I worked as an emergency medical technician-paramedic for almost 8 years in a rural area before I became a registered nurse. Just before I completed nursing school, a new hospital began offering emergency cardiac catheterization services 60 miles south of the response area where I worked. As a result, our ambulance service implemented a program to provide acute care and transport for patients requiring emergent cardiac interventions. I was frequently recruited for these transports because I was both a paramedic and an RN. As a nurse, I could switch roles to provide advanced cardiac medications and interventions, thereby providing a higher level of care.
One of my greatest accomplishments was the proficient handling of emergency cardiac patient care during the 50-minute transport. I knew every pattern on a twelve-lead ECG tracing, all the medication dosages and side effects, and I could intubate, ventilate, and establish IV access faster than you could say myocardial infarction. I was one of the best; that was until the day Mr. Hart* (not his real name), a 45-year-old man with a heart attack, changed my definition of excellent patient care — and nursing — completely.
A life-changing trip
Mr. Hart came to the ED of our small rural hospital with complaints of chest discomfort and dyspnea that had started suddenly while he was at work. He was diagnosed with a STEMI (ST elevated myocardial infarction) with elevation in leads I, II, III, AVF, AVL and V6, a pattern indicating serious acute inferior and lateral wall heart damage. As protocol dictated, within 10 minutes of diagnosis our ambulance was paged and “the 45-year-old STEMI,” as the ED staff described him, was in my care on the way to the cardiac catheterization lab 60 miles south.
Mr. Hart was loaded into the back of our ambulance, and I moved quickly through the motions of efficient patient care, applying a twelve-lead ECG monitor, taking vital signs, starting an additional IV, and administering a second dose of the thrombolytic reteplase within 10 minutes. I was thinking check, check, check as I went through my tasks. With all the required tasks completed, I turned to the driver and asked, “How close are we?” The driver responded, “45 miles out.” What!? What was I going to do for 30 more minutes, I thought, looking for the first time at the terrified face of “the 45-year-old STEMI” on the gurney?
To pass time and distract myself from the post-reteplase reperfusion rhythms displayed on the monitor, I started to talk to my patient. I learned that Mr. Hart was a dedicated husband and father of four little girls. He had never been a sick day in his life, worked several jobs, and was the sole provider for his family. Mr. Hart had no health or life insurance and was worried about the cost of all of this care and missing work but, most of all, he was scared. Who would take care of his wife and daughters should anything happen to him?
As the transport continued I learned more about Mr. Hart, who previously was known to me only as “the 45-year-old STEMI”, and his family. As I sat there talking with him I realized for the first time that my patients were actual people with families and fears and lives who ended up, through some misfortune, in my ambulance and under my care. They were not just a checklist of tasks to be efficiently and effectively completed. While I had spent years addressing the physical and emergency medical needs of patients, carefully honing my skills to be the best paramedic, had I ever thought about the humanness of those unfortunate enough to be on my gurney?
A change in perspective
In what seemed like only a few minutes I felt the ambulance slowing to exit the interstate as we neared our destination and definitive treatment. I left Mr. Hart in the capable hands of the cardiac catheterization team and headed back to my response area. I spent the 60-minute ride back to the station contemplating Mr. Hart, his wife, and kids, his fears about providing for them and his desire to watch them grow up. I reflected on my patient care practices and what it actually meant to be “the best.” I also reflected on how through the course of my paramedic career, patients had become a checklist of sorts with completion of tasks in a timely and efficient manner and a label of some illness, injury, or disease process.
As I arrived back at the station and completed reports and re-stocked supplies, my co-workers asked the usual, “How was the transport? Did you get to see or do anything cool?” I listened to the paramedic who had accompanied me and Mr. Hart on the transport describe “the 45-year old-STEMI,” patterns of twelve-lead ECG tracing indicating Inferior lateral MI, and the reperfusion rhythms. It was the same story I also had told many times before, only this time for me the story was different. “The 45-year-old STEMI,” now known to me as Mr. Hart, had a wife and four daughters, he was human.
The human side of patients
Emergency patient care, whether in the streets or in a hospital, is a challenging career. Complicated procedures and interventions need to be accomplished in minutes, sometimes seconds, and providers must have a high level of skill and confidence. Completing a checklist of required tasks, meeting core measures, and staying within required time limits guide the actions and priorities of patient care.
But does this focus on performance come at the cost of dehumanization, as patients become a checklist of interventions? How often do we treat our patients as a list of tasks or a disease process instead of a human being experiencing the effects of disease and illness and requiring care to heal? I marvel that for years as a paramedic I had fallen into the trap of completing tasks rather than caring for patients. I marvel that even as a new nurse I had not broken the pattern, until Mr. Hart showed me the way.
Tiffany L Petersen is an assistant nursing professor at Dixie State University in St. George, Utah.