I was a mere child when I started this job in 1983, three months before my twenty-first birthday. Now, close to a quarter century later, I look back on my career and think: how the heck did I get here? I never imagined I would be in this profession for quite so long. It seemed that when I was a young ambulance attendant there were no old ones around. Guys with four or five years on the job were revered as being worldly and all-knowing. Guys with 8 years or more were, well, antique. And I sure didn’t know of any ambulance attendants in 1983 that had been around as frontline medics for more than twenty years!

My college preceptors had been on the job less than a dozen years, but to me that seemed an eternity. To any 20-year old, someone over thirty is really old. My daughter who is 15 and my son who is 18 think I’m a dinosaur. Today, as much as yesterday, the truth holds that you can’t trust anyone over thirty.

So here I am as old as Noah writing a column about what it’s like to be in this career called paramedicine for almost twenty-five years. And like any old-timer, I’m going to tell you that it doesn’t feel any different than it did so many years ago. And that’s the truth. Because—and you old codgers out there will agree with me—nothing has really changed. Our job, with all the toys we have at our disposal, is essentially the same: drive to the scene, bed, oxygen, blanket, drive to the hospital. Sure, now we can do a few more things, like IV’s, symptom relief, cardiac monitoring, ALS stuff, et cetera, but in the end our job is still about caring for people. How do we ensure a long and fulfilling career in paramedicine when essentially the job from start to end stays the same? How do you add variety to a job that basically is never-changing? Well, I guess there are a couple of approaches.

You can go to work day in and day out and stay totally uninvolved in labour relations, company policies, planning or anything else. One of the beautiful things about our job is that we can leave it all behind us when we walk out the station door. Once you turn the keys over to your relief, or lock them away after the shift, your job is done. It’s not like being a teacher, where there’s papers to mark or lesson plans to be created. No, for us the day is over when it’s over. Aside from the occasional studying we have to do to keep current or to move to the next level of care, we’re no different than the mailman or the line worker. When it’s over it’s over.

In a way, I envy anybody who can do that. But, I’m afraid, I am not one of them. I have always been one to get involved with my profession. I’m passionate to a fault. I listen to stories from my peers or hear things come through the pipe and feel I have to do something. It’s the reason I started the Toronto EMS list server almost ten years ago, and I suppose it’s why I write this column. My career, I’m sure like yours, is and has been evolutionary. I started out wide-eyed and green behind the ears. There was that initial stage of being so clueless, even after graduating with honours from college. Then, as I gained experience, I thought I was the cat’s pyjamas. And I went through a phase where I was a little unsure of myself, as the more I saw the less confident I was that I had all the necessary skills to handle every situation. I went through a long period of anger and frustration, too. Anger at the city that employs me for disrespecting us so much. Anger at the fire department for putting a proposal in to city council to take over EMS, saying they could do it better, faster, cheaper. Anger at hospitals for not recognizing our value to the community and holding us hostage endlessly in off-load delay. Anger at the union for missing opportunities to get us whatever we needed, whatever that was at the time.

There is always reason to be disenchanted with work. But that kind of constant focus took a toll on me. I burned out and for a while I became angry and bitter. When you are angry and bitter at work it’s hard not to carry all that baggage home with you. Instead of leaving the problems of work behind, you bring them home and share them with friends and family who become unwilling participants in your misery. Your attitude towards your work pollutes your home life, and hostility between you and your spouse grows and festers, resulting in problems on the home front that manifests as marital discord. I don’t know of any comprehensive studies that have examined the marital dissolution rate amongst paramedics in Canada and the United States, but I would venture to guess that it must be very high, if only because anecdotally I have seen a lot of it close to me. I would suggest to those studying critical incident stress amongst emergency responders that this topic should be the next one to be examined closely, as I believe it plays a vital role in our mental health.

I have painted an ugly picture of one toxic scenario that snowballs out of control, but that is not the only way things can go. Longevity in this profession depends on our ability to recognize problems in ourselves and to take corrective action along the way. It is not unlike sailing along a treacherous coastline. A novice sailor will crash his vessel against the rocks and perish with his crew. An experienced helmsman with skillfully guide his craft through the dangerous waters, maybe suffering some bumps and bruises along the way, but with his vast knowledge of the dangers that lie ahead and his understanding of how other sailors successfully negotiated these same waters, our second seaman makes it through to safe harbour with his vessel and crew intact.

I consider myself lucky that I am more the latter than the former. Most of what I now know I learned the hard way. My ship has been damaged, but I’ve made repairs while at sea, and now she’s holding up fine. So, what have I learned?

Well, indulge me for a bit here, if you please. In my case, each time I felt myself edging closer and closer to those hazards along the way that threatened my trusty ship, I changed course. Sometimes not always as soon as I should have, but nevertheless I sought and charted a new direction. They say that change is as good as a rest, so I became an acting supervisor for three years and got to see the job from a whole new perspective. But I also wanted to be an ALS medic, so I gave up my acting supervisor position when I was able to pursue training as an advanced care paramedic. And when off-load delays were driving me close to quitting this job, I got into the emergency response unit program, where I seldom transport patients, and then only the most ill, so off-load delays are not usually an issue.

For a while I was involved in community work. I volunteered at a chronic care centre in an educational program to help teach teenagers to “take less chances” and to make smart and safe lifestyle decisions. I sat on a community police liaison committee in my neighbourhood. I worked on various committees; one ad hoc committee dealing with EMS issues, a couple of committees at Toronto EMS dealing with various work issues over the years; I participated on a committee working to preserve Algonquin Park; and I held a committee position with the Ministry of Health for a couple of years.

I volunteered in search and rescue work for about seven years, and learned a lot along the way. I took up various hobbies: dog training, photography, and others. I kept up old ones, like canoeing, hiking and camping. I spent time away from work as much as possible with my family. And recently I was fortunate enough to join a police tactical team as a medic, which is different enough from my day-to-day work that it feels like a whole new job. For me, the key to my survival all these years has been variety on and off the job.

Our profession is full of perils. Whether we get dashed against the shore and drown, or whether we can persevere and reach safe harbour is up to us. Steer wisely and heed not the siren’s song.