hot

Started the day off with three calls -- a man with abdominal pain, a man in DTs, and a woman with a headache since a fall a week ago who a scan done today that showed a subdural bleed. Then we got a little bit of a break, and then responded to the town pool for a little girl with head and neck pain after someone jumped into the water on her.

It is hot out.

DVT

12 hours. One call at a nursing home for a possible DVT. Spent the rest of the shift working on projects. No complaints.

Standing By the Car

Worked eight hours with another medic. I thought maybe that would get me out of the transfer runaround -- that and it being a Saturday. Still ended up with three transfers, although one was ALS. I don't understand the posting and assigning of calls sometimes. We're a double medic car in an area covering two 911 towns, a car gets sent from the city to our post and we're sent into the city to do a dialysis transfer.

The other three calls were decent. A 23 year old with kidney disease, HTN and IDDM, feeling weak. She had a BP of 220/110 and a blood glucose of 390. She got admitted.

We had another diabetic not taking her meds with a high blood sugar.

The last call was for a rollover in the north end of the city. We were quite aways away when they gave it to us because we were the only car free. I have probably done 10 rollovers in this park of town. I told my partner it was probably a stolen car and there would be no patients. That's how it always is. But I was partially wrong this time. The fire department was reporting downed wires and a patient under them. Another car cleared up and was sent because they were reporting multiple patients. We got there just after they did. I went to the EMT and asked for a report as he was helping board a patient -- an older woman who was bleeding from the mouth. He said she was the worst -- the other two were minor. I said I'd take her then. I came back with the strethcer and got her on it, only then did I realize the EMT was a medic. He was wearing his baseball cap backwards like another guy at the company and when I was talking to him, I'd hadn't seen his face clearly. I apologized then for stealing his patient. He was cool about it.

The story I got at the scene showed I was partially right in my impression. The car that rolled was a new car and its occupants had fled the scene. Same as always -- they steal a car in one town, then come barrelling down a residential street into the city, roll it, and then flee. The fire fighters told me the woman was standing by the car. I thought it meant she had been standing by her car that was hit by the other car when they got there, but as we were en route to the hospital and I was interviewing her, I finally figured out she was standing by her car when she saw the car speeding down the street out of control, and the car had struck her car and rolled over it, striking her. She had a smashed up face, broken teeth, and was somewhat confused. She ended up in the trauma room.

I got off an hour late.

Two Minutes

Did a bunch of transfers to start the day including a wait and return at a doctor's office. The poor woman we brought in barely fit on our stretcher. Her right side was flaccid from a stroke and we had a hard toime keeping her straight. At the doctor's office, a nurse took her BP and her pulse and listened to her heart. Fifteen minutes later the doctor came in and talked to her for about two minutes. he asked her is she had any chest pain or any trouble breathing, and then he listened to her lungs in two places while she lay on the stretcher. I offered to help him sit her up, but he said that was allright, and then he left. He wrote some notes for her, and then we left.

Other calls included a chest pain that was just hyperventilation, a motor vehicle accident and a drunk who fell down.

Tomorrow I'm only working eight.

Expired 2000

Hot, sticky day. Started off with a long transfer. We drove about forty minutes to pick up a lady at a distant nursing home to take her another thirty miles to a dialysis center. I guess they closed down the dialysis center near her. I was a little annoyed when I heard a basic car calling for a medic shortly after we got the call, but I didn't mind the air-conditioned drive. My car had just been filled with freon the day before.

On the way back we were sent to a chest pain. The pain came on at work for a fifty- four year old man unrelieved by his nitro. I gave him two nitro and the pain cleared up. I looked at his nitro -- it had expired six years ago.

Later did another dialysis transfer and an old woman with a UTI.

Back tomorrow for 12.

No Complaints

Worked 12 in the city. Only had to take one call -- a woman who had a syncopal episode. She was undergoing radiation and hadn't been eating. She was way orthostatic. Her pulse went from 76 supine to 92 sitting to 120 standing. I gave her some fluid and she felt better.

Other calls were for a psych off his meds with suicidal ideations, an MVA refusal, a couple transfers, a difficulty breathing that turned out to be a homeless man sleeping.

We started the day off with three hours of sitting in a suburban town. I read quite a lot of my book today.

No complaints.

Back tomorrow for 8.

Code

6:03. Person not breathing. The night medic hasn't left yet so he offers to come along. I'm thinking its going to be a stiff. We get updated. "The person has a pulse, we're about to use the AED." Okay. We enter the house walk through a narrow hallway,and then down a narrow staircase, and then around some big furniture to a basement bedroom where they are doing CPR.

We enter the room at 6:10. Man in his late fifties with a diaylsis port hanging out of his chest. He's warm. Family says he was talking to them shortly beforehand. A witnessed address. He's asystole now. I intubate him. End Tidal CO2 shows a good wave form with a reading between 17 and 23. We work him hard. Doing the new CPR. I get an EJ and in go the drugs. Epi and Atropine. (Later the night medic asked me why I didn't use Vasopressin. Vasopressin! Do'oh. I never remember we carry it now. It is zipped up in a small pouch. Over a decade of this, I am programmed -- epi, atropine. I give him some Calcium. Next thing I know the ET CO2 is up to 35. We stop compressions. He's got an organized rythmn and a pulse. BP is 124/80. It is now 6:30 -- a half hour into the call. We have to package him. Fortunately we can go out through a backdoor, but there will be a hill to push him up. As soon as we get him outside, the capnography drops down to 18. Back to CPR. More epi/atropine. Capnography gets him back up. We lose him again as we push up the hill, but regain ROSC as we near the hospital at 7:00.

Going down the hall, he starts to fade out again, and even though his ETCO2 is 32, we start CPR. The rythmn looks idioventricular. They work him awhile longer at the hospital, but he doesn't make it.

The capnography was very instructive. It did the following:

1) Confirmed placement of the tube.
2) Alerted us to ROSC three times.
3) Whenever we were doing CPR and the number started to fall, we switched compressors and the number came back up. At one point, I told my partner if he could get the ETCO2 up from 16 to 20, I'd buy at Dunk'n Doughnuts. He started pounding the CPR and the number slowly climbed all the way up to 28. Stopped compressions, the number fell off the cliff almost right away.
4) Confirmed continuously placement of tube. Pulling him out of the ambulance, the wheels didn't drop properly and we almost lost him. There was a lot of jarring, but when I looked at the monitor, the wave form was textbook. Tube still in place.

Here's the capnography trend summary showing Return of Spontaneous Circulation (ROSC).

***

Just when I start to feel like a paramedic again, my next two calls are for blood oozing from a catheter in a nursing home patient and a direct admit from an endoscopy center, both of whom called 911 instead of the commercial ambulance.

Later I did a dsypnea/chest pain with an MI/COPD history that felt better with a breathing treatment and two nitro.

No Bone Scans Today

Three calls. All old patients, a tough old man with chest pain and two old women who were drama queens. One complained of weakness and did a phony vertigo slow motion spin with knees buckling, all while maintaining her balance when we tried to do orthostatics. The other lady grimaced in pain when we said we were going to move her even though we hadn't moved her. She had fallen three days before and still had hip pain. The portable x-ray at the nursing home was negative, so the doctor wanted a bone scan, so they called 911 and sent us to the farthest hospital, which told us they didn't do bone scans.

Back for more tomorrow.

Cleaning

The internet was down at work and the computer I use was down, leaving only one older computer with not too much on it. So I spent the day cleaning out the storeroom, cleaning the ambulance, neating the quarters. Only did one call - a man with a fever coughing up blood.

Rotten Meat

First call was for a rotten smell. I was thinking dead body, but as we go there the police and fire were walking out saying it was just rotten meat, no body.

We did three calls -- a man in a nursing home with rib pain, a man status post shoulder surgery with an infection and a nursing home dementia patient who hadn't peed in 24 hours.

A rainy, drizzly day.

Mesmerized

10 hour shift. The day started out very muggy. Started out with a woman who fell and banged her knee a block from the hospital and wanted a ride in. We transfered a man from a VA with dsypnea to a local ER, took a patient from another ER to another hospital where his kidney specialists were, took a patient from a nursing home to an ER because her fever just wouldn't come down with antibiotics, did a hypoglycemic refusal and ended the day with a woman with a bleeding bed sore. At one point there was a torrential downpour, but fortunately we were doing a half hour transport so didn't get wet. I was in the back with the patient and was so mesmerized by the rain I forgot to call the hospital to let them know we were bringing in the lady with the fever. It was no big deal.


Back for another eight tomorrow.

Back Yard

Had the day off. Went swimming, and then had a back yard barbeque -- chicken, corn, pork chops, shrimp and a couple beers. Back in the city for 10 tomorrow.

A Good Partner

12 hours in the city. I got to work today with a woman I used to work with regularly on overtime many years ago. Her regular partner was on extended leave so I worked with her most everyday as she worked on my days off, so it was great overtime for me. What I like about working with her is she is so pleasant. She never rags about the company or about any other employee. She is nice to the patients and when we aren't on a call, she parks the ambulance in a quiet location, turns the engine off and reads a book. What a difference it makes in stress levels.

Day started off with a chest pain that turned out to be a ten year old boy who's chest hurt when he moved his arms. His mother was crying. "You hear about these young children having heart attacks." We reassured her and then transported him to the hospital where he was sent to the waiting room.

We then did a mild chest pain in a 91 and 1/2 year old who did nothing but crack jokes the whole time. He was Jewish and I asked him where he was born, thinking there might be a story about fleeing Eastern Europe(its amazing the number of patients you get in a year who are holocaust survivors), his answer was "I don't quite remember, but I believe I was born in a bed." He was hard to actually get a history from because he turned everything into a joke. My partner drove the long way to the hospital -- I asked her why later and she said it was because she was so enjoying listening to our conversation.

We were sent on a "sick call" in the city and when we got there there was no fire engine outside. The fire are selective first responders. They go to what sounds like a good call. They probably have protocols they follow. They usually don't go to the sick call. It was the top floor of a three story triple decked with a narrow stairwell. The husband showed up his wife in bed. She was in her late fourties. Her skin was like ice and very clammy. I couldn't feel a pulse or hear a BP. I had to use the automatic cuff and that said 90/50 with a heart rate of 92. Her husband said she had had a near syncopal episode and complained of not being able to see. We stood her up and did orthostatics. 80/40 with heart rate of 104. Again, she had trouble seeing. I was interviwewing her and she admitted sever bleeding from her fibroid. Then she puked all over the place. My partner went to get the stair chair. I told her to leave the equipment with me. I had a bad feeling. I have in the past had a partner bring the equipment back to the ambulance when they went to get the stair chair, only to have the patient suddenly code while we were getting them on the stair chair. Anyway, she didn't code. But in the ambulance, the machine said her BP was 64/38. Again, I could get on myself, and the machine is not very reliable. I gave her 500 cc of saline by the time we hit the hospital and she was looking and feeling much better although the machine was still reading a low pressure. The people were I believe Iranian, and were very reluctant to give me her social security number so I hadn't pushed it. She hadn't seen a doctor even though she had been having periodic spotting.

We were sent to intercept with a basic car on a cardiac arrest and got there as they were loading the patient. She was a cancer patient with a DNR but no paperwork. She wasn't in arrest, but she was out of it. En route she went apneic several times. I had her on the capnography and it caputured it. All we had to do was arouse her. My plan was to just deliver her to the hospital alive so they could call her doctor and verify the DNR. That's what happened. Turned out she didn't die, but they got all the paperwork together, transported her home and called in hospice care to help the family.

We did an 80 year old with kidney stones. I gave her 2 of morphine and it made the pain go away. I also used the capnography to monitor her ventilation. When I was in Ohio a medic from Texas showed me their pain protocol where they were required to do a pre and post sedation capnography strip. Her respirations stayed the same.

It was a good day. Some medic calls and no transfers. A good partner.

I knew as soon as I walked in the door...Plantar Fascitis

Get called for left foot pain. We find a three hundred pound man who says his whole left foot hurts -- so bad he can't walk on it. No trauma that he can think of. The foot is tender to touch and he can't really move it without pain, but the skin temp is good and he has distal pulses. Never happened before. He says he is on his feet all the time. I'm thinking a stress fracture or maybe some gout. At the hospital the triage nurse says, "I bet it's plantar fasciitis. She says she had it oonce and it comes from being on your feet all the time, walking on hard floors. "How about that," I say, "You learn something new everyday."

Two calls later, it's a five hundred pound woman with left foot pain. Hurts all over. No trauma. Tender to touch. "Ever had plantar fasciitis?" I ask. "No," she says. "I'm betting that's what you have," I say. "Its got to be plantar fasciitis." The cop on scene is looking at me like I am a medical wonderkund. My partner looks like he is about to pee his pants he is trying to keep from laughing.

We go to the same hospital. Same tirage nurse. I describe the symptoms. "No doubt plantar fasciitis," I say. She hits me with her clipboard.

Other than that. An uneventful day. Two nursing home pneumonias, a teenager vomiting, and two plantar fasciitises.

Air-Conditioned

At the risk of jinxing myself, it has been a slow stretch in a rather slow year for me, despite working as often as I do. I've had some challenging calls, but not many. I've only done two codes in six months. That's the fewest I've ever had in such a stretch. I've had many days in the past where I have done two in a day.

Its not that I am necessarily complaining. It was hot today 102 degrees. I spent most of it in the air-conditioned base.

Today I did two calls -- an abdominal pain and a man living in filth who was alert and oriented and did not want to go to the hospital. His daughter, who hadn't seen him in four years was the one who called for the ambulance. The police ended up calling in the health department and social services.

Three Calls

Three calls -- an intercept into another town where we were cancelled before we got there, an abdominal pain, and an old woman feeling faint in the heat. She was wearing a heavy coat and hat while waiting for her family to pick her up. Once inside the air-conditioning of the super market, she felt better and a relative sat with her while she waited for her daughter to get out of church and pick her up.

I spent much of the day working on my Capnography blog.

Good At the Bank

Spent the first half of the day posting in very quiet locations. I got a lot of underlining done in the Capnography textbook I have been slowly going through. Some of it is very heavy reading, but still some interesting concepts.

I did four calls -- a dialysis transfer, a fall refusal, a pregnant woman who had a syncopal episode, and a motor vehicle. It was hot and there were some testy people on the job today. Its going to be very hot for the next several days so I hope people can manage.

I got out an hour and twenty minutes late, but I didn't mind. As long as my check is good at the bank.

Registry Day Two

Back to work in the morning. We moved a little quicker, completing the task lists, and then compiling lists of general knowledge and skills needed for the job, worker behaviors, tools, equipment, supplies and materials, and future trends and concerns. In the end, the faciltator said he was very impressed by the array of work we did. We had 169 seperate identified tasks. He said generally each task equates to $1,000 of income, so we should be making $169,000 a year based on our responsibilities.

All and all it was an interesting process. I tried to emphasize pain management, research, and "people care" as important or needed aspects of our job. As I said before, I don't know how this will all turn out -- our role was just getting the process started.

I flew home, landed safely and after a day off tomorrow, I will be back at work.

Registry Day One

Okay, here's the deal on this committee. They have selected nine field medics from across the country with various experiences and from various types of services to spend two days with a facilitator from Ohio State to do a duty/task analysis of what paramedics do to help develop a curriculm and tests based on the real world. I am the representative from the Northeast region. There are people from Georgia, Missouri, Pennsylvania, North Dakota, Idaho, Texas, New Mexico and California ranging from one year experience to fourteen -- all of them have been nominated either by a state director, company president, EMS panel or medical control authority.

Our work will just be the begining of a long process that will eventually create a definition of what paramedics do, what our core competencies are, and what should be taught and tested to produce competent medics who the public can trust.

We are to complete a breakdown of duties and tasks that will later be further broken down into job steps. Our work will be reviewed by 1000 other paramedics selected from the registry's lists, and then gone over by a panel of EMS experts from the registry's board.

A Duty is a cluster of related ideas. A Task is specific units of work. Steps are what enable you to perform the task. An example of a job, duty, task, step would be as follows:

Job: Homeowner
Duty: Maintain the yard
Task: Mow the lawn
Step: Start the Mower.

Anyway, we start out by making a comprehensive list of things we do, going around the table until we are exhausted -- everything from check the oil on the truck to defibrillate to provide grief counseling. The lists are then hung on the wall and left there. Next we try to come up with the Duty List. I think we end up with 12 or 14. I didn't write them down by they were something like this: Maintain Response Readiness, Access the Incident, Scene Management, Perform Assesment, Provide Emotional Support, Manage Cardiac Care, Respiratory care, etc, Resolve the Incident, Legal Documentation, Operations Support, Community Relations, Professional Development. Then we had to take each duty and break it down into tasks. We got through two of the duties, and then called it a day.

They took us on a tour of the National Registry Building, which was quite nice, and gave us a little talk on what the Registry was up to as far as moving to online application and renewals, as well as some of their research projects, including one almost finished that shows EMS professionals suffer from sleep deprivation to a degree unlike any other recorded profession. One of the questions was something like "Have you ever gone to a friend's house to visit and fallen asleep on the couch?"

At night we went out to a great steak restaurant and had a wonderful dinner with cold beers and got to know each other better. I was very impressed with the other medics, as well as the people at the Registry.

Back at the hotel, I turned on the wanning minutes of the All-Star game and like a typical sleep deprived EMS professional fell asleep with the TV on in the middle of the American League's rally.

Unconcious

Just one call today. It comes in as a man unconcious in the driveway. My partner recognizes it as an address he responded to a couple weeks before. "He's a drunk," he says.

We find the man laying on his side a few feet away from the car. He has a suturable lac above his right eye. He is as my partner guessed -- drunk. His wife says he drove home, got out of the car and fell down -- same thing as happened two weeks before. He has no idea where he is or how he got there. He admits to having a few beers. As we c-spine him I think about the call the previous day where the bystander appeared upset that I hadn't c-spined the boy at the country club and here I am now c-spining this drunk in a poorer section of town. Why? Well, it is indicated for him. He is impaired, the boy wasn't.

We have a nice chat on the way to the hospital. He is angry at his wife because she called 911 and the police came and took his licence away(He isn't arrested -- he just will have to go to the motor vehicles department and get re-tested). I tell him she saved him from being arrested for drunk driving. He agrees she might not be too bad after all. he says he has to pee. I ask him to wait. He managed to hold it until we got to the hospital, but then when I bring the run form back to the place in the hall where they have him on a cot, I see he has already gone. He is still asking to pee, unaware that he has already gone now at least once. After calls I often debvate what i should and shouldn't have done. How is this for a dilemna -- should I have helped him with a urinal? Yeah, maybe I should have, but while I resolve to try to be a more humane medic the next time, and while it does trouble me slightly, I soon forget about it.

My relief comes in two hours early so i can get to the airport -- I am headed the Ohio to serve on a committee for the National registry looking into paramedics competencies -- whatever that means. I will soon find out.

The flight is on time, but the plane is small and rattles when the landing gear drops. I catch the shuttle to a Marriot Hotel and have a steak dinner and two beers and then head back to my room to watch SAVED. (More about the show in a later post).

I'm supposed to meet someone from the registry in the lobby at 8:30 the next morning.

The Diabetic City/ Class

Walter Payton, the great Chicago Bears running back, was known as "Sweetness." I think the medics in this town deserve the same name. While we're giving out new names, I think the town should be called "-------, the Diabetic City." We have a huge population of older black people, many to most of whom are diabetic.

It seems like everyday I am doing another hypoglycemic patient. Started today off with another one. 80 year old woman blood sugar of 48. She didn't eat. Lives at home with her husband, both on the verge of dementia. I gave her some D50, she woke up. Her daughter, who was there now after being called to come over, agreed to feed her and watch her through the day, and follow up with her MD. I also talked to the visiting nurse who was showing up as we left. She said the woman needed to be in a nursing home.

I do the ordering for our service and I order cases of D50 and we just go right through them. Same with glucometer strips. This is "The Diabetic City."

***

More calls.

A woman with pain in her right leg. A woman in a nursing home with a low blood pressure accoring to the staff, who said her pressure was 88/60 and she is normally in the 130's. We took it. It was in the 130's. The woman who was blind said she felt fine.

A woman who choked twice and had to have her family perform the Heimlick manuever. The only thing was she wasn't eating and hadn't coughed up any phlegm. She said she just couldn't breath or make a sound or get any air in. Odd.

Then we got called for a child who had passed out. It was at a country club. We found the young teenage girl sitting in a chair on the ground, feet up in the air with a man holding c-spine and a crowd of people standing around. They said she had been playing golf in the heat and humidity, and then wasn't feeling well after her tournament. She laid her head in her lap, then sat up and passed out and fell over backwards. They said you could hear her head crack from across the room. The only thing was she had no complaint of pain, no bump on her head. She was a little pale. I explained to the man that I was going to follow a protocol to determine whether or not I needed to c-spine her. He seemed sort of perturbed when I asked him to release cspine so I could have the girl move her head from side to side, and he stalked off. Everything was clear -- no neuro deficits, no pain on palpation, no limit of movement. Nothing. I did orthostatics. A stepping stone change from laying to sitting to standing. I asked the family what hospital they wanted to go to and they told me. I asked if they meant the affiliated kid's hospital across the street, but they said no, they would never go there. A doctor on scene had told them this was a trauma and they had to go to the trauma hospital. A couple years ago there was a big to-do when a child in a bad MVA was diverted by the trauma hospital to the kid's hospital where the child later died in the ER. I try to explain that this is a different degree of trauma. This is actually more a dehydrated related syncope than a trauma. But they insist, which is fine. I don't argue. If the hospital, which generally only takes patients 18 and over unless it is a serious trauma gets angry at me, I will just shrug and say, family insistence.

The family is very nice, but there is a little bit of the what took you so long to get here? are you sure he doesn't have a serious head injury? -- they said they could hear her head hit from across the room. No, I can't say 100 percent, but she has no signs of one. She doesn't even have a headache or a bump on her head. She is fully alert. She isn't nauseaous, she has no vision problems. When she closes her eyes briefly, the mother urges her to stay awake. I tell her if her daughter wants to rest, that's okay, she doesn't need to keep her eyes open if she is tired. I try to reassure her. I do give the child some fluid and some D50 as her sugar is in the 70's. I also put her on the monitor.

At the hospital I give the triage nurse the story and she scribbles some notes, then calls down to a nurse in the non-trauma wing we are going to and relays my story. My partner tells me later the mother is very upset with what the nurse wrote on the notes that it doesn't reflect what happened. She evidently read the nurse's notes while I was off writing my report, which I confess I put extra effort into to make certain I left nothing out.

I understand that every patient should be treated as if they are your child and that every parent has great concern for their own child and want the best, but I am a little uneasy when I feel there are two standards of care, where when you take care of a privledged child with connected parents, you feel as though you have to be more careful, more on the safe than sorry side. I suspect that at the hospital there may be the same pressures -- the family may insist the child may get a CAT scan and more tests than say an underprivledged child would get. I feel that I gave the child top flight, appropriate care. But I am left uneasy. Maybe it is because I felt the family viewed us as ambulance drivers and attendents and not as worthy as "The Doctor" at the club or their neighbor who was once a nurse before she married.

A part of me wanted to say look, I have assessed you child from head to toe, I have taken a full history. Your child is anorexic and didn't hydrate herself and she passed out and banged her head. It happens. She needs some gatorade and something to eat, and some rest in the airconditioning in front of the TV at home. But we are happy, more than willing to take her to the hospital of your choice becaue I understand she is a child and you want to be certain everything is okay. But she doesn't need a trauma center activation. But I didn't say that. I made her comfortable, explained everything I was doing, gave her IV fluid and some sugar, and transported her to the hospital of their choice.

I shouldn't feel uneasy, but I do.

I think it is the class difference in America that bothers me.

I need to ponder more.

Back

Back at work. Not in the door four minutes when we get our first call. An old man who fell and was dizzy and not feeling well. I worked him up from head to toe, put him in a hospital johnny, did a 12 lead, drew blood, etc, even filled out a blank copy of triage demographics. I got him to the hospital before the seven AM nurses came in. The night nurses don't deal with me that much, except for the ones who remember me from when I worked nights. They were all impressed that I had the patient in a johnny and the labs all drawn. They asked me to hook him up to their monitors and do the rest of their routine while they went for coffee. They asked where I was going when I didn't do that. I told them I was writing up the discharge instructions. Good to be back at work.

Next call was for a diabetic. Blood sugar of 44. I gave her an amp of D50, and while she came part of the way around, she didn't come all the way around. her sugar went up to 140. I gave her another half an amp. Still she was having trouble remembering her birth date and her social and other numbers. She said she hadn't eaten that morning or the night before, but she didn't know why she didn't eat. She had a headache and was very hypertensive. I think maybe she had a small stroke the night before, and her muddled thinking caused her not to eat that caused her sugar to go down. I took her in and thety worked her up as a medic alert. Even a hour later, she still wasn't right.

Then we did another old woman -- this time in an MVA. It was a minor low speed MVA frontal impact, and while she claimed to have had her seat belt on, she had a busted nose and massive skin tears on both arms -- she was on prednisone. En route she complained of some chest pain on breathing. She had osteoporosis. She got a trauma workup at the hospital.

Last call was for an old woman with leg pain.

Rastafari

Spent a week in Jamaica. It was my third time there, but the first time I stayed outside of an all-Inclusive resort. This time I really got to see the country and to "eat the fruit off the tree." I grew grey-whiskered stubble on my face, listened to reggae music, swam in the ocean and spent a couple days in the hills. I drank Red Stripe beer, ate akee with saltfish, pineapple, lots of mango, plaintain, gnip, Jamaican pears, and lots of jerk pork and chicken, along with curry goat. By the end of the week I could actually understand the local patois.

I had this conversation with a man on the roadside while my friend's brodda was in a small market looking for dinner.

Stranger: Wa-gwan-mon?
Me: Nothing wa-gwon.

What's going on man?
Nothing's going on.

My friend's brother came out empty handed. He said. "No fish today, sea ruff."

He is a Rasta and only eats fish, no pork. Not me.

So, anyway, I'm back, rested, and as soon as I shave, I'm ready for work at 6:00 A.M. tomorrow.