Just Be There For Each Other

Boston is my city. I’ve lived all my life within an easy half hour drive to the Hub. Except at rush hour, when it’s an easy two or three hour drive.  I have close family living in the city proper. All my life, going “into town” meant Boston. I still say “hahbah” for “harbor.”

I’ve spent the last thirteen years working on the ambulance in Boston’s northern suburbs. EMS being what it is, I have friends and co-workers and former partners working at every service and hospital inside of Route 128.

The events of April 15th hit a lot of people close to me very hard –excuse me –hahd, and I just want to say a few things.

As frustrating as it is, there’s a lot we can’t do right now, a lot we shouldn’t do right now, and only one thing we should.

We can’t change what happened. We can’t erase the fact that on a beautiful day, when the city was enjoying the annual celebration that is the marathon, bombs tore through the crowd, killing and maiming people who wanted nothing more than to share in the camaraderie of the event. There is no cause, no goal that can excuse that.

Most of us can’t do much right now to prepare for this kind of thing, or prevent the next time or punish those who carried this out. There are people working on it, and when they know more, we will be better able to act. As a paramedic, I’m sure our procedures will be updated, and when they are, I’ll make adjustments.

What we should not do is speculate. Let’s not scapegoat foreign terrorists or the militia movements or anyone else just yet. Better to be uncertain now and right tomorrow than certain and wrong today.

The one thing we can do, must do, is support and respect one another in our time of shared loss.  Don’t post graphic photos. Don’t belittle anybody’s urges to pray or hope or provide comfort, even if you disagree with their beliefs. Don’t call for revenge. In time, we can demand justice. Don’t utter the words “false flag” or “conspiracy”within striking distance of me.

Just be kind. Be a friend. Hug your kids and your family, buy your coworker a cup of coffee, let those close to you know that you care, because there may not be another chance.

And, Boston, remember: Don’t be a peckahhead.  Just be wicked pissah to each othah.

Holes in the Safety Net

I feel the need to bitch about the state of Massachusetts Mental Health system.

It works as though the Powers That Be sat down and said, "How much money can we spend and not actually solve any problems?" and went from there.

A few years back, they closed all the state hospitals. This basically meant finding all the mental patients to be cured and shoving them back out on the street. It was a cost cutting measure.

OK, fine. If we feel that "this ain't no hippy commune, you're on your own," that can work. Not exactly compassionate, but a valid philosophy.

Here's the rub. We still pay for it, we just don't get results anymore.

As an example, we got a call to respond to the phonebooth outside McDonalds for the man who was having suicidal thoughts. Fair enough. We headed out, finishing our coffee en route, because I'm not dumping out my $1.97 worth of caffeinated happiness for some guy who can't handle life's slings and arrows, and we find this gentleman at said payphone.

He has evidence of bilateral Samsonite Sign (suitcase in each hand), and wants to go to a Holy Family hospital, which is farther than the town hospital we normally use.

Me: Why the Hole?

Him: I was just there *hands me envelope of discharge instructions*

Me: *scanning papers* OK, you were released from the mental health floor yesterday. Have you been taking these meds?

Him: No.

Me: Ok. Have you called this doctor for follow up?

Him: No.

Me: O....K... So, what's going on today.

Him: *recites list of symptoms exactly identical to those outlined on his discharge instructions*

Me: So, pretty much the same thing that was going on before you were hospitalized.

Him: Yes.

Me: And this is their recommended solution, and you aren't doing it.

Him: *Long, "life is complicated" soliloquy. No ride to the pharmacy, can't make his doctor appointments, etc.*

Me: Uh-huh. So what do you want to go back for, if you're not going to follow the instructions?

Him: Oh, I was fine when I was there. I was at McLean's (another mental hospital) twice this month, then I was at Holy Family, and I'm fine when I'm there.

Me: *Reads more of his paperwork, finds that he was at McLean's from the 12th to the 16th, back from the18th to the 23rd, out for four whole days in the wicked world, then at the Hole from the 27 to the 29*

So, did McLean's talk to you about some follow up or a discharge plan?

Him: Yes, but *life is complicated soliloquy resumes*

Me: *aware that partner wants to get lunch soon* OK, hop in.

Clearly this guy cannot take care of himself out in the real world. Medicaid will pay for a 4 day stay at a short term psych ward, then he'll be given THE SAME FUCKING instructions, and sent out, so he can call me long about the 5th of the month to take him back.

Now, the guy has issues. Just looking at him and talking to him, he's not one of the guys who games the system and has a breakdown two days before the rent is due so he can live for free for a few days. He has real, honest to God issues. He does ok in an institution where they monitor him and make sure he gets his meds. So well, that they boot him out in four days with a list of follow up stuff.

But, he can't hack, and needs to go back.

Now, when we had this guy in a state hospital, it cost the taxpayers money. But now, in three weeks, it's cost them four ambulance rides, four ER visits, and sixteen days of stay at mental hospitals, plus the benefits he gets while on the outside for food and housing. And, guess what, It doesn't work. He's still just as nuts as he was last month.

Now, to put him in a facility long term, and make sure he can handle outpatient treatment before his release would be an expensive solution. Bopping him on the head and dropping him in the river would be a cheap solution. What we are doing is an expensive lack of solution.

God, I hate the way the government saves me money.

Author talk and book signing

Author talk resounding success. Easily made as much as I would have sleeping on the ambulance for that same hour and a half.

Ask a Bitter Medic: Vaccinations

I’d like to talk about some facts versus folk wisdom and pseudoscience about vaccinations, and flu shots in particular.

“But the flu shots just makes me sick,” you say. “Why take a shot that makes me sick?”

A fair question, and one that is easily answered, but we’re all too damn overworked, underfunded and harried to explain it, plus, we hear any anti-vaccine stuff and we just roll our eyes and punch a wall, pretending it’s Jenny McCarthy. 

Now, I know Ms McCarthy has tried to make amends for her crimes against public health by posing again in Playboy, and we’re grateful, but, Jenny, that’s not quite gonna cut it.

So, anyway, here goes:

The flu shot does not “make you sick.” It’s a dead virus. Your body recognizes the foreign invader and the body’s immune response can make you feel lousy. Fever, inflammation, nausea, these are all part of your body’s immune response.

The reaction to the flu shot lasts a day, and can be unpleasant. My five year old son got the shot and was cranky and achy for one evening. He coped, and HE’S FIVE.

The alternative is he maybe gets the flu.

Influenza is a highly contagious and dangerous disease. 250,000 to 500,00 people DIE worldwide each year from the flu.  Mostly older people, very young people and those with preexisting medical problems, but even the healthy flu sufferer will have severe symptoms for a week or two. And the flu sucks. You’re not limping in to work, like you have a cold. You are lying in bed with a high fever, praying for death’s sweet release.

Plus, once one member of the family has it, it will rage through the household like Chlamydia through a Christian Youth Bible Camp, and you lose a week’s sick time (or pay, if you’re one of us who doesn’t have all that much sick time) taking care of a sick kid while praying for death’s sweet release.

And if you follow Mitt’s advise and call an ambulance, we will take you to the ER, where they won’t be able to do a damn thing to cure the flu, but will subject everybody else to your germs, and run up a bill.

All the while, thinking “Why didn't you just get the fucking shot?’

This has been a Public service announcement by Bitter Medics Against Pseudoscience. We return you to the internet.

Yeah, we kinda know we’re fighting a losing battle, but there ya go.

On Aspirations, Realistc

Starting work at a new ambulance company next week. My goal is to hit the four year mark at a company.

  A dream I've had unfulfilled for twelve years.

I reckon you'd get your ass kicked for something like that.

A medic friend of mine had his toothpaste stolen at work. From his toiletry bag which was in the base bathroom. He became incensed at this, and had some choice words for the perpetrator. I think those words were "pathological lying scumbag thieving shit bag coworkers."


People told him to calm down, toothpaste costs a buck, keep his perspective.


Fuck that.


Stealing a squeeze of toothpaste from a tube left out on the sink, sure. going through another guy's bag and taking the tube is another.

It stuns me because I've always found people to be ready to lend stuff if asked. I've lent toothpaste, soap, shampoo, uniform parts, stethoscopes, ibuprofen, allergy medicine, money, food, and a few times my car to co-workers. People I only knew from working the truck. And I've borrowed most of those things when I needed them. All without thinking. I've come in early and stayed late for people. Taken somebody else's call because they needed a shower in the middle of a double shift.

In this business, we should look out for one another, and expect our co-workers to do the same for us. Having one another's back used to be the expected standard.


If I can't trust you with my $1.29 tube of Colgate, how can I trust you when you say you checked the cardiac monitor batteries? Or the expiration dates on the drugs? Or that you'll speak up when I'm headed down the wrong path on a complex medical call on no sleep at 3 in the morning?

Yeah, toothpaste is minor, but the disrespect is a betrayal. You don't steal from your partners, and you watch their backs, because EMTs and Medics are the only people who will look out for other EMTs and Medics.

If we can't count on one another, what does that leave us?

The Doomsayers Who Cry "Wolf"

A friend of mine recently wondered why nobody takes "preppers" seriously.  I thought about it. I know I don't take most of them seriously.  My friend is an exception. He lives out in the woods, off a dirt road in an area that has a low population and lot of seasonal residents. So it's last on the priority list for the utility crews and the snowplows. It's not uncommon for him to lose the electrical grid for days on end, or to be cut off from the main roads. So he made sure he has some electricity from a solar panel array, and ha woodstove that can heat the house or cook a meal, and he always has some dry food stored. He considers himself a prepper, but I say he's just embraced the reality of his situation.

We don't make fun of the guy with a generator or a few gallons of bottled water. If your road floods twice a year, maybe you want to own a boat.

The guys we laugh at are the ones who have a bomb shelter. They guys who stockpiled 9 mm ammo after Obama won the election so that you couldn't get it in stores. The guys who bury a box of gold in the backyard.

Why do we laugh at the "Doomsday Preppers?" Why don't we take people seriously when they warn of the coming apocalypse?

Because we've gotten used to them.

There is always somebody screaming that the world will end. And it never does.

The millennium, the plague, the Mongol invasion, the rise of Fascism, of communism, the Cold War, the UN, going off the Gold Standard, Electing a Catholic president, missiles in Cuba, the energy crisis (pick one), the Y2K crisis,  weapons of Mass Destruction, electing a black president, the mortgage bubble, global warming.

We've grown numb to the cries. Everything else has proven survivable, so this next thing will be too.

Yes, there are dangers on the horizon. Many of the things I mentioned above had real potential to cause havoc, bring down the established order. Not many did. Sure, people suffered, but some people will always be getting it in the neck somewhere, and if it's not you or anyone you know, it's hard to get worked up. Sometimes, maybe we should worry, but they've become like a car alarm. Nobody looks up or calls the police when they hear a car alarm. they complain about the noise.

The average person worries about working to keep the family fed and sheltered, and wants to enjoy their few precious free moments, not spend them fretting about an apocalypse that has never returned a phone call. 

So, being busy, being jaded at the consistent ability of doomsayers to be dead wrong. That's understandable. But we do sometimes get worked up about a waning. If the weather guy on channel 4 says it will snow, everyone in the state has to run to the store for milk and bread. Why does he warrant a listen, make us look up from or lives of quiet desperation, but not the guy who warns of an impending fiat currency collapse? Both of them are probably overstating it for the ratings.

Well, it comes down to perceived legitimacy. If the President says terrorists have weapons of mass destruction, we think, since he has advisors and an intelligence agency and a foreign service and all, maybe he knows something. Turns out that's really not a good call, but it makes sense.

If you own no clothing that isn't camouflaged and have a beard like an Old Testament prophet, nobody's going to listen. If your friends are still in debt from all the Ramen Noodles and peanut butter you convinced them to buy for Y2K, they've stopped listening. I'm pretty sure Noah's neighbors saw him working on the Ark and pretended not to be home when he knocked on the door asking if he could borrow a male and a female scorpion.

And if your preps involve a defensible island fortress to hold off the UN invasion when the come for your handguns, just realize that when you have your heart attack brought on by a steady diet of MREs and stress about black helicopters, the Mooseknuckle Notch Volunteer Ambulance takes a long time to get there. And they've seen two heart attacks this year. It's been busy.

So, yeah, that's funny.

Maybe they'll be laughing at me when I am clawing at the shelter door begging for  some radiation sickness pills. But my money's on the guy who lives in the city, surrounded by leftists and minorities and world class hospitals.

Deaf Comedy Jam

We get a lot of patients on the ambulance who are hard of hearing. And there are a lot of accidental straight lines and perfect double entendres thrown out in everyday conversation that are hard to resist. When these two things occur simultaneously, we tend not to resist, and this leads to some escalation where we try to keep a straight face and make one another break or laugh first, without the patient actually realizing what we're doing.

Yeah, it's childish, but, hey, we're childish.

An actual exchange between my partner and I this past weekend.

We picked up a somewhat deaf elderly patient with chest pain, and transported her to the hospital. She first complained of having choked on chicken, and my partner asked a lot of "choking on the chicken" questions, while the Firefighters and I made the obligatory comments about how that could lead to blindness, carpal tunnel, etc. I won that round, since the Firefighters always break first.

Then we did our assessment and drove her to the hospital. I was driving, so my partner was in back treating the patient. When we pulled in to the ER and I opened the back doors, he was looking frustrated at her arms and taping some gauze over a missed IV attempt.

Now, since A Hospital Which Cannot Be Named wants all the work done for them, like lab draws and IV starts or they get bitchy, we hate to bring in a patient without a line established, so he asked me to hop in and take a look at her right arm while he looked for another site on her left.

I jumped in the truck and checked, and, while her veins were lousy, I did find a likely candidate and successfully started an IV, and drew blood.

This is the dialogue which followed:

Me: I'm in.

Him: Good job.

Patient: Oh, you're good.

Me: Thanks.

Patient: But you must hear that all the time.

Me: Once in a while, but it's always nice to hear.

Patient: I hardly felt you put it in.

Him (quiet enough so I heard it but the patient didn't): He hears that a lot.

So I was trying so hard not to laugh that as I finished the blood draw and started to hook up the IV tubing, I fumbled a bit so blood leaked back out of the IV catheter before I could get the line hooked up and running. Not a big deal, it just looks a bit messy. And I mean, like a few cc's of blood, not a lot.

Him: Man, we better have the ER order some O Negative! There gonna need if with you starting IVs today. That never happens to me.

Me: (in my best preschool teacher voice) Well, that's because it only happens when you hit a vein.

_____________________

The best version of the game ever was played between me and my old EMT partner Nicole, who was (and probably still is, come to think of it) a drop dead gorgeous blond. We would pretty much just drive around all day trading sexually inappropriate comments and the one who laughed the most, lost. Our partnership was completely platonic. My wife and I had dinner with her and her fiance, and we danced at their wedding.

But our conversations on the truck were consistently sleazy and inappropriate.

One time I was trying to lift the stretcher into the ambulance with a very deaf patient on it.

Lifting the stretcher is routine, but involved. You roll the cot until the head end is in the truck, then lift the foot end off the ground and roll it the rest of the way while your partner raises the wheels. After raising the stretcher, you have to roll it into a yoke and then slide one of the struts into a clamp that closes and locks when the strut hits a tiny retaining pin that keep the clamp open. Add to this the fact that the company was cheap and busy, so we slammed the stretchers into place a lot, and the maintenance was pretty sketchy, so the clamp often failed to lock, or had to be finessed into place.

The ambulance is kinda high, I'm pretty short, plus, this time I was standing in a dip, so I had to lift even higher than usual. So, I'm raising it, Nicole is lifting the wheels, then I need to roll it in, guiding it into place and hitting the damn pin just right which, in this particular shitbox truck, involved a complex slide/pull/shimmy maneuver.

So, I'm struggling a bit.

Nicole: Having trouble?

Patrick: No, no, I got it.

N: Can't get it up? It happens to a lot of guys.

P: No, it's up, I just can't get it all the way in. Happens to me a lot.

N: Well, you gotta work at it. If you put some more finesse into it, it would slide in a lot easier.

P: It's not enough to slam it in. It's all about hitting the right spot.

N: So, you're having a tough time finding the spot? That happens to a lot of guys, too.

P: (tears of silent laughter) I think I'm gonna need you to help me out here....

By which time, everything you say is dirty, since you've put your mind there, and we are emotionally as mature as the average third grade boy.

Thank God we treat a lot of very hard-of-hearing patients.

Why I am a Luddite

So, at the local hospital, they have a shiny new computerized medical records system which allows nurses to pull up patient charts on the computer and view all the relevant history, meds, allergies, etc and add documentation right there.

Sounds great, right.

Well, so did the Titanic.

Ok, the problem is that now, instead of the old way when I dropped off a patient, where the nurse would walk into the room with me --maybe with a pen and paper or maybe like a really good waitress, just her perfect memory -- take my report, help get the patient moved over to the hospital cot, switch over the EKG leads, take vitals and start treatment, now they need to Pull Up The Record.

Here's a quick example of the old Stone Age way we did things, and the New Improved way.

Stone Age Emergency Medicine.

We arrive at ER. Go straight into a room with the patient. A nurse and a tech come in with us, the tech helps move the patient, the nurse poises her pen.

Nurse: What'cha got.

Medic: This is Bob. He's 56, and awoke this morning with 8 of 10 crushing chest pain radiating to his jaw and down his left arm. Took two of his own nitro tabs without relief. On our arrival he was pale, cool, sweaty, radial pulse of 92. EKG was sinus rhythm, 12 lead shows elevation in V2,3 and 4, BP 150/90, lung sounds clear, denies shortness of breath, nausea, or dizziness. Past history of high blood pressure, past MI [Myocardial Infarction, or heart attack] insulin dependent diabetic. Takes [lists meds] allergic to [lists]. We started a 20 gauge IV normal saline in his left hand, gave 325 mg of aspirin, two sublingual nitro, patient had some relief, states pain is  now 4 of 10. O2 at 4 liters, here are the bloods we drew. Any questions?

Nurse: Nope. Sounds good

Door to treatment time: 30 seconds.

New and Improved Emergency Medicine

Patient into room. Nurse out at computer, tech comes in to help.

Medic: Ok, this is Bob--

Tech: I can't take report.

M: Ah.

*moves patient over, not giving report. Goes out to computer where nurse is typing with both fingers.*

Nurse: What'cha got?

M: 56 year old male--

N: What's the name?

M: Uhm, Robert Lamontaigne. So, he's 56, woke up with--

N: How do you spell that?

M: -a-i-g-n-e. So, woke with 8 of 10 chest pain--

N: (to screen) Dammit. Do you have his date of birth?

M: Yeeaaaaaah...hang on... *looks at notes* ...May 12, 1956. So, 8 of 10 crushing--

N: Does he still live at 104 Oak Street?

M: Yeah. Sure. So two nitro with no relief--

N: Past Medical history?

M: Uh..high BP, lemme see...yeah, MI in '07, and insulin dependent--

N: Dammit! Is his PCP still Steinberg?

M: *blinks* Not a clue.

N: *to patient* Mr Lamontaigne! Do you still have Doctor Steinberg?

Bob: For my heart I have some Indian guy.

N: Patel?

B: Sounds right. The pain is coming back...

M: Yeah, so, chest pain. Got nitro and aspirin. Here's his EKG. IV in his--

N: You guys gave Oxygen?

M: No. Wait! Yeah. 4 liters. So he was in a sinus rhythm with ST changes in leads--

N: *sighs* Why won't this enter? Ok, Meds?

M: *completely lost train of report, grasping at straws* Uh...aspirin...um... Here *hands med list to nurse* So, he was pale, cool and --

N: *looking at list* Mr Lamontaigne, what do you take the Prednisone for?

B: Oh, I stopped that last May. I feel kinda dizzy...

*Partner signing frantically. Either we have a bad call or she really needs coffee.*

M: *rips page from notebook, hands over with EKG printout and med list* Yeah, have fun with Bob, here, we have a call...

N: *muttering to self* These Paramedics can't keep their reports straight.

Door to treatment time: Like a month. Dunno. I left while she was slapping the computer and yelling. Bob was looking worse than when I found him.

God, I love progress!

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.

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.”

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.