This article appeared as one of my "Nuggets" columns, in the Sept/Oct 1990 issue of Rescue Magazine

A friend of mine and I once got together for dinner after she had been awake for 36 hours. It was toward the end of her first year of residency in internal medicine at Harvard. She was haggard, red-eyed and had the waxy complexion of sleep deprivation most rescuers know well. Predictably, she fell asleep at the restaurant.

She had been living at her physical and mental limits for months. The toll on her system was frightening to witness. Later, I asked her how she carried on. She said something that, at the time, seemed too easy: "When it gets to the point where I'm sure I cannot go on, I reach deep down inside myself and pull out just a little more of what it takes."

Over the years, I've realized that her answer was not trite. It was subtle and powerful; it explained a gift that sustained her through her ordeal.

Rescuers often face ordeals of varying magnitude. Often, these require maximum effort for sustained periods of time. For example, any long litter carry across rough terrain takes a certain toll on those trying to provide a smooth ride for the patient. Trails are seldom wide enough to accommodate both a litter and those walking on both sides. It's awkward, exhausting work.

Recently, I heard another term applicable to sustaining a person through an unusual ordeal. It's "inner emigration." The expression was used in reference to people in communist countries who are not free to leave their circumstances (emigrate), so they leave mentally and go inside themselves, letting their imaginations take them to a better existence. They get temporary relief from dissatisfying emotional and physical conditions.

Humans have a lot more internal drive than they generally give themselves credit for. I have a teacher who says "the mind controls the body." When your body is tired, aching and screaming for relief, the rational (and probably smart) thing to do is to heed it and take care of yourself. But often, that's not realistic in rescue work. There are times when stopping could mean the difference between life and death for a patient. However, in such times, rescuers tend to reach for artificial means of support. When their limits are being stretched, rescuers turn to coffee, sugar and other nutritional "boosts," or even illicit substances, such as amphetamines.

Good nutrition is next to impossible to obtain during a lengthy rescue. You need only survey the kindhearted (but perhaps ill-conceived) offerings at the van of volunteers, who usually bring lots of hot coffee and donuts. Dumping a load of processed sugar into your gut alongside a dose of caffeine may initially provide a sense of refreshment, but in a few hours, the "crash" is going to create havoc on your system. This may lead to another round of sugar and caffeine. And so the wicked cycle is established. Such "nutritional" boosts are 0K occasionally, but not routinely.

So the tactic of reaching within yourself is a different approach to try. When a rescue situation demands a prolonged effort and you feel yourself approaching exhaustion, try summoning that internal strength. Reach within yourself with confidence that you can succeed. Strength will be there. This is not to say that it's OK to ignore your stressors and their effects on you for long. Proper recovery after any unusual effort is important. (1)

And the tactic of inner emigration is another thing to try. In those relentless situations that consume hours, when the pain of blisters and muscular soreness is distracting you, take a quick "vacation" in your mind to a pleasant place. You can't totally tune out the rescue operation, but you can let a positive distraction refresh you, rather than letting negative ones deplete you even more.

Rescue work is demanding, but it doesn't have to squelch your enthusiasm or kill you. The tactics of inner emigration and reaching within your soul for strength can help you provide the service of rescue in a more balanced and healthy way.

Reference

1. Mitchell, J: Emergency Services Stress. Englewood Cliffs, N.J.: Prentice Hall Inc., 1990.