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?

Adoption

Preface: I was adopted by my parents in 1965 as a six week-old infant. I’ve always known I was adopted, as have my two eldest sisters. There are six kids in our family, three of us adopted, three of us natural-born. I’ve never had any sort of a complex about being adopted; I deeply love my parents and my brothers & sisters. I’ve never been interested in finding my “birth parents;” I’ve never thought of my Mom and Dad and family as anything else but my family. Life goes by for forty-four years. And then...

There I was at work in my ICU, doing my little nursing thing, minding my own business. I get a new patient admitted from the emergency room. He’s had a stroke and is intubated and on a ventilator. He’s awake but the bleeding inside his head makes it impossible to communicate or recognize what’s going on. We’ll call him John (not his real name).

Anyway, I admit John and do my thing. I tried to find his family in the waiting room to find out more about his medical history, medicines, allergies, that sort of thing, but his wife had already gone home. No big deal. A while later the wife calls up on the phone to ask how he is, what are the visiting hours and so on. Before hanging up I say, “All right ma’am, my name is Sean, I’ll be taking care of him.”

“How do you spell your name?” she asks.

A lot of people ask me that. I’m very happy to spell it. “S-E-A-N. Spelled the right way,” I joke.

She continues: “This may sound strange, but how old are you?”

I raise my eyebrows, though this is a pointless action since I’m in a phone conversation. “Well, I’m forty-four,” I reply. “Why do you ask?”

She answers with what I interpret as a wistful tone, “It’s just that I had a son named Sean that I gave up for adoption. His birthday was 11/11.”

I stopped typing on the computer charting her husband’s assessment. “What did you say?” I asked.

“I had a son with John (the patient) named Sean. We gave him up for adoption. His birthday was November 11th.”

I said with a somewhat incredulous voice. “November 11th? Um, that’s MY birthday. What year?”

“November 11th, 1977.”

I breathed a sigh of relief, though I wasn’t entirely sure what exactly I was relieved of. I explained “That’s pretty wild, but it couldn’t be me. I was born in 1965.”

“1965? You know, it was so long ago, I may not be remembering right, and I’ve been so worried and tired with John in the hospital. It might have been 1965. We gave him up to Catholic Charities. Were you adopted, Sean?”

“Yes, I was. From St. Vincent’s.”

“St. Vincent’s? On Magazine Street? That’s who we gave him to!”

“Holy crap!” we both said simultaneously. She continued “Were you raised in a big Irish family?”

“Yes,” came my stunned reply.

“Did you grow up in Louisiana?” she asked.

“Yes.”

“Do you have blue eyes and dimples in your cheeks?”

“Um, yes.” I felt as faint as her husband must have.

“Do you have a full head of blond hair?”

“Y-y-yes,” I stuttered.

“Oh, my God!” she exclaimed.

I sat back in my chair, unable to move or speak. After a while, I collected my jaw off the floor and managed to bark out “Will you be here in the morning?”

“Yes,” she said. “I’d like to meet you.”

“Yes,” I agreed. “I want to meet you too. I’ll be here late after my shift for a class in the morning and I’ll come back to the ICU to meet you.”

“OK. I really want to meet you to,” she said, not saying the words we were both thinking, and hung up.

Could this be my birth mother? Could the guy in the hospital bed be my birth father? Is it possible?

I got up to take a closer look at my patient. Are there any resemblances? Does he look like me? As I examined him, I found frustration. I looked at his face and body. But he had been in a fire some time ago and was heavily scarred. His fingers had been burned off then and they were mostly nubs. He had pale, featureless skin grafts over most of his body and face. It was difficult to imagine a resemblance to anyone. He was sleeping. With my fingers I opened his eyes and gasped. The were the exact same blue as mine! I had explained my lengthy phone conversation to the other nurses. Two of them joined me in the room.

One of them said “You two have exactly the same nose.”

I looked closely. We did. And neither of them could deny the similarities in our eyes. A little while later I got him into a hospital gown, as the emergency room had stripped him naked. I noticed the pattern of the hair on his chest was the same as mine.

I needed some air. I had to take a few minutes to breathe, to sort out the storm of thoughts raging in my head. I went downstairs to have a cigarette.

I checked my own memory. I was born in 1965, right? I remembered the house on Chapelle Street we lived in till I was three. I remembered Vietnam, Watergate, the Apollo moon landing, Elvis and disco. I remembered the birth of all my brothers & sisters, all born before 1977. Yes, I couldn’t question my own memory. But I could question hers. Even she questioned hers.

I tried a different line of reasoning. What did I know about my birth parents? I had seldom asked, uninterested as I was in the subject. The only thing I know was that my birth mother was fifteen or sixteen and my birth father was seventeen. How old was my patient? When I admitted him, I had glanced at his hospital armband to verify his identity. It had said he was sixty-one. OK, so his age in 1965 he would have been... what? I couldn’t think enough to do the simple math. I pulled up the calculator on my phone. His age minus my age. Sixty-one minus forty-four. I punched in the digits and looked at the result. I blinked. I punched in the equation again. Seventeen.

Holy shit.

When I arrived back on the floor upstairs the phone was ringing. “ICU; this is Sean.”

“Hi Sean, it’s me again,” came the now-familiar voice of the wife. “I have to ask you, were you a blond baby but bald-headed? Did you used to walk around in a sort of circular stroller thing? With a round plastic thing around it that had toys attached to it?”

I thought back to my toddler days. I have an extraordinary memory for such things dating back to even before I could talk. It’s not quite a photographic memory; it’s called an eidetic memory. Images, the place of words in a book, the exact words of a conversation - all rattle around in my head with nowhere to go. I cross-referenced my own memory with the memories of photos I had seen of my own childhood. I clearly remembered my round walker/stroller thing. Some of my siblings had used it too.

“Yes, I did,” I answered. “How did you know?”

“Catholic Charities sent me a picture of Sean after his family had adopted him. I’m trying to find it now; I’m tearing up my house,” she said.

“That’s unbelievable!” I exclaimed.

“I know!” she said, also in disbelief. “I can’t believe I just called to see how John was doing and this happens!”

“Yes!” I replied. “I feel the same way!” I thought back to some of the information I didn’t have in my medical assessment to ask her, trying to seem a little bit professional, though all my emotions and thoughts were long gone. I could have asked about his immunizations, his prescriptions, his family medical history, social habits, anything. Instead I asked, “How tall is John? What’s his height?”

“He’s six foot one,” she answered.

It took a moment before I could say anything. “That’s my height.” I took a deep breath. “Ma’am, tell me your name again.”

(Again, not her real name) “My name is Beth. Beth Green Smith Brown.”

I insisted “Miss Beth, I know it’s four a.m., but would you be able to come down here to the hospital right now? I need to meet you.”

“I’ll be there in a few minutes,” she asserted.

Ten minutes later, the nurse I had informed of my experience told me, “Mr. John’s wife is in the waiting room. Are you nervous?”

“Yes, I’m very nervous,” I confided.

I met Beth. I won't go into a description of her so as to protect her privacy. I guided her to John’s room, holding her hand. It felt... I don’t know how it felt. Once in his room, I stalled. I tried to explain John’s medical condition to her. I stammered and choked. She said to him “It’s me John! And look who’s here! it’s Sean! Sean’s here!” John, with his swollen, bleeding brain, couldn’t comprehend.

Finally I decided I had to get down to brass tacks. “Tell me about this birth you gave up for adoption,” I instructed her.

She dug in her purse and pulled out an assortment of photographs. The first one was of a man in his thirties and a woman. His girlfriend or wife, I assumed. “That’s Brendan (not his real name). He’s my son. Or maybe, your... I don’t know, maybe he’s your... stepbrother?” she suggested. “I tore my house apart trying to find the pictures I have of Sean but I couldn’t find them.”

“Well, before we have a family reunion, let’s dig a little deeper. How long have you and John been together? I inquired.

“Since 1964,” she said.

The math fit perfectly. Crap.

“How old were you when you had this baby?”

“Twenty-four. I’m fifty-eight now.”

“And when did you have this baby you gave for adoption?” I pursued.

“1966,” she answered.

I paused. “I was born in 1965.”

She took a deep breath, sadness in her eyes. “Oh. I thought you had told me 1966.”

The math no longer worked.

“When was Brendan born?” I asked.

“He was born in 1971. He’s 38.” she answered.

“And was he your first child?”

“Yes,” she said. “It was my second child I gave up for adoption.” She went on to describe a conversation she had with Brendan in 1977 when he was very young, along the lines of Brendan asking her ‘why so-and-so’s mom can keep their baby, but you can’t.’ She gathered her thoughts. She knew that I had found the truth, that her second baby had indeed been born in 1977, not 1965. I suppose she had altered her story, errantly changing the year to 1966, having mistaken what I had said over the phone, in the hopeful desperation of locating her other son, and in her sad pursuit had altered the year to fit with my own life, though it would have made her pregnant at seven years old at the time of my birth. “I gave him up because I wasn’t going to be a welfare mom!” she asserted with a degree of pride in herself. I silently admired her desire for independence and self-sufficiency, even though her perception of time was somewhat… deluded.

“Do you think they might have lied to you about when you were born?” she asked with a shred of hope.

I pitied her for her husband’s illness and her lifelong desperation to find her lost child. I silently prayed that she would find some peace in her life, or at least that John would adequately recover from his stroke. I said to her, “No. I vividly remember being alive between 1965 and 1977. I’m sorry, but there’s no way I can be that son.”

We had little conversation after that. I was still distracted by the notion that I might have accidentally found my birth parents. After all, there was the incredibly identical story she had told me and there was the uncanny, unsolicited description of a child who sounded just like me. And there were John’s eyes.

I’m still not interested in finding out who my “birth parents” are. I’ll always have only one set of parents. But for the rest of my shift, I took care of John with, well, the kind of attention I’d take care of my Dad with. Good luck, John. And good luck, Beth. I’ll always remember you.

Metaphor Madness

Most of us like to try to sound marginally intelligent in our conversations with others. Not all, but most of us. Even when we aren’t trying to impress someone, we don’t want our friends and acquaintances to think “God, I can’t stand listening to him!” This is one of the reasons that cliches are unacceptable in scholarly papers, news articles and any form of writing that is designed to be of a professional ilk. Likewise original thoughts and metaphors carry a heavier weight in verbal intercourse than tired-out cliches.

Nevertheless, worn old cliches and metaphors do serve a purpose. Some are so aptly put that it is difficult to come up with a better phrase to illustrate one’s point. “Between a rock and a hard place” is one metaphorical cliche that comes to mind. It carries an indefatigable image to which anyone can relate. The circumstances it describes are immediately understandable. And you and I both know that no amount of learning or eloquence will eradicate tired cliches and metaphors.

Therefore it seems time that rather than declaring a moratorium on such phrases, it is time for a quick lesson on their use and structure. As stated, no one wants to seem unintelligent in front of anyone. The act of using a cliche or threadbare metaphor treads thin ice (there’s one!), so let’s make sure that you know how to properly use them.

Let’s look at a few examples. “It’s six of one and a half-dozen of the other” is a benign starting point. If you are going to use this cliche, go to the trouble of actually saying “it’s six of one and a half-dozen of the other.” A popular bastardization of this phrase lately has been expressed as “it’s what and what.” Remember, we’re trying to sound marginally intelligent. Abandoning the imagery that “six of one and a half-dozen of the other” carries just sounds stupid. To say “what and what” simply portrays the speaker as one who rummages around in his brain for a simple thing, a thing that should be right there on top of everything else and, being unsuccessful, asks the listener two questions “what?’ and “what?” because he can't even finish his own thought. Do you want to be the type of conversationalist that your listener thinks of you: “Jesus Christ, he can’t even come up with a tired old metaphor! I don’t want to listen to someone who can’t even find his conversational ass with both hands.”

Here’s another one. “God-given” and God-forsaken” are NOT interchangeable. "God-forsaken" is a description of something that even the Creator of all things has left alone. If you have a God-given right to something, do not say it is God-forsaken. This will have the rest of us picturing you finding something after digging through a dumpster of hazardous waste and horrible, rotting garbage in the effort to cling to that thing which even the homeless would throw out. If you believe that you have a “God-forsaken right” to something, then by all means, indulge in it, but don’t whine to anyone that no one else wants to be around you. Even God would ask what that smell is.

Do you you have a girlfriend? A boyfriend? Significant other? Life partner? Mistress? Sweetheart? Fuck buddy? Then please let the world know this relationship! Do not refer to them as your “boo.” It sounds as if you were going to say “boyfriend” but then got tired mid-word and just left it at “boo” because you were too lazy to finish the syllables. At best, describing someone as your “boo” sounds as if the individual in question is the person who scares you every Halloween.

Do not try to improve upon cliches and well-known metaphors. If you must describe yourself as being stuck between two difficult, if not impossible obstacles, then say that you were “between a rock and a hard place.” Do not tell your audience that you were “trapped between a cliff and a mountain.” Nor should your say you were betwixt “a concrete wall and a cement rampart.” Your metaphor may be amusing to the odd geologist or structural architect, but for the most part, we will think of you as someone who has clearly never gotten laid.

One more tip, because I’m tired and I want to go to bed. Avoid dogs in your metaphors. Utilizing the imagery of a canine is confusing, and can make you look like more of an idiot. The common phrase “working like a dog” is not consistent with the also common phrase “it’s a dog’s life.” If you describe someone as working like a dog (rough, sweaty, difficult work) then how will we reconcile the leisurely, lying-around-but sometimes-licking-my-butt imagery that “a dog’s life” conveys? Are you “dog tired” because you were working “like a dog” or because you laid around in the sun doing nothing on a “dog day afternoon”? Yes, dogs in conversation are inconsistent, confusing and often embarrassing. Avoid them. You don’t want to give your friends the wrong impression when you greet them with “Yo, dawg!”

Stay tuned for more metaphor madness in days to come. In the meantime, try not to sound like an idiot. Yes, this may mean you might actually have to use your brain when speaking. But then, isn’t that what you want to sound like you’re doing?

The Science of Apathy (Or Maybe the Science Fiction of Apathy)

The Science of Apathy (Or Maybe the Science Fiction of Apathy)

I love sci-fi. I love real life too. It’s always so much fun when I watch sci-fi movies about aliens and space travelers and such. They’re always trying to blend in with their disguises and their shape-shifting ways, only to be foiled by keen-eyed civilians or “the government.” Earth survives another day. Yay.

But then it comes down to real life. I’d love to believe in actual extraterrestrials. But I don’t. Why? I haven’t seen any. Nor have you. Or have we? How many times have you seen someone on the street that was just so ugly or deformed or unearthly beautiful? Did it ever cross your mind that they might be an alien? Of course not. Me neither. But here’s a fun thought: what if they are? I’m sure psychologists would say that our minds simply try to incorporate the unusual into our usual frames of reference. For example, a time-displaced caveman might refer to a helicopter as some sort of bird (remember that movie?). Likewise, we would probably just think of an alien as a different-looking human. We’d just say “Oh, they must just have Down Syndrome,” or “What a an unfortunate birth defect, having a head shaped like the Sydney opera house. She should get surgery for that.”

Which brings me back to sci-fi. Remember when Captain Kirk and crew returned to the 1980’s to retrieve their humpback whales? The Shat ordered his crew to remove their Starfleet insignia. Why? Who would care? Mr. Spock wore that bandana thing to hide his ears. Really? What was the point? (Pardon the pun.) I’ve seen lots of people with weird-shaped ears but it never once entered my mind that they might be an alien. I’d venture to say that you, dear reader, have done the same.

I’ve been a paramedic and a nurse for nearly twenty years. Many, many times I’ve listened to patients’ chests and heard heart tones on the right side as well as the left, or heard breath sounds when listening to an abdomen. Breath sounds in a belly or heart tones on the right side are exactly what you shouldn’t hear. But I never suspected that they might be a timelord like Dr. Who or other such alien with two hearts or otherworldly arranged internal architecture. I just figured that my stethoscope was really sensitive or the patient’s chest was particularly resonant.

The sci-fi show that I think strikes the nail on the head psychology-wise is “Invader Zim”, a Nickelodeon cartoon that only ran for a couple of seasons. In it, Zim is a green-skinned alien with no ears and pink eyes who lives in a freakish house. He goes to great lengths to disguise himself as he plots to annihilate the world. Zim needn’t bother. The only person who believes he is an alien is Dib. Everyone else is convinced Dib is insane. All the rest of humanity is completely apathetic about the unusual happenings surrounding Zim.

That’s pretty much how humanity really is. I don’t think that there are extraterrestrials living among us; which, if you’re an extraterrestrial, is the perfect disguise. The folks that believe in aliens are the “fringe” people, and they proclaim their stories of abduction and insidious alien plots between doses of Seroquel behind the revolving door of their psychiatric facility. What if they're actually right? Like I said, I’d like to believe in aliens, but I don’t. Does that make me as apathetic as the rest of the world? Probably, but I don’t particularly want to spend my days behind that revolving door in a Seroquel happy place.

So is there a happy medium? Can a normal person find a compromise between boring, sane apathy and the men in the white coats? Just for fun, next time you see someone unusual-looking, imagine that they might actually be an alien, instead of an unfortunate soul whose eyes are too far apart or in need of a good plastic surgeon to take care of that tail or proboscis. Just the other day, I saw a man who was odd-looking (I say he was a “man,” but who knows?) His eyes were really far apart and his skin was an odd shade, sort of like you would get by putting too much butter on burnt toast. His ears were odd too, almost star-shaped. My first thought? Some black guy born with fetal alcohol syndrome. My second thought? He could be an alien and no one else realizes, or cares! The second thought, that he might be an alien, was so much more fun than the depressing disease process thought! Try it! Just be careful who you talk to about it.

See you in the asylum!