Nothing To See Here

Started day off with a dsypnea – old guy with lung CA sitting on his front steps with his oxygen canister. Been having a problem for several days, but he could still talk in full sentences.

*

Next they sent us on priority to an MCI (mass casualty incident) at a high school in a suburban town we don’t normally respond too. We were the fifth ambulance in. It seems there were some sorts of fumes in the chemistry lab. We got canceled when we arrived. Most of the students were going to be refusals. They felt a little dizzy, I guess. It seems like the majority of MCIs I have been to over the years are at high schools and involve the chemistry lab. They are never anything serious. Some MCI's border on the ridiculous -- at least in terms of anyone who grew up in the 60's. I have several times been called to mercury spills, which involve someone breaking a thermostat and the little ball of mercury coming out. For this they evacuate the school. When I was a kid we used to break the thermometers to play with the cool balls of mercury. On the way up we joked about the scene we would find -- people in space suits all surrounding a little ball of mercury from a small thermometer. I would enter the room, pick up the ball of mercury and swallow it. "Scene's safe now," I would say. "Nothing to see here, nothing to see. Move on." My partner said I would be locked up for twenty years of observation if I did that today.

**

We get sent on a priority to a nursing home in a distant town for a 91 year old man with dsypnea. We find a man who is a full DNR having long periods of apnea. I look at his W10. He has Alzheimer’s Dementia, severe arthritis pain, and suffers from hallucinations. He is unable to speak due to a stroke. I ask the nurse if she called his doctor. The doctor wants him transported, she says. That’s how the doctor handles these cases. I am watching the man and he looks like he has died. He has frozen with his mouth open and there are no breaths coming out of it. His chest does not move. He looks very grey. I finally put my hand on his forehead. I am about to say, looks like his time has come, when his chest heaves suddenly and he starts to breathe again. I don’t understand the point of the transport. We can’t do anything for the man, but supportive care. We put him on the stretcher and take him in – to a distant hospital we almost never transport too.

**

Coming back into town, we are sent for a woman punching herself in the head on Main Street. “Maybe she’ll knock herself out,” my partner says. It takes awhile to get there and we find no one in the area. Clear. No patient.

**

Called for abnormal behavior. Find the police there who tell us about the lover’s quarrel they had to break up. Two Hispanic men in their late teens, early 20’s. One accused the other of cheating on him. Now one of them is threatening suicide. In the apartment foyer there are pictures of a beautiful woman -- many very sexy shots. It is Jennifer Lopez. It is a shrine to her, complete with candles. The one cop can’t understand it. “Why do they have pictures of a chick?” he says. “Are they trying to hide it?” “No, it’s all about the way she dresses,” the other cop says. “It’s about style.” “Yeah, right.” The cop says, “It’s style.”

We take the crying young man to the hospital for evaluation.

**

Next we are sent to a prison almost on the state line, for an inmate having chest pain yesterday with supposed ECG changes. We have to pass through several gates, all layered with razor wire. The man, in leg and wrist chains, in no distress. His new ECK looks just like an old one. A corrections officer travels with us. It is rush hour and we have to go all the way to a town on the other side of the city, to a suburban hospital where they have a prison ward. A long 26 mile through rush hour trip.

We are just coming back into the city when we hear a car dispatched to a man bleeding from the neck. Shortly after the PD requests a second ambulance. The second car is dispatched. We ask if we can go since we are precepting, but they tell us we are the only car left. It turns out to be a man with multiple stab wounds who is very combative. It takes the second ambulance awhile to reach the scene. They end up requesting orders to sedate the patient so they can contain him enough to transport him. We wish we were at the call. My preceptee who is just short of his required 30 calls could use some more traumas.

We get dispatched to for an unresponsive and find a sixty year old man who has passed out in the kitchen and wacked his head. He has no recollection of the event. I’m guessing he had a syncopal episode due to his bout with the flu, taking percocet and antibiotics and having a drink, then wacked his head and got a concussion.

At the hospital we hear about the stabbing. The medic on it said the guy was cut up so bad, he looked like he had gills.

**

Our last call is for a maternity. Woman’s third child. Her water broke and she was having contractions, but we got her to L&D on time.

And I punched out on time.

Target

Day off. I slept until almost noon, and then drank a big glass of water and several diet cokes with lime over ice. Spent the day lounging on the couch watching football and some episodes of Lost Season One which I bought on DVD, having never seen the show before, but heard that it was excellent. Then I went out to Target and bought socks, shampoo, underarm deodorant, TP, razors, light bulbs, Tylenol, soap, laundry and dishwasher detergent – the type of routine supplies someone who works all the time can start to run low on. For socks I bought twenty-four pairs of the same black sox so I don’t have to worry about stray pairs or being out of clean sox in the morning. I tossed all my holey socks and all my mismatched pairs accumulated over many years.

Came home, had cold turkey and Doritos, played a little online poker. Won $16 in $2-$4, and then laid down $11 to play in a one table no limit tournament. With seven people left, I go all-in with AQ, get called by A9, and watch a nine hit on the last card, so instead of having the chip lead, I am out. Watched some of the Pats game. Cleaned the kitchen and the bathrooms. Read some of my Lonely Planet: Bolivia. I’m probably going to go next May with the hospital group.

Slept restfully.

Dry Aged Steaks

Got to work, checked out my equipment, went to bed. At eight-thirty the tones went off, and I didn't get back to the base until almost two. I was only working eight hours as I had my best friend from Boston coming down for the night to grill steaks and drink beers.

The first call was for chest pain -- a ninety-one year old lady who lives alone. She was very nervous and kept trying to delay getting on our stretcher. She wanted to get a different pair of slippers, she wanted to make certain the back door was locked, she wanted to show us her meds in the kitchen herself, she wanted to call her son. Her heart rate was going around 150 in a sinus tack. Once we finally got her in the ambulance, she calmed down and her rate came down into the 80's. I've brought her in before and she is always ghard to get to go.

The second call was for a person unresponsive found by her daughter who came over to visit. It was either going to be a diabetic, a stroke, or a code. As we came down the hallway of the elderly housing facility, we could hear the AED's telltale sound: "Check for pulses, if no pulses resume CPR."

She was laying on the floor in the kitchen right by the front door. She had foam on her lips. The officer doing CPR told me she was very warm. I intubated her, tossed some epi down the tube, then got a line and gave her some IV drugs. She went from an idioventricular PEA into an accelerated PEA to vifib. I shocked her twice and then we had a rythmn with pulses. The capnography reading went up to the high twenties. I hung a lidocaine drip, gave her some fluid and we brought her in. She was still holding her own when we left.

Her family had come to the scene and were crazy with concern. I stopped on the way out the apartment door and gathered them around and told them her condition was very dire, we had her heart back beating, but were still breathing for her. I told them if they wanted to say something to her now, she might be able to hear them. Just take a quick moment, then we had to be on our way. They told her they loved her, and squeezed her arm, and then we were off. At the hospital, I happened to walk by the family room where they were seated, and our eyes made contact. I saw they had started to rise to say something to me, so I stopped and went in and talked to them for a moment, asking if the doctor had spoken with them yet. He had, they said. I said my thoughts would be with them. They all shook my hand and thanked me.

The next call was for a thirty-nine year old woman with chest pain for two days who said she felt like she had pulled a muscle. The pain increased on movement and deep breathing. She had good vitals and was a sinus on the monitor.

My relief was there when I got back, so after restocking and inputting my calls in the computer, I headed out, stopping at the new healthy foods supermarket that had just opened in my town, where I bought two dry aged New York Strip steaks, some big Idaho potatoes and zucchini. At the liquor store I bought several 24 ounce Coronas for me and 24 ounce Beck's for my friend.

We had a good night, drinking beers, playing music from our old drinking days (mainly Southern Rock -- Marshall Tucker, The Outlaws, Elvin Bishop, Commander Cody, Little Feat with some Johnny Cash thrown in) and catching up.

It was good to have some time off.

No work tomorrow.

Controversy

The Following appeared on Lou Dobbs CNN show:

DOBBS: Tonight, new worker outrage on the Gulf Coast. Emergency medical workers who hail from Ohio, who risked their lives during the Hurricane Katrina disaster, say that they were rewarded by having their pay cut in half, and they want that pay back. And they're ready to take the fight all the way to Washington, D.C. Lisa Sylvester reports.

(BEGIN VIDEOTAPE)

JOE KUNKEL, PARAMEDIC: I got bills.

LISA SYLVESTER, CNN CORRESPONDENT (voice-over): Joe Kunkel is a paramedic in Akron, Ohio. When Hurricane Katrina hit, he and 15 others from his union traveled to New Orleans to save lives while dodging hazards from snakes to sniper fire.

And how were they rewarded by their company? They say with a 37 percent hourly pay cut.

KUNKEL: It's pretty much derogatory from our standpoint, for the guys that are doing the job. You know, we go down for two weeks at a time on a minimum deployment, expecting, you know, to at least be paid our compensated wage for our collective bargaining agreement.

SYLVESTER: Under that agreement, (ambulance company name) pays a paramedic with five years' experience $14.17 an hour. But (ambulance company), under a 24-hour schedule, slashed wages for relief workers, offering only $8.83 an hour. A one-year paramedic made only $7.31 an hour, a little more than a fast food worker would earn.

At the same time, federal records show (ambulance company) raked in $8 million in FEMA contracts. (Ambulance company) declined to do an interview, but in a statement said: "Under the (ambulance company) pay plan, the weekly wages employees earn during their deployment were equal to or greater than their scheduled weekly wages at their home location.

DAVID HOLWAY, PRESIDENT, IAEP: If you take a look at the amount of hours these people were working, they should have received a lot more in salary, in benefits for that period of time. So the company, (ambulance company) pulled a bait and switch.

SYLVESTER: Ohio Congressman Steve LaTourette wants Congress to look at this contract and others awarded by FEMA.

REP. STEVE LATOURETTE (R), OHIO: You think the danger that we had in the Gulf Coast in general is profiteering. When you have these large contracts, it appears you can pay people whatever you want to pay, and it looks like the rest of the money goes into the profit column of the corporation.

(END VIDEOTAPE)

SYLVESTER: The union accuses (the ambulance company) of violating the Federal Service Contract Act of 1965 that ensures service employees a prevailing wage, and in Louisiana for paramedics that's at least $13 an hour. According to records obtained by the union, the company was being paid by the federal government $115,000 a month, but paying only $25,000 a month in salaries -- Lou.

DOBBS: And there's no straight line budgeting for per hour employee on that contract?

SYLVESTER: No, there isn't. It's one of the things that you have to look very carefully at the hourly wage versus the weekly wage. The company says, hey, if the weekly wages were the same as what you made, but these folks were making so many more hours, and they say their hourly wage should have been higher.

DOBBS: And of course, under the waiver of the Davis-Bacon Act, prevailing wages are not even relevant here, thanks to the president's waiver.

Congress is now set to vote as early as this week on a measure that would reinstate the Davis-Bacon Act on the Gulf Coast and force employers to pay the prevailing wage. Congressman George Miller of California is leading the fight to overturn President Bush's suspension of Davis-Bacon. He joins us tonight from Washington. Can you get your measure through Congress, a Congress run by Republicans?

REP. GEORGE MILLER (D), CALIFORNIA: I think we can. I think we found a way in which we can present this to the Congress. We have strong bipartisan majority in favor of overturning what the president has done. We lost in the Education Committee last week on a party line vote. There will be another vote I believe in the Transportation Committee maybe later this week, and then on November 4th, we have a right, the parliamentarians in the Congress have told us we have a right to an up-or-down vote on the floor of the Congress, and I think at that time, the bipartisan majority that we have will speak to this, and we will overturn in the House what the president has done to undermine the wages of workers in the Gulf Coast area.

DOBBS: At the point of which the federal government is giving cost-plus contracts, no-bid contracts out to the tune of billions of dollars, what sense in the world does it make to you, Congressman Miller, that this administration would be motivated to deny prevailing wages to workers in construction of the Gulf Coast?

MILLER: Well, they just caved in to a group of right-wing ideologues that hate this law. They've hated it for the 30 years I've been in Congress. And the insult to the taxpayers and the insult to the workers was that at the same time, they were handing out no-bid contracts, which led to the abuses that you just had on the previous story, that Congressman LaTourette was calling attention to. That the contract awarded had nothing to do with the cost of labor and the benefits just flow to the bottom line of Halliburton and Shaw Industries and these others that immediately got no-bid contracts, and the workers had no protection for the wages that they would be employed at.

DOBBS: Congressman George Miller, a good friend of working men and women in this country, we thank you for being here. And as you referred to Lisa Sylvester's story, Congressman, I'm sad to tell you, you ain't seen nothing yet, as the saying goes, from Louisiana. We'll be talking to Senator Mary Landrieu about the same issue with some remarkable people who were caught up in the same issue, Davis-Bacon.

We thank you very much, Congressman Miller. We appreciate it.

MILLER: Thank you.

***

I first read the above on an ems mail list. There followed a number of posts expressing outrage at the company. I also learned that a union in my area who had sent people at the same time I was there – many of who volunteered to stay longer -- had filed a grievance against the company on the pay issue. I have for the most part avoided posting anything on the list in recent years because the debate quickly deteriorates into name-calling, and everyone has to get the last word. Still I was so shocked by the story that I felt I had to post about my experience. I wrote the following:

I went down in September from the (my city) division. We had a three page list of people who volunteered to go. I didn't ask what the pay rate was when I volunteered. Maybe others did. Most I talked to didn't. Before I left I was given a memo, which detailed how I would be paid. I didn't have any objections to it. It seemed reasonable to me.

I was there for eight days. While I was paid less than my normal rate, I was paid 24 hours a day despite only actually working on the road a maximum of 12 hours. Some days I worked less. I was paid about $13 an hour for the first 40 hours of the week. The remaining 128 hours were at an overtime rate of an estimated $19.50. I grossed over $3000 for a full seven day pay week. (My next pay week included a 24 hour day at the $13 rate, then my regular overtime rate of $33 and some odd change kicked in after 16 hours of regular shift work.) I didn't have to pay a dime while I was down there. I had breakfast and dinner cooked for me( it was excellent food -- steaks, fried catfish, crawfish pasta -- good fare), and was given MREs and drinks to take on the road. Many of the people who were down there volunteered to stay extra time with full knowledge of what they were being paid. Some in fact stayed because they could make more money down there than they could up here. I have no idea what (the ambulance company) was paid by FEMA -- but I can say they delivered a good product. EMS was covered in Southern Mississippi. If you were sick, you got an fairly timely ambulance, despite bridges being out, road signs missing, and mega traffic jams.

My experience was a positive one.

***

I wasn’t certain what type of reaction my response would provoke, but I soon found out. The main poster who objected to my post made a valid point that the people who had gone in the first two waves were given the pay policy because it hadn’t been decided upon yet. He went on to say union contracts need to followed, inferring that the pay should have been at the regular rate I’m assuming for all 24 hours for all 7 days of the week. In subsequent posts to other responses, he continued to assert his pay had been cut by 37%.

I was torn whether or not to respond. On one hand my personal feeling was that it is hard for me to complain about the wages when I made so much money, particularly in helping people who had nothing. And while I don’t like to see the company I work for badmouthed when in my view, the shots were off-target, I also do respect the need for workers to stand up to companies when they feel they are being taken advantage of, and I understand the anger many medics feel about being paid so little for the valuable work they feel they do. I believe it was this long burning anger that fueled their actions. I think it was a bad move – in a public relations game it compares to recent union protests that in a nearbye city a few years ago kept defibrillators off fire trucks because the union wanted compensation for training, and most recently ended a school after school snack program because a union protested that teachers were handing out the snacks and not union cafeteria workers. Sometimes standing on a principle makes you look pretty silly and self-centered. While I admire union people who fiercely try to hold the line( and we need such people), some fights may cost you more in the long run. I would have a hard time pleading poverty and victimization when I probably made more in a week than one of my Mississippi EMT partners(who lost everything) could make working in ten weeks at their normal rate of pay for hours of work.

***

I ended up writing the following, but then choosing not to post it. I feel I made my point in my initial post, which was simply – I made good money when I was there.

I was in the third wave and thus had the advantage of being informed how I would be paid just prior to leaving. I made over $3000 for a seven day pay period. In (my city), I am paid per hours worked on the ambulance. In Mississippi I was scheduled to work 72 hours during that seven day period. Day one was travel. Days 2-7, 12 hour shifts. (One day I was brought in six hours early because they needed to send the truck I was in to Texas to prepare for Hurricane Rita. They told me to take the rest of the day off, even though I had already arranged to go out with another employee whose car was in because his partner was sick. They said it was slow and they had enough cars on. Many people in fact were given regular days off.)

So here’s the math using the following pay rates -- $22 regular $33.50 OT.

72 hours at Hartford rate -- 40 hours at $22 ($880,) 32 hours at OT at $33.50 ($1072,) Total pay $1952.

Instead I made something like $3069. To have made that money in (the city) I would have had to have worked 40 hours regular time, plus 66 hours of overtime for a total of 106 hours or about seven 15 hour shifts. Additionally I was fed excellent food and drink and had my laundry done for me, and had no commuting expenses. It was a good week for my bank account.

I guess the argument is that I should have been paid my regular rate 24 hours 7 days a week (which would make my check about $5000 in that case – nice!), even though I would not be expected to work but a half of those hours (even nicer!). If people in the first two weeks were told they would be paid at that rate, then they understandably have a beef, and should be compensated.

But for those whose working and pay experience were similar to mine, I would find it somewhat disingenuous for those of us who knew what we were getting paid, to complain, “They slashed my pay by 37%,” without adding, “but they only made me work 12 hours a day and they paid me for all 24 even when I was sleeping so in the end I made more money than I would have under my regular rate.” I’ll take that deal today if (the ambulance company) wants to pay me that rate 24-7 in (the city) with OT kicking in after the first 40 of every pay period. The math says, “That’s a nice raise, not a cut.”

Now it seems there are two issues that are underlying people’s contentions here. One, paying us a different rate is a violation of the union contract, and we can’t allow union contracts to be violated. If (the ambulance company had said, okay, everyone will be paid their regular rates, but only for hours worked as stipulated in the contract, and we’ll pay for your commute, plus lodging and all food on us, the contract would not have been technically violated, but we would have been paid less money. (If we want to get technical with contracts, at least according to the (city) contract, the work would have had to have been offered to part-timers first.)

The second, and perhaps biggest concern, seems to be that (the ambulance company) made millions at our expense, and we deserve a share of the windfall. If profit sharing is in our contract I haven’t read that provision. I have no idea what (the ambulance company) made or what their costs were, nor do I have any illusions that they are charitable organization. (If the government slapped the money down on the table, I’m sure they took it. At least they did the job.) And if they did make money, then the place for us to get our share is in our contract negotiations. I am proud to be a union man and believe we should try to get all we can from the company. Maybe all those nebulous millions are why, after we voted 125-3 to threaten a strike notice, (the ambulance company) finally gave us a decent contract offer with a 14% raise over three years. Not everything we might want, but better than in the past and a hard figure in these economic times for a union like ours to wave in front of an apathetic public and say look at poor us.

We all believe we are underpaid and it makes us angry, but frankly the public doesn’t care about us – they have their own problems. And you can talk about commercial versus municipal, but most of the municipal EMS services that have been sprouting up around here in the suburban towns, don’t pay so well either.

I stopped posting to this mailing list long ago, but I felt that the CNN story of workers’ complaints did not mirror my experience, nor those of most of the people from our division I know who went down there and many of the people from across the nation who I talked and worked with who had been there from the beginning – many of who asked to stay longer. I didn’t get screwed like they were saying we were getting screwed. If the full story was told to CNN, I don’t think it would have had the shocking news value the story did.

I respect everyone’s right to have an opinion and I believe in giving (the ambulance company) hell when they deserve it (as I have done often in the past). I just think arguments are most effective when the disclosure is full. And I wouldn’t have picked our Hurricane Katrina experience (at least as I experienced it) as an example to wave in front of the public. I don’t think it helps us as a profession or as union members.

***

I just couldn’t click the send button. Why inflame people’s anger? “Winning” an argument really isn’t important. What’s important is that you honestly say what you feel and allow others to do the same.

***

I was pleased that I waited because there appeared a number of posts that changed the debate to a higher level. I quote from one:

“While not involved or from any of the effected areas. I would like to say thank you to all of those who were deployed. And no matter what the pay rate or feelings about it, I am surte that all of those deployed did so from the heart and not as a making money plan. I am also sure that each individual that went down there showed the upmost professionalism. There are plenty of individuals such as (paramedic name) that are still down there. While I know some of those who were deployed, I am proud to have served with them in the field. And for those who I don't personally know who responded and are still thinking of responding, You bring great pride to this profession by showing the true face of those in EMS.”

And another:

“thank you. the gratitude from nearly everyone i encountered while in mississippi was overwhelming. from nurses, to mds, to the cashier at the makeshift wal mart in a tent, people were amazingly strong and gracious. i had one cardiac pt whose defibrillator was firing and he didn't make a peep until he asked me where i was from (we apparently have funny accents up here), after which he got choked up and thanked me profusely. i've been quiet regarding the pay issue because i have mixed feelings about it, but i think all of us who spent time there have come back with a greater appreciation for what's important in life (beer, since fema didn't allow us to drink). while i wouldn't call them 'perks', i'm continually grateful for the opportunities that this profession makes available to me.”

***

I too am grateful. And I respect everyone who has stayed in this field over the years when they could have gone on to more lucrative – at least financially – pursuits.

***

Only two calls today -- same address -- same doctor's office -- same patient -- transported to the same hospital. Lady with a cough and clear phlegm production goes to doctor's office, says she is having trouble breathing. They give her a treatment and call us. We take her in. She gets another treatment at the hospital and is given antibiotics. She goes back to doctor's office to get a note to get out of work, starts coughing, tells doctor she feels like her throat is closing. They call us again. We take her back in. She is very stable.

Digital Camera

My week turns on the first two hours of every Thursday morning. Since I am coming off three twelves in the city with my Wednesday evening shift not getting me home until ten at night, I need a quiet Thursday morning. I like to get to work at six, check my gear, then get in bed and sleep for two hours. If I can do that, I'm good to go, but if I get a call -- like this morning again -- shortly after I've walked in the door, I will drag the rest of the day, and on into Friday and then Saturday. Its just how it always seems to go.

At least my precepting student is here today, so its good for him to get a call, and I don't have to do too much, but sit back and watch.

It is steady today -- four calls.

An old man from the nursing home with chest pain, a woman at the doctor's office with chest pain, another woman from another doctor's office with dark stools, and then a good motor vehicle crash.

An old man probably falls asleep as he drives, drifts off the road and smashed into an old fashioned stone wall. Air bags go off, he comes to at some point finding himself in the passenger seat, bleeding from the mouth with a pain in his side. My preceptee did a fine job extricating the man, and then while he and my partner wheeled him to the ambulance, I pulled out my little digital camera and snapped off a bunch of photos to show them in the trauma room. On the way, my preceptee held off doing an IV until he had done everything else, full survey, vitals, oxygen, monitor, history taking, then and only then did he pop in the line. I try to teach my preceptees that in trauma what matters is getting the patient to the hospital. I had one preceptee once who despite all my lecturing in advance, the first big trauma we had, she grabbed a 14 guage needle and stuck the patient. She had no vitals, no assesment, much less a bag spiked or lock drawn up. She sat there looking at me, wondering what she should do now that she had an big catheter in the man's arm and nothing to do with it.

In the trauma room, after my preceptee gave his report, I showed the docs the photos. They were impressed. It made them take the patient who was alert and stable more seriously.

No Laurels

I did not write fully about my last call last night. My partner and I talked about it this morning as we did last night as soon as we had cleared the hospital. I apologized to her for the way the call went. I was embarrassed by it.

Here’s what happened. An hour before crew change, we get called for a fall. The 930-2130 shift is a ballbuster, but the one grace is we usually get out on time. Starting around eight, the dispatchers protect us if possible, holding us in reserve only if necessary. We were both tired.

The call is in a town where another medic responds in a fly car. He arrived just before us. We found a man laying on the floor. He said his back and hip hurt. The medic poo-pooed it. I tried to ask him questions about how he came to fall and where and how exactly he hurt, but the medic was already trying to get him up. The medic said he hurt because he had been laying on the floor a long time. The patient was elderly and had Parkinson’s and I thought well, maybe he’s right,maybe maybe he just had bad balance, fell and couldn’t get up. Maybe he had a touch of dementia as well as his speech was slow. Without going through everything, I let the other medic have his way instead of insisting on doing it my way. While it was technically his call until he turns the patient over to me for transport, in practical terms, I usually assume control over the patient when I arrive and that is usually fine with the fly car medic. Tonight, though in the back of my mind I want to believe the man is not hurt, that we can get a refusal and I can get out on time and get home, maybe have one beer, check my email, then lay my head on the pillow. So instead of c-spining the man, or at least lifting him gently from the floor, or erring in any way on the side of caution, we stand him up, and when he says he doesn’t feel right, we sit him down in a chair. We call his wife and wait for her to come home from her dinner out, thinking maybe she will say this is his normal and decide not to have us transport. She is a retired nurse who works on one of the floors that is notorious for treating EMS with disrespect. (This is an opportunity to show her what EMS can do, and I can only say I am glad she is not there to watch us bumble). While we wait for her, I take the man’s pulse, except I can’t feel it long enough to count it. The other medic scoffs and tries to take it. He says its sixty and regular. I ask if he is sure. Then he admits he can’t feel it well either. So we put the man on the monitor and he is in an afib at 80-100. Nothing too shocking there, but the man seems a little clammy now and so instead of waiting longer for the wife, we get him on the stretcher. I pick him up under the arms, and the other medic, grabs his legs, but he doesn’t lift high enough for us to put him(the man weighs 250) on the stretcher, which keeps rolling farther from us as we try to step toward it, and the man meanwhile starts complaining again of pain in his hip. We finally get him on the stretcher, his wife comes, says he looks a little pale and agrees to have us transport. When we get him in the back of the ambulance, he tells me he has neck pain. At this point, I don’t really see how I can c-spine him. I am saying to myself, you are an A-hole. While you know the man is unsteady on his feet, you don’t know if he tripped or got dizzy and fell, he could have a hip injury or heaven forbid, although unlikely, a spinal injury. And you call yourself a paramedic.

Anyway, as soon as the call was over I told my partner I should have taken control and done what was right. She said she saw I was trying to do right. I say it is my responsibility to see that right gets done, and I apologize again.

Bottom line I found out today the guy was fine, no broken bones, sent home the same night. Whew!

Calls like these are good only in that they catch you before you let your standards slip again. In EMS you have to prove yourself every call. There is no resting on laurels. I resolve that the next time I disagree with a fly car medic I will simply say, you can do that, but you will be riding in with the patient and I will following in your fly car.

Today I resolve to be a stellar medic.

It’s now five in the afternoon (I have a new used $200 laptop) and we have not really been tested today. An MVA with two patients – I insisted on c-spining one of them who had midline back pain – a woman with weakness, a nursing home patient going in for day surgery of a growth on his neck, a psych patient going to the psych hospital, and a woman blown over by the wind, who suffered a hematoma on the back of her head, but no loss of consciousness. What I have been today is friendly, I’d like to think compasionate, and thorough in the simple tasks, making certain the patient is made as comfortable as possible, doing a full assessment and giving good reports at the hospital, both written and verbal. And of course, clearing in a timely fashion.

*

The one funny moment was when as I was trying to assess the patient’s neck and spine, her son kept saying. “Really, its cold here, can we get her in the ambulance? Can we get her out of the cold now!”

“Just a moment,” I said, “I need to check her neck.”

“Please, please, she’s cold. You must get her out of the cold.”

“Just give me a moment. I have to make certain she doesn’t have a neck injury. It will affect how I treat her.”

“But it’s cold,” he says, then looks up at the sky in exasperation.

She checks out fine, so I have her sit on the stretcher.

“What hospital are you going to take her to?” the son asks.

I tell him the hospital just up the street.

“Can you give me directions?”

“In a moment, we just have to get her in out of the cold.’

“But I’m from out of town. Just tell me how to go.”

“In a moment,” I say. “She’s cold, I want to get her in the ambulance.”

“Will I be able to follow you?”

“Yes,” I say, “I’ll give you the directions, but first we just have to get her in out of the cold.”

*

We do a call for a one year old who has had his arm pulled out of his socket. The police come and question the mother. There are three mothers, six kids and a man in woman’s clothing brushing his hair in the sparse apartment. Two of the kids are slrrping. The one year old is in his aunt’s arms and she says he only crys when you touch his arm, which hangs limply by his side. The officer questions everyone. The story is one of the other children grabbed his arm and pulled, while he resisted. It seems to be a good story. The women all admit they have DCF cases, and they cooperate. They have been through this before. I finally get the kid and lay him gently on the stercher where we pad and secure him. He sleeps all the way to the hospital.

*

Last call is for a man with a CVA history, who can’t keep his balance. He says there is nothing wrong with him, while after sitting him up, we watch him slowly sink backwards until his back is laying flat on the bed.
*

We punch out on time.

Not a bad day. Not too much stress. Steady enough to make the day go by. All the patient’s and their families were nice. No one gave us a hard time, and we gave a hard time to no one.

El Sol no brillaba

It is pouring rain, hard cold, wind-driven, diagonal rain that hits you in your face and makes you walk on a slant. You get drenched before you can even put up the hood on your rain coat.


First call is at the Spanish Market for a man unconscious. It turns out he was just sleeping. While we are there, I go visit my favorite Spanish carryout stand and get boiled green bananas and root vegetables.

**

I practice some Spanish. I take it from the Cat in the Hat, El Gato Desombrerado.

El Sol no brillaba.
Hay demasiado mojado.
Es un dia para sientar adentro de la case.
Un frio, frio, dia mojado.

The sun did not shine. It was too wet. A day to sit inside the house. A cold, cold, wet day.

***

Next call is a nursing home transfer. As a paramedic you face many obstacles. Each situation is unique. How do you treat the person passed out behind the toilet? How do you get the man out of the back seat of the smashed car? How do you get the guy out of the ditch?

What is a smaller, but more everyday occurrence is -- how do you get the person out of their bed in the nursing home? Nursing home rooms are small, tight enough for stretchers without throwing in furniture in the rooms. Dressers, TVs on big stands, bedside tray. The man tells us to turn off the TV, and be careful wheeling the desk it sits on. He says yesterday, the leg broke on the stand and the TV fell. I move it very carefully. Then I move the bed stand that has a pitcher of water on it, the telephone, a half eaten breakfast, some pens, paper and glasses. I try to lower the bed rail, but it will not budge. It seems every bed in every nursing home and hospital has a different mechanism to raise and lower the side rails. I understand this mechanism, but it is broken. The rail will simply not go down any further, leaving it jutting up about three inches above bed level. We unlock the bed and pull it from the wall, place our stretcher next to it, then place a pillow on the bed rail, hoping if we lift the patient up the extra three inches, it won’t hurt when we move him across. I take the patient side. I will have to lift high and maintain it all the way across the bed. We lift on the draw sheet. The man is moderately heavy and as we pull/push him across, I lose my balance, and fly forward. My foot comes up and kicks his roommate’s bed stand, knocking over his pitcher of water and sending his false teeth dish chattering across the floor. I apologize profusely. They don’t appear broken. We take the patient on his way to dialysis – another situation handled.

***

We do a wait and return at the wound care center. The company doesn’t like us staying more then twenty minutes, so we always ask how log the patient will be. If they say more than twenty minutes, we clear and give them our number to call when the patient is ready. Most places are wise to us – they say twenty minutes, and when twenty minutes passes, they say just a little longer. Over and over. Today, the doctor says fifteen minutes and sure enough, she is done in fifteen minutes.

***

We get sent for the pedestrian stuck at the intersection of two downtown streets. We think it can’t be too bad because the traffic is so congested down there, no vehicle ever gets up much speed. We can see two fire trucks out ahead of us. There have been no updates on the radio demanding our ETA, telling us to hurry because the patient needs paramedics now. We pull up to the scene. I can see a crowd gathered under umbrellas around someone sitting up on the curb. I tell my partner it looks like nothing.

I get out and approach. I see a girl maybe eighteen talking to a policeman. She has a small hematoma on her forehead and a slight abrasion about it. I ask what happened. Everyone starts talking. “She got hit by a bus.” “She done fly through the air.” “That bus driver he should look out. He got to look when he turn.” The officer says she was hit. No LOC. “They say she flew through the air,” he says, raising an eyebrow.

I introduce myself to the girl. She tells me her name and tells me she has a headache. I ask her what happened and she starts telling me a long story about how she was just walking across the street and … All I am really interested in is that she is alert and completely appropriate in her answers and actions. I ask her if she has any pain in her neck or back and she just says she hurts all over.

We c-spine her, and get her in the back of the ambulance out of the rain. I tell my partner to head to the kid’s hospital on a low priority. En route I take vitals and finish my full body survey. I call the kid’s hospital to let them know we are coming. Normally I might not even call, but lately there has been a bit of controversy about kids and trauma, due mainly to one major call where a child died in the kid’s ER after the ambulance tried to take him to the local trauma center but was diverted. The kid’s hospital is operating under different protocols. I patch in, trying to stress that the kid is stable, unhurt except for the headache. They want to know full vitals. 110/70, 88, 18. They want to know how fast the bus was going. Slow, I say. They tell me to hold on. Finally they come back on and tell me to go to the trauma center. Okay, whatever.

We make our way there. Without even looking at the patient, they call a pedi-trauma alert. They are just going by protocol. The girl who is the size of a normal adult is 15 so she gets the full workup, wheeled down to the critical hallway and met in the big trauma room by several staff done up in gowns. I give my report. Struck while the bus was turning the corner. No amnesia. No LOC. Good vitals. No deformities, just the hematoma. Completely appropriate. They smile and nodd. When I bring my run form back, she is getting full body X-rays.

The nurse is apologetic. I had to call pediatric trauma, she says. Pediatric hit by bus. I don’t want to go to court and have to answer why I didn’t call a trauma. But, members of the jury, parents and grandparents, the child – the poor child -- was struck by a bus.

Last year a kid was in a bad motor vehicle accident -- the crew wanted to take him to the trauma center, but they diverted him to the kid's hospital over the medic's objections. The kid died four hours later in the ED because they were too concerned with his broken leg to pick up on the fact his aorta was about to rupture. The upshot was medics can overrule a diversion request if they think someone needs the trauma center, and the kid's hospital has become very skittish about any pedi trauma.

***

We do a woman who cut her hand with a knife while making soup. The floor sink and kitchen are splattered with blood. She looks like Julia Child as played by John Belusi on Saturday Night where she bleeds to death, while talking to the audience and trying to control her bleeding. She finally tries to call 911, but the phone on the wall is just a prop. Very funny. The dressing on this lady’s hand is soaked through. I take it off and hold pressure hard for ten minutes. Finally it stops. She refuses to go with us, and says she’ll have a friend take her to the walk-in clinic.

***

Still rainy. Its dark. We’re sitting here listening to the rumble of the diesel engine, Three hours to go.

***

Last call is for an old man with Parkinson's who falls and has shoulder and hip pain. We get out late.

Lawyers, Guns and Money

Had my preceptee back today after a couple week absence.

Started off with two COPDers with mild dsypnea.

Then we got called for a psych at the Y. The downtown Y is pretty much just a homeless/psych ward these days. We knock on the guy's door. Two ladies from mobile crisis, two medics, an EMT and three cops. The guy -- a large man -- sticks his head out of the door and starts harrassing the ladies, then he turns his head, sees us, and changes his tune. He is suddenly thrilled to be going to the hospital where he can then be transfered to the pscyh hospital. I guess his room is only paid through the next day. He gathers all his stuff, a couple bags, a boom box and big red electric guitar. "I'm happy to go, happy to go, coming right now. Let's go, let's all go." I have Haldol and Ativan in my pocket because we have heard he could be violent. But he is all smiles and babbles the usual psych babble about working for the CIA. "I'm an agent, that's right, that's me, but I'm ready. let's go, let's go get debrieved. I'm ready to come in from the cold."

We get to the hospital, and as we're wheeling him in, he starts changes his tune. "What's your name?" he demands. "What is your name?"

"Warren," I say.

"Warren what?"

"Warren Zevon."

"Bullshit! Give me my guitar. I have a summons for you. I have a summons, and when I am done, I will have all your money. Now give me my guitar. Don't you touch my guitar." He tries to grab the red guitar from me, but I keep it out of his grasp. I am worried he will try to EL Kabong me.

Now we are in sight of the triage nurse, and he really starts shouting. "I will destroy all of you. I have a summons in my bag and you will all be mine, motherfucker's!" He is now shouting at the top of his lungs and punching his fists together. I stand behind the stretcher. If he starts to tip it, I can grab it, other than that let him shout. The hospital security starts to gather and he is harrassing them now. "Com'on motherfuckers, comon sissy boys. You ain't tough. I have summones for all of you and I will own all of you!"

The nurse wants his jacket off and him searched. Securiy holds him down and we lower the stretcher so if he does fight, he won't tiopple the stretcher. He doesn't resist, but he continues to shout at them now. "Go on take my clothes! Go on rape me! Show your wives you like dick!"

A doctor comes to the front and orders Haldol and Ativan for him. She glances at us like why couldn't we have sedated him. I have the drugs in my pocket. "He was fine until he came in the door," I say.

"Rape me, rape me motherfuckers. I know you all like dick!"

We take him into the pscyh ward where the guards four point the man to the bed.

I stand outside the room holding his red guitar. I strum a few chords.

I sing:

Well, I went home with the waitress
The way I always do
How was I to know
She was with the Russians, too

I was gambling in Havana
I took a little risk
Send lawyers, guns and money
Dad, get me out of this

I'm the innocent bystander
Somehow I got stuck
Between the rock and the hard place
And I'm down on my luck
And I'm down on my luck
And I'm down on my luck

Now I'm hiding in Honduras
I'm a desperate man
Send lawyers, guns and money
The shit has hit the fan

Send lawyers, guns and money...

Lawyers, Guns and Money
-Warren Zevon

***

We take a lady with a head ache back to our most distant hospital. It seems this is her second ambulance trip today. She says they told her if her headache got worse she should come back. The firedaepratment has told us she is a frequent flyer. My preceptee says he remembers her from a couple weeks ago. I don't recall her. We get to the hospital and the doctor is perturbed to see her. A nurse says this is her 12th trip this week to the ER. She evidently has worn out her welcome at the nearer hospitals as well.

***

Last call is for a diabetic with a sugar of less than 20. She is very old and thin and pale and cold. My preceptee gives her 25 grams of D50. For a moment she looks like she is not breathing, like she dead.

She comes around slowly.

***

By the end of the night it is pouring rain again.

diabetic

Stuck

Earlier in the morning a car wiped out a telephone pole, bisecting it , and blowing out the powerlines exploding transformers all the way down the street, leaving half the town without power.

We get called for a lift assist. We find a 91-year-old woman sitting in an electric chair with her feet up. "I'm stuck," she says. "The electricity is out."

We consider calling the fire department to bring in a generator to power up the chair. Naw! We lift her out, and set her in a smaller chair. She tanks us kindly and we are on our way.

***

What do you do when someone you work with has unremitting BO? I'm not saying it happened today. I'm just asking what do you do? Do you say something? It is not an everytime occurance. Or do you roll down the window and stick your head out in the rain? That bad.

***

A 25 year old who had no breakfast feels dizzy in a store. Refusal.

A woman at a health fair has sudden onset chest pain. It hurts more when she breathes and moves. Her skin is warm and dry. There is no dsypnea. The first responders had a nonrebreather on. I put her down to a cannula. The doctor on scene questions my decision asking if it is wise given her chest pain, wouldn't the mask be better? No, I'm confident the cannula is fine, I say. That's good enough for me. She looks well oxygenated. He says nothing. I didn't slam him and he wasn't impolite in his suggestion. The lady is discharged two hours later.

I read an interesting article about too much oxygen.

Giving Oxygen May Do More Harm Than Good

The AHA says a cannula is fine. That's good enough for me.

Oxygen
Administer oxygen to all patients complaining of ischemic-type chest discomfort. Also administer oxygen, usually by nasal cannula, to all patients with suspected ACS.
-AHA ECC Guidelines 2000

***

A motor vehicle. Two big big patients. Fortunately no neck or back pain. They both go in for evaluation.

***

Got an interesting link on an email group that I have been watching tonight. It is a lecture that challenges many dogmas about EMS -- dogmas that many of us feel need to be changed.

A>C>L>S> -- What's USEFUL, WHAT's USELESS

The lecture given by an Emergency Physician is anti-working dead people, anti-lights and sirens, anti-helicopter, anti-ACLS drugs, anti-politics, anti-baloney.

***

Pouring rain tonight. Go to a difficulty breathing that turns into a refusal. Man has been drinking and throws up, but feels better.

Then we do a man with vertigo. He pukes all the way to the hospital.

***

The rain keeps coming down. Hard and cold.

Oh, I hope I get off on time.

Computers and Gloves

Only worked part of the day. I had it off because I worked Sunday for the Sunday suburban medic, but he had a meeting he had to go to for his non-EMS job, so I came in at one this afternoon. Did one call -- a COPDer with a respiratory infection. My partner here has finished fixing my good computer so I am psyched about that. I have spent most of the afternoon downloading programs using the DSL connection here. At home I have dialup. This morning I bought an old laptop so I can write in the ambulance. My partner is sprucing that up now, though it may not be ready until next week.

I will be very happy if I can write while I sit in the ambulance, not that I have had much down time lately.

I also worked out and did some errands this morning -- took a bag of change to the bank, bought three pairs of identical winter gloves. If you lose them on the job and it is cold, I always like to have a spare pair in my bag. I also have a habit of losing my left hand glove. If I lose a right, then I will be able to match the remaining left with the remaining right from another pair that I am bound to lose the left hand glove from.

I Really Would Like to Know

Two calls -- one I don't remember and the other that is burning me.

We are on the way back from the getting something to eat and stuck in a line of traffic when a car going the other way flags us down. The man says his wife is bleeding and needs directions to the hospital. We offer to take her. She gets out and it is readily apparent she is pregnant. I get her in the back and she tells me she is due for a ceasarian in a week. She is a complete placenta previa, and her doctor has told her if she starts bleeding, she has to get to the hospital right away. "She said I could bleed to death," the woman tells me.

In a complete placenta previa, the placenta covers the cerfix with the baby behind it, instead of the baby against the cerfix with the placenta behind the baby.

So we race lights and sirens to the hospital. The woman's panties and sweatpants are damp with bright red blood. I get her stripped and into a hospital johnny. It looks to me like part of the placenta is starting to deliver. I do not see any gushing of blood. She says she can feel the baby move down. She keeps repeating, "We're not going to make it."

Her skin is warm and dry, her vitals good. I assure her she will be okay, while I put in a large bore IV. I don't have much experience with placenta previa. She looks okay to me. The baby -- I don't know.

I call the hospital, and once we get there we go right up to the Labor and Delivery floor.

I tell them what is going on, they whisk us into a room. I get the woman off the stretcher onto their bed, then immediately I am aware of them staring at me, as I pick the straps up to get them out of the way of the wheels. "Yes?" I say.

"Thank you," they say again, but they keep staring at me.

The sheet I have placed over the woman is still there. The doctors and the nurses have made no move to pull it back to inspect the patient. They all continue to stare at my partner and I. I get it now. They are waiting for us to leave before they begin their examination of this woman, who I have already undressed, put into a hospital gown, and placed a trauma dressing around her like a diaper, after examining the protrudance coming out of her. As we go out, I hear a nurse tell another nurse to see that the door is closed.

Outside, I find a chair to write my report. I am not there five minutes when a nurse tells me it will be quite a while. "Excuse me," I say, "I am just writing my report up. My report for her medical records file."

"Oh," she says.

When I hand my report to the nurse -- I am not even going to try to go into the room to give it to anyone -- I ask another nurse who has just come out of the room, how it is going. She looks at me, and smiles, somewhat artificially. "They are all busy in there," she says.

The thing of it is -- I have been through this routine before. I know what this is about. In the ER, paramedics are a part of the team. In L&D, we are backwoodsmen. They are thankful we have brought their patient to them, and we can leave -- the door is that way. Talking to us, it seems is a HIPPA violation. I have brought a near delievery in before where I was staring at the head crowning, and made to leave immediately. Whenever they first see a patient coming in on a stretcher, they talk to the patient, ignoring us. I always step in, start a report and if they will listen, I give all of it. If they blow me off, they blow me off. I do my job -- I keep it short, pertinent, and end -- anything else you need to know will be in my report. they always give that fake smile like a banker who has turned down your loan and wants you to leave the bank quietly.

And it isn't just at one hospital, it is at both major hospitals, and it happens not just to me, but to just about everyone who brings a prehospital patient up there.

I'm tired of it.

I would really like to know how that lady and her baby were doing.

***

The other call I remember now was for a nursing home patient with a big psych history, who was most likely overmedicated.

Welcome to the Jungle

Today was better. Did six calls, but had a few periods of down time. Also my partner brought in his satellite radio so we played with that. It had whatever you wanted to listen to. Reggae, The Blues, Latin, Traditional Country. It had news channels and sports channels in Spanish. Whenever we went lights and sirens, it was my job to find a good song. We're racing down the streets with Santana, The Fabulous Thunderbirds "Tough Enough" or Guns and Roses "Welcome to the Jungle" as our soundtrack. It livened up the day.

I spoke Spanish nearly all day long -- either with patients, their families, staff in the hospitals or at the spanish restaurants. We hit all three of my favorite places. I had cerdo asada (roast pork) and yucca, sorullos(cornmeal and cheese), and chivio con morro y habecheros (goat with yellow rice and beans). I also bought a English/Spanish book. En espanol, El Gato Sombrerado, en ingles, The Cat in the Hat. By the end of the day I was just rattling off the Spanish. It is amazing what immersion will do for you, even temporary. One of the funny parts of the day was a insult rap off in Spanish my partner and I had. He got a Spanish speaking nurse to give him some insults because as a joke in front of Spanish kids, I often introduce him as "El mono que vive en el arbul con los animales salvajes(The monkey who lives in the tree with the wild animals)." It makes them laugh. Anyway, he was slamming me, and I was slamming him back. I won't list what we called each other, but there were some good ones in there. What I am finding is one of the best ways to work on my Spanish is when I am driving with a family member, I ask them if it is okay if I speak Spanish with them -- I tell them I am trying to learn the language. They always agree and we have nice conversations.

I am hoping to go to Bolivia in March with some of the same people who went to the Dominican last May. They are having a meeting on Monday about the trip. The only hitch is no one has called me about the meeting. I learned of it through a nurse friend who got called. So I am not certain if I am invited. The head guy invited me last May when he told me about the trip, but I didn't get a phone call. My friend thinks I am worrying about nothing. Of course I am invited, but I am worried since they are taking only a small group this time, since I don't work for the hospital I may be excluded, and since I am not a nurse, maybe I will be excluded. That's ridiculous thinking, my friend says. You are awesome. Just come to the meeting. They probably don't have a way to get in touch with me. We'll see. I just really want to be invited. I want to feel needed.

Here are my calls from today: A teacher with back spasms, a ten year old boy who got really angry and took a golf club to a stop sign and also chased some neighbors with the club, a guy who smoked angel dust and his family wanted him to get clean, a diaylsis patient with abdominal pain, a transfer taking back to the nursing home the woman we took in yesterday with abd pain post gall bladder surgery (the hospital found nothing wrong with her), and a diabetic who was drunk and passed out from too many beers.

As we took the guy who smoked angel dust out of his house, his mother kissed him and said, "I love you, you stupid cabron, you come back here like this again, I'll kill you." She squezzed his hand.

When I got home I found in the mail a bootleg CD I bought at EBay of the Springsteen Hartford Concert. Excellent sound quality. I set it on the CD player and listened to it as I lay in bed after I'd turned out the light.

Jesus was an only son
As he walked up Calvary Hill
His mother Mary walking beside him
In the path where his blood spilled
Jesus was an only son
In the hills of Nazareth
As he lay reading the Psalms of David
At his mother's feet

A mother prays, "Sleep tight, my child, sleep well
For I'll be at your side
That no shadow, no darkness, no tolling bell,
Shall pierce your dreams this night"

In the garden at Gethsemane
He prayed for the life he'd never live,
He beseeched his Heavenly Father to remove
The cup of death from his lips

Now there's a loss that can never be replaced,
A destination that can never be reached
A light you'll never find in another's face,
A sea whose distance cannot be breached

Well Jesus kissed his mother's hands
Whispered, "Mother, still your tears,
For remember the soul of the universe
Willed a world and it appeared."

-Jesus Was an Only Son

Bruce Springsteen

Getting Hammered

I’ve been getting hammered at work. My shift 930-2130 has no down time. You come in, you start doing calls and you don’t stop till its time to go home. Did eight today. A psych who was hearing voices telling him to stab himself, a young boy who choked on a vitamin, but was okay, a crack addict with pleuritic chest pain, an old woman in a doctor’s office who has altered LOC, a nursing home patient with abdominal pain, a woman who fell and bruised her ribs, a motorcycle accident, and a syncope.

Days like today I don’t know home much longer I can keep up this schedule.

Contract

Went to the contract negotiations that began at seven last night. I didn’t get out of there until 2:00 A.M. The final paperwork wasn’t finished until 3, but we came to a contract agreement. It was a very interesting experience, which I will write more about at another time. The bottom line -- I was impressed with everyone involved – my fellow employees, the team from the union, and management. There was give and take, compromise was made and I feel a decent contract was agreed upon – a contract which acknowledged the economic times we are in and the rising cost of heath care, and also acknowledged our worth as employees. Provided the union members vote to accept the contract, we will have a solid three-year agreement. There will be no job action and I will not have to sell my house or look for another line of work.

***

Busy Monday. Did three psychs, three abd pains, a dialysis transfer, a refusal, and a pneumonia from a rehab hospital going to a general hospital. The psychs were all teenagers, and all required efforts to keep the patients from fleeing. The first one was at a high school where a teen had discussed killing herself, but had no plan. The problem was when we got there there were three cops, three school staffers, three mental health crisis workers and the two of us, which is about eight people too many, maybe nine too many. With that many people you can’t let the patient save face or establish a good connection, so without that they have to act out even if they really want to the hospital. She had to be the bad girl, and try to run several times -- they had the cockamanie idea of letting her walk off some steam in the corridor, while being followed by eleven people. We just couldn’t get a chance to manage the patient. Once we finally got her in the ambulance with just her teacher, she was quite cooperative.

The funniest call was for a stocky teenager who had been causing problems at school, and did not want to go with us. There was just a cop, a security guard and us in the room. The school staff got out of the way, which was nice. The boy hid under a table and wouldn’t come out, so we had to go down and pull him out. Even though he was stocky, he was no match for the four of us. We got him on the stretcher, but he kept unlocking the straps, and trying to get off. My partner tried tying him down, but I’m not crazy about that approach. I got out my drugs and the cop got out his pepper spray.

“My finger’s feeling a little itching on this can of pepper spray,” the cop said to him.

“And this is a big needle,” I said.

“Or," my partner said, "you could just lay your head back on the pillow."

“It’s your choice,” I said. “We’re going to let you decide. Choice One, Pepper Spray. Choice Two, The Needle. Choice Three, you go peacefully.”

He looked at the can of pepper spray the cop was holding out like a housewife holding a can of lemon pledge. He looked at the needle I studied like I was Louis Pasteur. He looked at my partner, who held his hands open indicating his choice.

The kid didn’t look happy. He pouted and crossed his arms. “All right,” he said. “I’ll go.”

Repairman

My relief didn't show up last night at ten, and they were unable to get anyone out to cover me until eleven-thirty. I ended up spending the night in the bunkroom because I had to be back at six this morning. How sweet was it to get in bed, hear the tones go off, and not have to respond for the elderly patient with a high fever.

***

Got up at eight with a decent night's sleep under my belt -- I didn't sleep perfectly with the radio traffic -- but at least it was rest.

Got a call before I had even put my boots on. A seven year old who had a seizure for the first time. It was a little odd. He seemed like he had a slight fever, he had been having headaches for two days, his mother described him as shaking and stiff with eyes rolling back into his head lasting one minute, but there was no postictal period, no biting on the tongue, no incontinence. The only off finding was he had a fairly irregular heart rate. I know kids are prone to sinus arrythmia, but he was like two short beats, a long beat, two short beats, a long beat. Odd. The fever is possible, but I haven't heard of many febrile seizures starting at age seven. The shaking and stiffness certainly are indicitive of a seizure. I don't know. Headache, fever, irregular heart rate. Tumor? febrile seizure? syncope? We took him to the kid's hospital.

***

Driving back to town the sun finally broke through after eight days of rain. I could see a rainbow.

***

Continued to work on cleaning the supply closet and then setting up one of the ambulances that was trashed from a recent trip to Texas. The ambulance sent a crew to Texas to help out with Rita, they loaded it with supplies, drove all the way down there to do one transport -- a four hour trip evacuating two nursing home patients. One of the crew ended up in the hospital with dehydration. Anyway, the ambulance never got put back together properly so I worked on that.

***

We got a call for a 38 year old female having chest pain and difficulty breathing. I thought it was going to be BS, but when we got there there was an obese woman very diaphoretic, holding her chest complaining of tightness. I couldn't feel a pulse, although she was mentating okay. She said it had happened twice before where she had gotten this feeling and it had passed, but those times it had never been this bad. I put her on the monitor.

220.

6 of Adenocard took care of it and we had her back down to the 90's in a nice sinus. She was very appreciative. I love this type of call. I feel like a repairman. They call me in an emergency, I come right away bringing all my equipment. I diagnose the problem and fix it on the spot. She was surprised when I said now we still had to take her to the hospital.

***

In the hospital, she asked if chicken wings caused it.

***

There was one other funny moment on scene. She was a big woman and with all the rain her front yard was a muddy mess. We had brought the stretcher across the grass on the way in, but now with her weighing it down, we face a serious problem. Niether of my partners were very strong so the officer helped me lift the stretcher up, but as we looked across the muddy yard toward the ambulance, you could help but imagine the stretcher sinking deep into the mud, and having to get a wreacker to pull us out. The cop looked at the driveway next to the house which is blocked by his cruiser. He looks at the young man on my crew -- a nice, goofy kid -- and says, "Hey, pull my cruiser up a few feet so we can get by." The kid looks over his right shoulder, then over his left shoulder, and when he sees no one there and the cop still looking right at him,he points to his chest and says. "Me?"

"That's right, just pull it up a few feet so we can get by."

With a big grin, he gets in the cruiser and fumbles a moment trying to find the gear.

"Light'em up!" I call, "Hit the siren!" but he is too caught up to hear me.

He sets the car in gear and pulls up. I wish I have a camera to catch the picture.

"I didn't do it, I swear," I say, when he comes back, all smiles. "Got any tickets to the ball?"

***

On the way back from the hospital, we do a minor motor vehicle.

***

Tonight is the union negotiations. I'm tired, but feel I should be there.

Quarter to Ten

Pouring rain this morning when I came to work. Lots of standing water on the roads and sawhorses blocking off roads. When I pulled into the base, I saw the parking lot was filled with cars. Last night they had to evacuate an elderly housing area that had flooded. The ambulance bay serves as one of the town's shelters. The night crew told me about wading through knee high water. Not Mississippi, but still an impressive amount of water for here. I guess its supposed to stop raining today. Someone told me we had enough rain in one day this week that it would have amounted to 70 inches of snow for the day.

I slept for three and a half hours this morning. The cold rainy weather makes for good sleeping. Besides I was tired.

Did a TIA, then a couple refusals. An MVA and a kid who fell on his knee.

I spent much of the day cleaning out the store room. I'm in charge of ordering now and I needed to find out what we have and what we need.

I've decided better eating starts now -- or rather I decided that after having bacon, buttered rye toast and home fries for breakfast.

Had some Jamaican chicken soup for lunch and just had a protein shake with frozen berries. I'm still hungry.

I hope my relief comes in soon, as I have to be back here at six in the morning, and it is now quarter to ten.

Cold and Rainy

Cold and rainy again.

Three calls right off the back again this morning. 1) A woman hit by a car in the parking lot of a doughnut place. Never knocked off her feet. She has leg and arm pain. 2) A woman who has thrown up at a fast food restaurant, and then 3) a woman who slips on water at the grocery store and has severe pain in her Left tibia. She cringes when I touch it and I can see some deformity above her ankle. I try once for an IV, but have no luck and can't see anything to stick. Her pain is 10 out of 10, so I give her 5 mg SQ, and while she says her pain is only down to a 9, when my partner accidently hits her leg with the buckle on the stretcher strap, she laughs at him even though the pain has caused her to cry out. I tell her about the time I walked up to the guy who had broken his leg slipping on ice, when I hit the same ice patch and end up kicking his broken leg as I wipe out too. That has her in hysterics. Chalk up another satisfied customer to Sister Morphine.

***

I have been researching lights and sirens protocols to the hospital on the internet today. Some very interesting items.

1. The National Association of Emergency Medical Services Physicians (NAEMSP) Position Paper on the issue. Use of Warning Lights and Siren in Emergency Medical Vehicle Response and Patient Transport

2. A Merginet Article: Curtailing Emergency Driving Saves Money and Lives

3. A Pennsylvania Regional Council's Newletter Discussing Issue and the new PA regs.Lights and Sirens Use: It is a Big deal to EMS Services!

4: A PA Service's Policy/ Foxwell EMS: (PA): Emergency Response Policy

5. A disccusion group arguing merits/drawbacks of transport AMI patient's lights and sirens. Lights and Sirens Transport of AMI Patients


***

End the day with a rollover. They sent us no lights, no sirens. The accident was up on the mountain. When we got to the foot of the mountain, the traffic was backed up a couple miles already. We asked if they still wanted us low priority. They said yes. We crept up the hill. Five minutes later, a cop came on and asked dispatch where we were. Dispatch said we were coming on a low priority. He shouted for them to step us up -- there was a patient entrapped. We pulled out of the line and were up there in no time. The car was on its side in the middle of the road. The driver was unhurt, he just couldn't get out by himself. The fire department cut the windshield out. I leaned in and checked him out, then we pulled him out. He wouldn't go to the hospital. He signed the refusal.

On the way back I bought two slices of pizza. It has been raining all day again and the cold weather just makes me feel like eating some hot food. I want to start eating healthier again, but it has been hard lately. And now tonight, I am faced with the same dilemna. Its cold, its rainy. Its dark out. Last night I got at a vegetarian pizza, at least. I guess tonight maybe I should cook a chicken.

My computer still isn't ready. If it were I might play some online poker.

I should probably just go home and clean the house. I've got some long working days coming up, starting with 16 tomorrow.

Syncope

Didn't get too much sleep last night. This morning as I am driving into work, the ambulance is pulling out of the barn, so we did a quick medic switch and I went to the diabetic at the nursing home. 98 year old lady with a blood sugar of 40. DNR. We gave her some D50 and she woke up, then I asked the nurse if we could call the Dr. and see if he still wanted her transported seeing as she was back to normal and was a DNR. She called the Dr. and he said no transport. I told them to call again if they needed us.

I think about laying down right away, but I now have access to a decent computer so I write my yesterday's blog entry, and catchup on my email, and surf some internet sites I have been unable to check while my good home computer is broken.

When I finally lay down to catch a wink, the tone goes off. Old guy with Alzheimer's fell, needs help getting up. Get back to the barn, another old guy with Alzheimer's fell -- this time there was question of syncope. We couldn't get his wife to let us take him. We leave, and just as we get to the barn, we get called back on a priority. The guy has syncoped again. This time we take him in. As we head back to the barn, we get another call -- another syncope -- this time at a synagogue. We take the patient in.

On the way back to the barn I keep falling asleep in the front passenger seat. My head dropping suddenly, then me snapping awake. And so it goes.

I lay down, five minutes later, the tones go again. A syncope at a doctor's office. I think maybe if I syncopize myself, maybe I can lay down.

Around four-thirty, I finally lay down on the couch and put my feet up. Wake up it's time to punch out.

Tonight I think I am going to pick up a pizza and a video and just take it easy in front of the TV. It's been a long time since I have done that.

Company Man

Rainy, rainy day in a rainy, rainy week.

Started off with a diabetic. 25 year old man at work in a factory. Sitting there, skin cool, clammy, nonverbal. Pretty straightforward call. Sugar was 40, gave him an amp of D50. He came around, and admited he had neglected to eat breakfast. He refused transport, his foreman gave him some OJ and brought him a sandwich. We rechecked his sugar. It was 240. He signed a refusal. His foreman agreed to call us back if there was any change in his condition.

We responded for a 2-year old who fell through a glass table and cut his head. We get there and the fire department has already wrapped it. They say it is a good sized gash. The kid is in his mother's arms and is wailing away. We transport the mother, kid and his three year old brother. The mother is Indian. She is holding the crying boy, and she says. "Numba two baby, you give me so much trouble, but don't worry, mother loves numba two baby, no matter what trouble you give me. " And she kisses him. It was cute.

Then we got the best call we could hope for on a day of pouring rain(the worst call is a multicar MVA). A long distance VA transfer, taking a drunk down to detox. We get there and they have two drunks, so I say, hey what not? we'll take them both. And we do. It makes no sense to send a second ambulance. Both drunks agree not to bicker and the staff at the VA thinks they will be fine together. My partner calls me a company man. Since it is a BLS transport, my partner has to sit in the back with them -- and one of them does have a bit of an odor problem. I get to drive. It is a 40 mile trip, which is excellent for my driving score. 40 highway miles without a violation always helps bring up your score. Most months I am above the standard line. I'm not certain what the standard is set at. You get points deducted for speed violations, sudden decelerations or too heavy gravity turns and also backing up without someone pushing the spotter button. Deductions are divided by miles driven or vice versa. Pretty much all my violations are backing violations. If it's pouring rain, and my partner and I are in the front seat, company man or no company man, if I think I can back up safely, I back up without asking him to get out in the rain to push the button. So what if I lose a point? I already got my DVD player as raffle winner for Safe Driver of the Month last November.

Speaking of company men, I know of only one other medic beside me-- there may be more -- who laid down the $2500 a few months back to buy into the company. We own only a measly piece, but we were joking the other day about the "riffraft" in the union who are taking a hardline with the company in the current labor negotiations, trying to eat into our dividends. Nevertheless I believe we both voted against the intitial company contract proposal, which was turned down 120-3. They were having more negotiations today and at lunch we got an update that things seemed to be going better. The big hangup is health insurance. In the past, the union has been relatively weak in the face of the company's negotiators, but this year they seem to have formed a stronger front. I think pay is pay, but health insurance is a person's family and it illicits a much stronger response. I know health costs are skyrocketing, but people need to be assured that if they get sick or someone in their family is sick, they won't be wiped out. There were a lot of questions about the company's health care proposal that seem to be getting answered, and people seem to be saying, maybe the plan, which the company has now apparently modified, is not as unreasonable as initially thought. There are many other issues on the table that need to be resolved, but I am hopeful a public confrontation can be avoided. There is nothing wrong with hardball play at contract time -- that's good business (both for the union and the company). In the end I hope both sides can settle on something that works for everyone. While I am a company man, if ever forced to chose, I have to stand on the side of the people who work the streets.

Our last call was for a lethargic woman -- a 92 year old lady with severe dementia, whose son said she was just not acting right. It turns out she was in a rapid afib at 170. I gave her some Cardizem and her rate came right down to the 80's.

While at the hospital I saw one of our newer medics. I think she has been a medic maybe 2 or 3 years, after being an EMT for several before that. A nice, smart, well- meaning middle-aged woman -- who cares about being good at her job. She told me she was going to go part-time (I guess she's going back to her old sales job part-time), and she seemed sort of beatup. I don't know whether it is the job, the union negotiations, or all the routine crap that each profession and workplace has, and which sometimes can be onerous in this one, but she seemed tired and disspirited. It made me sad. You hate to see people who care leave, even if it is just to go part-time.

I guess the next negotiating session will be Sunday night. If it is, I will be there. I give a lot of respect to the people who are active in the union. They take a lot of crap -- from their fellow employees and from the company, and they do it without pay, and it always seems to beat them up. I will be there to support them.

Voice at the Table

Four calls today (1) an asthma, a woman who works in a school where there is new construction going on. She inhaled some fumes and tightened up. Same thing happened to her three weeks ago. Today was her first day back. (2) A woman vomiting, who was stable enough to meet us at the door, fully dressed, holding her pocketbook, ready for the ride to the hospital. (3) a dialysis transfer and (4) a two month old baby with abdominal discomfort.

I went to my regional EMS meetings (Educational Standards and Medical Advisory) today and we discussed the issue of some volunteer services using lights and sirens to go to the hospital on non life-threatening calls. Their reasoning was so they could get back to their towns to provide coverage. While I am against the use of lights in sirens in just about all circumstances except true life threatening emergencies, I do sympathize a little bit -- and only a little bit -- with the volunteers. The real problem is that there are not enough ambulances to provide coverage or rather there is not a system in place to put a mutual aid ambulance in towns whose ambulance is out. All towns have mutual aid agreements, but they merely reflect who will be called when a 2nd call comes in and it does not necessarily mean that service will be available to respond rapidly or at all – they may be out on a call. It is a problem with an area of the country that instead of using county government, uses local town and municipality government so there are a proliferation of small volunteer services and multiple private systems. It is not really the best way to respond to people’s needs. On the basic issue of lights and sirens I think as I said they should be used rarely, and I in fact think we(all ambulances no matter the service) are sent lights and sirens way too often for anyone's safety.

We also talked about letting basics use the spinal immobilization protocol paramedics use to allow them discretion over who to immobilize (I’m for it), a new exam for paramedics seeking medical control (I’ve been tasked with writing the exam and today I presented the cardiac section), and several other interesting issues. I enjoy these meetings because while not everything gets fixed (the coverage problem will not be fixed by us) we can make some changes that do affect the quality of care.

I am the paramedic representative on the committee, but may have to resign my post because the regional paramedic committee has stopped meeting and I feel somewhat like a fraud representing a defunct group. I will still go to meetings and do work, even if I will lose my vote, which isn’t that important as most everything is done by consensus. As long as I have a voice at the table, that will suit me.

Zen Zone

I’ve been missing IVs lately. Not all of them, but more than usual. IVs are my secret pride. I’d like to think if anyone could put an IV into a rock I could. I’ve studied the craft for years, missed enough to learn plenty of lessons, and for quite awhile now have considered myself an expert – the man. I think I have been doing so well, that sometimes I expect that no matter where I stick it, I will see the blood flow back into the catheter chamber. I think the problem is that I have gotten so confident that I am just not paying the close concentration I need to. I am falling out of my Zen zone. I stick and I miss and I go hmm, how did that happen? How dare you not succumb to my needle?

This morning the first call was for a nursing home patient with pneumonia. I missed the first time, and then got the second. I was a little annoyed I missed the first time. It was clearly makeable – a thin forearm vein. I didn’t hold traction and it rolled a little, then I went through it. I put the next one in the hand, but couldn’t draw any blood tubes because it was a little vein – thinner than the one I missed.

Second call was for a seizure. 27-year old guy. Extremely posticial. We had to carry him out in a stair chair. He started seizing again, more focal this time than the gran mal they had described. He didn’t have the typical veins of a strong 27-year old. I went for the AC, although I was a little uncomfortable with my angle. No flash, rooted around, got a flash, but couldn’t advance. I couldn’t see any veins, so I went by anatomy and feel. The problem was where anatomy wise there was a vein, it felt like a tendon. I knew there were no tendons where I was considering sticking. I stuck. Nothing. I tried another one and the catheter bent on his skin. I had to give up then because his seizure was getting worse. I gave him some Versed IM, which stopped it. I tried a fourth time for an IV and missed. In the ER, his mother said they had trouble getting IVs in him. I came back later and they were doing a central line so I felt a little better.

It was a rainy day so we did 3 MVAs. The most impressive was on a side street between two SUVs. I’m thinking one was stolen because even though both cars were destroyed. The patient from one of the cars was missing. This is in an area of town where it very common to do rollover and find brand new SUVs rolled, but no patients there – only reports of them running down the street. The two patients from one of the SUVs were walking in circles in the street, one bleeding from the forehead. Their car had no front end – it was completely pushed in. The driver had no idea he had been in an accident. The passenger knew he’d been in one, but didn’t remember how it happened or what happened next. The other car was destroyed to the point there was no front passenger seat. I took both patients, BLSed them on a priority. I hardly had time to do vitals, a full survey, put them on 02, and get their names, dates of birth and social security numbers. They both got the trauma room on mechanism. The cop came in and said he’d never seen a crash like that and had people live. He also said the phantom car had two people in it, according to witnesses who saw them running down the street. I don’t how the passenger lived.

I was very annoyed on scene with a firefighter. I showed up and asked where the patients were. He ignored me while he questioned the guy with the cut forehead about his name and address. The problem with first responders, who are required to do paperwork, is their paperwork needs sometimes come before their doing their job, telling us what the hell is going on. Other times I have had first responders try to delay our rapid transport so they could get the patient’s name and info for their records. Some towns the first responders don’t do any paperwork.

Other calls were for a demented nursing home patient with lung cancer and dehydration, a young man who wanted to kill himself and a transfer from the hospital to a rehab hospital.

I did get the IV on the dehydrated lady, a little 22 in a small forearm vein and while I couldn’t get bloods, the bag of saline flowed. Back in the zone.

I wasn’t going to work tomorrow because I have my monthly EMS regional meetings, but they are short cars so I worked the same deal I did last month. They will drop me at the meetings at 12 and pick me up at 4. I’ll work 930-1200 and 1600-2130.

I hope to get to the gym in the morning. Right now I’m watching the baseball game, hoping the Yankees lose and the game doesn’t go too late.

4 calls

Rainy Day. I'm off tomorrow thank goodness. I admit to being tired.

I sit down to write my entries and all I can think to write is

4 calls. 1) A seizure that turned into an MVA 2) a nursing home pnemonia 3) a seizure 4) a nursing home flu

I can do better than that. The first call occured as I was pulling in to work. I switched with the night medic and as we approached we were updated keep coming code 3, patient seizing. The night medic heard that and got in the 2nd ambulance and came to back us up, but after I got out and saw there was little damage to the car, I cancelled him. It was just a seizure that caused the patient to drift off the road and tap the tree, not a car into tree major head injury causing a seizure.

The second call it was pouring rain. There was a marathon going on in the city today and the roads were all blocked off. It took us forever to get to the hospital. The patient had a heart rate of 156. I gave her some fluid and that didn't change it. I couldn't make out p waves. although the 12 lead computer reader said it was a sinus tach. I had her try to bear down, but that didn't slow the rate any. At the hospital they gave her lopressor, which revealed a sinus tack, but that then dropped her BP to 60. They gave her fluid and she was looking a lot better. Their diagnosis pneumonia and a UTI.

The third call was a seizure, a 37 year old woman with no history of seizures. her mother describes a tonic clonic seizure and the patient had a bit tongue. I recognized her as a patient I have had before. A strange psych patient. She had a history of migranes. I told the nurse she took amytriptyline. The patient said no, she took IMtex for her migranes. I said, you have a bottle of amytriptyline. She said I call that IMTREX. Her pupils were dilated wide.

The last call should have been handled with tylenol at the nursing home.

It's pouring rain. I can't wait to get home.

Dream Baby Dream

Four calls. 1) a three year old with pnemonia 2) a 65 year old lady with hyperglycemia 3) a 74 year old with asthma and a 27 year old with syncope in a doctor's office. I didn't do a thing. My preceptee did everything, and all quite well. I am going to recommend he be cut loose.

***

After work, I went with a good friend to the Bruce Springsteen concert at the Civic Center. It was a solo acoustic performance. It was a great concert. I have been a big Springsteen fan since high school when Born to Run came out. This is the 4th time I've seen him in concert, but the first time as a solo accoustic performer. I really admire him. He sings about ordinary people who continue to live and love despite the darkness that surrounds their lives.

One of the highlights for me was the song "Wreck on the Highway," which was on the River which came out when I was in college. Springsteen rarely ever plays it in concert. It is a simple spare song about a guy who comes on a car acccident on a rainy night on a dark country road. He sings:

There was blood and glass all over
and there was nobody there but me
As the rain tumbled down hard and cold
I seen a young man laying by the side of the road
crying, 'Mister, Won't you help me please?'

He sings about watching the ambulance take him away and thinks about a state trooper knocking on the guy's girlfriend's or wife's door to tell them that their man has died.

He ends:

Sometimes I sit up in the darkness
And watch my baby as she sleeps
Then I get in bed and I hold her tight
And I just lay there awake in the middle of the night
Thinking about the wreck on the highway.

William Faulkner in his Nobel Prize Address said "I believe that man will not merely endure: he will prevail. He is immortal, not because he alone among creatures has an inexhaustible voice, but because he has a soul, a spirit capable of compassion and sacrifice and endurance. The poet's, the writer's, duty is to write about these things..."*

And that is what Springstein does. Despite the darkness in many of his songs, he nevertheless lifts us up. Last night he sang "The Rising," "Promised Land" and "Long Time Coming." They were new arrangements obviously, but were very powerful. When he sang "The Rising" he stood in front of a spotlight that projected his shadow up against the far wall of the center. It was errie ghostly, and it couldn't help but make you think about the souls of people who died on September 11 or any other day trying to help others and how nothing ever really dies that was worth living.

Sky of memory and shadow (a dream of life)
Your burnin' wind fills my arms tonight
Sky of longing and emptiness (a dream of life)
Sky of fullness, sky of blessed life

Come on up for the rising
Come on up, lay your hands in mine
Come on up for the rising
Come on up for the rising tonight

He closed with a song called Dream Baby Dream that was absolutely mesmorizing. It was about opening up your heart, no matter how hard your life has been.

Come on and dry your eyes...
I just wanna see you smile
I just wanna see you smile
Yeah, I'm gonna see you smile
Come on baby, dream baby dream

Report from Mississippi

Two calls. A woman with back spasms, who couldn't get out of bed. We asked her how much she weighed. She said 190. Are you sure? I asked. Well, the last time I weighed myself. More like 260. We called medical control and got permission to give her 10 of morphine. It helped enough that she was able to get out of bed and walk very slowly down stairs to our stretcher.

Second call was a man with Irritable bowel syndrome who was dizzy and throwing up.

My preceptee who already has been cut loose in the neighboring state is already good to go. I just have to talk to the EMS coordinator. He has done 8 calls. They may make him do 15, but he could be cut loose today.

***

I recieved an email from a friend who went to Mississippi in the group following mine. Here are excerpts from her report (printed here with her permission):

There isn't a single person who doesn't fear the unknown, and yet everyone around me seemed so pumped up about the unknown of what their new responsibilities would be for the next 12 days. Would I be accepted? Would there be a few more minorities? Would I meet some redneck who'd rather die than let me treat them? What the hell did I get myself into by agreeing to come?

I slept from 2030 to 0100 that night, when 3 screaming persons woke me up to help move folks from outside to inside because the tents outside collapsed from Rita winds. Now I'm awake and not sure what to do with myself. I tried to close my eyes again but now the songs of the snorers, and the mumbo jumbo in my head is moving at mock 70. I eventually fell asleep again, but at 8am I don't think anyone there had any true mercy for the night shift because awake we all were and no one slept after that.

It wasn't until September 24th at 1830 Mississippi time and 1930 our time when I began checking out my assigned home for the next 12 hours that I was able to put some of the emotions into a true perspective. I worked with (), and within the first 5 minutes she gave me the run down of the radios, and this monstrosity of a thing called the NOMAD. She laughed at me for whipping down the door handles, the dash board, and then she asked what I expected of her. I laughed because I wanted to know her expectations of me, after 10 minutes, we laugh at each other and we go available. I had no idea what the heck she said on the radio, but she was the SMS version of my regular partnet, and I knew I would be okay. I couldn't believe how proper everyone was and how technical the sounds of the radio everyone talks in code here! Then 31 miles later we are at our post. There is nothing, absolutely nothing in site in the dark! We sit in front of a gas tank that says Neil Gas off of 53! I ask where we were, she said Kiln. This is the home of some famous athlete and the people here are those who Larry the Cable Guy and Jeff Foxworthy talk about. I then realize that if there were one place in the world I would be terrified of working it would be South Mississippi. We did 3 calls and moved around a lot! 180 miles were put on our ambulance that night! I said damn. She told me that they average 250 miles a day even with highway 90 when it was there! I couldn't see much of the destruction at night, but we had lots of issues finding our 3 calls for a lack of street signs, hit a few areas that hadn't been cleared so my map reading abilities were put to the test. We got off about 1 and 1/2 hours early and it was breakfast.

I was so happy to be on nights I couldn't imagine having to work in the heat and the sun! Of course my next 11 shifts were evenings with a 430pm start, the up side to those hours is that everything looks different in the light. I finally understood what the heck everyone was referring to in the stories of destruction and having nothing and having no where to go, I wish I had my video camera, but in the same breath as I took my first picture, I decided that I really couldn't take any more, and by day number 6 the debris started to wear on me. It almost felt selfish because I knew that my home was a few days away, and our streets weren't like theirs. The one thing I said to all was that I truly couldn't complain out loud because regardless of what was inside I was there to work and do whatever, I was pleased, because I really couldn't complain. In some ways it was a vacation because folks were respectful and we got out of work early every night, little things like please and thank you got you things like praise from dispatch who could make or break you in any EMS system! But people were generally appreciative of my presence and were excited to hear about the place I called home. It helped them believe in life after Katrina! That's not work that's fun! Getting picked on for being a Yankee and speaking plan, it brought smiles to watch me struggle to understand the locals and it really made work fun! I couldn't feel that at home people are mean in New England.

The calls were the same crap, the same intensity as being at home, when the shit hit the fan, but in SMS my work ethic was good and consistent, which excited the folks around me. I probably did 12 routine ALS calls and 2 routine trauma calls (MVA's good mechanism type) The rest was truly bullshit stuff. How funny when everyone is tripping out because the 27 year old looks like shit complaining of chest pain s/p open heart surgery? Well, let's see, the open heart surgery was secondary to a stab wound and GSW, and well he's had pain all over his body for a week, went to two different ER's and now he's in too much pain to talk. Rest assured all the marijuana wouldn't stop the coughing, and gee hospital number 3 probably ain't gonna fix his problem either. The cops and FD on scene, my partner, they all had to be introduced to the "con-artist gone sick!" How funny! It was good.

I averaged 3 to 5 calls a shift. With the exception of that first night, each of my partners were new EMT's! one had been an EMT for two weeks prior to Katrina, but old military and as he called himself a true redneck born and raised in the most southern old traditional part of Mississippi, the next was in his 4th week 19 years old and before Katrina never even stepped foot in an ambulance, and the last was a 27 EMT veteran of 9 months already in medic school. He was what everyone from SMS referred to as a "flamer." He is the one who put my mind at ease when it came to the anxiety of being accepted. He told me of black rednecks and white rednecks and gee as he put it if most folks were cool with him they'd be happier with me, and the only thing I should be worried about was our safety as a pair! Then he laughed and so did I. All had exceptional energy rip roaring and ready to do work. Each had their stories of the day after the storm. Most of their stories were amazing and made me wish I had the self discipline to have kept a journal or had the ability to write to help them share their stories because we are an extreme group and most of the general public will never know.

I was so ready to go home by day number 9, I got into my ambulance and took our first call we got to transport to "K-Mart" general. It was wickedly impressive. 4 calls later I was done and we were down to 3 shifts, it had been going well, I still couldn't tell the difference between post 23 and post 9, expect that Diamondhead had the open DairyQueen! I was exhausted physically because sleeping was a joke and for 4 days in a row, they served pork, so there wasn't much to eat for me that didn't come out of the MRE bag and that was getting old.

On day 10, we sat for 7 hours and didn't do a single call, it was the first time that ever happened. We sat across from K-Mart general for most then with two hours left we did our one call that turned into the call from hell. The long in the short, it was an emergency transfer from the E-Med tent for XXX hospital to XXXX hospital with a 52 year old male having a probable MI. The covering MD decided from the moment we stepped out the ambulance we weren't moving fast enough, and really didn't like the fact that after he yelled at my partner for trying to untangle their ECG wires to replace them with ours, that he wouldn't be the person giving direct care. He was upset because he snapped his fingers in my face and demanded that I immediately give the patient morphine, because he said so, wasn't actually how things were going to get done. He referred to me a gal, said that he didn't care where I came from that while in my ambulance I was to do whatever he said and that was it, he attempted to mentally and physically push me around he got so close in my face, when I smelled the ETOH, I smiled and asked him to slide down into the corner and give me space to do my job. He continued to bark, my patient who was uncomfortable was irritated, I tried everything to keep my composure, to stay patient focused, it was the longest 30 minute ride, we got there my partner then took the flap when the doctor wondered if my partner took the scenic route, since everywhere has become the scenic route. He was really mean in front of a patient! He made racial slurs, in front of a patient, who let me do what I needed to do for him because he himself wanted to believe that I would do right by him get him to the cath lab, so he would be saved from his second heart attack. But how could this be happening?

My partner started the clean up, I began to write, a nurse looked at me because I could no longer fight the tears, she said they are glad that I was here to help, and next time give that MD a bag of peppermints tell him to shut up and suck on them to shut his mouth. The MD at XXXX hospital, praised our efforts and even said that the patient is pain free on his way to the cath lab, while another nurse made a point of saying that the doctor on board didn't save the patient's heart, the medics did! The conversation I dreaded most was with my partner, because I was not sure what his interpretation of the way things went were going to be in support of me, he was born and raised in the South he called himself a true redneck a true American old traditional southern man! Hear he was standing in front of me said that the bus was back together, I asked him for a few minutes to finish the paper work and to clean myself up. He started to walk away and the burn in my stomach grew bigger. Then he stopped turned around came up behind me smacked the back of my head and asked why I put up with the shit from that doctor, why didn't I make him stop the ambulance, to escort the MD out of the back of the ambulance, he was waiting for the chance to kick him out of the bus but wouldn't until he got the word from me. He hugged me and said that even on a regular day no one deserved that kind of treatment. I was tired it was an hour pass crew change and I wanted to go home to my bed, my blankets, my dogs, that one call almost ruined what had truly been a pleasant experience, then I lost my stethoscope, your flashlight and the whole trip was ruined. I cried myself to sleep, and it was sunrise.

I slept for three hours to wake up to folks screaming that we had to move all the cots out and build military style bunkbeds to make room for the 56 people coming later. Depressed and tired. I have to get over yesterday, because well I only have two shifts left and home is the light at the end of the tunnel.

In just 14 hours the things that angered me the night before seemed unimportant. My misery turned to peace. My scope was returned to me, I got back the flashlight I borrowed from you and all was well. I had a chance to "pay it forward." I found a journal that someone had been keeping and after a few hours managed to return it to them, I then was able to come to a conclusion as to why I wanted to come and experience the Gulf Coast. To pay it forward! My last night sucked, it left just 6 hours to get all packed and be ready to leave, but even that didn't matter. If I could learn anything it should be my mission to somehow share whatever I learned. If someone has helped me in some way in a day, my mission for the next day is to help someone else, return the favor someone has done for me. I want to smile everyday, not cry or pout when things feel like they suck. I got uncomfortable by all the "thank yous" because I didn't do anything different from the way we do things at home, except to be a stranger, a Yankee, a New England princess, in the South. I made new friends, and I now know where Gulf Port, Mississippi is on a map.

Tonight and Thursday night I will work my own shifts and listen to all the union issues and Gulf Port will be a memory. I am thankful for that chance to see and participate in the challenges there. I am more thankful to all the people for making me see how important my profession is. I am even more thankful for the patience the dispatchers, and partners for giving me a chance. I have a greater respect for my EMT partners, and I am happy to be home.