Show Your Work

When I was in grade school, I struggle with math. Mr. Evans was a stickler – an Englishman teaching math to 6th graders. He was engaging but took no bull. We laughed when he called rubber bands “rubbers”. But when it came to the work, he was not messing around. Algebra was serious business to him. Seeing how “solving X to find Y” might have practical application in my future seemed pretty obscure at the time.

Funnily enough, I would find out decades later that algebra had a direct application in my professional life. Go figure, showing my work actually had value. Algebra doesn’t appear to have any physical application in real life (3 out of 4 adults agree!). However, what I could not have predicted back in 6th grade was that my ability to solve X to find Y correctly was the difference between doing the math right and maybe saving a life, or doing it wrong and ending one.

I spent almost a decade working on an ambulance. I started as a volunteer EMT, became a firefighter and advanced to working as a paramedic for both a 911 service and a critical care transport ambulance company. There are still days I miss that time in my life. The adrenaline, the sense of tangible purpose, the lights, the sirens, the vehicles, and the authority all were very intoxicating. Even the uniform made me feel important.

One of my paramedic instructors, Rodney Ray, was unwilling to let his rowdy bunch of young men in our paramedic training program get out without being competent. Competence was not a nice thing to have, competence was a requirement. The stakes were too high and he reminded us of that on a regular basis. For as many times as we laughed about the silly, the bazaar and funny calls that we went on, he made us focus on the small percentage of calls where we could make the biggest difference and had the opportunity to insert ourselves and turn around the condition of a patient whose health was crashing right in front of us.

And this is where algebra came in. This part of paramedic school was daunting for everyone, if for no other reason than most of us hadn’t thought about algebra since we took it in 6th grade. But all of a sudden we were doing drug calculations. Rodney wouldn’t let us use calculators. He demanded that we be able to do the math with pen and paper, and then in our head. Solving X to find Y.

Imagine it’s 3 a.m. and you’re jolted from a dead sleep with a pager screaming at you and a dispatcher telling you that there’s a man in an acute health crisis, complaining of shortness of breath. You arrive to find a man struggling to breathe, ashen, pale and looking panicky. The phrase we had for this look was FTD. This man was Fixin’ To Die right in front of you. Your blood pressure goes up just looking at him, as well as your heart rate. His wife and family are looking scared and lost. The time is now, you must act.

You administer oxygen, take vital signs and determine pretty quickly that he is in acute heart failure which is allowing fluid to build up in his lungs. Patients in “acute CHF” report the feeling of drowning, and not from water that’s on the outside but the water that’s on the inside. This is one of those few small percentage calls that field personnel not only can but MUST intervene to stop a dramatically downward spiral into becoming a life-ending event.

Listening to his chest I could hear crackles, and his breathing was labored. He can barely whisper “I can’t catch my breath”. Yeah, me neither right now. It’s time to go to the hospital and we’re not messing around. See, this was rural New Mexico, and we had a 45-minute drive ahead of us, and I would need to administer medication and route.

We quickly transferred him to the gurney out to the ambulance, in the back and then we were on the road. My drivers were always conscientious but the ride still sucked. It was bouncy in the back of the ambulance as we raced towards the hospital. The back of an ambulance rocks like a porta-potty might be if you shifted your weight back and forth from the inside. With the results of tipping it over being just as dramatically bad.

Now here’s the math part. Remember it’s now 3:45 a.m., you still have bed head, your heart rate’s up, so is your heart blood pressure. It’s just you and the patient in the back and he’s not getting better. It’s time for you to do your math, show your work. Solve X to find Y.

Drug dosages are based on milligrams per kilogram so for every kilogram that someone weighs, they need a specific number of milligrams of the medication. But this leaves you with two problems: 1. You need to know what the patient weighs in kilograms, not pounds. 2. You need to distinguish what the concentration of the medication is to see if it is so you can determine how many milliliters are going to produce the correct number of milligrams that you’re going to administer to this patient’s IV. Milligrams, milliliters, kilograms, pounds. Find X to solve Y.

I’ve never been more grateful for Mr. Evans. Mr. Evans forced me to show my work. He would threaten to give me a zero on any out for a test where I didn’t show all my work even if I got the answer correct. It was at these 3 a.m. hours that my ability to do the math and show my work really shined.

First I had to guess my patient’s weight, and because I’m an American I naturally think in pounds. Then I had to convert the pounds to kilograms, (2.2 lb to kilogram for those interested). Then I had to figure out how many milligrams I needed to administer by multiplying those by the kilograms by the dosage, and then how many milliliters to administer based on the number of milligrams per milliliter in the drug dosage.

And did I say it was 3 in the morning?

Show your work. I could never have projected in 6th grade that algebra and Mr. Evans would have such a profound impact on so many people’s lives. Mine especially. But this is like anything else. We have all suffered through some difficult time or educational experience or life circumstance where we really didn’t want to do all the work that was necessary. And what we couldn’t see at the time was that the profound lessons we were learning that would serve us in the future.

Remember, the time that you invest in parenting is “showing your work”. There are many days that you can’t see if practical application of reminding your kid to take out the trash, asking them to pick their stuff up, demanding that they are on time (like they said they would be) has any particular long-term benefit. But this is us “showing our work” as parents.

It’s not likely we’re going to be the ones who are in the ambulance at 3 in the morning, struggling to figure out how much medication to give someone else, but when we show our work the benefit shows up for them when they’re 30 and struggling to figure out what’s next when they lose their job, when their heart is broken and they don’t know what to do about it, when they feel like they’re in over the head and all alone. When we show our work the beneficiaries are our kids.

Today I’m super grateful for Mr. Evans and Rodney Ray. The lessons are: show your work, you never know when the work is going to change lives.

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