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I wrote a letter to a friend of mine who's a writer, a fellow Coastie and, oddly, has the EXACT same birthday as me! I wrote it out as freely as my pen would flow and then went back to proofread. As I read it, I realized I had an amazing blog post here!. I was speaking to him (in ink) with an honesty and freedom I haven't used in a LONG time in this blog.

I will excerpt:

"My life continues to be a series of sublime moments that awe me without fail"

Yes, that's true but here's the blog-worthy part:

"You wrote in your letter that you haven't ever found the place where you can say, 'Therein lies the boogeyman!' Well, I think I have found him. This boogeyman lives in the most uncomfortable place. He's right here *Taps Sternum*.

I told myself that I was coming to this land without any prejudice, preconception or bias. I truly came here with my heart open to every person I meet but, DAMN!, It snuck up on me!. 
If I walk down the mall in Washington, DC and someone is looking right at me and they track me with their eyes and head as I pass, My first reaction is going to be, "OH HELL, It's on!!!" and to get ready for a running fight.

This is the most obvious example of how wrong my notions are over here. I'm tall, white and odd-looking. This is a society that, truly, abhors personal violence. I'm more likely to be killed by a meteor than to get into a fight with an Arab.

I had been going around this place in a state of high alert, ready to 'throw down' and get busy. Then, one day, I was at a shopping center and I was tired of this hard-look, closed-face 'eyeballing' I was getting at every turn.

I had been here long enough to learn the basics of greeting and salutation. My predilection to languages allows me to speak Arabic with an almost perfect regional accent. So, here is a young Arab guy in his traditional dress with prayer beads in his hand. He's looking HARD at the big, fat, white, American me!

I lock eyes with him.

I see he has no weapons (training will never die).

I tilt my head and dip my chin in a gesture I've learned as both welcoming and courteous. I say, 'Salaam Aleikum (Peace be upon you).' But my hands are free (that damn training!).

The BIGGEST smile EVER explodes across his face and he enthusiastically says, 'Wa Aleikum A Salaaam (and upon you, Peace!)!' He throws his arms wide in a gesture that is, at the same time, welcoming and disarming. What a charming young man!

Now, it's broken English, MTV-references, and a crowd of young Arabs who are eager to show off how much English they have learned from the internet and TV. I received no less than seven invitations to dinner and later get text messages inviting me to coffee, weddings, etc.. It's handshakes, back-slapping, smiles and enthusiastic affection. The EXACT opposite of what I feared.

All of the fear of foreign people, backwards societies and unfathomable religions had been clouding my view of the truth I had written to you before, my friend:

People are just people.

The boogeyman was in me. I'm sure each of those young Arab men saw the boogeyman on my face as I returned their 'hard stares' and I've since learned to put a pleasant smile on my face out in public. Once I stopped being afraid of the boogeyman (or, stopped being afraid of people I don't understand) I find I move though this country like an honored prince.

However, I'm white, tall, American and MALE. Only the King (peace be upon him) has it better than me.

Yes, Racism. It's alive and well here. I have found that, along with suppressing the 'boogeyman' in me, I've had to suppress the 'Outraged Defender of the Weak' hero that lives in the very front of my conscious. There are not enough numbers in my mind to count the times I've had to stop myself from punching the **** out of someone. There are many times in my work here when I have to engage in the uncomfortable exercise of suspending my compassion.

That has been, for me, the hardest part of moving here.

Life is cheap here. I see so many preventable deaths that are attributed to the 'Will of God.' Is it appropriate that, just because someone is from Bangladesh, he should be a laborer and treated as chattel? Is it 'The will of God' that the Indonesian housemaid you've hired should also have sex with the man of the house because she is, in essence, a slave?

Slavery was only made 'illegal' here in the late 60's. Enforcement?

I'm still trying to reconcile those wonderful, generous, welcoming young men (who later helped me buy a mobile phone) with the notion that any one of them would willingly rape an Indonesian housemaid because they thought that's what Indonesian housemaids are for. ... Or that ANYONE could think that another human being existed to be raped.

The 'boogeyman' isn't always immediately recognizable as the 'bad guy.' My strong desire to go punch the life out of those ********* and to 'Defend the oppressed' has to be held in check. The boogeyman wants to go a-prowlin', kicking ass and saving people exactly as we learned in all the comic books and TV shows of our youth.

The problem is that all of those 'hero' stories relied upon a moral, rightful and same-thinking society there to receive the rescued victims of our heroism. There are not a lot of comic stories about how Batman helped that gang-rape victim have the strength to continue to go to therapy. I've not read a comic about Superman helping the teenage son of a woman who was attacked deal with his own anger and sense of helplessness. Nope. That's, somehow, not heroic. We western (read: American) 'heroes' think we can swoop in, fix the problem, receive accolades and leave. Obviously this notion has guided our foreign policy over many administrations.

I have suffered the hard lesson that I cannot be a hero here. In the USA, I could activate a victim-advocacy system when I encountered child, elder, spousal or other abuse. I often was able to do positive good because I saw that clues that someone was a victim and our society had mechanisms in place to help.

Not here. That's not easy to deal with as a paramedic.

Even more difficult is the situation I encounter where the victim is so ignorant of their life station that they are not even aware that they are being victimized. It's just how their life is.

I had a 13 to 16-year-old actively giving birth the other day. She had no F*****g idea what was going on. She's probably lived in a tent her whole life. Once he found out the baby was a boy and healthy, the 18-year-old father gave not a F**k about anything else. Meanwhile, I was busy keeping 'Mom' from bleeding to death and helping her deliver the placenta.

I'm not the hero there. I'm just the guy who helps make sure that mom and baby live until tomorrow. What they do with the rest of their lives (or what is done TO them) is not my purview. That's the part that runs up against my notions of 'hero.' That's the part that hurts the most.

'Well, what the heck am I doing here?' I ask myself. 'What is my role here?'

Again and again I have encountered other medical practitioners (nurses, doctors and others) who were clearly hired based upon what they can show on paper vs. what they can DO when the poop hits the air mover. Perhaps I need to feel I'm positively contributing to my workplace an our 'unit mission' (props to my Coastie audience). In the context of what and how I do my job, I often find(to my own horror) that I'm the most competent, trained or willfully assertive member of the resuscitation team.

There's my niche!! That's where I fit in!

I have learned to gently guide, direct and supportively 'push' the other medical personnel in my sphere to practice medicine in a way that is focused on the patient more than covering their own (or their manager's) butt. I work with a bunch of smart, driven, caring practitioners. However, I think I'm the only one who's not afraid to say, 'Let's do what we have to do!!' and that's the most important thing I do every day.

Somehow I'm in exactly the right place.

I'm not a hero. I'm not going to pull a comic-book-style rescue on anyone. I think the important thing is that I'm not afraid to give that little 'push' for my patient. Have I grown old enough to realize that the best work I can do here is by stepping back?

I hope so.


Halfway through the letter, I had to refill my pen. I'm going to bed with ink stains on my hands. Does that make me a writer?



In a few weeks days, I'll be moving over to the First Responders Network. These guys are awesome. Met 'em at the EMSToday conference in Baltimore this year.

Look for me soon at http://www.maddogmedic.com

w00t! My own domain! I'm turning into a grownup!

Stay tuned!



Where we're headed?

This Guy gives me hope for my profession.

With folks like him riding ambulances and being members of our community, we will improve.



Jolly and I are on night shift at the main clinic when we get a call for a security guard who's collapsed at a facility about 45 minutes away.

We roll.

On the way, we're advised that the patient has been loaded into a security vehicle and they are racing to rendezvous with us. We meet on the dusty shoulder of a desert highway. A panic-eyed security guard opens the back door of the SUV and I see our patient.

He's blue. It's been at least 20 minutes since we got the call.

That's not so good.

BVM, good air movement. I holler over my shoulder to Jolly. He slides in and we quickly transfer our patient to the ambulance. No pulse, no respirations.

Load and go, pump and blow!

The drivers hired by our company for the ambulances are not medical personnel. They are local employees who are sliding towards retirement. They have NO training in emergency vehicle operations and no concept of what it's like to be in the back of an ambulance. They also drive like locals.

Our particular driver has been infected by the urgent panic of our patient's colleagues. He goes screaming down the highway, around corners and over speed-bumps in such a way that Jolly and I can barely keep up CPR, much less attach a monitor, intubate or start an IV.


Jolly is alternating between chest compressions and bracing himself against the movement of the ambulance. I'm doing my best to manage the airway with basic adjuncts while screaming "Schweiah, Shcweiah, F*****g Schweiah, already!!!" Over my shoulder. ("Schweiah" means "Slow") The panic makes the driver deaf.


At the ER, we work the code with the rest of the staff, most of whom were my students in an ACLS class I had taught 3 days before.

Asystole on the monitor.

Tubed with a 7.0. Bilateral 16s, wide open. Enough Epi to make a sloth break a 4-minute mile.

We call it after about 30 minutes of working. We went that long mostly for the benefit of the patient's coworkers who were looming outside the door.

51 years old. This was only the second time he's ever seen a doctor. Also the last. His previous visit was 7 years ago and it ended with a prescription for cholesterol and blood pressure meds that he never filled.

We did our best but there's always that let down. Maybe it's the adrenaline wearing off, maybe it's the obvious grief on the faces of his friends.

It's late. I clean up and hurry over to the commissary next door to grab a missed dinner before they close.

The Indian guy at the checkout looks at my name tag. He pronounces my last name carefully.

"Do you know what your name means in my language?"

I shake my head. I'm really tired.

He wears a big grin. "Murderer!"

Great. Just great!



Pretty Lucky Guy Part II

After about 26 hours of ground and air travel, I'm safe and sound in my little desert Kingdom. I got through Bahrain with no delays. Even drove right over the Pearl roundabout and spied some flags and banners. Not much going on. While things are showing as busy and dangerous on the news, none of the much-covered unreast reaches this far into the unpopulated wastes where I live. Occasionally a camel may protest by blocking traffic for a while but otherwise things are quiet.

I'm a pretty lucky guy.

On my way out the security gate to go to work this evening, the young security guard brightens up when he sees me.

"Hello my friend!" He says with a big grin. He looks vaguely familiar but I go through so many gates and see so many security guards that it's hard to keep them all straight. I figure he's just being super-friendly as many locals are here. It's really quite charming.

"Do you remember me? You helped me!"  He says,  reaching out his hand to shake mine.

BING! It hits. It's the pretty lucky guy I treated a few months ago. I shake his hand warmly as he grins and smiles.

"Ali! How are you my friend?" I'm a little surprised and delighted to see him.

"I am fine, Al Hamdulillah (thanks be to God)! Thank you so much, my friend!" And he is. He's got  few scars on his forehead from the accident but he's up and walking around with no pain. Back on the job and happy to be there.

And grateful.




"Home again, Home again, Jiggedy-Jig..."

A spinner takes a mass of wool and makes it come together into an organized yarn of useful thread. A knitter binds that thread into a useful garment that fends off the cold.

Tonight, I'm hip-to-hip with my father in the kitchen of my parents' house. We're cleaning up after an awesome dinner my mom put together. I can think of no better way to spend my last night in the USA after my awesome experience at the EMSToday Conference and the amazing meetups provided by Zoll, Chronicles of EMS and First Responder Network TV.

Mom put on a fantastic feast and Dad & I are doing are doing our duty to clean up the aftermath. We be talkin'... We talk about politics. We talk about race. We talk about women and, ultimately, we talk about music. We both love the blues and the popular music that has evolved out of the blues. He likes Bonnie Raitt and Eric Clapton. Me? I like 'em too, but I do see the DIRECT connection between the blues and Led Zepplin, the Black Keys, or, even, the Beatles.

"Sheesh, maddog! When are you going to talk about EMS? We didn't sign up for some discussion on popular music in the USA and the UK in the 20th century!"

Well, here's where it folds together:

Robert Plant and Jimmy Page didn't set out to be one of the greatest bands of the 20th century. They originally just got together to listen to some old recordings of American blues artists that were pressed onto vinyl and shipped to the UK. From this collaboration came the awesomeness that was (and still is) Led Zepplin. (If you ever doubt that connection, please listen to the Levee Song, Dazed and Confused, I Can't Quit You, Baby and just about everything else they've done  --- wikipedia link HERE)

After meeting many of my blogging professional colleagues this week (and a poet!), I'm beginning to realize that none of us set out on our own personal journey to be superstars. We just became 'medics to fill a need in our community or to advance our careers or to keep us busy or to follow our fate-given calling. Whatever the reason, we came to here, now. We are paramedics. We are internet users. We are attuned to convenient, prescient and useful collaboration.

And, as such, we are bloggers. Somehow, doing that (blogging), we become better medics. As bloggers, we gain different insight into our day-to-day work. Thus, as medics, we become better bloggers. We know we are not alone.

We all take all these disparate threads of our experiences, con-ed, seminars, advice of colleagues, websites and medical journals and we try to spin and weave something that resembles a competent practice that, under the right circumstances, can save a life or two. That's all we ask for.

But, wow, we often feel like we are the only ones holding back the tide of death and misery. How many times have each of us felt alone? I do it all the time. Every time that loneliness has cut me deep, my fingers dance on the keyboard. I tell you (the collective 'you') about it and that, in itself, fends off the lonely.

Thank you all for reminding me that I am not alone.

I say to the rest of you out there: You are not alone!

Ask the question!

Vent your rage!

Share your funny!

Say It! Ask it! Do it!

"...Do. Or do not. There is no try. ..."

I used to tell my students, "Go forth. Do great things." I can think of no better advice to my newly (re)discovered community of blogging EMS providers.

I thank you all from the very bottom of my living, breathing and creative soul.



Recent Keyword Activity

Apparently some folks in Canada have been getting to my blog by putting the following into their Google search:

"bedoin peeing in sand"

Will the madness ever stop?



So much to write about.

Wow! What an amazing time I had at the 2011 EMSToday conference. I learned a lot, met some amazing people and have been re-energized to make this blog fly.

There's so much to write on but I've got 90 minutes until hotel checkout and too much knocking around in my head. I'll be with family for the next day or so then I have about 24 hours of plane and car travel to get me back to my tiny desert town.

I want to write about the people I met and the impact of social media on blogging. I've seen a DRAMATIC change over the last 2-3 years. I want to discuss that.

The recent protests in the Middle East merit mention considering where I live and work.

Give me a few days to get all these thoughts organized and I'll be pushing out some posts over the next few days.



Boat? What Boat?

While at the EMS Today conference in Baltimore, I popped by the EMS blogger party hosted by Zoll. (Thanks, Charlotte!).

What an amazing time. What an amazing group of people! I met some of the brightest, sincerest and funniest bloggers out there. I realized that my recent inactivity and general decline of blogging has led me to miss the boat. Social media, facebook, twitter and the increased interconnectedness that we get from that has transformed EMS blogging.

I started it as a diary of sorts of my times and efforts becoming and then working as a paramedic. Now, these amazing professionals share information, teach each other, engage in collaborative learning that would not have been possible 10 years ago and would have been unusual 5 years ago.

I feel like I took a long nap and then woke up to find my house full of the smartest, most motivated people I've ever met and they're all clamoring to do cool stuff.

People like Tom Bouthillet, the Happy Medic and so many others were there last night and I have to say to all of you, thanks. You have made me feel welcome again into this growing community of blogging EMS providers and I'm really glad to be back. You have inspired me.



Growing Pains

Howdy, all.

As you can see, I've updated my blog template from the same one I was using since 2004. UGH!

Unfortunately, my old comments program, Echo, failed to make it across so I have to now start using the Blogger comments and have lost all of my archived ones.

Furthermore, I was using Blogroll for my links bar. They've now gone defunct and I failed to backup my links. If I've linked to you in the past, please send me an email or comment and I'll restore the links manually.

Oh, if you're in Baltimore, come by and see me and other bloggers on Thursday night! Click Here.


Baltimore EMS Blogmeet 2011 is ON!

Howdy, Kids!

I've traveled 8,000 miles to be at the 2011 EMS Today conference and I'm keen to meetup with some other bloggers!

WHEN: Thursday, March 3rd, 2011 from 6pm until about 7:45
WHERE: Pratt Street Alehouse, at 206 West Pratt St., Baltimore (right across the street from the Convention Center)
WHO: EMS Bloggers and all of our thousands of screaming groupies!
WHY: Why the heck not? At least you can come chastize me for not posting as often as I used to.

Afterwards, I'll be heading out to the JEMS Meetup at UNO's Chicago Grill. The details are here. The JEMS Meetup promises to be pretty big and I'd like to have one just for bloggers beforehand. Come out to one of them, come out to both! WOOHOO!

In keeping with previous blogmeets, I'll be wearing a hat to be recognizable. This year's selection is below:

See you all there! Comment below or email me as needed.




On the bus from a remote clinic to home after night shift.

Sunrise on a desert landscape out the bus window while listening to the Drive By Truckers.




Bawlmer, here I come!


I'm going to the 2011 EMS Today conference in Baltimore, MD.

I've previously done a "blogmeet" however, I'll likely not be wearing the same hat.

Who's game this year?

Email or comment. Let's do this! Bloggers of the (EMS) world: UNITE! (to eat, drink and tell stories!).