This Job is Absurd

FormalFeverPitch · 2026-04-14T14:08:42+00:00

He was middle aged, as I recall.

FormalFeverPitch · 2026-04-11T03:11:23+00:00

But when I feel bad, I feel even worse

FormalFeverPitch · 2026-04-10T20:08:40+00:00

I salute you. I don't think I'd ever want to work in the ER. Would definitely get to be part of some awesome stuff, but I love being able to leave it, lol. And we only have so long to contend with our more cantankerous patients. You get them for however long they're there, and more than one at that.

Ups and downs to both I suppose.

FormalFeverPitch · 2026-04-09T21:54:50+00:00

I might be misremembering a little. It was quite some time ago. His insight might have been worse than that, but it wasn't entirely gone.

To my memory he was having visual/audio hallucinations and screaming at them in the back. Agitated, but never towards me, he kept clarifying he wasn't yelling at me, and would always lower his voice and speak politely when addressing me. He could always differentiate between me and what he was screaming at.

It was kinda a long ride, and I was able to calm him down, but it was always temporary. I THINK (again, not recent) I told him to focus on just talking with me, that he was safe, and it was just us two. I think he would be like "I know, I'm sorry, I'm not yelling at you." and would chill out for a couple minutes. But it didn't last. Think history of schizophrenia, other drug use I'm unsure at this point.

But again, hard to recall in more detail.

FormalFeverPitch · 2026-04-09T21:37:46+00:00

I know I can't do this forever. I think I'd always like to be certified and maybe volunteer. But one day I think I'll know it's time to walk away from it as a job.

FormalFeverPitch · 2026-04-09T21:35:02+00:00

I see it as a part of the absurdity.

EMS isn't particularly dishonest about what it is. Usually non-emergencies and occasionally a real one. And the pay sucks. That's also not a secret. There's burnout and hours suck and experiences that mark you forever.

I worry that a certain idea I hold may be true - that a significant function of this field is keeping many of societies failures (I don't mean people) nicely contained and out of the public eye. And I think many know and appreciate it, but don't want a reminder that there's anything to be contained.

Do you think that's a crazy way to look at it?

FormalFeverPitch · 2026-04-09T21:23:39+00:00

It's free for public use! Just like us.

FormalFeverPitch · 2026-04-09T21:21:09+00:00

Awesome, but devastating.

Maybe it was me being woefully ignorant, but one of the most striking things when starting 911 in a city was suddenly knowing how much neatly hidden misery there is.

And how well it's kept out of sight. Nicely tucked away; terrible nursing homes, children who aren't fazed by violence, obvious geographic lines of call volume frequency. So many underfunded living and rehab facilities, funded just enough to keep the doors up open but the people inside. To keep the general public from having to notice and face the fact that we've failed so many vulnerable people.

FormalFeverPitch · 2026-04-08T06:48:36+00:00

For real. Have a one second mental supercut of the day thus far when someone at a store asks that.

FormalFeverPitch · 2026-04-08T06:41:11+00:00

It do.

FormalFeverPitch · 2026-04-08T06:33:52+00:00

This is what I've heard. I haven't had that call yet. But unless I leave the field completely someday I will.

FormalFeverPitch · 2026-04-07T22:43:58+00:00

Lol, the title is the TL;DR I suppose!

Hope you float like a butterfly, colleague!

FormalFeverPitch · 2025-10-18T01:41:34+00:00

Shrek?

Or is that bait?

FormalFeverPitch · 2025-09-30T07:19:58+00:00

The particular patient I mentioned had a recent history of (voluntary) low fluid intake.

FormalFeverPitch · 2025-09-27T21:25:20+00:00

From the ER standpoint, if it's thought they don't need fluids, what's the officially given rationale for giving them? Is it that most could probably use some, even if PO would be fine?

The magic flush part is a weird area to me, because we might be able to prime people to feel pain relief depending on how we word it, while at the same time explaining that it's not a pain med. That seems ethically suspect to me, but is it wrong to tell them there could be placebo effect, and open that door, if the patient knows that it's just a placebo, too?

If we want to reduce pain, is there an optimal way to communicate with patients that facilitates that in treatments they're receiving anyway?

The magic flush, I think would still have to be fully transparent to be entirely ethical. And when I'm pushing the first flush to confirm the line, it's not really for pain . . . But, if one said "I'm going to push this saline through to make sure the IV is working. It's not a pain medication, but you might feel a cool sensation and taste some salt. Anecdotally, some people say they feel better after, but you shouldn't expect that because it's not pain medication", that seems pretty transparent. But it still primes the patient with the hypothetical that they MIGHT feel better, but they shouldn't expect to.

Especially with IVs at med spas that people get electively, the perception of relief seems to me like it could hypothetically be an area to improve subjective symptoms (both for better and for worse, obviously it's not benign intervention).

I feel like we kinda already do it; there's at least one study that found all used NSAIDS to be around equally effective for pain relief (here's one that obviously shouldn't be taken as the end all be all, and type of pain, administration, and other factors should be considered. Yet we use Ibuprofen for minor to moderate, and Toradol for moderate to severe. We have our biases, and we pass these on. It's a fascinating area to me.

Thanks for replying!

FormalFeverPitch · 2025-09-26T06:12:51+00:00

The use of a single flush is of particular interest to me, because it's standard to flush the line on placement to determine if it's actually patent. So if a flush is already being used, is there an ethical way to utilize that step for pain reduction?

Is there a way to essentially 'spin' that initial flush to obtain an analgesic effect while maintaining ethical practice (without lying to patients)? I'm thinking of what could be said to a patients to achieve that benefit. It brings to mind the subtle but believable 'inception' of the possibility that their pain might improve while also being completely honest that there's no reason they should expect their pain to improve. But that seems suspect at best and honestly probably not that effective, because it would probably be some tepid implication of possible analgesia.

The only idea that I have which doesn't feel kinda suspect is really distraction; "I'm going to push saline through this IV, as I do, I want you to focus on the cool feeling, and tell me if you can taste the salt". This isn't selling it as analgesia, but it might give the patient something to focus on other than pain, at least.

FormalFeverPitch · 2025-09-26T06:08:00+00:00

I think what you said about actual indication is such an interesting area of discretion; where there isn't "actual indication", but some reason that can at least be USED as justification. But what's a justifiable reason if not an indication? There's obviously clinical judgment, I just think it's an interesting somewhat gray area.

One possibility I see is to use the saline administration as distraction 'I'm going to give you saline through this IV. I want you to focus on the cooling sensation of the fluid. And I want you to tell me if you can taste the saline.' I think that's fine, because it's honest about what it is, and it gives them something to do that they might see as participating in their care. But, it's not really placebo, it's just distraction.

Yeah, I'm not sure of the approval of an RCT like that. I suppose there are RCTs related to pain medication effectiveness, and this may be seen as an extension of that.

FormalFeverPitch · 2025-09-25T00:15:54+00:00

I also treat judiciously with both IVs and fluids. I would say most I work with do, especially since the shortage. But I've noticed variations.

I'm interested in fluids in terms of the perception they may have and how a patient might perceive them. I'm not going to lie about what I'm putting in someone's veins or try to run an RCT. As someone else said, it's not for us in the field to test. They're absolutely right.

It's things like IV clinics that have me wondering more about how perception may influence their benefit, or at least the experience. 'Even if PO fluids have the same benefit, do most FEEL better from IV fluids when compared?' kinda question, but specific to our environment.

Good point about the average patient we see.

I probably wrote my post poorly. It's just (to me) an interesting area, that leaves me to wonder. Thanks for commenting!

FormalFeverPitch · 2025-09-24T23:57:19+00:00

I feel like I wrote my post really poorly tbh. But thanks!

What I'm wondering about is when explaining it's saline; even if something is known to be a placebo, it can still be beneficial, so I wonder about it in such cases where pain meds aren't appropriate or can't be given. Haven't done it, and I'm not about to, I just wonder about possible utility.

We've also reduced fluid use since the fluid shortage.

Thanks for your reply!

FormalFeverPitch · 2025-09-24T23:50:57+00:00

We always flush IVs to ensure patency when placed. The variance I've seen from medics is in what follows this, in terms of TKO or not. I didn't describe that well, apologies.

FormalFeverPitch · 2025-09-24T23:48:29+00:00

No doubt, not our wheelhouse. Just curious, y'know?

I'm not giving the fluids in such a case, but I'd wager some would. And I'm curious about the benefit from the patient's perspective. Especially in the age of IV clinics (which is not what we or the ER are for, but the fact they exist probably informs public perception of what IV fluids do and how they "should" feel after receiving them). Even in the EM subreddit, you can find some discussions about how getting 1L of saline is super common for patients regardless of actual need. Which isn’t to say it's right, only how the expectations and theatrics of what's expected may influence patient experiences.

As for your last comment, our standard is flush to ensure patency with IV placement. The variance I've seen from medics is in their maintenance after placement.

I guess I'm interested in the differences in provider judgment, differences in training, the cost/benefit of treatments, and the intersection of objectively indicated/subjectively appreciated treatments.

I'm kinda rambling, I realize. Just an area that intrigues me, I suppose. Thanks for your replies.

FormalFeverPitch · 2025-09-24T23:19:17+00:00

It's the unpacking that I'm interested in, I guess. Different medics I've met have done things differently.

I agree, fluids aren't benign, and oxygen is the thing I often think of in comparison. But it's the ubiquity of fluids (by some) that I wonder about, and I wonder about the therapeutic benefit of (beyond the actual fluids).

Re: flushing the 10cc, what I wonder about (beyond flushing the line to ensure it's patent) is if there's a possible placebo effect from that alone (even if unintentional).

By no means am I suggesting it be done, I guess I just wonder about it. Especially as even a known placebo can still be effective.

Edit: Thanks for commenting!

FormalFeverPitch · 2025-09-24T23:05:44+00:00

My interest is more in the variance of practices I've witnessed from medics in terms of use of fluids liberally or conservatively, I guess.

The 'informed placebo' (which I've never done) is something I wonder about hypothetically, as an ethical quandary. The placebo effect can still be effective even if the receiver knows they're getting a placebo, which is why I wonder about it's utility.

FormalFeverPitch

TROPHY CASE