Vet Talk

No Running: Slow is Smooth and Smooth is Fast

In emergencies, no shouting. No throwing. No drama. No running.

April 10, 2017 (published)

doctors running Bigstock

We’ve all seen too much TV.

My guess would be that if I stopped 100 people on the street and asked them “When someone has a heart attack, do you walk or do you run?” I’d get 90 responses of “Heck – you run! As fast as you can!” and maybe 10 odd looks. The odd looks might be due to the neck tattoo I just got that reads “Poor Life Choices” or the rotten tomato on a string that is my constant companion (It’s an emotional support tomato, if you must know.)

In any case – on TV, when the badness happens, people start running in that gravely serious something-bad-just-happened-and-we-must-hurry mode, mouths set in a look of faint disapproval at all those people who are not running.

That’s not how it goes down.

If you run during an emergency, and you trip, and you hurt your face or your brain (which is mostly behind your face, and just a little bit up from the face part of your head) then not only do you have the original emergency to handle (the one that made you start running in the first place) you have a brand-new emergency to boot. You just became the emergency with your hurt and bleeding brain-face.

There’s a saying in the military that I think sums this all up nicely: slow is smooth and smooth is fast. This mental pretzel illustrates that, in order to be most effective when seconds count, you have to fight against that little TV-drunk voice screaming inside your head that says "Run! Run like you have little sparkly wings on your feet and super footy jetpacks and just flat-out RUN! RUN LIKE THEY DO ON TV!"

In situations that call for efficiency, for example when a patient in my ICU codes and I have to start CPR quickly, I do not run. I walk quickly and with a sense of purpose, but I don’t run. I don’t want to take away from the patient’s emergency and become an emergency of my own. I also don’t want to forget a crucial step in the fog of speed – forget to turn off the anesthetic gas during an arrest in the OR, or miss a lethal heart rhythm on the EKG in my haste. If you rush, you miss things. If you miss things, patients die.

I learned this when I was a volunteer fireman during the first two of years of vet school. I was on a medical call, and they had just wheeled the unfortunate patient into a trauma bay at the hospital after an ambulance run. I think this was my first time behind the scenes in a human hospital ER.

The patient, whose name I never learned (and who did not make it), was in full cardiopulmonary arrest and the EMTs had been doing CPR en route to the hospital. I remember thinking, as the attending came into the room and took over the case from the EMTs, “Man! Am I going to see some running now! Running and shouting and throwing stuff and pointing and shouting and running!”

You see, my TV-brain was all fired up and excited to see some TV-level medical drama from watching too much TV.

No. It was not to be.

I recall the attending standing at the head of the bed and…directing. Calmly—but firmly—directing the assorted six or eight people on the trauma team and orchestrating who did what and when with the precision of an air traffic controller. He was calm, firm, confident without being cocky and had total control of the situation.

No shouting. No throwing. No drama. No running.

I was gobsmacked (and, if I’m to be honest, a little disappointed). I thought in order to run a proper code, you had to shout and carry on. I thought drama was a necessary part of the whole thing.

Stupid, lying TV.

They lost the patient but ran a damn solid code. So solid, in fact, that if they had been working on a patient with just a little more life-force, their calmness and skill might have made the difference. They did well, and they did well because they had solid, non-panicked leadership who (calmly, firmly) told them what to do and (calmly, firmly) modeled the resolve they needed to do it. They did not have an attending who came screaming around the corner, blood streaming from his hurt-brain face because he fell and smashed it on the ground and then said “Hey, guys, I think I hurt my brain-face…help!” They did not have an attending who forgot some important detail because his own brain was a mess of conflicting and jumbled hurried thoughts.

This is why the airline cabin crew tells you to put on your own oxygen mask first; in order to help others, you have to breathe deeply, take control and be calm and firm (which you can’t do when your brain is screaming for oxygen).

I think of emergencies a little bit like the way a seatbelt works if you pull too quickly on it: too fast and it all locks up and doesn't work at all. If you go slowly and carefully, the mechanism works the way it should.

So If it looks like your veterinarian or the ER veterinarians aren't moving fast enough when your pet has an emergency, maybe it's because they took to heart the message given to one of my friends when she was in vet school: "We're going to proceed calmly and professionally. Folks will always want you to rush in like there's a fire, but there's no emergency that's going to live or die based on a couple minutes difference."

Unless your house is on fire or there’s a giant dragon or shark or bear (or, worstest of all…the dreaded shark-bear) chasing you down the street…don’t run.

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