More Soft Skills From The Ambulance

A couple days ago I posted some of the lessons I learned in the back of an ambulance that have translated into my career as a SQL Server Consultant or a DBA. I promised I had a few more.  Here they are.

“I Don’t Know What You’ve Been Through”

Empathy. My friend Tom LaRock wrote an excellent, must-read, blog post about this topic. Go read it. Back? So I can’t add much to this point – but I can tell you about what it is like to see people at their worst. There was the guy with the head injury who had to be held back a bit by some police officers and fellow firefighters. The instinct is to assume the guy is just being the worlds worst person and start treating him like he is treating you. Except – he’s not himself, his head injury is bad enough to be showing those kind of signs (WARNING SIGN!).. Or the patient’s family who just lost a loved one and is a bit forceful and panic stricken with you doing CPR on Uncle Joe near the Thanksgiving table.. We had the benefit of knowing exactly what the folks we interacted with were going through. As Consultants? We may not know what someones motivation was, what was going on, what else is happening to them. We can’t just assume the worst and give it back. We need to rise above it, see the other people as people, understand we’ve all screwed things up and do what we were hired to do. That can’t look like angry e-mails and firing a client right away. It can’t look like trashing the folks before you. Everyone has a story. Until you know it, we need to put the jump-to-conclusions mat away – far away.

“Call It” Earlier

There are a couple schools of thought out there with the right response on a patient who is, well, dead when you get there. Some folks will get the call for the unresponsive patient, not breathing, no pulse, CPR in progress (or not in progress) and practically no matter what get there, and start “working that code” – start doing CPR, start the IVs, throw the drug box at the patient and rush to the hospital doing everything possible. Even if the signs and status point to it being a total waste of time. There are a couple reasons here. One of them is a real reason and perhaps an overriding one out there in some schools of thought – you don’t want to be the one to tell the loved ones that there isn’t anything that can be done… It’s tough! “I’m sorry.. Your mom… Your sister.. Your dad.. Your uncle.. Your wife… has died. There is nothing that can be done at this point.” is a rotten thing to have to say. Heck it gets me choked up thinking of the calls I’ve been on where that was the answer. But when you don’t say it what happens instead is false hope enters the family, they’ve watched the movies and are thinking pretty good chances exist, you bring this patient to the hospital after shouting “CLEAR!”  The other thing that happens is the hospital has to create a patient record and do a few things, get some specialists in to check a few things and then make the same determination that 10 minutes earlier you should have made.. Guess what? That hope is gone. And in a few weeks – in most hospitals out there – that family gets a pretty nasty bill to add to the weight of the grief they just dealt with… As consultants we are sometimes called into disasters. Sometimes, not all the time, the right and best and only good answer is “I’m sorry.. This project is hopeless as is. The foundation is so weak that we can bill a bunch of time and help shore things up but it will never go well, it sounds more expensive than some performance tuning, but the best option here is for you to start over.. In the long run you’ll save money, and it is painful to hear right now, but it’s right.” That’s not easy to say. But when it is right to say – it must be said. Otherwise you are just prolonging the problem and making money in doing so.. Do you want to be known as doing that?

“I’m Going to Die”

Now I’m a hypochondriac of sorts – not horrible, but slightly – and I have medical knowledge – I’m dangerous.. When I tell my wife (after eating the worlds biggest Mexican dinner and drinking a bunch of soda) “something’s wrong!” I think I’m having a heart attack.. I don’t blame her for saying “why don’t you try and burp a few more times first…” with an unconcerned look on her face. She doesn’t start dialing 911 or asking me about life insurance details, she just says “no.. you aren’t.. go burp”.. But.. That’s just me. And there is a point here. In EMS they tell you – listen to your patients. Not just the big statements, but really listen. Let them describe it in their own words. Don’t fill in words for them. You get a good history this way and that goes a long way. But when a patient in a bad situation with signs and symptoms that point to something pretty serious says “I feel like I’m going to die” – that’s a real thing. A feeling of impending doom is actually a symptom to watch for. And I’ve seen it in two patients. One ended up being right about 30 minutes later at the hospital. I truly think the other one was right but the bleeding was stopped and fluids given soon enough and blood replaced soon enough that he survived – scary call to this day, thought he was already dead when I got there based on his color and position until he started talking… As consultants – we can’t just ignore the people. We can’t just focus on the signs and symptoms. We should look to them for sure – but the more folks on the ground we can talk to. The more we can listen to – really listen to – the easier our job is and the more focused we can make our digging into the issues. Listen to the customer! I can’t tell you how many times I’ve had consultants come in or work with consultants who don’t have this critical skill. And I can’t tell you the times I’ve actually looked like the hero pretty easily by just listening with empathy, listening with understanding, acted like the duck, put two and two together based on the information on hand and the things said and helped a client move forward.

So there you have it. A bunch of lessons. I could write another 8 I’m sure. All from mistakes I’ve made or situations I’ve been in or horror stories I’ve heard.  Like the time an instructor was telling us about when he was working with a new EMT-B and they got to a small apartment building with stairs. Experienced guy said “bring the O2 bottle and stretcher, I’ll get the rest” and it turns out the newer, more nervous guy was attempting to bring the “big” oxygen tank (the “H” sized one) that is for the onboard Oxygen system on the ambulance.. Not the little O2 bag with the D size tank – communication lessons there..

But I won’t give anymore.

A few related posts that have something to do with a lesson I may have learned from time in the Fire/EMS Service:

• Checklists, Recipes and Algorithms – Lessons from Pilots, Chefs and Medical Professionals
• What’s Your Point? – Identifying the Chief Complaint and history taking
• Don’t Splint Your Database Server to Death – It happens. Focus on the basics is lost and a patient can have a non life threatening injury so well cared for with so much attention that they die of the not so obvious serious situation. DBAs do it all the time, too.