Be well. Practice big medicine.

Newman | The Positive Paramedic Project #4 We all started out as FNGs

Hal Newman – a long time ago… FNG days.

A nugget of EMS organizational wisdom every day. #4 We all started out as FNGs


Aahhh, the Rookie. FNG. JAFO. Cherry. New Guy. Newbie.

Steve Merling heard them all. He was also one of the youngest members of CSL EMS. His transition from Apprentice to Medic was, in a word, rough. There was a fair bit of resentment from some of the older members. Some folks erected artificial barriers in his path. He end-arounded them and created another route. Adapt and Overcome seemed to be written in crayon on Steve’s forehead. Every shift morning he’d stare at the figure in the mirror and linger on that catch phrase. And then he’d drape his way-too-expensive-for-a-Rookie stethoscope over his shoulders, tuck in his shirt, and pull on his boots.

Steve cruised through his Apprenticeship smoothly: he displayed poise and maturity well beyond his years. He was a student of the art of caring and he was a quick study when it came to street techniques versus boxed algorithms. He handled the stress of the moment and could be counted on to do the right thing when life verged on death. Of course, we had to remind him more than a few times not to overstep his own boundaries—but most of us could remember the same struggle to break free when we first heard the call as medics. Steve’s evaluations were solid and he joined the Team as a Medic after more than fifty patient contacts as an Apprentice.

Aahhh, the Rookie.

I remember a call with Steve wherein he had that blessed stethoscope draped over his shoulders and bent down to help c-spine immobilize an elderly woman who had fallen in the street. The steth fell from Steve’s neck into the face of the patient. He was mortified. She just laughed. But the punchline came when our Apprentice abandoned the Stryker stretcher he was holding in-place on the sidewalk to gently place Steve’s stethoscope on the front seat of our rig. Seconds later the Stryker rolled off the edge of the sidewalk and flipped onto its side. Fortunately, the patient was still on the ground. She laughed aloud at the sight of Steve’s near-apoplectic facial expression. Thank goodness for her wonderful sense of humour.


I rolled back-up for Steve and his partner J-P Caron on a fall call. Steve and J-P had encountered an Emergency Physician freelancing at the scene. When I arrived, they were c-spine immobilizing an elderly woman who was supine on the floor alternately sobbing and gasping for breath. There seemed to be an inordinate amount of discussion involved in the delivery of care. Steve and J-P wanted to sit the patient up and administer oxygen. The physician insisted they proceed with “simple immobilization.” The patient was a survivor of the Holocaust—we could clearly see the tattooed numbers on her forearm. She was terrified by the prospect of being tied down. She struggled to break through the straps. Steve told the physician that he had auscultated her lungs and they were full-up with fluid. The good doc pooh-pooh’d Steve as a well-intentioned but essentially useless ground-pounder. The patient was trying to rip the c-collar off her neck. She was totally focused on trying to sit up. The physician instructed the ambulance crew (they had arrived a few minutes after me) to tie the patient’s hands down. She screamed a few times and then just put her head back down onto the board. She stopped struggling.

Have you ever seen a patient give up on the will to live?

I have and it’s not something that will fade away nicely any time soon.

Steve told the physician he could hear the patient “gurgling.” The doctor ignored Steve and helped the ambulance medics use triangular bandages to finish restraining the patient’s hands. Steve got down on his stomach next to the patient’s head and tried to reassure her—to talk her through this latest nightmare in her too tortured existence. He held her face in his hands and tried to explain away the straps, the head immobilizer, the collar, and the hand restraints. She gave no indication she understood what he was saying.

The physician accompanied the patient to the hospital aboard the ambulance. He was there when she died. She coded en route to the ER. Full-blown CHF. Pulmonary edema. Aspirated because she was in the horizontal death bop position on our stupid backboard. Died With Physician Assistance.

Aahhh, the Rookie.

Steve was very quiet for a long time. He tucked his stethoscope into his pants pocket, took a few deep breaths, and then said, “She could have been my grandmother.” He had done his best and had tried hard to Adapt and Overcome. Sometimes it’s impossible even for the most versatile and capable Medics. Occasionally all we can do is care. Steve Merling had made the astonishingly fast journey from Rookie to Partner in just one call. One call J-P Caron and I will not forget for a long time. No matter how hard we try.


Be well. Practice big medicine.

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