Transcriber: Hyerin Kim Reviewer: Michael Nystrom
We meet people
on the worst day of their life.
In a single moment, everything can change.
Your hopes, your dreams, your future, uncertain.
And your life in the hands of strangers.
We are those strangers.
When we come to work each day,
we don't really know what the day holds.
In aviation terms, this is instrument flight in the clouds, above the clouds,
a world of grey mist, swirling shadows.
We don’t know who we’ll meet, where we’ll meet them
or under what circumstances.
We may meet you on the side of the road.
We may meet you at the bottom of a cliff.
We may meet you in a small hospital when you need specialized care.
Far, far away.
Sometimes this is all about high technology.
In this case, a young man who needs a new heart, 14 infusion medications,
a ventilator, a balloon pump, on ECMO.
We’re pumping his blood out of his body,
oxygenating it out of his body and pumping it back in.
In a desperate race to survive.
And sometimes it’s just about high touch.
The most powerful tool in medicine that we have
is the touch of the human hand
to ease fear, to ease uncertainty,
to ease pain.
In EMS and in emergency medicine,
we choose to live in a world of what we call the “uns”:
unexpected, unplanned, undifferentiated,
undesirable, of course, unhealthy for us.
But most of all, uncertain.
The moment, and the next moment, and what is the gap between.
I think there are four things that our touchstones,
our belief in this that keep us focused as we go forward.
The first is the most profound promise, I believe in the history of humankind.
If you call us, we will come.
9-1-1.
Indeed, there’s actually 119 distinct three-digit numbers all over the world
to summon help in a medical emergency.
And those emergencies happen.
And a call to 9-1-1 in this case, three young men,
a loss of control in a pickup truck.
And one of them, the truck rolled and rolled,
trapped in the truck with gasoline running all over him, unconscious,
a brain injury, multiple broken ribs, a lacerated punctured lung,
a lacerated liver, broken femurs, a dislocated shoulder.
Out of time, 9-1-1 summons multiple people to give him a chance.
It was a long way back for Jamie.
I got a note from his mother that Christmas saying,
“I’m headed to the rehab hospital to visit Jamie.
But without all of you, I would be visiting Jamie in the cemetery.”
And that’s really the second piece of this,
that in medicine there is always been the dream of reanimation.
To bring life from death, to restore the moment.
Group of snowmobilers, Bonnie among them, in the willie wags of Maine.
One day, they come upon a clearing with this yellow sign saying,
State of Maine Emergency Rendezvous Point.
This is how you get help. This is where you are.
They’ve never seen one of these. They stopped and took a picture.
15 miles down the trail, they realized they're missing one of their party.
And they go back and forth and finally find Bonnie.
Someone goes back to this place because they knew they could call 9-1-1.
We can see all of her insides.
Seven dispatchers. State Police.
Somerset County LifeFlight.
Teamed up, because indeed what had happened is Bonnie had missed a turn,
gone down an embankment.
Her snow sled landed on top of her,
a spiked track laying across her chest and abdomen.
And the throttle stuck wide open.
The call to 9-1-1.
The dispatchers figured out where people were
because they weren’t at the site anymore.
And the helicopter landed 150 yards up the trail.
And jackmen, EMS and the wardens brought Bonnie to them.
When I was talking to her later, she said, “I knew I was going to die”.
She said, “I knew I only had minutes left. I was saying my goodbyes.
It was so hard to breathe.
I was in so much pain, and I was getting drifty.
And suddenly there’s someone in a green suit standing above me.
and says, ‘I will put you to sleep. I’m going to take care of you.’”
And she said, “Okay.” She said, “That sounded good at the moment,
even though I was pretty sure I was never going to wake up again.”
But because we follow the science and the art of resuscitation
and we carry blood and we carry TXA,
and we can do things that must be done in the first minutes.
And we can travel at 170 mph through the sky, not tied to roads.
Bonnie got to waiting trauma surgeons.
And 17 surgeries later, goes home,
marries her fiancé.
They’ve now bought a house in Cross Lake.
They snow sled every winter.
And she got a second chance.
And yes, it sometimes feels like we just live on adrenaline,
and there’s never enough time, and we’re always in a hurry
and we’re trying to beat eternity.
And not every story will have a happy ending.
But in every case, we need to be safe. We need to create safe.
We need to be worthy of trust.
When someone puts their life or the life of a loved one into our hands,
the hands of strangers,
and we have to be highly reliable to get it right every single time,
to do everything we can to get it right every single time.
We don't know who we're going to meet.
Whether they’re going to be a premature infant or one of our elders.
But they are someone’s mom, someone’s sister, someone’s daughter,
someone’s grandparents, someone’s uncle or aunt.
And we have to do everything we possibly can together ...
to restore that moment, to reset the clock,
to beat the geography of time,
to create a second chance at a future.
And it is always a team effort.
The Japanese have a term for this called ‘Kintsugi’, the art of golden repair,
that no matter how torn Bonnie,
no matter how broken Jamie, something is,
with care and reverence,
it can become whole again.
And in doing so, sometimes, not just have a new life,
but be more beautiful and more resilient.
I started this by saying we meet people on the worst day of their lives.
One of my patient’s mothers, a young patient said,
“Actually, it was the best day in our lives because my six-month-old
got a second chance.”
Can we go backwards?
For Megan,
the worst day and the best day came in equal measure.
Nine months pregnant on Vinalhaven Island about to deliver a child.
It had been a normal, happy, healthy pregnancy.
And then one Sunday afternoon,
She hemorrhaged. And she hemorrhaged. And she hemorrhaged.
And the call to 9-1-1.
When the first responders from Vinalhaven EMS and Fire
and someone from the clinic got there, she’s unconscious on the floor,
white as a sheet, and you can find no discernible blood pressures.
When we got there a few minutes later,
indeed, we could find no blood pressures.
With a Doppler stethoscope, we could find a very faint carotid pulse.
But ominously with the Doppler stethoscope we could find no fetal heart tones.
No time.
Act! All the training, all the instinct, everything together.
Squeeze everything we have into Megan, every fluid, every bit of blood.
There’s no time to get to the big hospital across the bay.
Five minutes - catastrophe.
There’s an emergency doctor, an obstetrician standing at the doorway
with a Doppler stethoscope.
But because Megan has been resuscitated, now there’s fetal heart tones.
Into the operating room,
a crash cesarean section, deliver the baby, resuscitate the baby.
Start salvage surgery on Megan.
A baby team from Barbara Bush,
another LifeFlight helicopter at the end of surgery.
On to Maine Med,
to an operating room at Maine Med, a neonatal unit at Maine Med, another ...
ICU at Maine Med.
And two weeks later, Megan and her baby go home.
A call to 9-1-1.
And to think of what that took, 150 people working together.
Doctors, nurses, EMTs, paramedics, everyone working together.
To save two lives.
And Kyra, like many of you, in a few short weeks will graduate.
Smart, capable, creative, ready to take on the world.
And that’s really the fourth piece that holds us together every day.
The imperative to act on the behalf of a patient.
There are so many things torn.
There are so many breaks in our world.
A handful of stories out of the 33,000
out of the hundreds of thousands, everyday
in EMS and emergency medicine across Maine,
across the country and across the world.
There is always an imperative to act.
There is always, if you call us, we will come, to be there.
There is always the art and science to make a difference.
And there’s always the gift of service, to work together to change things.
As you go forward from here,
think about this.
Think about how those four pieces become whatever you choose.
And we certainly hope that many of you will choose medicine,
and choose emergency medicine and choose EMS.
But whatever you choose:
To be there, when needed.
To concentrate on the art and science of repair.
To fix what’s broken.
To mend the tears.
Not just the patients,
but all the people around you, the world around you.
And every day we look at this.
And in the words of Goethe:
Knowing is never enough.
We have to apply.
And willing is never enough.
We must roll up our sleeves and do.
Each moment, each day,
a choice and an opportunity.
Learn to embrace the uncertainty.
Learn to embrace uncomfortable.
And together, make a difference.
Thank you.
(Applause)