All things must change

Months since the lost post here, much has changed.

Firstly, the job has changed. Where I used to wake terrified and excited each morning, wondering what jobs would come down and if I would be able to handle them, I now wake tired, never feeling like I get enough rest and looking forward to the next set of days off, which seem few and far between.

Not to say I don't still love the job - the excitement still gets me and the adrenaline can still get pumped through my system several times a day on the good days, but the bad days are now more monotonous and 'auto-piloted', as if my body and mind lie in wait of 'the next big job'.

Where once I would have a slight tremble in these 'big jobs', despite knowing exactly what to do and be doing it, my hands are now calm, still - my mind sure and planning at least two steps in advance. I've approached major overdoses, CVA's, respiratory distress and cardiac arrests all with the same confident, calm approach that once seemed so comical about the profession but has now become a stable flow of my life.

The wife is frantic, her husband having overdosed on many tablets of tricyclic antidepressants, his ECG shows things are not looking good and his level of consciousness is dropping with each passing second. She runs at him, grabbing him and trying to 'help' move him to our stretcher. I calmly pull her off her husband, force her to face me and not him, tell her how she can help by finding the empty medication wrappers, let us look after him. My partner and I position him laterally, maintain his airway, oxygenate and load him into the Ambulance. The wife has left us, running from room to room as if she can hear the packets calling her, but she cannot quite work out where they are.

Secondly, I have changed. I still make the bad (good) jokes, smile frequently and small talk, but the naievity of my youth is now long gone and I can't help but feel somewhat colder inside. I realise how little of my youth I took advantage of, partying little and studying perhaps too much, and while I know technically I'll still be a youth for several more years I feel older - aged beyond my time. But I am still happy, loved and in love, if anything now appreciating more the sheer preciousness of life, so easily lost, so easily wasted and so easily enjoyed and cherished - made more than just time on this planet, an experience to hold dear and utilise to it's most full. 'On job' I comfort and counsel those who have lost, those who are losing and those who fear for their loved, I show sincerity and understanding and have been told I'm good at it - but it feels as if it comes from someone else, some other source, because in reality I am cold inside to steel myself from the emotional aspect of the daily onslaught of misery we face, and must face.

The wife is crying, sobbing into her hands. We are prepared to leave the scene and she steps up into the Ambulance passenger seat. She was unable to find the medication packets and again feels a failure and powerlessness that only someone watching a loved one dying can ever understand. I tell her that her husband is in a serious condition, but that we are monitoring him closely and will have him at the hospital shortly for definitive care. I comfort her best I can, talk with her to find out more of the details of what had happened, the little facts that at first don't come out but can drastically assist treatment. I weigh our options; try to look myself for the packets, further delaying transport but perhaps having a better idea of what we are up against, or transporting knowing some of the story but getting us to hospital quicker, where many hands make stabilising this patient much easier. On arrival the patient was talking, albeit nonsensically, but now he is only responding to painful stimuli - even then only with much effort. I decide to go with the latter, and we pull out of the driveway.

There is a dangerous balance in this job. Care too much and you can't seperate yourself from your jobs - the misery consumes you and the sheer weight of suffering crushes you. Care too little and you seperate yourself from your jobs completely - you become too cold, burnt out and resenting the patients more and more each day. The balance varies from day to day - sometimes you need to care too much, remind yourself that you are human and the importance of the decisions we make between seconds that can save or damn a human life. Sometimes you need to be cold and untouchable, shield yourself from the onslaught. As long as you can find that middle ground again, survive and endure.

We arrive at hospital and rush him into a Resuscitation suite. A frenzy of bodies, hands, minds and tools check vital signs, draw bloods for analysis and ensure the body stays ventilated,the heart beating sufficiently. The wife is moved to the waiting room for what will be the longest few hours of her life.

The world has changed. Or at least, my understanding of it has. This 'first world' country is far from it. The addage that a person is smart, but people are stupid takes on a greater understanding and the acceptance that people do very strange, often stupid things in 'emergencies' is made. People live in squallor. People live in filth. People live in luxurious mansions with bedcovers that cost more than I make in a month. People have children, children have children. People make mistakes. People get hurt, get sick, get old.

People die.

I always knew about and understood death, but there is a familiarity you make with it after many encounters. There is an essence to it, a feel that cannot be described or conveyed. Sometimes even an anticipation en route to the scene, somehow we know what we will find.

The wife has gone home, although I doubt sleep will find her tonight. Her husbands blood still moves around the body, oxygenated and delivering nutrience to the organs. He is to be transferred to another hospital for acute high dependancy care, although his outcome remains unknown.

We have finished our paperwork, submitted the report to the hospital and move back to the car. We push the little button to make us 'Available' again, and we await the next job. As always we don't have to wait long, and a siren wails off into the night, the previous job cleared from the mind as routines, protocols and plans are laid for the next patient.

All things change, but for now I know where I am in life, where I am going and what roads lie ahead. 

And I am happy.