You can’t hide those lyin’ eyes.

Being an ambulance crew member involves bending the truth quite often. It’s a skill you develop early in your career, an essential part of your job. Not in a nasty way, but in a clinically reassuring way. Reassurance, one of the strongest tools in our arsenal – “It’s going to be ok….”.

When your patient is having a heart attack before your eyes, the last thing you should be doing is telling them! I sat my initial training exams many years ago. Most of the questions gave a story. A patient was presenting certain symptoms, what was my diagnosis and how would I treat them? In the treatment section, we were guaranteed at least one point if we wrote, simply, “Reassurance”. This applied to unconscious patients too.

Sometimes reassuring the patient involves a slight… embellishment of the truth. You learn to hide your feelings of concern for the patient and develop an ability to put on a friendly, caring face. Neither of the latter are fake, if we didn’t care we’d not be in that job. It was more an ability to decide what our faces displayed to the patient, what was in their best interests. A good crew mate will have come to the same conclusion as yourself, and a silent look would confirm “GLF on the journey to hospital!”.

Other times your face had to hide sadness. Our job was to care, and that’s what we did. But sometimes that brought sadness – the elderly who had no relatives, the young disabled patients who’s lives had been changed forever by unfortunate circumstances. Most didn’t want our sadness of sympathy, they just wanted our help and a brief moment of support. That’s what our faces showed them.

Often it was the relatives who needed our support. If the patient had CPR ongoing, we would try to remove the relatives from the room. They didn’t need to see some of the treatment involved in a cardiac arrest – the broken ribs as a result of the chest compressions, the tube placed down the patients airway. If more crew members arrived to help or, as sometimes happened, the police arrived, one of us would take the relatives into another room. This would always involve them asking how their loved one was. Rather than tell them that, at that point they were clinically dead, we would tell them that they were “quite unwell but we were doing our very best for them”. What that meant was that, until protocols dictated, or a doctor appeared and called things to a halt, we weren’t giving up. The feelings of futility were hidden, although we were very cautious not to deliberately instill false hope in the relatives.

“Embellishing the truth” was part of the job, but your fellow crew members could usually see in your eyes exactly how you were really feeling, what you were really thinking. Mostly that was because they were feeling the same thing. Not telepathy, just an understanding. It was never malicious, and none of us enjoyed doing it. It was an unfortunate but very important part of patient care.

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