Relax. Breathe.

You're 21 years old, and you wondered what you'd do with your life. And the billboards and commercials seemed so enticing. After all, a career spent saving lives seems pretty darned noble, now that you think about it. So you called the 1-800 number or typed the URL of the website into your browser, and you paid your fees and completed your application and submitted your shot records and took your physical, and you felt  that nervous thrill of anticipation, and maybe just a litlle self-congratulatory, because you had just committed to something important.

And you wondered if you had what it takes.

And from the first day of class, you were bombarded with information that seemed like just so much esoteric knowledge to a girl barely three years out of high school. You learned how to trace blood through the heart, and about bronchi and alveoli and gas exchange and tissues and organs and systems, and the names of muscles and glands and parts of the brain. You learned not only that there are 206 bones in the human body, but also the names of the bones, and maybe even the major parts of the bones you couldn't even identify a week before.

You learned acronyms like SAMPLE and PEARL and DCAP-BTLS and OPQRST and AEIOU TIPS and a dozen others, and the unspoken message was that these things were important to learn, and often forgotten, so you needed a memory aid to keep them all straight in your head.

And then you learned how to fix things when something went wrong.

You learned to tell the difference between a venous bleed and an arterial one, and how to stop the ones that were bright red and spurting. And you learned about burns and hypothermia and infection control and stopping the burning process, and about strokes and heart attacks and aspirin and nitroglycerin, and about asthma and emphysema and CHF and oxygen and CPAP, and splinting and immobilization and when you could straighten out a fracture and when you couldn't, and how to strap people to hard boards to keep them from being paralyzed, and how to pull them out of mangled cars, and how to deliver a baby, and through it all was the not unspoken message, the one your instructors said aloud countless times, pounding it into your head:

"Pay attention, this is important. You will have someone's life in your hands."

And you learned how to operate cool machines like an AED, how to literally shock someone's heart back to life, how to breathe for them when they couldn't, and how to compress their chest to circulate blood and that precious, life-giving oxygen, and Jesus, how am I gonna keep all this straight in my head when I can't even remember the steps to a medical patient assessment, and…

… relax. Breathe.

You learned how to eat an elephant; one bite at a time, and pretty soon youl looked up from your plate and wondered where the elephant went.

That's how EMT class was. It seemed overwhelming at first, but you were diligent and kept working, and one day everything just seemed to fall into place, and all those fragmented and incomprehensible factoids came together and make sense. And you gained a little confidence, and you felt comfortable doing those skills, and sure enough, when the final exam rolled around, you aced it.

And then the waiting game started. The certification exam was still a month away.

So you studied and practiced and met with your classmates and argued over those factoids, and memorized the whole friggin' EMT textbook, and you answered all the workbook questions and wrote all the DOT objectives by hand, and one of your classmates recommended a test prep and study guide and you took one of the practice exams and – Holy crap, I only scored a 70! I'm gonna fail! – you studied even harder and obsessed even more and you wondered if you had what it takes, because sure, class was tough and you passed it, but that was class, and this is the exam, and every ounce of work you've put in thus far will have been wasted and you wondered if your doctor would give you a prescription for Xanax and…

… relax. Breathe.

It's only a test. And when you sat down at the computer to take it, the first couple of questions were hard, but then they got easier, and you started remembering stuff, and you felt pretty good about it, but some of them stumped you, and then you realized that you had answered 116 questions, and you didn't know if that was good or bad, and then all of a sudden the test program just… stopped, and said you were done.

And you went home, an icy ball of dread in the pit of your stomach, and second-guessed every question, and called your classmates for ideas and support, and you psychically tortured yourself for 48 hours, obsessively refreshing the browser page that was supposed to display your exam results, until the page finally changed, and…

… you failed.

And you beat yourself up over it, and that cynical and destructive part of your brain sneered and said, "See? I told you you didn't have what it takes."  And you listened to that part of yourself for a while, because how could you possibly believe that you were up to the task of saving someone's life, and good Lord, everybody else in the class passed, and you're the only one who failed, as if that isn't enough clue that you should just give it up, and how the hell did you ever think you could become a paramedic one day when you can;t even pass the EMT-B exam, and…

… relax. Breathe.

And you pulled up your big girl panties and studied even harder, and figured out what you had done wrong, and when you took the exam for the second time there wasn't the fear of the unknown like there was last time, and you felt much more confident in your answers, and - Holy crap, the program cut off after only 78 questions! I failed it again! – and…

… relax. Just breathe.

You didn't fail it again, but you couldn't quite let yourself believe it until you got the card and the patch in the mail. And when it came, you did a little Snoopy dance by the mailbox. "Hey, I'm an EMT!"

And then you set about trying to get hired, but you were told that there were no openings. The company only hires a couple of EMT's out of every class, and you weren't one of them. Nonetheless, you kept your hopes up, and checked in frequently, certain that you were driving the recruiter slowly insane.

And you know, maybe you were.

A year dragged on, and you had long since abandoned hope that you'd ever get hired, and you started to turn your mind to other options. And then the call came – could you report Monday for your drug screen and your pre-employment physical? Of course you said yes, and your heart started hammering, because amid all the joy of getting hired, of finally having the opportunity to go save some lives, also came flooding back the doubt and uncertainty.

"I've been out of school a year," you told yourself. You were too rusty. It took you two times to pass your exam, after all, and you hadn't used any of that knowledge or skill in a whole year, and surely they'd spot you as a fraud the minute you walked in the door, and…

… relax. Breathe.

The company isn't going to turn anyone loose on patients if they're not minimally competent, and they didn't in your case. And your preceptors taught you the company policies and protocols and showed you their particular way of doing things, and critiqued your inevitable mistakes, and before you knew it, you were on the schedule, earning a paycheck in your chosen profession.

They put you on the swing shift, meaning that not only were you working a different station from day to day, but often in a different city, and always with different partners. And you learned quickly that each medic has their own particular style, and their own particular idea of what your duties should be. Some of them wanted you to fetch and tote the gear, and some wanted you to sit there, help push the stretcher and be silent like a good little EMT. The only time they even let you drive was when they climbed in the back with the patient, and they bitched about every little bump and hard turn you took on the way to the hospital. When you made a mistake or didn't know the answer to a question, many of them just sneered condescendingly, judgement heavy in their voices, and asked, "Didn't you learn anything in EMT school?" 

And you found yourself thinking, "Maybe I didn't learn anything in EMT school." And so your default action became standing silently in the background, afraid to move or speak without specific instructions, unwilling to do anything without first being ordered to, for fear that whatever it was would be the wrong thing and anger the touchy bastard you had as a partner this week.

Relax. Breathe.

Within every organization there can be found a certain percentage of assholes. Eventually you're going to work with some of them. And some of them are not assholes at all, but they've managed to forget what it was like to be a newbie, nervous and unsure of yourself. And some of them are not natural teachers, and you still need a lot of teaching. You just have to remember that even an asshole can teach you how not to act. They're not going to be your mentors, but they can serve as cautionary tales. Try not to learn their bad habits.
 

So now, they have given you a permanent station assignment, working with a medic who has been doing this since you were in kindergarten. And everybody has told you what a good medic he is, and how much you'll learn on his truck, and if you want to go to paramedic school one day, he's the partner who will get you ready. Only, the station is in a different city, one you're totally unfamiliar with, and you're pretty certain this übermedic has pretty high standards for his partners.

To make matters worse, it's a busy truck, and not one of the regular Borg ambulances. This one is a critical care ambulance, full of a bewildering array of drugs and equipment you never even discussed in EMT class, and frankly most of it intimidates the hell out of you. And you fervently pray that he'll let you stand silently in the background, where you can't screw anything up.

Only he doesn't.

He tells you right off the bat that you're an EMT, you went to school to learn how to do this stuff, and he expects you to do it. He tells you that if he wanted a pack mule who could carry heavy loads without doing much thinking, he'd just grab the closest firefighter on scene who looks like he has nothing to do. He told you he expects to to assess patients, and make good decisions based on your assessment. He tells you that 75% of the job is BLS, and that in his mind, that makes your contribution to patient care even more important than his own. In short, he saddles you with the one thing you've wanted: responsibility.

And you're not sure if you can handle it.

Relax. Breathe.

You're not the first rookie partner he's had. He's spent 18 years working with people just like you. He's going to let you screw up, because we learn more from our mistakes than we do from our successes, but he's not going to let you screw up in any way that negatively impacts patient care. And when you do screw up – and you will – he will never belittle you or chastise you in public. He'll wait until after the call, and he'll do it in private. It's a critique, not a bitch session.

And if you recall, he told you that very thing, your very first day on the truck with him.

But of course, you being you, that increases your stress level even more. You don't want to screw up. You want to impress this guy with your mad EMT skills. So you put even more pressure on yourself, and since you're nervous and second-guessing every move before you even make it, you screw up even more. And you've heard all the stories about how good a teacher this guy is, and you're dead certain that his students never made so many mistakes, and he probably thinks you're a total idiot, and…

… relax. Breathe.

He can't cook you and eat you, and besides, rookies are much too raw and tender for his tastes. He prefers to dine on well-seasoned medics who think they're salty. Crushing a rookie is like… well, like clubbing a baby seal. There's no sport in it.

He's tolerant of mistakes, and he makes plenty of his own. If it doesn't seem that way to you, it's just because time and experience have taught him how to hide them, both from his patients and his partners. He's human, just like you. And while he doesn't mind correcting mistakes, he does mind correcting the same mistakes again and again.

That makes him impatient, and you've figured out by now that he's even more intimidating when he's impatient.

So relax. Breathe.

Learn from your mistakes, and don't repeat them.

And he knows that all this responsibility is a new thing for you, and that none of your previous partners expected much from you. Some medics don't give their EMT partners any responsibility because the deem you unworthy of trust, and other medics do it because they don't trust themselves. They doubt themselves, and thus they feel compelled to assert their control over everything. 

Your current partner believes neither of those things.

So relax. Breathe.

Work out your choreography with him. If you get in the way, he'll work around you, and tell you where to stand next time. If there'a history question that needs asking, and he hasn't asked it, spit it out. He only cares about the answer, not who posed the question. If there's something he asks you to do that you're uncomfortable with, speak up. Don't just stand there impotently like a deer in the headlights. He'd rather you be bold and decisive than timid and unsure of yourself.

He really doesn't understand timidity, so you'll have to bear with him. He's trying to understand you. He himself has never suffered from a lack of confidence, a quality that many of his colleagues mistake for arrogance. He's not arrogant, he just decided long ago that he'd rather correct the mistakes that come from being overly enthusiastic, than he would constantly goad and encourage someone to take action. And he accepted long ago the responsibility of making sure those mistakes never hurt anyone, so…

… relax. Breathe. 

You'd have to fuck up pretty egregiously to really hurt someone, and he's not going to let that happen. And when it comes right down to it, even with all the experience and the letters after his name, the ways he could fuck up and really hurt someone usually are the result of him forgetting something he learned way back in EMT school.

That makes your knowledge just as important as his. There's truth in the saying, "Paramedics save lives, and EMT's save paramedics."  So cover his ass, and he'll cover yours.

And he knows that it's a big step from driving a little compact car to manhandling a big, heavy ambulance through congested streets, weaving in and out of traffic, with your lights and siren blaring. He's okay with you being a little slow and tentative while driving, because a safe ride is always better than a fast ride. And eventually, you'll be confident enough to drive safe and fast.

He'd just like to point out, however, that if you're running with lights and siren, and you're still going slower than 95% of the traffic, there's not much use in lights and siren. When little kids are passing you on their bikes, he'd much rather you take pity on his tired old ears and back it down to non-emergency. The lights and siren don't save us that much time, anyway.

So relax. Breathe.

Smoother is better every time. In fact, make smooth your default drive setting. Everything you feel up front in this rig, he feels 10 times as acutely in the back. More importantly, so does the patient. And he learned long ago that patients are far more impressed by the smooth ride than by his mad paramedic skills. So when he instructs you on little nitpicky things like smooth acceleration and braking, or squaring up to curbs so that both sets of wheels hit it at the same time instead of individually, it's because those little things make huge differences in the ride.

As a matter of fact, make smooth your default setting in everything you do. Hurrying usually just makes the call more stressful for everyone, and increases your likelihood of making a mistake. He's fond of saying, "Slow is smooth, and smooth is fast," and he'd like you to take those words to heart. that's what he's trying to tell you when you're fumbling with equipment and you're blushing like a tomato and that stricken look is plastered on yuor face, when he takes you by the arm and slowly, gently tells you,

"Relax. Breathe."

And he'd like to tell you that you've been doing a good job lately. You were shaky at first, but he notices the improvement, and he'd like you to know that he's proud of you. You have it in you to be a good EMT, and he doesn't say such things lightly. But you're not there yet, and if there's one thing you still really need to improve on, it's navigation. Learn the streets. You've got a map book and a GPS. Learn how to use both of them effectively, and learn when each is inappropriate. Because when you're making the same navigational errors after three months on a truck with him, he's silently telling himself…

… relax. Breathe.

And he's trying manfully to suppress the urge to snap at you, and thus make you even more unsure of yourself. So do yourself a favor, and start studying the map.

And one of these days, sooner than you might imagine, you're going to find that you're not nervous any more. You're going to feel confident in your knowledge and skills, and you won't recognize that timid, insecure rookie you used to be. And you'll have gained a whole new body of knowledge that wasn't even covered in your EMT class, and you'll wonder if you might have what it takes to be a paramedic. I think you do, but what matters is that you think so.

You'll know when that day comes, when we have an EMT student riding with us, and he's fumbling with the equipment and his hands are shaking, and it's not me but you that takes him gently by the arm and says…

"Relax. Breathe."