MaddogMedic

MOVED!

2011-04-26T19:41:00.000+03:00

My blog lives HERE now.

Check it out!

--maddog

http://www.maddogmedic.com/

Hero?

2011-04-26T02:14:00.002+03:00

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.

--maddog

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?

Moving

2011-04-21T08:24:00.001+03:00

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!

--maddog

Where we're headed?

2011-03-16T20:48:00.000+03:00

This Guy gives me hope for my profession.

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

--maddog

Murderer.

2011-03-16T07:14:00.000+03:00

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.

Chaos.

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.

*Sigh*

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!

--maddog

Pretty Lucky Guy Part II

2011-03-11T19:19:00.000+03:00

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.

Cool!

--maddog

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

2011-03-08T05:44:00.002+03:00

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.

--maddog

Recent Keyword Activity

2011-03-07T06:45:00.000+03:00

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?

--maddog

So much to write about.

2011-03-06T18:30:00.001+03:00

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.

--maddog

Boat? What Boat?

2011-03-03T19:11:00.000+03:00

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.

--maddog

Growing Pains

2011-03-01T22:17:00.001+03:00

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.

--maddog

Baltimore EMS Blogmeet 2011 is ON!

2011-03-01T02:43:00.001+03:00

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.

--maddog

Commute

2011-02-11T07:24:00.001+03:00

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.

Nice.

-maddog

Bawlmer, here I come!

2011-01-17T22:25:00.000+03:00

Soooooooo....

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!).

--maddog

Tidying up.

2011-01-10T08:20:00.001+03:00

I've been making a few changes to my blog and there are more to come. Sorry for the boring "housekeeping." I've gone through and edited a few posts to make my blog just a tiny bit more anonymous. It might just be paranoia but I'd rather be on the safe side.

In the next week or so, I'll be making some more cosmetic changes and updating some broken links. I'm still using the same Blogger template I started with in January 2004!! Wow! I'll be looking for a newer, more functional layout that still has the same clean style.

Why all this recent activity? Well, I've "unplugged" from the biggest time-waster of all time: Facebook! Man! That thing just drained all the creative energy out of me. I'd sit down to just, "see what my friends are up to" and the next thing I know, 2 hours have passed! I'd look back and see that I had done NOTHING substantive; I hadn't had any meaningful communication with anyone, I hadn't written anything worthwhile and hadn't done a single productive thing!

That thing is like a drug! I had to put that mess down and walk away!

*Yawn!* Yes, I know. That was boring. More exciting posts are on the way. I promise.

--maddog

Life in the Kingdom Part 2 of ?

2011-01-05T14:26:00.002+03:00

Well, here's a bit of news that may affect yours truly. It appears that the Ministry of Interior intends to try to regulate all online publishing via "licensing."

Hmmm... You know, I'm squirrelly enough about getting "found out" that this is just the thing to put me into hiding.

Never fear, dear reader, I'll soldier on and post post POST!

This bit of news does open a door into another discussion. There is NO free press here. In fact, it's kind of funny, coming from the United States where, basically, the press can say ANYTHING they want to. Here, it's not so much. A lot of what I read in the local English language press, aside from grammatical and translation errors, is full of unsubstantiated facts, opinion of the author (or editor) presented as fact and a clear sense of "talking around" an issue.

I'm not media-savvy enough to discuss the issue at length but when I read the local press, I'm always left with a sense that there's an actual story looming behind the print and somehow it isn't allowed to come though. I wonder if readers here take the news for fact or if they have developed a refined ability to read between the lines. There's much that has been said about the Bedouin ability to perceive much more than what is on the surface. Does that apply to reading the news as well? I wonder. I don't have the answers. It's yet another thing to ask my hosts, colleagues and Arab friends.

For my own sake, I'll have to carefully navigate the next few months of my blogging. I know other bloggers here in the Kingdom who do not blog under a nom de plume. I wonder what it'll be like for them.

Strange times in a strange land.

--maddog

Life in the Kingdom Part 1 of ?

2011-01-04T13:37:00.001+03:00

I see that I've just kept going on (albeit slowly) blogging about my work and antics as a paramedic as if there was no change in my life at all.

But there has been. For those of you who only occasionally visit here, I've moved to the Middle East and taken a job over here as a paramedic in a small clinic in the middle of the desert (Really!). I've posted a few things about working here and some of the differences but it's mostly been in the context of a particular call. Of course there's entries like this one that make it obvious that I'm not in the USA anymore.

My call volume is considerably less than in the USA and, honestly, I'm not as fresh-faced and filled with wonder as I used to be. These may be reasons I'm not as frequent in posting. I'm still here and I'm still having a blast. There are times when It feels less noteworthy.

I'm going to try to change that. At least I'm going to try to post more about EMS and, specifically, about my particular experiences over here in the desert. I've got a pretty cool thing going on here and, honestly, it's worth sharing.

Over the next few weeks, I'll be posting 2-3 times per week describing the peculiar, different and outright bizarre aspects of my life here in the Kingdom from my perspective as a paramedic. I'll discuss how the EMS system is structured differently, how we practice medicine differently (and the same) and how my attitudes towards, death, suffering and human treatment have shifted to adapt to my life here. It's pretty odd.

Please feel free to hit the comments or email me if you have any questions or if you're curious about my life over here.

More soon (I promise this time)

--maddog

Car Vs. Camel!

2010-10-08T17:37:00.003+03:00

Jolly and I are working this warm desert night when we get called for a car accident about 30 km south of our location. I let Jolly take the front seat and I hop in the back of the ambulance. From the dispatch information we receive en route we figure it's a single-car accident with two victims. Injuries unknown. I know this stretch of desert road pretty well. It's straight as an arrow and completely unlit. I drive it from time to time to work at a remote clinic about 140 km away. On the way to the scene, I find myself wondering what would cause someone to go off the road on such a straight length of highway. Well, I decide, I'll just have to see when I get there.

It's moonless and dark when we arrive. No streetlights and no other light source for a few kilometers in each direction. This is the middle of the desert, you know. We park as close as we can but the car is up a 2 meter embankment, about 20 meters off the roadway. Jolly goes ahead to check it out. Anticipating trauma, I grab two backboards, collars, and the usual. Jolly hollers at me to not bother.

This is going to be good. I scramble up the rocky embankment and join Jolly at the scene. Jolly is a local so he's doing all the talking with the local police and security personnel who have arrived before us. This frees me to check out the car. We have a Toyota Camry resting upright on its chassis. The front and the rear are completely smashed, there's not an intact piece of glass in the whole car and the sheet metal of the roof looks like it was ripped off with a giant can opener. No sign of the roof anywhere nearby.

There are no tracks leading to the car either. Just an impact print about 8 meters behind it, then blank sand then another impact crater a few meters back. End over end roll. Up a 2-meter embankment. Wow.

The driver (I assume he was) is completely wrapped around the center console. Yes, completely, like 270 degrees of twist. His head is so badly deformed that it's clear we're not rescuing him. Even assuming we can cut him out of the car. The nearest rescue squad is at least 45 minutes away. The passenger is lying next to the car and I get that the responding police had pulled him out of the front seat. He, too, has a badly deformed cranial cavity (skull). Even though there's no brains leaking out, both of these guys have what we call "injuries incompatible with life." No, they weren't wearing seatbelts.

Jolly and I proceed to search the surrounding desert. We surmise that the car bounced end over end and, without a roof, we worry there may be someone lying out in the sand having been thrown from the car. We work our way back along the estimated path of the car. From the bits, pieces and imprints in the sand we figure this car was going pretty fast. About 100 meters back, we find the gouges in the shoulder that shows us where the car went off the road. To have traveled 100 meters, bouncing end over end, that car must have been going pretty dang fast when it left the road.

100 meters further down the road, we see another police car with its lights on. There's a dark mass on the road in front of it. As Jolly and I work our way down the roadway, the smell hits us. I've not smelled anything so nasty and vile in my life. It's the smell of an eviscerated camel. We find the roof of the car. Most of it is still in the camel. A quick look tells us the story: Our two friends were speeding down the road when, out of nowhere, there's a camel in their headlights. They hit the thing full speed. I estimate they were doing at least 200kmh. This is not unusual in this country and specifically in this part of the country.

The front of the car snaps off all four of the camel's legs and the camel's body hits the roofline of the car. It rips the metal off the roof and impacts with both occupants' heads, killing them instantly, I'm sure. Bounce, flip, the camel goes over the car leaving the Camry to swerve a bit, travel a few more meters, hit the shoulder and begin it's aforementioned end-over-end flip dance to finally rest another 150-200 meters further on. It's an impressive display of physics, biology and plain stupid.

Jolly and I are shaking our heads as we get back in the ambulance and head home, leaving all three bodies for the police to deal with.

And, Oh! The smell!

--maddog

Night shift is a b***h!

2010-08-30T01:43:00.000+03:00

Car vs. Camel. (Well, I think we can ALL figure that one out!)

Bedouin babies!

USA vs. KSA: Who gets the patient????

Stay tuned!!

-maddog

Pretty Lucky Guy

2010-07-31T06:40:00.001+03:00

His name is Ali and, according to the ER doctor, he's a pretty lucky guy. I have to agree.

We got called to an accident down the road. About 20 minutes later, we arrive at a crest in the road, made notable in the moonless night by the collection of cars and police lights.

About 30 to 50 meters off the road away is a bashed up compact car resting in the rocky sand. Our patient is the driver and he's secured to a backboard in a Red Crescent Society ambulance.

Here's a wierd bit: since the patient is an employee of my parent company the Red Crescent Ambulance waited on scene for about 10 to 15 minutes for us to arrive and take the patient to our company hospital which happens to be a few kilometers from their base.

Oh well. That's how thing are done over here.

The Red Crescent ambulances around here are staffed and equipped at a very basic level. Some have the ability to start IVs, administer glucose checks and give nebulizer treatments but that's about as advanced as they get. The Red Crescent guys had secured my patient to a backboard but hadn't secured his head, applied a cervical collar, conducted any examination or even taken vitals. They pulled their stretcher out as we approached with ours and I had to wade through the typical crowd of well-meaning but dangerous bystanders grabbing, pulling and trying to "help."

The Red Crescent guys don't speak English and my Arabic is not much more advanced beyond "Yes, no, thanks, hello," and "Where do you have pain?" but I immediately see that they want to lift the patient off their backboard and onto ours. I use a little pantomime, make eye contact, smile and then grab each of their hands and out them where they should be for a proper logroll. They get it right away and we do it by the numbers. It's neat to see that common training show up even across such wide gaps in culture and geography.

In short order, we get Ali transferred to my backboard and cot. I quickly move him into the ambulance so the nurse and I have room to work without being crowded by the bystanders, onlookers, police and anyone else. The nurse I'm working with this night, a strong-willed, unflappable and solidly competent Jordanian woman, makes the call to take this patient to our company clinic in the nearby city instead of our tiny "camp" clinic. I think she realizes that there is an emergency physician on duty at the city clinic and only a general practitioner on call at our "camp" clinic.

I do my assessment en-route and find that he's got a painful left hip but no shortening or rotation of the leg. This would indicate a break in the thigh or dislocation or break in the hip where it meets the pelvis. His thighs are pain-free when I push on them and his pelvis is stable. All the rest of him is fine. No signs of head trauma, lungs are good and clear, extremities are intact and give good pulses and motor/sensory response. All his vitals are fine. The only thing is this hip pain and the fact that he doesn't remember a big chunk of the accident. I wrap a folded sheet around the upper part of his thighs and tighten it like a band. This produces immediate relief from his pain. Other than an IV and monitoring, that's about all I can do for the guy until we get to the hospital.

From what Ali tells us, he went off the road, not wearing a seatbelt, and rolled "many, many times." During all this rolling he said he "went out the window" and landed in the sand. So, we're looking at the unbelted driver of a car involved in a multiple rollover with ejection. All he's got is a painful hip and a few cuts on his hand and thigh.

Yep, he's a pretty lucky guy.

--maddog

These hands

2010-07-20T02:06:00.001+03:00

There are times when I look down and see my hands. Yes. Of course. We all see our own hands all the time, but there are times when I see them.

My fingers are pretty long. Sometimes I think they're too long to be "manly."

My fingernails grow too fast. I want short, unobtrusive nails that don't look shiny or pretty. However, they just grow that way (and fast!).

"Clip...clip...clip...,clipclipclip"

Herself tells me that my hands are big and strong and make her feel safe. When she's not there: I don't see that.

What I see is my hands being wrong for what I want them to be.

I want my hands to be strong, every time. I want my hands to do the perfect thing, every time. I want my hands to be absolutely and perfectly "right on" every moment they touch someone.

Every time I touch a patient, I question that. It doesn't matter how well I do my job. It doesn't matter how well (or poorly) my patient ends up. I will always look at my hands as if they belong to someone else.

This is the worm of doubt.

How did I do that?

Did I do that right?

Are these my hands?

--maddog

"And so I reach out my hand, and he grabs it"

2010-07-10T01:14:00.001+03:00

This guy is a 'medic. And this post is a clear indication that he's a GOOD medic.

"What's a good medic?" You ask?

Well, that answer is complex, nuanced and full of opinion. I ain't ready to fight that battle in the blogsphere yet.

However:

All of us paramedics get the same training, to a point. We all have to pass the same (or similar) test to be blessed as a paramedic. There are folks who will argue the contrary but, please, for the sake of my posting, let's assume my statement is true. I'm sure I'll get a bajillion comments when I finally do post on what makes a "good 'medic" but today, I want to talk about one thing that makes this guy a "good medic."

Some of the best in our profession don't try to be doctors. We don't try to be nurses. We recognize that this is what we do and we put effort into doing it better and into improving the efforts of those who come after us. There's a lot to be said for being a paramedic. There's a bit more to be said for being a good paramedic. There are volumes to be told for being a great paramedic.

What is "that thing?" What is the one thing (if we can condense it down that much) that makes the difference between a paramedic and a "good" or, even, "great" paramedic?"

The short answer for me is, "I don't know."

But I do know what I've seen in the paramedics, EMTs, Firefighters, Cops and public servants that I've met in my job.

We care.

When we do our job, no matter how busy our county/system/service/company is, we treat one patient at a time.

When we have the privilege to treat them, they are the ONLY patient we've ever seen and ever will. It's the zen, hokagare, samurai way, or whatever you choose to call it, but it's what paramedics do. We are called upon to consistently deliver the compassion, care and individual feeling that makes that difference. Everyone who needs a paramedic becomes a member of our family. Some of us want to do well. Some of us are just tired of the dying and killing and some of us, honestly, want to really, REALLY, help.

When the public (yes, you!) see us. You are at your worst. That only challenges us, further, to be at our best.

Nobody is a 'medic for the money.

Nobody is a 'medic for the groupies.

We do it (and keep doing it) because we care.

This guy? I hope someone like him comes to my house when I have to make "the call."

--maddog

Resistance is Futile!

2010-07-08T14:05:00.001+03:00

Let's talk a little about combative patients:

A combative patient is one that fights treatment or control. This can happen for a variety of reasons. When we talk about combative patients in EMS, typically, we're talking about folks who have a brain injury or are hypoxic (brain's starving for oxygen) and they start flailing about. You see, when the brain's in trouble, i.e. starved for oxygen, the body kind of goes into "freak out" mode and starts lashing around in an attempt to somehow correct its oxygen starved state. When you're the paramedic in a small box that's moving down the bumpy road at high speed with said combative patient, this is what is sarcastically referred to as, "fun."

Now, there are patients that are combative because of a physical injury. Then there are patients who are combative due to a chemical insult (too much booze, pills, or whatever they ingested, snorted or shot up) and then there are patients who are combative just because they're ornery! Yep. The injured a**hole. Now, technically, we shouldn't refer to these patients as "combative." That term is usually reserved for folks who do not possess the ability to make an informed mental decision and we've got to fight 'em for their own good. The very reasons they are in such a combative state also usually alters their mental faculties so that they can't give or withhold their permission for treatment. That's when we get "implied consent." and proceed to do the things necessary (we hope) to save their lives, etc..

Now, let's go back to the ornery ones:

Some folks are just a pain in the butt. They get themselves all banged up, cut up, sick or otherwise in a bad way. Not enough to alter their mental state, mind you, but enough so that someone calls for a paramedic and they actually need some treatment. But they get stubborn and it's a constant argument to get them to let us do the simplest things. For example, I had a patient a while back who had an unfortunate meeting with his lawnmower. This 80-year old gentleman got tired of waiting for, "them darn kids" to show up and cut his grass that he went out, sandals and all, to do it himself. Well, needless to say, the mower somehow rolled back and he's a bit stubbier on his left foot than his right as a result.

We arrive, find him bleeding a bit, uncomfortable, furious, ornery and in full possession of his mental faculties. No, he doesn't want us to take him to the hospital. No, he won't let us bandage his foot. No, we can't start an IV and hook up the monitor. Who cares how many cardiac medications he takes, "I ain't goin!" All the while he's swatting at my partner and I when we get close, waving his arms around and being a pain.

In the time It took his wife, daughter, my partner and I to convince him to let us treat and transport him, I could have driven him back and forth to the hospital 4 or 5 times. Yes, I could have taken a refusal from him but I would have been back later when he finally gorks out! This happens more often than I'd like in the USA.

Now I'm over here in the Kingdom and there are a lot of differences. I don't see as many drunk, high or chemically altered patients as I did in the USA. I know they exist in the Kingdom but not where I practice, I guess. I also expected a lot more distrust and even open hostility to my white face and lack of Arabic language skill from many of my patients. However, that's just not so.

The men who have fallen under my care seem to be in one of two states: Dramatic flailing, wailing and hollering over the tragedy and pain or completely limp as if they had swooned. Usually, if they're in the first state, they quickly swoon with a melodramatic sigh as soon as a medical person shows up. I'm always so surprised at how uncomplainingly they put up with any of my treatments. A patient may cry out at an IV stick, sure, but he usually doesn't pull back, strike out or otherwise act "ornery." It seems to me that, once medical help is perceived to be on scene, the patient just gives all into Allah's hands and sighs all the way to the hospital. After fighting ornery, bloody lawn-mowing 80-year olds, It's a nice change!

I haven't had any Arabic women patients. Usually, they are brought in by their husbands to the ER directly. I'm sure if I ever do have an encounter with a female patient over here, It'll be seriously blog-worthy!

--maddog

Surfing the Chaos.

2010-06-23T21:01:00.004+03:00

We get called for a motor vehicle accident (MVA) a few kilometers away on the nearby desert highway. Though we are a company EMS service that exists to provide medical care to our own facilities, we are often called upon to help out the general public. No problem. I like the work.

My Arab partner, AJ, and I both hop on the responding ambulance since it was reported there were multiple patients. AJ gets in the back and I ride up front. Neither of us is driving. Over here, the ambulance drivers are, typically, company workers from other departments who are nearing retirement. They have no medical training, limited usage of English and, other than getting the cot in and out of the unit, aren't very useful to a paramedic on-scene.

We arrive at the place where two ribbons of asphalt meet in a "T" in the middle of the rocky waste of the desert. A small pickup truck carrying two young men went barreling into the intersection without considering the large lorry that had stopped to make the turn. That is typical of how men drive over here. Just go fast!! The rest is in God's hands!

By the time we arrive, there are at least fifty men all standing around the accident scene, looking, talking to the victims, pulling them out of the car; It's chaos. The front of the pickup is trashed. The driver is sitting in the front seat looking dazed. There's a nice star on the windshield over the steering wheel. Ok, Got it.

The passenger is lying on his back next to the truck. AJ and I can tell that he got out himself and laid down. He's pretty bloody from what looks like a busted nose but it's hard to tell what else. More on that in a bit. AJ and I have to physically push people out of the way to get to our patients. There's no concept of "stand back, the paramedics are here" in this country.

The driver is swiveling his head back and forth and talking to people. I figure he's been there for about 20 minutes before we arrived, he can wait 5 more. (yes, It takes us that long to get there sometimes). I quickly decide to help AJ package the passenger.

Now. My USA readers must understand some key differences here: there is NO rescue squad, no fire engine blocking traffic, no reliable and competent rescue techs briskly deconstructing the wreckage to allow us easy access to the patient. Also, there is no concept of "get out of the way and let the paramedics do their job" either. Everyone who shows up either wants to get close and look or feels they can contribute by grabbing the nearest thing and pulling, pushing, hollering and getting in the way. I get more than a few angry looks as I use my 230 lbs to shove people out of the way between the patient and me.

Oh, police? Yes, the police are there. Probably the ENTIRE shift has come to the scene and parked their cars everywhere. Only about half of them have put their lights on. Are they controlling the crowd? No. They are a part of the crowd: equally shoving, pushing, jostling for a look and so on.

Like I said: Chaos.

Back to AJ and I with the passenger: AJ is chattering in Arabic with the patient. I do a rapid trauma assessment and find blood everywhere. Is the patient bleeding everywhere? No. He's wearing a Thawb. A Thawb (or Thobe) is a long, white garment that is traditional with Arab men. Imagine a white dress shirt that goes all the way to the ankles. They come in many colors but the most common is white and they're almost always made out of finely woven cotton. Which makes them an excellent blood sponge. I'm serious. Get a nick on your wrist and before you know it, your entire sleeve will be red and drippy.

This guy's got a bloody nose, a busted lip and a cut on his elbow. It's making him look like an extra from Shaun of the Dead. Talk about challenges to patient assessment! Awesome!

AJ and I quickly get this guy collared, boarded and loaded in the ambulance. Now, there's two patients and we're basically the only available ambulance for about 150km. We move the patient from the stretcher to the bench-seat and secure him with the seatbelts. He's maintaining his own airway, able to answer my questions and, since we have no other choice, is left in the ambulance while AJ and I go get the driver.

Yeah, I know. I'm sure some of you who are EMTs and paramedics are shaking your heads and thinking, "Abandoned your patient?" or "The driver should not have been left. He should have been boarded and collared too!"

Yeah, I know, I know, I know!!! I was thinking the same thing! I had just arrived from the USA and had not yet grown accustomed to being completely unsupported. Yeah, we had about 50 bystanders but they were all medically useless. Even if I had additional resources to call upon, even the most basic of them would have taken 30 -90 minutes to arrive. If a Mass Casualty Incident is one which the number of patients exceeds the capacity of the local EMS to handle, then this was an MCI.

And that's how we do it over here.

So, back to the driver: AJ and I again have to wade through the crowd to get to this guy. Collar on, lay him down onto the board. Slide board onto cot. Re-assess ABCs and we head for the ambulance. The crowd is getting so pushy and curious that we need some isolation to work. We get to the ambulance and I'm astounded to see it full!! There are about 5-7 Arabs in the ambulance. They're all talking to the passenger, kissing him, touching his head, one or two are weeping and one or two have a look of morbid curiosity on their faces.

Now, I've learned that my size and strange appearance (bald, beardless, big and, dare I say it?, burly) scares most of the Arab men I've met. I use this to my advantage. Out comes the "Sarge" voice and, even though I'm hollering in English, they get the message and clear out of the ambulance pretty quick as I go charging in.

We get the driver into the ambulance and divide our efforts. The passenger speaks a little English. He's mine. AJ discovers that the driver is asking the same questions over and over again and, though he denies losing consciousness, can't remember why he's there or how the heck he got into an ambulance. Both these guys are boarded, collared and can only look at the ceiling of our ambulance but they can hear each other. The driver is worried about the passenger. He keeps asking where he is and reaching out to touch him. The passenger keeps repeating that he's okay over and over again.

Yep! Driver's got him some head trauma!

Neither of these patients were in a hurry to die so, AJ and I didn't have too much of a challenge managing them medically. Our biggest challenge was physics. The driver of our ambulance (remember him?) has gotten so excited by all the drama, blood and people that he's driving the ambulance as if he were being chased by the devil. In all my years of having to deal with over-enthusiastic volunteer firefighter drivers, I've never encountered a ride as chaotic, bumpy, swervy and generally crazy as this!! Even in 35-foot (10 meter) seas in the Bering Sea, I had an easier time.

Keep in mind that, even though each of our patients presented with signs of pretty serious injuries, our treatment plan was constantly being adjusted and re-evaluated based upon priority, safety and the vagaries of the situation. If chaos is a sea, we do our best to surf the swells and keep from capsizing. Really!

Somehow, we managed to start a couple IVs, get some vitals, assess the patients, immobilize and bandage some injuries.

We survived the trip to the hospital which was chosen, not on the nature of the patient's injuries and the closeness of the facility but, as it works over here, by the employer of the patient. More on that later. In fact, my whole experience in a non-company hospital (we have our own) was so surreal and interesting that I think it deserves its own post with its own ruminations.

Suffice it to say that it was an eye-opening welcome to the world of EMS in the Kingdom.

My thoughts at the end of the call? "This is going to be a blast!"

--maddog

Holy crap! I'm back!

2010-05-07T19:32:00.000+03:00

I went on a short trip to India. Kolkata is INTENSE.

In the mean time: my laptop died, my home computer died and I got assigned to a remote area clinic even deeper in the desert.

At this Remote Area Clinic (RAC), I've had very limited computer access. The only computers available at work are the ones in the general emergency room and the attending doctor is is VERY nosy. I've stopped him a few times from reading over my shoulder. More on that later.

Well, now we finally have an office for the paramedics where I can blog in privacy. I have a few days off in about a week. Herself and I are discussing a drive to The Big City to get a replacement laptop. There's an Apple-authorized reseller and I need to see what the price difference is 'tween them and the USA.

Ok. I've actually had some calls and such. I'll be posting about that and paramedic life in the Middle East soon! I promise!

--maddog

Traveling

2010-03-14T07:40:00.000+03:00

I'm heading out for a week of knocking around the Near East. Nothing EMS related, just going to visit some pals. Probably won't be any posts until I get back. See ya!

--maddog

Chicks Dig It

2010-03-12T06:15:00.002+03:00

I had made some raspberry ice cream with dark chocolate chips. I brought it in to work to share with my fellow medics and the ER staff. My Arab paramedic partner is amazed that I can cook and loves the soup and bread I've brought in to work. The ice cream prompts the following from him:

"How come you only have one wife? Chicks dig this kinda stuff, you know?"

I swear, the funny moments are going to kill me.

--maddog

Search Keywords, Oh my!

2010-03-10T11:21:00.003+03:00

I use a software to track visitors to my blog. It gives me all kinds of useful information, including what search terms people entered that brought them to my site. Often they relate to EMS, sometimes people find me who were looking for another "maddog" and, every once in a while, I get a doozy.

Here's my favorite from this week:

"i am pee out of the wrong hole is that okay"

We live in a strange world.

--maddog

First Call in the Kingdom

2010-03-10T11:12:00.001+03:00

We get a call for car vs. pedestrian right near the clinic. The caller reports that the victim is dead. Since it's quiet in the ER (no patients), the attending doctor decides to jump on board. The accident has occurred in a small area right outside the compound called "the Village." It's a collection of houses and shops that evolved from a squatters camp many years ago. Some of the houses are pretty nice now and there can be seen a few expensive cars parked here and there.

As nice as some of the houses are, the side streets are still mostly sand and gravel, there's no real street lighting and the one main road that goes through is not lit at all. Some time in the past, speed bumps were put in the road to keep folks from driving their customary 160 Kph through at all times of the day or night. All this means is that most of the drivers swerve off the asphalt onto the hard sand shoulder to go around them, often without slowing down.

This is obviously what our young driver was doing when he was probably quite surprised to find an old Bedouin in his headlights. It's clear he tried to swerve: there's only impact dents on the headlight and fender, but it wasn't enough. I have to literally shove my way through the crowd of men to get to the victim.

The Bedouin is lying in the sand about a meter from his leg. There's no active bleeding from the amputation site. In the lights from the ambulance, the sand around him looks black from his blood. I don't think there's a liter of blood left in his body. His eyes are glassy and fixed, blood and clear fluid (cerebrospinal fluid) are leaking out of both of his ears and his nose. This means that his skull is fractured inside and the fluid from his brain is leaking out of his head. No pulse, no breathing and his chest feels like a bag full of loose blocks from all the broken ribs. The nearest trauma center that might have a hope of helping this guy is at least 90 minutes away and he's busted up worse than a celebrity divorce.

The Doctor looks at me with her eyebrows raised as I check for a pulse. I shake my head.

"Get me a strip." She says casually. She means and EKG showing if there is any electrical cardiac activity. She's looked at the scene and put it together herself. She's not expecting any and neither am I.

I expose his chest to put on the leads and see that he must have tumbled or been dragged. His clothes are full of rocks and sand. In fact, I have to wipe away sand from his skin to get my electrodes to stick. Just as we expected, he's in asystole (Flat line, no heart activity).

Doc and I pack up and leave our bedouin to the care of his family and friends and the driver to the care of the police.

And that, as they say, is that.

Things are very different here.

--maddog

Catching up, Part II

2010-01-13T13:59:00.001+03:00

From my previously referenced post:

2. Why I have been radically paranoid about posting anything for the past 2-3 years:

Well, it has to do with my fear of getting in trouble with my employer or with coworkers. You see, I've tried pretty hard to keep my blog anonymous. I've changed the name of the people involved, hidden some patient information and even edited a few photos to remove identifying marks and such. So far, as a simple medic in the big pool of medics out there, it's been pretty effective.

Then I got a job teaching at a university.

The privacy laws there are pretty strong. Also, my school is pretty unique and, I imagined, it would be very easy to figure out who I was and where I was teaching if I was blogging about my experiences there. Which is too bad. There were a TON of funny stories that came out of the classroom, let me tell you. So, you can imagine that I'm already unsure whether I should blog about my experiences at the Alma Mater. The job is time-consuming enough that I'm not getting out on an ambulance very much but I am teaching, guiding and, in some cases, precepting paramedic students who do. Lot's to write there, like I said.

Then one day, I'm walking down the hall from my office and one of my students walks by and says, "Hey there 'Maddog!'"

He doesn't use my name (Mr. So-and-so). He calls me Maddog. I don't go by that name on a regular basis and I require my students to always use title and last name when addressing anyone on the faculty and staff. Now I'm thinking, "Crap! One of my students is reading my blog!!!! ...and that means they probably are ALL reading it!!!"

This effectively shuts down any blogging I do about that job! It also tells me that I'm not nearly as clever as I think in regards to hiding my identity and such. Now I'm paranoid that everyone is reading what I've written and knows who I am and is furious with me! This paranoia extends to all areas where I'm working and has lingered with me for the past 2.5 years. Only now, with much to write about and the weight of this blog being 6 years old, am I working to overcome that and get more words out to you, my readers.

So, there you have it. I've had some sweet part time jobs in the interim, done some pretty neat calls at the volunteer house but, here again, I've been too paranoid to write about them. My intention when I started this blog was to keep the content focused around my experiences in EMS and related topics however, in the past two and a half years, I've been worried about violating privacy laws and offending people in my EMS world.

All of this leads me to the next item on my list:

3. A discussion about what I intend to do with this blog.

I still want this to be EMS related but, living in another country, there will be a bit more of the "personal crap about maddog" stuff in it. I've got a lot of content already from being here but not a lot of calls. I ran my first actual ambulance call just the other night and I've been here for almost two and a half months (yes, it's slow). Expect to see a comparisons of how EMS is delivered here vs the United States, a few stories about some cool calls and a bit of content about my travels outside work. I still need to work out how I'm going to write a lot of this and keep within the guidelines of my employer. You see, my employer is very clear about how quickly they will fire me if I break their rules of confidentiality and such. I like this job so far and I'm not keen on getting fired. We'll see how it works out.

I encourage my readers (if I have any left) to use the comments function and ask me questions. I'll write about what I think is interesting but let me know what you want to hear about. Thanks for reading!!

--maddog

Catching up...

2010-01-07T10:12:00.000+03:00

From my earlier post:

"1. A synopsis of what the heck I've been up to for the past year or so"

In January, 2009, I had been working at the University for about 2 years and had all but made up my mind to leave. I was enjoying the academic life but I was realizing that it really wasn't for me. I didn't leave my job, sell my house and go back to school to be a college professor. I did all that to become a PARAMEDIC. Even though I was teaching students who, I hope, will become some of the best paramedics in the world, my personal practice of medicine was lacking. Working at the University was a sweet job, however. I was left to schedule and plan my own work. I had summers off, great benefits and all that stuff. It was sweet! However, I did have a lot more administrative crap that I wanted to handle and, when it came right down to it, I wasn't being a paramedic as much as I wanted to.

So I decided to leave.

I still had the rest of the Spring semester to finish working and, thank goodness, have an income, healthcare etc.. You see, Herself and I had a small business, a Yoga studio, that took a hard hit when the US economy dived. We had to close the business and still had a substantial chunk of debt hanging over us. We had burned through much of our savings and, with our income at the current levels, could pay back the debt over time but that didn't leave much for retirement and savings. Now, we could have defaulted, bankrupted, etc.. Many businesses fail and those who invested in or lent the businesses money end up losing too. However, we felt we needed to be true to our principles, we decided to pay back every dime. (No bailout for us!!)

So I needed to make a lot of money.

One option was to get two full-time paramedic jobs. It's possible with offset schedules and a lot of people do it. However, EMS agencies were feeling the economic pinch as well and many weren't hiring new 'medics. Things were looking grim on the home front. I was picking up a lot of part-time work in addition to my time at the university but not enough to sustain us once I left my teaching job.

So I started looking overseas.

With my military background and the current state of affairs in some parts of the world, there were a LOT of opportunities overseas for me. I applied to a plethora of jobs. I had offers to go to Khandahar, Baghdad, Darfur, and other such festive locales, mostly as a paramedic supporting contractor operations. As you can imagine, they offered me a LOT of money and, if I came home alive, I'd be pretty well off.

Meanwhile, in the USA, I'm working at an EMS company that does inter-facility transfers and provides staffing for an ALS chase car in a rural county. I'm having me some fun!!! I'll blog on that later.

Herself and I are preparing ourselves to be apart for a year or more while I go out into the world to seek our fortune. Kinda scary but the money's good. Then an offer pops up that looks really, really sweet! I end up taking a job with an oil company as a paramedic. This company is so big that they own their own hospital and several clinics as well as an EMS agency. They offer me a position in the middle of the desert in a very secure, stable and safe Middle-Eastern country.

Now, pardon me if I'm vague. My employer is pretty clear about releasing specific information about the organization and such. I'm still navigating how I'm going to blog about it and keep within the rules.

I'm offered less money than the high-risk war zone jobs but, Herself gets to join me, the company moves our entire household to a lovely house in a company-owned, company-built town in the middle of the rocky desert. The benefits are AWESOME and things look good.

So, after a summer of paper shuffling, interviews and medical checks, We've sold our house and moved overseas!!! We're now living in a lovely man-made oasis and, it being January at the time of this writing, the weather is LOVELY. (we'll discuss this again in August!).

So, there's the synopsis. Things are very good here. We have a lot of chances to travel. We've bought a 4X4 for desert camping and getting around. We call it the "camel" since it's brown, has a hump on the back (1999 Land Rover Discovery) and gets us across the desert. Work for me is VERY SLOW compared to what I was doing in the U.S.A.. However, the character of the work is very different. More on that later.... I promise!

--maddog

Update in the pipe.

2009-12-29T12:10:00.001+03:00

I'm still sorting out the content for this blog and how it has changed. My company is pretty strict about publishing information and I need to be sure I don't step on any toes (least of all, mine!).

Coming up:

1. A synopsis of what the heck I've been up to for the past year or so.

2. Why I have been radically paranoid about posting anything for the past 2-3 years

3. A discussion about what I intend to do with this blog.

4. Why the heck I haven't posted anything cool from the Middle East yet.

Stay tuned!

--maddog

Chillin'

2009-11-13T21:52:00.001+03:00

I'm at the big corporate headquarters for training this week. Not much to blog about. If things get slow, I'll try to catch up on some cool stories from back in the USA and more info about life here in the Middle East.

Be well.

--maddog

My little patch of Desert.

2009-11-12T23:47:00.002+03:00

Here's where I work:

It's a tiny clinic situated in a small man-made oasis, smack-dab in the middle of the desert, surrounded by pipelines, gas plants and other assorted facilities for oil production. Salt water is de-salinated and pumped in from the Arabian Gulf to provide drinking water, irrigation and such. The place is charming, green, full of songbirds and looks like a little paradise. Now, it exists as a housing and administrative facility supporting all the oil-related operations that are scattered around the desert.

in this little pocket of green is a small clinic. We have an ER of sorts. About 4 regular beds, a "trauma room" and an isolation room. Not much to it. its' staffed by 2 nurses around the clock and the doctors are there from 7 to 4 Saturday Through Wednesday. The weekend is Thursday-Friday here. Typically, we have 2 paramedics on duty at all times, along with a driver. How we deploy those resources is the subject of another post. (Got a bit more research to do on that one before I publish).

So, there we are. In the middle of nowhere. Apparently, the 'Medics average about 15 calls per month! Yah, busy, I know!! HA! The prehospital care unit (my department) exists to provide EMS to the residential community and the outlying work areas at all the various petroleum facilities. We also will respond to auto accidents and other "110" calls in the area. Though there is no national EMS service or even a guarantee of medical care in this country, my company, altruistically, offers care to anyone who calls for it. Things are pretty slow (thank goodness) but I hear that most of what they run are auto accidents. I can see why. Nobody in this country wears seatbelts. Not even for their kids. They go careening down the road, ignoring lanes, directions of traffic and the like. It's chaos! My two hour taxi ride to my new home was an amazing and somewhat harrowing experience. Craziness!.

So, I can imagine a couple of these yahoos going flying along at 160Kph each, ignoring all concepts of traffic regulation, unbelted and then, BAM! Well, you can figure the rest. Nice, eh? I've been on the job for a week and haven't run any of those yet.

I'm not on shift-work yet. They've got me on day hours so I can dash about taking care of all the various paperwork messes that need my attention. Good thing too, I've spent half of each of my workdays running from one office to another figuring out what color my ID badge should be! (that took about 5 days!). Machiavelli would weep! Unfortunately, I was on just such an errand when the ambulance went out on an accident with two patients. DRAT! Oh, well. There's more where that came from!

We've got brand now Ford F-350 ambulances with the standard box on the back along with a hydraulic lift for an isolette in case we transport a sick baby. Odd thing: they only stock ONE Backboard per unit. They also don't have a decent place to park the ambulances inside so, we don't keep any medications on the unit. If we do, the heat will destroy them. We medics have a semi-permanent trailer outside the ER for an office. It's got a couple computers in the office side and another room with a TV, couch, fridge, etc. It's not a bad place to hang out. If that's too boring, one can always go in to the ER and hang out with the nurses. They're a pretty amiable bunch. I'm sure I'll have stories about them soon.

Here's a neat thing: If we get a really sick patient or one that needs to be intubated, the staff call in the paramedics to do that! How cool is that? I write a whole other post on HOW. I kinda want this one to be about the WHERE.

The weather here is pretty nice in November. It gets up to about 90F (32C) in the midday but drops to about 60F (15C) at night. Very breezy and VERY dry! I went for a 5k run the other day and, though I sweated, I wasn't wet. Just coated in a fine film of salt. Like I said, dry! The dry air and regular breeze keeps it feeling pretty nice, even in the heat. Now, I understand it'll get up to 135 degrees Fahrenheit (57C) during the summer months of July and August. UGH! Right now, I'm enjoying the balmy fall into the winter.

More to come!

--maddog

Boots on the ground.

2009-11-03T16:29:00.002+03:00

Herself and I have arrived in the Kingdom. We're in temporary housing (read: hotel) at headquarters until we finish orientation and they run us out to our new house in the middle of the desert!

Right now, we're at a mall (Huge!!!) shopping for new iPhones (3GS! Win!).

Stay tuned!

--maddog

Goodbye, My comrades!

2009-10-17T07:35:00.001+03:00

I have resigned from my local, hometown, volunteer firehouse in preparation for my move to the Middle East.

Tonight, I went down there to clean out my locker and turn in my keys. My name was still on the board under "EMS Sergeant."

I was feeling cry-prone when I arrived. That pulled a tear or two out of my eye. You see, had I not resigned, tonight would have been my night for duty. I'd have been running with "Skipper," "FirePlug," "Brooklyn," "Peru," "Fester," "WMD," "Squiggy" and the rest of the crew.

Fortunately, when I got there, they were all out on the call. Nobody was there to see me stand in the empty ambulance bay and sniffle.

I get to clean out my lockers and such before anyone gets here. They arrive, having stopped for dinner on the way back from yet another auto accident and promptly settle down to eating. They're not paying too much attention to me other than an occasional "Hi."

Have I already "passed on?" Have I so quickly fallen from being one of them? I'm not sure. The banter is still there. We still bust each other's chops as if I were still a member but, there's a relaxing of authority. I'm no longer "Sarge."

Then the cake. WMD pops out of the chief's office with it and surprises me.

"We'll miss you, Sarge!" in blue frosting.

And a framed picture. Someone thought it was a good idea a few months ago to get a picture of the whole crew in front of the engine. We're all there, in our gear, trying to look proud, mean, tough or just present. It's in a frame and, because I'm the tallest, I'm in the middle. Despite the "tough look" on the faces of these men and women, it really looks to me like I'm surrounded by my family.

I manage to not cry until I get home. Still have leaky eyes as I write this.

Triple Threat, I will miss you all!!!

--maddog

Zoom-Zoom!

2009-10-14T00:22:00.001+03:00

I've had my first day on the chase-car. I've being precepted by the lead Field Training Officer (FTO) and the former chief of the organization. No pressure, maddog.

The "chase car" concept is one that works pretty well in a sparsely populated area that doesn't have a big enough tax-base to afford a fully-staffed paramedic-equipped ambulance on every corner. How this rural county works is this: there are several "rescue squads" who provide a slightly higher level of Basic Life Support care. They can do all the things an EMT-B can but are often staffed by people who can start IVs, give fluids and check glucose. This covers at least 50-70 percent of the calls for Advanced LIfe Support (ALS or, me!).

So, you have about 10 rescue squads with a total of 10-15 BLS ambulances covering an area about the size of Manhattan but with the population of, say, one building in downtown (during the business day).

Yes, we have farms.

Yes, we have tractors.

Yes, they roll over. (more on that later)

Now, the ONLY ALS provider around is the one, the only, the maddog!!! I, and my boss, are in an SUV that was built with the oversized engine, tightened suspension and "flashy-light-thingys" that allow us to go really fast and legally break traffic laws. This vehicle is equipped with all the gear, medicines and such that we need to do our ALS job, versus the BLS job that the ambulances do. Oh, did I mention that it goes REALLY FAST??

This is a recipe for FUN!!!!

Preview:

-Trailer Parks!!!

-Diabeetus!!!!!

-Stomach ache? No, Sir, That's your heart dying!

-Jesus Juice!

-Can you breathe through your ears?

Stay tuned!

--maddog

Ch-ch-ch-chaaanges!!

2009-10-13T19:28:00.001+03:00

I've got a new job. In 3 weeks, I move to work as a paramedic in the Middle East!

I'm going to have to figure out how to navigate the differen privacy laws and not violate my company's confidentiality policies but, I promise you: THERE WILL BE STORIES!!

--maddog

Paramedic Refresher, Day one!

2009-09-15T06:38:00.000+03:00

Oh my!

I'm grabbing a paramedic refresher course about 7 months before my license expires. Typically, I teach in the one that runs about 6 months later but, this year, I likely won't be there. I'll post more about that later when my official offer arrives in the mail. For now, nothing is assured until it's in INK!

So, anyway, there's 18 very experienced and, in some cases, quite jaded, paramedics and me. We're jammed into a classroom and forced to sit and try to stay awake while another paramedic puts up powerpoint slides and reads them to us.

I bravely resist the urge to gouge out my eyes with my Non-Reflective Military Matte Black Cap-O-Matic Space Pen. I'm a brave man. I have control.

Lucky for me, I survive to the end of the class where, wisely, the instructors run a practical, hands-on portion, relevant to the lecture that pained us so much that morning. This is where us 'medics get to actually walk the walk. Everyone's been spouting comments about how they've seen this and they've seen that. Each medic has an opinion on how their particular employer or medical director can do a better job of providing higher quality medical car to their patients. Sure sure sure...

Now, even though we are "treating" a plastic and electronic "patient," all of us have a chance to jump in and DO something or stand back and continue to be the griping critic.

The Scenario: An 8 month old in respiratory arrest. the simulator is actually turning blue and we can actually feel a pulse, however faint. Half the "hotshot" medics in our group stand around and make comments while the other half stammer and look for gear. Someone else jumps in and starts ventilating our infant patient with 100% oxygen. They've become the "team leader" by default but aren't doing much to direct the rest of us. I'm casting about for the next thing to do while the de-facto team leader stammers. There is an EZ-IO drill.

An IO drill is VERY similar to a cordless drill one would use to make holes in walls in their home. The big difference is this particular battery operated drill is used to put a rigid needle into a long bone like the shin or the arm, in order to quickly and VERY effectively give us medics a way to save someone's life with fluids, drugs and other goodies. You see, a long bone is a bone such as the femur, humerus or tibia. They play an important part in generating red and white blood cells and, in the terms of a circulatory system, are very much a big, hard blood vessel.

The maddog is a fortunate medic. he's used this tool before. I quickly realize that I'm the ONLY one who's used this tool before, besides the instructor. Our scenario is set in "real time" so that means we are all working this hunk of very realistic plastic as if it were a real baby with real parents and a real life-threatening condition.

I grab the drill and, with smooth precision, choose the correct needle, attach it to the handle, direct an assistant (who has magically appeared from the few medics who are actually INTERESTED in learning something) to spike a bag of fluid and get to work. With the practice and precision that only comes with doing something OVER and OVER again, I perfectly drill a hole into the leg bone of this simulated child, with a special drill/needle that enables me to deliver drugs and fluids.

Somehow, after starting the line, I'm the only one who remembers that an 8-month old in bradycardia gets epinephrine if oxygen doesn't make their heart rate increase. I call it out, and "push" the drug.

The key part of this story is that I'm getting open-mouthed stares of amazement from men and women i've seen time and time before in the field. They know me. They've seen me do my thing yet, somehow, in the atmosphere where we're wearing jeans and performing our skills in the classroom, they fall back and let me run the show.

Now that I think about it, perhaps they've been doing that on every call.......

--maddog

Yep, That's me!

2009-09-14T06:13:00.002+03:00

We're floating down a river. It's a bunch of close and dear friends. We're each sitting on little inner tubes and, in a calm spot, the antics ensue.

Some folks are trying to stand on their tiny tubes. at 6 feet 4 inches, and a shallow river, I see this as a dubious task, at best.

Soon, it's, "Maddog, do downward dog!" so, being the amateur yogi that I am, I do my best to execute a Downward Dog (or Adho Mukha Savasana) on my tiny river inner tube. Somehow this inspires many people to great feats of silliness. then the comments start:

"It's pretty shallow. You're going to crack your head!"

"It's OK, Maddog's here. He'll take care of us!"

Ugh! I just want to float down the river

"I'm off-Duty!" I say!

laughter ensues.

........

A few hours later, the same crowd is at dinner. Someone orders a monster steak.

"Holy crap! that's gonna kill me!"

"It's OK, Maddog will save you!"

I'm a few drinks deep. The steak-eater looks at me. I waggle my eyebrows.

"I'll save you, honey." I say.

His girlfriend immediately responds with "Woohooo!!!!"

laughter ensues.

The paramedic? Oh, Yeah, that's me!

--maddog

9/11, Of course, but...

2009-09-11T21:38:00.001+03:00

It's good to remember the attacks on 9/11 and we should always honor our heroes who rushed in to respond to the attacks. I certainly do.

...you know, I was going to write something cranky and scathing about how EMS workers are always marginalized and shoved aside to make room for Fire and Police and how the delayed recognition and honoring of the EMS workers lost in the WTC attacks was an example of that but... I find that after 8 years, I don't have that much anger in me anymore. I've become so used to "working behind the scenes" that it doesn't even bother me anymore.

It's time to move forward. FireFighters, Paramedics and Cops. We all protect and serve. I don't need to be a hero. I don't need to be recognized. I'm just happy to have a good job doing what I love. Eight years ago, we saw what hate, anger and ignorance did to over 3,000 people and their families. There's no room for that in my world anymore.

I know I do good. My patient outcomes speak to that. I move through this world and do my work with compassion and dedication. I know that. I don't need anyone else to tell me.

Get over it, maddog.

He stands up, stretches and looks around the blogsphere.

By the way, It's good to be back!

--maddog

R.O.S.C.

2009-07-21T05:56:00.002+03:00

Return Of Spontaneous Circulation!

I'm not dead yet!

My non-bloggable job is at its end!! w00t!

My VERY-Bloggable job(s) are ongoing!!

More to come (I REALLY promise this time!)

--maddog

Blogmeet and Blog Move

2009-03-30T14:56:00.002+03:00

The blogmeet went awesome! More to come on that.

I'm also struggling with the move from blogger to wordpress. I've successfully moved my blog entries from one platform to the next but moving the comments is a bit of a pain and Wordpress.com won't let me modify the templates at all to insert any code. I've been pretty happy with Haloscan for the comments and don't really want to change.

Fooey!

Any ideas?

Epijunky, you're hosting your own. Any guidance (I'm clueless!)?

Here's my current rundown:

Blogger:

Pros:
Control over the template
Haloscan works
Cons:
No native iPhone blogging tool
Interface is clumsy

Wordpress:

Pros:
More tools and widgets
It's Pretty!
Native iPhone blogging tool
Cons:
Have to use the native commenting tool (all require moderator approval!)
Cannot change template
may be a size limit (saw $$ for more space advertised in there)

Any input?

--maddog

Blogmeet: It's ON!!!

2009-03-25T16:04:00.003+03:00

Ok, Kids, Here's the deal:

Let's have a blogmeet at The Nest. It's a bar right across the street from the convention center in Baltimore. They have a downstairs bar and eating area, Pool and games on the 2nd floor and a martini-bar style lounge on the 3rd floor.

I'll be there, and, depending on how many people show up, we'll be at the bar, in one of the upstairs zones. We'll do this on Saturday, March 28th at 4pm. The last conference session ends at 4pm and the exhibit hall closes at 3. We'll make it a happy-hour style event and we can move on from there as needed.

Sound good?

Here's the details in short:

WHAT: EMS Blogger Meetup!
WHEN: Saturday, March 28th at 4:00pm
WHERE: The Nest, 200 W Pratt St. Right across from the convention Center
WHO: EMS Bloggers, Faithful Readers, Groupies, YOU!!!!!
WHY: Why Not!!!???

I'll be there early. If you want to find me, I'll be wearing this hat:

Post Comments or Email me if you have questions.

--maddog

EMS Today Conference (Blogger Meetup?)

2009-02-11T05:51:00.001+03:00

EMS Today is coming up in March.

I'll be there.

WIll anyone else?

Wanna have a Blogmeet?

Hit the commments or email me

--maddog

iPhone blogging test.

2009-02-10T17:56:00.001+03:00

I'm not dead. Just finding Blogger to be less and less convenient. If anyone has experiences with Wordpress, specifically importing from Blogger, give me a holler!

--maddog

Little Bodies

2008-12-12T09:48:00.002+03:00

I sit on the floor of my living room. I make a circle with my legs and my dog finds his way there. He curls up and seems contented to be surrounded by "the boy." My hands find their way from his head to his hips and I feel his story along the way.

He is young, strong and fit. I can tell this from the shape of him. He is not a big dog, however. One of my hands covers his whole head. He's a burly boy but compact. If I reach, I can place my hands all the way around his chest. My thumbs meet in the middle.

Dogs are not people but, right away, I'm taken back.

My fingers meet between the shoulder blades and my thumbs are on the top of the sternum.

No person should be this small.

I squeeze and shove with my thumbs (We call this "chest compressions")

No person should be this small.

I am simultaneously squeezing and carrying this child.

Blue.

Floppy.

We push air in. We move the blood around. We do it all perfectly.

We know.

It is still exquisitely painful....for everyone.

Nobody should be this small.

--maddog

"Big truck...big truck...there you are"

2008-12-05T08:07:00.004+03:00

(This one is for my friends, Elvis and Koehler......)

I'm rolling down the road.

I'm not driving a 16,000 lb ambulance. I'm driving my "compact" station wagon. I'm on my way home from work, not on my way to a call.

Big truck, big truck, there you are...

I see you. I rely on you. You move the way a professional (like me) should. You see ahead by 1/2 a mile and move your lane to make your exit.

I see that.

I drop back to let you in.

I know. I'm just a "four-wheeler." I'm part of the problem.

Last week, it was a "four-wheeler" who put herself between you and safety. You put on your brakes and grabbed that wheel like it was the end of the world.

You were in the berm. Soft grass and a gentle shoulder saved you. (along with your seatbelt).

The "four wheeler" had no idea of the chaos she caused with her thoughtlessness. I'm sure she/he was on the phone/checking email/texting. It doesn't matter. The end result is the same.

You, who's income is affected by your safety record, are in a ditch. You did that to save someone's life.

The driver of the "four wheeler?" She (he) had no idea. He did not even hang up the phone.

I check you out. YOU know you're ok. But I do my job (Heart rate, Blood Pressure, Breathing effort and a good sense of "what's wrong"). Your beloved rig is on its side next to the highway and there are things broken beyond what you and I can fix.

Yeah, You're OK. Shaken, angry and ready for a loooooooonnnngggg vacation but, to me, you're OK.

48 hours later, I'm driving my little station wagon home from work....

"...Big Truck, big truck...there you are...."

Yes, you can come into my lane.

Yes, I'll slow down to let you pass.

Yes, I'm not a "big truck" driver, but, somehow...I understand.

My car has four wheels but I'll never want to be a "four-wheeler."

"big truck....big truck....there you are...."

--maddog

Alive:Improved?????

2008-11-21T07:43:00.005+03:00

We get ANOTHER call for trouble breathing. This one is to an apartment complex that caters to people who are just barely this side of needing "assisted living."

We've gone there so much that we have a key to the front door on the ambulance as our standard equipment.

We arrive to the 3rd floor apartment to find a woman who is 84 years old, up on her feet, agitated and talking like this:

"I"
GASP
"am"
GASP
"Having"
GASP
"trouble"
GASP
"catching"
GASP
"my"
GASP
"breath"
GASP, WHEEZE GASP

Get it?

I ask her about previous medical history (Heart disease, lung disease, diabetes, hypertension,etc.) and get a "no" at every single one.

She is house proud and wants to jump up out of her seat to open every door, move every piece of furniture, show us every thing every time we move. Over and over again, I ask her to, "Ma'am, PLEASE! Sit down and be still!!" after I've given her 15 liters per minute of oxygen.

Finally, while I'm struggling to fit our large cot into her tiny apartment, She jumps out of her seat! I have to use my 'Cop Voice',

"SIDDOWN! DO NOT MOVE STAY RIGHT THERE!!!" (I'm doing my best to scowl) "You! (I actually point at her) stay right there and let me do my work, OK??"

This earns me a meek nod from my patient as she hungrily sucks on the oxygen mask as if it were water and she was 5 days in the desert.

On the cot, out the door (keys, alarm, etc) into the elevator and into the back of the ambulance. Go, go, go!

I can't really figure out how an 84-year-old woman with NO previous medical history is having this problem just out of the blue at 3:00 am on a Saturday morning.

Until someone knocks on the door of my ambulance.

Now, you must understand that I get this all the time. Curious (Nosy) neighbors who are concerned for the welfare of their friends (Morbidly curious about who's dying before them) are always ready to ask me all kinds of impertinent questions.

I'm ready for this when I find my patient's daughter with a leather-bound book that contains all her mother's medications, medical history and allergies. It turns out our 84-year-old patient has had atrial fibrillation for the past 10 years, Hypertension (high blood pressure) and a whole bunch of other problems for just as long.

"Did you take all your pills today?" I later ask "Mom".

"Pills???" She replies.

Right! Ok! She gets the full work-up. Nowhere in the history I got from the daughter do I read anything about dementia or Alzheimer's disease but I'm trained to presume the worst.

Her Blood pressure is 200/104 (WOW!) and her 12-lead shows the early signs of an inferior MI (this means that the bottom part of the heart is sick and not getting enough blood/oxygen, etc and is not doing its job).

She's NOT complaining of any chest pain but the vague inferior MI signs lead a cautious medic to go above and beyond. We perform a 15-lead (for those of you who have been to a Bob Page seminar, it's V4R, V5-V8 and V6-V9) you all know that a right-sided MI (a sickness or oxygen/blood starvation of the RIGHT side of the heart) is a bad, bad thing. Even more so because we are not regularly taught to diagnose and treat this kind of sickness as a regular part of our training.

(Simply put, the right side of the heart takes blood from the body and pumps it to the lungs so it can dump all the Carbon Dioxide it acquired from the rest of you and trade it off for Oxygen the rest of you needs to keep doing whatever it is that you do!)

The 15-lead shows a very slight deficit (infarct) there. Cardiologists look for at least 2mm of S to T wave segment elevation to tell them that the patient is really sick. I only see 1mm of S-T elevation but she's not hurting yet.

*In my head to myself: "do we have to wait until it's a FULL-ON heart attack before we decide to transport/treat them for a heart attack??*

We give her oxygen, aspirin and not much else as she's not complaining of any pain. Her trouble breathing is still there but she can now talk to us 5-8 words at a time between breaths. When I listen to her lungs, I can hear nothing but good, clean air moving back and forth. If I heard the sound of crackling cellphane or the crinkling of fine paper, that would tell me that her lungs are filling up with fluid, most likely due to congestive heart failure.

I was somewhat disappointed to hear clean/clear lung sounds. A case of pulmonary edema with congestive heart failure is one of those things we can treat really quickly and effectively if we catch it in time. However, things are never this easy!

We decide to go to a cardiac center (clearly, it's a cardiac event!) and we call 'em up by radio.

I've been spoiled. I'm used to talking to Emergency Medicine doctors. They value the opinions and judgement of Paramedics. They know when we speak of a patient who is "combative," for example, we actually mean, "She's drunk, bashed-up, possibly brain-injured but DEFINITELY beating me up and I'm ALL BY MYSELF in the back of this ambulance for the next 10-20 minutes so, PLEASE, give me permission to sedate them to a state of mutual happiness right NOW!

This time, I spoke to a cardiologist.

No fault on them. None at all. However, I think this cardiologist has become too accustomed to working in a hospital or Emergency Department where she has an unlimited number of ER techs, Phlebotomitst, Respiratory Techs, Nurses, Radiologists, Interns and other help at a moment's notice.

In the back of the box? It's me, the scared paramedic intern and the confident, capable EMT-B. And, THAT'S IT!!!

"Give your patient 0.4 to 1.2 milligrams of nitroglycerine (NTG) and monitor vitals" says the cardiologist.

I know. I know that if my patient is truly having a failure of the right side of her heart, she's deader than a doornail not 20 seconds after I give her this medication.

"Roger, [Cardiac Center], I understand your orders per [Doctor So-and-so] for 0.4 to 1.2mg of NTG, however, I must impress upon you that this Medic believes the patient may be suffering an inferior/right sided Myocardial Infarction and NTG may be detrimental to the patient outcome." is what I say over the (recorded) radio.

"understood, Medic XXX. Please administer 0.4 to 1.2mg of NTG, Sub-lingual and report any changes."

"Roger, [Cardiac Center]. 0.4 to 1.2mg NTG as per [Doctor So-and-So], please confirm spelling of doctor's name. "

"Medic XXX, [Doctor So-and-so (spelled out)] authorizes 0.4mg of NTG. Please consult and advise if any changes or if you need orders for further administration."

OK! Now the Cardiologist has had time to refer to her (his?) drug reference and brush up on the concepts of 'Pre-load' and 'After-load'. I think I covered my butt by pinning this on the doctor in question ("Pls confirm spelling...."). I have to say, with a blood pressure of 200/104, I'm not as cautious about giving her a medication that will open all her small arterioles and allow her blood pressure to drop a lot.

I'm also not so cavalier that I don't start two intravenous lines (ways to inject a blood-like fluid or medications into her bloodstream) with 1000ml bags of fluid (one of the most important things we need to revive someone) connected to each one.

We give her ONE dose of Nitroglycerine (0.4mg)

Her blood pressure DROPS!! from 200/104 to 128/60.

OH MY!!!

However, she's still awake and talking to us. All this time I have my hand around her wrist. I'm feeling the pulse of blood through her wrist. At first it was "bounding" or hitting back against my fingers pretty hard.

Unlike my compatriot, I'm not so freaked out by her drop in blood pressure. I can still feel her pulse in her wrist. My thinking is, if her heart is strong enough to push blood all the way out to her wrist, it's strong enough to push blood to her brain, into her lungs and to back-flow into the arteries of her heart. Yeah, we dropped her pressure HUGE but she's still going.

In the ER, the Cardiologist asks me if we gave her ANOTHER nitroglycerine dose.

"Hell, No!" I reply

"Why not?" She asks me with a cross look on her face.

I put my hand on her arm, "Doc, have you ever worked alone?"

She looks puzzled. This is a foreign concept to her.

Alive: Improved.

--maddog

Alive:Improved

2008-11-08T04:50:00.004+03:00

The call goes out as "Trouble Breathing"

CC-Rider and I are together again. Our driver, SmokeyJoe, is a recent Paramedic who's still getting his ride time in. He left the USMC and started paramedic school when he was 32. (Sound familiar?)

CC-Rider says to the both of us, "This is your call! I'm driving!" She clearly has much faith in us.

The "trouble breathing" is a woman sitting on the floor in the open front door of her house when we arrive. Her face, lips and neck are about twice the size they should be and she speaks to us in a pattern like this:

"I...GASP...ate...GASP...a...GASP...pistachio...GASP..." (you get the picture).

"Ma'am, are you allergic to anything?"

"Yes...GASP..nuts...GASP!"

I look at SmokeyJoe over the top of my glasses and see his eyebrows do their best to meet his hairline.

Ooooookay! it's GO TIME!

I don't need my stethoscope to tell me that she's closing up. From a foot away I can hear a noise like "HeeeeEEEEEEP!" every time she breathes in. My stethoscope does tell me that she's not moving any air in her lungs other than the very center of her chest. Basically, this means that her allergic reaction is causing the muscles around her bronchioles (the smaller pipes that lead from your windpipe, or bronchia, to the business parts of your lungs) have all squeezed down really hard and are blocking any air from getting to the parts of her lungs that will enable her to get oxygen into her body and carbon dioxide out.

This is what we call, "bad."

Her husband hovers nervously in the foyer. SmokeyJoe and I waste no time. We practically fling her onto our cot, dash the 10 yards to the medic unit and load her up. CC-Rider is already there and bobs her eyebrows at me, asking what to do.

"Epi, IM." I tell her, indicating her to inject 0.3mg of epinephrine into my patient's arm muscle. This is a pretty cool drug. The paramedics in the UK accurately call this drug adrenaline. That's what it is. It's the thing that makes your lungs open up, heart race, blood vessels constrict and dries up any secretions in your mucous membranes. (Pseudo-ephedrine, or sinus medications is a form of this). The dose we give people having allergic reactions (anaphylaxis) is, for the human body, HUGE!

It works quickly and very well, however, it just buys us time. It'll probably wear off before she's done having an allergic reaction. SmokeyJoe tries and fails to get an IV line on twice. I tell him to start a neb of albuterol. This is a drug that acts directly on the aforementioned bronchioles and cause them to open up. We deliver it by nebulizing it so the patient breathes it directly into the lungs (quickest way to get it where it's needed).

Meanwhile, I drop the IV perfectly into the patient's left arm. This is significant in that it's my first successful IV in over a year (not a lot of chances to start one when you're a teacher) and I was nervous that I had "lost" my skills. CC-Rider jumps in the driver's seat and we roll. Our patient is breathing easily and has the hyper, nervous laugh that comes with getting jacked up with more adrenaline than your body can make in an hour.

She's not the only one breathing easier. SmokeyJoe and I are already confident in the fact we had a "save."

What I mean is, had we not arrived (or arrived late) this one would have closed up and suffocated. She'd be dead at age 33 and her husband would be a lost and confused man, having watched his young wife die before his eyes.

We turn her over to the friendly staff at the local hospital and in the part of my paperwork that says, "Condition of Patient Upon Arrival at Destination:" I gladly choose "Alive:Improved."

Life? It's good.

--maddog

Epiloge: I saw her a few hours later when we brought another patient at the same hospital. The sight of her happy (normally sized) face made up for the "died-despite-all-we-did-and-we-did-it-right" condition of my current patient.

Second Guessing.

2008-10-13T06:13:00.002+03:00

I'm in a unique place.

One of my students is also a member at my volunteer firehouse (where I am the EMS Sergeant). She has another four months until she becomes my student (begins field clinicals) but she's still "one of mine."

She came to me with a rather prescient question today. She had been the primary provider on an accident. She was riding the ambulance and the fire engine (with our station officer on board) had been dispatched on the call too.

It was an auto accident with very minimal car damage. There was a "star" on the windshield but not in the typical place for head impact. Relevant too, was the fact that the driver (my student's patient) was seatbelted. No airbags installed on his car.

He was also "altered." This means the person driving the car was in an altered mental status, or was so out of it that he did not remember the question that was asked of him 2 minutes before.

My student said, "Off to the trauma center you go!!!" In fact, as she arrived on scene, she asked for the status of the local trauma center.

The officer, however (someone who is primarily involved in fire suppression), said, "No, you should go to XXX hospital" (the closest but NOT a Trauma center).

60 hours later, she catches me in the Chief's office and asks me if she made the right decision.

Now, understand that these "questions" are never asked. They are always prefaced by a story. She's telling me the story and when she gets to the part about "star on the windshield + altered mental status" I interrupt and say, "Trauma Center!"

She counters with, "What if it's a seizure or EToH?"

I respond with, "Look, If its a seizure, EToH or a stroke, the local trauma center can handle that. If it's an altered mental status due to a stroke or an epidural bleed, for example, then the local "community" hospital is going to transfer them to the trauma or the stroke center (both in the same place) and that will delay care.

I tell her, "I would have made the same decision. Fire donkeys and cranky nurses be damned."

She sighs her relief.

I asked her if that's where her patient went. (To the Trauma Center) Yes, but she feels bad about "second guessing" the officer on the call.

I ask her, "Who's in charge of patient care?"

Her shoulders drop and I can visibly see the stress fall away...."Me!"

"Then it's your call and you made the right one."

"Thanks, Sarge!" A flip of a wave and a spring in her step and she's gone.

She's ready for the next one.

-maddog

Please don't eat before you die!!!

2008-09-14T18:44:00.000+03:00

Well, yes, I told you "More to Come" and here it is!

We get called to a townhouse for one having trouble breathing. Dispatch has done a great job of getting information and we know that, even though she's 42 years old, she's already had a heart attack, suffered from congestive heart failure (CHF), and has an extensive history with a LOT of drugs.

In the door & up one flight of carpeted stairs.

This place smells horrible.

There are a lot of concerned people standing around who, I assume, are family.

Another flight of stairs. (Why is this so common!???)

Into the bedroom where she's lived for the past couple years (we can tell that walking in).

She's on a big recliner. She's got all the signs of a lifetime of being unkind to her heart. I see all this and I see her chin on her chest (not natural). Right away, I can see that "trouble breathing" is now "NO breathing!"

ZIP! I slide in and check a pulse while moving her head up to open her airway.

"I got nuthin!"

This galvanizes the other two medics I'm working with. Mind you, this is my second shift with them. The last one was exciting as well.

It's game time!

CC-Rider and I quickly move our patient from the recliner to the floor. MedicToMyRight (who, strangely enough, is again to my right) dives in to help. We also have some well-meaning, enthusiastic volunteer firefighters too.

The room is suddenly crowded.

As my patient's head is wedged between the recliner and the wall, I can't immediately get a quick assessment of her airway other than getting a basic airway (OPA, or OroPharengyalAirway) in her mouth.

I roll it in and she doesn't gag. This means that the airway is "tolerated." This also means that the patient is in a bad way. The control of the gag reflex comes off the brain directly and if there is no gag reflex, that can be pretty bad.

At this point, Volunteer Firefigthers are "bagging" (pushing oxygen via a special bag) into this woman. There's a lot of gurgling. We're having a tough time getting air into her lungs versus her stomach. (Can't breath through your stomach so, that's bad.)

I check again for a pulse and find none. I start chest compressions. All my paramedic training and the most important thing I can do for this woman (Really!!!) is something I learned about 12 years ago (CPR!).

Now, let me take a moment to tell you about OPAs. They are merely a piece of plastic curved in a way to keep your tongue from falling back in your throat. The more modern ones are very much like a curve plastic stick that does the job while allowing air to move around it. The older ones, however, are more like curved TUBES that, essentially do the same thing but are a pipe going into the back of the throat.

Neither one, however, does a dang thing to keep air from going into the stomach, versus the lungs. (two pipes down there, remember!)

The OPA that I grabbed from the bag was the old style. As I started to slam down on her chest with all my might, the pressure of the air in her stomach, combined with the full meal she just ate contrived to make a geyser.

Each time I pumped on her chest, we got a bit of vomit shooting 12 to 18 inches up in the air.

The Vomit Comet rides again!!!!

It's at this point that CC-Rider and MedicToMyRight look at me. They shake their heads. Last shift we had a code and this is looking to be the same way.

Down 2 flights of narrow stairs, through the living room and into the medic unit we go.

We intubate, hook her up to a monitor and give her a TON of ACLS drugs.

All the while we're being driven by a volunteer firefighter who's wearing a full stetson hat, a torn t-shirt and his bunker pants.

He hits every bump and curve at 65MPH.

We all get puked on as we bounce around the back of the ambulance like ping-pong balls in a tornado.

...and he gets lost on his way to the hospital.

Basically, he exemplifies every un-professional characteristic of our volunteer service (keep in mind that I'm a volunteer and riding as one during this call).

What a donkey!!!!

After the call, as we're cleaning up, I pull him aside.

"Hey, man, Howareya?"

"..Um...Ok"

"Great..thanks..listen,...can I ask you a favor????"

"...Um...Ok.."

"Yeah,....great...Listen, Um...Don't ever drive a medic unit agin..Ok?"

He's gettign defensive at this point...."What?"

We've walked away, out of earshot of everyone else, by this point. I put both hands on his shoulders.

I look him right in the eye.

With the most firm and benevolent, fatherly look I can put on my face. I say:

"It would be bad."

I keep looking at him.

He's thinking this is some kind of man-fight and gives me a defiant look.

I keep looking at him.

"What?....Welll...Sh**........"

I keep looking at him.

His shoulders hunch and I can feel him getting tense. He tries again to be tough...

I keep looking at him.

"F*** you!"

I keep looking at him.

"F*** it, I hate the ambulance!" He says with a flame in his eye.

Success..

--maddog

Smoova!

2008-09-10T07:31:00.002+03:00

38 year old male. Bleeding from the head after an assault. We arrive about 2 minutes after the engine crew does. We were all called here by the police. They've got the scene safe enough for me to enter the house.

I find a guy sitting on the couch, holding a bloody towel to his head. He looks right at me as I come in the door and answers all my questions appropriately.

He's got a 3-5 inch gash on the side of his head.

"Sir, what happened?" I like open-ended questions sometimes, I can get a lot more information that way.

"I come in 'da house. 'Dat ***** went upside my head wiv a smoova!"

Now, being from where I'm from, I know what "upside the head" means. I can see it in my mind's eye. Someone took a big wide swing and hit him in the temporal area (above the ear between the forehead and the back of the skull).

But what the heck is a "smoova?" So I ask him.

"A 'Smoova'?"

"Yeah! A Smoova!"

I look to the firefighters standing around me. They look as puzzled as I do.

"Sir? What's a 'Smoova'?"

"A Smoova!! Y'know! For you clothes!" he makes an arm gesture like he's ironing a shirt.

A "smoother." An iron.

Ok! OW! That must have hurt!

I love my work!

--maddog

Pacemaker + Fail = Pump and Blow, Load and Go!

2008-08-29T06:53:00.003+03:00

The call is for "trouble breathing" but by the time we get there, it's something else. A community swimming pool and it's a guy in his late 60s. He started having trouble catching his breath in the pool.

The BLS (Basic Life Support) crew is strapping him to their cot. I have the luxury of doing nothing but looking at him (many hands).

"Um...I don't see breathing." I feel like the kid who said the emperor has no clothes. My words galvanize a group of people into action.

BVM, Cot to the medic unit, IV, EKG. Go go go go.

Nope, he's not breathing and his pulse is fading fast. I'm on his chest so I look to my right and say to the medic I just met 3 hours before, "You've got airway and breathing. Get me a good tube. you're second line for ACLS drugs. Got it?"

I'm the new guy but she nods at me as if I was there every day for 20 years.

I look to my left where CC-Rider, my new pal and best friend, has already pulled out the combi-pads (sticky things that allow us to shock someone's heart) and EKG leads (more sticky things that allow us to analyze what the heart is doing).

"IV and meds, Please."

That earns me a wink and a nod.

I dial up the EKG and see that this guy is in a ventricular escape rhythm (the lower 2/3 of his heart is trying to beat) but it's way too fast (about 70/minute). CC-Rider and I realize that we can't put the combi-pads in the usual place because he's got a big, metal square under his skin just inside his left shoulder.

Can you say "Pacemaker?"

I can...and i did.

OOOKay. Well. pacemaker or not we treat this patient. I see no pacemaker "spikes" on the monitor.

Can you say, "Pacemaker FAIL?"

I can and do.

MedicToMyRight drops a perfect tube and we get a capnography wave that is good but the CO2 level does not get above 17 mm of Hg and is dropping (this tells us how much air is getting through the lungs into the blood by measuring the return Carbon Dioxide). I'm looking for a nice wave and a level above 28.

That's when I see pink foam surging up the airway tube on every exhale.

Pulmonary edema.

Deep suction takes out a LOT of the "juice" and we get a capnography reading of 30. Lovely!

I'm doing chest compressions by this point because there is no pulse that any of us can feel anywhere.

IV is in.

Pump and blow

Epinepherine, 1mg. BAM!

Pump and blow.

Check the monitor:

Asystole. (flatline) No heart activity.

I'm not giving up!

Pump and blow.

Capnography says 15mm of Hg and dropping.

Crap! Suction again!! It climbs to 25. Good enough!

Atropine: 1mg

Pump and blow.

Epinepherine: 1mg

Pump and blow

EKG is a flat line with occasional, weak attempts by the heart to do something.

Diesel Thereapy!! (Drive fast!)

Perhaps a bit too fast. The firefighter who jumped in the driver's seat of our Medic unit made a traffic decision that lead us onto a Hella-bumpy road.

Only my experience in the Coast Guard on small boats in high seas keeps me upright. CC-Rider and MedicToMyRight are both on their butts on the floor.

We arrive at the hospital a bit frazzled but with a completely worked patient. I'm standing on the carriage of the cot so I can continue chest compressions without having to walk. All the while, I'm directing the 3rd round of ACLS drugs and getting the BLS provider to work with MedicToMyRight to check that we haven't lost the tube and we're still suctioning the HUGE amount of fluid infiltrating this guy's lungs.

Like usual, we seamlessly merge with the resuscitation team and I find myself moving to airway with bagging and then drawing up more drugs.

By the time I have a chance to step back and wash my hands. It's over.

The doctor declares this one dead. Ah, fooey.

Not that we didn't see that one coming. This guy had a pacemaker that kept his heart beating well. He also was doing all he could to keep that working right. According to the staff at the fitness center, he was a regular. Swam a mile every day.

Unfortunately, his pacemaker failed. It failed while he was in the middle of his swim. As a result, his heart was not able to crank out enough pressure to his body and then the pressure in the blood going to his lungs began to rise. It got to the point where the pressure of the blood going to his lungs started to push the water in his blood into the breathing space of his lungs.

Pulmonary edema.

Acute congestive heart failure.

CC-Rider, MedicToMyRight and I were cleaning up and getting ready to talk about the call. In my head, I'm thinking about what went well, what went wrong and what I could have done better.

We all agree that by the time we got to the patient, there was not much more we could do. His heart had stopped working properly and he had stopped breathing. We did what we were trained to do and, we did it exeedingly well. We all worked together as if we were the same person.

As this was the first time I worked with CC-Rider and MedicToMyRight (the first call, in fact), I asked how I did.

"Maddog, You're in charge!"

"That was awesome. You knew exactly what to do and you told us when to do it."

"You 'da man!"

Golly! *cue maddog blushing*

But wait! We did this again and again!!!

...more to come...

--maddog

Scared?

2008-08-18T04:04:00.005+03:00

I got "pinged" by a reader. She's a regular and she hadn't seen me post in a while. So she sent me an email asking how I was doing.

Somehow, coming from a stranger, that meant a lot to me.

I've been busy with family death and my own non-blogging obligations. Yet, there's more than that.

You see, I'm a fundamentally broken man. I feel that I don't fit into where I am. There are parts of me that don't fit into how the rest of the world lives. I'm working really hard to make myself fit but I see the reminders of how I don't and it's a powerful thing. I'm reminded all the time of what an outsider I am.

I try and I try but, really, I'm not like anyone around me. We all live as if we will never die, or, if we do, it'll be a thing we're all ready for. We will all die. Many of us will do so unexpectedly.

That sucks. Big Time.

I'm aware of that all the time.

(Here's the really scary part:)

I know my father will die. I'll likely be there

I know my mother will die, I hope I will be there.

I know Herself will surely die and I will surely be there.

EVERYONE will die (even me!!!).

But many of us live comfortably because the frailty of life is not in our face. We assume that so-and-so will be there tomorrow. We operate under the assumption that we will all have friends and family around us tomorrow as we did today.

Am I the only one who feels in his guts that this is SO not true?

I'm scared all the time.

Am I allowed to be scared?

--maddog

What would YOU do???

2008-07-19T09:15:00.004+03:00

We, who do what we do, live with the persistent knowledge of what we have done.

It's so very easy for those who have not done what we have done to dissect our actions.

"Yeah, maddog, but I would have done THIS. "

All I know is that I came on scene and there were people, and blood, and gunk, and a big mess.

I put tubes where they should go. I pushed on the things that needed pushing and I gave the drugs that needed giving.

The whole time I'm sweating how well or how poorly I'm doing. It's not about me, It's about my patient.

You can sit back in your "armchair" all you want but, it was ME that was doing CPR, Intubating, pushing the drugs and otherwise making the decisions that helped the family know we had done all we could.

You will never be the medic that I was at that exact moment.

Me? I'll spend the rest of my life thinking about what I could have done. I don't need you to ask me stupid questions.

--maddog

EDIT: This post was written in response to the casual comments by a less-than-professional jerk after a particularly difficult call. It is NOT directed at you, my dear and loyal readers! Thanks for reading.

Cocktail Parties

2008-07-07T07:08:00.004+03:00

An earnest young student asks me a serious question:

"What's the hardest part about being a paramedic?"

I look her right in the eye.

"Cocktail parties."

I say this with all seriousness.

She leans back in her chair, blinking her disbelief.

It's the social that's the most difficult.

Here I am, out with a bunch of people who have no idea what they'd do if someone died right in front of them.

I, on the other hand, know exacttly what I'd do!!!.......Pump and blow, Load and go!!!

(If the preceding phrase has no meaning for you, then you're definitely not an EMT. )

We, who do what I do, live with the persistent knowledge of how easily and how frequently people die.

We also live with the constant assurance of our role in that process. We know what we are to do and when we are to do it.

I find that I alternate between the responsibility of being guardian of all life around me and the honor of being the shepherd of the passing of life around me.

At times, it makes me dizzy.

At cocktail parties, it's awkward.

--maddog

How to make a nurse laugh....

2008-07-06T06:32:00.004+03:00

Roll into the ER at 0500?

No.

Have a perfectly healthy, whiny patient with abdominal pains?

No.

Tape a "falling hazard" warning sign to your shirt and stagger around the ER saying "Coffeeeee.....""

BIG YES!!!

--maddog

Sometimes, we win.

2008-06-09T06:30:00.006+03:00

I did an amazing thing, apparently.

Duty Night. Chillin' in the lounge chairs, watching a movie I've seen before and don't mind seeing again. Earlier that day, I had played in a kickball game with some other folks from the Firehouse. Good times. No beer for me as I was heading directly to the Firehouse afterwards.

Roswell pops his head into the lounge, "Hey, maddog, can I see you?" He tilts his head in a way that tells me he need to talk to me RIGHT NOW.

"Sure!" Off I go. He leads me back to one of the dorm rooms where his girlfriend, JLB, who's also a firefighter/EMT, is lying on the bed. They've been drinking steadily for the previous 7 hours (they started at the kickball game). She's lying on her side, breathing at a rate of 60 breaths per minute.

OoooooooKay! Pulse is 92, BP is 130/82 and her blood is 99% saturated with oxygen (SpO2=99). These are all good. Oh, yeah. She also smells boozy to the max!!! The thing is, I can't rouse her at all. I do exceedingly painful things to her but she doesn't respond. That is bad. However, considering her blood pressure and pulse are reasonably OK, I'm willing to adopt a "wait and see" attitude and see how long it takes her to sleep off her drunk. Roswell and I roll her onto her left side and make sure she's got a clear "vomit path" in case she barfs. We're trying to ensure she doesn't breathe in, or aspirate, anything she pukes up.

I'm standing next to the bed, discussing with Roswell what we should do. We were just deciding to check on her ever hour when her noisy breathing stops.

We look at each other.

We look at her.

We look at each other again.

This is the first time I've ever seen Roswell scared. Strangely enough, and totally out of context, I realize that, despite the ups and downs of their relationship over the past 2 years, Roswell really loves JLB!!

I roll JLB on her back. I move her head back to ensure her airway is open.

She's still not breathing.

I check her pulses on her neck (carotid) and her arm (radial). What had earlier been a steady "THUMPTHUMPTHUMP" is now a, "THumpthumpth...tu..th.......th......t...t....p....p................"

Everything is now bad.

"Hey, Roswell?" I say in my calmest voice, "I think we need to start a medic unit, OK?"

In a flash, he's gone.

I try again to get JLB's airway open and, again, try to rouse her with painful stimulus.

Still no breathing.

Check the pulse again. I can barely feel it. It's beginning to dawn on me that I may have to do CPR on a woman who I consider a family member. I guess I better get her off the bed and onto the floor!

I cradle her like a child and move her to the floor. She's as limp as a rag doll (or the newly dead). By this time RockSteady has shown up. He was a Paramedic back in "Joisey" before he came down here to be a financial planner. He runs at the Firehouse because, deep down inside, he misses it.

"What do you need?" he asks me. As calm as could be.

"AED, O2, BVM, a medic unit and wake everyone up." I reply in a tone that I hope sounds as calm as RockSteady.

Brooklyn shows up with the "Go" bag and the O2 Kit. This kid has learned much from the maddog. I drop a 22fr Nasopharengeal airway in JLB. Her jaw's pretty tightly clenched so I know I'm not getting anything in her mouth. At least I can help a bit with a flexible tube down her nose to help get oxygen into her lungs. I get out the Bag-Valve-Mask (BVM). This is a device that allows me to put a mask over your nose and mouth and squeeze air, via a specially built bag, into your lungs. I'm trying to breathe for JLB. By this time, Brooklyn has left to go get the stretcher. I check JLB's pulse again.

Nothing.

I check it AGAIN!

No, Really, I mean NOTHING!

"Crapcrapcrapcrapcrapcrap!" I'm saying to myself.

Weed has slid into the room at this time. She's still half asleep. I've never worked a bad patient with her but she and I work together as one.

"I got nothing" She says to me. She's feeling for a pulse too.

"Right!" I say. Weed hands me the scissors and In about 1 second, I've got JLB's shirt and bra cut off. Weed takes over the ventilations.

At this point, part of my mind is remembering how many times JLB and I have joked about getting "Trauma Naked" by cutting someone's clothes off. We say that this is a real possibility when someone dates a paramedic. Now, here she is, "trauma naked."

I start shoving on her chest with all my weight. I'm forcibly and mechanically taking over for her heart. I'm slamming it flat to force the blood in it to go out to her body and lungs and then springing up suddenly to allow it to fill up with blood to, again, be forced out to her body by the next compression of my body weight on her chest. It's not elegant but it IS effective.

I do about 2 rounds of 30 compressions when the AED arrives with Brooklyn, Ninja and RockSteady. We slap the pads on her and stop CPR long enough to have the machine tell me that no shock is advised. I go right back to CPR.

Here's the freaky bit:

I finish my 3rd or 4th cycle of chest compressions when JLB's eyes snap open and she takes a deep, ragged breath.

Woah!

Did I just do that?

"Hey, darlin'! Glad you've decided to come back and join us!" I say in a voice I hope sounds lighthearted and calm. Her eyes orient towards me and she makes eye contact. Well! This is Very Good!!!

She fades in and out. Her respiratory rate never gets above about 6-8 per minute so, I keep assisting her ventilations with the BVM and a full dose of Oxygen.

Brooklyn, Ninja, Weed, RockSteady and I get JLB moved out on a Reeves stretcher. This is a nice tool for getting people out of tight spots without jerking them around too much. As we load her onto the stretcher/cot in the engine bay, we hear the Medic unit pulling up out front.

Smooth and easy we move her into the medic unit. Weed and I stay in the back to help out and Ninja jumps in the driver's seat. Off we go. The medics hook JLB up to the EKG, check her Carbon Dioxide output (Capnography), her blood pressure and other vitals as well as starting an IV in her left arm (after an attempt in her right arm and her external jugular vein with no success). All the while, JLB is alternating between lucid periods where she's looking at me and asking where Roswell is and complete unconsciousness with a respiratory rate of around 4-6 breaths per minute.

The two medics, Weed and I work together like we were cogs made for the same machine. Medic #1 calls the hospital on her cellpone and gives them a good, solid report so they know exactly what's coming in the door when we arrive. It pays off too. We roll right into a critical care resuscitation room and are swamped by nurses, techs and doctors.

As soon as we arrive at the hospital, we're swarmed by other firefighters, JLB's family and a few cops too. It's a circus. I hand off ventilations to a tech and clear out of there. I wash my hands and find a spot out of the way to wait and see what happens.

20 minutes and 2 liters of intravenous fluid later, JLB is answering questions and completely alert. 1 Hour later, all of the people involved are having a CISM debrief in a conference room in the hospital. 2 hours later, JLB is going through a battery of tests, EKG, 12 lead, Blood work, etc., etc.. I'm back at the station, filling out my reports and restocking my gear.

They keep JLB at the hospital for a while to do a full workup. By the time she slides into CAT scan, I'm dead to the world asleep.

I did everything as I should and made no mistakes. Clinically, I'm pleased and satisfied. 14 hours later, telling the story to someone who's not a firefighter, I can't stop myself from crying. No sobbing of loss of control. I simply cannot stop the tears from flowing out of my eyes.

She woke up. Her eyes opened and she looked right at me. I'm beating on her little body hoping to push enough blood around to keep her brain from dying and she opens her eyes and looks AT ME.

Somehow, this is the part the overwhelms me.

-'Medic

Indy 500.

2008-05-27T04:08:00.002+03:00

Yes, I was there.

Every year, my brothers and I go somewhere awesome with our father for Father's day. Though it was a bit early, we went to the Indy 500 this year.

This pretty much sums it up:

Brreeeeeoooowwwwww!!!!

-maddog

Nothin' Doin'

2008-05-12T04:56:00.004+03:00

It's a fill-in night at the firehouse. I've asked Helga to cover for me in the past and I'm paying her back now.

There's this kid. Her mom and my Mom went to Nursing school together. Her older sister is a doctor and she's thinking the same thing.

In the interim, she's decided that being an EMT-B is a good idea as a start on her road to her MD. An application, background check and a physical exam (Ironic?) later, she's a member.

Now, she's my problem.

The only time we roll the ambulance tonight is to go get ice cream at 11:00 at night.

Exciting times, no?

She fits in so well that I feel she's been here all along. This is one of those cases where someone is well suited to be here contrary to all assumptions.

I don't have a blog-name for her yet. She plays it too close to the vest for that at this point. For now, we shall call her, "Sis." She is more like a sister to me than anyone I've ever known at the firehouse. She's beautiful, confident and capable.

I have great hopes for her.

Tonight, she joked with us, commented on bad movies with us, made a senior member blush and was first on the engine when it got toned out for a fire. I watch this person for 4 hours and realize that nothing will stop her and she will do well in all she puts her mind to.

That's some powerful stuff.

'Go, Sis, GO!'

--maddog

Sunny Day

2008-04-19T17:45:00.003+03:00

It's the first beautiful day of Spring. temperatures creeping into the 80s. Lovely.

Around 11 am, he puts his favorite lawn chair in a sunny spot, grabs a cup of coffee and has a seat in the sun. He's 93 years old.

It's a beautiful day.

Nine and a half hours later, we find him. Still sitting in the char, still holding his (now empty) coffee cup. From a distance, it looks like he just rested his chin on his chest and went to sleep. Up close, I see the signs.

For him, I think this beautiful day never ended.

For us on the engine and ambulance crews, we smile quietly and look inward. Passing is sad but, somehow, this one seems to fit.

Not a bad way to go.

-maddog

There are smells...

2008-03-26T05:46:00.002+03:00

I am driving south on a major highway. An interstate, in fact.

There are smells leaking in to the confines of the vehicle I drive. They are smells like any other.

It all comes down to context.

There is a smell I call "vaporized rubber." Its the smell of locked wheels sliding across tar pavement. Some of that black tire material becomes a vapor and gets into my nose. I have smelled the remnants of this as I pull up and survey the scene of someone's bad decisions

"Diesel urgency" is a smell that exists in many areas. Chemically, it's the smell of insufficiently burned diesel fuel. This can happen when a diesel engine is accelerating excessively (Go faster! She's fading fast!)or when one is desperately trying do decelerate(Oh Crap! Oh Crap! Oh Crap! *BANG*). It is also the smell equated with spilt diesel fuel hitting a hot surface (Get 'em out now!!).

This, too, is a smell I equate with highway calamity.

I, however, am not driving an ambulance tonight. I'm merely driving home from work. These smells leach into my nose and brain via the ventilation system of my car.

Around me, the day to day catastrophe of an interstate occurs. I am just another commuter.

The smells remind me.

--maddog

Testing, testing, 1, 2, 3...

2008-03-25T18:12:00.003+03:00

Yes, I have an iPhone. I'm testing to see how well blogger works with it. So far, I'm having a bit of difficulty getting blogger and Safari to play nice. The only way I can enter text is via the HTML only window.

Ugh!

--maddog

Death and I...

2008-03-23T05:38:00.002+03:00

I'm dead asleep and it's the address coming over the dispatch radio that wakes me before the bell rings. Somehow I'm attuned to the addresses and street names in my home town.

"One not breathing" is an ominous call for early in the morning.

During our run to the scene, dispatch updates us that CPR is in progress. I've got 2 trainees, Babygirl and Fireplug. They wear stern faces and follow my instructions with immediacy and exactitude. Babygirl is about to go into the military and Fireplug has been active duty army for about 12 years.

We roll into the house to see the daughter doing chest compressions on her father in a hospital bed in the living room. Grizzly is my partner on this one and, in his 30 years at the firehouse, he's seen enough of this. We work without speaking. No pulse, no breathing, nothing.

We grab the top and bottom of the sheet and move the patient to the floor. Stiff.

"Cot and backboard, into the house." I say. Without looking, I know that Babygirl and Fireplug are on it.

Grizzly gets the monitor ready as I try to secure the airway. I can't even open the jaw to get a oral airway in. The chest is crunched in from the CPR and the stomach is distended. We slap the pads on his chest as the Medic unit arrives.

"When did you last see your dad?" I ask the daughter.

"Last night, when I gave him his morphine."

We logroll her dad and see the dark purple blotches of pooled blood on his back. This is called "dependent lividity." He also moves like a board. I can't unbend his arm to look for a vein, nor can I move his head at all. Rigor Mortis. The Stiffness of Death.

The two other medics bustle in the front door, just ahead of the cot and backboard. I give the lead medic "the eyebrow" and say,

"Lividity and rigor."

The medic hands me the leads for the EKG and plugs my pads into his monitor. We see a flat line (asystole) on all leads.

Dad is cold.

"He's dead, isn't he?" says the daughter. She works for the recreation department and is CPR certified. She's been all business since we walked in the door but this is the first time I've heard a quaver in her voice.

"I'll call it." says the medic.

"I'll talk to her." I tell him.

"You sure?" he asks. He's looking me in the eye. I look him back.

"Yeah, She's a neighbor." He nods and pats my shoulder and calls in for the police and coroner.

She's already on the phone with her sister in California.

"He's dead, isn't he?" She's got her hand over the phone receiver.

"Yes he is. He seems to have been for a while." I look right at her. I will not shy away from this. Her eyes now start to fill up.

"Here, tell my sister, will you?" She hands me the phone and sobs.

"Hello? This is "maddog", I'm with the Fire department."

"Is my father dead?" says a scared voice from 2800 miles away.

"Yes he is. He died last night, it seems. I'm sorry." This is the point where it hits me. I was expecting this but it always hits hard. My face is getting hot and I feel the welling of tears in my eyes. "Your father is dead."

"Thank you so much for being there. Thank you so much for what you do" She says. That's the hammer-blow. My cheeks are now wet. "May I speak to my sister now?"

"Sure." I croak as I hand the phone back. The daughter sees my tears as she takes the phone. I will not shy away from this. This is what I do. She mourns with her sister on the phone.

As we put away our gear and my eyes dry up I see the leering face of the full moon as it dips behind the trees to the West. It looks like the skull of death to me this night. I can imagine it nodding at me as if I've done my job and been in the place I'm meant to be for this one life.

This is what I do.

--maddog

I can't FEEL anything!!!

2008-03-23T05:23:00.002+03:00

I'm now a Sergeant at my volunteer Firehouse and, this particular duty night, I'm in charge.

1900, Assign housework, apparatus checks and get dinner ordered. We eat, run some training and then get ready for a long night.

You see, the moon is full and the night is one of the warmer ones as spring starts to seep its way into our area. I'm ready for stabbings, shootings, fights, drunken silliness and more.

First call: car vs. car at an intersection. I have the most cooperative and mellow patient in the world. She's in the driver's seat and got t-boned (side impact) she's got no complaints other than a painful hand and head. The arriving crew before us has already put a collar on her and we arrive in time to extricate her.

Both cars are sitting where they stopped and I have to crawl over the hood of one car to get into the passenger door of the one my patient is in. The plan is to pull her out, feet first, from the driver's side door onto a long backboard. My job is to guide her head and shoulders down into the passenger seat and to keep her head in line with the rest of her spine. It's not as elegant as it would seem. Cars these days are built in a way that they seem to wrap around a person and make it difficult to just turn them 90 degrees and lay them down. I have to negotiate the parking brake, gearshift, armrest/console and the bucket seats. All the while we're bouncing this girl around a bit. She's not complaining, wincing, or crying at all.

This is not normal.

We get her onto the backboard, into the ambulance and YoungJim and I work her up. Rapid trauma assessment reveals no obvious injuries or pain other than her left hand. Ok. I ask her if she hurts anywhere other than her hand (NO) and if she feels different or funny.

"I can't feel anything." She says calmly.

UH OH! I'm thinking she can't FEEL anything!!! Quickly, I check that she has motor, sensory and a pulse in each of her legs and hands. I pinch the top of each foot, "Wiggle the toes of this foot."

"Ow! Ok." she says.

Same with the other foot and both hands. Good. Apparently she meant that she didn't feel ANYTHING as in she wasn't hurting anywhere. YoungJim and I take the tension down a few notches and calm down.

Grandma's going to ride with us.

"Do you mind if I take your grandma for a drive?" I ask the patient.

"Please do." She replies. "She needs to get out more." I install Grandma in the front passenger seat and drive easy and smooth to the hospital.

--maddog

...Smells like burning rubber and EtOH!

2007-12-03T06:57:00.000+03:00

Car accidents. If you run from the cops in your car. You'll be arrested. Especially after you drunkenly wreck your car into the woods.

If your girlfriend does a lot of heroin before the vodka shots. She gets to ride with me. She was wearing a goosedown coat. We almost had a catastrophe in the back of the ambulance when the rookie medic started cutting the jacket off of her. Fortunately we stopped him before he filled up the ambulance with a cloud of goose feathers!!

The rest of the night was quiet for us but nobody else. The radio was hopping for everyone else in the county besides us.

The next morning RT and I head out for coffee. We're getting waves from the employees as we pull in front of the coffee house. As I'm getting out we get called for an auto accident about 2 blocks away at a nearby high school.

We arrive on scene and I see a couple cars pulled into a parking lot and nobody really hurt. Out of the ambulance with gear bags and gloves. I see a woman sitting in the back seat of her own car with the door open and a man standing by his van. I ask what happened. It's a good way to get a story and see if anyone's hurt.

"She was pulling out and didn't stop..."

"He was driving too fast..."

"She didn't even look..."

"He was supposed to stop...."

"I was honking my horn..."

"He tried to kill me...."

"woah" says I.

"He doesn't know how to drive...."

"woah!"

"She doesn't know how to drive!...."

"Woah!"

"He thinks he owns the road...."

"SHUT UP!" I finally holler. They both clamp their mouths shut.

"I'm not the police and I don't care who's fault it is! All I care about is if someone's hurt."

They look at each other as if this is a foreign concept.

"Is anyone hurt?" I ask again.

"Look at my car!" Says the woman. I do. I see some scraping on the driver's side but no real damage.

"How fast were you going?" I ask the van driver.

"About 20, 25 miles an hour." The street is congested enough that I believe he couldn't have gotten much faster than that.

I look at the woman. "Are you hurt?"

"My car!"

"Lady, I'm a paramedic, not a mechanic. I couldn't care less about your car. Are YOU hurt?" (keep in mind, I haven't had coffee yet. I'm a bit cranky)

She looks at her shoes. "No." She says sheepishly.

"Good. Because I need me some coffee!"

They sign refusals and I'm out of there!

--maddog

...What's that smell?

2007-12-01T01:50:00.001+03:00

Duty tonight at the ol' Firehouse. I've got a feeling that something's going to happen!!

Stay tuned!

--maddog

Face lift?

2007-11-27T07:45:00.001+03:00

I've started a fancy new blog over there at The Running Medic. It's really pretty!

This one, on the other hand, was started with the old blogger setup. I haven't converted it over to the new one as it's a bit of a hassle to re-load all the stuff I added, Blogroll, Haloscan comments, etc.

Now, I'm thinking that it might be a good idea to do that. It's looking pretty tired.

When I get time.

--maddog

Runrunrunrun

2007-11-26T14:29:00.001+03:00

I'm running again.

I've even made a blog about it. Since this one is for EMS-related stuff, I've made another blog to track my efforts to prepare for the JFK 50 Mile Ultramarathon!!

Yeah, I'm crazy.

--maddog

"Man, this is what it's all about!"

2007-10-31T06:55:00.001+03:00

Rain moves through the area, bringing a flurry of accidents. We're dispatched to one after another. Often times, perhaps due to the construction of cars these days, there are no injuries. We arrive on scene, look around at busted cars and get legal signatures from people who don't want to go to the hospital (and probably shouldn't.).

We clear one accident and are on our way back to the station when we get called back to another one not far from the first. We're in stopped traffic on a two lane road. I pop on the sirens and lights. execute a 3-point turn and we're off to the races again!! Wheeee!

To get into position, we've got to go past the accident on the opposite side of the divided highway and turn around at the next exit. Some clown, on their cellphone while driving, almost takes me out with a 3 lane swerve. I suppose he couldn't see the 16,000lb, 9 foot tall, rolling ambulance with flashing strobes, wailing sirens and an air horn that's beating out a rhythm that sounds oddly like the cowbell in the beginning of "Honky Tonk Woman" by the Rolling Stones. Yes, I'm weird like that.

I start wading our way through the traffic to find the Medic unit in front of us and a trail of bashed, wrecked cars on the shoulders as we proceed. None of them appear to have injured people and we diligently report each one to the dispatch center as we go along.

Traffic is backed up because there is an SUV in one of the travel lanes. It's surrounded by police vehicles from the nearby military base, the state and the particular federal agency that patrols this stretch of highway. (Odd, I know but that's how things go sometimes). The patient is on the shoulder, out of the car already. RT immediately dives in with the medics doing patient care so I take the opportunity have a look at the vehicle.

It's got only 3 wheels. The front, passenger side wheel has only an axle stump where the wheel should be. Somehow, this driver has lost the entirety of the front wheel assembly. Tire, rim, brake caliper, ball joint...the whole mess. Both front fenders look like crumpled aluminum foil and there's not a single piece of intact glass or plastic on the vehicle from the doors forward. The busted grill of the SUV makes it look like a hapless boxer after a bad night.

Inside the car is another story. The patient is already out of the car and on the ground. The side windows have been broken and there is glass on the seat inside. This means that something broke the side windows from the outside. Rescuer? cop? rock? Errant Bird? I don't know. File that away for later.

Both airbags have been deployed. (significant) I can't tell if the driver (who is now being wrestled by the medics and RT) was wearing her seatbelt but the windshield has been broken from the outside and there is no evidence that a head hit it from the inside (hair, blood, brains or skin embedded in the glass). The seats are still bolted to the floor there is no blood or other evidence of trauma inside the car. The dashboard, steering wheel and other interior components are not deformed. This is good. It appears that nobody bounced around too much inside this vehicle.

Our patient has been living a life that is in no way deficient in calories. I dive in to help getting her to a backboard and then to the stretcher. During all this, I notice that her collar has slipped up her face. I go in to correct it and she wiggles her head around to get it out of the collar. She's already got a pretty short neck and her "upper body development" is not making it any easier. We improvise something useful and get her immobilized to the backboard, onto the stretcher and into the waiting medic unit.

While RT and the medics wrangle with the patient, I take a moment to query all the police as to how she got here. Broken windows and a busted windshield: Did she roll over? "No we had to break out the windows to get her out of the car."

Where's the missing wheel? "About 3 miles back. After she hit the 3rd car, she kept driving, on the road and in the median, with only 3 wheels and up to about 75 miles per hour!" I look at the police car that stopped her and see that it's covered in mud on the front of the car from the bumper to the lightbar. Woooh!

How long were you chasing her? "About 3 miles. Once we stopped her, she said that she was not allowed to stop for any police as she's the daughter of the top colonel of the army." Oooookaaayy.

"We pulled her out of the car and cuffed her. She immediately started to complain that her chest hurt. I put her on her side and then she started shaking."

Right-O! I hop into the medic unit and pass all this information onto them. RT is going to drive their unit and I'll follow in mine to take RT home once we get to the hospital. We get rolling onto the nearest trauma center. Halfway there, our dispatch starts calling the medic unit asking for their status. That's when I realize they haven't called with their patient information and destination yet.

After a few calls from dispatch to no avail, I hear RT mark up on the radio and advise them that we're all en-route to a particular trauma hospital and we'll advise upon arrival. Mind you, I'm driving an empty ambulance behind the medic unit and don't have a full appreciation of what's going on inside.

We arrive. Once we do, I park in a convenient spot and pop over to help unload. The doors to the unit are still closed and RT is still up front. What's going on? I pop the back doors open to see two medics looking frazzled and each trying desperately to hold down the patient. She's thrown off her collar. and thrashed around quite a bit. In the confines of the ambulance, the medics are holding her down to keep from getting hit. The looks on their faces are pleas for help. Apparently she's been fighting them for the whole drive and has even tried to fake a seizure or two. The medics have been so busy trying to hold her down and not get hurt themselves, they haven't had time to call anyone on the radio.

"RT! Come open up and get us out of here!" I say as I hop up to the head of the patient to help out. I try to put the collar back on her. Just as she snaps at me with her teeth, one of the medics says, "Watch out! She bites!"

I jack both of my thumbs into the space behind the angle of her jaw and below her ears. This is called the infra-orbital pressure point for law enforcement types and causes a LOT of pain without any tissue damage. I look her in the eye (both of which are very open right now).

"You bite me, I'm going to knock you out!"

Her whole body relaxes enough for us to get her out of the ambulance and into the loving arms of a waiting trauma team. I don't put the collar back on her but I do hold her head to keep it from moving. I also have my fingers placed in the same spot I "zapped" her before as a reminder that if she gets frisky, she's going to pay for it.

The trauma team is ready and, really, not very impressed with her antics. If you thought I was cruel. the trauma doctor is an absolute sadist.

As we clean our gear, one of the medics says to me:

"Man, this is what it's all about!"

The stress of the call sloughs off of us and we laugh and laugh.

--maddog

Kids, kids and More kids!!

2007-10-21T05:05:00.001+03:00

We get dispatched as the 2nd ambulance on a car accident.

On our way to the scene, the incident commander (the chief of the neighboring station) asks us if we have a problem taking 3 stable kids in car seats.

RT and I look at each other. He knows he can "tap out" and drive, leaving me in "the back" to handle things if he's over his head.

"Ambulance XXX, We're direct. No worries" I reply.

Here's the deal on scene:

Mom's driving the minivan with two 11 month-old twins and a 22 month-old son in car seats. The minivan gets rear-ended. Kids are fine (that's what car seats are for) but mom's neck and back hurt. RT and I work on mom. We get her extricated to a long board & immobilized to our stretcher. Into the ambulance we go and start doing our trauma assessment to be sure we haven't missed anything.

While we're doing this, firefighters start loading car seats and kids into our ambulance. By the time we're on the road, we have a 38 year old woman in full spinal immobilization as a precaution, 3 screaming children in car seats and RT being a stuffed-toy-laden octopus who's spending equal time entertaining toddlers and treating his patient.

At the hospital, I have to go in and get help from one of the waiting ambulance crews. We roll in. One EMT with a kid in a car seat and two others pulling a stretcher containing a woman on a backboard while holding identical boys on their hips.

At the nursing triage station, it's wait wait wait.

The oldest boy is content to play with his toy while still strapped into his car seat. No escape there. RT has one twin with a biblical name. Biblical name #2 is on my hip.

As I shift Biblical name #2 from hip to hip, I notice a particular smell.

Now, RT has a son but his ex left before the boy was born. Even though RT is very much involved in his son's life now, he's never dealt with toddler management. Mind you, we're already a spectacle in the emergency room with one patient on a cot and three little kids being wrangled and corralled by two harried-looking EMTs.

I catch a nurse's eye.

"Can u get me diapers and wipes?"

Her eyes widen in recognition. I look significantly at the toddler on my hip and nod at her with a knowing look.

"I'll be right back!" She drops what she's doing and dashes off.

Five minutes later, I've got this little man on his back on an exam table and am fighting him to get his onesie off.

Clearly he has a healthy diet! Bleah!

Another 3 minutes pass and he's clean, changed and dressed.

I walk out of the exam room and mom puts a hand out to touch her baby. Her hand finds my arm.

"Thank you."

The nurse from before comes bustling by.

"They teach you that in Paramedic school?"

I smile.

--maddog

Kids, faces, windshields, necks and helicopters.

2007-10-18T05:45:00.001+03:00

We get on scene to an accident after the rescue squad. I had to plow through some pretty heavy traffic to get there.

I see a car with front end damage, a spiderwebbed windshield and a knot of firefighters around someone on the shoulder of the road.

I take a moment to look over the car while my partner gets in to see the patient. There is no passenger seat. The driver's seat is there but the front passenger seat has been removed. The windshield has a spot on the passenger side where something round (most likely a head) has struck it from the inside and caused it to shatter and bulge outward. It seems to me that whoever hit that windshield came from the back seat. That's a far way to travel.

Lying on the side of the road, there's a crying kid of about 7 or 8 years of age who's bleeding profusely from his chin. The attending firefighters are as distraught as he is. He's a kid, he's bleeding and he doesn't speak a word of English. Something about hurt kids makes us all get silly. All of the crew from the rescue squad are pretty worked up. these guys are top notch and I've rarely seen them so upset. They won't let my partner get close. It's like a rugby scrum!

In short order, I get everyone to take a moment to catch their breath, slap a dressing on his cut chin, talk to the kid in Spanish and find out the following:

1. He was in the back seat.

2. He was NOT wearing a seatbelt

3. He doesn't remember much

4. The back of his neck hurts A LOT.

From the cut on his chin and his complaint of neck pain, cut chin and the shape of the windshield bulge, I surmise that this kid flew from the back seat and face-planted into the windshield causing his head to hyper-extend, or bend backwards as much as it will go, as his body kept moving forward with the force of momentum.

This is bad.

I look over to the scene commander, my Lieutenant. I point my finger in the air and spin it around a few times. I'm telling him we need a helicopter NOW. This kid is potentially really messed up and needs to get to a children's trauma center ASAP.

"Called for it when we got on scene. ETA is 3 minutes." He says as he winks at me. LT's got my back!

We get the kid packaged (cervical collar, backboard, immobilized) and moved into my ambulance where I have room to work and light to see. The bleeding on his chin, however dramatic, has stopped and appears to be superficial. Good. His pupils are normal and reactive and he's not leaking out of his ears, nose, mouth or eyes (other than the crying). Good. Skull appears intact, no problems on the front of the neck but the back of his neck is very sensitive to touch. So much that I don't have a chance to fully see if anything is out of place. He's too tender for me to probe that deep.

Lungs are clear and he's breathing without too much effort. No apparent injuries to his chest or abdomen. Pelvis stable. All his limbs are solid, intact and have pulses with appropriate sensory and motor response. His other vital signs are pretty normal considering he's in a lot of pain and scared.

Other than his neck this kid's fine! His neck, though is really troubling me.

By the time I finish my assessment, the helicopter has landed and the medic is at the door of the ambulance. He's a tall, stern cop/medic with a no-nonsense, don't-get-in-my-way look about him. His eyes are scanning and talking in the whole scene.

I run down the basics and tell him my assumption about the mechanism of injury. I also fill him in that the kid doesn't speak English. He doesn't look at me until I explain my thinking on how the kid's face hit the windshield and how that relates to his severe neck pain. His eyes dart to me, he nods once and says, "Let's do this."

less than 90 seconds later, the kid is in the helicopter that is roaring its way skyward. I hear the medic on the radio indicate they're taking the kid to the local children's hospital, Priority 1.

I take a moment to watch the flashing lights of the Bell Jet ranger in the clear night sky and then turn around to clean up my ambulance open up traffic and clear the scene.

-maddog

The Golden Rule

2007-09-19T04:31:00.001+03:00

Though I am still a paramedic and, from time to time, still get out and do some “paramedic-izing” my full time job is a college teacher.

This semester, I am teaching several lecture classes. One of them is a seminar for freshman who have declared my department's major as their own. It's one of those, “introduction-to-college-life-this-is-you-in-the-big-bad-world” kind of things. Each week we meet for an hour and talk about things that impact them as students and as emerging adults. We've done group problem solving exercises, we've discussed campus life and where each student is from. We've done icebreakers and “getting to know your neighbor” exercises. All in all, these kids are a really neat group of people.

Today, My assigned topic was “diversity.” On the face of it, it's a tricky and possibly onerous subject. Many have tried to teach it and have done it poorly. I did my best. I worked up a nice presentation with minimal powerpoint bullets. I referred to campus resources for student culture organizations, built in time for the students to discuss their perceptions of people and even fit in a homework assignment having to do with dissecting your own bias or prejudice (everybody has one).

Well, I walked out to the lobby and saw my students lounging around. Through the window streamed pure sunlight, dappled by the green leaves of a Bradford pear tree. Two of my students are Muslim and were pretty weak after about 5 days of fasting during Ramadan. I looked at my students, I looked at the classroom (two small windows) and I looked out the sunny lobby window again.

“Hold on.” I dashed out, printed up my lecture notes. Tossed my laptop into my office and returned to the lobby.

“Follow Me!” We all traipsed out to the sunny courtyard. I took the class outside!

I went through my notes. I delivered my lecture well. My students responded well and we had a pretty good time. I tackled some tricky issues (race, religion and sexual orientation) but a lot of discussion came out of it and it was good.

Somewhere in there, we wandered off the lesson plan. We were talking about respect. Respecting people's basic human rights, their humanity and their individuality. During our discussion, I realized that a core principle of accepting and appreciating the lovely diversity of people around us is respect.

“What is the golden rule?” I asked the students in a moment of inspiration.

“Treat others the way you wanna be treated” replied a bright-eyed enthusiastic freshman.

“Exactly! 'Do unto others as you would have them do unto you.'” I replied. Something was happening, I felt this idea coming up my brainstem into my cognitive lobes. Sparks were flying!

I looked at another student in the eye. “Do you wish to be treated with respect?”

“Yes”

“And you?” to another student

“Sure!”

“And you?”

Nods

“And you?”

More nodding, and on and on.

“Well, how do you pay for that?”

Confused looks.

“How do you ensure that you are treated with respect?”

The bright eyed student piped up, “Treat them that way!”

“YES! That is the thing!” (The idea was really boiling now!)

“We MUST treat others the way we want to be treated! And the only way to be sure we do that is to look at that person and say to yourself:”

I paused. I looked right at a student in front of me.

“You are me.”

She looked a little confused.

I waited. I knew this was a doozy.

Her eyes did that: “get wider because I suddenly get it” thing! It was awesome!!

“That's right! Each person I encounter is NO different from me in the ways that really matter. Each person I meet is another one of me and I will treat them and accept them as if they were myself!”

“This is the most important thing for you to realize. If you get this, I mean really get it, then you can have compassion, acceptance and all the other fancy words. Most of all, you start to enjoy the amazing and wonderful range of people that move through our lives. Skin color, nationality, religion, physical shape, sexual orientation or politics cannot change the fact that, fundamentally, we are reflections of each other. We are alike in the ways that really, really matter! It's so GREAT! It really is!”

“When you become medical providers, you will start to look at each patient and see them as yourself. You will start to develop compassion because you can feel how you'd want to be cared for in their place. You'll treat your older patients as your aunts, uncles, grandparents, and your younger patients as your own brothers and sisters. Once you find a way to recognize yourself in the face of everyone else, regardless of where they're from and what they look like, you will find the key to all of this. You'll find it a natural thing to respect people, accept people and take joy in the broad range of people that move through your life!”

I find myself really worked up!! I was really onto something (and I still think so!)! This is really, really it!!!

Each one of my students' faces are shining at me! I mean it they're really shining like they get it too!!!

Then they start looking past me into the rest of the courtyard. Eyes shoot off to the side to the nearby lecture hall entrance.

I turn around.

My class of 15 students has suddenly grown to about 40!

Their faces are shining too!

--maddog

This is really NOT about politics.

2007-08-24T02:40:00.000+03:00

..Honestly! It isn't!

I made a promise back in an early post that I would not discuss politics. This is not about my political views but it is about how politics can affect us all.

There was a decision made by the director of NHTSA. It, basically, says that no engineer, scientist or anyone else who does research into safety standards may speak to the press or the public on record. The only person who can do that is the director. An attorney appointed by a politician.

This is BIG news for us safely people but it is not caught by the front page press. It appeared in a blog in the automotive section of the New York Times online.

It's >>>Here<<<.

To this, I posted a brief but, I think, cogent comment. While many were raging about the lack of journalistic access and how our government is becoming more and more fascist, my angle is more along the lines of safety.

Here's my comment verbatim:

"This is exceptionally disturbing even beyond the journalistic perspective.

The NHTSA was responsible for starting the entire industry of EMS in the US today. It responded to a paper called, "Accidental Death and Disability - The Neglected Disease of Modern Society" that was published by the National Academy of Sciences by establishing a set of guidelines for highway safety and driver safety.

From this came the seatbelt law, the establishment of the guidelines for emergengy medical transport and countless safety laws that were imposed upon, and fought by, the automobile manufacturers.

As a paramedic, I'm appalled that this agency seems to be suffering a "throttling" effect by a political appointee. The "conspiracy theorist" in me sees a connection between this and the influence of the automobile manufacturer's lobby. (then again, I'm sure I see a lot of things like that)

The main disturbing point is that the engineers and scientists of this agency produce data that has a direct affect on the safety and injury prevention of all of us. I can't tell you how many times I was amazed to find an unhurt driver or passenger due to an airbag, seatbelt or rollover protection.

If the straightforward, factual information produced by these men and women is filtered through a person who may be influenced by a political agenda, I fear that we, as the public, may not recieve the full benefit of their work. This is what this agency does! It actually saves a lot of lives. It should be allowed to continue to do so."

Grrrr!

--maddog

The sum of the parts...

2007-07-10T06:17:00.001+03:00

Here's my cat in my lap. He's been out for far too long. His coat is scraggly and he's getting kind of thin. My hands move over his little bony body and I feel what's going on. I can feel the big wad of food he just ate It's a hard lump just below his ribcage. I can feel him breathing and rumbling as I pet him. As I rub his shoulders, I can feel the ropy latissimus muscles moving across his scapulae. I know all of his parts. I'm worried about his kidneys and bladder. As I feel around his ribs to where his kidneys should be and down his belly to his bladder, he complains no more than usual. Good.

Thirteen years ago, when I got this cat, he was no more than a bundle of attitude wearing fur pajamas. Today, I still have great affection for my cat but he's more than just a fuzzy beast who demands food and pets. I see him as an organism. I know his parts. I have a greater understanding for how these things work.

I do this to people too. I can see both parts of the gastrocnemii in my dad's calves as he hikes up the trail ahead of me. He's got great legs from so many years of hiking and playing soccer. When I'm sitting still, watching the world stroll by, I can spot the woman with cardiac problems from her pedal edema, the COPD patient from his barrel chest and bottle of oxygen as he walks by. I also can see the worrying signs of aging in my parents as I've never been able to see before.

My perception of people has changed since I've become a paramedic. People, for me, are more than just their outward appearances. My awareness goes deeper than that. I can see their muscles, bones, tendons. I can see where they're moving wrong. Scars tell me a story like they never did before. Yes, those railroad tracks on someone's chest? That means they've had their heart open and if they're gasping for air, bad things are happening. The intellectual part of me finds this infinitely fascinating but the human me is alarmed at times to see the frailty in those I love.

I know that everyone's got a heart, two lungs, an enteral tract, a liver, eyes, brain, blood, a lymph system, IgA and all his companions, etc.. In fact, I know it more than I ever did before. I could become alarmed and frightened by how fragile all these creatures are but I'm not. I'm in a constant state of wonder that someone so wonderful and complex as my brother, my wife, my niece my cat, my dog or my father can be so much more than a simple collection of anatomical structures.

We are so much more than the sum of our parts.

If we were just meat, there would be no place in the world for people like me.

This is why we (EMTs, paramedics and rescuers everywhere) do what we do.

--maddog

maddog? Who? What?

2007-06-11T05:15:00.001+03:00

A lot has been going on.

With my new job and new certification (yes, I'm a paramedic now), I'm still not sure of what should be posted and what should not.

There is more on the way.

---maddog

Maddogmedic = Rampmaster

2007-05-08T05:07:00.001+03:00

I had a different job this weekend.

Check out the Kinetic Sculpture Race in Baltimore, MD.

I was the RampMaster:

It was pretty Awesome!!

As the RampMaster, I was in charge of making sure the sculptures entered and exited the water safely and without any spectators being run over, hurt or otherwise damaged.

I even helped out when one or two capsized:

..and, yes, the costume was intentional.

(thank you Mark Barry for the photographs!)

--maddog

Still processing....

2007-04-20T05:46:00.001+03:00

The killings at Virginia Tech are horrible and disgusting.

I'm reacting to them on many levels. I'm an EMS provider, I'm a former Federal Officer with a lot of tactical training and I'm also a college teacher.

Ugh! Heavy stuff!

I promise a lot more words soon. I really need to get it out and here's the place.

I just need to process it a bit more.

--maddog

Call me Noah.

2007-04-16T02:38:00.001+03:00

I just finished a stint at the volunteer house that extended about 8 hours longer than planned.

It rained over 6 inches in less than 24 hours.

I've been busy! I'll have details soon.

--maddog

RIP Mr. Vonnegut

2007-04-12T14:07:00.001+03:00

The modern author who has had the most influence on my life and outlook has passed away.

If you haven't read anything by him, do so. If you have, do so again. It's worth it.

--maddog

Fun Birthday Run! (Brrrrr!)

2007-04-12T05:46:00.000+03:00

As I mentioned in an earlier post. I ran the Ocean City, MD 1/2 Marathon on Saturday, April 7th.

Here's what it was like:

That's me, running into the blizzard! The snow was beautiful!

Good times.

--maddog

Ad sense?

2007-04-11T22:28:00.001+03:00

I've been contemplating trying to make some money off this thing. It certainly would move me to write some more. I've checked a few other blogs and see that some of you are using Google's Ad Sense program and one or two have more specific ads.

I have a few questions:

People with Blogs that have ads: How much are you making? Roughly? Is it worth it? Any suggestions?

Readers: Is my blog being Ad-Free an important factor? Will you be totally turned off and accuse me of "selling out" if I put Google's Ad Sense into my blog?

I'm leaning more towards Ad Sense. When I've seen it in people's blogs, it looks pretty unobtrusive.

Let me know what you think by email or comment below.

Thanks,

--maddog

Ah, the beach! Sand, Sun and Snow!

2007-04-10T23:44:00.001+03:00

I celebrated my birthday by running 13.1 miles in the snow at the beach. Yay fun!

Hopefully, I'll have some pictures for you soon.

--maddog

Older (Wiser?)

2007-04-06T14:54:00.000+03:00

Today is my birthday!

I'm 6 squared!

--maddog

EMS Today 2007 Blogmeet?

2007-03-09T01:05:00.001+03:00

Ok, kids! EMS Today 2007 has begun. Before I dash off to a work-related event, I want to see how many bloggers will be in town.

On Friday night, I propose we have a blogmeet at DSX, it's a sports bar across the street from the convention center at 200 Pratt Street.

I'll be there at around 6:30-ish an I'll be hanging around a while. I'm tall, bald and wear glasses. Come introduce yourself and have a beer! Let's see how many blogger and bog-readers are going to be in town.

This'll be neat.

PhillyDan suggested it and I hope to see him and everyone else there!

--maddog

Ecto? Just Testing

2007-03-01T19:16:00.001+03:00

I'm trying out a new 3rd party blogging tool called Ecto.

We'll see how well it works. I really don't like having to write my blog through a web browser. nor do I like using a word processor to write and then cut and past. Too gunky. I have been using Firefox but, again, the web browser thing prevents me from writing off-line.

Ok, Enough of the test. Let's publish!

--maddog

Why I hate the new Blogger (part II)

2007-02-23T07:30:00.000+03:00

Well, I just wrote up a post and sent it by email and it didn't work.

I'm forced to use this stupid, clumsy web-interface that still does not support Safari.

Here's the text of the message I tried to send:

"Well, since Google (TM) has taken over Blogger, none of the 3rd-party clients or applications I use to post to my blog work. Never mind that I've been using them for 3.5 years.

Crap.

That's the MAIN reason I haven't been posting so much. A lot of cool things have happened. Before, It was a matter of writing it up in my journal software (where I've been working on other things, including a few manuscripts) and hitting "publish."

Well, NO MORE!

Now I'm forced to use a Google (TM) portal which Still does not recognize Safari.

I'm writing this one by Email.

Sigh! "

The message sent out successfully, according to my e-mail client. It never made it to the web page.

Apparently, Google (TM) wants everything done through their web portal. Or they don't like the subject line.

I know I'm getting all this for free but, I'm so frustrated, I'm ready to dump and delete the whole blog!

Any advice?

--maddog

Physics

2007-02-06T05:54:00.000+03:00

I've been hella-busy lately. Sorry about that. I have a ton of posts that I haven't published yet. See, I got a new computer and Google/Blogger forcibly switched me over to their new format. This means that my old application on my old comptuer won't work with the new blogger. I now have to get an internet connection, log on to blogger via Firefox (it doesn't support Safar yet) and post that way.

Bah!

Meanwhile, I have 2 items to share:

1. Who's coming to EMS Today, 2006 and should we arrange a "BlogMeet?" Email me or hit the comments.

2. I ran a small vehicular accident today:

Amazingly, the driver was completely unharmed! I checked him twice and he was truly uninjured!

--maddog

Search Term of the week!

2007-01-22T21:14:00.000+03:00

"amputee having sex"

Wonderful!

--maddog

...With his service pistol...

2007-01-22T06:14:00.000+03:00

One of the cops in my town died.

He did it with his service pistol.

I wasn't his closest friend but we got along pretty well. I have no idea how he got down this road but it sucks.

He did it with his service pistol.

He died by his own hand.

He did it with his service pistol.

He's gone

He did it with his service pistol.

Cops everywhere can understand how disturbing that is.

He did it with his service pistol.

I'm very upset. Herself and I talk about it (one of the 1,000 reasons I love her).

He did it with his service pistol.

There's something particularly disturbing to police when another officer kills herself/himself with their own service weapon. This is the gun is issued to them by and owned by the city/county/state/agency that gave them their police powers. It is the physical representation of the trust placed in them. This is a trust to carry and wield the power of deadly force and to wield it wisely. This is the trust placed in the officer to make the right decisions every time!

He did it with his service pistol.

When he/she turns that weapon on himself/herself, it is a violation of that trust on many levels. The trust to use that force wisely, the trust to know oneself, the trust to call for help when needed.....

He did it with his service pistol.

Any officer of the law can feel this tragedy. Especially as it comes from the end of the symbol of that trust.

He did it with his service pistol.

I may not be a healer, but I'm in the profession of healing.

He did it with his service pistol.

This can't be healed. If only I had known....

He did it with his service pistol.

It hurts me everywhere. It's a sore that hurts no matter what I do. There is no salve for this.

He did it with his service pistol.

He's gone and has left a jagged, painful hole in his absence.

He did it with his service pistol.

Louis, What have you done?

--maddog

No, what's YOUR number?

2007-01-20T13:50:00.000+03:00

Two guys were walking back to their apartment when they got jumped by a gang of kids.

The police called us in to check out one of them. When we arrived, the police were rushing out of the apartment on their way to the next instance of violence.

My patient is a native Spanish speaker with a severely swollen face. Otherwise he's OK. He doesn't want to go to the hospital.

But he likes me!

"What's your number?"

"Well, If you need us, call 911."

"But what's your number?"

"911"

"What number do I call if I want you to come to my house?"

"911!" (I'm still thinking my Spanish is not up to par.)

"But what if I want you to come to my house? What's your number?"

"Nuevo-Uno-Uno(911 in Spanish) es el numero para los paramedicos (...is the number for the paramedics)!" Perhaps his face is swollen to the point I can't read the nuances of what he's trying to tell me.

"No, no, no! What's YOUR number?"

"Nine-One-One!!"

Bean puts her hand on my shoulder: "Time to go!" She doesn't speak Spanish but she knows what's going on.

All the way back to the station:

"Maddog's got a Boyfriend!...Maddog's got a Boyfriend!...Maddog's got a Boyfriend!..."

Oh Crap!

--maddog

How many patients?

2007-01-20T05:53:00.000+03:00

I'm doing chest compressions: "ah-one and two and three and four......" and so on and so on.

I look to my right.

There's the husband.

He's wearing the "I can't believe what I'm seeing!" look.

"...and fifteen and sixteen and seventeen......"

"Clear!"

ZAP!

And so it goes.

--maddog

Bulldog? Bean? What? Who? Where are you, anyway?

2007-01-19T00:08:00.000+03:00

I got this comment from a reader:

"Whatever happened to Bulldog? (or is she now Bean?)"

Well, that's a good question and it illustrates some confusion I have allowed to occur.

I volunteer at my local firehouse as an EMS officer. I mostly drive the ambulance, train new kids and occasionally provide care. In my writing, I refer to this place at the Firehouse with a capital "F". This is where most of my fun "hometown EMS" stories come from.

Bean is one of the volunteers there and I've known her for over 10 years.

My crappy job, at a private ambulance company, was where I worked with Bulldog. I went to a part-time position when I got hired by a nearby University. Bulldog still works there. I just don't see her as much. :(

So, I hope that doesn't create too much confusion. I volunteer at the Firehouse. I occasionally work at the Crappy Job. I work full time at the University (teaching paramedics!) and have applied for a part time paramedic position with a regional emergency response agency that I'll call "The Boonies" if I get the job (It's kinda way out there).

Good enough?

Perhaps sometime I'll post a "cast of characters" for my dear readers.

--maddog

Booze, trucks, mobile phones and pockets.

2007-01-18T04:01:00.000+03:00

If you remember the call I ran earlier this week.

I just found the patent's cellphone in the pocket of my turnout Jacket.

Yikes!

He was probably too drunk to remember what happened to it. I'm going to try to get his home address and mail it to him.

Oh my!

--maddog

EMS Today 2007

2007-01-17T03:51:00.000+03:00

The EMS Today conference is in Baltimore this year.

I went in 2005 and met up with the macmedic.

I'm thinking of going this year.

Anyone else? I figure a few of you EMS blogger out there might be going. Let me know via comments link or email.

Pints?

--maddog

Promoted?

2007-01-16T03:25:00.000+03:00

The chiefs & other line officers at my volunteer Firehouse have been bugging me for a while. There is a position of "EMS Sergeant" that has become open recently. Due to my education and possibly the fact that I'm the highest trained and qualified EMS person at the whole station, they've been pestering me to apply.

I really don't have the time. I'm worried that if I commit to doing more for my Firehouse, I won't have the time to do it and I won't come through. I'd rather say "no" than say "yes" and let everyone down. I've been deflecting their requests and encouragements with this very argument.

Then they got sneaky.

Herself and I had stopped by the Firehouse after walking Mr. B in the woods. He was all muddy and needed to be hosed off before we took him home. While we're there, the deputy chief, Sunshine, comes up to us and asks me if I've put in my application for the EMS sergeant position. I begin the usual argument that I really don't have the time to do all this, yada yada yada.

Meanwhile, Herself saunters over to the bulletin board where the position announcement is. She reads over the list of duties and responsibilities and says,

"You can do this. Hell, you do most of this anyway."

Sunshine smiles at me.

Crap!

Well, it turned out better than I had hoped. Helga had applied for the position too. She's on an opposite duty rotation from me. her strengths lie in the administrative and organizational areas and less so in training, field operations and orienting new members.

Chief decided to split the position in two. Helga is the EMS Administration Sergeant and I'm the EMS Operations Sergeant. I'm in charge of all EMS training, stock and supply on the ambulance itself, quality assurance of field practice and skills and making sure new people get trained and turned over in a timely manner. Stuff I already do.

Ok, then!

--Sgt. maddog

Sunday!

2007-01-15T02:21:00.000+03:00

Just Sunday. Not terribly exciting. Cleaned the house. Later, I'll be headed to dinner.

I did roast a delicious leg of lamb. The house smells wonderful.

Not much that's EMS-Blog-worthy. Nor was I particularly inspired to go on about anything.

Well, it is Sunday!

--maddog

Sirens? Lights?

2007-01-13T18:59:00.000+03:00

I'm driving to an accident that's downstream from all the rush hour traffic. This means I have to wade through the congestion on the highway. We usually ride the shoulder if it's big enough. In this case, the shoulders are all too small for my huge ambulance. This is when I get to perform a "Moses."

Just like Moses parted the Red Sea, I drive my ambulance right down the middle of the lane divider. I'm sounding 2 sirens at different frequencies and patterns as well as working a diesel air horn in a way that cannot be ignored.

Just like the Red Sea of legend, the traffic parts in front of me.

Most of the time.

This one instance, an SUV decides to take advantage of the break in traffic that I caused to get over 3 lanes to the exit.

His doing so causes me to stand on the brakes with both feet to keep from making an accordion out of him.

He moves out of my lane. I pull abreast of him and Bean and I look at him.

He's on his phone. He gives me a dirty look.

It's worth mention at this point that the air horns on my ambulance are mounted on the front fenders. This happens to be at almost the exact height of a person's head when they're driving a typical American car or SUV.

I don't know who hit the horn first, me or Bean (we both have a pedal for the diesel air horn).

His window was open.

He almost jumped into his passenger seat. (and he dropped his phone)

Wow! Justice!

--maddog

Booze, trucks and mobile phones.

2007-01-13T06:19:00.000+03:00

This guy is pinned in his work van. The dashboard and engine compartment have folded over him like a clam and pinned his legs. The van says something about Suchandsuch Plumbing. It's 2:30 am on a Saturday morning and I 'm getting a buzz from smelling his breath.

Bean is trying to put a collar on his neck. He's alternating between trying to hit her and give her the finger. His truck is against the side wall of a bridge. Every time he smacks her helmet, she teeters over a 25 -foot drop to another highway.

Fun!

All the while he's on his mobile phone.

I take the phone from him and talk to the caller.

"Who's this?" the voice asks.

"This is Paramedic [Maddog] from [Somwehere] Fire department. Who are you?"

"Oh, He's my boy. I'm his homey."

"Were you hanging out with him tonight?"

"Yeah."

"Where?"

"Oh, we was just chillin' you know?"

"Yeah, I know. Cool. Been drinkin' some?" (I suprise myself at how easily I slip into character)

"Oh, yeah. We wuz fo' sho'! Where he at? I'm'a come pick him up."

"Duuude, if you been' drinkin' as much as him, you bes' stay at home, knowhaimsayin? Else I'll be scoopin' you off the road next. You feel me?"

"Aw Sh**, man. He gwoan be aiiit?"

"We'll do our best. He'll be at [somewheretown] hospital tomorrow, if you need to see him."

"I'll pick him up tonigh!"

"What! nonoNO! You stayin' right THERE, Fool! I'll take care of 'your boy'. You sleep it off before you drive a car, aiit?

...

"Oh, Aiiiit."

*click!*

Wow! I think I saved someone's life!

--maddog