EMS is an unlikely profession for someone like me. I hate chaos and loud noises and they make me downright uncomfortable. Worse, I really don’t care for the company of the real hardcore Type-A personalities that permeate EMS; the vestiges of the police and fire types that we tend to spill over in to move on to. I’ve often said the EMS is like the Air Force of emergency services and the Marines are the cops and the firefighters are the Army. Sorry if you chose a different service for yourself in real life, but this is my analogy and as an INFJ and an author I am REALLY good at making analogies.
For those of you who aren’t familiar with the Meyers-Briggs personality type (you can find out your own by Googling the MBTI exam and taking it yourself) I’m a breed that is the rarest of the rarest
Pokemon people. Only 1% of men and 3% of women fall into this category and I myself had no idea I was one of them until a few months ago my wife gave me the test to take. I tested out as an INFJ, but because I’m in EMS the psychology end of medicine didn’t do much for me. Once I started reading up on it though I was blown away by the fact that I was reading what might have been my biography written by someone who I had never met. They seemed to know so much about me, some things I didn’t even realize for myself.
In a nutshell INFJs are often:
- quiet leaders
- great depth of personality – intricately and deeply woven, mysterious, and highly complex, sometimes puzzling even themselves
- abstract in communicating
- live in a world of hidden meanings and possibilities – part of an unusually rich inner life
- abstract in communicating
- artistic (and natural affinity for art), creative, and easily inspired
- very independent
- orderly view towards the world but within themselves arranged in a chaotic, complex way only they could understand
And here I thought I was just a weird kid. It turns out that the idiot I had as a third grade teacher was wrong. I didn’t have a learning disability. What made matters worse in that situation though was that someone made the mistake of telling my family that I was incredibly intelligent, to which any parent might be thrilled to hear. Unfortunately that didn’t mean I was a good student, after all if you judge a fish on it’s ability to climb a tree it’ll go through life thinking it’s stupid. Soooo, as you can see I’m not a doctor or a lawyer and there are no degrees taking the place of wall paper in my home.
People like me aren’t cut from the same tree as many of you are. In fact there have been some INFJs who actually believe they aren’t human. I don’t think this of myself, though I can sympathize with that feeling (and it’s great plot fodder so…)
My best friend in medic school once declared that he and I were “kind of competing” in class. I don’t know where he got this from, but I hate competition. I hate it. I detested gym class, not because of the physical elements of it – that was fine. I just hate competing because in the end it’s utterly meaningless. Clin-Con? I can’t imagine a worse example of EMS ego than that. I hate the EMS alpha-dog ego to begin with, so why would this be something I’d even consider doing. Why? It’s competition based on practices used in saving lives. That’s absurd in my mind.
But here’s the thing, ok? The point of this entire blog entry is to point out how different my way of thinking is and always has been. It’s a story of how difficult it was for me to cement myself into a field that was not built or designed for someone like me; someone who thinks like me, acts like me, or goes through life like me.
Ultimately it’s the back story to how Twenty-Five at the Lip was written.
I’m a Highly Sensitive Person. Now being an HSP doesn’t mean emotionally sensitive especially, but rather that outside influences have strong effects on me. Something heavy dropped on the floor of the ambulance bay is going to make me jump, and even shout at someone, but more likely to myself. The Nextel is another element of this. It’s an unpleasant noise, not because it means I have a call, but because it’s an OBNOXIOUS sound and I am sure if there is any justice in the universe the creator of that little jingle has a special place reserved in Hell for them. The thing is that sudden loud noises put me into that sympathetic fight or flight response and it takes someone like me longer to come down from that than the average person. People who worked opposite shifts from me used to hate that I changed the ringtone on the Nextel to something quieter and more humane for my own benefit. After reading a couple of numerous blogs and books like The INFJ Handbook by Marissa Baker I had this light go on in my head. For someone like me, that kind of thing is COMPLETELY NORMAL.
Now of course if you’re not an INFJ, or any of the introverted types, or even aware of this sort of thing you’re going to think I’m really strange, and that’s cool. As a medic I’ve had some interesting experiences with partners who weren’t sure how to work with me. Some people even avoided picking up my shifts because they thought that my quirks leant to some sort of para-god core. The funny thing about this is that INFJs are both born leaders and detest leading at the same time. People look to us for guidance and leadership and while we often give it reluctantly we hate having attention put on ourselves. For me in EMS that translates to “quiet codes” where one person speaks at a time and nobody yells. It also means saying “Thank you” a lot, and using terms like “we” and “us” when things go good and “I” when they don’t. That is taking responsibility and spreading credit, not the other way around.
Regardless these traits also come with some peculiar behaviors and ways of looking at the world. I’ve always been like this. When I was four I was assessed at the recommendation of my preschool because of bizarre, sometimes adult, behaviors that some might have pegged as me being an “old soul.” So my parents carted me over to a psychologist who asked me some pretty rudimentary questions that any four-year-old might be able to answer.
“Jimmy,” they asked me. “What do you do with bread?”
Now any other kid, and normally thinking person, is going to tell you ‘Make a sandwich,’ right? My answer was,
“You make bread pudding.” This was a reasonable answer for me because my grandmother makes – literally – the best bread pudding you’ve ever had and it was my favorite. That was the only logical answer that my four-year-old mind could come up with.
“What lives in the water?” they asked me. Now surely my answer was ‘fish’, right? How could it not be?
“The Loch Ness Monster.”
See the thing about this is that the answers I came up with weren’t wrong. They just weren’t the typical answers you’d expect. This is why I detest the National Registry exams…
One of the really cool things about the INFJ personality is that we are capable of coming up with creative solutions to sometimes difficult problems, though sometimes they might seen cumbersome or odd. In our mind if the job gets done then it is done right. Unfortunately this doesn’t always translate well in EMS and it makes us look strange or incredibly awkward bringing about unwanted consequences.
This one day at MedTech an EMT approached my friend Angie and lamented “I wish I hadn’t picked up the medic shift.”
“Why?” she asked.
“I’m with Windale…”
Now this might have resonated some sort of empathetic response from someone who hadn’t worked with me, but Angie came to his, and my, rescue. She came to me and actually told me he was nervous about working with me. This made me really upset because I knew I had something of a reputation as being that weird guy in the company, but also being really smart and capable. Some people saw it as a double edged sword. “He’s new,” she said. That was all I needed to hear.
INFJs are often natural counselors or teachers (we’re also writers – ta-daa) and so with this in mind I decided to make my approach to this guy in the way that I’d always wished someone had instructed me when I was new. The entire day before I had to put myself in a mindset of how I was going to relate to this person because ultimately I was the more experienced provider on the truck. Within ten minutes of just sitting on the truck and talking with me he realized that I wasn’t the intense guy he’d perceived me to be. He also started reading Twenty-Five at the Lip.
Just for shits and giggles though, I told Angie that I had him so upset that he was curled up in the fetal position on the floor of the ambulance crying and mumbling “He’s from Hell… he’s from Hell.”
This other time someone asked another partner of mine, Jeremy, how he managed to work with me for 16 hours a day. His reply was that I’m simply “particular,” not hard to work with. Most find that I’m fun to work with because we are doing stuff with patients as opposed to BLS driving everywhere.
When I started running calls with new people they actually found it to be like what they expected EMS to be in the first place. Too much time at your average private EMS company can make us complacent and not really that interested in providing the level of care that’s necessary. Just going from nursing home to the hospital for abnormal labs isn’t all that exciting until you start to realize what ‘abnormal labs’ can actually mean. For instance, an elevated troponin is also considered ‘abnormal’ and rightfully so. I ended up with people vying for my shifts because I actually did stuff, not just in the truck but at bedside, setting up IVs, oxygen, monitors, 12-leads, even meds. I let them play, which is something that some medics don’t like to do.
It wasn’t till I started working with a basic partner or a cardiac that I truly found myself in charge, and not under the Type-A eye of another paramedic, that I succeeded. Ironically enough, it was because I was thrown to the wolves and allowed to practice the way I knew which was based on the unique experiences I’d had. I got to be ME as a medic, not someone else’s concept of a medic.
I had a supervisor at a Fall River (Borden City in Twenty-Five at the Lip) based company in the North End who had failed medic school two or three times and had to settle for being a cardiac so that he could become a supervisor. Apparently this company promoted people based not on merit, but your practical ability – that is if they thought you might kill someone you got promoted so that they took you out of the standard lineup. But I digress…
He took some exception to the way I practiced, which was sort of humorous in it’s own right considering his own background. I explained to him that I spent a great deal of time in the ER and my way of approaching patient care was very much influenced by the example set at those institutions. Remember the Loch Ness Monster? I practice a sort of osteopathic approach to EMS, look at everything and treat what’s wrong. To clarify: just because the nursing home called for a rash on your patient’s leg, doesn’t mean you ignore the fact that he’s in congestive heart failure and they didn’t pick up on that. Another way of looking at this is to call it shotgun medicine; pull the trigger and see what you hit.
I think deep down this guy was somewhat threatened by me, which explains the Homeric odyssey that he sent me on, jumping from base to base all over Southern New England. I finally landed at a base in New Bedford (Taberport) with a new supervisor that I’d worked with at another EMS company based out of Dartmouth Massachusetts some years earlier. In the words of my great-aunt Ruby he was a ‘bitch bastard’, just as I’d remembered him being. Before I knew it I was leaving that company, though not overly upset about it given the circumstances. I still had a nicely padded resume and a laundry list of references to call upon. It wasn’t hard for me to find another job, and a better one at that.
There’s a joke writers collectively understand. “Be careful or you’ll end up in my novel.” Ron West, John Prince, and Bobby Carrerio are very thinly veiled people in Twenty-Five at the Lip. Writers have the ability to immortalize people and as sensitive and sentimental people we love to do this. Always be kind to writers because there’s a good chance you’ll end up immortalized somehow. You can be a Valerie LeClaire or you can be a Ron West. Your choice.
Let me bring this back around, because my INFJness is really going strong here. A lot of us are really quiet, and that’s a testament to our introverted nature. People like me are also known for having extroverted moments that are marked by needs for deep, intellectual conversations complimented by almost manic behaviors. For me one of two things is going to happen:
1) I’m going to use up all my fuel and just roll to a stop and crash, or
2) Someone is going to say something about me being weird or stupid because they don’t understand this part of my personality and I’m going to shut down, build an impenetrable wall, and immediately revert back to the safety of my introverted nature.
It’s like being a turtle; a turtle will let you see it for what it is and there is an incredible amount of things a turtle can teach you, if and only if, you’re willing to figure out their nature and language. The thing about turtles is that if you push the turtle, poke it, or try to hurt it somehow it’ll turn into its shell and that’s it.
People who don’t even know about this MBTI thing (myself included until just recently) will discover an INFJ and be completely drawn to them. Many INFJs have experiences where strangers will gravitate to them and just start talking to them. This has happened to me a few times myself, and I’ve also had some amazing luck getting ‘difficult’ patients to calm down and let us work with them.
Then there are things that really irritate us. Something that’s always bothered me is when I’m writing something down and I get interrupted. If I lose my train of thought it’s like I’m losing my sense of direction. The bridge has been hit and Sulu doesn’t know where the heck we are. Meanwhile I’m about to go into fits of Shatner. As it turns out this is pretty typical and I felt bad about it not realizing this was a perfectly natural response to someone with HS, compounded by the God-awful sound of the Nextel or someone talking over me while I’m giving a med report. There’s nothing worse than my report being interrupted by some absurd question that I was getting to if they had just let me. I missed the radio so much because I could talk, say everything I needed to, and then answer questions as necessary.
If you’re confused by any of this I’ll try and make it clearer:
Have you ever tried to hold to a conversation at a concert? I’m not talking a small coffee house with a shitty band playing Radiohead covers. I’m talking The Rolling Stones at Shea Stadium. Or how about the floor of the New York Stock Exchange? Those are really loud places. Why would anyone do that, you might ask. When I get interrupted in the middle of talking about something, I ask the same question because my brain, at all times, is like an air traffic control tower. There are millions of pieces of information flying around and I’m trying to keep track of the important stuff pertaining to the STEMI I just brought you. If you interrupt me to ask about their lung sounds I’m going to get screwed up and lose my place in the story I’m reading out loud to you. I’m getting to it. If there was something urgent about the lung sounds you’d have heard it by now.
Now the average medic is probably going to explode having read this. There’s a procedure after all, isn’t there? Of course there is. There’s the “right way” to do something and then there’s the “other right way” to do it. We go on so much about not being cook book medics that we unknowingly end up being cookie-cutter medics. Is it really any better?
The thing about being an INFJ in EMS is that the Type-As who are so drawn to, and make up most of the EMS population, set the standards for what it is “to be” in EMS. I’m not talking about the docs who write your protocols, because I will guarantee that 99% of them will get us every.single.time.
What I’m talking about is the macho, Rambo-style, know it all who is an expert at everything and can rattle off paragraphs and figures from their EMT or medic text books. That’s a great talent and I’m glad you have it, but if you’re the type of FTO who tells a new, scared shitless medic or EMT that they have no business being in EMS because they can’t spew out the contraindications for Procainamide off the cuff… then this is me telling you to eat shit. If you have zero tolerance for questions or mistakes then you have no business being an FTO. Take off that pin and give back the pay raise that comes with it. Go back and sit with the other cowboys in the dick-measuring corral.
It took me a very long time to get comfortable with my skills as an EMT and a Medic. Worse though, it took me longer to accept myself for the sort of EMT and Medic that I am. Being different in a field like this is tantamount to treason. You’re expected to fit into a very specific mold, for no reason other than the mentality that makes up EMS. Possibly the most ironic thing about EMS was summed up by one of my early preceptors when he said, “You’re nervous, and the bully in me is picking up on that.” Someone in a profession that is based on giving aid to the sick and injured has bullying tendencies? If I didn’t already know that based on my previous history I’d have been blown out of my boots by that statement. In my unconscious INFJ state, I shut down to him from there and fortunately was given another preceptor. In the end I’m still here. The reason for that it because I’m a survivor – a lot of INFJs are. For one reason or another people in their formative years have had to endure. The result of the endurance, sometimes, is an ability to see the world very differently than most of the population. To have the ability to come up with creative answers to difficult questions. And to fall into leadership positions, even though we don’t really want them.
How’s that for a mind fuck?
On the other end of all this is my own humanity. Despite the theories some INFJs have of themselves, I am at least partially human. That means I’m entitled to mistakes, and when it comes to being a preceptor myself I’ve certainly made them. Sometimes you pick up behaviors that you didn’t think you were capable of, just ask children of abuse or alcoholism. In moments of stress and high anxiety I’ve yelled at students and precepts. I’m not proud of it, but I’ll freely admit that it was wrong. That’s something else that I had to address to myself when I wrote Twenty-Five at the Lip. If you’re like me the last thing you want to do is hurt someone, and that goes doubly if you’re in EMS. Never forget why it is that we are here.
As I bring you to the end of this psychological tour I’ll share with you something that my friend Lisa sent me. She was the model for Snuffy that you’ve seen a number of times and I could recall on several occasions EMTs venting to me about the conditions they worked under where the egos of their partner filled most of the front cab. She sent it to me saying that it reminded her of me, which was an incredibly humbling feeling. I can’t cite the author because there wasn’t one provided. It could easily be, and should be, anyone in a position of leadership in EMS. We INFJs don’t like being in leadership roles, but often end up there because of our insight and ability to lead, not ruthlessly manage.
That EMT over there is mine.
I’ve been in their shoes. I’ve walked through the shit they are walking through. I’ve put up with the shit you’re giving them. I’ve been them. They may one day stand where I stand.
That EMT has my back. That EMT does my CPR. That EMT starts my IVs. That EMT cares for my patients. That EMT is my partner.
Do not bark at my EMT. Do not ignore my EMT. Do not discourage my EMT. Most of all do not treat my EMT like they are less than us.
I say “my EMT” not because I am a medic and they are an EMT, but because that is my EMS sibling. I get to give them shit, because we spend 12+ hours a shift trying not to annoy each other and to get along. Because I trust them to have my back. Because they’ll never let me down. Because that EMT is my partner.
I need my EMT. You will respect them, or leave them alone.
-That EMT’s medic