Hank's Blog O' Bull

Fear of the Unknown

2014-02-17T06:50:00.000-08:00

Sometimes I have to wonder why I do what I do with all the adversity, disparity, carnage and sorrow that I see. I see it in the ED and I see it out in the public. There are just certain instances that make me stop and think about what I do and how easily that my patient could be me and then I’d be dealing with their circumstances.

There are also those patients that make me stop and think about my life and how I’ve done things, right and wrong. Have I been in their shoes? Can I truly be empathetic or sympathetic? More and more I find myself relating to the plight of my patients and their families as I get older. I find myself saying, “yep. Been there, done that” quite often.

This weekend was one of those weekends that made me do a lot of thinking.

Wonderful couple came in the other day as one of them was complaining of CVA-like symptoms. The patient had had one before with no lasting effects. Had been following all the doctors orders in regards to medication, diet, exercise, and lifestyle changes. Yet even though all these things had been done to the “T,” the symptoms popped back up out of the blue. The patient was surprised, frustrated, and very upset. Why, after all this effort, was this still happening? Why bother continuing on to do the “right thing” when this still happens?

At the time when they came in we were busy and I really didn’t have a lot of time to sit and talk but the look I was given told me it was best to sit and chat for a while, to try and relive some stress that was apparent and evident in the patient’s eyes and face. The same questions kept popping back up. The wrinkled brow and questioning eyes never left the patient’s face. The hands were constantly moving, needing something concrete to grasp to make some sense of what was happening. And the same routines were replayed verbally over and over trying to find something different that had been done out of the ordinary to explain this sudden recurrence of the CVA symptoms.

We talked about the signs, the symptoms, the medications, the routines, and anything else that had gone on in the past 6 months or so. Nothing had changed. Then the questions changed to, “why continue?” The patient knew why but still asked anyway. It was fairly obvious to me that the fear of the unknown was eating away at this patient’s mind and raising the stress level even higher. “I’m just a paramedic but I’ve seen this a lot. I’ve treated this often.” I offered various scenarios of what I’ve seen and how I’ve handled things, all the while making sure the patient understood that not everyone is alike; we all have the potential to react to things differently (health problems, medications, procedures,…). I mentioned about being proactive by continuing to do what the doctors had said. I reiterated like I do quite often that medicine is not an exact science; that’s why they call it a “practice.” We prescribe and do things based on evidence, experience, and knowledge knowing that not everyone will react to the same way or respond to the same treatments the same every time. Things change. People are unique. Situations vary from one minute detail to the next.

But what it all came down to was this patient’s fear of what lies ahead and not knowing. I said, “I could get killed in the next 90 minutes as I’m driving home from here. I just don’t know.” And with that simple statement after all this dialogue lasting almost 45 minutes, I noticed two raised eyebrows that said, “you know, he’s right.” We all have the fear of the unknown but we can’t let it consume our lives and what we do. We cannot run our lives based on what we don’t know. We cannot let the unknown issues dictate how we go through our daily lives. We prepare as best we can and take what each second, minute, hour throws at us and deal with it. We do the best we can. The unknown cannot consume us or we too will become consumed with worry and fear.

As I left that patient’s room for the last time I did so knowing that I had eased at least a small amount of the stress and fear that was hanging in the air. I heard a spouse say, “He’s right. We DON’T know what will happen in the next 10 minutes so we’d better get prepared.”

Making a Difference

2012-11-28T08:04:00.001-08:00

When I was in high school I worked during the holidays and summers for my uncle. It was usually hard work that went hand-in-hand with some long hours, especially on shutdowns. The money was good for a high school kid and I enjoyed spending it. I learned a lot from him and the guys who worked for him. I also learned my work ethic from him, something that not many people seem to have these days.

His work ethic as a business owner and employee was one that never ceases to amaze me, even today. He's constantly on the go, always working, and he takes great pride in his work when it comes to details and the smallish things that a lot of people overlook. It's the extra couple minutes of cleaning, putting a nut on a bolt the right way, fixing the ding in the sheet metal that wasn't our fault; things like that he's always done to ensure customer satisfaction so that they come calling again if they needed our services.

Daily here at work I do a new contractor orientation. I may have 1 or 20 people come through this class and I see a wide variety of people from all walks of life that come to work here. One thing I always make a point about during that class is taking pride in the work that is performed here. Working at a children's hospital is a little different than anyplace else I've ever worked. I'm sure that some of it has to do with me having 3 kids but it's part of it. Many people have come through here telling me that their kids were treated here, someone in their family was here, or that they themselves were here. I always mention that we're building a hospital to take care of and treat the future generations and to not cut corners. It might save a little time and money to put "this paint" on versus "that paint" but would anyone want to come here knowing that corners had been cut to save money if they were bringing their own kids here? I want the best for my kids and I hope that everyone working here feels the same way.

It's all about taking pride in your work, craftsmanship, and the work ethic you exude every day. Hopefully some of it's infectious to those working around you. I want people to be proud of what they do and what they accomplish. I want people to be able to stand back and look at their handywork after they're done and smile saying, "I did that!" All the while knowing that eventually, at least here, that a sick child who's here for treatment will be able to be treated better, have some enjoyment, or be more comfortable just because someone took the extra couple minutes to do things the right way, put that little extra added touch, or made things look that much better in the patient care areas.

Daily I see hundreds of people walk through our doors knowing that they've come to one of the best places for care of their kids: all colors, shapes and sizes, and religious beliefs. They all come here for one reason; to get their child healed and back to leading a normal life. All of that could not be possible without the dedication of the staff, doctors and nurses, and the people who built and keep the facility running like it should.

Most jobs I've ever worked I hear people gripe and moan about this problem or that problem, all too often just to be heard. The problem is usually insignificant and meaningless in the realm of their job but it still gets heard. "It's not my fault. It's not my problem. Someone else left it that way."

Seriously?

Do something about it. Take a little pride in your work and of where you're working, regardless where it is. Too many people want a pat on the back for things that are so small and minute that it means nothing. They want credit for something that they didn't do. Make a difference. Take a stand. Maybe someone else will see you pick up that board that isn't yours as you put it in the trash and do the same, all in the name of making things look better and cleaner.

Recently I saw an article about legacies. I thought long and hard about that and wondered what I've done. I don't want to be remembered for what I've done, built, or how much money I made. I want to be remembered for the contribution I've made to my kids and to other people. Since I was 17 I've enjoyed helping others and trying to make things better for people. You need a couple bucks? Here you go. You feel crappy? Here, let me give you some medicine and try to make you feel better. You don't understand that? Here, let me try to explain that to you so that you do. I enjoy seeing other people getting the due credit they so richly deserve but never have because they're like me; they won't brag or boast about accomplishments just to get recognized. They don't want to be in the spotlight. I too don't deserve it so I don't push myself on others. If I get noticed for anything, I want it to be for what I've done, based on my merits and the pride I've taken in my work.

Be proud of what you do. Look at all the peoples' lives you can possibly touch by doing a better job at work. A smile and a kind word goes a long way. The extra minute you spend on that task making the results just that much better can be the difference between a simple smile or a huge toothy grin full of gratitude and wonderment. Be that person who makes a difference in someone else's life.

My favorite thing to do here where I work? Walking down the halls and hoping I see a patient I can wave at. I truly love it when a child smiles and waves back at me. It really does make my day :)

The House That Love Built

2012-03-28T12:30:00.000-07:00

Being a part of the medical community has allowed me to see a lot of grief, tragedy, hurt, sorrow, and pain. But there’s also the healing and happiness part of it that isn’t always seen by everyone.

I’m a grown man with 3 kids, all of them still in elementary school. The one thing that’s probably gotten harder as they’ve grown older is me dealing with pediatric patients. I picture my kids as the ones in front of me. I treat the kids like my own. They hurt, so I hurt. They want comfort, hopefully I can do something to provide that to them regardless if their parent or guardian is there or not.

My “real job” is doing construction safety, basically OSHA compliance on a construction site. My current job is at the only Level 1 trauma facility in the state of Indiana for kids; Riley Hospital for Children at Indiana University Health. The drive is long every day and so are the hours, but being here, being a part of this fantastic place in a small insignificant way makes it all worthwhile. This is one of those places where miracles happen daily.

Recently I got a chance to tour the Ronald McDonald House located here within the facility. They only have 6 beds here for patients’ families but they offer a place to rest, relax, get away from the beeping pumps, monitor alarms, and noises associated with being in a patient’s room or unit. The House Director showed me the rooms and told me about what they do, who they see, and why they do what they do; they provide a respite, a place of healing and rest that families so desperately need as they’re here with their child receiving treatment or life-saving intervention.

The Director showed me the journals that were in every room that families who stayed there often read and then wrote in, in their own words, about their own personal story. How I would have loved to have read those stories but it would have ripped my heart out. I also respect everyone’s privacy and the need for peer support, such that I could not give them as I haven’t been in their shoes.

Today we had a site lunch and I asked the Director to come up and speak as many of the guys and gals here have heard of the Ronald McDonald House at Riley but don’t know much, if anything, about it. Daun Hughey and Joe Schulz, the Director of Development, came up to speak and brought this video for everyone to see. As the video played about the Ronald McDonald House both here at Riley and one just around the corner from here, I scanned the room of grown men and women, sitting quietly in chairs after eating lunch, to see their reactions. A couple looked away from the screen, another couple dozen dabbed at their eyes, more nodded their heads, but everyone and I mean everyone had their attention firmly on that video. Priceless, simply priceless.

The people of our site are building this hospital for those kids and their families. They’ve heard of some of the things that happen here but now they got to see a side that few others do. They got to hear and see what some of the families have to go through, the hardships they’ve faced, and how they get through every single day while they stay here for days, weeks, and months with their sick child getting possibly the best medical care in the US. Riley is one of those places everyone hopes they never need but thank God every day that it is in case we do.

If you’re ever in Indianapolis and have the need to feel loved and welcomed, feel grateful for what you have, want to donate a little time, money, or supplies, I urge you to stop by the Ronald McDonald House here at Riley. Daun has a "wish list," as she calls it, that always needs things checked off of it. I’ll personally take you there, introduce you to the Director and some of the awesome families and volunteers who call the Ronald McDonald House at Riley their second home. You’ll see very quickly that it is truly, “the house that love built.”

Here's another link to the video http://www.youtube.com/watch?v=mGPgeZSSDDA
And here's one to the Ronald McDonald House www.rmh-indiana.org/

It's That Time of Year

2011-12-22T09:39:00.000-08:00

It's nearing Christmas Day around here. Everywhere I go I see signs of Christmas. Trees, lights, signs, for-hire Santas walking down the sidewalks, pictures of kids oogling over their favorite toy ads, and all sorts of other visual reminders of the holiday season.

I look forward to Christmas for a couple reasons. It's to remember the birth of Christ but it also seems to bring families closer together. People give more. People tend to help out a little more. People seem to be just a little nicer than at other times during the year. Two of our kids still believe in Santa.

We watch the old Christmas cartoons I watched as a child. We make cookies on Christmas Eve and put out the reindeer food on the yard, the plate of cookies and milk by the fireplace before bedtime. It just makes things more fun.

And then there are some of the things that pop in my head at this time of year that make me sad, things I don't necessarily want to remember but I do, and they usually come up now. These are things that while sad make me very grateful for what I have around me each and every day.

I see people every day on a specific sidewalk just a couple blocks from where I work begging for money. They have no job. They have no home. They have practically nothing. I occasionally drive by a large shelter downtown and see the crowd milling about aimlessly outside waiting for the next meal, waiting for the next bed to open up so they can go lay down or just stay warm for the night.

How many people have lost a friend of family member throughout the year? They will be spending their first Christmas without that loved one, without that friend. There will be a profound emptiness in the time of families, togetherness, and love. I look at those who are working Christmas Day. I've done it countless times. I've been in foreign countries on Christmas Day and other holidays, spending it with people I work with; no family, no presents, no catching up on family gossip or eating my mom's killer apple pie.

I always think back to Christmas Day 1991 when I was working on an ambulance. Low man on the seniority list, just finished with Paramedic class. A cardiac arrest, a pediatric one, all of 6 months old just brought in to this world to experience her first Christmas. The jokes and happiness we had in the ER that morning cut short by this totally unexpected tragedy. We all worked and worked for seemingly hours doing everything we could to revive this frail little girl. Somehow, by the grace of God, we did. She was transported by helicopter to a children's hospital where she passed 3 days later. Heartbreaking, truly heartbreaking.

I cried that day. I cried because of what had happened, what I witnessed, what we all had done, and what we had achieved on that day, Christmas Day. I think of how that family lives with what happened on that day so many years ago and how their lives would and are forever changed by the events of one day, that day, Christmas Day.

But life goes on. We all do. Lest we forget those who are not here with us anymore. They will always be with us and there will always be the reminder of being with them, even if for just a short period of time. Those who have passed, those who are working, those who have nothing, and those who have everything.

There's still kindness in the world and I see it every day. There's still love in the world and I experience it every day. There will always be the hatred and cruelty that will mar what we see and blur our views, but that will go to the back of the line.

For everyone who is missing someone, for everyone who is not home with their family, for everyone who has nothing, and for everyone who has everything, be glad you have something, yourself. Merry Christmas and Happy Holidays to all.

I Love My Job!

2011-10-07T05:51:00.000-07:00

Like most people in the EMS field, I didn't get in to this for the money. Granted, I was 17 when I began my involvement with ambulances and the love affair has grown steadily since then. I'm 40 now and I can honestly say that I love my job, I love what I do.

A lot of us quickly realized that the money just isn't easy to find in EMS so we have second and / or third jobs to help make ends meet. A lot go on to other careers but stay in healthcare. Some go on to do something completely outside of our world. But the dedicated bunch of EMTs, Paramedics, and others that remain in the EMS world, destined to be wanting more money but loving their jobs so much that they dare not leave are still here.

EMS used to be my only job. It was my first career. I loved it then, I love it now. I'd say I'm a "seasoned veteran" who's seen a lot but not everything. I've done my fair share. I've worked all around the world. I've gotten to do things most would only dream about. Yet here I am, still part of a volunteer department and loving it.

When I moved out of state I left my first EMS position behind, the place that opened up so many future doors for me. I came back after a couple years because I felt I owed it pretty much everything. I don't do it for the money, I do it for dedication and pride. I'm proud of who I am and what I've become. No, not all of my decisions have been good ones but I've learned from my mistakes. Helping others is at the forefront of what I like doing. That has transcended from the EMS world in to whatever else I do as well.

My "other life," or my real job (the one that pays the bills) is as a safety consultant on construction sites. I walked in to doing safety when I was working offshore on oil and gas drilling rigs around the world. Safety and EMS out there pretty much go hand in hand; you do something unsafe and get hurt, you go see the medic. So I fit in perfectly doing both. It's worked well for me and here I am.

It seems as though the last couple sites I've been on have somehow been tied to healthcare. I've worked at a facility that makes medicines, some of which I've either taken as a patient or given to some of my patients. Then I began a project building a new hospital. Now I'm at a site where we're building a new tower for a children's hospital. It's always been frustrating because I've started a lot of projects but have never gotten to see the end. Safety is usually one of the first positions to be removed from a site due to budget constraints. So as my sites have been completed I've only gotten to see the finished product if I've gone back on my own.

But with the hospital project it's a little different, a little unique, and it makes me smile. I spent two years on that site, seeing it go from a hole in the ground to a nearly finished facility, one that will specialize in cardiac care. I've gotten to know the hierarchy of the hospital very well. I know the building like the back of my hand. I hold a vested interest in it because I will be taking my cardiac patients there. It'll be a true definitive care facility for those patients I pick up.

What's special is that I will be working there as an employee in the ED. I even asked the manager if i could work the first shift that the facility is open. She told me that I've "earned it," and that it was mine. I beamed with excitement after hearing that. Finally I get to see a facility I worked on, helped build, and will be a future customer of. Now I get to be there and see how everything we all toiled on for so long will work.

As I wait for that one to open up and to begin working there I've been moved to another location. This time it's a more special place. One of those places that makes me tear up when I see certain reminders or hear certain catch phrases about the place. I'm at a children's hospital, building a new tower for kids who so desperately need to be here. This is one of those places that nobody wishes was needed but everyone is thankful that it is, just because of the special things that happen here,the miracles that happen daily, the lives that are saved because of the awesome people and care that the sick kids around here can receive. This is one of only 250 childrens' hospitals in the US. That's not too many if you stop and think about it. Only 250 facilities to take care of our sick and injured children, nieces, nephews, and grandkids.

I did an informal "Hank Poll" the other day and approached 42 people working here out of roughly 175. Every single one of them either knows or is related to someone who has had a child or relative treated here. I'm one of them. This facility is part of a large network and my youngest has been here a couple dozen times. Close friends of mine have had their kids here. People I work with have been here or had their kids here. And everyone has come out better and healthier.

I walk around here daily just smiling knowing that I'm part of building a new tower that will help children, help them heal and get better, be a comfortable inviting place for parents to bring their sick kids to be treated and hopefully back home very shortly after. I see the stuffed animals on the banister in the lobby and smile. I can remember #3 saying, "daddy, I want one of those!" and pointing to one of the big lions. I see kids being pulled around in red wooden wagons instead of wheelchairs. I see kids smiling in the family areas with IV poles next to them as they color in books with their parents. I see adults sharing french fries from McDonald's with their kids in the lounge areas outside the lobby by the cafeteria. I see and hear kids playing together upstairs in the patient rooms with their siblings.

I've called this building, "the best place in the world." I'm proud to be a part of it. I honestly hope I never have to bring one of my kids here ever again. I would like to see a place like this never be needed by anyone, but I'm damn happy that it is here in case it is needed by anyone, including me, to help sick and injured kids from not just here but anywhere in the world.

Places like this with me a small part of it, make me honestly say, "I love my job."

Drives Me Nuts...

2011-07-28T07:26:00.000-07:00

A toothache at 2am.

An earache at 430am.

Drunk drivers who hurt or kill other people when they're perfectly fine, other than the obvious fact that they're brains are switched "OFF."

Yep, ambulance runs. There's plenty more where that came from.

"Take me to _____ Hospital. I have my 'card' and you have to take me."

People who meet you outside their house with a packed suitcase in hand, ready to go.

"Can't get this damn splinter outta my hand."

"Oh, this ain't no big deal cher. I've had me 8 babies already. This one will be awright. Jes tired uh bein' damn pregunant like."

"Ain't gonna go there. They's some mean peoples there. Take me to ______ (60 miles away). They knows me theyuh (smiles with a toothless grin)."

A girl's first period with her mother right next to her. Would have thought the world was coming to an end.

Sore throat. Seriously? A damn sore throat???

Out of medication and there's plenty of free medicine at the hospitals.

"My momma's already theyuh and I wants to go see huh. Can y'all take me theyuh?"

"My hair hurts."

Big boogers that just can't be removed.

Bugs in ears.

People who get return trips to hospitals still wearing the gowns they came home with a month prior; and it looks like they haven't been washed or taken off that entire month.

Oxygenated patients who smoke, still smoke, or are presently smoking in my presence with oxygen on.

Patients who have to have a smoke before they go to the hospital. Sorry, I wait for no KOOL.

People who swear at me, not with me.

Assholes. Cocky.

Other healthcare providers who critique how I'm handling them or their family.

Healthcare providers who are on scene first and do the complete wrong thing for the patient's welfare.

Family members who just won't shut the hell up and let the patient speak for themself.

Police who don't help out when asked.

People who just won't help themselves. They don't care, don't give a shit, or whatever. If you don't, why should I?

Lastly (for now), people in EMS who don't have the passion, drive, compassion, to be there day after day helping others who truly need our skills and expertise. If you don't like it or want to be there, leave. You drag the rest of us down. 23 years in to my young EMS career and I still love it.

Hangin' It Up

2011-07-06T11:07:00.000-07:00

I've always been told that healthcare providers are the worst patients. I agree. We know too much. We self treat. We self diagnose. We're never wrong. We're never sick. We know more than most doctors. I usually tell my patients, as I'm sticking them, that it's odd that I have to hurt them to make them feel better. I also tell patients that medicine is called a "practice" because it's just that; it's NOT an exact science.

I've wondered, more often recently than before, about the future. What will I do? Will I keep in the healthcare field? How long is too long? Am I burned out? Have I had enough? Do I still love it, have the passion for it, want to educate and impart my experiences to others?

Things now aren't what they used to be. Instead of people bossing me around and telling me what to do I'm kind of in that seat now. Our generation is taking over from another one and we're molding the next generation to take over from us. It's kind of neat to see people I grew up with running things, owning businesses, making money and having families and doing all the things we watched our parents do.

I am a picky person. I don't settle for second best. I know what I like and that's it. I don't accept change very easily unless I can see benefit and immediate results from it. I used to act first and think second but now I've changed that. I try to take my time and make informed decisions and calls before I pass judgment on someone or something. I try to not let biases get in my way.

I, like most, get fed up with the system. I get tired of hearing bullshit complaints from nurses, doctors, hospitals, or patients about something we did supposedly wrong. It takes my time and energy away from doing my job to investigate things and back my staff up. It's a pain. First off, are they not accountable? Why am I getting the call and not them? Well, I am in the head chair so it is kinda my job. But hearing bullshit complaints and dealing with petty issues that need to be resolved elsewhere grows old.

Another issue I have is taking care of kids. Pediatric patients have always been tough no matter the situation. Having kids of my own makes it even tougher. I picture any pediatric patient I have as being one of my own. Can i give them the same treatment, the same compassion and care that I would if they were my own? Sure I could but I wouldn't want one of my kids to need my skills and knowledge. I would never want to stick a needle in my child's arm or immobilize them after a wreck or put them in a splint because they fell and broke their leg. I'd hate that. It hurts even now to see my kids get so upset when they get booster shots. I can see and hear the terror in their eyes and cries yet it's for their own healthy well-being.

I know I can't always make things right. I can't always kiss the oowies and make them go away. A hug doesn't work all the time or a rub on the head, a scratch of the back. Those times hurt when I can't make the pain go away, for my kids or someone else's.

You know, I've never, in 23+ years had an adult call that's bothered me. From my first cardiac arrest to being puked on to my first evisceration. I've seen a lot but not everything. The only run that still, to this day, bothers me is a pediatric one. I don't remember the name but I can remember all the minute details of who, when, where, what happened, almost regurgitate it from beginning to end. Almost 21 years ago that happened and I can remember it so vividly.

I see people who have been doing this for years and they get burned out. They lose their drive for helping others. I haven't gotten to that point but dealing with all the bullshit is old. I get tired of the lack of respect, the not getting answers, the accountability or lack thereof people tend to have.

I've contemplated for the last year of slowly letting myself out of this realm. I don't think I'm ready. The younger generation is up and coming and eager to step in to our shoes and push us to the back of the class as they assume their positions in front. I'm almost ready to see it happen but I have a little more left. For now, I'm where I'm at. If you don't like it then I say, "tough shit." Come at me with respect and desire and I'll help you get whatever you want. Come at me with disdain and laziness and I'll boot your ass out the door. I've earned the respect of my peers and I expect it to be shown to me as I'll show it back with eagerness.

If It Wasn't Documented, It Didn't Happen

2011-05-16T10:28:00.000-07:00

Many times in my EMS and professional career I've come across that phrase. It's been said to me, I've told it to others, I've overhead others having conversations about it.

For the sue happy world documentation has to be one of the best defenses we can have. I stress upon people all the time that we need to document the most minute details in some of these cases. A lot of areas are going to check boxes and things like that that reduce or eliminate narrative sections. Several years ago when I worked elsewhere they looked at doing that, thereby eliminating what the EMT or EMT-P wrote. Check boxes are simple, quick, and easy but leave a lot to be desired. Of course there are those calls that can easily be documented by ticking a box. But not all.

People have asked me, "have you ever been called to court or been deposed?" Yes I have and it's no fun. I've had runsheets or PCRs torn apart because I misspelled a word, forgot a minute detail, misquoted what the patient said, forgot to get a signature, or didn't use the preferred widely accepted abbreviation.

I'm a firm believer of, "if it wasn't documented, it didn't happen or it wasn't done." I'm in the midst of a suit that happened 2 1/2 years ago. I explained to the lawyer that I was raised writing everything down; what I saw, what I heard, what was said to me, what the scene and surroundings are. If those things are pertinent to the patient, the outcome, or for future reference they need to be written down. I told her that I typically write novels for PCRs because I want to make sure I cover my ass as well as my service's. I don't want anyone to get in trouble because of something I did or didn't do and failed to document.

Crime scenes are especially vulnerable to being called to court. Drunk driving accidents or any car accident is likely to be called to court. Workman's comp cases and jobsite injuries are very common ones where someone sues later for a settlement.

I've seen 4 and 5 sentence paragraphs for an ALS dyspneic patient and I've seen 2 and 3 pages for BLS car wrecks. The people writing them vary as do their styles and the ways they were trained. Their mentors and preceptors may have done different things in their documentation. I tell people to make their own variation of different people to adequately suit their cause and develop their own style. I used to get criticized for taking so long on my reports but I was able to stick it back to my employer the first time I got called to court and had my usually long narrative with me. It allowed me to remember that particular incident 3 years post.

Discussed with some people last week about SORs and their need. Those too are cya things. Ran in to a situation recently where someone didn't want any c-spine or lsb after we'd already placed it on at their request. I asked the patient if they'd be willing to sign an SOR or AMA form releasing us of any liability before it was removed. The response? A quiet, "no." So we went about our job or helping the patient out. There were some special details that needed to be in the documentation but it was needed to help cover us, show what we faced, how we handled it, what we said, what we knew needed to be done yet were not allowed to because of the patient's wishes.

How often do people actually document that a steering wheel was bent? Which direction? Was there damage to the interior of a car? How far did the door protrude in? Which airbags deployed? Did anyone notice the multiple pill bottles on the sink next to the 10 empty alcohol bottles? Ever mentioned about the odor or smell of the inside of the house? Was it pertinent to the problem at hand? What did the patient tell you? Be specific. Quote exactly. What we write on are legal documents and can come back to be your best friend in court,... or they can haunt you.

There are also things like irate parents and family members who spout off things that don't need to be documented but need to be addressed or passed on. Case in point would be a parent who is spouting off everything from the time you walk in to the door to the time you drop off the patient in the ED. But in that brief moment the patient is away from the parent the story changes, the details come out; your treatment may easily be swayed by what you see AND hear from the patient them self. Most people can speak for themselves. Give them the opportunity if you can as it's for their benefit (obviously). I usually try to bring the nurse or staff out of the room / area and discuss things with them so I'm not corrected, told I'm wrong, or make situations worse by that family member. And make sure you document whatever's pertinent.

If it wasn't documented, it didn't happen.

End of Life Miracles. Awesome!

2011-04-27T21:58:00.000-07:00

I’m sitting in one of the most uncomfortable chairs ever made by mankind. Hospital furniture is unforgiving at best and hell on spines, backs, arms, legs, every possible bone in the body that comes in contact with them.

“It is a dark and stormy night,…” actually it is. There’s a tornado watch out for our area until 3a and it’s only 1148p. The big stuff has already rolled through with just some lingering showers still remaining in the line, at least what I see on the radar on my phone.

Room 624 is a rather noisy place. About 3 feet to my left is my wife, trying but failing at sleeping on a roll-away bed and her mother is next to her in another. The nurses up here brought them in here last night when they stayed in here to keep an eye on the room’s patient.

6 feet in front of me lies my father-in-law, all of 73 years young. He’s got a PICC line in his left arm. Hooked up to that is a maintenance line of .9NS, a PCA pump with morphine running TKO @ 2mg / hr and 1 mg boluses q 10 min. He’s on 15 lpm via a partial non-rebreather mask and hooked up to an oxygen “oximiser” which is basically a high pressure / high flow humidified oxygen device. He’s got that hooked to a nasal cannula at 30 lpm. The noise of the high flow oxygen is almost deafening but it’s doing its job.

Pulmonary fibrosis is sapping the life out of Bill, my father-in-law; one of the best men I’ve ever known, ever will know, and an all around fantastic father, papaw, and man. Hard working, educated, sentimental, sensitive, no bullshit kinda guy he is; always has been and still is today. Even with all this he still has a wicked sense of humor.

He was diagnosed with PF about 8 months ago and began using oxygen at home PRN. Then it went to constant use @ 2 lpm, then 4, then 6. A week ago he developed pneumonia which sapped things quicker. The docs told us he had 3 – 6 months to live. After the pneumonia kicked in and really began whipping his ass the docs told us it was down to a couple weeks, if that. The digression in status continued rather quickly from there and still does.

But what this is about, other than the background history, is what I’ve seen, what we’ve seen in the last two days. I can’t explain it, it defies logic, it’s almost miraculous. I don’t think dad will ever go home from here and twice in the last two days I, we thought it was the end. He’s still here and let me tell you about it.

Dad’s a recovering alcoholic and scotch was his drink of choice. Hasn’t had the stuff in a decade since he’d stopped. Went to AA and treatment and got dry. Best move he ever made. He’s slowly been making requests for things and getting affairs tidied up since he accepted the end is near. Three days ago he said he’d like to have a shot of Johnnie Walker, the “best stuff they make.” He’d never had it and I knew it was JW Blue. I’d seen it in duty free shops all around the world. Damned expensive so I never bought any.

I called around to at least 14 area liquor stores and none had it. Went to another half dozen and the same. So I went to work yesterday morning and made a couple calls to find a bottle somewhere, anywhere, regardless of cost. He was worth it and I’d travel if I had to. He’d paid his dues and it was his wish to have that one last luxury of life and I was making damned sure he got it. I made the call to the fourth place in Indianapolis and I asked the clerk if he had a bottle of it. “I have one bottle and that’s it.” My eyes lit up and my hands grabbed for a pen to write down directions. I told the man to guard it with his life, pull it off the shelf, hide it somewhere that nobody else could see it; this was the last request of a dying man who so richly deserved this taste of excellence.

I left work and hurried down the road to get it. It was only 10a and the clerk seemed more happy than I was to sell it to me since I told him what it was for. I paid for it, snuggled it safely in the crook of my arm like a newborn baby, smiled from ear to ear, and hurried to my truck to deliver the fantastic present.

Throughout the day Bill had been declining in status. Sats were in the low to mid 70s, pulse in the 110 – 120 range, doing a lot of belly breathing and moaning, and had us all wondering how long he could work so hard to get his next breath.

I left that afternoon to go pick up our kids to bring them to see papaw. I went to the barn to do some work and forgot my cell phone in the kitchen. #2 went to the house and came running back to the barn carrying my phone. “Daddy, someone’s been calling you. Your phone’s been going crazy!” I saw 12 missed calls, 9 text messages, and 7 voice mails in the last 15 minutes. My wife was frantic, telling me he was about gone, taking his last breaths, and he was asking where I was, that he wanted to see me, “my son,” and his wife. I grabbed the kids and rushed to the hospital in my truck.

I was met by a friend of my wife who’s also a nurse. She met me at the elevator with tears streaming down both cheeks, the corners of her mouth turned downward in a sad frown, and she said, “The end’s almost here. Hurry up and get in there.” I left our kids with her and walked inside. The minister was there as was Bill’s wife, me, my wife, my sister-in-law, and Bill’s brother-in-law. We said a nice prayer, all told him we loved him and that everything would be all right. We were all teary eyed and some crying, knowing the end was in sight. “It’s all right to go. Everything will be fine. Don’t worry about mom, we’ll take care of her. We’ve got everything under control so there’s no need to worry. Rest and relax and go if you want. We love you, we all love you.”

I looked around and said, “I think it’s time we do this before it’s too late.” I walked to the other side of the room to the closet where I’d hidden my smuggled bottle of Johnnie Walker Blue Label and put it on the counter. I pulled out a couple shot glasses I grabbed form home and poured 4 shots out. I gave one a shot glass to Bill, one daughter, his brother-in-law, and one for me. We made a toast to family and love and downed our shot. Damn, that was some smooth stuff; worth every penny. I’m not a scotch drinker but that stuff was wonderful! Dad's response? "Man! That's goooooood" with a wide smile and twinkling eyes.

Now for the good part.

In about 30 – 45 minutes after that shot Bill was talking normally. Even though he was still wearing a non-rebreather he wasn’t gasping for air. His pulse dropped to below 100. His sats climbed in to the mid 90s. He was visibly relaxed and breathing wonderfully. I grabbed the ears off of the RT and he was clear. No wheezes, no congestion / rales / crackles, nothing. We were talking like normal. We began talking about family, old times, work, making jokes and laughing; it was comical. We had gone from doom and gloom to laughing and cracking up. The scene reminded me of the movie “Awakenings” when the patients “come back to life” from their frozen Parkinsonian states. It was a miracle! It was neat as hell. It was something that I couldn’t explain. This 180 degree turnaround could only be attributed to a shot of scotch! For the next 4 hours it was like this. Simply fantastic; unexplainable but fantastic. Wow! Even the minister commented that he “now believed in the power of Johnnie Walker Blue Label.” We all cracked up on that one, even dad.

After about 4 hours things began going south again. I likened it to patients I’ve had before who had a fantastic turnaround for a short time before the end crash. Seen it happen before and I thought this was that too.

Through the night things steadily got worse. During the next day things continued downhill to the point of putting on the high pressure oxygen and adding a PCA pump. He was working hard, harder than before. Coughing came more frequent with blood tinged sputum. He was tired. He said he was and we all knew it. It couldn’t be much longer.

I went home to get our kids again and bring them up. When I got here I was met by my brother-in-law who brought in Bill’s other two grandkids. We all went up to the room and the boo hoos began again. It was a repeat but worse of yesterday afternoon. We all said a big prayer and were hugging, crying, and saying our “goodbyes” all over again. I looked at my brother-in-law who knew the story of the day before’s events and said, “Let’s do another round and call it ‘the Final Shot Round 2.’ “ He smiled and agreed. All of the immediate close family was present. All the grandkids and relatives who were close and tight knit gathered around the bed. I poured 7 shots, enough for every adult present. We said another toast as I asked dad to offer it. He passed that honor to me. “Family” was all I could muster out between sobs and caught breaths. Dad finished it with “love and togetherness always.” We all clinked our shot glasses and plastic cups and downed our Blue Label again.

And it happened again. In about 30 minutes the breathing eased, the sats skyrocketed to 98, 99, 100%, the coughing ceased. The speaking was easy but slightly labored. But the conversation came again. The jokes, the stories, the laughs, anything and everything. Twice in two days. Another day, another brief miracle of a couple hours to spend with this fantastic man just talking and living as normal, even if we were in a hospital room. The kids were eating popsicles courtesy of a floor tech, we sat and talked and joked as the kids played. Dad even removed his NRB so he could talk easier and hear better as we all talked, seemingly at once. It was fantastic. The emotional roller coaster had made another stop in his room yet again.

So now it’s after midnight and he’s lying on his right side, moaning with each breath. The belly breathing has resumed again, the PCA pump still running in its medication. The RT just gave him a nebulizer treatment, shortly before his nurse gave him some haldol to relax him so he could sleep a little. He’s struggling for each breath. I know he’s worn out and tired. He’s worked harder in the last couple months than he has all of his life. This damned disease is sucking the life out of Bill, the man who has to be the best father-in-law a person could ever ask for. A friend, a mentor, a papaw, a gentleman, protector, and just all around fantastic person to everyone he met.

But we all got to see not one but two huge rallies. Unexplainable by any means. I’ve seen it once but never expected twice. I still can’t figure it out and I don’t want to try. I just want to remember these two “awakenings” as they happened. The love, laughter, conversation we all had for those 3 or 4 hour windows was truly fantastic. I still shake my head and smile about it.

We’ll try it again later today if we get the chance. If not I’ve already decided to take the rest of the bottle and do a toast graveside with all of us who witnessed those rallies. It’ll be a fitting tribute to this man, this terrific man, father, and friend to us all. The bottle will go with him, one way or another. It’s his bottle, not mine.

But for now life is again quickly fading away in room 624. I’ll miss you Bill, dad, pal. At least not just me but everyone got to smile and talk with you these last two afternoons like nothing was wrong. It was terrific. It was fantastic. It was a miracle that happened not once but twice. I know the end is near but those extra precious moments we had were just, how to say it and give it justice, were awesome. I’ll always smile when I think about it.

My eyes are welling up as I finish this as he struggles 6 feet from me to breathe. But I’m also smiling knowing what I know, seeing what we all saw, and enjoying those last moments. Take a break. You’ve earned it. You deserve it. Rest and relax. I’ll miss you dad, thank you for everything. I love you.

Love,

Your son-in-law

Death and Dying

2011-04-25T18:33:00.000-07:00

Dealing with death is never easy on either side of the fence. I guess I’m lucky in that I’ve not lost too many close relatives or friends. About a week before Thanksgiving in 2004 I lost my gramma, a woman I miss every single day. She was my pal, my confidant, my mentor, everything. She took care of me and I tried to take care of her in return.

She’s the closest relative I’ve ever lost.

In the business of EMS we deal with death frequently. Mind you, it’s not necessarily every single day or shift but in some settings that may be the case. In our small area we see some but not often. We have some from old age, from overdoses, from car wrecks, from other means. We aren’t a homicide mecca around here but we do have one or two a year.

Some of these deaths come from homes. Others come from a retirement home or community, others an ECF, highways, roadways, or even one of our three local prisons. We get the gamut from everywhere. Some old, some young, some too little to walk or talk.

Each person deals with death and dying in their own way. Each has their release. Each handles the scene or the people in their own way. The first time I did CPR on someone I was 17 and she was in her mid 90s. No problem. The first child I did was in the middle of the school day and she was 13. To this day her mother puts a memorial in the local paper on her birthday so I am reminded of it every year. The first infant death I had was Christmas Day 1991. All three of those times I was asked if I was okay, if I needed to talk to someone, if I was handling things all right. Each time I had no problem. I got upset, I cried on one, I still think about all three as they’re still fresh in my mind even all those years ago.

I’ve dealt with screaming family members, fights by bystanders who were like warring factions, loud noises and distractions from roads, fires, a little bit of everything. Most every time I’ve had to, in some way, deal with the family. Some of those times it’s been “pleasant,” if you will, while other times it’s been a nightmare. More so now than in the past I try to make sure the family is addressed by someone else if not by me. They’re a part of my scene and my patient and they need to be dealt with too. They may need a shoulder to cry on as nobody else is there. They may be too distraught to call anyone. They, like us, deal with death and dying in their own ways that may not mimic the way we do. “Normal” people don’t see death as often as we do nor do they deal with it in the ways we do. They have an attachment to our patients where normally we do not. We may not know them. In a small area like ours we may well know the person or a friend of family of the patient. Usually around here most deaths touch someone on our service in some way, close or distant.

We aren’t nurses who see these patients for an entire 12 hour shift or weeks or months in an ECF and get to know them. We don’t get to know their quirks, their personalities, the way the smiled or looked at someone. We normally don’t know their families and if they were visited or abandoned. We see them for a short time, carry them to the hospital or simply wait for the coroner or local funeral home to come and collect the body.

Some people are in denial. Some people cry hysterically. Some people pass it off as, “it was their time.” Everyone’s different. The one big thing I try to do other than deal with or make sure the family is dealt with is keeping some form of dignity with the patient. If they’re pronounced on the scene we need to let them keep their dignity. I’ve seen scenes before where all the clothes have been ripped off, the crew pronounces them, then leaves the immediate area while others are milling around this now naked dead body. Dignified? Professional? No. If I were a family member and saw that I’d want someone’s head. I’d try to have someone’s job. I wouldn’t treat someone like that and I damn sure don’t want my family treated that way.

I’ve also seen providers lose sight of the picture because they have an attachment to the patient and not provided standard care. Happened? Yep. Understandable? Yep. That’s where the others need to step in and help out, get them aside and let proper care happen.

Probably all SOPs or protocols address DNRs, advanced directives, or living wills. At times the family forgets where they are. They may change their mind at the last minute and want everything done. They may not want anything done yet the patient DID want something done. I’ve seen it all. It’s hard to comfort a patient’s family as we’re pounding on their chests, sticking needles all over the place and pushing all sorts of drugs and putting tubes here, there, and everywhere. We’re working hard in an effort to save people. We don’t always succeed but we give it our best shot.

Medical professionals deal with death. But when it’s us who’s on the other side it’s the same as above. We now become those who may be hysterical, crying, upset, screaming and hollering, lose sight of what’s best for the patient, anything at all. When it’s our loved one everything we know and have been taught kinda goes out the window as it’s now our crisis, our family member, our loss; not someone else’s that we need to console their family. We want someone to console us, to give us a shoulder to cry on, a door to punch, something to help ease the loss of our close family member right in front of our faces.

Remember that we see one side of death and dying. We’re not usually on the other side. If you ever are, God forbid, and experience that loss please remember how you were treated, what you felt, the profound sense of loss and emptiness you feel or felt. The next time you have a patient that dies on you or you are called to work on and you’re around their friends or family, remember those things. Remember what you craved and needed during your event. Remember those things and try to make them feel better, more comfortable; be empathetic. Keep the patient’s dignity intact and help the family all you can. It may be staying on scene to talk to the family, making calls for them, waiting until someone else shows up.

It could be you in that scene. How would you want to be treated? Death and dying is never easy, for anyone. Keep those things in mind and let your best judgment and conscience be your guide.

Change,.. for the better?

2011-04-07T11:47:00.000-07:00

Think back when you first got in to EMS. What type of equipment did you have? What was the quality? Were they things you thought would be around forever? Were they techniques that were the "latest and greatest" only to be superseded in 5 years? What about personalities, traits, and qualities of our people? How about our patients?

Used to use a Datascope and LP5. Now we're up to a LP12 or LP15. 12 leads in the field, capnography, pulse oximetry, all that from one monitor. Used to be everything separate and HUGE.

Two man cots were the norm. What a pain! The amount of back injuries had to have been astounding during those days. Saw one a couple weeks ago and thought of how long ago it was when I used one. Then the one man cots came out with the Teflon runners. Still a pain to put in a bus. Now we have electric cots. Nicer to maneuver around but the added weight may be a concern for some. I think ours is about 27 lbs heavier than our old ones.

The old gumball lights on a truck's exterior used to be "it." Now a vehicle can be "Griswolded" up with LEDs. Man, what a difference! Sirens also have made neat changes. The old "Q" to the Rumbler, which I think is neat. I do like how a lot of departments have a Q on their vehicles in keeping with tradition or just because it's always been a reliable warning device.

AEDs have progressed mightily. They've been out since 1979. We got our first one in 1989 for $12,500 and it was the size of a large carry-on luggage bag. Had a nice screen to see the rhythm and it was damn heavy. Now ours are about the size of a big laptop and cost around $1400. The new ones can be "automatic" and do seemingly everything for you. Long battery shelf life, lighter, smaller, cheaper.

@IRLMedic mentioned BSI. Holy cow! Didn't it used to be a sign of a busy or "good" shift because of the amount of blood you had on your uniform? It was for me! Never brought another uniform to work if one got dirty. Nah, it just showed the other crews how busy I had been. Gloves? Safety glasses? CO detectors and monitors? I gripe at new EMTs and our rookies if I see them without gloves on, regardless of who the patient is. I'm not the best example but I also do a good job of keeping clean and not getting anything on me.

We are lucky enough to have received a grant for a Glidescope. It's a terrific tool that, in my eyes, is making intubation a lost art form. I love the fact that it helps keep our faces away from a patient's face in case of unexpected showers of vomit and other nasties and that it gives us a great color picture of what we're after. Expensive, yes. In a couple years the cost will probably be cut in half.

Our CPR changes have been rolled out this year. Seems like every couple years there's a change or two in store for us. This year they remove drugs and have even less emphasis on respirations. Used to be hyperventilation was good and airways were paramount. We could push drugs through an ET! Now if we can't get them tubed and no peripheral line we just put in an IO. With BIGs and EZ IOs IV problems are seemingly a thing of the past. IOs didn't used to be thought of in adults, just kids. Now they're becoming more and more standard first attempt on certain situations for time's sake.

We used to treat HTN in the field. We used to give a lot of bicarb, calcium and mag. Some of the other meds I used to carry were Brethine, Lanoxin, Mannitol, Decadron, nitro paste, among others. I think I'd be hard pressed to find those on a bus now with short transport times, if at all. MAST pants were the norm; Sager splints and build-a-boards; steel O2 cylinders. Just a year or so ago I got rid of an old bicycle pump suction unit I had in my supply closet. I remember when V-Vacs first came out and they were lauded because of the way they could suck up a can of Chunky soup in no time flat. Remember the old blue laptop case looking suction units that never seemed to have enough power to suck anything?

So, what's next? What else can be improved on? I'm trying to think of different ways things will be improved in the next year, 5, or 10 years. I'm amazed as I look back and see all the technological changes I've witnessed, how treatment modalities have changed, and how everything in EMS continues to evolve in to a new form of medicine, rife with technology and knowledge, fueled by exuberance, dedication, and longevity.

EMS will always be around and we will continue to change with it as it changes. How will you accept the changes we make?

Anonymous BS

2011-03-31T07:51:00.000-07:00

Thought for a while what to title this and couldn't think of a good one. So the "Anonymous BS" stuck out as keeping some anonymity along with the amount of BS involved.

We as pre-hospital professionals are just that; professionals. It's not to say that everyone is on the same level or on par with everyone else. Different places teach different things, instructors vary, personalities differ, and skill levels are obviously different. But we all know the basics.

What about issues when dealing with staff at sending or receiving facilities? Everyone has their favorite, so to speak, on both sides of the coin. It's nice for me to walk in to an ER and know the tech or nurse I'm talking to. If the doc's handy and not busy and I know him or her I'll go shoot the bull for a couple minutes. And I'm sure it's just as nice for the staff to know the crew bringing in or taking away patients; they know the person performing the care, maybe their skill sets, how long they've been around, are truly compassionate, those sort of things.

What drives me nuts is not being listened to when I take a patient somewhere. I spit out information on the radio or phone before I get there, and again when I get there and most of what I say isn't taken down or in. Granted, it doesn't happen often but it does happen. We are a vital link in transferring and providing care to those patients. We see them in uncontrolled environments, see their first actions or reactions to treatments, and try to improve the situation and report on how things have progressed or digressed.

Another issue is the lack of proper care some people receive prior to our arrival. Several times I've shown up on accident scenes and am met by someone who identifies themself as a nurse. Okay,... are you an ER nurse? Do you know anything about pre-hospital or trauma? Several times these same people are the ones who have removed patients from cars or trucks and had them walk around the vehicle and then lay down when they should have stayed where they were in the car; they were in NO danger and should not have been moved. Do they know about holding c-spine? Did they do a primary assessment? Mind you, I'm not slamming the nursing profession but not many nurses know a lot about pre-hospital or have been through a PHTLS, ACLS, or PALS / NPR course unless it's required for their job.

What about trips to ECFs? Ever shown up to find a patient with a nasal cannula at 10 lpm? What about a non-rebreather at 4 lpm? How about CPR being done on a bed without a short board and watching those bed springs get one hell of a workout. Ever seen that? Seizure patients being held down with beds, chairs, carts right next ot them. Another one I've seen is giving cola or orange juice to an IDDM who's now hypoglycemic and completely unresponsive. The word "aspiration" comes to mind pretty quickly.

I've been to a lot of ECFs around the country and it's just like any medical facility; there's the good staff, and there's the bad staff. Same goes for pre-hospital; we have good EMTs and Paramedics and we have our bad lot as well.

One thing I've always tried to do is educate people I see who are doing something wrong, regardless where they're at. If I see a cannula on too high a setting I'll say something. If I hear of a wrong medication given to someone I'll say something or question it. I have the right to question anything I feel is incorrect because my concern is for the patient, not for the staff taking care of the patient. The same thing applies to the staff questioning what we do. We know things they don't and they know things we don't. Some of these patients have drug stores on speed dial because their med list is a mile long. Do I know every one? Nope. Hopefully the staff does and they can tell me when, how much, actions / reactions, whatever's pertinent.

They give report to me just like I give report back to them on return or to another when I drop someone off somewhere else. It has to be communicated thoroughly and completely.

We all have to deal with the BS on every side, from receiving to transferring, emergent to transfer. It's how we deal with that BS that makes a difference in how we handle the situation and continue to treat our patients the best we possibly can.

All Shifts Are Not Created Equal

2011-02-08T10:00:00.000-08:00

Strengths and weaknesses; we all have them and we all know everyone else does too. Some people flaunt theirs and other do what they can to hide them. Some are out in the open for all to see while others are deep-seeded and difficult to find. There are still others who hold on with the faintest of hopes that they’ll eek by and never get caught with their pants down and those who think they are God’s gift to mankind.

Look at our field, EMS. Do we have those people, I mean both extremes? Do you know any? Do you work with any? I’ll bet that everyone says that they do to both counts.

So the next batch of questions come in; what have you done about it? Have you said anything to a superior? To that person? Have you tried to eliminate the problem or help it? Are you trying to be proactive in your approach with the patients' interests at heart or are your hands tied?

I went through EMT class when I was 17 and a senior in high school. I passed my written and practicals before I turned 18. It took me about a year before I felt truly comfortable with my knowledge and skill base. At that time I felt that I could handle anything thrown in front of me. I loved being an EMT. I was aggressive. I wanted calls that would challenge my skills. Seems normal, right? I got in to Paramedic school when I was 19 and finished when I was shy of my 21st birthday. It too took me about a year or so to feel truly comfortable with my skills as a Paramedic.

It wasn’t long after I got out of Paramedic school that I began to realize I wanted to see things done “my way.” It was the correct way, or so I thought, and that everyone else should be doing it that way. On one hand I like helping and teaching others how to do things, imparting my knowledge to them (hadn’t gotten all the experience just yet). I liked teaching others. I liked precepting EMT and Paramedic students. Here I was only 21 and already doing that. I wanted to do my part in helping others succeed at good patient care. Then as the years crept by I got more in to educating and making sure that others did things the right way; not necessarily “my” way, but the proper way.

Everywhere I’ll go I always run across some who seemingly have no clue. Their hearts are in the right place and they like being a part of something like EMS but if put out on their own in a busy, not necessarily messy, cardiac arrest or multi-systems trauma that they soon would be overtaxed. These are the people who would either freeze on the spot or would be so focused on one thing that they overlook the obvious which could be detrimental to the patient’s outcome.

Have I been there? Yep. So have a lot of people and they should have no problem admitting it. I haven’t seen everything but I’ve seen and done a lot. I have learned to slow down and take a look at the overall picture of a scene, regardless what it is, prior to moving forward. For example, on car wrecks I’ll always look at the outside of the vehicle first so I know what kind of damage has been done before I look inside at the patient and the interior compartment. I know there’s always urgency but not to the point of overlooking things.

So, what do we do about these “weaker” people? Do we discard them? Do we put them on shift with someone who will carry them? Do we keep them as warm bodies in cold seats? Do we educate them in hopes of rehabilitating them in to productive members of our EMS crews?

Usually these “weak" people are easily identified. They usually hang back and are the followers, not the leaders. They do not direct. They seem pensive. They may be terrific “hands” on a scene but if placed by themselves they will not function adequately or at a substandard rate. Mind you, I understand that not everyone is suited to be a "leader" and that's perfectly fine. But often the people who need the help, need the experience, get pushed aside by the leaders of the pack, the more aggressive ones who want to make sure things get done. There are times when that's needed but others when things can be slowed down to allow them to be a part of the call, do some skills, have a hand in direct patient care, and be let to feel more comfortable with their surroundings and skills as we the leaders watch from an arm's length and are there to jump in at any given moment if things go south.

How do we handle them? How can we? More times than not they’re placed with partners or shifts that can absorb their skills in to their own and they become that needed set of hands to do work, not necessarily the thinkers on the call. The “weaker” ones are placed with the “stronger” ones to balance out in hopes that they may, by course of osmosis, absorb the necessary skills and knowledge to be productive, to function normally like most others do, to properly and adequately care for the patient and protect themselves and the crew at the same time. Big tasks to be asked of all, all at once, and handled by a group that routinely do each and every day without a bat of an eye.

I’ve found that bringing inadequacies to some people offends them. It makes them feel inferior like saying, “you suck at being an EMT,” when they probably humped it to get through class. Do it tactfully. Offer suggestions. More and more I’m critiquing runs after the fact with the crews not only because I have to do internal a & r but because it helps everyone in a smaller group discuss what they saw, what they did, what part they took in the call, and ask / answer questions. If a single person has a problem or I saw something that wasn’t right I’ll ask that person on the side what they saw, what they did, what they thought of the run, and then offer constructive criticism.

Find out what their weaknesses are, if possible. Is it knowledge? Is it skills? It might be something as simple as letting them "get their hands dirty" on a call. They may not feel comfortable doing some skills or handling a particular piece of equipment. It might be that a certain type of call intimidates them or scares them.

I’m not the smartest Paramedic out there as I learn things all the time, even after 23+ years in EMS. I still miss subtle signs. I too focus in on one thing and miss the obvious. It’s happened to all of us at one time or another.

If you see someone who has problems or questions things, help them out. Don’t let their questions go unanswered. The longer they linger the longer they may go and not properly treat a patient because they’re afraid of doing the wrong thing. In the end they’ll leave EMS because they feel inadequate and that they don’t know how to help people. Answer questions. Ask questions. Practice with these people, with crews; do training the right way and don’t make a pencil exercise out of it. Talking about things and actually putting your hands on are two completely different things. They’re not the same. Hopefully with help, education, perseverance, and determination by both sides these “weak” people will become the stronger ones and help the next batch of “weak” people.

Listen, learn, educate, and help. Such a vicious cycle but we’ve all been there before.

Pre-Hospital Christmas

2010-12-23T09:34:00.000-08:00

I've been in this business for about 24 years, give or take. It's been a full time job, it's been a part time job, it's been a volunteer job. It's taken me around the world to some fantastic places and allowed me to meet some wonderful people everywhere, a lot of whom I'm still friends with and converse with on a regular basis. One thing has always stayed constant, no matter where I've been or what I've been doing; the holidays.

Oft times I was the "low man" for seniority and had to work the holidays. I was young, not married with no kids, and it didn't bother me all that much. I love being home for Christmas but not being there sometimes is part of life for whatever reason. So I usually accepted it but tried to make amends somehow. The holidays have always been fun for me by spending time with family and friends, catching up, playing cards, and eating an obscene amount of food.

As I look back on the past couple decades I can see my holiday season somehow always intertwined with EMS, the FD, or work, and the memories are about Christmas. I know that there will be many more to come and lots more memories that will flood in ten years from now but I remember these very well.

Let's see; I was late picking up my date to a Christmas dance one year because I was on an ambulance run. I didn't have to go but I was in town, felt the need to help out and hoped like hell my date would forgive me. It didn't go over too well but we had a fun night.

Christmas Day all over the world and pulling them all together is interesting. I've volunteered on Christmas Day many times and usually it's very quiet around our hometown. I can't really remember a lot going on until later on in the afternoons when most of the presents have been opened and the lunches had already been served. Yeah, we've had the occasional choking because gramma stuffed her mouth a little too full with turkey and stuffing or grandpa slipped and fell outside trying to help little Joe ride his new big wheel that Santa brought. FYI, big wheels don't have a lot of traction on ice; neither do patent leather shoes, grandpa!

I've spent many a Christmas Day overseas or offshore. I had a couple terrific Christmas Day dinners in the Persian Gulf with "family" and friends. I remember the best present I got one year happened to be a case of beer. I thought it was a little odd but it served as a terrific present from my "Gulf Mom."

I remember moving a rig in Nigeria on Christmas Eve. I was sitting in the wheelhouse eating peanut M & Ms, drinking a Coke, and tracking Santa on NORAD's website and announcing over the rig's PA system where Santa was located. At midnight someone else beat me to saying, "Merry Christmas" on the PA. I was bummed someone else beat me to it. After all the hard work I put in to finding out where Santa was and that had to happen. Man,...

The first Christmas I spent in Louisiana was fun. I was told by a partner earlier in the year that I'd be in shorts and a t-shirt on Christmas Day. Being from the Midwest I laughed. Lunacy is what I thought about that. No way, impossible, couldn't happen. On Christmas Day I happened to be working and was taken over to my partner's house in Amite. We had a terrific morning, lunch, and afternoon at Jeff's house. I was taken in by his family and treated as one of their own. They even had a small present for me, which I was totally surprised by. He was one of my favorite partners to work with since that day and I always tried to work with him when I could just because he was such a terrific, down-to-Earth kinda guy. And, I had on shorts that day.

Usually the offshore bunch gets treated very well. Mind you, we're at work away from family but we're with our second family. It, like any other normally celebrated holiday, is just another normal workday for us. I've fried turkeys offshore on holidays. I've grilled red snapper (yummm) for Christmas dinner. The good thing is, most of the drilling and production companies spare little expense when it comes to the holiday meals. Filet, shrimp, lobster, whatever. The catering staff always managed to decorate the galley and office areas with tinsel and light and other hanging things. In the Gulf of Mexico I used to take strands of lights and line the boom of our 120' bow crane to make it in to a huge Christmas tree.

I surprised my mom one year when nobody expected me to come home for Christmas because of work. I took a couple days off work, drove all night to get home, and walked in gramma's back door and right up to mom and surprised the hell out of her. One of the few times I'd ever seen her cry because she was happy. That was a good day and I'm smiling just thinking about it.

Probably one of the hardest EMS runs I've ever dealt with happened many years ago on Christmas Day and I think about it each and every year; about the run, the little girl, the people I worked with, how we worked our asses off that day, and that little girl's family. I cried that day and it still chokes me up just thinking about all the details I can so vividly remember about what happened. Wow, what a day! It went from one extreme to the other. We all went from doom and gloom to cheering and happy in that hospital ER.

And now I get to spend my Christmas Days at home with my family. My wife of ten plus years, our three kids, one dog, gazillion cats, and whoever else decides to show up. Our son "knows" about Santa and the two girls know he's the guy that brings all the presents. What's really neat is one of the gentlemen who "plays" Santa locally is good pals with my in-laws. So they see him a couple times a year and he always remembers them. Santa knows what's going on, trust me. They believe it and in him.

Seeing their faces light up when they see the cookies have been eaten, the milk's almost gone, the crumbs on the fireplace hearth, and ALL those presents under the tree makes it worthwhile. Santa is their pal. He brings them all the goodies and toys they've wanted all year long. They're so happy and carefree that morning, or at least until they see a toy the other child has that they wanted and didn't get. Then all hell breaks loose and it's every person for themselves.

This Christmas season has been full of surprises and one I'll remember for a long time, if not always. It's been full of trials and tribulations, of hard work and taking time off, dealing with illnesses and families who are having difficulties, a bad economy and a lot of people needing a little assistance just to get through the holidays. It's had one hell of a surprise with Chris and Kari, and a wedding or two to boot. What's similar here to all of these is that in some way, shape, fashion or form, they all (for me) somehow tie back to EMS and the people we're involved with.

Christmas isn't about toys and presents. It's about giving, sharing, remembering, loving and caring, taking care of each other and watching out for everyone else. It's about Christ and His miracles which we've seen already this year firsthand. Put all those things together, dash in a little EMS and who we are and what we do. Now you have one mixed up bag of stuff that most normal people wouldn't be able to make heads or tales of. But we know. We understand. We, the First Responders, EMTs, Paramedics, Firefighters, deal with it day in and day out. We are a huge family that remembers all of the little things, what it used to be like then and what it's like now yet we persevere and continue doing it each and every day because we love our jobs. We love helping other people. We love being a part of such a huge family.

Merry Christmas to all and a safe and healthy New Year.

A Christmas Miracle In The Works

2010-12-03T07:38:00.000-08:00

"wow, just WOW. i'll be smiling all day, all week,...:)"

That's what I put as a facebook status earlier this morning. Just one of those life events that happens to people that I hear about and it makes me smile; gives me hope and cause to know that there is still a lot of good that happens to people. I've had a lot of good happen to me but this one isn't about me or my family. It's about two other very good friends of ours who have been blessed not once, but twice in the last year or so. Sit a minute, read further, and I'll explain without a lot of detail. By the end you'll see why I'm smiling, why everyone who knows the story is smiling.

On August 21, 1976 Kari Anne Hoppes was born. Little did anyone know that this little girl, less than 5 months later, would be going through chemotherapy, radiation treatments, and ultimately a nephrectomy (kidney removal) for a cancerous tumor found on one of her kidneys. Of course nobody wants to hear of things like that happening to anyone, let alone a child, a baby, someone who is defenseless and brand new to the world. I guess thankfully she didn't understand what was happening to her frail little body and hopefully wouldn't remember the pain and trials she went through.

As life went on she grew up normally, minus one kidney. She graduated high school, became an EMT, went to college and graduated as a nurse who currently works in an emergency room helping others. She's been devoted to a life of serving, caring, and helping those who are sick and injured.

Somewhere in the middle she met her future husband, Chris. They dated for a while and then broke up. Eventually they got back together again and finally got married on March 10, 2001. Next year they'll celebrate their 10th wedding anniversary. Chris is a firefighter, paramedic, and flight medic who is always on the go, working wherever he's needed, whenever he's called, but knows that family always comes first.

After they got married their house was a little empty so they got a couple "children." Duke and Hunter were their babies, BIG babies. A Mastiff and chocolate Labrador make for some large babies to handle but they were babied and pampered like no other. They were terrific companions and guardians to their "parents" and to the house.

After trying to conceive a child without success Chris and Kari decided to try and adopt a child, something they both very badly wanted in their lives; a namesake to call their own.

A phone call came unexpectedly one afternoon in late 2009 asking if they were still interested in adopting a little newborn boy. Without hesitation they both instantly said, "YES!" Later that evening they were at the hospital to pick up and bring home their, "gift from Heaven," as Chris calls him. Joshua now graces their house with pattering hands and feet, coos and cries of a normal one year old child, and keeps his parents smiling from ear to ear as they've become ever the doting parents. He IS their pride and joy.

Now over the last couple months Kari's health has deteriorated as her lone kidney continues to decline in function to the point of failure. Lots of doctors visits have happened to discuss treatments, outcomes, and prognoses and what could be done to help stave this off or to fix the problem. She's had a couple recent surgeries which is one of the short term options to help. During this time she's been off work, reduced in her abilities to function normally, even to the point of no driving or lifting up Joshua to carry him around.

Kari has been placed on a transplant list for a kidney. Here a lifelong care provider now needs help to continue to live normally. It's almost to the point of not being fair: here she has helped others for many years yet this has to happen to her while she's still young. She was dealt a bum hand, overcame the initial odds and has survived while still helping others. Why her? Why now? With all the good that has just recently come in to their lives, why this?

Chris told me a couple weeks ago that he was going to get tested to see if by some miracle that he could be a compatible donor for Kari. The odds of that are very slim but he wanted to check anyway. I don't think it was a huge secret but it wasn't one he made too public. A lot of people knew what was happening with Kari and like a normal loving husband he wanted to see if he could help out in any way. He told me that if he was compatible that this, "would be the greatest Christmas present I could ever give her."

They were at dinner last night at a local restaurant, full of other patrons eating their dinner, and with Kari's mom. Chris' cell phone rang during dinner. It was the doctor's office. They'd called to give him the results of their compatibility testing. He told me that he said, "You want to give me the results now???" But they gave him the unexpected results and all he could do was think of how he could tell Kari what had happened, what he'd done, and what the results were.

He was a match.

He leaned over and told her everything. After he got done she screamed with joy and excitement. Chris told me that everyone in the packed restaurant looked their way as the three of them hugged and cried with this wonderful news. It's December, the time of giving, the time of joy and blessings, and the time for God's miracles to be celebrated. This, is most definitely one of them.

The work's not over yet but the hardest task of determining compatibility is. A husband is compatible to his wife and will give part of himself to let her continue her young life healthy and happy, to be able to do things normally, and get back to some sense of normalcy.

As a friend to both I couldn't be happier for them. I couldn't be prouder of Chris for what he's done and will do. I couldn't be smiling more for their family for what they've been through and the blessings they've received in the last year. God works wonders and this is no exception.

Smiling. That's all I've done all day today when I've thought about them and all they've gone through, all they've shared with me, all the headaches and heartaches they've had, and knowing that hopefully, God willing, all will soon be over. This is turning out to be one of the best love stories I've ever known.

"wow, just WOW. i'll be smiling all day, all week,... :)"

Head Honcho

2010-11-22T10:21:00.000-08:00

Recently I filled out a survey at work (non-EMS) where one of the questions was if I was satisfied (or not) about the possibilities of advancement. That same question pops up year after year. I worked in other places at EMS jobs or EMS related jobs and the same question popped up those places as well. Do I think my chances are good to advance? Could I advance my career?

And then I started asking questions of my own.

Do I want to advance? What benefit could I give my company by advancing? What's the job scope? How much more responsibility will I have to take on? What are the headaches and pitfalls? Do I have the qualifications? Will I gain or lose respect from colleagues by taking this advancement? What would I hope to achieve? What kind of goals would I need to set for myself or the company? And as always, what's in it for me?

The old adage of "not being able to please everyone all of the time" is SO true. There's seemingly more people to deal with in EMS and the fire service because of our schedules than a normal 9 - 5 job. We have a lot of people because of different shifts. We deal with the public, with our staff, with vendors, and with healthcare facilities. Some even deal with government entities. Some services are paid, some are volunteer. The problems are similar on both sides of the playing field.

Saw someone ask today on Twitter about why he wanted to get back in to management. I replied, "because I got sick of the inadequacies, the inefficiency, the bull%&, and KNOW I can change all of that." Just my thoughts that have been seconded by lots of others all over the world.

Probably one of the biggest problems I faced was respect when I was named the head cheese. Respect doesn't come easily. It has to be earned from peers, colleagues, superiors, and subordinates. If it's not there, the road could be long, uphill, and potentially very, very rocky. It matters not how long you're been in the job, how much experience you have, or how many hours you pull each week. It's about respect. I have 23 years in EMS and by no stretch do I hold the seniority belt at our service. I've gotten to see and do a lot all over the world but I pale next to others.

We are lucky, luckier than most, in that we have a huge array of experiences, experience, and knowledge from which to pull from. The amount of sheer knowledge and experience I have to lean on is tremendous. I try to use whatever I can to help make the best decision I can in the best interest of who we are while trying to fulfill our service's needs. I poll some for advice and others for experience. I get a lot of unsolicited advice and suggestions that are always taken in to account. Some I tear apart on the spot and play devil's advocate, others have a lot of validity and they're used when the situation merits.

When I began my reign I wanted to change the world. I was met with a lot of resistance for a variety of reasons. One probably was that I failed to talk to others first. I wanted things one way without consulting those who were doing the work. While my intentions were what's best for the service I lost sight of the need to accommodate for those who did the work, including myself. Just because I do things one way doesn't mean everyone does, nor do I do things for the same reasons as others. Everyone's situation is different.

Being in charge IS a lot more headaches. It IS a lot more responsibility. But if nothing else, I too have learned from my mistakes. I've learned by watching others make mistakes so that I know which avenues to take and which pitfalls to avoid. I don't have all the answers but I do know that EMS is a fickle animal and it takes a lot to keep things running smoothly. There are the daily rigors that must be dealt with but they can be managed. It's the super duper debacles that come across every once in a while that make the job very challenging. Our service runs itself. I honestly view myself as just another cog in the wheel. I don't need to micro manage everything and never have had to. Maybe I'm lucky in that respect where others aren't.

I'm sure that there are people who want to be in my shoes making the decisions, doing the same tasks, dealing with issues and problems with their version of justice and punishment. Not all view things the way I do and I accept that. But for now I'm here making those choices,... with assistance. I've learned to ask, not something I used to willingly do. If I need help I get it. If I can handle it myself, I do. Sometimes it's just easier that way. When my desire to see our service continue to succeed wanes, I'll gladly step aside. I understand that some of my decisions and choices could greatly impact the public we service and who depend on us 24/7/365.

I love my job. I love EMS. I love the challenges it serves up. I don't like the problems and headaches but I signed up for it and know that they too must be dealt with. I do what I do in hopes of keeping our great service alive. People long before me got our service running and it's my goal to keep it that way while trying to improve things as I can. I take questions, listen to suggestions, welcome feedback from everyone. If I didn't love what I do, I wouldn't be doing it today, 23 years later.

Being A Paramedic

2010-11-05T05:47:00.000-07:00

What does it all mean? What is the meaning of life? What do we do, or can we do, to help keep it?

Eh, just questions bound for nothing.

I was thinking the other day about EMS and what part in it I play. Why did I begin? What role do I play? Have I accomplished my goals in the pre-hospital world? Have I achieved what I wanted to? What is it that keeps me here and has for so long?

We're fortunate in our community to have a high school explorer program. We take a select group of high school seniors and train them to be first responders and stick them on a crew. They carry pagers during their school day and if we get a call they simply get up out of their class, head to the station and go on the run. When they're done they go back to class. It's their responsibility to catch up on work they missed. We've had this program for over 25 years and it's amazing how much it's done for people.

Our high school program has allowed us to show high school students part of the medical profession. Lots of our kids have gone on to be EMTs, Paramedics, nurses, RRTs, Rad Techs, you name it. We have a whole host of professions that have arisen out of our program. I'm no different in that I started in 1988 as a high school rookie. Now I'm the ALS Director and thrilled to be able to continue to give back to my community.

But I look at my 20 + years of EMS and ask these questions. Next year I'll be starting my 20th year as a Paramedic. Holy shit, has it been that long? I can remember giving narcotics to people even before I could legally drink alcohol. I always thought that was pretty ironic.

Part of the reason I've hung around for so long is the service, our service. Who we are, what we are, what we've accomplished, are just some of the things that make our service and EMS great. We, like most other volunteer services, take great pride in those things. I'm proud to be a member. I'm proud to see what we've become. I'm proud to see all the changes we've been through and how we've persevered. I love being a part of something like that.

I see the EMS profession as it is and all the changes it's been through just since I've been in it. It's amazing how technology has changed, thoughts have changed, patient care has changed just in that short time period. yet through everything our industry has evolved drastically to embrace most everything in the mindset of "whatever's best for the patient we'll do."

For example, intubation was one of those "cool" tasks we'd get to do once in a while. Now with the advent of Glidescopes and other visual tools, intubation is now becoming a lost art form. Remember the old Datascopes and LP5s? Now we have the LP12s and LP15s that allow a lot of the guesswork to be taken out of patient care and treatment. We can see what's going on in 3D fashion and treat better than ever. Hell, just take the mass push and introduction of AEDs and how they've increased the survival rates of sudden cardiac death.

Probably one of the things I'll never be able to answer is the question if I've achieved my goals or accomplished what I wanted to get out of EMS. I'll say that those are ever-evolving and constantly changing answers. They're being added to daily or shift-by-shift. My goal is to provide the best possible patient care to each and every one of my patients. I want them to feel safe, comfortable, and to have trust in me that I'm doing everything in my power to help them.

I want to empower others. I want to pass on my knowledge and wisdom to those just getting a start. Hopefully they'll learn from my mistakes so they don't have to do things the hard way. Understand why I do what I do in the best interests of the patient, the crew, the service, and themselves.

I've accomplished my goals of helping others and seeing them live longer and healthier lives. But on the days that my patients don't get better I have to readjust that goal, critique what I did, and improve upon those problems to make sure they don't happen again. If not, I try to find out what else I could have done to make things better. My knowledge base is limited as I've not gone to medical school. I learn something every shift. Therein lies another part to that of needing to continue my education. The smarter I am in patient care, the more tools I have to help my patients get better and get back to some sense of normalcy.

I hope that in the next 25 years people will come up and take my place, become the educators and administrators of the EMS world and continue to evolve in to what the public wants and needs. I'm curious just what types of new technology will be available then and how much more efficient we will be with those new tools and skill sets.

Keep saving lives, keep working hard, and provide the best possible care we can as providers. Improve ourselves so that these kids will grow up healthier and safer than we have.

Taking Care of our Kids

2010-10-21T06:09:00.000-07:00

Bothered? Yes, I am. I'm trying not to use certain words to describe some vile people in the world today. I'm also trying to figure out, as I type, how to put this so others will understand the anguish I feel.

Kids, children, rug rats, pediatrics, infants, neonates, preemies, whatever you want to call them, they're the part of our population that happens to be one of the most defenseless bunch. They rely on us, the adults, to take care of them, to defend them, to protect them and keep them safe from harm. WE are their security blanket.

Seemingly every day I see in the local news how some poor child has been injured as a result of domestic abuse. They've been smacked, burned, smacked, or whatever. I opened the website of one of the local TV stations today and saw where one child had actually been "stomped" on. Another had been burned. Yet a third had broken arms and brain damage. Seeing these types of stories hurts. I guess one would think that certain areas of the world may be immune to these types of problems yet they aren't. They're everywhere. Abuse is everywhere.

Every time I go through a PALS or NALS class I always think about using some of these skills and knowledge on one of my kids. Would I? Could I? How could I block out the fact that I'm working on my own child? How will I react? Will I freeze up and keep mumbling over and over that this is my child? God forbid it ever happen but to others, it has. It does happen. People every day see their children or ones that they know hurt, injured, or even killed at the hands of others or some other medical problem.

My first true pediatric emergency happened on Christmas morning shortly before I was to finish Paramedic class. I was low man so I got stuck with working the holiday. Obviously not where I wanted to be as I've always been a family person and spending those times with them meant a lot to me.

I remember it was a gorgeous Christmas morning. I walked in the ER with my partner to see the entire ER was decorated with lights, tinsel hanging from the desk and counter areas, not a single patient was in any of the rooms, and the back counter facing the patient rooms was filled with tray after tray of holiday goodies brought in by the ER staff who, like me, got stuck working that day. A couple of the nurses had on Christmas - themed scrubs and tops on. Someone had a radio on in one of the back rooms playing Christmas carols and we had picked up and decorated a small 3' tree in the corner of the ER by the ambulance entrance. Hell, if we had to be there on this gorgeous holiday morning we were going to do our best to make it bearable. We were having fun all sitting down behind the counter telling stories, catching up, talking about family and what we were going to do when we left there that afternoon, and how quickly we could come back in the next day and show off our new presents.

0904 A local volunteer ambulance service about 10 miles south gets dispatched on an unresponsive infant. As was our area's SOP we were dispatched shortly after as the nearest ALS unit. My partner and I hopped in our truck to head south. Pediatric runs are never fun, regardless of the call. They induce a lot more stress since thankfully we don't deal with a lot of them. But the possibility is always there, every day, every night, all the time.

0906 We mark enroute just ahead of the BLS unit from the southern department. We're told by dispatch the infant is not breathing and CPR is in progress. Both our hearts sank. We looked at each other with a quick glance that said, "Shit. This is Christmas. This isn't supposed to happen on Christmas Day!" I got out of the passenger seat and went to the back of the truck to get things ready for my partner.

0913 We met up with the BLS truck heading north towards the hospital. We both pile out of the truck to see what was going on. One of their crew members met us halfway with a lifeless baby girl, not yet 6 months old, in his arms, coming to meet us. We had a big modular bus so we simply went in our truck; more room, easier to move around. We sat on scene for a couple minutes as two of the volunteers got in, continued CPR and were bagging this little girl. I intubated the little girl without problem and secured the tube as best I could. My partner started an IV and got on the radio to alert the ER what we were bringing in as well as telling them to get our doc ready. We got so busy doing that that we actually asked one of the volunteers to drive our truck back to the hospital with us as passengers. This was one of those "extenuating circumstances."

We arrived in the ER bay with CPR being done. No breathing, no pulse, nothing. We'd done all we could do and now it was time for the ER staff to put down their cookies that we were all enjoying less than 30 minutes earlier and work their asses off. We remained out of service as we stayed in the trauma room to help out; whatever needed to be done, we did it. We started another IV. I did compressions for another 30 minutes while an RRT ventilated. The doc barked out some orders to one of the barrage of nurses in the room. Somewhere in the middle of it we were told to stop. "Let's do a pulse check." The monitor showed something that resembled a faint sinus tach. We'd been working on her for about an hour.

Holy shit there was a pulse! A faint brachial pulse was felt. Someone else felt the other side to make sure I wasn't nuts. They too felt it. Instantly a huge smile crossed my down turned face. I heard a couple whoops and hollers in the background and in the hallway outside the trauma room. We all knew this little girl had a long way to go but we'd done our part in helping her. This was our Christmas miracle.

Everyone went around patting each other on the back, hugs were exchanged, and "good job, well done" seemed to be the phrases said to everyone by everyone else. A true team effort by all of us; all of us, who none of us wanted to be there that morning, THIS morning, Christmas morning, at work. We wanted to be at home enjoying the holiday with our families.

About an hour later we flew that little girl down to a children's hospital for definitive care. As the helicopter took off from the pad outside the ambulance bay I stood there watching, wondering, hoping that things would get better. I played the scene over and over wondering what I could have done differently. What could I have done better? Was there anything we forgot? Anything we did wrong? All I cared about was that was did our part. We helped out. We gave this little girl a fighting chance to live on this morning of December 25th. As they rose up in the air I cried. I was spent. Here I was 20 years old and emotionally worn out. I'd gone from one extreme to the other that morning; it wasn't even noon yet and all this had happened.

That was the first and last patient I've ever cried over.

She wasn't the victim of abuse or violence like the ones in today's news. But I think of her every time I see stories like these in the papers. How can people treat kids, let alone their own, with such hatred and malice? Thy can't talk back. They can't defend themselves. They can't protect themselves. They NEED us to do it for them. We are their shields. I often ask myself if there was this much abuse when I was younger. Have families changed that much over the years? Have attitudes changed? Have personalities evolved so much to bring out this much violence towards children? It sickens me. It hurts. It makes me want to find these people and beat the shit out of them. How can they do what they do? How can they hurt a child?

Children are our future. They are what we raise them to be. They emulate us as adults, mentors, and parents. We are to be here for them. We educate them, protect them, and love them. The three pictures here are of my three kids. I adore each of them and will lay my life on the line for each of them. They are what I live for each and every day. The hugs, the kisses, the "daddy, I missed you today" words, and the "I love you" that I get several times each day from all three of them.

Love your children or those close to you. Protect them. Be there for them. Educate and mentor them. The greatest form of love I've ever felt comes from my kids. They mean it when they hug me. They love to be around me and me them. There's no greater form of happiness than a smile, kiss, and hug from a child that all say, "I love you."

Good Communication Is Essential!

2010-10-08T05:32:00.000-07:00

Huh? Wuzzat? You say something?

One thing I was always taught was to listen to what was told and confirm what you thought you heard. Yeah, I've had those moments where I "thought" I heard something and my brain played tricks on me. I'll take it as part of growing old (er).

Maybe it's part of selective hearing. Maybe it's selective listening. Maybe (God forbid) it's a combination of both. Again, I'll always use the standby of just getting old. I know my hearing isn't what it used to be and I'll blame that on my partial hearing loss. I can see myself in 10 or 15 years wearing a hearing aid if things don't get better. I'll be using a doppler in the back of the bus just to hear a patient cough.

Precepted a new Paramedic student the other day and had to laugh when we were done with our run. Older lady who wasn't feeling too hot and wanted to go to the ER. She'd just gotten home after a hx of seizures and had been home less than 1 hr prior to our arrival. We got her all loaded up and put in the bus, O2 and monitor done, lock placed and secured, cbg done, and then all was fine with the world.

Then, out of nowhere, <<bllllleeeeeeccchhhhhh>> here came the pukes. Just one easy round of it with a couple dry heaves. No projectile messes but enough to cause a little cleanup to happen. Looked over at the monitor and see her rate drop to the mid to high 50s. Her initial BP was 100 / 60. She had vagaled out on the toilet which was the reason for the call (unresponsive but breathing). She now was talking and alert but all this happened at once. I asked for another BP. It was still a little low, lower than before but not under the magic threshold of 90. Still bradycardic and I noticed some couplets beginning. She said she felt all right but still was sick at her stomach.

I'm sitting at the patient's head in the single seat while the student's on the bench seat on the patient's left side. I hear him say something about giving her some drugs. I hear "dopamine" and his question of if we should give her some or not. "Dopamine? I haven't given that in over 10 years and only used it twice in 20 years!" Huh? He wanted to give her that? For having a sick stomach, a little pukey, a little bradycardic with some couplets and a slightly low BP? Really???

So I begin quizzing him on the drug; it's uses, contraindications, side effects, dosages. All of these things he's not too sure of since they're just beginning pharm in his class. After a couple minutes I ask him why he's wanting to give such a powerful drug for these reasons and him not know everything about it's actions and reactions. It just didn't make sense to me.

His response was, "Dopamine? Huh? I was talking about Zofran." Oh dear God,... He was confused as to why I was battering him on the why fors and why nots of giving dopamine and here he was asking about something else. I was giving all the reasons why not, what sort of reactions we could look for IF it was given to any patient. I had been thinking to myself and wondering why in the hell he wanted to give dopamine, yet I didn't bother to confirm with him exactly what it was he was wanting.

Ever called in a report and a doc says one thing and you hear another? Ever asked for an order, you get one response and hear another? Ever played the telephone game as a kid to see how one sentence starts and then ends totally different?

Kind of one of those "look at the drug three times before giving it" to make sure the right one is in your hand. I know that in my 23 years of EMS I've never been in the back of ANY bus that's quiet. I've taken patients in cars, trucks, buses, ambulances, boats, and helicopters and there is no such thing as a quiet ride to the hospital anywhere in the world. If there is, I haven't found it yet. If nothing else, this one reminded me (and us) to always confirm orders or requests before doing anything. Ask for confirmation and repeat things. Document if necessary and question if something's just not sitting right.

We didn't give her zofran. She puked once and that was it. Saved another!

On A Patient's Level

2010-10-04T06:29:00.000-07:00

One of the things I used to hear way back when was to treat a patient with respect. Listen to them and give them some dignity. Hear them for what they're saying, not just to hear them for the sounds they make. I don't hear any of those things too often these days.

Why?

Have things changed so much in just a couple generations that dignity and respect are not taught? Are they not a paramount issue on each and every patient? Do people just not think about those things anymore? I'm not saying that those things don't happen because they do or they're practiced, just sometimes I see it not to the level it should be or not practiced at all.

Each patient tells us different things about themselves, their condition, their surroundings, what they feel like, et all. Do we listen? Not always or not every detail is taken it. Sometimes those details get in to the ad nauseum and mundane that have absolutely no bearing on what's going on. Other times those minute things could be leading up to a bigger problem or could tell a story about something else that's not being voiced or give clues to what might be going on.

Go back a minute here,...

I had a run this weekend with an Alzheimer's patient. Very nice patient who can't remember a whole lot of anything. Usually upset due to the lack of memory and not knowing what's going on about the present condition or anything else around her. She's still at home being cared for by her devoted spouse. This time she fell and hurt her neck. She had had a syncopal episode which lead to the fall and the following 911 call.

After we got her packaged up and in the back of the truck she was still upset. One of the crew members began taking her blood pressure. The patient could not turn her head to see what was going on with her right arm. All she knew was someone was grabbing it, touching it, and there was something squeezing her upper arm. I stopped the process and spoke to the patient and then to the crew member. Being in the position the patient was in, c-spined and on a board, she could not see to her sides. All she could do is look up and count the specks on the ceiling of the truck's box. I slowly told her what was going on and why we were doing it. I told her who was doing it. I then told the other crew member to always make sure we tell each and every patient exactly what we're doing.

Telling our patients what we're doing helps build trust. It initiates conversation. It calms them so they know what to expect, especially if they're in a position they cannot see what's going on, like this woman was. Something simple as telling a patient that I'm putting on electrodes helps. Some people might wonder just why I'm sticking my hands under a woman's shirt, so I explain it to them. Why I'm doing it, what I'm trying to accomplish, and that it won't hurt at all, or if it will hurt, I tell them.

We all know that cervical collars and spine boards aren't built for comfort but we need to verbalize these things to patients. Let them know these things are being done for their safety since we're not human x-ray machines. It always seemed like an oxymoron that sometimes we hurt people to make them feel better or protect them.

But we need to tell these people what we're doing and why. Even for those, like this woman, who don't always understand, comprehend, or remember what happened, we still need to let them know what and why we're doing things. Let them see your face.

Talk to them in terms they can understand. I see a lot of doctors come out and spew medical terms to people who then become totally dumbfounded about their medical condition. They are now more confused about why they're sick then before. Understand that most people don't have a thorough understanding of medical terminology. Try to explain things to people where they're understand easier. It let's them know what's wrong which in turn helps to reassure them. And for those Alzheimer's patients who can't remember much? Repeat yourself. I've had patients who forget 5 minutes after I've told them what I'm doing and why. They get upset, they calm down after I tell them. 5 minutes later they get upset again so I have to tell them again and they calm down,... again. It's a vicious cycle but sometimes it needs to be done.

Finally we all have those patients who just want human contact. They've been left by family at nursing homes, they have no family left, they live at home with no outside companionship; those people. They're the ones who just like seeing people, anyone to talk to, just to have contact with the outside world.

Talk to your patients. Find out the details. Gather them all in and then toss out the ones that have no bearing on the present condition or problem. Let them tell you what's wrong. Even those who don't speak can tell you what's wrong. Sometimes the silence speaks volumes. Are you listening?

Pre-Hospital Box of Chocolates

2010-09-27T08:05:00.000-07:00

I struggled with the title of this post since it may cover more than just this or be a little off topic. At any rate, sorry for the confusion.

I've been in the EMS profession since 1988, a relative newcomer but old by other standards. I've practiced pre-hospital medicine all over the world on 5 continents. I've gotten to see a lot and do a lot but by no means everything. I've experienced a wide array of calls, had some really odd ones, had some confusing ones, had some that were textbook and some that were so far-fetched that the book seemingly needed to be rewritten.

But no matter where I've gone I always come across one group of providers that has always given me fits. Generalizing? Yes, I have to. I cannot and won't be specific but this particular group seems to give me more trouble and make me scratch my head more than any other.

I really want to go in to specifics but I'm letting my better judgement take hold here and reserving comments.

For some reason some people seem to make things, how should I say it, "difficult?" I realize that some people do not necessarily have pre-hospital experience or education, and that's understandable. But they should still have some of the basic things down pat, especially if they've been in the medical field for any length of time.

Just some of the "top of my head" things I've seen or been told (feel free to add your own);
1.) A nasal cannula @ 15 lpm
2.) A non-rebreather @ 2 lpm
3.) A patient who's talking, a & o x 4 with a pulse ox of 39%
4.) CPR being done on a patient bed that bounces up and down with every compression
5.) CBG (blood sugar) of <10 with no patient deficits
6.) Blood pressure of >300 with a normally functioning, no pain, no complaint patient
7.) Patient on the toilet, called for a cardiac arrest; arrived to simply lift the patient's head (to open the airway) and they began breathing again
8.) Numerous calls to 911 for transportation (as an emergency) to the local hospital for headaches, ear aches, a "tickle in their throat," and for one "runny nose"
9.) Patients stating they have one complaint and the staff stating the patient has a completely different set of complaints
10.) Patients who are normally in a vegetative state with no ability to communicate period somehow tell the staff they have a complaint of pain or problem

These are all calls I've had that I can easily remember for one reason or another at one place or another. There are more but this is a good start. It's not uncommon to get called for a cardiac arrest only to arrive and find the patient awake, alert, and talking. What happened? It's also not uncommon to get called for a simple transport only to find out the patient is in dire need of medical care immediately. It's one of those, "you never know what you're going to come across when you get there." Be prepared.

Assessing a patient, you'd think, can be a simple task. Go from head to toe, assess the simple ABCs and go on from there. Do a complete secondary survey and find the finer points. Be detailed. Find out all the smallish items that may indicate an underlying problem that may not be readily seen yet don't overreact if it's not anything of importance. Take note of it and go on.

But it still floors me how assessment skills can be so different from prehospital to anywhere else. Take this call for example that I did with a BLS crew. Patient with a CVA history among other things. Has had a cough recently, is febrile, I & O normal, everything else appears fine. Patient's GCS is a 15, Very alert, oriented, knows surroundings and is very pleasant to converse with. The Cincinnati Stroke scale was normal x 3, 3 hours prior per staff.

We were told the patient's pupils were unequal and non-reactive, was complaining of chest pain, was febrile, had unequal grips and could not use the right side (where old stroke was), very confused and disoriented. Their diagnosis was another stroke.

The patient's grips WERE normal bilaterally. NO chest pain, used right side (all of it) without a problem, knew exactly what was going on and recited family history and family members as well as local happenings along with time, date, day of the week. Pupils were BOTH reactive and responsive to light. All of this was done in front of the staff as we assessed this patient prior to transferring to our cot.

Huh??? Where did these observations come from? We were told all of this came on within the last 30 minutes prior to our arrival. The patient even told me that they (roommate also) were watching TV together and talking about the shows (roommate confirmed this).

One correct finding? She was febrile.

It is true that we never know what to expect on any call, no matter the background of the call or where it may be located. We are called to a sick person and it turns out to be an overdose. We get called for an MVA and it turns out to be a shooting. We get called for an injured in a fall and it turns out to be a cardiac arrest. Anything is possible. Our station used to have a plaque on the wall stating, "Expect the worst, hope for the best." True words by someone who knows and has experienced a lot. We always have to prepare and expect the worst possible scenario and hope that it's not, for the patient's sake.

Assess everyone no matter how routine a call it may be. Even the simple transfer from ECF to a doctor's office for a checkup needs a quick once over. Do a good head to toe. If nothing else, those are the patients who are good to practice basic assessment skills on. Listen to the lung sounds and different fields. Look at the diagnoses and see if you can see any of the stereotypical signs that come with what they have. Look and feel the extremity edema of a CHF patient. What does it look like? What does it feel like? Do you see any JVD? Can you find a good pedal pulse on someone who has gross pedal edema? Do you feel any masses or pulsating areas in their belly on palpation? Do you palpate bellies? Do you rock their pelvis or feel their neck? Do you look at their ears or nares to see if there's any exudate? What about their mouth? Any open areas or bleeding?

All of these things can be very helpful in determining what may or may not be wrong with a patient. True, not all of them will be pertinent to every patient, but some of them may very well help diagnose what's wrong with them and better lead us down the right path of treatment prior to our arrival at the hospital. As always, document what you see, felt, and heard (or were told) as well as the responses to the treatments given.

Details, Details,... Good Documentation

2010-09-24T06:58:00.000-07:00

"It was a dark and stormy night,..." Don't all run sheets usually start that way?

My first big trauma run came during my senior year in high school, about 2 weeks before graduation. I'd been an EMT for about 5 months and loved being a part of EMS. Big nasty single car accident with both driver and passenger ejected. Here I was still fresh out of EMT class and learning all that I could get my brain wrapped around. I loved the EMS world and all it had to offer; the skills, the challenges, the patients, everything. I embraced everything with open arms.

About 10 years later I happened to be running around the station and was talking with some people about old runs. That particular run came up and became the main topic. I still remember it vividly and I still have some of the newspaper clippings and pictures in one of my old scrapbooks. As we were talking about it I asked about seeing my old run sheet. "Here's the keys," I was told. So I set out on a mission of rummaging through years and years of old run sheets to find this one needle in a haystack report.

About 30 minutes later I found it. I was shocked. I was dumbfounded. I couldn't believe how I'd done my report. It was all handwritten other than the headings for the certain sections. My narrative? Less than 3 complete sentences. This was a BLS narrative for an ejected passenger, unconscious, decorticate posturing, with shallow breathing and crappy V/S. I know because I remember what I saw because of the run, not from my run sheet.

Since that time I've been to court and given depositions on a handful of cases. I've been talked down to by lawyers, I've been cross-examined by lawyers, I've been made to feel that I don't know what I'm doing in the EMS world by lawyers. It happens. They do it for their clients, not because they don't like or trust me. But one constant comes from every time I've been to court or given a statement; documentation is king.

I was floored at the amount I could recall about this incident and the utter lack of details actually put on paper. Laziness? No time? Education? Were there specific reasons why this was like this? Back then we had to leave our run sheets at the hospital before we left there. On rare occasion we'd finish them later, like if we caught another run before we got done writing it. This one? No clue. I will say that in my EMT class documentation was never harped on or drilled in to our heads.

Fast forward about 1 1/2 years from then. In Paramedic class and again, documentation wasn't stressed. If anything, I learned documentation from my boss who was one of my preceptors. He schooled me in the fine art of documenting a run. All the details, the pertinent negatives, the treatments and responses, the finer points of the scene that were visualized that may have played a part in the patient's history of the present (or past) problem; things that should be documented. I got my run sheets torn apart thoroughly by him on a routine basis, even the BLS transfers I did for him he'd go through with a fine-toothed comb.

While a lot of services and departments are going for ease, efficiency, and time saving measures when it comes to reporting, I'm still and always will be a fan of good documentation and a thorough narrative. I worked for a service a while back that began toying with electronic "notepads" for their run sheets in an effort to reduce paper use and speeding up sending reports to the main office for billing purposes. There was no place for a narrative. None. My questions were these: Does a narrative need to be generated on a BLS nursing home or doctor's office visit? Sure it does. What did you see? Why was there a need for this transfer? Is it not possible that this patient could change in front of your eyes or you see, and document, something that an extended care facility staff member did not? How many times have you heard about people getting calls about missing personal effects a patient had? Ever gotten a call from a facility asking about a hematoma or mark on the patient's body that wasn't documented on the transfer sheets? Guess where the blame will lie on that one.

Has it happened? Yes. The best defense we have is our documentation. Even though we typically only see patients for a short period of time, our run sheets need to paint a vivid picture of what we saw, what we did, and how they reacted to our treatments. Sometimes these run sheets come back to haunt us years after the fact. Can you remember every run you did in 2008? How about 2009? I'm sure there are the memorable runs but what about the mundane ones? Is it not possible that the mundane BLS car wreck on January 4th, 2009 ends up being a court case where someone is getting their pants sued off and you're called to be deposed? Even more, you or your department could be named in the suit for malpractice. Possible? Very. Does it happen? Damn right it does.

Spelling, grammar, punctuation, capitalization all matter on run sheets. I'm not the world's best but I do a fair job of being detailed in my reports. If spelling is wrong you may get called "lazy" by a lawyer for not taking the time to spell check. "Since you didn't use spell check and were lazy in your reporting, were you lazy in treating my patient? Did they get the care they deserved because of your inattentiveness?" Or incorrect grammar and / or punctuation could lead to, "Since you don't care enough to use proper grammar or not use the correct punctuation then you obviously don't care enough about patient care and treating my patient to the best of your ability."

These run sheets may need to be recalled years down the road. Other than pictures our documentation is the best thing we have to help us remember, jog our memory about a particular run. Take your time putting them together. Put pertinent details and the pertinent negatives. Make it easy to read; not necessarily a book, but one huge long paragraph is difficult to digest sometimes. Try to keep things in chronological order; what you saw, what you were told, what you did, how you did "it," what the responses were, end result when arriving at your destination. It's all about CYA. Protect yourself and your department the best you can.

Pride

2010-09-22T11:48:00.000-07:00

I'm part of a smaller department in the Midwest. Our EMS is separate from the fire service but located in the same building. Most of the people on the fire side belong to the EMS service. We're one of the lucky departments on both sides because staffing seldom has been a problem. Other departments know that usually if they call us they'll get a fully staffed truck or crew out the door in a matter of minutes. We have about 40 people on the fire side and roughly 90 on the EMS side. Both sides are volunteer save 2 paid EMTs during the weekdays and our paramedics are paid a minimal hourly wage.

One thing I've seen year in and year out is a lack of pride. I've been a part of this service since 1988 and certified in something since January 1989. I was giving narcotics to patients before I was 21, which was old in itself.

There are a lot of us around that have been a part of our service since high school. Some grew up around the department. Me? I just knew I wanted to be a part of it. Nobody in my immediate family is, was, or has been anything medical anywhere. I enjoy the thrill and challenges that the fire and EMS services both throw out each and every day.

Probably the hardest thing to deal with is pride and the lack of it I see quite often. I speak about it often to people, I practice it every shift, I wear my department attire with pride; I like to show it off. I don't use it as power to stand over people. I don't flaunt who we are and what I am. I am one of millions nationwide trying to make a small difference in my area and maybe elsewhere through education, communication, or experience.

We boast a lot of people as members of our service. Yet time and time again we see just who the people are who take pride in our department and what they are. These are the people who show up for meetings and public events, cover shifts, train and educate others, and truly want to make a difference. These are the same people who want their voices heard about opinions or issues, take care of the equipment we have, and want to help others out. Pride, pure and simple.

The same core group is there day after day, shift after shift, helping others out without fail. Donating time or energy is second nature. Helping others is human nature. What's "volunteering" called? Maybe "dedication?" I'm one of those that realize that had it not been fore our departments I wouldn't have gotten to do or see half of what I have since high school. I've traveled the world and gotten to do things most can only dream about. I credit it all to where I began my EMS career, at a small volunteer BLS service.

How do other departments get others to take more pride in who they are, what they are, and what they represent? Is it that generations have changed that much? Have thoughts and cultures evolved to the point where respect has gone out the door? The generation coming up now is being raised by my generation. I'm not that old yet I see kids today that don't have the same desire, work ethics, or passion for things like I used to, like my generation did when we were their age.

Like most EMTs, AEMTs, EMT-Is, and EMT-Ps, I busted my ass to get my certification and license and I was damn proud to show it off. I still am. I've made a living by helping others and one that I'm very proud of. I feel like I've made a small difference in peoples' lives through education, caring for others who were sick or injured, or just by being "there."

I love what I do. I still do after all these years. Next year begins my 20th year as an EMT-P and 23rd as an EMT. I'm proud of what I've accomplished. I'm proud of what I've become. I'm proud to say that I've made a difference in some peoples' lives. I'm proud of my roots and where I began my career and I'll always come back here.

Teach pride as best you can. Make others proud of what they have and who they are. Hopefully the generations to follow will keep the same level of pride in the EMS and fire services that we have. Remember that pride in who you are, what you do, what you're a part of, can be defined differently by all. Be proud of everything you do. Take pride in your work and efforts.

We, the Caregivers

2010-09-20T07:17:00.000-07:00

I was reminded this weekend just how much we do to help patients as well as their families.

Got called to the house of a soon-to-be frequent patient we'll transport. This call was in the wee hours of the morning so I'm already worn out as I hadn't gone to sleep yet. The call was for "altered level of consciousness." Those are those kinds of calls that you never know what to expect since that can be caused by a myriad of things.

When I got there the BLS crew was already in the house attending to the patient and finding out a brief history of what was going on. As I walked in to the very clean and neatly kept house I was met by the patient's son who was about my age, maybe a couple years older. He kindly directed me to the back of the house, to the master bedroom where his ill father lay on the bed.

So I made my way through the halls and found the bedroom, brightly lit with nothing out of place, the carpet neatly vacuumed and the furniture glowing from a recent polishing. Smells of a faint vanilla from an unseen air freshener emanated throughout the room. Pictures of kids and grand kids and old wedding pictures dominated the top of a large chest of drawers detailing to all who entered that this couple loved seeing their family in print every time they walked in and out of their room. The bed was neatly made and creased ever so slightly at the top edges, save for an elderly gentleman laying horizontal across it with his head square on one of the huge down pillows.

This man had been recently diagnosed with leukemia and was a clergyman, according to his wife. He hadn't been feeling too well recently and had been to the doctor's office a lot as a result. Tonight wasn't any different for him but he just had a "far away look" in his eyes, according to his mate, that "just didn't look right."

As I began peppering her with questions to find out a little more extensive history to put together I stopped myself and realized just how upset she truly was. Tears were welling up in her eyes, her upper lip quivered as she spoke, her eyes constantly on her spouse of 57 years as he was being attended to by the BLS crew, and her left knee was bouncing ever so slightly with worry and apprehension.

I looked behind me to make sure the crew was doing all right and to see if they needed my help. They all were doing fine. I returned my attention to the wife and politely apologized to her for not introducing myself. I offered my name and hand and she returned both to me with a slight smile and look up in to my eyes. I slowed down my questioning and lowered my voice just a little bit for her. I wasn't yelling but quieting things down a little usually helps tone the entire scene to a bearable level. The crew loaded our gentleman on the cot with assistance and out they went.

I stayed behind.

This wonderful, yet truly worried woman would be following behind shortly to the hospital with her son. The crew was fine without me so I offered an ear and a shoulder to this man's wife. They had been together for 57 wonderful years, built a wonderful family with lots of visible grandchildren in the pictures. I got to know a couple of their names and a smile came out as each of them was told to me. I knelt down on one knee so she could look down on me and not up. I wasn't "above" her and I don't like being perceived like that. I'm here to help and have been for 23 years, less than half the time these two people had been married.

As I asked her simple questions and talked to her about her family I got several pats on the shoulder, small smiles, and lots of tears. This woman was terrified of losing her husband. She questioned why he was now sick with this disease at his age. Why now? Why him? What was she going to do without him? She was truly frightened by that prospect and rightfully so. I stayed and talked with her for a while and offered what positive, comforting words I could.

I left her in the care of her grown son to take her to the hospital. We left each other after having only met about 20 minutes prior with a wonderfully warm hug. It was one of those hugs that made me think I'd known the woman all my life because it was a genuine "thank you" hug, one that made me feel pretty good. It made me smile.

Not that we made everything all better but we were all there to help her and her husband. He wasn't feeling well and she needed a shoulder to cry on. More and more I realize that we, as caregivers, need to be more attentive to the family, bystanders, and friends of those we take care of who are sick or injured. They need care and attention just like the patient does, just not in the same sense.

We need to make sure we slow down and take the time to talk to them, speak to them on a level they can understand, show empathy and compassion, and let them know we'll do everything within our powers to help them both out. In this case is was something very simple; someone to talk to, someone to hold her hand, someone to lend a shoulder to cry on, and someone to receive an absolutely wonderful love-filled hug that merely said, "thank you."

9/11, Never Forget

2010-09-10T20:57:00.000-07:00

The day after 9/11/01 I wrote this letter and emailed it to our local paper. I was offshore in Trinidad working at the time and was glued to the TV watching CNN and CNN world. I flew home through Miami exactly one week after to find that my letter had been published in the paper as a "Viewpoint" article. Here it is, complete as it was published in the Herald Bulletin.

Over the course of the last week I have sat and thought about what I could say to the rest of the world. I am an ordinary US citizen and have virtually no power to talk to the rest of the world. Yes, I do have email and a telephone but I cannot reach as many people as I would like to. I, the everyday citizen who has no special talents, am not an actor, am not a political figure with a booming voice that can be heard through political circles around the world. This is my media to express my opinions and thoughts. This is the way I can communicate with people; with other normal everyday people to show the thoughts and feelings of one individual.

I am currently at work and in a place that I am confined to for several weeks at a time. When I get here I cannot leave unless relieved. I cannot go home to spend time with my wife and unborn child. I cannot go out to the movies. Normally I accept all of this as part of my job. But this last week this has been damnable. It has been very difficult to stand by and not be able to do anything. I have been here all along watching these tragedies unfold in front of my very eyes on the television and read about them in the local newspapers. I have internet access and have seen the pictures and read the stories posted on various web sites. I am saddened by all that I have seen. I am even more saddened by the fact that I cannot leave here to offer my knowledge and skills to those who need it. My heart aches. My sense of security thrashed. My nation violated. My assumed safety horrified. My anger increasing. My sympathy mounting. My tears always flowing.

September 11th was America’s second “Day of Infamy.” That day will always be remembered by the generations alive today. History has been written and will be re-written. It will be seen, heard, and remembered by the future generations in their history books, on old video archives, and on old press clippings on microfilm at the local libraries. That was a day that I will always remember where I was at, what I was doing, and wondering what the future will hold for not only me but the rest of the world.

I have read articles and editorials from the various newspapers around the country and world with messages of hate, anger, revenge, sorrow and sadness, and most deplorable of all, jubilation and victory. It is our granted right in America to have freedom of speech and opinion. Maybe this is one reason why someone has chosen to smack us down simply because they live in a place that does not offer these basic freedoms. The reason why these acts happened may never be known. So for now all we can do is wonder and formulate a hypothesis as to why.

The images I have seen of people cheering and celebrating are heart wrenching. It hurts. It makes the anger in my soul boil like nothing ever has. I am a patriotic person who gets choked up at the National Anthem during sporting events. I am not a vengeful person but I, like most Americans, want justice done. I do not wish to see innocent people around the world suffer the way our people suffered through this. That would not be right and morally just. But I want justice to be swift and merciless. I want those responsible to pay for what they did to the American public as a whole as we saw or heard about those acts in our homes, offices, cars, airports, or wherever else we were on the morning of September 11th. I want the justice to teach others a lesson that these types of acts will never again be tolerated anywhere in the world.

Fortunately and thankfully the world as a whole has come together to see that this is a problem we all face. This is not simply America versus the terrorists. This is most certainly the world against terrorism. NATO and the European Union have pledged support and I honestly believe they will be there to help in any way necessary. Always before the Americans have been the “helpers” to other countries. Now, unlike before, people are turning to extend the favor back to us. The corporate help from around the world is immense. The governmental responses from various world leaders has been quick and unrelenting to support this cause. They realize that these acts could have easily taken place in their offices and on their homeland. Solidarity around the world is alive and well.

I have cried numerous times viewing the pictures and reading the stories depicting the scenes of these crimes, the damage done, the innocent people lost, the families traumatized forever, and for the people of our great nation who will be forever scarred by these horrendous acts of violence. I have also cried for seeing people come to the rescue, the swiftness of change to help ensure our safety and security, the fast-moving responses by various assistance organizations, and for seeing the ordinary citizen help out with food, a bed, or simply standing on the street holding a candle, saying a prayer, waving a flag, or cheering for those who have come to help in our nation’s greatest time of need.

President Bush commented that we will react on our terms when we are ready and at our choosing. I have faith that he will and the rest of the nation will stand solidly as one behind his decision. Yet when those actions, whatever they may be, are carried out we will not cheer, jeer, or jump up and down in the middle of the town square celebrating others’ demise. We will refrain from that simply because we will know that justice has been served. We will take solace in the fact that our families, friends, and co-workers have been avenged. We will not “be even.” We will not have “settled the score.” We will, however, feel that justice has prevailed for now and for the future in hopes that the world will remain a safer place without those despicable people a part of it.

I thank the government of our blessed nation for the votes of confidence to see these actions are retaliated against. This reaffirms that our government is full of people working for the people and doing the peoples’ wishes. They know and understand just how badly we have been hurt. They also know, as do we all, that our nation will rise above this terrible day and remain as strong as ever and even stronger than we were before. We are bruised and bloodied but not down; not by a long shot. We have come together and will continue to do so in unimaginable numbers and strength that the world has never seen before. Good will over power evil. We are a great and powerful nation. We will prevail. We will be strong and support each other. Raise your chins and be proud to be a part of the greatest nation on Earth.

Finally, for every citizen around the world who said a prayer, who stood in the street for a moment of silence, raised a flag in solidarity with their American brothers and sisters, felt sympathy or empathy towards our nation, has come forward and offered assistance, has donated their time, money, or skills, or has comforted someone else who grieves, I thank you from the bottom of my heart.

God bless America, the land of the free and home of the brave.