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.