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

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

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

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

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

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

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

Buckle up, kids!

--maddog

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

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

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

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

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

"No, Ma'am."

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

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

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

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

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

--maddog

The stink of death.

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

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

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

"Dispatch, we'll take that call."

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

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

McGee and I slide into the room.

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

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

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

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

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

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

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

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

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

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

"Physiological empathy!" Says, I!

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

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

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

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

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

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

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

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

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

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

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

But there's the smell.

The smell of death.

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

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

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

Ow.

Ugh.

Crap!

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

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

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

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

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

--maddog

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

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

"Do you have any medical conditions?"

"Yeah, I have diabetes."

"Do you take anything for it?"

"Yeah, insulin."

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

"About a month ago."

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

"I can't move my legs!"

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

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

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

--maddog

Yes, school has DEFINITELY started!

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

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

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

I miss it.

I'm back.

--maddog

School starts!

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

I'm excited!

(What a dork!)

--maddog

Night of Insanity: Final Chapter.

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

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

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

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

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

Both medics look at me. Then at each other.

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

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

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

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

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

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

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

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

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

"Oh yeah." says mom.

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

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

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

"He's wearing pajamas!" Giggles ensue.

--maddog

The Night of Insanity, Part Two!

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

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

ARGH!

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

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

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

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

"You got a Lifepak 12 in your truck?"

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

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

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

"You coming?" I ask the supervisor.

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

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

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

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

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

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

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

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

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

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

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

"I'm hungry!"

Coming up:

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

Hometown EMS, Yoikes!

Stay tuned!

--maddog

The night of insanity, Part One!

What a night!

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

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

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

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

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

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

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

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

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

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

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

"I have to pee!"

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

"My head hurts and I'm uncomfortable."

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

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

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

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

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

"Of course you can." She does.

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

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

Wheee!

I'll write about that one next.

--maddog

Stay Tuned? (and bring your Bean-o)

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

Yum!

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

--maddog

Who am I?

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

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

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

"That's so awesome!"

"I could never do that!"

"You're so strong to do that!"

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

HA!

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

Well, that proves it. EMS ROCKS!.

--maddog

YAWN!

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

*Yawn!*

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

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

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

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

Cya!

--maddog

I'm back!

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

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

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

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

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

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

ARRRR!!!

--maddog

The Ladies' Man!

I'm riding with a hospital-based ALS chase car system as part of my clinical rotations. I'm loving it as I only go on ALS (advanced life support) calls that give me a chance to work up my assessment and treatment skills.

We get called to a nursing facility across the street from the hospital. An injury after an assault. We arrive at dinner time. This place is clean, orderly and has a wide range of patients. Our particular patient was bitten on the back of her right hand by the woman sitting next to her at dinner. As I hear it from a nurse, the biter has severe Alzheimer's and sometimes acts out.

My patient is calm, well dressed and not in obvious pain. The ambulance crew who arrived before me have already done an admirable job of bandaging her hand and she smiles at me as I walk in. She's pleasant and chatty as we move her to the cot and to the ambulance. She's slim and athletic looking, about 75 years old. She explains to me that she usually helps take care of the biter, picking up her clothes and spending time with her, and she can't understand why she bit her on the hand.

She tells me she plays tennis every day and is worried that she won't be able to play for a while. I jokingly explain that she can learn to play left handed and then when her right hand heals, she can play with both and take on doubles teams. She gravely considers this.

"That's a good idea. I'm going to do that!"

Up to this point, I'm thinking she's a member of the staff or a volunteer. My preceptor hands me the report paperwork and I see she's a patient with dementia and Alzheimer's herself.

She's a real sweet lady.

We chat as I get her vital signs. At one point, when I go to take her blood pressure, I rest her left forearm on my knee.

She looks over at me and winks.

"I've got my hand on your leg, young man."

And so she does!

--maddog