By Michael Mastroianni
It was the beginning of 2004. The best way to access the Internet on the go was the BlackBerry. Barack Obama was a state senator representing Chicago’s South Side. And U.S. Army special forces had just pulled Saddam Hussein out of a hole in the ground.
I started on a BLS bus in Pittsburgh’s Hill District. August Wilson made the neighborhood’s tough beat famous and things hadn’t improved much since his time. There were one or two shootings a week, and the medical calls indicated the poor health that plagued many of the residents. After two months in, a midnightcall to hypoglycemic unawareness was almost comforting.
The quiet patient was nothing like his daughter, who mixed crying with shouting so much that we were concerned she was about to become a patient with a panic attack. She had waited to call 911 until her father’s glucose dropped to 60 because she didn’t know what his insurance covered. They were lucky that the bill for the call probably didn’t top a grand.
A week later, a man had nearly sliced his hand in half in the kitchen and tried to bail out of the back of the bus on the way to the ER. He only stopped trying to escape when we said we already had his information and we’d have to call the police. The crest of the heartbreak came later in the month when the mother of a hit-and-run victim asked more questions about what her insurance covered than how her son was faring in the fight for his life.
Every time I saw Saddam Hussein clean up a little more on TV, I thought “that guy has health insurance now.” And it was better than the policies for the soldiers taking care of him.
By springtime, my partner and I sounded like a pre-recorded warning to the constant questions about cost and insurance: “they’ll sort that out at the hospital,” “this isn’t the time to worry about that,” “if you refuse medical care, you’ll get worse and it will only be more expensive.” The droning tone didn’t comfort anyone, so we had to hide our boredom with the questions – as well as frustration at the way things are, and the nothing we could do about it.
We learned slowly that the only power we had to comfort people in pain as they entered a complex system of care was the softest power at all: tenderness. There were no promises we could make, and people often lied to us to protect themselves. So we smiled. We spoke like we would to our relatives. Our tone through every word had to say “we’re here to help you, you’re not alone, and you will get past this awful day.” At least fewer people tried to jump out of a moving ambulance.
Medicine and politics are on opposite sides of a river. This is why it’s so extraordinary that doctors, hospitals, and insurers have united in opposition to the American Health Care Act because it is neither American nor health care. It’s a tax cut, which is a highly political and completely non-medical way to handle care. Just ask any EMTs who hold boot drives to keep their unit open.
But EMS services can be political to most of the people affected by either the AHCA or the likely looming Medicaid cuts. Medics and EMTs can look like “the health industry,” come to lurch people into an expensive maze of providers and insurers. Sometimes they’re the enforcers of “the rules,” which only the rich or lucky can shirk. And any uniform can seem threatening to people who are used to or afraid of getting stopped by police or immigration services.
Things will be more dangerous for first-response personnel because things will be more dangerous for the people they are most likely to help. And it protects people in the field to remember that the typical for police and emergency workers is often the unacceptable to the people who will often remember the day they meet you forever – because it is scary, painful, and often life-threatening.
EMS work is already tough, and a hard day – or year – can result in “service with a snarl.” So don’t get bored or lazy. Stay alert for every call, if it’s to a quiet house or a crime scene. Keep your breathing regular. Connect with people. Never forget that you have the opportunity to make someone’s worst day a little less terrible. And it may just make your day a little better, too.
Michael Mastroianni
Michael Mastroianni is a former paramedic with an ScD in instructional design, specializing in cross-cultural and cross-lingual medical instruction. He is based in Philadelphia, where he works on urban social services and supports projects in Somalia, Haiti, and Iraqi Kurdistan. He enjoys practicing and teaching writing for grants, articles, and students' creative outlet, and enjoys journaling during his travels.