They are still good people (providers) underneath. The rust must be removed.

IMG_8204A little boy and his grandfather were leisurely walking down their street talking about what the boy wanted for his upcoming birthday. The boy had no sooner finished saying “I want a shiny new bike grandpa”, when they came upon an old rusty bicycle with a hand written “For Sale $20.00” sign on it.

The boy is perplexed as to why his grandfather would take such an interest in an old rusty, flat-tired bike leaning against a fencepost. The boy thinks to himself “there is no way grandpa will buy this bike. He knows I would never ride that ugly bike. My friends would laugh at me… The fact is it’s not only outdated and out of style, but it is covered with rust and has two flat tires…”The boy folds his arms and scoffs as he watches his grandfather reach into his pocket and remove a Twenty Dollar Bill. The boy is more than a little confused when his grandfather hands the money to the owner of the bike. After the purchase, and a handshake the grandfather begins to push the rusty old bike with flat tires back toward his house.

As soon as the boy and his grandfather reach get home, they take the bike to the garage around the back of the house. The grandfather excitedly starts pointing out tools to grab so they can get to work on repairing the old rusty bike. They flip the bike upside down and with a few twists of a wrench, the wheels are off. Next comes the chain and pedals. Removed and placed into a bucket of solution to soak.

As the slow moving grandfather grabs some sandpaper in his old, tired and sore hands he begins to sand on the rusty frame of the bicycle. The boy still confused about this whole thing asks his grandfather “Grandpa, what are you doing?” to which the grandfather replies “You see son, under this rust is still good metal. You can’t see it yet, but it’s there and rust eats at metal like cancer, you remember cancer right? The boy nods his head in affirmation. The grandfather goes on to say “ If we don’t remove the rust before we put the new paint on, the rust will still be there eating away at the metal, and all we have done is waste a good can of paint”. The little boy finally gets up the courage, he stands tall and asks, “Grandpa, why are we having to do all of this work to this bike instead of just going and getting a new shiny one?”

The old man stops sanding and wipes the dust from his hands moments before wiping tears from his eyes. He looks at the innocent face of his young grandson and says “ When your dad was your age, I bought him this bike when it was all shiny and new. That dent on the handlebars came from the first day he rode it. When he got old enough to drive, he sold his bike and here it is.” The boy becomes excited about the bike. He yells “This was really my dads bike?” The grandfather says “It sure was and now it will be yours. All we have to do is fixer up.” The boy then grabs some sandpaper and jumps in to help sand the rust away. As he does, the boy asks his grandfather “Did you cry when my dad died from cancer?” The grandfather says “I did, and I still do. But I see so much of him in you and that makes me smile”.

After sanding, soaking, painting and waiting, the bike is finally done. Good as new would be an understatement. It’s better than new, it’s improved. The old dirty rust was stripped away, new paint and tires brought new and better life to the bike and in return to the grandpa and the grandson.


In emergency medicine there is a rust in our culture. It is like a cancer, destroying morale, causing not only burnout but a jaded perception of “patients”. I have seen it and so have you. Just listen to the water cooler discussions, what is said in break rooms or at the nurses’ station, ambulance bases and fire departments across the country.

What was once pristine is now rusty. There are still good, no great people, underneath, we just need to strip away the rust before we can reveal to them a better way. Too often agencies are quick to throw them away and “buy a new one” instead of fixing the ones we have invested so much time in.

It takes 4 hours in DT4EMS’ EVE jut to get people to see the rust, and us to sand enough of it away just to get to the point where they will let us show them their metal and put a new, fresh coat of paint on.

I feel like the grandfather. I have watched many careers “die from cancer” because no one revealed the culture was the problem, not them as an individual. Our culture has become so jaded, hateful and full of anger. I have seen it and heard it all over the country, how the lines of custody versus care have been blurred. Providers feeling compelled to intervene in situations they should not then getting in trouble/reprimanded/fired/arrested when things go wrong.

The next generation is like the grandson, the ones that are following us into emergency medicine. I see it on their faces and hear it in their voices when we show them the truth. We get to them early enough, the rust doesn’t have time to cause damage. It is only with the veterans so engrained with the culture that take the most sanding. Once they see the facts, they begin to help us sand. They don’t even wait for us to start to apply the paint; they start spraying it on themselves like cologne on a first date.  🙂

We are all on the same side. We all want what is best for real patients. We are not asking people to not do their job, we only ask them to do it safely. When people (front line to admin and medical control) take EVE, they leave with their culture changed. Their rust is removed. We are mission specific. We are culture changing. We are DT4EMS.

President/CEO DT4EMS

President/CEO DT4EMS