Bulldog Falls out!

Bulldog and I are working a "day" shift. This means we end up with a nurse on board. There is benefit to this. Since the company only deploys a few nurses per day, we are kept in reserve for the calls that need a nurse. Furthermore, when we do get called, the patients are both challenging and interesting!

We run a few calls that morning. Really sick cardiac patients who need us to keep them from dying before they get their coronary arteries surgically opened up. Neat stuff!

Since the Nurse we're working with is not the most pleasant person in the world, Bulldog and I react by being on top of our game. Between the two of us, this nurse has not much more to do than chat up the other nurses at the sending and receiving facilities. That morning, this RedHeaded Nurse (who, coincidentally, has been referred to in this blog as the "CSC.") referred to me as a "Wheel Chock" and my partner as "useless." Two calls later, she was singing a different tune.

That afternoon, we're in a bookstore run by a friend of mine. It's me, Bulldog and The Redheaded Nurse or RHN. We're having a great time. Across the bookshelves, I hear the radio beep. Bulldog has the radio and I know we have a call. We exit our rows of books at about the same time and I see Bulldog's not feeling right.

She's concentrating really hard on her feet. It's as if she has to look carefully where she is stepping. I feel my eyebrows come closer together. My brain shifts into "observe the behaviors of the patient" mode.

"You Ok, Bulldog?"

"Yeah, I'm fine. We got a call."

"I know. You feeling alright?"

"I'm fine!" With all the emphasis that italics can convey.

"Ok, Then." I say, as we head out to our ambulance.

On our way across the sidewalk, The RHN sees Bulldog almost stumble.

"Are you ok?" She asks.

"Yeah, yeah. I'm fine." says Bulldog.

"You OK to drive?" I ask.

"Um, I think so..." Bulldog replies. Her eyes are going left and right.

Now alarm bells are going off in my head. One of the things I love the most about working with Bulldog is her complete confidence and composure with driving the Medic unit. She's got the skills to deliver me and my patient to the inner-city hospital quickly and smoothly. No small feat!

Now I hear her confidence wavering. I move myself to block her line of sight from RHN (who she doesn't really trust).

"Are you OK? Really?"

"Um, No. I'm numb all down my right side and I can't feel where my right foot is."

"C'mon." I say. I say it in that way that only medics can. There's no question. You're in trouble and I'm the one to help you. Come with me.

She does.

"I'm not getting in the cot!"

She does.

"You're not putting the monitor on me!"

I do.

"You're definitely not starting an IV on me!"

I don't but I do check her blood sugar. Way too low for having had a sugar-laden coffee drink from S***bucks just 20 minutes before.

"Which hospital do you want to go to?" I ask her.


"I'm giving you the choice. Which hospital do you want to go to?"

"Goddamit! You might as well take me to *$&^^^# Hospital!" Bulldog is not happy!

We take her there. Before we leave, I call dispatch.

"Dispatch, 229, we cannot take that call. Transporting our driver to *$&^^^# Hospital for possible CVA or TIA. Our driver is Dizzy, nauseous and suffering from right-sided paresthesia, and ataxia. Our ETA is 20 minutes. Traveling code 3 (non-emergency)."

Dispatch acknowledges but the supervisor (mentioned before) comes on the radio:

"229, can you run that cardiac call?"

"Um...229 to Dispatch. NO! (I almost drop the F-Bomb!) As I said previously, we are transporting our driver to $&^^^# Hospital for Right sided paresthesia, ataxia and dizziness. (I use the big words because I know this supervisor is in school.). We are out of service. How copy?" I speak clearly and distinctly. There is no question.


Well, that's the end of that!

Bulldog's diagnosis is non-specific. She leaves the ED with referrals to a cardiologist, a neurologist and a highly qualified chauffeur (Me!). The supervisor puts our nurse on another truck but keeps me with my partner. We leave work early and end up in a roadhouse about 35 miles from the office. We drink beers, bitch and moan.

Bulldog is angry. Her pride is hurt and she's ready to leave this place. I don't blame her.

It seems that after saving a life, I quickly left that place myself.

-more to come!!!



...Stay tuned!

Bulldog gets dizzy!

A life is saved!

An alma-mater speaks!

Maddog succumbs to gravity!

More to come...




Well, I've been at my job for a few months now. It's the 1st job since I've graduated and gotten my medic license. There's some things that I like and some things that I really don't like about this job.

Things I Like:

The Work:
My company provides inter-facility transport services. This means we take sick people from one hospital to the next. My specific job as a paramedic is primarily to transport patients who need cardiac catheterization or bypass surgery to the specialty hospital for that procedure. This means that many of my patients are very sick and require a lot of complicated machinery and drugs to keep their hearts alive. This usually turns out to be clinically challenging and interesting.

My Partner:
She is a 5 foot, 2 inch, 104 lb woman I shall refer to as "Bulldog." She's smart, thorough, and very keen on patient care and being an advocate for her patients. She's an EMT-B and her role in our medic unit is to drive and assist me as needed. She's awesome at both. She laughs at my jokes, doesn't mind the music I like to listen to and she let's me eat french fries off her plate. Awesome!

My Schedule:
I work two 12-hour days followed by two 12-hour nights followed by four days off. It's pretty sweet. Here's an example: Monday: 7am to 7pm, Tuesday: 7am to 7pm, Wednesday: 7pm to 7am, Thursday: 7pm to 7am, off for the remainder of Friday, Saturday, Sunday and Monday. Back to work at 7am on Tuesday to repeat the process.

My Workload:
It varies quite a bit. Since Bulldog and I are often released into he wild with a big ambulance and a full tank of fuel, some days I have time to go shopping, sit in the park and read, run errands and more. Other days we're so busy that by the time I take a break, it's an hour past quitting time. The variety is what I like the most.

Things I Don't Like:

My Pay:
I'll never get paid what I want to ($1,000 per hour with unlimited vacation) but at least I hope to get paid what I'm worth. Currently I'm earning about 10-15 percent less than other paramedics with my experience and training. Pah! Furthermore, there has been mistakes (not enough money for the hours I worked, not paid overtime for overtime hours, etc.) on about 75% of my paychecks since starting there.

My Company:
The office looks like crap, the human resources department is slow and backwards and the management enforces policy on a basis of convenience. Management tells us that they don't have the funding for raises but the company bought a new BMW and a new Jaguar for the top 2 managers at the office. I also referred a friend to work here. At the time the company had a policy to pay a $250 bonus to anyone who refers a new employee. I referred someone who has been working here for 4 months. Each time I ask for my bonus, I get another excuse.

The Management:
We have shift supervisors, fleet managers, HR managers and call center supervisors. At any one given time there may be 2- 10 members of management around the office.

The other day, I walked into the office to find the shift supervisor and the fleet manager asking Bulldog whether she's had sex with me or not and how many employees she's given oral sex to. A classic example of inappropriate behavior, if not sexual harassment. Everyone was smiling like they were joking but I could see that Bulldog was not amused. Later, when I asked her about it, she said she's complained before, even in writing. The only outcome of her complaints was dark looks from the manager she complained about and a move to a different shift.

Just a few weeks ago, I was gathering my gear and paperwork for another shift. The shift supervisor was in the room along with several other employees. One of the more annoying and incompetent employees, Bullet-head, was showing off pictures on her mobile phone. She was going around, shoving her phone into people's faces and then laughing. She did the same to me. It was a picture of a quadruple amputee having sex. Then a cartoon of a man masturbating at people. I ask Bullet-head what she would do if I found those pictures offensive.

"It's just a joke!" She says.

The shift supervisor looks on and does nothing. Awesome work atmosphere!

So yeah, my job stinks. Often I'm the only one who comes in to work in uniform: Boots black, clean clothes, shirt tucked in and cleanly shaven. I also don't trust the company at all. They don't enforce the uniform policy, the sexual harassment policy, driving safety policy and more. There are people driving company ambulances who were convicted of driving while intoxicated 6 months ago!

In my job, I handle narcotics. They are regulated by the state EMS board and by the Drug Enforcement Agency. If the management is so lax in enforcing the simple policies, how diligent will they be about the drug management policies? If there's a mistake, my ass goes into the grinder too!

So, I'm looking for another job. I've got 3 prospects right now:

A 911 response agency that employs chase-car paramedics in a mostly rural and farm area. Good pay and a 24-on 72-off schedule (sweet!).

A full-time position at my alma mater that's on annual contract.

A 911 response position at a retirement community. A small response area but the same schedule and similar pay to the other 911 job.

Unfortunately each of these potential employers are diligent and careful. The process of hiring will take a while as they will actually check my references, conduct a background check and consider my eligibility carefully. I guess that makes them that much more attractive. At my current employer, there are several persons working who have been convicted of drug possession, domestic violence and robbery (State court records are available online!). I'm sure there wasn't much diligence there.

The upshot of all of this is that I really love working as a paramedic. I just need to find a better place to do it.

I'll keep you posted of the developments as they come. I've got another post coming up where I do something extremely rare in transport-ambulance service:

I saved someone's life.

More to come...



My Ganglia and Mr. B's Danglias

Mr. B is off today to become a bit less "Mister." It'll be interesting to see how differently he behaves without the dangly bits. Kind of sad but it is a requirement of the animal shelter. It also makes sense to control the animal population.

On the topic of meningitis: I'm in the clear. My headaches are likely due to my discovery that I haven't found the best place in the world to work. Certainly not the best paying! More on that later....

I'm just back from a fast 2 mile run (ugh!) and I've got to shower, pick up Mr. B from the vet and finish the lesson plan for a class I'm teaching. More later, I promise.



Pain in the neck or pain in the a**?

I'm taking a patient through the emergency room out to the ambulance.

"Hey, Come here." says a nurse. Normally, I love that kind of thing but I've got a patient on my cot and I can't just stop.

The nurse is insistent. She drags me into an empty exam room.

"That sick patient you brought in this morning?"

"Yeah?" Says I.

"Well, he's got Meningitis."

EEP! "Bacterial or Viral?"

"I don't know, I'll find out."

Why does the base of my skull start hurting all of a sudden?




Writer's Block

Wow, it has been a long time!

I've had this big clot in my creative vein for a while. I just can't seem to get to it.

I've got plenty of material: My life as a paramedic (yay! I made it!), my job at a private transport company and the antics therein, the changed dynamics at my volunteer house now that I'm a paramedic in name but not in practice, my experiences driving our brand new ambulance and many other things have come up but I can't seem to get them down in words. I'm also teaching a 3 credit course at the university I just graduated from. Many of my students were classmates last semester. Interesting stuff. There again, I should write about it.

Hopefully, this entry will be the "clot buster" or the thrombolytic to my creative clot.

Since I only have an hour to clean my house, go shopping, vote in a primary election and make dinner, I'll just post some personal news:

He's a 2 year old mutt from the animal shelter. We connected very well at the shelter. He came home yesterday. His name (for this blog) is Mr. B.



There is no greater love...

I am but a brief episode in some people's life. I'm sure I'm one of the most forgettable parts of their lives. I'm often there at the end of their life. My presence, as a medic/ambulance driver/smiley guy who hauls the cot, is memorable, but the essence of me is easily forgotten.

That's OK. I'm not here to be memorable. I've been taking people home to die (discussions with hospice nurses) or to the operating room to die (dour looks from surgeons). It's not important to me to be the shining beacon of grace to anyone's memory. But I do love.

Each dying person, each brave-faced husband, each openly weeping brother is a recipient of my love. I truly believe that our job on this planet is to love everyone. I do that as best I can. I treat everyone with the respect and honor that I would want for myself.

During any 12 hour shift, my heart will break 4 to10 times. The last time will be as strong as the first. We all deserve love. That's what I do. It doesn't hurt me. I'm not "drained" by this burden. I come away from this with the feeling that I have given my whole heart to this. Everyone in my care deserves no less. I am in the right place at the right time.

Honor, respect and devotion to duty.

There is no greater love.



Another day on the job.

Bruno and I happen to be working together this day. He and I graduated from the same Paramedic program and during those 4 years, we discovered we like each other a lot. We both love running, pints and EMS. He volunteers in a neighborhood not far from mine where most of the area violent crime occurs.

It's my second day out of training and I'm working as an EMT-B driver until all my local Paramedic paperwork comes back. On this particular, beautiful day, our call volume was low and easy. We spent an hour parked under a tree in an arboretum reading the paper while waiting to pick up a patient from a nearby dialysis center.

Life is good!

Except for the shooting.

Later in the afternoon, we stop at an office supply store to pick up a clipboard and some pens for me (I'm a total pen whore!!). Finished with our shopping, we're sitting in the ambulance having just started the engine. From the rear:

"Ping, Pank! Pang! Ping! Ping! Pank! Pow!"

Bruno and I look at each other.

"We've been shot!" we say simultaneously. We both know what guns sound like.

"Twenty-two?" I ask skeptically.

"Nah, smaller than that. BB gun, I think." He replies.

I hazard a glance over my shoulder to see two kids running away from the parking lot.

I look over to Bruno. We nod then go out the doors simultaneously. Low and fast we slip out of the front to our respective side's rear wheels. Cars on either side provide cover. Stay in a crouch. Quick scan reveals no other shooters. My hand automatically goes to my right hip but the only thing that sits there these days is my cellphone. Great!

I come around the back of the unit and discover that Bruno's been doing the same thing I have. Low, fast and using available cover. This kid's never been trained but he knows what to do. He might live a while!

The coast is clear and a woman comes up to us to tell us she saw it all. Now comes the fun part. I call control.

"Ambulance 138 to control, We're going to need another unit to take our 5:30 call. The rear windows of our unit have been shot out. Local PD has been notified. Our location is Suchandsuch shopping plaza on Somwhereorothher Highway."

"Control to 138. (Loooonnnnggg Pause) Um, Er, Uh, Ooookaaayyyyy. Your windows have been shot out????? Uh, Yeah, um. Wait! Is everyone ok??? yeah!"

"138, Control we have no injuries."

"Control, 138. Ok, Right. yeah, Um, .....uh......Stand by!"

I think I just rocked someone's world. A short while later, another voice comes on the radio, presumably the supervisor.

"Control, 138. Stand by your position, a supervisor is on the way. Is your unit drivable?"

"138, Control. Copy supervisor en route. Unit is drivable but not fit for patient transport. PD is on scene and we have a witness."

"Control, 138. Outstanding. Disregard supervisor en route. Return to base when investigation complete."

"138, Control. Roger that. ETA 25 minutes."

Cool, baby. Nothing but cool!



Volunteer firehouse shift

I ran a call to a local residence. The call was for the father of a grade-school classmate of mine. When my former classmate came into the house I saw the look of anxiety on his face change to relief when he saw me. Somehow, my being there made it all right.

Unfortunately, we had a loooooonnnng wait at the emergency room. I went out to the waiting room from time to time to give the family updates and such. the second time I went out, my classmate and his mother were joined by about 5 people from the neighborhood. All of whom recognized me.

"I better see all of you at the Crab Feast this year!" I insisted. They laughed. The Crab Feast is our hugely successful annual fundraiser.

The second call came after midnight. It was dispatched as a car flipped into the woods on the major interstate. We arrived on scene to find a PT cruiser on its side in the woods. Both the driver and the passenger were out and talking to the police. They denied any pain at all. The passenger was a rather buxom young woman who's flimsy half-blouse had popped open during the vehicular antics. Bean was quick and business-like with a blanket while the cops and firefighters tried not to gawk.

I did a quick exam of both patients and found them to be unharmed. Really! They both were belted and both were asleep when the accident happened. The alcohol on both of their breaths was a contributing factor, no doubt. I left them in police custody.

The last call was for a woman presenting classic symptoms of choleocystits or gallstones. Nausea and abdominal cramping pain woke her that morning and she was retching yellow bile when we arrived. We transported her to the same emergency room I was at earlier. We arrived at shift-change and were quickly whisked into a room! Nice!

One of the off-going nurses gave me an update on my classmate's father and we both agreed that it was good we got him into the hospital. He had called us because his legs and "nether parts" were swelling and it turns out he had gone into persistent atrial fibrillation and the swelling was caused by fluid buildup in his tissues due to reduced cardiac output. Had he not gone to the hospital, his condition could have worsened over the next few days into full congestive heart failure.

The only other news from the volunteer front is I'm getting cleared to drive the ambulance. Bean is about to be cleared to ride as the EMS provider and I'll be able to free up a firefighter if I drive her on EMS calls. The big freightliner ambulance is a lot of fun to drive. I feel like I have the biggest Tonka truck in the neighborhood. Too bad it's not yellow!

Coming up.... Maddog has a job! and Blog website changes!




Been to the shore. Went sailing, swimming and sunning. Caught some seafood and ate it. Caught a sunburn and wore it.

Volunteer duty coming up this weekend followed by my new job.

More to come!



The Re-test!

I had scheduled with a local fire academy to sit in on the practical test they were conducting for their paramedic and EMT-I candidates. I just needed to retest the IV start station and that's it.

I get there 1/2 hour early, my stomach a roiling storm of anxiety.

"Anxiety, Maddog?" you ask, "You just have to go in, do one thing you've done a million times and you're a paramedic! What could make you so anxious?"

Well, you're right. It is an easy thing. I just have to go, start an IV on a mannequin arm, don't do anything stupid and I'm done. The problem is the stakes.

If I fail this one thing, if I goof up or get snagged on a technicality, the consequences are maddeningly painful.

I'd have to go back to "remedial training" which is about 24-40 hours of refresher training and then take all 12 of the practical stations again!!!

All because of a 3-inch piece of tape.

Yes, I'm anxious.

I'm in a classroom full of people.

They call my name second.

I enter the adjacent auditorium and walk up to the IV testing station. On the table are two mannequin arms. One has an IV established and another is untouched. I ask the evaluator and she tells me that the one with the existing IV is for the medication administration portion of the test. I examine it and see that the catheter is secured to the arm with:


Yes, that's right. The IV that was started by "the expert" is done in a manner that failed me the last time.


Back on target, I review my materials. The evaluator tells me that we don't have the clear, sterile occlusive dressings (commonly called Tegaderm), so I'll either have to use tape or simulate. Ok, no problem. I'm getting the sense that this testing site is not as picky as my last time around.

I do my thing.

I don't mess up (I think).

The evaluator gives me no indication of whether I failed or not. That's it. I've taken my shot. Now I have to wait and hear if I'm a paramedic or a Pair-of-hands.

This is the worst part.

I go back to the classroom where the rest of the candidates are waiting. A few questioning looks come my way as I come in. I shrug. I think I passed but I don't know for sure. I review my copy of the evaluation sheet. I can't see that I've done anything wrong. Still, I'm not sure if the evaluator has dinged me on anything.


I listen to my iPod. I meditate. I try to read. I try anything to distract myself from the maddening wait.

Finally a testing official comes in to the room with a score sheet in his hand. I'm ready!

He calls someone else! ARGH!

Again he comes in! Nope! Not me.

One more time? He butchers my last name but I don't care.

Out in the hall, I ask him, "Is it remedial training and full retest for me?"

He's got a poker face. He has to ask me the official questions, "Do you have any complaints of discrimination or were there equipment failures?" This is a requirement before they give us our results. It's also the candidate's only opportunity to lodge a complaint.

I've got no complaints and I tell him so.

The poker face vanishes. A big smile and a handshake. "Congratulations!"




The aftermath......

Well, here it is. A week after everything is done.

Here's how it went down after my last post:

Tuesday, 5/16: Study Study Study Study and study some more. I took 3 pre-tests and passed them all. Went to bed early.

Wednesday, 5/17: The written exam. I finished the 180 question exam in an hour and a half. I walked out of there feeling pretty good about how I did. Considering I passed all my practice exams and reviewed the questions I missed, I felt pretty good. Ok.

Thursday, 5/18: Showed up at school around 9am and practiced my stations for the practical over and over. I had a plan, I had to do each one correctly without failing 3 times. If I failed a station, that didn't count towards my total. I had a checklist and I meant business. I worked my butt off. One thing that was giving me fits was a taping method to secure an IV. I don't have a picture nor could I find one online. I had been taught by everyone I know that a good way to be sure an IV is secure is to put a loop of tape over it and make a "chevron" to keep the catheter from getting pulled out.

Well, with gloves, sticky tape and such, it's a difficult endeavor for the beginner. Since it's been taught to me as the way to secure an IV, I practice and practice and practice. I want to get this right. Eventually, I get the hang of it and get it down. I've seen a lot of nurses and paramedics do this and I want to be sure I get the IV skill station perfect.

I spend a lot of time working up my dynamic cardiology, static cardiology, trauma assessment, spinal immobilization (seated and supine), bleeding and shock control, adult intubation, medication administration, pediatric intubation and intraosseous access. When I leave the lab Thursday afternoon, I'm feeling confident that I can get this thing done. Which is a good thing since my volunteer firehouse has a kickball game that evening and I end up pretty smashed on cheap beer. (UGH)

Friday, 5/19: Almost the day from hell. Woke up with a hangover (Damn you, Miller Light in a can!). Spent most of the day getting ready for a party I'm DJing that night for Herself's company on board a dinner cruise boat. The problem with this is I expected to show up with my laptop, iPod and mixer and just plug in to the existing system. The dinner cruise boat tells us at the last minute that it's against company policy for anyone to use the shipboard equipment except the house DJ.

An amazing friend comes to the rescue with amps, subwoofers, speakers and other electronic madness. We lug it all in a minivan to the dock, load it up and the party's rockin! Maddog has got mad tunes!! Fortunately for me, at 10:30pm, the crew shuts us down. I mean 10:30 on the dot! Pull the plug! Normally, I'd be cranked as I like to keep it going all night. Not tonight, though. I have to get up at 5:30 am to be at the community college for my paramedic practical exam.

I actually manage to get home, get about 5 hours of sleep!

Saturday, 5/20: I woke up on time, had a good breakfast, packed a lunch, reviewed my drug dosages and headed out the door! I got to the testing center early and the atmosphere was jovial. My first station was bleeding and shock control for the basic skill. I go through it, pretty well, I think, and walk out of there feeling good.

I keep telling myself to visualize a positive outcome. I don't dwell on my past performance, I keep focused on the next task. The next task is dynamic and static cardiology. I go through and think I did ok. There were a few points where I wasn't sure but I reviewed my protocols and am sure I go it right. Sort of. There's still a lot of doubt. Technically, I did the right thing but did the evaluator see it? Did I miss something critical?? It's nerve-wracking!!! I see all of my classmates doing the same thing. Ugh!

You see, with national registry testing the evaluators are not allowed to give you any feedback on your performance. The logic is that the testing is an evaluation of one's skills and abilities, not an opportunity for learning. As a result, I walk out of each station with only my own assessment as to whether or not I passed. The results are tabulated and given out when everyone has completed all the stations. It really does take a lot of effort to focus on the next evaluation and not repeatedly review one's past performance.

The day goes on.

Trauma assessment. Perfect!

Pediatric airway: Perfect!

Pediatric IO: Perfect!

Adult Airway: Double perfect!

Oral Station (where one has to talk through a call from the time dispatched to patient delivery at the hospital, including all aspects of scene management and patient care): Perfect X 2!!!!

IV start and medication administraion: Perfect!

I'm feeling pretty good. I'm thinking I've probably failed my dynamic and static cardiology. I'm delighted about my performance everywhere else but I won't know for sure until a National Registry official walks into the room, calls my name and takes me out in the hall to tell me my results.

The waiting? It kills me!

Finally, my name is called. The official tells me that I passed everything except IV.

WHAT!!! IV!!!! Wow! I must have made some dumb mistake! That means I passed EVERYTHING ELSE!!!! Woohooooooo!!!!

I'm delighted! I have this vision of leaving the testing center completely finished. Completely done!!! Wow! I just have to go back in and re-take the IV station (they're letting us take one of our two re-tests on the same day).

Ok! One more to go. No sweat. I review over and over again while I'm waiting for my name to be called. I'm going to nail this one and do it perfect!

My name is called.

I go into the station. I do it exactly as I was taught and perfectly!

I walk out of there feeling like a million bucks. Once again, I have to wait in the holding room for the official to call my name and tell me my results. This time, I'm not too worried. I pretty sure he's going to shake my hand and congratulate me.

He calls my name. I go out to the hall with him.

He's not smiling. He does not shake my hand.

I failed it again!!!!!

I'm outraged!! I cannot believe it!! What the hell! I did the station perfect! It's the most simple one of all!! I've started a bajillion IVs in the field and in the lab. What the hell did I do wrong???

Nope. Can't tell you. Thats now how national registry works. You're here to be evaluated, not trained.

I make noise.

I stomp my feet.

I almost make a scene.

Chief, the director of my program, comes to me to ask me how I'm doing. I tell him I failed when I should not have. He starts with the "well, that's how it goes..." speech but I stop him.

"No! I did everything perfect! I did it fucking perfect!" Yes, I drop the "f" bomb. Chief has never heard me cuss. He knows I mean business.

"I'll see what I can do." He says and hurries off.

The medical director for my program, my teachers and the head of the department are all present this day. Chief gets them to lean on the evaluators under the pretense that I may challenge the evaluator's ruling. A bit later, I'm asked to step out into the hall. I meet with Chief and my medical director, Dr. S.

"You violated the sterile field."


"You put a piece of tape around the IV tubing underneath the Tegaderm, or bio-occlusive dressing at the IV site."

"Of course I did! That's how everyone's taught me to do an IV. It's supposed to keep it from coming out. In fact, I practiced my ass off to be sure I could do it right!"

"Well, apparently, that's not the proper way to do an IV." Dr. S. tells me.

I turn to chief.

"Why didn't you teach me that two years ago?"

He just shrugs.


As you can imagine, I'm a bit pissed. I go outside, I call a friend and vent for a bit. Ok, I missed one station, I'll have to test it again (Not until june 13th at the earliest, goddamit!), but the upshot of all this is this:

I passed all the stations I was worried about! In fact, I passed them on my first try!!!


Ok, so I've got a slight delay in my process to certify for paramedic but, it's in the bag! I head downtown to meet with herself and a bunch of other people who have nothing to do with EMS.

Sunday, 5/21 to Wednesday 5/24: Played video games. Read crappy spy novels and murder mysteries. Stayed up all night goofing off. Went running and did a spot of beer-drinking.

Thursday, 5/25: I graduated from college!!!

Friday 5/26: I checked the National Registry website. Under "written exam" it says "Passed."

One more IV start and I'll be a paramedic instead of a pair-of-hands.




Home stretch....

Oral exam and review with my medical director today...

Written exam for NREMT-P on Wednesday...

Practical Exam for NREMT-P on Saturday.

I'll post when I can.

(waving hands in the air and running around) AAAHHHHHH!!!!!!!



...and that's a BAD day!

If I'm doing this to you:

You're probably having a really bad day!

Speaking of bad days, one of my patients was shot in her own home. She deteriorated pretty bad during transport and developed a nasty hemothorax (blood in the chest cavity). I'll try to post more detail later. I'm hella-busy this week (and the next 2 until my registry test!!!! EEEEK!).



monday, Monday, MONDAY!!!

In my last entry, I wrote a list of "coming soon!" items. Doc Shazam commented on them as such:

"Just some guesses:
#2 - Normal saline?

#3 - DOA?

#5 - Hyperkalemia?

#6 - Did they survive???

Well, Doc, and the rest of you reading, here you go:

"#2: Dehydrated Patient Miraculously Restored With a Miracle Drug!"

The call was dispatched as "sick person." This kind of call induces a lot of eye rolling at Lucky McGee's station as it usually means some indigent person who doesn't feel well and doesn't have cab fare.

We arrive at a single family home to find a woman in a postal carrier uniform sitting on the couch. She's drowsy and obviously uncomfortable. She said she's been having diarrhea all day. "It's like I'm peeing out of the wrong hole." Add a little vomiting and she's rather volume depleted. I check her skin turgor and am surprised to find it actually works like in the books.

Pinch a bit of your skin on your elbow, knee or other bony part. Generally, if you're not dehydrated it plops back into the shape it was before you pinched it. This is called your skin turgor. Patients who are dehydrated have poor skin turgor, that is their skin stays a bit in the shape it was pinched. It makes a little "tent." Sure enough, this woman had a little tent on her elbow after I pinched it.

We load her onto the cot and then into the ambulance. She's fading in and out of consciousness. She's so dehydrated that I can't get a line. her veins just fall flat when I try to start an IV. Lucky comes over at my request and starts a good one in the arm. Once the IV is started we hang a bag of fluid. Some jurisdictions use Normal Saline which is just water with the same salinity as blood (0.9%) but in this place they use what's called Lactated Ringers solution. It's got a bunch of stuff in it but is basically the same. Most importantly, It's got water!

By the time we arrive at the hospital, I have squeezed about 400 ml of fluid into my patient. She's woken up fully, is feeling much better and looking about 10 years younger.

Water, the miracle drug!

"3. How a nursing home killed my patient and I get the 'blame.'"

We get a call for "trouble breathing" at a nursing home.

As it usually goes in this particular city, the Fire department arrives before us and are already preparing the patient to be transported. I walk in and see an elderly man with a gastric tube (a tube going directly into the stomach through the abdominal wall) hunched over to his left side. He's pale, sweaty and trying desperately to breathe. The nursing home has him on 2 liters per minute (lpm) of oxygen by a nasal cannula. The first thing I do is haul out a non-rebreather mask and hand it to a firefighter.

"Hook him up to about 12lpm, willya?" I ask and it's done. I listen to the patient's lungs. He sounds really "gunky." This means I hear coarse crunchy noises in his lungs when he breathes. It's a sign that he's got some fluid or something in there. He's also using his accessory muscles to breathe and this is causing a lot of retractions. This means that his diaphragm and muscles in his ribs aren't enough and he's using his shoulders, neck muscles and more to try and open his lungs up. Right away, I see this guy is in trouble and we need to PUHA.

Pick Up, Haul Ass.

A nurse or attendant hands Lucky a sheaf of papers that contains the patient's conditions, medications list and some doctors orders. After delivering her payload, she promptly disappears.


In the ambulance, Lucky and I get a line started and begin to debate whether or not we are allowed to intubate. The patient has what's known as a "Do Not Resuscitate - Arrest" or DNR-A. This means if he goes into cardiac arrest, we're not allowed to re-start his heart. It's not clear if we can intubate or take heroic measures before he goes into arrest. Either way, his oxygen saturation levels climb from 77% in the nursing home to 95% in the ambulance. I've accomplished this by sitting him up higher and straighter and increasing the flow of oxygen.

The ride to the hospital is very short and we deliver the patient to the emergency room and a waiting team. I read the patient's paperwork and find that he's on a gastric tube because he has no gag reflex and there is an order not to lower him any more that 30 degrees from. Dammit! When we had arrived at the nursing home, he was completely slumped over on his left side.

When we returned to the hospital later, the doctor who treated him came over to talk to me. He said that the resuscitation team did intubate him and suctioned about 500 ml of the "food" that's pumped into his stomach from his left lung. It appears that while he had been slumped on his side, the pudding-like nutrient stuff flowed up his esophagus and into his lungs. The patient did not recover from the insult to his system and later died. If someone would have checked on him and then simply sat him up, it might not have happened.

All day long, Lucky tells everyone how great I am, "He's already killed one today!"


"5. Missed dialysis becomes nausea and vomiting becomes abdominal pain becomes premature ventricular contractions."

The call went out as stomach pains. In the nursing home we find the patient in a daybed clutching his stomach and in a lot of pain. He's sweaty and warm too. It's a riot in there. There are 2 nurses, a cop and about 3 other residents of the nursing home. Each one hollers a different fact at me.

Okeydoke. Load 'im up! He's got a shunt in his arm where he hooks up his dialysis machine. It appears he missed his last dialysis session and has been suffering diarrhea, vomiting and stomach cramps all day.

Neither Lucky or I can get an IV on this guy. His veins, what are left, are horribly scarred. Between the dialysis and history of IV drug use, he's a mess. Oxygen and monitor. The 3 lead shows some S-T elevation but it looks old. I set up for a 12-lead and get a good analysis when we stop at the hospital.

In the ER, I hand the 12-lead to the nurse. Peaked T-waves and PVCs popping out all over the place.

"Missed dialysis?" She asks me.

"Yep!" says I.

Your kidneys are responsible for regulating the amount of potassium in your blood. If you need dialysis, it's because your kidneys aren't doing a very good job at all. Miss a dialysis session and the potassium levels in your blood get too high. This messes with the operation of your heart's ability to work right.

Good call, Doc Shazam!

"6. Pulmonary Embolism (blood clot in the lungs) + thrombolytics + stopped heart = the ENTIRE ER staff is exhausted!"

While Lucky McGee and I were dropping off another patient in the ER, our driver came over to me.

"Hey, man go to the resuscitation room, you'll find that interesting."

Ok! I like interesting things. In the resuscitation there's a doctor doing chest compressions while a nurse ventilates an elderly woman. The woman has a cast on her right leg. Everyone else is kind of standing around watching.

In a "code" situation, everyone is usually doing something. It looks like chaos but often is very orderly. in this case I'm puzzled that nobody's doing anything. After a minute or two, a nurse relieves the doctor doing chest compressions. I'm watching the heart monitor while compressions are being done and there's a good, regular waveform. Nice job!

"What's going on?" I ask another doctor standing next to me.

Turns out this woman was riding in a car with her son driving. He was driving her from New England to Florida. She couldn't drive because she had broken her leg a week or so before. Half way to Florida, she just slumped over and stopped breathing. The son drove directly to the emergency room of this hospital.

The doctor thinks it was a pulmonary embolism. Her heart was in asystole (flatline) so they decided to try to break up the clot. They pumped her full of Alteplase, a clot-busting drug, and were moving it around her bloodstream (and her lungs) by doing CPR.

"The problem is," says the doctor to me, "Alteplase takes anywhere from 10 to 30 minutes to take effect. We've committed ourselves to this course of action for now."

I see other ER staff lining up to take their turn doing chest compressions. They start to eye me and my student badge. Uh Oh! I'm outta there! I've done enough CPR to last me a while.

We left before I heard the ultimate outcome of the patient but it wasn't looking good. She had apparently been "down" (not breathing) for a good 5-10 minutes before the son even got to the hospital.

DANG! That's a long post! Thanks to Doc Shazam for the comment and feedback. I'm riding with Lucky McGee again tomorrow. My certification tests and finals are coming up in the next 3 weeks. I'll try to post as much as I can.



The trailer: "Coming soon!!"

Crazy day with Lucky McGee. We left on our first call at 0600 and didn't return to the station until 1545.

The highlights:

1. Everybody poops. Some more than others!
2. Dehydrated patient miraculously restored with a miracle drug!
3. How a nursing home killed my patient but I got the "blame"
4. "Seeya later, handsome!" from a 79 year old lady.
5. Missed dialysis becomes nausea and vomiting becomes abdominal pain becomes premature ventricular contractions.
6. Pulmonary Embolism (blood clot in the lungs) + thrombolytics + stopped heart = the ENTIRE ER staff is exhausted!
7. Cranky Firefighters and justice served.

I'm off to bed. I'll fill in details tomorrow.

Good night!



Volunteer Firehouse, overnight shift.

A rainy night at the volunteer Firehouse. We had a full crew, that is, enough to staff both the ambulance and the engine. Which was fortunate later in the night as we had thunderstorms and drunk drivers galore.

I had arrived early and picked up a call nearby for a 21 year old with trouble breathing and a headache. The calls sheet also listed him as an asthmatic. Out here in the Eastern US, the pollen count has been ridiculously high so, I wasn't surprised.

We arrive at the apartment and a young woman leads us back to a bedroom. I stop her while I'm still in the doorway, hand on the handle. My crew-mates are behind me. The fresh-faced new kid doesn't understand what I'm doing but my driver knows how I work and pulls him back out of the doorway.

"Do you have any pets in the apartment?" I ask the young woman.


"Is there anyone else in the apartment?" I ask.

"Just me and him." She replies, indicating our patient aaaalllll the way in the very back of the apartment.

After a look around, I enter. I indicate for her to lead the way and I close the doors to the other rooms in the hallway as I go. I hate surprises.

In the back bedroom I find a young man lying on the bed. I ask him what's going on and he tells me he's got a really bad headache. He gives me a lot of detail and speaks in complete sentences without needing to pause for breath. My initial impression is very good. He's giving no signs of being short of breath.

I have him sit up and take off his outer shirt. He does all this with no difficulty. I listen to his lungs and hear some wheezing in the lower part of his right lung. I ask him if he has his inhaler.

"Yeah, I just got it yesterday."

"Have you used it before?" I ask him.

"I used it for the first time this morning at around 9am."

"When did your headache start?"

"About 9:15."

One shot of the inhaler and his wheezes clear up and I've got him breathing 100% oxygen from our bottle via a non-rebreather mask. He's not complaining of any shortness of breath and his vitals all look good. He had been diagnoses with asthma the day before and, it seems, hadn't gotten used to the side-effects of his albuterol inhaler.

He doesn't want to go to the hospital. In fact, his roommate had only called because his father, who's on the way from 60 miles away, had insisted. I assure him we can take him if he wants but he says no. I'm sure he's going to have quite a discussion with his dad later on.

The other call before bed was for a nursing home patient. Her doctor had done a blood test that morning and the results indicated that she might be in kidney failure. She's got a medicine and illness list that goes forever. I ask her attending nurse/technician/whatever for some background, i.e. When was the last time she took insulin? Is she normally like this? When was the last time her blood sugar was checked?

He hands me a sheaf of papers and looks at me like I have 4 head and am speaking Aramaic. It always amazes me how much better care nursing home patients get when the ambulance crew arrives. Her blood oxygen level was about 82% when we arrived and she was getting 2 liters per minute of O2 via a nasal cannula (a little pronged tube that shoots oxygen into your nose).

Well, she's breathing through her mouth so the O2 is not going anywhere. We put a non-rebreather mask on her, crank up the flow rate to 15 liters per minute and her O2 saturation goes right up to 100% and she becomes almost instantly responsive and almost alert.

Basic patient care! WOW!

Off to the hospital where I write up a very thorough patient report.

The remainder of the calls that night all happened between 2 and 6 am. They were all traffic-related (car accidents) phoned in by people who were speeding by the accident at 70mph and not stopping. As a result, half of them were not there when we got there and the other half were either non-injury, broken down cars and one person who just pulled over to sleep off all the "cerveza" he drank at the strip club. (He got a ride with the police).

Nothing too exciting, I'm afraid. I'm riding the day shift with Lucky McGee tomorrow as a paramedic student. I'll be riding in a city that is one of the top 5 heroin cities in the US. I'm sure I'll have something interesting, exciting or, at least, funny for you after that.




Is it appropriate to wear black on Easter Sunday?

Today has got to be one of the most painful days of my life. I awoke to the sound of my best friend dying. I carried her downstairs as she vomited and her bladder let go.

My wife and I raced her to the emergency animal clinic. There was nothing to be done.

An overdose of phenobarbital slid her silently away as we held her head and cried.

I miss you, pooch.

She was my pup for 12 years. I took her on vacations. She was the best.

I'm gonna go cry some more now.



The difference between pre-hospital medicine and physical therapy...

"All patients lie, you know." Says the physical therapist friend to me.

"Yah. I know." says, I, thinking of the drunk/addict/prisoner who's "faking it."

"What do you do if the unconscious patient doesn't respond?" he asks.

"Well," Says I, "You put a stick down their throat or a tube in their nose; If they object, they're faking it."

(Oropharyngeal or naso-pharyngeal airway.) This is the best way to ensure someone can breathe, regardless of their mental state.

"Shit, man. You have a cool job!" He says.

The therapist is now intrigued by being a (volunteer) EMT.



"...You say it's your birthday!" Dah Nee no Nee nee ner..;."Well, Happy day to you!" Dah Nee no nee nee ner....

I turned 35 today!

I received a ton of well wishes.

Herself got me a book. It's Karambolage by Arnold Odermatt.

From the Review:

"With thoroughness and a meticulous attention to detail, Arnold Odermatt photographed automobile accidents on the streets of the Swiss canton of Nidwalden between 1939 and 1993. For 40 years, the Swiss police office recorded the wrecked cars left in the wake of excessive speed, drunk driving, right-of-way errors, and plain foolishness, in poignant, sometimes funny, and always strange atmospheric photographs."

Let me tell you: It's a great book! What fun to look at photos of auto accidents from so long ago and done in such a style! They seem to be artistically arranged!

An example:

And another:

I love it!

Each picture tells a story for those of us who know how to read a deformed car. There is also a history lesson. There are no airbags, crumple zones or side-impact guard bars. Twisted metal and physics rule the day in these pictures. I'm particularly enamored by the prevalence of VW beetles in this book. They were, mostly, ubiquitous in Switzerland during that time and persist in being my personal fantasy car.

As it was my birthday, my family invaded my home. Wine, food, nieces (3 and 4 1/2 years old), and silly stories helped make this the happiest birthday I've had in an entire year!

I'm so lucky!



Do you need a seatbelt if you have an airbag (or six)?

At my volunteer house, we get called out for a multi-vehicle accident. Apparently, a brand new (2006) German Import crossed 4 lanes of traffic and hit head-on into the cement barrier in the median.

By virtue of traffic, our arrival vector and the ambulances that got there first, my ambulance was assigned to a barely injured belted driver of one of the cars that was struck by the German Import as it crossed 4 lanes of the interstate.

The passenger of the German Import was uninjured. Both front airbags, Both side airbags and both curtain airbags deployed on the German Import. The passenger wore her seatbelt.

I was about 30 yards away from the German Import. From there, I could see the outwardly bulging impression in the windshield. I could also see the ring on the driver's forehead as the other crew loaded her onto the backboard and began CPR. The ring was clearly visible because it was depressed about an inch into her skull. In fact her eyes, tongue and face were protruding from the pressure of the impact.

She was driving a brand new $25,000 car with all of the latest safety features but she died because she didn't use the most basic one: a seatbelt.

MY patient, on the other hand, was driving a 10 year old, inexpensive, Japanese sedan and was only shaken up. Seatbelt.

Buckle up, kids!



"Are you flirting with me?" or "The ladies man! Chapter Two!!"

Lucky McGee and I get a call for a "sick" woman. In the city where I'm doing my clinical rotations, a Medic unit (an ambulance with at least one Paramedic on board) is sent to every call requesting an ambulance.

She's 73, she's got a fever and, clearly, the flu or a cold. Ok, we'll take her to the hospital.

On the way, I'm keeping up my usual chatter. I'm taking her vital signs while Lucky McGee is doing paperwork.

While I'm checking her blood pressure, she asks me, "You got any kids?"

"No, Ma'am."

"When you do, I bet they'll be good lookin' like you, hon!"

"You think I'm good lookin'? Ok, when we get to the hospital, you need to get your (glasses) prescription checked too, eh?"

"Aw, cutitout! You're a handsome boy!"

I put on a serious look. "Ma'am, are you flirting with me?"

She pats my knee. "Yes. Yes, I am." *wink*



The stink of death.

There is a smell on people who are recently dead (or dying). Perhaps it's all in my head but I smell it. I ran a code today (did a lot of stuff on someone who's heart had stopped to reverse that) and I got the "stink" on me.

I'm riding as a student with one of my preceptors who I'll call "Lucky McGee." I'm calling him that because, 12 years ago, he fell 50 feet to his death while fighting a fire and was resuscitated. He's a GREAT preceptor.

We're wrapping up from another heroin overdose when a call comes out as "not breathing." Lucky McGee knows I need experience with endotracheal intubation (putting a tube in someone's windpipe to be sure they can breathe) so he "squirrels" the call. It's right down the street. I hear him say:

"Dispatch, we'll take that call."

The patient is 89 years old and is at a nursing home and an EMS supervisor had arrived before us and taken over care. What I didn't know was that Lucky McGee called the supervisor and told her not to intubate the patient. He told her that he had a student who needed a tube and if she thought the patient could wait, hold off until I got there.

As it turned out, the patient had been down (not breathing and/or pulseless) for a while before we were even called. That didn't matter to me or any of the other 8 rescue workers in the room when I arrived. We all worked her as if she was our own mother.

McGee and I slide into the room.

"Maddog, Set up for the tube." He tells me and I do so.

I'm set up and I "go in" with the laryngoscope. This is a device that is, basically, a "spade" to move the tongue out of the way and show me where the vocal cords are. It scoops the mouth open and has a light on the end of it that lets me see where to put the tube.

I see the vocal cords perfectly. I pass the tube perfectly. Apparently, when I was removing the stylet (an insert that makes the tube stiff and easy to push), I dislodged the tube from her trachea and it slid into her esophagus. When checked, it showed as being in her stomach.

I pulled the tube and ordered the patient to be ventilated. There was some fumbling but we got some air into her in short order. We did a really good job of putting air into her lungs without an endotracheal tube. This, combined with the regular, rhythmic shocks to her heart, caused my patient's heart to start beating and for her to try to breathe on her own.

I was undeterred. Despite the positive change in my patient, I knew she needed an airway.

"Stop bagging, I'm going in." I tell the firefighter who's helping.

This time, my patient's been knocked around a bit by all the other people there. Her head has shifted and I can't see her vocal cords or any necessary part of her airway. I'm digging around with my 'scope but I can't find her vocal cords in time.

"How do you know how long to look, Maddog?" You might ask.

Well, this is one of those cases where what you are trained to do actually works in the field. When taking the time to pass an endotracheal tube into the trachea (windpipe) of someone who's NOT breathing, one necessarily deprives the patient of oxygen and breathing. Understandably, one must limit the amount of time that one deprives the patient of oxygen. In hospitals, there is a cornucopia of devices such as Pulse Oximetry, Blood Gas Analyses and other deep and dark magic to determine when someone has been long enough without oxygen. In the field (such as in the crappy room of a patient in a nursing home) we may not have such tools.

So, you ask yourself, how do I know if someone is short on oxygen?

"Physiological empathy!" Says, I!

I hold my breath from the moment we stop ventilations on my patient. When I need to take a breath, so does my patient. It seems cosmically fair to me. I'm going to jam this tube down your throat. The least I can do is starve for oxygen with you. More importantly, I know when my patient needs to get more air.

After digging around for a bit, I need to take a breath.

"Bag her!" I command and give the 'I need your help' eye to my preceptor.

Lucky McGee slips into my spot. He takes a second to re-position the patient's head. He tilts her head back a bit more and then performs a perfect intubation. His true coolness is displayed when he asks me to confirm the tube (listen, with my stethoscope, to her stomach and lungs to make sure we don't have air in one and we do have air in the others). The man is dead on. I'm learning from a master, no doubt.

Once we have an airway, we move the patient to our Medic unit. On the way, she loses her lovely heart rhythm an her pulses. CPR starts and I say, "Pacing?" to Lucky McGee.

He nods and I set the cardiac monitor/pacer/defribrillator to 80 beats per minute. I start the pacing (this is where a regular, rhythmic shock is given to the chest of someone in order to make the heart contract and pump blood the way it's supposed to) low and work my way up. At 45 milliamps, I begin to see electrical waves that tell me her heart is responding to the shocks.

"I've got electrical capture," says I, "check for pulse."

"She's got a pulse!" Says Lucky McGee. Awesome! I'm making her heart beat!

Unfortunately, that quickly goes away. We 'work' her. This means we pump her heart for her, breathe for her, shock her heart and give her drugs that will (hopefully) make her heart go to work on it's own. We don't have the legal authority (nor do we want it) to declare this patient as dead. I've done marathon sessions of CPR before. I get to work and we 'pump and blow' all the way to the hospital.

In the ER, the doctor declares her dead. Nurses take over the necessary parts of the process. As I clean our cot, our monitor and gear, I watch the team perform the legally necessary steps of declaring someone truly dead. They use a sonogram to check for any heart activity, record the EKG of a flat line (asystole) and such.

Okeydoke! Get the medic unit ready and we go back in service for the next call. Like nothing unusual had happened.

But there's the smell.

The smell of death.

I'm sure I'm the only one who notices it. Every dead person I've 'worked' has a smell on them. It's a combination of a lot of elements. There's urine, bad breath, some unidentifiable sour smell, and a bunch more I can't articulate into words. The thing is, it's a sticky smell. An hour later, it's on me. It gets into my clothes. I smell it later. It somehow works its way into my pores. It gets in me.

Is it a condemnation of my inability to 'save' this one? Is it a reminder that sometimes we paramedics are the shepherd of death as well as the giver of life? I don't know. These questions are too philosophical for me. All I know is that I stink.

I turn down the offer of a pint after work from Lucky McGee. Instead, I go home and change into some running clothes. I go out for what should be an easy 4 mile run but turns into a 3 mile march of misery. I'm trying too hard to outrun something. As I sweat, I can smell it. I can smell the death. It's in my pores. It's in me. I try to go faster. My knees hurt. I try to go faster.




Now, I'm sore, cranky, sweaty and I smell bad. Somehow, I feel I've sweated it out. I go home and get the dog.

The winter sun is setting but I have about 20 minutes of light left. The pooch and I go out and I don't even bother with the leash. She's 13 years old, incontinent and mostly blind but she's still my puppy.

In the open field, she runs for the joy of running. Go, puppy, Go! I run with her. Somewhere in that field, the Stink leaves my pores. A shower at home is all it takes. I'm ready again.

There is no doubt. I'm ready to be a 'medic. I'm ready to be the best medic I can be.

"Try not. Do, or do not! There is no try."
--Master Yoda



Didn't I see you on an episode of COPS?

Zach and I are dispatched to the local police department. They had someone in custody who they needed looked at.

"Do you have any medical conditions?"

"Yeah, I have diabetes."

"Do you take anything for it?"

"Yeah, insulin."

"Really? When was the last time you took your insulin?"

"About a month ago."

The cop by the cell door shakes his head. He's an EMT too and he knows that an insulin dependent diabetic can't go more than a day or two without insulin. I give the guy some lemony glucose paste to keep him occupied.

"I can't move my legs!"

I check and he's got pulse, motor and sensation (reflex) in both feet.

"Buddy," Says the cop, "I chased you for six blocks before I had to hit you with the tazer. I can't move MY f***ing legs!"

Zach and I go back to the firehouse. Sometimes we watch COPS reruns. Sometimes we live them!



Yes, school has DEFINITELY started!

And that's, pretty much, where I've been for the past month and a half.

I haven't even been keeping up with my regular EMS blog reads. I find I'm missing my regular posting. I write this blog for my own sake, really.

I also write (by hand) in a real paper journal with a real pen. What goes into there are my thoughts on the rest of my life that's not EMS related. Over the past month and a half, my life has been so full with "other" stuff that I haven't had or made the time to post here.

I miss it.

I'm back.



School starts!

Classes start tomorrow! I've bought all my books! I bought a new pen! I've filled my notebook with fresh, crisp loose leaf paper!

I'm excited!

(What a dork!)



Night of Insanity: Final Chapter.

I hop in the ambulance, gobbling chili as I go. The call is to an address I know pretty well. The fire engine is already out on another call and as we climb the hill to our destination, we see it. There's a fire right across the street from where we're going. A friend of mine lives in that set of townhouses and I think, "Gee, I hope he's ok." I find out later that he is ok but it was his house burning.

Poster Girl, Sky Captain and I enter the house of my patient. I know this woman. Her son taught me to ice skate when I was 8 years old. She has a bunch of medical conditions including, diabetes, high blood pressure an amputated leg, extremely brittle and breakable bones. According to all her doctors, she should have died a few years ago but she's still going. She's persistent, energetic involved in the community and irrepressibly cheerful. She's one of my favorite people.

Not cheerful tonight. She's got abdominal pain 10/10 with nausea and vomiting. Hasn't been able to keep anything down for the past 18 hours. I greet her and her husband. She even manages a smile when she sees it's me. She's in a lot of pain but her mental state is good and she answers all my questions appropriately. She's got a blood pressure of 238/180. She hasn't been able to keep her blood pressure pills down. The call was dispatched as an ALS (Advanced Life Support) call and the Medic unit arrives soon after I do.

I give my report to one medic while the other seems to be doing his best to find a reason to downgrade the patient to BLS (Basic Life Support, i.e. me) so they won't have to transport her. They're giving each other the look I've seen before.

"I was going to palpate her abdomen to rule out a AAA when you got here." I say. A "triple A" is an Abdominal Aortic Aneurysm. That's where the main aorta going down the abdomen gets a tear in it and hurts like crazy. The real danger is if it bursts then the patient will quickly bleed to death. Not much I, as a basic provider can do for that.

Both medics look at me. Then at each other.

"If I'm going to take her, I'd really prefer one of you to come with me. With her pressure and abdominal pain, I'm a little nervous. There's not much I can do if she bonks." says I.

Both medics sigh, nod their heads in resignation and one tells me to get their cot. I'm getting a reputation, I suppose, of not letting the local medics get away with anything!

Back at the station, it's midnight. Blessed sleep.

At 4:30 the bell rings again. I stagger out of the bunkroom and think I'm still asleep. "14 year old female, Chest pains, trouble breathing." Squawks the radio.

14? Chest pains? Great, I'm surely still asleep. I look at the printout. Sure enough: 14 years old.

I put my bunker pants on over my flannel pajamas and hop in the ambulance. Poster Girl is driving, Sky Captain has found his sleepy way into the back.

In the apartment, I find a worried mom, a pair of sleepy siblings and a 14 year old girl sitting on a couch. She's crying and rocking back and forth while clutching her chest.

I get her to calm down a bit and get her to describe the pain. She says it's a burning that work her up about 4am (20 minutes before). Poster Girl interviews mom to get medical history, medications and allergies. I hear the mom say, "She takes Prevacid."

"Does she have acid reflux disorder or GERD?" I ask.

"Oh yeah." says mom.

"Has this happened to you before?" I ask the daughter. Still crying, she nods. Her vitals are all good for a 14 year old kid but she's in a lot of pain. We walk her out to the ambulance and I sit her in the cot as upright as it will go. I hook up some oxygen and get her strapped in. As we drive to the hospital her pain decreases to almost nothing.

We have to wait a bit in the ER for a bed. Mom is there with the two little siblings. The boy is about 6 and has a look of constant skeptical distrust. I lean over as if to tell him a secret.

"I'm wearing pajamas." I say in a stage whisper. He looks even more skeptical. I hike up the cuff of my bunker pants over the top of my boot, revealing a plaid flannel pajama leg. I wink at him. A couple minutes later, I hear him whisper to his sister.

"He's wearing pajamas!" Giggles ensue.


The Night of Insanity, Part Two!

I return from the previous call to a firehouse full of people. This includes a couple who live in town who are interested in volunteering. I have invited them down to check the place out. All they see is a chaos of people, fire trucks and ambulances rushing in and out. Herself is serving out chili to any takers and spirits are high.

I dash out my paperwork from the last call and go into the kitchen. The ladle is poised over the bowl, ready to deploy a spoonful of chili deliciousness when the bell rings again.


27 year old male with chest pains. 27? with chest pains? Whatever, off we go. I've got Poster Girl driving and Sky Captain in the back as my trainee.

Oh, yeah, and all the medics in the area are busy. I'm on my own. Great!

The guy was driving his tow truck when he began to feel funny, we respond back to the same Major Interstate about 200 yards away from the previous accident of the night and pull in front of a flatbed tow truck. I get my gear on and get out. As I do so, there is an EMS supervisor walking my patient to the ambulance. Okeydoke. In you go!

I'm interviewing the guy and he's actually complaining of a strange feeling in his chest like his heart is skipping a beat. I feel his pulse and, sure enough, he's got an extra beat in there every now and then. I turn to the EMS supervisor,

"You got a Lifepak 12 in your truck?"

He looks at me surprised, "Um, yeah."

"Thanks!" I say. He looks at me again and then heads off to his truck.

Back with the Lifepak, I pull out leads, hook up my patient and print out a strip. (don't have a copy, sorry.) Sure enough! He's got some early ectopic (unusual) heart complexes on the readout. I call them Perfusing Premature Junctional Contractions. The QRS complex is a bit too narrow for me to call them ventricular. All the same, my patient is hemodynamically stable (has and maintains good blood pressure and is heart is adequately moving blood and O2 around his body), has a good mental status (knows where he is, who he is and what day it is) and is mostly just scared.

"You coming?" I ask the supervisor.

"No, and you can't take that either." He replies, indicating the Lifepak. He gives me a smile. We introduce ourselves to each other and shake hands.

Off I go to the hospital. My patient is nervous and chatty. I tell him everything that I'm doing and why. He seems really interested and I go a bit deeper into the science. He's eating it up. My lecture on the functions and dysfunctions of the heart carry us all the way to the hospital. We ended up going to another one further away than the last but it had the attractive feature of being open to receive patients.

My patient takes no meds, has no allergies and has no history of cardiac problems. His father, however, has high blood pressure, a 4 way bypass and takes lots of meds for his ticker. Okeydoke. My patient's blood pressure is also 222/118. That's pretty high for 27 years old.

At the ER entrance there's a man waiting who looks a bit like my patient. He's wearing a guardedly anxious look on his face.

"Are you Dad?" I ask. He nods.

"C'mon." I say, indicating him to follow us into the ER.

In the ER, the charge nurse asks for and expects a full report. She listens carefully to my entire report and even asks a few questions for clarification. It's nice to be appreciated! We transfer my patient to a bed, make a few jokes, pat him on the back and get ready to leave. On my way out, Dad stops me and shakes my hand.

"Thank you very much." he says, solemnly.

"Thank you, Sir. I trust you won't take offense if I say I hope I never see you like this again."

This seems to relax Dad and he gives me a smile.

Back at the firehouse by 10:20pm. Paperwork done by 10:25. Bowl in hand, chili on ladle at 10:26. Bell rings at 10:27. I'm running to the ambulance, eating really tasty chili. Poster Girl gives me a look when I get into the ambulance, shoveling chili and rice down my gullet.

"I'm hungry!"

Coming up:

I respond to the house of one friend while the house of another burns across the street! 14 year old with chest pain!

Hometown EMS, Yoikes!

Stay tuned!



The night of insanity, Part One!

What a night!

I arrived about 45 minutes early to the Firehouse to get dinner set up. I have a gallon and a half of venison chili in a pot on the front seat of my car and all the fixin's in the trunk. I'm opening the trunk of my car when the bell for the ambulance goes off.

Out the door I go! Rear-end collision on the Major Interstate. I arrive as the rescue squad from my old station is preparing to extricate the driver. I pop into the car to check her out briefly. She's in a good mental state, denies loss of consciousness and her main complaint is neck and back pain. The squaddies have things well in hand so I get out of the way until the driver's out of the car.

Backboard, straps, immobilize the head, into the ambulance. Police take a report while I do a quick trauma assessment. Nothing noted but tenderness. I check the status of the area hospitals and am told by communications that the nearest hospital is open and ready to receive patients. Ok! off we go.

Unbeknownst to me, about 5 miles away was a 5-car pileup. I arrive in the ER with my patient at the end of a line of 6 other car accident victims. The nearby trauma center has been overwhelmed from previous incidents and is on re-route. Suddenly, I'm in for a long wait.

An hour later, I'm still waiting for my patient to be triaged and to hand over care. I call the Firehouse. Herself was going to meet me there to dine with us. Sure enough, she's there. I ask her to get dinner set up and start the rice. She proceeds to not only do that but to feed everyone, thereby earning the undying love and adoration of every firefighter there.

Back in the hospital, I still had a long wait before I could transfer my patient to a cot next to the nurse's station and head on out. I have to say, I was quite annoyed at the other ambulance crews that were there. One crew kept harassing the nurses for a bed for their patient when it was clear there were none. Meanwhile, one member of this crew tells me their patient has an altered mental status (AMS) so goes ahead of mine who only has pain. We're having this conversation about 15 feet away from their patient.

"AMS, Eh? When was the last time you took vitals?" asks the maddog.

"Uh, when we transported her." says the mouth-breathing dork who transported her. That would have been about an hour ago.

"Unstable patient gets vitals every 5 minutes and, unless I'm mistaken, she's still your patient." replies the maddog.

"Uh. Oh. Right!" Off dashes the mouth-breather for a stethoscope and blood pressure cuff. Meanwhile I strike up a conversation with their patient. She's doesn't have an altered mental status, she just doesn't speak English. A few sentences later, I discover she's mostly complaining because her necklace is caught in the collar and is pinching her really bad. A few adjustments later, the patient is much quieter and the crew who brought her is much meeker.

Meanwhile, my patient is becoming more agitated. She's in a lot of pain, strapped to an unforgiving and rigid backboard and unable to move anything except her hands and arms. Her head hurts. I raise her cot a bit to take some blood pressure from her head. that helps a little bit.

"I have to pee!"

"I'm sorry, Ma'am, I can't take you off the board until you've been x-rayed. We're worried about your spine and neck."

"My head hurts and I'm uncomfortable."

"Yes, I know. I'm sorry but it's for the best. I don't want you to hurt your spine." I see this isn't working so I get personal. "Ma'am, if you were my sister or mother, I would do the same thing. I'm worried that you may have injured your spine and we have to keep you from moving until we can find out what's wrong. Please don't try to move."

"This thing is uncomfortable!" She digs at the collar and tries to twist her head. Out comes my 'cop voice.'

"STOP MOVING. STOP MOVING YOUR HEAD NOW!" No shouting but firm and clear. The whole ER gets quieter. I get my face right over hers so she has no choice to look at me.

"Do not move. Do not move your head. Do not move your feet. I don't care how much it hurts. Do! Not! Move!" I stare her down.

She grows meek. "Can I hold your hand?"

"Of course you can." She does.

I find myself managing and triaging 5 patients and getting the admittance paperwork started for the nurses. All the while holding my patient's hand. As a result, things move a smidgen more quickly and I finally leave an hour and a half after I got to the hospital.

Back at the station: I manage to finish my paperwork, wave to Herself and put one spoonful of chili into a bowl when the bell rings again. 27 year old Male with Chest pains. No medics available.


I'll write about that one next.



Stay Tuned? (and bring your Bean-o)

I'm filling duty tonight so I won't be with my usual duty section. I have been cooking for my duty section and the word has gotten out. I have 4.5lbs (2Kilos) of venison in my fridge and will be arriving at the firehouse with a gallon or so of venison chili.


Hopefully, we'll have some calls that will be worth telling about. We'll certainly have some culinary stories.


Who am I?

I went to a party tonight, hosted by Herself's company. They're a literary, book-selling company.

I played the part of the obligatory, entertaining husband. ... For a while, at least.

Everyone I met and spoke with was wowed by me being in EMS.

"That's so awesome!"

"I could never do that!"

"You're so strong to do that!"

Here I am, Amazed and in awe of the authors, publishers and the bigwigs of the book industry who are standing around me. Amazingly, they're all pumping me for stories about EMS.


I started out trying to talk about Herself and Herself's company. I ended up answering questions about EMS and what I do (and will be doing).

Well, that proves it. EMS ROCKS!.




Not much going on. I've run a duty night or two with no calls. I'm on semester break so, no stories from clinical rotations or classes.


Sorry about that. Well, here's some upcoming things that might be interesting:

1. I'm going to try to get the following certifications this semester: Emergency Vehicle Operator (so I can drive the Bambulance), EMS instructor, through my volunteer service, and CPR instructor. The last one is offered through my shcool. The first two through my volunteer service. The thing is, they're State certifications so, if i get a job at an agency in this state, they'll look super-good on my resume.

2. I'm going to see if I can do an independent research project this semester. I'm going to look at the number of ALS (Advanced life support or paramedic) calls that have originated from within my first due (my station's primary response area) and then see if there is a need for an ALS-capable unit in my area. This includes my home town where I and my family live. Of course my motives are somewhat selfish.

Ok. I'm filling in duty this Friday night. Perhaps something interesting will come of that.




I'm back!

After 5 months, I have internet access at my home again! Yay!

Look for more regular updates from me (I'll try for daily). Also you'll see:

1. More specific medical and trauma musings and questions, as I have learned much and continue to do so.

2. A few soapbox rants on issues affecting EMS today.

3. Progress reports on my FINAL semester in school, including the possibility of an independent research project involving my hometown and a needs assessment for ALS service.

4. Running. I'm going to include my progress and a few thoughts as I try to prepare myself to become a 4-marathon-per-year athlete and lose some of the weight I've gained over the past couple years.