Posted by: medicblog999 | May 2, 2010

My Ritual.


As I was getting ready for work this morning, I was going through my steps for getting out the house on time and without waking the kids, when I started to actually think about what I was doing and taking note of what I was thinking about, which made me realise that I pretty much have the same routine each and every morning when I come to work.

Now that in itself isn’t that surprising is it? After all, I have written on this blog in the past about my OCD and how that keeps raising its head every now and then.

No, what I found surprising, when I actually consciously made the effort to realise where my mind was going, is the mental routine that I have before I get out of the door and also on the way to the station.

As well as all the usual stuff such as tip toeing downstairs and dashing for the alarm panel so that the little one doesn’t wake; cleaning my teeth, getting washed and wetting my hair in the kitchen sink (so that I don’t have to turn the upstairs bathroom light on), and absolutely not playing any music or putting the radio or TV on; I find my mind wandering.

Now this may sound a little weird but I am sure that some of you will go through similar things, even if you don’t realise it (or at least I hope you do so that I don’t seem like a complete freak!)

As I am putting on my uniform, I find that my mind set starts to change. I start to think over the last few days of work, even if the last few days were a couple of weeks ago. What jobs did I do? How well did I do them? Is there anything that I learned from those jobs, god or bad that I can take into this upcoming shift? How can I be better than I was yesterday?

I put my trousers on and tuck my T-shirt in. My belt goes on as well as my radio clip and my multi-tool. As I fill my right hand trouser leg pocket with my guidelines book, I remind myself that I need to refresh myself on certain drugs and dosages. It always now reminds me of Justin’s post ‘Dose that kid’ and how much he reminded me of my responsibility to keep up to date and not rely on pocket books to make my life easier for me.

As I put my gloves and tourniquet in my other pocket, I think about how things are changing with cannulation. How recently, the amount of cannulas I am putting in has decreased so much since I have moved away from thinking that a certain condition requires a cannula because the ‘book’ says so, to

“Does this patient actually need a cannula? Do I need to give an IV medication or am I likely to need IV access en route to hospital?”

If the answer to those questions is a no, then they don’t get a cannula, sometimes to the annoyance of the A&E department.

I bend over and start to tie my boots, and this morning I get a slight feeling of how the day is going to be. I am not a psychic by any stretch of the imagination, although I do believe that certain people have special gifts, but sometimes I get a feeling of excitement about the day, and other days I get a feeling of nervousness, almost as if I know that I am going to get a bad job.

Sometimes this feeling can be so strong that it is quite unsettling, and even more worrying, more often than not, it comes true (although I am sure that is just plain co-incidence)

Once my boots are on, it’s time for the after shave and a quick look in the mirror. Not because I am vain, but because I have a responsibility to my patients, their families and my service to look professional and even smell professional.

As I leave the house, I have a quick look up to the upstairs bedrooms, curtains closed, and feel content that my family are still sleeping soundly. I feel thankful that I am going out of the house to help people and am not sitting in the house waiting for help to arrive. I feel grateful that I am in a position that enables me to have such an impact on so many people’s lives, but also feel pressured to ensure that I am everything that they should hope for as I walk through their doors.

On the way to work in the car, I think about what piece of equipment I need to get out of the car or the ambulance and re-familiarise myself with. It’s been a while since I last used the KED or the traction splint.

Then for the last 5 minutes of the drive in, the iPod goes on and I sing at the top of my voice until I pull into the station.

I lock my car and walk across the station yard, quickly looking to see what vehicles are on station, then I open the door to my station and my day begins.

I walk in and say good morning to everyone, then I head into the office and collect my things and realise that right there and then, I am doing the job that I was put on this planet for.

Its a wonderful feeling, and it has never changed in the 10 years that I have been in this profession.

But I always secretly hope that this day isn’t going to be the day that I finally complete my check list of ‘bad jobs’ to get. There is still one on that list that hasn’t been ticked yet, and I will be very happy to make it to the end of my career with that list uncompleted.

But for now, its into the rapid response car and out onto the streets!


  1. I don't think that you need to have OCD to have a ritual. Or if you do, then we probably all have some level of it! The uniform always go on in the same order, the same things go in exactly the same pockets every time, and if something ends up in the wrong place, you find yourself lost… To a certain degree, routine is what's necessary to get by in a job that is anything but… On another point, slightly off the track of the intention of this post – that of cannulas. I've found recently that the opposite is true – I've been cannulating more, partially because of co-operation between us and our local hospitals. Over the last couple of years (ish), paramedics in our area have started taking bloods. There are those who complained (still do) that that's a job for the nurses in A&E, and we shouldn't be doing it, whereas I look at it as a bonus. It's better for the patient, saves some time and a pair of hands at the hospital, take into account that while we have one patient to concentrate on at a time, nurses have several! Above all else, if I cannulate routinely, when I find that I need the skill in a hurry, it's there as second nature. The nurses tend to be grateful too! At the moment it's only by local arrangement, and not service wide, but I think the idea is slowly expanding. Don't know if that's something that would take off anywhere else, but I for one, recommend it.

  2. I love the ritual. There's a certain mindset that you need to cope with some of the things that you experience, the ritual puts you in the right frame of mind. As a volunteer I find it even more important to have a ritual. If I'm rushing through my ritual because I'm late leaving my paid-job, it throws me off for the whole shift. It makes me change gear mentally. It prepares my kit so that its all ready – something you can't underestimate. It's good to be able to put your hand on the bit of kit you need when you need it.

  3. Tut tut Mark – no breakfast ! most important meal of the day honey !

  4. I'm only an EMT student, but I go through a ritual of sorts myself before class, I make sure my class uniform is clean and neat, that my boots are shined, that my appearance is squared away, and I review my notes and the textbooks to refresh my memory on what we have covered and what we will be covering. I also make sure I have my stethoscope and BP cuff with me.Regards,Brad

  5. My service used to do that in the past, but it ended over 10 years ago. I know of a couple of consultants who would like to see us taking IV bloods at the time of cannulation but the good ol union steps in and says no.I personally wouldnt have a problem with it, but the decision makers seem to!

  6. McDonalds on the first standby Fiona, you know me!

  7. But I always secretly hope that this day isn’t going to be the day that I finally complete my check list of ‘bad jobs’ to get.I've taken to calling it “my EMS bucket list.” Fortunately or unfortunately, I've checked off two of them recently.

  8. I work for a county run Paramedic service here in the Southest US, servicing a mid-size city, and we've been doing the blood draw here for some time. The two local hospitals (one Level I and the other level II trauma, both with PCI capabilities, both who will take acute CVA and STEMI cases to their respective areas right from your stretcher) endorse us drawing blood on the way to the hospital, and have even put together a kit for us (angiocath, extension adapter that is compatible with their equipment, and the actual draw materials) all in a marked ziplock biohazard bag. They will use our samples to 'get the ball rolling' without waiting for the hospital's own blood collection personnel to get paged, make their way down to the ED, etc. It seems to work out very well for the patient in the end.Thanks for all the posts.

  9. Oh my, so glad that I am not the only one who is like this. However, that being said, I also suffer from OCD. Routines are important and I find that the day just seems to go a bit more right than wrong, if followed. I am also very routine oriented in my patient care duties as well, which is nice for the folks working with me, because they know what's next etc. Great post.

  10. Great metacognition! Oh how true, though!

  11. Great metacognition! Oh how true, though!

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