite there though he certainly describes some of the conflicts accurately. He won't be overcome by the pressures because he's set a timetable to get out of Dodge before he gets ambushed by the steady accumulation of more and More and MORE assaults on his humanity. He still seems to be able to distinguish between. him the professional and him the human. Burnout is about losing the human.

Burnout is about, first, the loss of innocense and then second, giving up the desire to regain it. It's about slathering layers of protection over yourself that you can't take off once you're home. He knows where he's going, and it's NOT deeper into it.

Given the current day circumstances -- that EMS is largely a dead-end job, absent of lateral mobility with high failure to success ratios and nowhere to turn to for perspective or emotional support (except here, maybe!) -- he may be making an appropriate choice.

I say that because for a lot of people on this Forum, I recognize it's a "have-to" thing rather than a "want-to". If it ain't there, it ain't there and he's smart to recognize it. At the same time I detect he does take the job and patients seriously; it's just not a career.

Writing, by the way, has the same rewards and in both professions they are anything BUT stability, accolades, remuneration and security. I suspect he may be smart enough to stay away from that as a career as well!

But OP your writing is good and you still have heart there. One thing is for certain, leaving EMS will press you hard to find such incredible material to work with.

Best of luck and I hope you come back!
 

firetender

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With the feelings expressed there I would think it is not beneficial for him or his patients to stay

Sent from LuLu using Tapatalk

Feelings come and go, moment to moment. Acting off of feelings is different than expressing them.

The difference between him and you is that he's expressing them publically. If you are out there and do NOT have feelings like his run through you -- since, for the most part they ARE not at all uncommon and very much part of the territory -- then it might be helpful for you to look at what you are denying or suppressing in your own.

It challenges me when you are quick to judge fitness to serve and don't notice that all this stuff is part of being human.
 

Sasha

Forum Chief
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Feelings come and go, moment to moment. Acting off of feelings is different than expressing them.

The difference between him and you is that he's expressing them publically. If you are out there and do NOT have feelings like his run through you -- since, for the most part they ARE not at all uncommon and very much part of the territory -- then it might be helpful for you to look at what you are denying or suppressing in your own.

It challenges me when you are quick to judge fitness to serve and don't notice that all this stuff is part of being human.

Don't insult me by insinuating that I harbor the same hatred and distaste for my patients that he verbalized here.

Being human is having compassion for your fellow humans.. I don't see any compassion for his patients expressed in his narration.
 

18G

Paramedic
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I get exactly what Firetender and the OP are saying. I definitely relate.

The OP hit so many things right on the head. The feelings come and go and many times you can't control them. I am going on 16yrs of this and see very clearly. Sometimes I think my clarity is too great and gets in the way at times when I'm around so many who have yet to gain the same level of clarity. The sad part is some people never do and keep falling in line with the same status quo bull:censored::censored::censored::censored:.

My patients always come first and always will. I been nagged here of lately because some think I take too long with my patient care documentation or I take to long prepping my patient for transfer when I am only ensuring the appropriate care and interventions have been performed so my patient can be transported comfortably and safely. As I said in one of my other posts, this is the bull:censored::censored::censored::censored: that frustrates me.
 

firetender

Community Leader Emeritus
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Don't insult me by insinuating that I harbor the same hatred and distaste for my patients that he verbalized here.

Being human is having compassion for your fellow humans.. I don't see any compassion for his patients expressed in his narration.

First off, Sasha, I believe I know you much better than to insinuate that you harbor hatred and distaste for your patients. I have no doubts about your patient advocacy and support and apologise if it came off otherwise.

I didn't see the OP as harboring such things either. Most of his post was about the mechanics of the call and him questioning himself about something quite common; the disgust we feel about saving the lives of people who by all outward appearances do not want to live. In my experience, underlying it all is the frustration of often not being able to save those who truly desire to live and contribute.

And he wasn't without compassion or empathy either:

My partner pulls the nose hose out and I can almost feel his relief, those things are super uncomfortable.

So my comment to you was directed at the times when I don't see you terribly compassionate to your medic peers when they go through such human conflicts and emotions.
 
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