What Does It Mean To Do It Right?

I heard the faintest hint of a siren off in the distance.  It was a long way off, but I still didn’t have much time.  I put down my model Boeing 727, quickly, carefully, and leaped for the staircase.  Rumbling down the steps, almost breaking my neck, I landed at the front door, slung it open, and darted onto the lawn.

Peering half a block north from my Rotherwood Avenue home in Evansville, Indiana, I could see Bellemeade Avenue where it crossed my street.  I wasn’t too late.  In a moment, an ambulance would burst by in a blur of white and orange and flashing red lights as it went wailing and yelping its way to St. Mary’s Hospital just to the east.  The screaming ambulance would be in my sights for only a split second, but it was so worth it.

The sight delivered as reliably that day as any other day, and I let out a sigh of both satisfaction and longing as the doppler effect lowered the notes on the passing siren.

Now it was back inside the house because the show starts in a little bit.  But, oh no.  Oh no!  My oldest brother can’t get the TV reception to come in clearly.  Oh no!

“Vince!” I pleaded with a whiny cry.  He’d gotten Adam-12 to come in clearly, but now, even messing around with the rabbit ears wouldn’t get us a clear picture for EMERGENCY.  Try the round antenna thingy!  Reynold’s Wrap, maybe?

Though it was 1974 and I was seven years old, two things were dependably true.  I was gonna be a paramedic, and I was a whiny child who cried a lot.  Literal crying.  Tears.  All the time.  The crying came from being a generally scared and meek little kid.  I was afraid of everyone and everything.  Not my family, but anyone else that wasn’t a notably friendly face.  That was half my drive to be a paramedic.  I needed people to protect me and make me feel better, and I wanted more than anything to grow up and be the person who protected other people.

The other half of my drive to be a paramedic came from NBC every Saturday night, so long as the reception was good.  I didn’t care about the high-angle rescues.  I didn’t care about the structure fires. I didn’t care about the house collapsing down the side of a mountain because it was built on an old oil well.  But I was consumed by Squad 51 pulling up in someone’s driveway and two paramedics walking through the door with a jump kit and heart monitor.  Watching them kneel on the living room floor while attaching an EKG and starting an IV was captivating.  A calm, mutually respectful conversation with the ER doc on a radio phone, and then the spellbinding sight and sound of the EKG transmitting to the hospital.  The scared patient looking up to them, depending on them.  And the paramedics delivering.

Some enigmatic force drew me in.  Even at seven.  Paramedics walking into someone’s home and providing emergency medical care.  Making them feel protected.  I was going to put these two things together, and that’s how I’d spend my life. 

I started by getting the Emergency Care, Second Edition EMT textbook from Clifford Library on the University of Evansville campus and reading every page like it was a novel.  Geek.  Nerd.  I was only 12 then, but I felt grown when I was reading that book.

I was 16 when my parents moved us kicking and screaming to Raleigh in 1983.  I found my solace in an EMT class at Wake Tech at 17, knowing I’d turn 18 just before the state test.  I consumed information insatiably each night from instructors Glenn, Larry and Linwood.  All with the last name Barham.

Being the fifth of six kids, the importance of my schooling had been lost in the shuffle.  I’d never been a strong student.  But with this topic I was vitally interested, and I found I could have been a strong student all along.  If I was going to do this, I wanted to do it right.  I wanted to learn the material inside out.  I wanted to be good at it.  Really good.  If people were going to depend on me, I wanted to be worthy.

In 1985 I joined Garner Rescue Squad and ran my first call.  My mind seemed to leave my body when the tones first went off.  As the bay door rose and the red lights bounced off the street signs in the early dawn light, I felt…. sick.  I’d seen that bay door rise for Squad 51 a thousand times, and now I was actually doing it.  I was simultaneously exhilarated and horrified, right up to the very edge of reverse peristalsis. 

Oh no. Please no. Vomit in an ambulance on a call is a regular thing.  Vomit in an ambulance on the way to a call is hard to explain.  Maybe this ain’t for you, kid, if you can’t even get to the call before losing it.  Fortunately, I’m not much of a thrower upper, and everything stayed contained.

A simple chest pain call.  And for all my good scores in EMT class, I was at a complete loss.  The EMT-I in charge rattled off all the right questions as I quietly sat in awe.  I had learned what questions to ask, but they just weren’t available to me.  I couldn’t figure out how he was able to casually come up with the right questions under the squeezing stress of being on a real EMS call.  Turns out I was the only one stupefied.

But I figured it out.  By 1986, I was an EMT-Intermediate.  My instructor was kind to encourage me to consider EMS professionally.  That had always been the plan, but it was affirming.  By 1988, I was working for Wake County EMS.  By 1989 I was a paramedic, and by ’94, a field training officer.

I found that I could be, and was, that person I had wanted to be since lying on the floor on Rotherwood Avenue watching EMERGENCY, when the reception was good, and catching those fleeting glimpses of real ambulances racing by on Bellemeade Avenue.  I was, day in and day out, lucky enough to be the person who was helping frightened people feel safe and taken care of. 

Of course, making people feel that way wasn’t the only thing that mattered.  There’s that whole nuther thing of clinical care that should, well, kind of be part of the mix.  As seen on TV, I was reading EKGs, starting IVs of Lactated Ringers, popping the yellow endcaps off prefilled syringes with my thumbs, and having calm, mutually respectful conversations with ER docs on radio phones.  Not necessarily in that order.

I was having the time of my life putting my newfound academic capacity to work.  But I noticed a couple of classmates crying all over their desks while protesting about having to learn acid-base balance during EMT-I class.  “We don’t need to know this,” they’d moan like the whiny child I used to be. 

I found myself fascinated with learning acid-base balance and was eating it up along with every chapter of every book in my EMT-I class and my ensuing paramedic classes.  While I felt like I had to work a lot harder than others to get within the clinical ballpark of some of the coworkers I had great respect for, I did eventually feel confident and proud of my ability to assess and appropriately treat emergency medical crises.  I believe I got good at it, as I had set out to do.

My entire professional existence from 1985 through 2003 was hinged on responding to calls on an ambulance.  But by the mid-1990s, I was getting tired. If you worked with me during those times, you saw it.  I was as subject as anyone else to what we collectively refer to as burnout.  In my own mind, my burnout manifested itself mainly by my being quiet on the way to and from calls, not wanting meaningless banter with partners, during times that I felt the stress.  Just wanting to go back to sleep.  Please, God, let us be last up so we can go back to sleep.  Even for an hour.

I only hope that at my lowest, no patient of mine ever saw any worse in me than a guy who could’ve been a little more patient or helpful than I was being at a given moment. 

I don’t recall ever being openly hostile or aggressive, but we all have to be honest about who we are, who we’ve been, or who we’re capable of being.  We don’t have to have been beyond reproach every time, but we should be willing to aim for it.  And we should certainly do no harm.

We’ve all faced patients or family who are hostile toward us, during which time some assertive pushback is often in order.  Those types of calls aren’t what I’m referring to when I question my own burnout.  I mean me just being mean.  I hope, and I believe, that any such occasion would have been exceptionally rare, if at all.  But I’ve acquired enough wisdom to know that we don’t always come across as we believe we do.  Or did. 

We all have our countless imperfections.  It’s a question of how much the people around us suffer them.  I would leave it to the women and men I’ve worked with to judge whether I ever got out of line. For that matter, I’d leave it to them to judge whether I provided the good clinical care that I believe I did. 

By 2003, I was lucky enough to move into a district chief position and then an administrative role, and the days of being a paramedic on an ambulance were mostly over.  Not completely, lord knows, but mostly.  Now looking back, I’ve developed firm ideas about what it means to do it right.

First, do no harm.  I don’t claim that idea.  It goes way back.  Whether clinical harm, impatience, or outright aggressiveness, doing it right includes doing no harm.

Smart, effective clinical care must be priority, because that’s when doing it right has the most acute impact.  That’s when the reason we even exist as EMS is put to the test.  I learned to get good at it, and my oh my have I since lost it!  But that’s not what I do anymore. 

Being good at it clinically doesn’t mean being exactly right every time.  That’s unachievable.  But it does mean being humble enough, and being enough of a continual student of paramedicine, to say, “yup, I screwed that up.  Help me figure out how to get it right.”  Those words will elevate the respect people feel for you, not diminish it. 

And being good at it clinically also means holding yourself responsible for staying current with evolving research, skills and practices.  Checking those boxes is required through continuing education, but it’s up to us to genuinely better our clinical selves regularly.  Knowing that I helped give a patient their best chance at a good outcome, and that they wouldn’t have necessarily had a better outcome with a different paramedic, was my traditional litmus test.

Making people feel well-cared for must come right after, or with, good clinical care.  On virtually every call we run, we have the ability to make someone feel that their existence is important and that their well-being matters, if only by the way we interact with them.  We have the means to make them feel protected and looked after, if we choose.  That’s part of medical care, and each of us expect it when we seek care for ourselves.  Even if it’s just for the 20 minutes we’re with our patient, it may be the only moment that week that they feel the world even knows they’re there.

We’ve all seen coworkers slip into the wretched abyss of deciding who deserves their care.  Whether someone should’ve called EMS.  How there ought to be a way of eliminating the “BS.”  How many cars there are in the driveway.  Whether we’re a taxi. 

I can only hope they save themselves from an unwinnable emotional battle that only perpetuates their misery.  We will never solve any of those concerns on a call-by-call basis.  We will never impact ED overcrowding.  We will never “teach anyone a lesson” about calling 9-1-1.  We can only become less happy by trying to solve national level healthcare problems from the cab of an ambulance. 

Trying to embrace, metaphorically, of course, all the patients I interacted with was my most promising path to happiness and fulfillment in EMS.  To portray that I was always successful would be disingenuous, but I knew it was True North.  Besides, those badass clinical interventions are infrequent.  There has to be something more to find satisfaction and longevity. 

On the less serious calls, I tried to take pride in the fact that someone called 9-1-1 because they didn’t know how to navigate their situation, and I had the privilege of being the person that helped see them through. That has value in this world.

It’s easy for me to talk from where I sit now, even to the point of sounding preachy.  But I walked the walk for a long time, and it was trudging up those endless, exhausting miles, uphill both ways, that certain wisdom began to reveal itself.

Now with my EMS career in the rearview, I feel grateful that I had the indescribable honor of serving so long as a paramedic, including all of the varied things it means to be a paramedic.  From the scared, meek little boy in Evansville whose eyes widened and heart raced at the sights and sounds of an ambulance, I am grateful to have become what I was determined to be.  I can only look to my many coworkers to judge how well I lived up to my own expectations of what being a paramedic should mean.  About how well I lived up to trying to do it right.

But most of all, I’m proud to have been a part of our thing we call EMS.

 Jeffrey Hammerstein retired from Wake County EMS in in April of 2021 after 36 years of service to the citizens of Wake County. He served as a Paramedic, District Chief and Assistant Chief over Community Outreach and Public Information.  He lives in Garner, North Carolina with Letitia, his wife of 34 years.  His son is a detective with the Garner Police Department, and is married with a 2 and a half year old son.  His daughter is a paralegal with an estate attorney in Chapel Hill, North Carolina.