D Newman | The Positive Paramedic Project #93 To be a first responder

A nugget of Big Medicine for your consideration from the late David AH Newman. #93 To be a first responder

My late father, David AH Newman, originally wrote this piece for Big Med in 2007.

It is an interesting take on what makes a first responder and seems particularly apropo while the Newtown school massacre is still much closer than it appears to be in our collective rear-view mirror.

I’ll preface it with his comments:

“You may not receive heartfelt thanks for what you do. Sometimes you will be blamed, because people suffering pain and loss need to blame someone. It goes with the territory and only time can redress the injustice. Learn to accept the hurt with the good things, and don’t be too hard on yourself. 

“If you can give support and show compassion beyond the minimum the situation seems to call for, you and your colleagues will long be remembered with gratitude, and you will build reservoirs of credibility and affection for you and others to draw upon; and you will know that what you are doing is worthy and significant.” To be a First Responder

[November 2007]

Foreword 

This is an exploration into the forces and values which guide First Responders of all kinds everywhere.  

If I had gone at it the usual way, I might have surveyed the populaces First Responders serve. Or I might have analyzed articles on First Response to produce lists of descriptive words and their frequencies. But instead of  being scientific and rational and following an approved research methodology, I decided to follow my intuition.     

Of course, intuitive ventures leave you with an assortment of cryptic phrases and imagery, which then have to be dressed up in words and arranged according to headings – and that is a subjective process,  so my own background has something to do with the result.

Finding a title was challenging, because it raises the question: “What’s this going to be used for?” It might be a  useful article for would-be first responders to read, and ask questions around. Then someone could fill in some of the blanks with stories from her personal experience.

It might also serve as a starting point for those sufficiently interested to take issue with and add to – helping to gradually accumulate a “First Responder Manual or Book of Front-Line Wisdom” – “Aphorisms from the Field.” You will encounter quite a few aphorisms in what follows: an aphorism is a powerful one-liner which rings true across time, distance, and circumstance.

The Nature of the Work

First Responders never know exactly what they will have to deal with next, or when, or where. They have to become expert at dealing with the unexpected. They are always led by the situation, however, they can and do learn to be prepared – to be ready to take on whatever comes. It needs a “Job Shop” mentality, and an assortment of general-purpose skills and tools.

Provide for what is needed to meet the Future — Accumulate Strength through Foresight. That is your best insurance.

Most calls are routine, in the sense that experience and commonsense help to minimize the risks. But exceptions happen, and then precipitate rushing into danger — Heroics without consideration — can endanger and sometimes kill; you and others. Heroism should be a last resort. So Patience becomes a strength.

Whatever situation you are called to is sure to involve danger for someone. So don’t give in to confusion: be firm in finding out  what the situation really is, to the extent you can, and don’t jump in blindly. Seek verification, and document the evidence. Trying to enforce your will on the situation means ignoring the emerging reality – and reality does and will emerge. 

Judgment

Hippocrates said, in his most famous Aphorism — “Judgment is difficult.” Judgment has to be informed by experience and by the facts. Informed judgment equates with Situationally-Relevant Wisdom – and that amounts to Know-how. Judgment can’t be taught, though it can be exercised.

If every situation was clearcut and only needed a yes-no answer, there wouldn’t be any need for judgment. But nearly all real-life situations involve trade-offs, and sometimes there are no good answers – only combinations of more or less good and more or less bad. However you decide, someone will inevitably suffer – and you, if you have any feelings, will also suffer, inevitably. You too are mortal and stress is real. Your colleagues and advisors can help you deal with it: don’t try to stand alone: you are a member of a team and the team is there for you, as you are for the others.    

Deal with multiple demands and competing claims resolutely and intelligently. Use your informed judgment to assign resources and energies — as in Triage situations. Follow the rules, and your values, and don’t be afraid to talk it out with colleagues – but remember that coming to judgment is not the same as taking a poll. Advice and consensus are simply more elements to consider. Facts alone will not give you an absolute answer where there are no absolute answers.

It isn’t enough to rely on your enthusiasm to carry you through. Enthusiasm creates opportunities for both Greatness and Illusion. Judge carefully. 

Don’t judge anyone unless you understand the special circumstances surrounding the individuals and the action. There are always special circumstances. Treat each and every person as someone special – as a unique being caught up in a possibly unique situation.

Confront whatever is causing Suffering

Some may regard suffering as noble – even pious; perhaps its in the human makeup to seek virtue in  the most grim experiences – when we are the ones afflicted. But it is not noble, pious, or virtuous, to ignore and pass by the suffering of others. Suffering is evil and there must be no compromise when facing it.

It is the first responsibility of a First Responder to look out for and attend to sufferers. Service is about easing the path.

‘The way to exorcise suffering is to make energetic progress in the good’. The ‘good’ isn’t always easy to define. But a sure sign, and a useful measurement, is the observation of re-awakened life.  

There is a great mystery underlying the struggle, which, for humankind, is without limit and end. The struggle has its dangers, not least becoming entangled in our own hatreds and passions — passion and reason cannot exist side by side. Know thyself, and be on guard: we are each our own worst enemy. Self-Knowledge (Inner Perception) allows inner concentration on outward events: essential when you have to confront and subdue Outer Danger.

You may not receive heartfelt thanks for what you do. Sometimes you will be blamed, because people suffering pain and loss need to blame someone. It goes with the territory and only time can redress the injustice. Learn to accept the hurt with the good things, and don’t be too hard on yourself. 

If you can give support and show compassion beyond the minimum the situation seems to call for, you and your colleagues will long be remembered with gratitude, and you will build reservoirs of credibility and affection for you and others to draw upon; and you will know that what you are doing is worthy and significant

Desire for Independence and the need for Role

We all want our independence, our freedom to do our thing unhampered by the restrictions of authority and the rules, regulations, and protocols imposed on us, and that we impose on ourselves by our choice of profession, training, and service. At the same time, we need others.

Most important, and most irritating, we have no choice but to fit in with the formal structure of society; otherwise we have no place to fulfill our calling. We are forced by our calling to train, to meet standards, to accept credentials, to follow the rules.

We must fit into the on-going structure of assignments, of peers and supervisors, of mentors and teachers – and of how they choose to judge us. Peer acceptance, in particular, is the biggest hurdle, and, the greatest reward. There is nothing quite like winning acceptance as a member of a team.

While structure, status, and rules do get in the way, they sometimes are a blessing — if you have the courage to think for yourself, and have earned enough authority to follow your hunches.

Hippocrates states that ‘Experiment is Perilous’ – its usually safer for the provider as well as the patient to go with what ‘we’ know works because we’ve seen it work often enough. Be wary of applying untested ‘remedies’: because life and well-being are precious and must not be put at risk unduly. The modern expression is “Evidence-based.” Note that ‘Evidence-based’ is not the same as “Conventional Wisdom,” which is seldom wise and lacks factual support.

But what has worked time and again, and for many, may not work for a particular individual – or the situation has already deteriorated too far. Sometimes you may have to judge whether or not to push the limits. Hippocrates said: “Desperate situations may demand desperate answers.”

It takes rare courage to decide, and if you go ahead with a last resort attempt, it may not work; and then the patient is dead, or worse, and you are in deep trouble because you departed from the accepted norms. This is why many breakthroughs happen on the battlefield and during pandemics and other disasters – because the usual standards do not apply.     

We learn and we try. Life goes on and lives go by, and there’s always more to learn and to try. As Hippocrates said: “Life is short, and the Art long.”

Have the courage of conscience to say “No” to orders which are poorly thought through, unnecessarily hazardous, or cruel and humiliating to the sufferer or to their families, or to your colleagues. Challenge the tradition and the ‘received wisdom’ when it clearly flies in the face of the evidence. Shun the monsters in the system. Report such events and individuals, and errors and omissions, without fear or favor. You owe it to your colleagues and to the people you serve, and ultimately you have to answer to and live with yourself.

Being true to yourself and to your calling has its challenges.

Emotional Growth

First Responders are never alone, though it may sometimes seem to be a lonely existence. However, relationships are the central fact; as exemplified in the team interplays, the provider-patient relationship, and the learning, mentoring, and  teaching.

Relationships depend on a capacity to allow feelings into the open, and then fulfillment, joy, and love – in the best sense – happen. Everything alive has feelings, including feelings for others; though humans can develop blocks against showing it — Blocking is one defense against emotional overload, but it comes at a high cost. Personal Growth, like Caring,  is impossible without Understanding and Compassion.

The best defense is to recognize that the emotional burden can at times become overwhelming: when it seems everything in our life is coming apart. This means accepting that each of us has finite limits, and needs help. We seem to be getting better at doing that: it is no longer shameful to admit to being      human and mortal. Problems sometimes are not of the outer world, and only loom large in your mind. Talking it through can help you regain perspective.

Don’t take it out on yourself, or on your significant others who only want to help you, and for all  the right reasons. And music has its own soothing power.

Fulfillment

Your work can bring you a sense of self-worth which is a wonderful asset when derived from knowing you are on your own special personal path, and that your path is worthy.

Find your on-going process of being as you go through life: your life is your very own significant enterprise. Seek to learn, discover, and understand whatever you think will help make you what you believe you are meant to be — to the extent one can in one lifetime.

Don’t become impatient: learn as you go, and don’t be afraid to change your situation when you think  you should. Everything comes in its own time (Ecclesiastes).

Making It So — Act with Purposeful Consistency

Join in the Stream of Life with a worthy goal or purpose. Then you can act with dedication and devotion, without doubt or fear,  in continuous support of your mission.

Your words should be supportive, positive, consistent, and truthful. It only takes one person of inferior character to frustrate and put down many others. Build teams carefully, and trust peer selection. 

Bring your earned credentials and authority to each situation, tempered always by understanding and compassion. 

Be a center of stability for yourself and others as things happen; be supple, yet solid in what counts.

Time

Time is alive, dynamic, and has many aspects: we live according to Cyclical Time — The Seasons and the Life-Cycle; we all seek The ‘Right’ Time; we try to live in accordance with ‘The Times’; we sometimes desperately want our ‘Set-aside’ Time for contemplation and inner discovery. And on some level, we ‘know’ we are part of ‘All-Encompassing Time’ — the on-going Process of The Cosmos.

We also speak of ‘Moments out of Time’, markers with potential for greatness or doom — when all creation stops for an instant — the birth of a new life, the collapse of a hope — a time to live and a time to die. There are even those rare, sacred, instants when time itself is transcended, allowing us an intimation of Creator. 

All of these aspects and qualities enter into the lives and works of everyone, and of First Responders in particular. First Responders know from first-hand experience that the Cosmos has dimensions beyond what we can measure and understand – they have been ‘touched’ by it, though they may prefer to not talk about it — because its impossible to communicate the experience to someone who hasn’t ‘been there’: other than to acknowledge that ‘It’ does happen.

Values

As you Grow, the Values you live will influence the world around you. Recognize and accept you are an exemplar – let your light shine, illuminating your path, and serving as a beacon for others.

You have the potential to impact many lives – for good or for ill. Live appropriately.

 

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