Words by Steve Sunny Whitfield
Last year I was in our backyard mud-kitchen with my son when my wife called for me. She said that one of our neighbours was at our front door asking for me. I tiptoed through the house to the front door trying delicately (and not successfully) to limit the mud on the floor when I saw June (name changed). She was an elderly resident from three houses down and she looked rather shaken.
As I opened the door and greeted her she looked down sorrowfully. “Jim’s fallen over and he is not speaking to me” she said flatly. I didn’t know Jim that well, or June for that matter, but we had exchanged friendly waves while living on the same street. She had seen the ambulance parked outside our home whenever I was on-call so she had come seeking some help.
‘Have you called an ambulance?” I asked her but she just looked down and shook her head.
“Its ok, call an ambulance and Ill get my shoes on and come with you.”
At her house I found Jim, pale, cyanosed and pulseless. I explained to June that Jim’s heart had stopped and that I would provide cardiac compressions until the ambulance arrived. I knelt down next to him and began squeezing blood around his body with every compression.
June just sat silently watching me while she observed her husband of over fifty years lying motionless and lifeless. I had no gloves on and no equipment so I was providing the most basics of basic life support until I heard the wonderful scream of a siren. I knew that the crew would have gear and equipment and I would soon be relieved. When the crew walked in, I knew them. Damo and Clare were colleagues of mine. They also had a student observer with them whom I didn’t know who they put straight to work relieving me. While the student worked away on the chest, Clare leaned over and handed me the defibrillator pads which allowed her to assist Damo with the airway.
Jim was provided the very best care possible however following several rotations and several cycles of resuscitative efforts, the decision was made to call the case. Both Damien and I explained to June that despite all of our best efforts, she would need to prepare herself to say goodbye to Jim. The police arrived soon after and I bid farewell to the crew before walking back home. As I approached my house my wife was standing outside looking alarmed. There were two ambulances, two police cars, and her husband walking away from the scene in muddy clothes. “What happened” she asked me as I took my shoes off. “Jimbo died” I replied without a trace of emotion.
There was a momentary silence so I looked up and saw that my wife looked horrified. Whoops.
Upon later reflection back at the mud kitchen, I realised how callous my answer would have sounded but that was the only way I could describe it. Jimbo had died. It’s what people do when you work in a reasonably chaotic environment such as paramedic practice. It’s not that people died all the time, but as a paramedic you are exposed to life altering moments far more than a normal person. But normal was where I had started in my student days like so many others. Now, years later something inside me had obviously changed.
Was I to callous? I didn’t think I was uncaring… Did I have any empathy? I thought I did but part of surviving this kind of work is the learning how and when to switch your emotions off. Although we get it wrong sometimes I thought I had a good handle on this trick because I had long learned that emotions were often unhelpful in situations like that afternoon. I just wanted to get back to the backyard with my son, resume my day off and be normal again. I sat there perplexed.
The ambulances soon departed June’s house, the police departed our street and poor old Jimbo departed this world. But I was still fairly unfazed.
Do You Remember Empathy and Compassion?
Compassion and empathy will make you a patient advocate and a good paramedic, but too much could also be the reason you suffer a break-down or end up leaving the profession. Where sympathy is a shared feelings of another; empathy is when you understand the feelings of another but do not necessarily share them. In other words, sympathy is a statement of emotional concern whereas empathy reflects emotional understanding. Did I have either anymore? During my student paramedic days some of my clinical instructors had stressed the importance of maintaining empathy yet others had stressed that an emotional separation was key to survival.
I had joined the paramedic profession because I wanted to care for people, yet here I was having just attempted to resuscitate a neighbour without an emotion in the world. I had changed somewhere, and I wondered which side of the equation was where I was meant to be.
Researchers investigating this paradox have explored the purpose of empathy in healthcare and discovered conflicting results. The notion that a health care professional requires genuine empathy to provide best care to each patient is in direct comparison with the opposite notion that a health care professional is able to best care for their patients by remaining clinically detached. That is, by not becoming emotionally involved with patients, the debate claims that emotional separation will enable the clinician to make objective decisions concerning their patient care, and they will experience longevity in their career.
I believe that paramedics are always striving to provide the best care possible to their patients, but they are also trying to survive. Most paramedics get into this career due to an above average level of empathy and compassion, yet everyone will approach their clinical practice differently. This will no doubt be informed by their previous experiences. Sitting there in the mud with my son I realised that although I may be perceived to lack some empathy these days, the emotional separation clears my mind of clutter and permits me to navigate some high stress situations, thus do my job at work and at home. The emotional separation has also allowed me to survive mentally. That said, we still care for humans and its someone’s family member in our charge so a little bit of empathy will keep us human.