On My Soapbox

No really, I'm literally on about soap. You'd think it wouldn't be that challenging. All I want is a decent bar of soap. Not anything like "Dr. Ganja's Super Organic Earth Soap With Genuine Cannabis Naughtiness" or "Miss Victoria's Soothing Tiny Bubble Body Cleanser With Exfoliating Aromatherapy Modules" or even "Ultra-Macho Sweaty Guy Bodybuilder Body Wash With Genuine He-Man Pheromones (Women will throw their vaginas at your armpits!)".

I just want a bar of soap. Not body wash. One that I can get at the grocery store, not have to go to a boutique, or order from a stupid catalog. I've been trying various soaps and can't find one that's decent. Here are my experiment results:

Irish Spring: Smells nothing like Ireland or spring. Perhaps they mean the bed spring from an overly-scented Dublin whore's boudoir?
Safeguard: For when I want to smell like an old men's locker room.
Olay: Dead fish. 'Nuff said.
Ivory: 99.44% pure toxic chemicals. And what is that weird itch afterwards?
Lever 2000: For when you want to announce your presence to everyones' noses while you're still out in the parking lot.
Camay: For when I want to smell like an old ladies' locker room.
Dove: Out, out, damn'd soap! I need to use a loofah afterward to get the "moisturizing" cement off.
The dogs' shampoo: Remarkably, the least offensive surfactant in my bathroom!

So, those are the soaps that are commonly available at the store. If I've overlooked any, please recommend your suggestion so I can try it. Until then, I'll be enjoying my shiny coat and freedom from fleas.

My Living Will

My “Living Will”

I, Sean Fitzmorris, being of sound mind & body, and the fact I’m posting this on the Internet notwithstanding, do hereby make this my request should I ever be incapacitated by injury, disease, or other life-threatening process.

Under no circumstances are any healthcare providers, paid or volunteer, to perform CPR on me, including artificial respirations or chest compressions. There are exceedingly few people that survive such therapy and frankly, I’d rather use that slim chance to win the lottery.

Should the preceding request go unheeded and I am on a ventilator, under no circumstances should artificial ventilation continue for more than one week. If I cannot be taken off the ventilator in that time, please remove the endotracheal tube or whatever artificial airway is in my body and turn off the ventilator. I will take my chances. 

Under no circumstances am I to be fed. This includes tube feedings via any port in my body including intravenous, nasogastric, orogastric, percutaneous endogastric or duodenal routes, or even if someone should offer to cut up my food and/or feed it to me. Should the recommendation for such a form of nourishment be mentioned as part of my care, I summarily refuse it.

I refuse any procedure involving a cerebral angiogram. 

I refuse any “clot-busting” agents, including tissue Plasminogen Activator, streptokinase, retavase or any other drug used for this purpose. I do not want to hemorrhage in my brain or any other organ I am using.

Any of my organs or tissues may be harvested for donation. However, if it is recommended that I receive any donated tissues or organs, I summarily refuse. I’ve seen those poor souls after getting an organ transplant, and it may be life, but not as I know it or want it.

Under no circumstances am I to be dialyzed, in any way, shape or form, including hemodialysis, CVVHD, SLED, or CAPD. I am a happy person, and dialysis is just sad.

Should the recommendation be made that I have artificial holes created in my body for the purpose of breathing, eating, nourishment, or excreting waste of any kind, I summarily refuse it. This includes tracheostomy, tracheotomy, cricothyrotomy, colostomy, nephrostomy, ileostomy, suprapubic catheter,  PEG tube or any other ostomy.

Should the time ever come when I cannot clean my own anus under my own power, all medicines I am receiving are to be stopped, all nourishment is to be halted, and all hydration, oral or intravascular, is to be ceased. I will either get better or die; either is preferable to me.

Under no circumstances am I ever to be placed in a nursing home, skilled nursing facility, long-term care facility, or any other place of similar ilk. Allow me the dignity of dying in my own home or that of my loved ones. 

Should the circumstances of my death be attributable to stupidity of my own causing, feel free to laugh and poke fun at my corpse. I would have loved the joke, too. But do not subject me to any of the situations I have outlined above. Thank you.

Sean Fitzmorris

7 December 2010

The Onus

The Onus

When you come to the hospital or call an ambulance, you are expected to be the main agent in directing your own healthcare. You have the right to decide what you are willing to undergo toward your own care. You are encouraged to ask questions about what the staff is doing or planning to do, possible outcomes, side effects and alternatives. Every invasive procedure requires your informed consent, whether it is a lumbar puncture, surgery, a colonoscopy, a central IV line or anything that is beyond minimally invasive. At any time, you may decide that you do not want this or that. You can refuse any medication, any procedure or any tube that is inserted into your body. You may even leave the hospital whenever you want. The refusal of any aspect of your care that the healthcare providers deem necessary is accompanied by the possible consequences of your refusal. If you don’t want to go to the hospital after a car accident, the paramedics will explain why you should go and advise you that if you do not, you could suffer long-term injuries, paralysis or even death. If you still choose not to go, they will respect your wishes and have you sign a form stating this, despite the possible untoward outcomes. The same goes at the hospital. You could be in the process of actually dying, but if you don’t want the care that is offered, the doctor will say “You realize that you could/will die without this lifesaving treatment, don’t you?” After your affirmation of this, you will be allowed to leave and die in whatever way the Grim Reaper finds you. 

There are obvious problems with this mentality, both on the part of the patients and that of the healthcare providers. Allow me to focus on the latter for a moment. As a healthcare professional (in the state of Louisiana, at least), when someone decides that they don’t want this or that type of care, you are required by law to respect their wishes, no matter how deleterious their refusal may be. UNLESS they tried to commit suicide. Or unless some third party says they "think" the patient might have maybe sort of tried to commit suicide or otherwise harm themselves. At that point the patient is committed under a Physician’s Emergency Commitment, or PEC. A PEC remains in force for 72 hours during which the patient is a ward of the hospital until a psychiatrist releases them from it. As one doctor recently explained to a patient who balked at a PEC, “you have no rights and cannot make any decisions for yourself because you’re a danger to yourself. You are a ward of the hospital for the next 72 hours.”

Now, the clear problem I have with this idea is this: people can decide for themselves what they can accept as “healthcare.” Even if not choosing a particular route will cause them to die. The doctors and nurses and paramedics must allow every patient who wants to do so to refuse care and die. The healthcare providers may view the patient’s refusal as suicide, but must nonetheless respect their wishes as long as they are informed of the consequences. Why is this not the case with someone who came in for a self-inflicted overdose or slashed wrists? Why can they not refuse care despite the obvious deleterious effects such a refusal can encompass? The congestive heart failure patient can leave the hospital after informing the staff that he is going to never take his meds, load up on pure sodium and pig out on the highest-fat food he can find and wash it down with gallons of alcohol and the hospital staff will happily wave good-bye to him as he shuffles on his swollen feet out the door. But if a perfectly healthy person wants to leave the ER after an ill-considered attention-getting gesture like scratching their wrist with a butter knife or taking an extra Ambien or Vicodin, that person is PEC’d, restrained and kept there against their will for days. Why the double standard, medical people? How is the CHF person not a danger to themselves or "gravely disabled," (as the PEC paperwork states is a condition of needing to be PEC'd)? I know that the horrible, black-magic “L” word is key here (liability). But if the refusal paperwork that the CHF patient signs is good enough to cover your asses when their cyanotic, swollen body is found buried under a mountain of fried chicken bones and bottles of Olde English 800, why isn’t it good enough for the person who wants to leave the hospital or ambulance after their silly little stunt? How is it that that person can’t direct their own healthcare, regardless of the possible deleterious outcomes?

Before you black-wearing, pill-popping, self-cutter emo people start cheering, though, allow me to direct a little insight in your general (though not specific) direction. People call the ambulance all the time for whatever problem they have. They show up at the ER all the time, again for whatever problem they have. Many are admitted to the hospital for said problems. Then after calling the ambulance or landing in an ER room or finding themselves in their hospital bed, they decide that they don’t want this or that thing. “Don’t stick me with a needle again!” “I don’t want those EKG wires pasted all over me!” I hate this catheter; take it out!” “I’m not going to take those pills!” they shriek. Then why on God’s green Earth did you come to the fucking hospital?  If you don’t want to be in the hospital, why did you call the fucking ambulance? What the hell did you expect? Despite the recent explosions of feel-good advertising that hospitals have embraced over the last decade or two, being in the hospital sucks. It’s an unpleasant experience, fraught with frequent tests, poking, tubes & wires, questions, assessments and yes, needles (or worse). Being carted there in the ambulance is at least as unpleasant, with a rough ride, countless questions, no bathroom, no food or drink and yes, needles (or worse). The medical experience is not fluffy bunnies, warm blankets and bedtime stories. Did you think it was? If you have the many years of medical experience and education to make meaningful decisions about your care, then by all means, take matters into your own hands. If you do not, then shut up and the let the professionals do what you asked them to do. If you want to get better by the standards of Western medicine, then call 911 and go to the hospital and comply with all the stuff the paramedics & doctors & nurses tell you and do to you. If you don’t want to undergo the barrage of unpleasantness that is the hospital experience, then stay the fuck home and let nature take its course. Save everyone else the trouble and ass-pain.

Thank you. This message is brought to you by The Medical Industry, who doesn’t really give a shit about you or your problems, but are willing to deal with it as long as we get a paycheck.

My Kharma Greeting Card

Feel free to copy & send to whomever is deserving!

Assorted Memories (Involving Food)

Assorted Memories (Involving Food)

Around age 12, I poured rice down the sink for some reason. My parents are upset because there’s no garbage disposal. I suggest running water down the sink. They say that water doesn’t dissolve rice. They are stumped & irritated when I say, “Then why is water called the ‘universal solvent’?”

I’m 7. We’re at a restaurant with my uncle, aunt and cousins and my family. We place our order. An eternity and a half later, we still have no food. My dad inquires about our order. It turns out that our waiter has quit his job. He quit right after taking our order. I feel a little guilty because it’s hard to imagine that it wasn’t us who pushed him over the edge.

My grandparents take me out to brunch one Sunday at their favorite restaurant. The restaurant also happens to be where I work as a busboy at my first job, so I know all the staff there. Typical of a 14 year-old, I'm a little embarrassed to be seen out with my grandparents. It’s weird having my coworkers serve me. To make it even weirder, my grandfather throws up all over the table after brunch. 

At age 25, I’m working as a waiter in a restaurant while I’m attending EMT school. I’m not very good at it. One of my tables is a single diner, an Asian woman. I try to keep all my other tables going and totally forget about this woman, and I leave her with a dirty plate in front of her for about 45 minutes. I apologize and bring her the check. She still leaves me a decent tip, and I’m fascinated that she signed her name on her credit card slip in Chinese characters. I show her signature to all the other waiters. They don’t care.

I’m in New York City for a vacation about 6 years ago. In Greenwich Village, I pass Anthony Bourdain hailing a cab. I’ve just read his book. I don’t say anything, but nod to him in such a way that I hope it conveys “Dude, you’re my favorite chef/author/TV host ever. Thanks for being awesome.”

On my wedding honeymoon, my new bride wants to impress me with her cooking. She makes what she calls a strawberry cheesecake. Instead of topping the cheesecake with strawberry stuff, she’s mixed a pack of strawberry Jello into the cheesecake filling. It is the color of Pepto-Bismol with radiation poisoning. I call it Plutonium Pink. She comments on the spaghetti and meatballs that I made; that she’s never had a meatball the size of a grapefruit. Touché.

Ten years ago, my mother-in-law served me a dish that she refused to name. It was some kind of meat pie, with two kinds of meat. She asked if I like it. I said I did, especially these bits of meat, which I point out. She says it is steak and kidney pie, and the meat I particularly like is kidney. Until then, organ meat grossed me out. I ask for seconds. 

In Greece, my friend Mike and I sit down in a restaurant. It’s difficult reading Greek, so instead of trying to translate the menu, we ask the waiter to bring us something local, that he might like. We expect some souvlaki or lamb or grape leaves. Instead he brings us a huge platter with a large cooked octopus in some sort of spicy red sauce. It is delicious. We eat all of it.

When we were little, my sister Erin used to put A-1 steak sauce on everything. I watched her pour A-1 onto celery sticks and eat them. I tried it. It tasted like A-1 on celery.

Somehow, my wife and I start discussing pickles. I say something about the cucumbers that are made into pickles. She refuses to believe that pickles are made from cucumbers. I am bewildered that she doesn’t know this basic fact and sarcastically ask, “Where did you think they come from? The pickle bush?” She still refuses to believe me. Later at the grocery I point out to her the ingredient list on a jar of pickles. That was a bad idea.

Councilman Stokes Is an Explosion In an Idiot Factory

Someone on Twitter, @RobRiscoe, asked my opinion on this fiasco:

The incident occurred in Jackson, Mississippi and there's been considerable hullabaloo in the EMS community regarding it. Normally I don't voice my opinion on things where the answer is as clear as this situation. But since I was asked...

As you can tell by the title of this article, Councilman Stokes has proved to the world that he knows absolutely nothing about the subject on which he has chosen to pontificate in hilarious ignorance.

"You got to take risks; you can't let citizens die!" In a backwards way, he is correct. The shooter and victim took their risks in whatever behavior preceded the shooting. The EMT's try not to let citizens die. But Councilman Stokes, I must ask you, had the EMT's arrived on an unsafe scene and gotten themselves shot and killed, then wouldn't there be two more citizens dead besides the first victim? We can continue this formula - then two more EMT's show up and get shot, and so on - until all the EMT's in the city are dead. You see, going into that scene and 'taking risks' might not be the best policy.

As every EMT is aware, even scenes that are declared "safe" often remain very unstable and can go downhill to "extremely unsafe" in a heartbeat.

(Should we tell Councilman Stokes about what we do when that happens? Actually leave the scene?)

One of the solutions for this "problem" that Stokes has proposed is having the city go into the ambulance business themselves, rather than contracting with AMR. That's fine. No offense to AMR, but certainly few would have a problem with there actually being more ambulances in the city. Tell us, Mr. Stokes, where will you find the EMT's to staff your city ambulances? No doubt you wouldn't want those wimps from AMR to come over and work for you, with all their insistence on "scene safety" or whatever they call it.

Councilman, I have news for you. Your "problem" isn't with AMR. Every EMT in this country, to be certified as an EMT, has to go through an EMT course approved by the nation's Department of Transportation. And in every single one of those classes, the first lesson on day 1 is "Scene Safety." During that class, it is ingrained into the brains of every prospective EMT that you do NOT go into scenes that are not safe! If the scene becomes unsafe, leave! Every practical exercise that the EMT's will perform during class must include the question "Is my scene safe?" If they do not ask that question and determine scene safety, then no matter how magnificently they perform the practical exercise, they will fail. Every day from day one, scene safety will be burned into their brain.

That, Councilman Stokes, is the culture of the pool of EMT's from which you have to staff your nascent city ambulance service.

Perhaps Councilman Stokes would prefer if the class would go something like this: "Hello and welcome to EMT class. The first thing you should know is if you are called to a scene where gunshots are still going off or cars are still colliding with each other or gangs are stabbing each other all over the place, don't worry, just go right ahead in. Everything will be fine and unicorns and rainbows will sprout from your footsteps."

Really, Councilman Stokes? Would you actually want EMT's who were schooled to take such risks? If they are willing to "take risks" with their own personal safety, then what kind of risks will they take with the care they deliver to their patients? When you're in the back of that ambulance one day, maybe when the medic pulls out some big scary tube or needle to put into your body, will you want the EMT's to say "I've never done this procedure before, but I'm willing to take the risk!" Or maybe "You don't have to sterilize the site where you're going to stick in that needle/tube/scary device. It's a risk that he may die from a horrible infection, but we're willing to take it!"

As a casual aside, according to the news video, which I trust more than the "facts" of either Councilman Stokes' or the outraged mother-in-law of the victim, I notice that AMR is accused of taking 21 minutes to arrive at the patient. But then later in the video, the dispatch, en route, arrival and at-patient times add up to only 7 minutes and 25 seconds. This is well under the national average of 9 minutes. Did Stokes even bother to actually investigate the details of the call? Or is he just taking the word of some emotional, angry woman off the street?

Councilman Stokes, you are a fucking idiot.

History According To The 64 Crayola Box

All the "Flesh" in my box forced the "Indian Red" into a tiny corner. Then a bunch of "Brown" immigrated from another box, causing the "White" to create an uproar. They pleaded with the leader crayon, "Gray" to do something, but he was only worried about the "Pink" in the crayon military. Meantime, due to tax increases & healthcare reform, "Green" virtually disappeared from the box.

"Found Wanting" now available for everyone!

Just wanted to announce the release of my book, "Found Wanting." If you've seen my Facebook profile, you know I've been yammering about various problems with its release. Well, finally, it's out now! It hasn't yet hit retailers like Amazon and the iPad app store, but it's available already! You can get it from the wholesale publishers (for a LOT cheaper than my original publisher!).

If you'd like the print version, a real, actual book, then click this link: http://www.lulu.com/product/paperback/found-wanting/12812792

Just click Add to Cart and checkout like any purchase!

If you'd like to download "Found Wanting" to your mobile device like iPhone, iPad, Kindle, Nook, Kobo, Stanza or other device, then click this link from your mobile device: http://www.smashwords.com/books/view/25111

You have to register (it's free) and select which format you want. Don't panic!  Pretty much any device will read the .Epub format. If you have a Kindle, you can download the .Mobi file. You can also read a free preview of the book! Just remember to go back and purchase the full copy!

"Found Wanting" will be available via retail outlets like Amazon and the iPhone app store in 4 - 8 weeks, so get your copy now! Why wait?

Thanks to everyone, and enjoy "Found Wanting"! All the best!

-Sean

Assorted Memories - Regarding Vehicles (and Water)

When I was small, my grandparents would take us to the Lakefront airport, a small airport for private and charter planes. They still referred to it as Shushan Airport, its name back in the old days, like when the Wright brothers were still around. We would watch the planes take off and land. It had a big, beautiful lobby that only much later would I appreciate as being classic art deco. Sometimes military planes would be there, old WW II planes that were still in service - big, gorgeous Constellations with three tail fins or awesome DC-3’s. There were lots of seaplanes too. I was always fascinated with the metal-cast scale models of  airplanes in the huge display cases in the lobby. I wanted to be a pilot.

My mother took us to the Lakefront airport one weekend. My grandparents were out of town. She wasn’t quite sure of the way. She made a wrong turn and we found ourselves at the nearby boat launch. She made a big deal of it. She said “I almost drove into the lake!” about a zillion times. She had me thinking we had almost died.

I’m 12. We’re going to Pensacola to stay at the summer house of a friend of the family, Mr. Chanel. He’s French. And rich. My Dad is driving the station wagon to the beach. The bridge across the bay is very old, narrow and seems rickety. I’m scared the bridge will collapse from age. That night I have a dream which combines my memory of my Mother declaring our near-death by boat launch with the scary bridge. In my dream, we’re driving across a rickety bridge which angles down into the water. I wake up crying. The dream occasionally resurfaces even today, but I don’t cry anymore.

I’m 23. I have a part-time job driving a truck transporting mail at night. I drive from the main post office on Loyola Avenue to Picayune, Mississippi to meet another driver from Jackson, Mississippi. We’d swap trucks and I’d drive his mail truck back into New Orleans. My friend Mike and I share the job; he drives 3 nights a week, I drive the other three nights a week. One night Mike decides to ride with me even though it’s his night off. He wants to meet his girlfriend, Sherry. Sherry is driving back into town on the same highway from a trip. We meet Sherry. Her friend Iliana is riding with her. Mike gets into Sherry’s car and Iliana rides with me in the mail truck. Iliana is from Cuba. I’ve known Iliana for a few months and I like her. She holds my hand as I drive. 

I’m 25. I live in Listowel, Co. Kerry, Ireland. My friend Mike has asked me to come with him on a tour of Europe. On the overnight ferry from Ireland to England, we are bored, so we make up a story to occupy the time. It tells of César and his friend (whose name I can’t remember) and their adventures. The story serves as a running theme for our own adventures all over Europe through the next month.

I’m 34. I have Eric as my permanent partner in the ambulance. He is also a paramedic, so we can swap duties - he drives one call, then I drive one call. We get along incredibly well. He is my partner at work and has also become a friend. I love going to work because we make each other’s day pleasant. Our partnership only lasts two months. I am then assigned to work with the medic that no one else can get along with. I spend several months with my new partner. I am miserable. Eventually, we start to get along. Eventually, I start to like working with my new partner. Eventually, I look forward to coming to work so I can be with my partner. Shortly thereafter, I am assigned a different partner, the latest one that no one wants to work with.

My sister Shannon is in the hospital. She is eleven; I am exactly one year older. We both have the same birthday, a year apart. Shannon is having her tonsils taken out at Hôtel Dieu Hospital. Children are not allowed in the hospital. My parents tell me and my other sister Erin to wait in the car. We do. It’s hot. We’re there forever, it seems.

I’m 30. My parents have entrusted me to keep their car while they’re out of town. My wife and I leave the house; we’re going to take their car to go wherever it is we were planning on going. Their car is no longer in front of our house. It’s been stolen. I file a police report. Four days later I’m working on the ambulance with my partner Mike (not the same Mike as I mentioned). My cell phone rings. It’s the police, saying they’ve found my parents’ car after a police chase and it’s been crashed into a parked car. The driver has been taken to the hospital. Mike and I drive to the scene where I confirm it is my parents’ car. Later at the hospital, I see the punk who stole the car. He’s lying on a spineboard, strapped down. It would be so easy to kill him, or at least beat the living daylights out of him. My partner Mike sees how angry I am and physically pulls me back, away from the teenage punk.

I’m 16. My year-younger sister has a license to drive. I do not. I’m in no rush to get one because I don’t really care if I can drive or not. She is driving to school and will drop me off at my school. We pick up her friend Michelle who goes to Shannon’s school. “1999” by Prince comes on the radio. Shannon and Michelle sing and car-dance to Prince. I don’t particularly care for Prince, so I stare glumly out the window.

I’m 3. The school bus picks me up for my first day of school. Mr. Jimmy drives Bus #22. Later, he would also teach Catechism, though it wasn’t a Catholic school. I ride Bus #22 for the next ten years. Forty years later I meet the brother of one of my co-workers. He also rode Mr. Jimmy’s bus, #22, though I don’t remember him. He didn’t go to Mr. Jimmy’s Catechism class because he was Jewish.

I’m newly married at age 28. My wife Grainne and I are driving across the Lake Pontchartrain Causeway. We watch the ducks, seagulls and cormorants flying and floating on the lake. While driving across the 24 mile-long bridge at 60 miles an hour, she locks the electric door locks. Mystified, I ask her why. She says “You never know who’s going to rob you.” I consider the logic of her statement but can find none. I ask her, “Who do you think is going to rob us? A rogue pelican?” She turns up the radio. 

I’m 10. We’re going to Pontchartrain Beach, a local roller-coaster type theme park. My sisters and I take turns chanting “Pontchar” - “train” - “Beach!” each of us taking a portion of the name, splitting the four syllables as fairly as we could between only three children. I am dying to ride the Zephyr, the biggest roller-coaster New Orleans had ever seen. In the line for the ride, I confide to my Dad that I’m scared and I don’t actually want to ride the Zephyr anymore. We quietly leave the line. 

Assorted Memories - Unassorted Memories

Unassorted memories:

I’m 3 years old; I notice that the heavily stuccoed wall next to my bed has a plaster pattern that might be interpreted as a face. I spend the next 3 years talking to the tiny plaster face, wishing I didn’t know it would never understand what I said.

I’m 18. After some sporting event, possibly football, at the Superdome at which my friends Steve & Marty and I got rather drunk, I decide it would be appropriate to punch Steve in the face. Steve is 6’1”, easily 250 pounds and used to be a college linebacker not very long before. He hits me back, after carefully explaining why the recompense is at least as appropriate as my initial punch. I remember groaning on the ground shortly thereafter.

I’m 24. I’ve been in Ireland for a month. My flight home after my vacation is the next day. I use my new friend Henny’s phone to call my parents at home. My youngest brother Michael answers. I  tell him to tell Mom & Dad that I won’t be on the flight home because I’ve decided to stay in Ireland. I remain in Ireland for a year.

I’m 6. My sisters Shannon and Erin and I have made a pastime of watching the new house get built next door. One day, we go to the window in our housekeeper’s bedroom to watch the heavy machinery do its thing. We eat ice cream. Shannon has chocolate. I have chocolate and vanilla. I discover the “swirl,” when your ice cream is just soft enough to swirl the flavors together, resulting in a delicious combination of breathtaking flavors (although it is a disgusting shade of brownish poop color, as Erin points out).

I’m in first grade. I’ve read a book called “Molecules” three times. I have questions about nuclear physics. I ask Ms. Surgi, my first-grade teacher about the cohesive properties of atoms, protons, neutrons & electrons. She is stumped.

I’m 39. My friend Greg and I are at a bar. I’ve recently moved out from the house my wife and I have shared for many years. We take turns discussing our “women problems.” After a few minutes, I literally cry into my beer for half an hour. 

I’m 21. Still living with my parents, I’m walking through my brothers’ bedroom to get to my own bedroom, actually the garage that’s been turned into a garconniere. I ask my brother Patrick a casual question, to which he lies about the answer. I’m incensed that he lied. I recall my parents’ admonishment, “Don’t hit your brother! Don’t hit anyone unless they're your own size!” It occurs to me that Patrick, aged 17, is easily my size, perhaps even a bit bigger.  I allow my anger to get the best of me and slug him several times. He gets a black eye, swollen and barely able to open it. The next day, my Dad has a photo shoot with a local magazine, as he’s running for public office. The photographer takes several pictures of our happy family. The photograph that appears in the magazine pictures my brother with one eye open, the other swollen shut. I’m smiling.

Speaking of photographs, there are very few family pictures in which I am not standing on my tippy-toes, to appear taller than everyone else.

I’m 26. I’ve just gotten back from a contract job in which I maintain aquariums through Bobby’s pet shop, where I work. Dr. McSwain calls Bobby, whose office aquariums I’ve maintained for a year. He’s complaining that ‘his fish are dying.’ Too embarrassed to go back, I ask my co-worker, Chip, to go to his office to check out the mysterious fish deaths. He returns later, and explains that I forgot to hook up an air tube that oxygenates the water in the aquarium. Two hundred dollars worth of tropical saltwater fish have died (this is about three actual fish; Dr. McSwain has a generous aquarium budget). I am too embarrassed to go back; I ask Chip to take over the account. Bobby never deducts the losses from my salary.

It’s my fortieth birthday. I’m in Anaheim, California, living as a refugee after Hurricane Katrina in New Orleans. I rejoice that I’m two thousand miles away from anyone that would have a “Lordy, Lordy,  Look Who’s Forty” birthday party for me.

I’m one year old. It’s my birthday. I don’t understand the importance of the one-piece jumper my aunt has given me as a birthday present. I try to escape the festivities the adults are enjoying but the three steps up to the kitchen are too high for me to climb. I learn their drink preferences by overhearing their requests from my Dad, who rarely drinks, but is the party bartender. I don’t know what a “Martini” is yet. An “Old-Fashioned” mystifies me; at a year old, my idea of old-fashioned is last week’s stuff. The thought of a drink “on the rocks” will perplex me until my speech patterns are fixed enough to ask about it years later. Eventually I make it outside, where Maria, the girl next door, plays with me in my round strolly-walker thing.

Lasagna, Sean-style

Well, I never thought this blog would turn into a cooking show, but like a thousand folks asked for my lasagna recipe just because I put a picture up on Facebook. Interestingly, I also tweeted the entire cooking experience on Twitter with photos., but hardly anyone responded. Slightly disgruntled at being underappreciated, I'm putting the recipe here like I Twittered it. Because really, who wants to read "spread evenly across the pan" or some crap like that? That's like the Ambien zombie of literature. Anyway, here's the recipe as posted on Twitter with links to pics! Click the http links if you want to have a friggin' clue what I'm talking about!

 Welcome everyone to#seanskitchen!

Today's dish: lasagna! All you vegans out there, cover your eyes.

First orders of business when in #seanskitchen - preparation. Vodka & soda is a good choice. http://yfrog.com/nezdclj

If someone gives you shit about cocktals at 3:30pm, offer them a cocktail!

Second step in preparation for #seanskitchen - mood music. This is entirely up to you. http://yfrog.com/c9488hij

Get your shit together. If u don't like italian sausage, go hide with the vegans. #seanskitchen http://yfrog.com/ccj7waj

Get your biggest, most psycho-killer knife and chop up those tomatoes! Show them no mercy! #seanskitchenhttp://yfrog.com/6wkliwwj

Stick those tomatoes in a pot. Turn up the heat. Ignore those who say you should remove the seeds. They're pussies.http://yfrog.com/nbzbiaj

When it's all steamy, turn down the heat and torture those tomatoes. http://yfrog.com/n8ltbrj

Ad a lot of garlic! Did you think we're not gonna use fucking garlic? http://yfrog.com/56v89pj

Add some olive oil & italian seasoning. Use a lot! You're seasoning all the lasagna, not just a pot of tomatoes.http://yfrog.com/83wh7tj

Use whatever the hell tomatoes you want! Just use tomatoes!

Take your big scary knife and disembowel the hell out of some italian sausage! http://yfrog.com/mv8dssj

How u gonna cook that big ol' pasta? In a big ol' pan.http://yfrog.com/epwhgj

Take the skin off the sausage. Save it to make a festive costume. http://yfrog.com/b5zs4jj

Brown that fucking sausage. Use a goddamn bigger pan than me. http://yfrog.com/n3ao1cj

You're not cooking in #seanskitchen unless you use at least three burners. Fuck you, microwave.http://yfrog.com/mwgchyj

When some sausage falls on the ground, let the dog have it! This is why you need a bigger goddamn pan!http://yfrog.com/5c1sej

When it's browned, drain it & let the sausage rest. All meat needs to rest after heat! Even human meat!http://yfrog.com/mr2jmrj

You're still simmering those tomatoes, right? SIMMER DOWN! Don't make me come over there! http://yfrog.com/j3dohf

Use whatever crackpot way you want to tell when pasta is ready. Just put some olive oil on it, for Chrissakes!http://yfrog.com/ngqi2j

Let the tomatoes simmer while the meat rests, the pasta drains & you mix another adult beverage.http://yfrog.com/6lfvtj

Welcome back to #seanskitchen! Your pasta is drained, your italian sausage better have rested. Your tomato sauce is saucing.

Is your tomato sauce all thick & gooey now? Good! If you have an Italian grandma who says sauce needs to be cooked forever, kick her ass.

Make a layer of italian sausage in the bottom of a pan. Feel free to use real Italians. http://yfrog.com/49yqicj

Layer the pasta on the meat. That shit is still hot! It helps if you get pans to fit the pasta, unlike me.http://yfrog.com/ngj1xej

For God's sake, make a layer of ricotta cheese! Don't be stingy; what is this, weight watchers? #seanskitchenhttp://yfrog.com/htxl3zaj

Make another pasta layer. Add some veggies! I'm using artichoke hearts. Or spinach, eggplant, whatever. I don't care http://yfrog.com/b9b5uvj

Spread your awesome tomato sauce all over those veggies! Make 'em orgasm. http://yfrog.com/mtgzblj

Oh sweet Jesus, don't forget to preheat your oven!http://yfrog.com/mxk09nj

More pasta! Shred your mozarella! Do it now!http://yfrog.com/861x0qj

Put those pans in the freaking oven that Jesus reminded you to preheat. http://yfrog.com/7f7peuj

Leftover pasta? Eat it!

Now on #seanskitchen, baking time. I guess 20-25 minutes? We'll have another break

Those of you that take offense to #seanskitchen, no lasagna for you! Yeah, you!

That shit is DONE! this is what golden-brown looks like on#seanskitchen  http://yfrog.com/mvbxnyj

Let that shit cool down! It's friggin' HOT! Distribute to friends when cool. Thanks for joining #seanskitchen!http://yfrog.com/j3cnaj

This is Freaking SWEET!

This blog - yes, the one you are reading right this very minute- made number 7 in a list of the 50 Best EMS blogs on the web! http://www.medical-assistant.net/ems-blogs
Many thanks to my devout readers! Tooting my own horn? You bet I am!

In other news - For those of you that don't know despite my similar self-horn-tooting, my book, Found Wanting, is due to come out in print in the next few months! No idea yet exactly when or how much it will cost, but you should totally make plans to buy it! I'll sign it!

I wrote Found Wanting last year (2009), and had it on here for a while but took it down when I signed the contract. (Contract!) Here's a hint about the book: serial killer paramedic! I know you're just DYING to read more now! (Dying - haha, I made a funny!) Anyway, thank you so much for your support! Stay tuned!

-Sean Fitz

Ramp Rants - Partners

Ramp Rants - Partners

In an ambulance, you spent a good portion of your life with your partner. In my service, I would spend 12 hours a day in the ambulance with the same person, for 7 out of 14 days. That’s 25% of my life. Being a partner in an ambulance is, in some ways, a closer relationship than marriage. My wife would work days and I usually worked nights. We would see each other for a few minutes in the morning, when I was getting home and she was leaving for work, and then a few more minutes at night, when the reverse was happening. But at work, I’d say hello to my partner and then spend 12 continuous, unbroken hours with him or her, talking with them, listening to each other’s music, smelling their food and seeing their face. With my partner, we would respond to crises throughout our entire shift. Our exasperation with stupidity would peak simultaneously, our adrenaline would flow together during life-or-death emergencies, our boredom at times would cascade into a common pool of ennui. You eventually get to know your partner’s quirks and pet peeves; you not only know, but understand what drives them; you even become personally acquainted with details you’d never imagine you’d know of another person, like what their farts smell like. The old saying goes “an experience shared is twice as sweet.” When you’re sharing those experiences in an ambulance responding to medical emergencies day in and day out, it has an effect more powerful as a shared experience than any sunset, dessert, wedding or vacation spot could ever hope to have. And unless your spouse, family or significant other is also in EMS (God help you if they are) EMS partners may well rank as of the most unintentionally intimate relationships human society has ever created.

Therefore, it behooves me to describe your partner. If you have been in EMS for years, no doubt you will recognize some of, if not all, the partners you have had. If you are new to the field, here’s an idea of what to expect in your nascent career.

"The Great Partner”

This is the person whom you should never expect to be paired with. In the extremely unlikely circumstance that you are, you will quickly come to appreciate this individual. He or she will have far more than a passing knowledge of EMS. You will be impressed with their knowledge of the profession and the care they deliver to your patients. You will be able to handle a complicated scene with them and know exactly what you and they need you to do and barely speak a word about it to each other. He or she will drive the ambulance carefully, not throwing you around the back of the truck. Alternately, he or she will thank you for a good ride when it was your turn to drive. You will both happily agree on the same place to get lunch. Your relationship will make it a pleasure to come to work, you’ll look forward to your time together and take mental notes of each others’ medical techniques. If something needs to be done and you can’t handle it all yourself, like triaging a multiple-casualty scene or calling in a report to the ER while you’re busy doing CPR, you will confidently delegate that task to your partner and you will not have to worry about them fucking it up. You will enjoy each others’ company even outside of work and be friends with their family. Once administration gets wind of how well you get along with your partner, you will immediately be split up... at which point you will find yourself with one of the following.

"The Talker”

This person will never stop talking. When you come to work and hope for an easy shift, the patients may be compliant with your wishes, but your Talker partner will continue to prattle on about their latest argument with their spouse, their patient they had last week who had a hangnail, their credit card bill, their kids, their trip to Cleveland, their mother, their child, their burger on a soggy bun from the drive-thru last week, their hairdo, their review of some movie you’ve never heard of and what they saw on TV last night. You will fall asleep at some point during your shift and when you wake up, your partner will still be yammering on uninterrupted, oblivious to your absence during your nap. You will be delayed from taking the next call because you had to go find your partner who was busy telling the emergency room doctor about the condition of someone’s clothes on an emergency run they handled last year.

If you’re not partnered with the Talker, you may find yourself with...

“The Chick That Thinks They’re Hot”

This will be a female, obviously. She is at best a mediocre EMT. She might be able to adequately apply a cervical collar and long spineboard, maybe even a bandage. But when you ask her why she thought it was necessary to spineboard the atraumatic grandfather with chest pains, she will thrust out her boobs at you, then make a quick turn on her heels so you can get a view of her glorious ass as she goes to make up the stretcher, or herself. Any coherent answer when asked about her erratic actions on the scene will not be forthcoming. Years after being at your EMS service, she will still not be able to adequately explain the mechanics behind CPR, she will still interpret a 12-lead EKG exactly as the EKG machine interprets it, and will she be not able start an IV under the best of circumstances. But... she will... um.... uh.... Dude! Check out those tits!

The Paragod

A close relative of the Chick That Thinks She’s Hot, the Paragod can be a male or female and has been everywhere, seen everything and knows everything there is to know about EMS. Even though he or she is known for jumping in the driver’s seat despite it being their turn to take the patient, the Paragod will insist that whatever their actions were on scene were the best possible actions to take, even if they deliberately stabbed the patient in the eyeball with an IV needle. This partner has responded to every possible permutation of anything that could ever go wrong with a human body, and the Paragod will fabricate a story to back up their claims. The Paragod responded to the World Trade Center on 9/11 and saved every survivor; they personally, physically carried the President of the United States to their ambulance when he was injured or unconscious; they wrote the medical protocols that some country with nuclear weapons uses in their EMS services. If you question the Paragod on why he licks sterile equipment prior to inserting it into a patient’s body, he will sneer down his nose at you, point to his advanced-level patch on his uniform, and say, “When you get one of these, then you can ask about why I do something.” The Paragod will be recognized when you find yourself daydreaming of actual plans to assassinate your partner.

“The Eternal Newbie”

This poor soul will have been at your service for twenty years, but every day will be their first day on the job. You will marvel that in twenty years, he or she will still not have picked up on the proper way to apply a nasal cannula, or splint a fracture, or read a map, or figure out the best way to get to the hospital. You can play dumb and offer your partner helpful advice, even though he or she far outranks you in seniority, to which he will reply “Oh yeah, I knew that! I must’ve had a brain fart.” This will be the same response he offers even if you call him out twenty times a day. Alternately, you can become insanely angry at their idiocy, jump and scream and insult them, to which your partner will give you a doe-eyed look that says ‘I have no idea what you’re talking about.’ Defeated, you will curl up into a metaphorical fetal-position (if not a literal fetal-position) and wonder how your partner ever passed his EMT exams, let alone made it through twenty years at the same EMS service.

“The Actual Newbie” (AKA “Ricky Rescue”)

Sooner of later, you will be partnered with the “new guy.” He or she will be fresh-faced and eager to save the world. Your partner will shout with joy when he turns on the lights and sirens. This eager beaver will lie on the radio, saying that your crew is miles closer to a “good call” than the crew that was actually dispatched. Ricky Rescue will shout driving instruction over the PA system to cars in front of your ambulance. He will become sullen and morose during slow periods between calls. He will become sullen, morose and angry when your emergency call is not some horrible trauma scene, such as when the gunshot call you were dispatched to actually turns out to be a little old lady with arthritis in her feet. He will drive 120 miles per hour to get to a motor vehicle accident, probably causing a few more accidents along the way. He will want to perform every procedure that an EMT can possibly perform, but will balk when you ask him to write the report. If it is Ricky’s turn to make up the stretcher and clean the back of the truck after a call, it will not be done. You will recognize the Actual Newbie/Ricky Rescue because he will show up to work on his first day wearing every possible accoutrement ever made with the label “Tactical,” including tactical flashlight, tactical knife, tactical boots, tactical window punch, tactical trauma shears, tactical baseball cap and tactical underwear.

“Crispy”

The Crispy partner will most likely be your first partner, a paramedic that was burnt-out since before you could spell “EMS.”. He or she will find no joy in his job and will do his or her best to bring you down into his or her bitterness. Every call will be a horrible waste of time to your partner, no matter how dire the circumstances were that caused EMS to be summoned, and no matter how significant a difference you make in the patient’s life and existence. Any call, no matter how serious or trivial, will be met with an angry “harrumph.” Be prepared for objects to be thrown around the cab of the ambulance when dispatch assigns you a call. Be prepared to slink away silently when the Emergency Department staff questions your partner about any of his actions or non-actions while transporting a patient, because your Crispy partner will launch into a frustrated diatribe describing the need or lack of need for whatever it was the staff was asking about. You will recognize Crispy as you approach his ambulance; there will be cracks in the windshield on his side of the ambulance from clipboards or computers hurled viciously onto the dashboard during his bouts of anger over getting assigned a call. One point to remember (to your advantage or disadvantage): in his eyes, YOU are the Newbie/Rickie Rescue, no matter how long you’ve been at your service.

“The Family Guy”

This person will wear out the battery of their cell phone several times a day. They will be on the phone all throughout your shift together as they talk about “family issues.” You will hear your partner’s side of the conversation all day as they argue with their spouse, discipline their children, fight with the cable guy doing work at the house, chat with various contractors regarding the lowest bid for work to be done on the house, whine to their lawyer about paying child support and during slow times at work, you partner will describe in nauseating detail all the goings-on in his or her family dynamic. After a week or two with the Family Guy, you will know all about their spouse and children in ways you don’t know your own spouse and children.

“The Walking Crisis”

The Walking Crisis never has a good day. Every day, no matter how benign the calls are, will be “the worst day ever.” The patients might have a minimum of problems, be extraordinarily cooperative with your partner and yourself, and thank you profusely for your service, maybe even offer you some food or drink, yet your partner will find something wrong with the call. “Oh my God, that was awful!” you partner will exclaim after every EMS run. If you enquire why they found the call so stressful, they will respond by elucidating some vague, unlikely, unobservable possibility, the repercussion of which invariably result in their suspension, firing, revocation of their certification and possibly jail time. Often the Walking Crisis will overlap with the Family Guy, as their “horrendous” job description spills over into their home life. Your partner will spend their time between EMS calls talking on the phone with family members about worst-case outcomes in whatever circumstances their family is in. “Junior got an A in math? Jesus Christ, I thought he wanted to be an artist! This will never work out!” your partner will say.

“The Slut”

The Slut will be recognized the first week of orientation. The Slut can be male or female. By the end of the first week, the Slut will have had sex with at least one fellow employee, often that employee will be his or her field training officer. If the Slut is a female, after six months of her employment, most of the male employees will obliquely refer to her skills at sexual prowess. There will be whispered references to her as “The Suction Device,” “The Bottomless Pit,” “The Sperm Bank,” “The Freak,” and other crass but recognizable names. If the Slut is a male, a meaningful fraction of the female employees will be taking maternity leave within a year of his hiring. The Slut may or may not be a good EMT, but to many of the people who make that determination, their professional skills will likely not matter much.

“The Gay”

You will find an extraordinary percentage of your EMS co-workers are gay. This can have both advantages and disadvantages. If you are a gay male and your partner is a gay male, your chances of getting laid just went up, as is also the case if you are both gay females. If you are a straight male partnered with a gay female, you can both have a good time ogling the attractive females that you encounter during your shift, and the crew with the gay male/straight female can have the same fun pointing out attractive males to each other. The disadvantages can be a problem, though. The Gay, if they are too horny, promiscuous, or opportunistic at work, can acquire the gay version of the label “The Slut” among that portion of the work community. If two gay males or females from EMS become an item, they run the risk of the dreadful “Family Guy” problems (and label) as a result of the shrieking drama that can be so endemic to gay relationships. Further, your straight co-workers will get endless fun pointing out the ongoing spectacle between you and your co-worker boyfriend or girlfriend.

“The Social Butterfly” (AKA "The Silent Treatment")

The Social Butterfly will usually be on his or her cell phone, texting updates to Facebook, Twitter, MySpace and various other social networking sites. Actually responding to EMS calls will be a chore, as actual EMS work tends to distract them from texting their boyfriend, girlfriend, or 3rd-grade classmates. Expect little in the way of conversation from the Social Butterfly; somehow actually interacting with another human being (you) is far too cumbersome an activity compared with the instant gratification and massive life-affirmation they receive when someone “likes” thier Facebook status (“OMG, my partner is so lame! He actually wants to TALK to me WTF?!!”).

“The Fighter”

The Fighter will be related to the Walking Crisis. Paranoid at every turn, your Fighter partner will call for police backup for every 2-month-old with a fever. The Fighter will manage to get into a difficult situation on a call with a patient who is completely alone and unresponsive. Be prepared to apply restraints to every patient because “They’re combative!” according to your partner. Even if you are not partnered with the Fighter, you will hear them on radio asking for another crew to help with the the “uncooperative” patient. The patient could be an arthritic little Grandma who offers you some of the chocolate chip cookies she baked earlier; somehow the Fighter will press assault charges on her when she reaches to give your partner a hug.

“Driving Miss Daisy”

Miss Daisy has an infinite number of personal errands to run. Don’t be fooled by the nomenclature “Miss” Daisy; this partner can just as easily be a “Mister.” It is unthinkable to Mister or Miss Daisy to run personal errands on their day off, while they’re off the clock. Be prepared to visit their mother, shop for groceries, stop off at the electric and water company so Miss Daisy can pay their bill, purchase their hardware at the Home Depot, pick up their kids from school in the ambulance, give friends a ride home from the bar in the ambulance and attend some school class in between calls. Miss Daisy will never make and/or bring her own lunch, so you will be meeting her boyfriend, girlfriend, spouse or other family member so lunch can be delivered to Miss Daisy while on duty. Note that the closest location that the friend can meet you and Miss Daisy is clear on the other side of town, as far away from your dispatch-assigned location as you can possibly be. Do not be surprised when Miss Daisy asks YOU to inform dispatch why you are forty miles from where you were expected to be when dispatch assigns you a call.

“Sleeper Cell”

Not unlike Miss Daisy, the Sleeper Cell will have personal duties to perform that probably should have been done on their time off. However, the duties will fall under only one category - sleep. This partner will do their best to sleep during their entire shift. You will wonder what activities could possibly be so exhausting that your partner actually falls asleep while attempting to intubate a non-breathing patient. The moment your stretcher is made up and secured back in the ambulance after a call, you partner will be stretched out on it, with “Zzzz’s” almost visible on their snoring breath.With some partners, the cause of their sleep deprivation isn’t too hard to find - the narcolepsy may be secondary to his off-duty antics being “The Slut.” Possibly, the partner schedules too much abuse during her time off as she cooks, cleans, sends the kids to school, and runs her errands on her days off (the Family Guy?) then looks forward to napping in the ambulance. You can recognize the Sleeper Cell easily - you will be responding to a call, lights and sirens blaring, potholes jostling the ambulance to the point that your heads are actually making contact with the ceiling but your partner is snoozing away, undisturbed, oblivious to the fact that your ambulance overturned upside-down just now.

“The Soldier of Fortune”

This die-hard ex-military person will sneer in the face of danger, insult you for calling for backup when six big guys attempt to shoot you with pneumatic spearguns and steal your ambulance, and will be packing a firearm somewhere on his person. Every conversation will start with “When I was in the military...” This partner will regale you with war stories (literal stories of genuine war). The Soldier of Fortune will actually purchase “Soldier of Fortune” magazine and point out articles, insisting you read the review of the latest X-10 Kill-o-Matic weaponry. No situation in your experience is as awful a crisis as “This one time, in the military...” The Soldier of Fortune will spend his time off engaging in re-enactments of the Civil War or collecting unlikely weaponry, like a catapult or a guillotine. Do not engage such a person in conversation, it can only end badly.

“The Partner of Questionable Hygiene”

This partner will be recognized the moment you climb into the ambulance. You will imagine that the previous crew, while cleaning, had missed some foul turd that a patient had left behind. You will inspect the ambulance for the cause of the aroma. Unsuccessful, you will fall into a deep depth of depression as you slowly begin to realize that the stench emanates from you partner - the partner who you will not only have for the rest of your shift, but have just been assigned to work with permanently. Bring extra tissue paper to wipe your eyes and blow your nose as the irritants of his personal gasses fill your ambulance. If you lower the window in the ambulance, they will raise it again, claiming he or she is “too hot” or “too cold,” as your partner seals you into your personal corner of stink-hell. There are advantages to the Partner of Questionable Hygiene. When you have a patient on your stretcher, if you fart, it will be easily attributed to your partner. Conversely, your patient may have an episode of uncontrollable, explosive, stinky, diarrhea incontinence on your stretcher, in which case the smell will be unnoticeable, obscured as it is by your partner’s personal odor. Recognize this partner when fellow employees anonymously present him or her with a basket of personal hygiene products, including, but not limited to deodorant, soap, shampoo, laxatives, tampons, Gas-X, Febreeze, laundry detergent and cologne.

“The Princess and the Pee”

Not necessarily a female, the Princess cannot, under any circumstances, get their hands dirty. Should a stray drop of blood, urine, vomit or bodily fluids mar their perfect uniform, the Princess must go home immediately and will most likely file a personal injury report. The Princess will arrive at work with her makeup perfectly applied, his hair immaculately coiffed. Any object or patient heavier than a newborn baby will require backup for lifting assistance. If the patient is actually a newborn baby, your partner will be unable to touch it, “in case it throws up or poops.” The Princess is a delicate winter blossom, unaccustomed to the hysteria that frequently accompanies emergency medical calls. Such hysteria paralyzes the Princess and they cannot possibly be expected to function when there is “drama” going on. Starting an IV or bandaging a wound is outside their scope of fragility. The Princess cannot ever be expected to get so physically close to an actual patient so as to assess vital signs or use a stethoscope.

"Mister Clean"

Mister Clean has an extraordinary need to keep the ambulance sterile. Probably diagnosable with obsessive-compulsive disorder , he or she will spend a large portion of their paycheck on cleaning items for the ambulance. Whatever cleaning equipment your company provides will be far inadequate for their needs. Mister Clean will have a large bin chock full of bleach, Windex, scrubber pads, Armor-All, sponges, brushes, brooms, mops, a vacuum cleaner and anti-bacterial soap. They may keep their own pressure washer machine to scrub the outside of the ambulance. At least once a shift or more often, this partner will launch into a cleaning frenzy to scrub, polish and straighten every item in the ambulance. When you look under the hood at the engine, the caps for brake fluid, radiator coolant, windshield washer fluid and oil will have colorful hand-made labels identifying each. Your eyes will frequently burn as the ammonia and bleach mixes during their cleaning fits. You dare not leave lunch leftovers anywhere as they will be thrown away the moment your partner finds them idle. Mister Clean will stare at the drop of the patient's blood that fell on the floor, transfixed, mesmerized at the fantasy of cleaning it up. Should you offer to help clean the ambulance, your hand will be slapped away when you reach for Mister Clean's stash of supplies, in the fear that you might disrupt the meticulous organization of their precious paper towels.

Thanks for reading! Hopefully you’ve found a little light to brighten your day. As you climb into your ambulance for another shift with your partner, I want you to ask yourself not only “Which one are they?” but also “Which one am I?” (And if I missed any partners out there, please describe them in the comments!)

Onward and upward.

The Darkest Secret of Nursing Revealed

So last night I was absconded. Shocked actually. And it takes a lot to shock me.

“What is this terrible scandal to which you were exposed and subsequently shocked by?” you ask? It is this:

I work on the Neuro ICU. We get all the brain injuries. Strokes, head injuries, spinal surgery, nerve damage... that sort of thing. Last night we had a patient with a traumatic brain injury who was pronounced brain-dead. The rest of his body didn’t get the memo so his lungs, heart and all his other organs were functioning just fine ( fine, that is, in an intensive care unit sort of way). The family of the patient (God bless them) had seen fit to authorize the patient to be an organ donor. (By the way, when I die, please donate my organs too.) The Organ Procurement nurse was working on our unit doing her thing - prepping the patient for organ harvesting, contacting all the people that would be involved, and so on.

As I was working nearby, I overheard her conversation. She was working out the details of the organ procurement surgery. At one point in her telephone conversation, she asked about what time anesthesia would be available.

This struck me as odd. “Anesthesia?” I thought. “Why would a brain-dead person need anesthesia?” The purpose of anesthesia is to make sure the patient is so unconscious that no pain is felt as the surgeon cuts into them and does whatever he has to do. But why would someone with no brain function require such a service?

I asked one of the other nurses. “Why do they need anesthesia for someone who’s brain-dead”

The answer was stunning. “It’s to prevent cruelty and to maintain dignity. Just in case the patient can actually still feel pain.”

What? In all my years of medical experience I had always been taught, and told others, that someone who is brain-dead feels no pain. “Don’t worry, he’s not feeling any pain right now.” “If you’re worried about it, she felt no pain in her condition.” “No, it was a painless way to die.” Such were my responses to concerned family members and friends on many, many scenes of trauma, disease and death.

But now another medical professional had stirred those subtle doubts. “In case” they still feel pain? You might as well drill air holes into the coffin “in case” they might actually still be alive! All at once, the state of medicine in our modern day came to the front of my brain. With all our tests, amid all our technology, after thousands of years of medical observation and knowledge, we still don’t know if a brain-dead person feels pain? Seriously?

I have often said that as I learn more about medicine, alternative medical practices appeal to me more and more. But here was hard, concrete evidence that our medical world simply has no clue about what REALLY goes on in the mind! “In case” they still feel pain? Holy shit! What other senses might still be lingering? Hearing? Will they report to Saint Peter the snide remarks about the embarrassing mechanism of their death (that porn on the TV we found them “stiff” in front of?) Will they detail the smells surrounding their demise (it’s okay if I fart; they’re dead - they won’t mind)? How long does the sense of touch linger? (Hey cops! Look how far I can put my finger into this bullet hole!)

The implications are staggering! I want to be an organ donor, but if we’re so uncertain about what is and isn’t sensed by the dead brain... well, I dunno! I mean, little girl with the bad heart, I know it sucks having to live most of your childhood in a hospital. Grandma, it must be really painful to wonder if you’ll survive to see your new grandchild born before you get a new kidney. I’m sorry you have to worry about your baby, new mom, wondering if you’ll see him off for his first day of school if you get your new corneas. But jeez- will it hurt if you take that stuff outta me?

---------------------------------------

I totally intended to make this a sarcastic, ironic, doubt-inducing post. But after having written it and thought about it, I can still say - “Please, if I won’t need them, take my organs and give them to someone who will.” Even if it hurts some.

Spreading Around Easter Joy

Easter can be a frustrating holiday. Gorge the kids on sugar and sweets then force them to sit still during church. Realize that your Easter bonnet isn’t as bonnetty as everyone else’s. No football during the family dinner. Here I’ve come up with a few ways to make Easter a lot more fun. Try a few of these suggestions to enhance your Easter merriment. Feel free to email them to Martha Stewart. It’s a good thing.

Fill your easter eggs with C4 explosives! Fun for the whole family!

You know the phrase "fuck like rabbits"? Apply that to your family Easter bunny diorama!

At Easter Mass, tell the parishioners that the apostles hid their Easter eggs in the Shroud of Turin.

When your mom's house is decorated with Easter lilies, remark "Did you ever notice how phallic Easter lilies are?"

When all the kids are enjoying chocolate at Easter morning, it's the perfect time to introduce Leroy, your new boyfriend.

Entertain the kids by showing them how mommy can peel an Easter egg without using her hands.

Make screaming noises whenever someone bites the head off a Peep.

You can wear white after Easter. Recruit the whole family to do experiments to make sure your tampon is up to the task.

Discuss with your family the homoerotic qualities of the name "Peter Cottontail."

Boil and dye a fertilized egg. Then crack it open and take photos of the children's joy. Then put them on Facebook.

For Easter, tell the family the story of how the giant bunny fell down Alice's hole.

Jesus' mom was one of the first ones to suspect that someone robbed her Son's grave & did terrible things to His corpse. Discuss.

Have the Easter bunny invite all the kids' moms to sit on his lap. Then have the kids do it and explain the "egg” in his pants.

Coloring eggs is fun, but once you’ve colored one, it’s just a repeat. Discover what else you can color. Add some dye to the toilet bowl.

Tell the tale of how if Jesus sees his shadow on Easter, then it’s six more weeks of Lent.

Instead of ham or fried chicken or whatever you usually have for Easter, make a delicious rabbit stew.

Hide your Easter eggs on ant hills. If you live in the south, fire ant hills. Enjoy the children’s screams of happiness.

Go to Communion by hopping up the church aisle and sing the Peter Cottontail song in appropriate lounge-lizard vocal style.

Instead of getting the kids a live bunny as an Easter gift, get them one that’s already skinned & cleaned. Encourage them to elaborate on why this is better.

Bite the ears & tail off the chocolate rabbits, and carefully re-wrap them before putting them in the Easter baskets. See what animals the kids decide they are.

And finally...
Put insulin and syringes in the Easter baskets. Watch the fun as the kids inject each other. Then after your fun-filled day of activities, enjoy the silence as they lapse into an insulin coma.

Happy Easter!

Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?

Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?

You remember your hospital clinical hours, right? Maybe you're doing them now. They never seem to end. Back in the dinosaur days of EMS when I was in paramedic class, the only place we did clinicals was in the ER, because the emergency room is the most like EMS, right? And back then, EMS wasn’t exactly taken very seriously. Appreciated, yes, maybe even commended, but seldom taken seriously. Most of our clinical time (two hundred forty hours!) was spent watching the nurses start IV’s and push drugs, watching the doctors intubate patients and helping fetch and carry things thither and yon. Few of the nurses trusted us enough to actually stick a patient with an IV. We only practiced intubation after the patient was pronounced dead. 12-lead EKG’s took the same place as Egyptian hieroglyphics in our curriculum. At best, we might inspire enough confidence in the staff to allow us to give a pill or rub some ointment on a rash.

Nowadays, the curriculum includes over four hundred hours of hospital clinicals spanning not just the emergency department, but the ICU, med-surg floors, labor & delivery and surgery. On the surface it seems like the ways to be bored have increased exponentially. And if you’re looking for something to do, you may find yourself in the same predicament we did back in my class, when the Tyrannosaur was the king of the earth, and go look for an empty patient room to nap in.

One thing is for certain, when you take your hospital clinicals you’ll be a newbie. A “lowly” EMT (actually, you’ll be worse- an EMT student!), so judged by the nurses and doctors on the floors who don’t know you from Adam. You may be able to run circles around any other EMT, but there’s no way you’re going to prove that to crotchety old Nurse Ratchet. And she won’t care if you did.

So is there any benefit to the spectrum of torture your instructors are putting you through? If you want to be an excellent EMT, there most certainly is!

Maybe, just maybe, you’ll get to stick an IV. The CRNA or anesthesiologist might let you intubate a real, live person. Good, you need that. But it’s no big deal. Why? Because you can teach a monkey to intubate or start IV’s. All that takes is training. As an excellent EMT, you need to seek out education. And the hospital environment provides you with multiple opportunities to do so. Training teaches you how do do stuff: “Is my scene safe? I put on universal precautions. How many patients do I have?" Blah blah blah. What to do on every scene you’ll ever have. What education does is teach you how to think critically about your scene, especially when your scene is one of those “what if...” situations that EMT class can’t prepare you for. A great deal of education can be gleaned in the hospital.

Let’s look at some examples. One thing you’ll have to do on every call is write a run report. “Nobody’s gonna read this thing besides a lawyer,” you say to yourself. On the contrary! Many, many times the very first thing a physician or nurse will do when initially encountering your patient is read your run report. Your run report stays in the patient’s chart until he or she is discharged. It is referred to nearly every time a new doctor or nurse has any interaction with your patient. Even if they’ve been in the hospital for months and you’ve long forgotten about the call, your words are still being read and taken into consideration. If you are doing clinicals, try to take note of how often EMS reports are read. Now imagine those are your words being read. Is the report clear? Is the mechanism of injury and pertinent history accurate? What did you do for the patient? Why or why not? And be assured, your spelling, grammar and penmanship are under keen scrutiny. It is those words that will make the difference as to whether we EMT's are to be taken seriously by the medical community!

Speaking of what you did or didn’t do for the patient, another valuable lesson you can learn from hospital clinicals is the concept of continuity of care. Though your responsibilities may end when you hand over the patient to the emergency department staff, the patient’s care does not. More importantly, what you did while the patient was in your care has repercussions long after you’ve gone home and forgotten about the call.

Did you intubate the patient? Once your patient is intubated, you’ve assumed responsibility for the airway & breathing - two of the cardinal aspects of the ABC's. By intubating them, you’ve effectively made them vent-dependent. Once the body realizes it doesn’t have to breathe, many times it doesn’t start again. In your hospital clinicals, take a look at the patients who are intubated, particularly by EMS. A week or two after you’ve patted yourself on the back for “getting that tube” while hanging upside down in an overturned car in a ditch at night, that patient may well be getting a tracheostomy. That sweet grandma with CHF might not ever be able to speak the words to thank you for “saving her life” because she’s dying of ventilator-acquired pneumonia. Are you SURE you absolutely NEED to intubate that patient? Is there anything you can try to prevent an intubation and subsequent vent-dependency? The chest decompression you performed, the perhaps-less-than-aseptic IV and the hypotension you induced by walking your patient to the ambulance also all create a huge change in the continuing course of care for the patient.

The drugs you push have effects beyond the ER doors, too. Educating yourself about them can make the difference between an EMT who can pass his test and an excellent EMT. If you’re in clinicals, take a look at how the course of care is altered by drugs the EMT’s gave. Did EMS max out the patient on Atropine? The care changes. When EMS pushed labetalol on the hypertensive crisis, did the patient’s asthma kick in and now they have to be intubated? Another detour in the path of care. That patient with eclampsia - why is the ER giving them levophed after EMS pushed the magnesium sulfate? All those drugs have side effects, some of them deleterious. What may make you seem like a hero at the moment may cause an unnecessarily extensive hospital stay for the patient, added expense for insurers or taxpayers and a negative outcome in general.

In the hospital, you’ll encounter equipment that you’ll believe you will never have to think about again. Wrong! Many patients are discharged to home care with a variety of medical devices. As was stated earlier, the emergency room is the most like EMS right? Well, that’s no longer the case. A huge part of EMS calls nowadays have to do with ongoing care. That’s right- home health. People call EMS when their home oxygen machine breaks or their premature infant’s feeding tube is clogged. Imagine going to the home of a chronically ill patient who’s receiving tube feedings. The feedings are still running to the PEG tube and you have to disconnect it to package them for transport. How do you disconnect it? How do you flush it? Use your hospital clinical time to find out. Some patients go home with a Wound-Vac device to remove exudate from a surgical wound or pressure ulcer. When and how should you disconnect it? How long can it safely remain off? What should you do if it is accidentally dislodged? Again, pay attention and ask questions in the hospital. Some patients have a PICC line (Peripherally Inserted Central Catheter). Can you use that for IV’s? How should you access it? If it starts coming out, what should you do? There is a cornucopia of devices that you may not feel you need to know about, but in reality you will have to deal with frequently. Quinton cathers, Foley catheters, suprapubic catheters, colostomies, home ventilators, home CPAP and BiPAP machines and tracheostomies are only a few of the things you have a golden opportunity to learn about while doing your hospital clinicals, and you will be glad you did when you encounter them on scenes.

You can take note of other things too. True, cleaning a patient isn't a priority in EMS. But try to assist the nurses to turn and bathe that 600-pounder in the ICU. Help them keep the combative head bleed still for a minute during the CAT scan. Feel the soreness in your muscles the next day. The nurses will acquire a newfound respect for you and you will appreciate what they do when they have to do it without your help.

Use your hospital time to really learn about patient care, not just the bare minimum of EMS training. Understanding that what we do in the back of the ambulance has a lasting effect on our patients’ outcomes will make the difference between you being an adequate EMT and an excellent EMT. Remember, any trained monkey can start an IV and memorize ACLS algorithms. Being an excellent, educated EMT is not only what makes you stand out, but is also what truly makes a difference. And making a difference is one of the reasons we all started in this field, isn’t it?