Tension is contagious. The job is stressful, what’s happening is scary, yes, but it’s sometimes in these situations that the most important thing you can do isn’t anything life-saving — simply put, you have to keep your cool.
Emergency is a department where you think you would meet some of the most resilient people in the world — people who are unflappable and good under pressure. Some, even the majority of them, are. Not everyone can be perfect, however, so it’s important that the unflappable stay calm, with an even tone of voice, without rushing. It’s precisely because tension is contagious that the naturally un-tense among us mustn’t get caught up in the tension.
Respiratory is a tense job, period. I’ve had moments I clearly remember primarily because of that squeeze of adrenaline burning the memory into my brain. The stress response is a strong thing: my hands shake, my speech is fast, pupils dilated, time dilated, memory sometimes not the most reliable. It’s a struggle in these moments sometimes to keep my tone of voice even, to not rush my words into an unintelligible mumble, to not get impatient to the point where I begin taking my stress out on other people.
It only takes one person to destroy the calm. Even when things are hairy and scary, voices don’t have to be raised, team members can ask for things (rather than demanding,) and tempers don’t have to be short. It’s when the one person who’s not in control, who lets tunnel vision take over, who lets their stress spill into their voice and their ability to cope evaporates in the tension. This person can be the most dangerous player on the team, simply because they stress other people out — those who don’t have iron fist control over their emotions — and it’s in this stressful state, with someone barking orders at you, yelling at you, that you begin to rush, and your judgment and decision making skills become impaired.
This is when experience helps — not because experience will tell you what to do, but because experience will make you harder to stress out, generally speaking. The exception to that rule, of course, are those people that have a tendency to become flustered even with experience. It’s worse, because the less experienced team members pick up on this, and then end up in this situation of “if they’re freaked out, then I should be freaked out!” Things spiral into disorganized chaos from there.
I’m at the head of the bed most of the time. I have a very clear role to play and a specific job that is, truly, nobody else’s. Nobody in that room barks orders at me for the most part, and I don’t order anyone else around. Once I’m doing what needs to be done, everything else follows. In a sense, it’s tense at the beginning, but once airway is secured and air goes in and out, I am a spectator at the head of the bed. Maybe it’s what makes it easier to be calm.
This feature of the job allows me to fade in the background and observe people. I consider it a point of pride to remain collected and cool. While spectating, I take notes in my head — notes about the people around me and how they’re handling the stress. I think it stands to reason that the people I observe setting the tone, giving orders in even tones of voice, or focusing efficiently on the task at hand, tend to be the people I gravitate towards when the situation isn’t stressful and hairy. I find their resilience enjoyable, and for the most part, they’re also highly intelligent people who are exceptional at their jobs.
A lot of people start out with emergency medicine in mind thinking that they get to be a hero in those dramatized situations they see on television. The truth is that the best people for the job are the opposite — not trying to showboat their heroics, not making the situation into a dramatic cluster of chaos, but those who calmly go about the task at hand with focus and skill. The truth is, the best run codes are the ones where everyone in the room looks like they are just this side of bored. There’s nobody pressed with anxiety that things should be happening faster. The lack of tension means that it’s easier for everyone to take a second to think. And while in those situations speed is crucial, speed is useless if you haven’t had a chance to think.