Everything is in your head

I recently responded to an incident in which a large number of people were exposed to a substance that's essentially harmless, but not something you typically get on your skin. A significant number were reporting a burning sensation and other symptoms. Ultimately, their symptoms resolved and none required emergency care. 

I think their condition likely had two causes. First, fear and anxiety at having been exposed to a foreign substance caused them to pay close attention to the normal sensations coming from their bodies. Their perceptions were filtered through biased cognitive processes, with pain as the result. Second, the reactions of the people around them actually influenced their perceptions of their own bodies.

It's easy to dismiss mass psychogenic illness as "hysteria" but I think it's an indicator of the powerful role our innate social impulses play in our health. We gather data and form our experiences not only through our nervous system, but also through other people.

Someone asked me recently if I'd ever seen a connection between my demeanor on an emergency incident and the patient's outcome. "Almost every single call," I replied. Fear and anxiety are hidden amplifiers of patients' symptoms. While I never hesitate to perform whatever medical interventions are necessary, sometimes calm and compassion are the most powerful tools at my disposal.

It's as if we have a second, invisible nervous system that extends out from our bodies and connects with others. 

I'm not going all woo-woo hand-wavey here. I can't cure a developing heart attack with niceness. But take this example: in a heart attack, cardiac muscle tissue doesn't receive enough oxygen-rich blood, and becomes hypoxic. Eventually, deprived of oxygen, it will die. A fast-beating heart uses up more oxygen, rapidly exhausting the limited supply. If my demeanor helps ameliorate a measure of that anxiety, and slows the heart down a little, might it help preserve a little precious cardiac tissue? 

Maybe, maybe not. I can't find research that addresses the patient's anxiety level during the event and compares it to long-term survival. But that's just one of the ways I see a little human compassion having far-reaching effects in EMS. We spend a lot of time training people how to perform other critical skills. But no one ever trained me in basic techniques for demonstrating compassion and reducing anxiety in patients. It's time for that to change.