End of life planning

We recently had a class on the new MOLST form, or Medical Orders for Life Sustaining Treatment, which is replacing the old DNR (Do Not Resuscitate) form.

It's better, since it applies to all healthcare providers, when the old one was specific to EMS, so hospitals, nursing homes and so on often had their own internal forms, which we couldn't legally honor, so a bunch of people who really didn't want a closed casket got shocked and intubated and had their ribs broken. Plus, it's more customizable, so you can indicate what treatment you do want. Like, "please do CPR, but don't keep me on a feeding tube."  


This got me thinking, and a few pints later and I have developed a brilliant theory on how to make your wishes known on withholding life support, without worrying that the kids will off you for a hangover.

I've seen enough lousy quality of life in the nursing homes I've been to on the ambulance to have decided how I want to be treated, should I ever wind up in one.

Every morning the nurse is to ask me "Sir, we're going to shoot you in the head today. Is that ok with you?"

If I am able to answer in an intelligible fashion (or at least shake my head vigorously) they are to treat me as usual.

If I am unable (or unwilling) to respond, or can only go "Pppppppppppppllllllllllbbbbbbbbbbbbbbbb

bbbbbbb!!!!!!!!!!!!" or say something like "How do you like my dress, Mrs Haversham?" they are to bust a cap in me like I was Ol' Yeller.

Overheard at bathtime in the Paracynic household

Me: Ok, little buddy. Time for tubby.
Seth: Can I take my clothes off?
Me: That would help, yes.
Seth: Can I take my pants off and dance?
Me (shrugs): Sure. We'll just pretend it's Last Call.

What? He asked.

My four year old son was asking me about primary and secondary colors.

Him: Daddy, what do you get when you mix red and blue?
Me: Purple.
Him: How about blue and yellow?
Me: green.
Him: What do you get when you mix green and orange?
Me: Centuries of sectarian violence.

Now, tell me if I'm missing something

But as far as I can see, the only reason to oppose gay marriage is that you are an asshole.

Nothing about letting other people have the same rights as you takes away anything from your marriage. It matters to them because it will allow couples a handful of important legal rights in very stressful situations.

If I am brought to the hospital in a coma, and my wife tells the doctor to treat me aggressively, or to let me go peacefully, they will listen to her. My girlfriend of twenty years will get no respect at the ER.

Especially if she shows up while my wife is there, deciding whether to pull the plug.

For sick partners, end of life decisions, child custody, inheritance, all those things that occur when we really don't need added stress, the married person is pretty much covered, the life partner, regardless of how long they've been together, or how committed they are, is not.

So, why not extend that  courtesy to a long term partner, who wants to commit to someone?

It's not about hurting the "sacred" nature of marriage. Liz Taylor, Larry King, and Britney Spears have already made a mockery of that, and nobody's trying to take marriage away from celebrities.  It's not about religion. No really, it's not.  The Catholic Church won't marry gays, but neither will it marry two Jews or Muslims, or even Protestants, but we aren't trying to take marriage away from heathens.  It's not about producing children, since we don't try to take marriage away from infertile couples, or couples who just don't want kids.

So, the only thing that I can come up with is that you think gays are icky, and don't want to give them rights.  We go down that road and we'll have to let broads vote and darkies drink out of the same fountains.

Now, if anybody has a real, constitutionally defensible reason we should treat homosexuals like second class citizens, please let me know, because right now, I'm just gonna run with the theory that you're an asshole.

40 Hours? I though you said you work full time.

When I was growing up, my dad worked one full time job.  He had one degree. We had a three bedroom ranch house, two cars, and went on vacations. We lived pretty well. My mom didn’t work until all three kids were in school.  We all had extra activities like art lessons, riding lessons karate, dance, whatever.

I am pretty much right at the median household income in America.  I work 64 hours in an average week. And not at a minimum wage, unskilled job, but as a paramedic and an orthopaedic technologist.  I have two degrees.  We live in a two bedroom ranch house in the same town I grew up in. We drive a ten year old car and a thirteen year old car. We have one child who has activities.

Everyone I work with on the ambulance has a second job. A mere 48 hours at a skilled, demanding, professional job requiring multiple licenses, continuing education and constant recertification doesn’t put us at a median household income.

When attempting to quantify the progress the middle class has made in the last thirty years, the best value I can think of is “fuck all.”

We shouldn't be shocked

An American soldier snapped and killed some Afghan civillians.

This is terrible. Inexcusable. There's no justifying this action.

But, although the man who pulled the trigger must be held responsible-- and it looks like he will be-- the military should look at how they failed.  One thing I learned in the Corps is that when one of your people fails, it's your fault.  You, as his superior, should have seen the signs, should have tried harder, done better.

This as yet unnamed soldier had done four combat tours between Iraq and Afghanistan.  He had suffered a head trauma. He was returned to active duty in a combat zone. None of that excuses what he did, but should we be surprised?

We've been at war for over a decade. A nasty, ugly sort of war without clear objectives. A war where enemies dressed in the uniforms of our Afghan Army allies attack and kill coalition troops. Where the enemy fighters vanish into the population. The lines between soldier and civilian, enemy and friend, are blurred.

We've been fighting too long, with too few troops on the ground.  People have been rotated back into the line of fire time and time again.  It's only a matter of time before somebody goes off the rails. We've seen it before, and we probably will again if we fail to take a hard look at our procedures.

In this kind of war, we rely on the locals to help us identify the enemy. To spot the booby traps. To support the new civilian government. A year of careful positive work winning hearts and minds can be erased by one atrocity.

We, as electors of the people who send out troops into harms way, have to understand and accept that you can't fight a war on the cheap, and that actions and strategies have consequences.  We need to demand that our leaders do a better job, or admit that it's not working and cut our losses.

War is one of those things that should be done right or not at all.

Just Pretend He's a Labrador Retreiver.

I figured out how to handle my issues with Firefighters.

It came to me when we were called to assist a BLS Fire Department ambulance.  The patient was an elderly man with a fever, who had been in rehab for an infection. He was absolutely stable, but needed a ride to the ER for some blood work and maybe a new antibiotic.

As the obvious rookie Firefighter-EMT gave me a hurried and breathless report on the patient’s condition, I noticed something in his expression.

Eyes wide, leaning forward, muscles tensed, mouth slightly open.

The expression that anyone who has ever played with a lab knows. Behind those eyes, the racing thought was Throwtheballthrowtheballthrowtheball.

Firefighter; "Yeah, he ‘s complaining of chills and shakes.” Throwtheballthrowtheball

Paracynic: “Ok. Is he oriented?’

FF (blinks): "Ummm...yeah. History of diabetes." Throwtheballthrowtheballthrowtheball

PC : "But he’s oriented?"

FF: "Uh-huh." Throwtheballthrowtheballthrowtheball

PC: "You check his vitals?"

FF: *pause* "Yeah. Pulse is 92 and bounding." (only Firefighters use “thready” or “bounding” like this) "I couldn’t hear his systolic BP, but his diastolic is 52." BALLBALLBALL!

PC: "Ok. You could palpate a pulse, so his systolic is decent, and his diastolic is decent and he’s oriented. He’s already being treated for infection. It sounds like he just needs a ride to the ER. You comfortable taking him?"

FF; *silence*  OMGBALL!!!!!!!!!!!

PC: "...Y’know what? Why don’t I start an IV line and ride this in with you?"

FF: *nodding hyperactively* WOOT! BALLBALLBALL!


Now that I’ve reframed the way I look at it, I’m ok. It’s really quite liberating.