Heromedic dispenses some wisdom to the EMS masses, and firefighter medics face a nationwide crisis.

February 2007

Dear HeroMedic:

I hope this letter finds you well. I have a rather embarrassing situation to ask about. I hope you can help. Every time I get to drive the ambulance Code 3 I tend to get aroused. I don’t mean emotionally—I mean sexually. After about 3 minutes I got more wood than Home Depot. When I get out at the scene, everybody looks at me. Can you help?

Dick
Pointy Wood, AK

Dear Dick:
Join the club. This has been happening to me for 20 years. Don’t be afraid to show off that Code 3 wood—the chicks dig it. In fact, wear tight pants and a big smile. You are clearly one of the chosen EMS providers. Some take EMS as a vocation. To us, it is our whole damn life. Remember that scene on the fire truck hose bed from the movie Backdraft? You can have a scene like that in the back of your bus if you get over the embarrassment of a Code 3 response putting lead in your pencil. Welcome to the Code 3 Woody Club!

Fraternally,

HeroMedic
“Bay Area Paramedic of the Year”

and plunks down into a chair. She lets out a sigh heavy with frustration.

“What troubles you, Sister?” asks the Mother Superior. “I thought this was the day you spent with your family.”

“It was,” sighed the Sister. “And I went to play golf with my brother. We try to play golf as often as we can. You know I was quite a talented golfer before I devoted my life to Christ.”

“I seem to recall that,” the Mother Superior agreed. “So I take it your day of recreation was not relaxing?”

“Far from it,” snorted the Sister. “In fact, I even took the Lord’s name in vain today!”

“Goodness, Sister!” gasped the Mother Superior, astonished. “You must tell me all about it!”

“Well, we were on the fifth tee…and this hole is a monster, Mother – 540 yard Par 5, with a nasty dogleg left and a hidden green…and I hit the drive of my life. I creamed it. The sweetest swing I ever made. And it’s flying straight and true, right along the line I wanted…and it hits a bird in mid-flight not 100 yards off the tee!”

“Oh my!” commiserated the Mother. “How unfortunate! But surely that didn’t make you blaspheme, Sister!”

“No, that wasn’t it,” admitted Sister. “While I was still trying to fathom what had happened, this squirrel runs out of the woods, grabs my ball and runs off down the fairway!”

“Oh, that would have made me blaspheme!” sympathized Mother.

“But I didn’t, Mother Superior!” sobbed the Sister. “And I was so proud of myself! And while I was pondering whether this was a sign from God, this hawk swoops out of the sky and grabs the squirrel and flies off, with my ball still clutched in his paws!”

“So that’s when you cursed,” said the Mother with a knowing smile.

“Nope, that wasn’t it either,” cried the Sister, anguished, “because as the hawk started to fly out of sight, the squirrel started struggling, and the hawk dropped him right there on the green, and the ball popped out of his paws and rolled to about 18 inches from the cup!”

The Mother Superior sat back in her chair, folded her arms across her chest, fixed the Sister with a baleful stare and said…

“You missed the fucking putt, didn’t you?”

Until next time…

And here I was thinking that using phrases like Iraq War, big tits, naked webcam, Paris Hilton and such were increasing my hit count. Little did I know it would be another phrase entirely…

…for horseplay in the workplace. Far be it from me to suggest that cops, EMTs and firemen ever adopt anything other than serious poker faces and engage in a harmless prank every now and then.

Nope, the cops sit in their cruisers reading up on the criminal code, firefighters spend their time at the station washing apparatus and memorizing the laws of thermodynamics and the Emergency Response Guidebook, and medics laboriously study the pharmacodynamics of the latest Wonder Drug of The Week. Occasionally we get struck with an attack of whimsy and do something really frivolous like study up on left anterior hemifascicular block and other Really Cool Ventricular Conduction Defects.

Really.

Please note that all of these pranks were designed to be played on co-workers and loved ones. Under no circumstances should you throw imaginary spiders on your hallucinating psych patient or hand a box of EKG electrodes to the alcoholic street person with the instruction that they are timed-release aspirin patches. That’s just unethical.

The following pranks are not to be construed as anything that actually should be performed in the workplace. Any resemblance to an existing prank, real or imagined, is purely coincidental. The following pranks were performed by trained professionals. Do not try this in your workplace. Exposure to said pranks may result in incurable silliness, improved demeanor and relief of workplace stress. Occasionally, the humorless or easily offended may experience the following adverse side effects: anxiety, humiliation, anger, itching, rash, feelings of alienation, and anal leakage, and may result in allegations of unprofessional conduct and whiny calls to the Human Resources Department. Not approved for use in animals, except EMS dispatchers.

1. Saran wrap the toilet bowl. A timeless classic used in squad room and firehouse restrooms since the dawn of time. Or at least, since the invention of toilets and Saran wrap. Best used with muted lighting, since the glare off the Saran wrap tends to give the prank away.

2. Apply Armor All to the squad bench in the ambulance. All it takes is a hard braking maneuver while your partner is sitting on the bench…okay, forget I said anything about that one unless your ambulance has padded cabinetry.

3. Paint your squad mate’s fingernails while they sleep. Requires a delicate touch and a high degree of stealth. Best applied to the most macho, homophobic guy in the station. Pick a daring color like Slut Red. Testor’s enamel model paint works well in a pinch.

4. Swap the PA and radio mikes on their respective holders. Simple, but effective. Best used on partners who like to use the PA to berate motorists on emergency calls and moo at cattle as they drive past.

5. Call in a license check by DL number to the rookie police dispatcher. You cops probably know the numbers by heart. When the license comes back to Delicious Peters, or Santa Claus…try not to snicker too loudly. If you use the DL number for Mickey Mouse, always ask for a spelling. Priceless. Extra points if someone else on the channel chimes in the last…Emmm Ohhh Yoouuu Esss Eeee!

5a. Cops, if someone gives you Ronald Reagan’s DL number, avoid calling it in unless you like having the U.S. Secret Service call the Sheriff and ask pointed questions about what a Deputy is doing calling for a criminal background check on the former Commander In Chief. Not that I know any deputies who have done such a thing, of course.

6. EMTs…find a length of oxygen tubing. Attach one end to the fill line in the toilet tank. Route the oxygen tubing behind the tank and tape the other end to the bottom of the seat, pointing forward. Wait for someone to flush the toilet and you get…instant bidet. Not recommended for people who flush as an afterthought, because the sodding thing will run forever and flood the entire ambulance station, forcing you to spend $120 on a shop vac and a carpet shampooer to clean up the mess, and forcing you to make up elaborate lies to keep the boss from finding out and firing you. Or at least, that’s what I’ve been told.

7. Cover the insoles of your partner’s boots with KY Jelly and put them in the freezer overnight, then slip them back in place when he isn’t looking. Works best with removable insoles.

8. 20% Benzocaine spray on the toothbrush is a classic. It’s even funnier if you get a call immediately afterward and your partner has to go out in public with his face threatening to slide off his skull. Be sure to provide a bib to catch all the drool.

9. Suspend your partner’s car keys on a string, then hang them in a gallon jug of water. Put in the freezer overnight.

10. Rub a squad mate’s bedding down with Owens Corning fiberglass insulation. This is the prank that ends the prank wars. The Shock and Awe of practical jokes. The H-Bomb of horseplay. For any victim with a history of severe allergies, it might be a good idea to have the Epi and Benadryl ready. I’m just saying.

11. Next time your partner is in the shower, find the outlet valve on the hot water tank. Turn it off. Listen for the screams and giggle.

12. If you’re mechanically inclined, crawl under a co-worker’s Jeep and run a jumper wire from t
heir brake lights to the horn. It won’t give a full honk, but they’ll wonder what the hell that sound is every time they hit the brakes.

13. Medics, don’t throw away that unused bag of IV fluid that you spiked but never got to administer. Instead put in in a pressure infuser and stow it behind your partner’s seat. Tape the end of the tubing inconspicuously to the headrest of your partner’s seat. Kink the tubing, and paper clip it to the shoulder restraint. Open the roller valve wide open. Wait for your partner to put on his seat belt. Extra points if you can convince him that the ambulance roof is leaking.

14. On the next hot day you pull up next to a co-worker’s ambulance in the ER ambulance bay, see if they locked their rig. If they haven’t, switch the all the climate controls in the cab to “Hot.” Turn on the fan full blast. Sit just around the corner and wave at them as they drive past, stewing in their own juices. Salute them with your Slurpee or ice cream cone.

15. Now this one only works on rookie EMTs and first year medical residents…but next time a patient shows a lot of artifact on the EKG, extol the virtues of the Modified Scrotal Lead. Pick any rationale…

See all that schmutz there that obscures the tracing? That’s bony artifact, son. Bone don’t conduct electrical current near as well as soft tissue. What you wanna do is find an alternate lead placement that avoids all those bones. I prefer MSL 1. Take this here black electrode and move it down to the bottom side of the patient’s balls. See how that looks straight up through the pelvis to the patient’s heart? Ain’t nothin‘ in the way but soft organs and empty space. Only reason I ain’t doing it now is cuz Mr. Johnson here is awake and alert. But you can bet that if I had to…

Then wait for the inevitable moment when the rookie tries it for real. Hopefully the EMT will do it in front of a Stuporvisor or Field Training Officer. Even better if the first year resident tries to impress an attending physician with this new addition to his Bag O Tricks. That’s the kind of gag whose legend grows over time.

Until next time…

You find the weirdest stuff when you look at the referral links and search terms in Sitemeter.

Just found this site while browsing around, and damned near pissed myself. Think of it as The Onion for medical folks. Unfortunately, it hasn’t been updated since October 2005, otherwise it would be on the blog roll.

That is all…

A few days back, a self-appointed EMS hall monitor took it upon himself to inform me of the damage I am doing to EMS with my little blog here.

Among other inaccurate, misinterpreted and generally just-don’t-get-it comments, he accused me of being an EMS cowboy, apparently because of the following statement, “A good paramedic knows when to deviate from protocol.”

I defend my statement. In this profession, our protocols, or Rules of Engagement if you prefer, are designed to provide a floor for medical care. The weakest paramedic, by following protocols, can at least provide the same minimum level of care as the strongest medic.

At least, that’s the theory. All too often, the protocols are written in such a way that the strongest medic is forced to lower his level of care to that of the weakest paramedic. The protocols provide a ceiling of care, rather than a floor. So it occasionally becomes necessary to decide, in the best interests of the patient, when to deviate from said protocol.

A good medic does this, often consulting with a medical control physician where necessary. A weak paramedic applies the protocol blindly, secure in the false knowledge that he has Done The Right Thing by following written orders. This serves neither the patient nor the profession of EMS. We have a responsibility to use common sense and a degree of discretion in the application of protocols which cannot address every eventuality.

People who think in concrete terms cannot grasp this concept. Abstract thinking and appreciation of nuance escape them, much like our EMS hall monitor. They get so caught up in the words that they fail to grasp the message. They think in the algorithmic terms so common to our profession, terms that, in my opinion, do a disservice to new medics and quash any critical thinking skills they may have.

If A, then B.

If X, then Y.

CPR, shock at 150 joules. Resume CPR.

Secure the airway.

Add a dash of vasopressin and a pinch of amiodarone. Knead with continuous chest compressions. Bake repeatedly at 150 joules and let cool in the ICU. Serves eight.

These recipes for care are nice tools for the weak of memory (myself included), but this profession requires a Thinking Cook. You have to recognize when you’re off the page. Many people simply cannot do this, and sadly enough, many of them have found careers in EMS.

So if I have the good sense to deviate from protocol where necessary, and to consult the Doc for permission NOT to do something, and that makes me a Cowboy…

…then Yee Hah. I’m proud of it. Personally, I prefer Bryan Bledsoe’s definition of EMS Cowboy much better than Recovering Paramedic’s. I think I fit Bryan’s definition better.

Until next time…

Suitably scrubbed, whitewashed, obfuscated, fictionalized, muddied, folded, spindled and mutilated to appease the PC sensibilities of any self-appointed EMS hall monitor and patient confidentiality ombudsman…

“Well, she just won’t eat,” the daughter explains. “All she does is just poke her food around. She won’t drink, either.” The daughter clasps her arms in front of her, her face twisted in worry and frustration. The old woman just lies there listlessly, not speaking. She’s awake, but I’m not sure how much she can understand.

“Why don’t you tell me what kind of medical problems she has,” I suggest gently. The daughter sighs, nods. She exhales heavily.

“High blood pressure and diabetes…” she replies, and her voice trails off. Her eyes are red-rimmed from crying.

“Alzheimer’s? Lung or heart problems?” I prompt.

“No, nothing like that,” she shakes her head. “She’s always been pretty healthy, up until Dad died a few months ago. You remember.”

I do remember the call, although so many get jumbled in my head these days. People recognize me as the man that cared for their son or uncle or grandmother. Some of them even call me by name. Yet to me, so many of them are just vaguely familiar faces and half-remembered medical complaints. It bothers me.

I see so many people, Ma’am. The faces just blend together after a while. And when you met me, I was the face you encountered in a horrific time for you. I wish you could forget that day, and forget my face. But I do remember your Dad.

The Abshire name is an old one in Podunk Parish. From Podunk to Hooterville to Pixley and Frog Holler, their names take up two pages in the phone book. They are lawyers and bankers and farmers, loggers, mechanics and businessmen. In the cemetery north of Hooterville, there is the grave of a Confederate soldier who bears the family name. They run long on hardy boys who grow up to be honest and hardworking men, and the occasional girl who finds her own kind of strength from growing up in a household of rowdy brothers.

The Abshire daughter I’m talking to now was referring to a call three months ago. She had called 911 after her mother had called her to tell her that her father wouldn’t wake up. Lillian Abshire had awoken to find her husband still in bed next to her. That in itself was unusual. Though long since retired, Melvin Abshire woke shortly after dawn every day. Life was too short to waste it in bed when there was work to be done. Lillian had told her daughter that she didn’t think Melvin was breathing.

When we arrived, Melvin Abshire was dead, but still warm. There was no rigor or lividity present. Whenever he had passed away, it wasn’t too long ago. At first they wanted us to code him, but I guess my reluctance showed on my face.

“We don’t know how long he’s been down,” I explained as gently as I could. “I could try, but chances are we won’t get him back. The things we’d have to do to him…”

Please don’t ask us to torture this man’s body, my voice said without words. Let him go with dignity. Let him die in peace.

“Let him go,” Lillian Abshire had said, looking up from her chair at the breakfast table. Her voice was hollow, but firm. “I don’t want anything done.” Her daughter and three of her sons were with her, one of them standing behind his mother with his hands on her shoulders. You could see in their faces that they didn’t like it. Abshires were not taught to give up easily, but they were not taught to disobey their mother, either. I remember being struck by the strength in her voice and the pain in her eyes.

Right now those eyes are vacant. I can’t see much of Lillian Abshire in there. She looks nothing like the woman I saw that day. She is emaciated, her skin sallow and slack. I sit carefully on the bed beside her and pick up her left hand. She is still wearing a wedding band. Her veins show up like a blue roadmap underneath her translucent skin, her pulse rapid and thready.

“Miss Lillian,” I call softly. “Can you hear me? It’s AD. We met a few months back.” Her eyes focus and look around briefly, then settle on me.

“I remember you,” she says softly. Her voice is scratchy, weak. “Who called you?”

“Your daughter Elaine called,” I explain. “She says you haven’t had much of an appetite lately. She’s worried about you.” Lillian’s eyes close and her hand pulls away.

“I’m fine,” she says flatly, turning her head away from me. “You’re wasting your time out here.”

“She is not fine!” Elaine insists desperately. “Mama, talk to the man, please! Tell us what’s wrong with you!” she pleads, her voice breaking. I shoot a glance at Pardner, standing nearby with a BP cuff and stethoscope. He nods imperceptibly and puts the cuff and scope on the bed beside me.

“Miss Elaine, why don’t you help me gather up your Momma’s medications and such,” he suggests, wrapping an arm around her shoulders and steering her out of the room. “You can tell me what’s been going on with her lately while we’re at it. I noticed your Momma’s flowers are bloomin’ real purty out there by the porch. I been hoping we’d get some good rain here lately…”

I listen to Pardner’s voice fade away and gently touch Lillian’s shoulder again. “Miss Lillian, please talk to me. I’d like to know how to help you.” I sit quietly and wait for some reaction. Her eyes are still closed, but she can hear me. There are tears beneath her eyelids. As if noticing it, she squints her eyes shut and shakes her head.

“Can’t help me,” she says, almost inaudibly. “I wish everyone would just leave me alone and let me die.”

Now what do I say to that? Start asking her pointless psych questions about suicidal ideation? She’s not crazy. Do I play the guilt card and point out what this is doing to her children?

“Well, I wouldn’t be a very good paramedic if I just let you die,” I say, trying to make a joke of it. She opens her
eyes and looks at me.

“You’ve done it before,” she says flatly. There is no accusation in her voice, merely a statement of fact. “Just leave me be and let me go.”

“Miss Lillian, your husband was already gone,” I point out. “You’re not.” There is nothing else I can say. I refuse to make trite, clichéd observations to this woman. She deserves better.

But Lillian, you have so much to live for. You have children who love you, grandchildren who wouldn’t understand. Yeah, and you’re close to ninety years old, and your husband is dead. You live in an empty house with nothing but memories. Who the hell am I to question your choices?

“Miss Lillian, don’t make me leave you here. You’re dehydrated and malnourished. Let us take you to the hospital, please.”

“I’m not going to be fed through some tube,” she snaps, her eyes glittering. There is life in her still.

“You can refuse whatever care you want, at any point you want,” I inform her, sensing the possibility of a compromise. “Just let us take you to the hospital.” She sighs, shrugs. Closes her eyes.

“Whatever you want to do,” she sighs. “I don’t care.” It isn’t so much consent as acquiescence.

“Pardner!” I call out. “Let’s go.” Presently he appears, holding only a couple of medication bottles and a small vinyl wallet containing Lillian’s Medicare and insurance cards.

“These are all she has,” he says, handing them to me. A bottle of antihypertensive medication and a bottle of Actos, just as we’d been told. “Elaine wants to ride with us,” he adds.

“Fine with me,” I say, “but up front. Let’s get her on the stretcher and go.” Pardner moves to the other side of the bed and pulls the fitted sheet free of the mattress. He steps up gingerly onto the mattress and bunches the sheet around her.

“Now Miss Lillian, don’t you go telling those ladies over at Mount Pisgah that you had a strange young man in your bed. They’d all die of jealousy,” he jokes. Elaine chuckles, but Miss Lillian acts as if she hasn’t heard. We gently package her on the stretcher and wheel her outside, muscling the stretcher down the porch steps.

The Abshire house is surrounded by shade trees off a bend in Highway 138 in Hooterville, the southern corner of Ignorant Thicket. Forty acres of cleared hardwood bottom slopes gently away behind the house, ending at Hawg Creek. When Melvin was alive, these fields were tall with hay, and a small section contained a lush vegetable garden. Now it’s fallow and choked with weeds. Just to the left of the gravel driveway sits a huge white oak tree, with the obligatory tire swing hanging from one branch. Ten years ago, when we first opened an ambulance station in Pixley, we had sat at a picnic table under this tree and drank tea so sweet it threatened to shut down my pancreas. Melvin had told us of the history of the area, where the best fishing was on Hawg Creek, and given us permission to hunt on his property.

“Just don’t shoot toward the house,” he warned sternly. “My grandbabies play around here.” Before we left that first day, Lillian sent us off with a mess of fresh picked corn, tomatoes and squash. It was not the last time she did so over the years.

We load Miss Lillian in the rig without much difficulty. At 89 years old, she probably weighs less than her age. I follow the stretcher in and settle on the bench seat beside her. Pardner pauses before closing the rear doors, raised eyebrows asking if I need anything.

“I got it from here, bro. Give us an easy ride to Big City Regional Hospital,” I tell him. Pardner grunts in affirmation and closes the rear doors. Presently I feel the rig lurch as he turns around in the yard, and Lillian and I watch her house fade in the distance as we ease back out onto the highway. I reach into the IV cabinet and pull out a bag of saline and an administration set. I spike the bag and give Lillian’s left arm a glance. The veins are easy to see, but sticking one may be another proposition entirely.

“An IV and some fluids wouldn’t be a bad idea, Miss Lillian,” I say quietly. “You’re pretty dehydrated.” Without a word, she raises her left arm and places it across my thigh. She still says nothing, just stares passively out the back window as I gently slip a 20 gauge in her left forearm. I tape the catheter down, using paper tape on her fragile, translucent skin. I open the roller clamp wide and let the fluid run as I wrap the blood pressure cuff around her arm and attach the cardiac monitor leads. During all this, Lillian says nothing. It’s as if she doesn’t even care what I do to her.

“So how are you feeling?” I venture again. “Any nausea or vomiting? Weakness? Are you just not hungry, or can you not keep food on your stomach?” Lillian just stares listlessly out the back window and gives no sign that she has heard, her left hand still limply resting on my thigh.

She hears me. I know she can. She just doesn’t care any more. She has given up, and nothing or nobody is going to change her mind. She wants to die.

I sigh and gently place her hand by her side and shift over to the jump seat at the head of the stretcher. The monitor shows a sinus tachycardia, maybe 110 beats a minute. Aside from the slow rise and fall of her chest beneath the sheet, the beep of the cardiac monitor is the only sign she’s alive. Ambulances are not built for comfort, and Louisiana highways are not friendly to fragile little old ladies with no subcutaneous fat, yet she shows no reaction as the rig bumps and sways over the potholes and ruts of Podunk Parish’s back roads. Pardner is taking one of his patented shortcuts to Big City and holding a lively conversation with Elaine in the front seat. I hear laughter and catch a few snatches of the conversation – something about his uncle Shorty, a drunken mule, and the ladies Sunday school class. Elaine erupts into riotous laughter.

The man never meets a stranger. That’s his gift. By the time we get to Big City, they’ll be the best of friends.

“My partner and your daughter seem to be getting along,” I say. “He’s got a million stories, and all of them take three hours to tell. Betcha twenty bucks he drives Elaine crazy before we get to the hospital,” I tell Lillian, half jokingly.

In the rear window, I catch Lillian’s reflection as she opens her eyes. She says nothing for a long time, and then her mouth breaks into a wry smile and she chuckles. “I’ll put my money on Elaine,” she says, her voice dry and
cracking. “She started talking at eleven months old and hasn’t shut up for sixty-three years. Drove me and her daddy to distraction.”

“Oh really?” I ask dubiously, grinning at her as I move back over to the bench seat to sit beside her. “She may be a talker, but Pardner’s the champ. What makes you think she can take his title?” I tease.

“That child made straight A’s all through school, except for conduct. Wouldn’t stop talking. She came into this world caterwaulin’ at the top of her lungs, and she’s had something to say ever since,” Lillian says, shaking her head wryly at the memory. “Melvin tanned her hide a few times when the teachers gave her bad marks for talking in class, but we gave that up. She was such a bright child in everything else, it felt wrong to whip her. We figured she’d grow up to be a lawyer.”

“So she’s an attorney?” I ask. “Does she practice in Podunk Parish?” This prompts a burst of outright laughter from Lillian.

“Heck no!” she says ruefully. “Met a fella that liked to talk almost as much as she did, and got married right out of high school. Worked as a hairdresser for forty years and gave me four grandbabies along the way, and wouldn’t you know it, not a one of ‘em has much to say.

“Maybe they grew up knowing they couldn’t get a word in edgewise,” I wink. “Or maybe the talkative gene skips a generation.”

“Lord I hope not,” she laughs, slapping me on the knee. “I’ve got great grandbabies who are gonna start talking any day now. At my age, I need the peace and quiet.”

That’s it, Lillian. Keep talking. Tell me all about those grandbabies.

“So you have great grandchildren?” I ask, intrigued. “How many? For that matter, how many Abshires are there? Y’all are a big clan.”

“Lord only knows,” Lillian sighs, smiling. “I have enough trouble keeping count of my own brood. The Abshire boys took that ‘be fruitful and multiply’ verse to heart. Melvin was the youngest of six boys, and all of them raised big families themselves.”

“Okay, so how many in your brood?” I ask, winking at her. “Impress me with your powers of procreation.”

“Well…” she answers, her voice trailing off as she does a mental count. “Melvin and I had seven – all boys except Elaine. She was our middle child. Lost Melvin Jr. to polio before he was two years old, but I have six children still around.”

“It must have been hard to lose a child like that,” I sympathize. “It was,” she sighs. “For a while I didn’t want to have more kids. Then Brian came along, and we had two more back to back. Then the war came along…”

“Melvin served in World War Two?” I ask. “What branch of service?”

“Army Air Corps,” she answers. “He was a gunner on a B-17. He probably could have gotten out of going overseas, but he felt like it was his duty. We managed without him, but Lord it was hard. Seemed like forever.”

“My Dad and an uncle served on B-17s in the war. I had another uncle who flew P-38s,” I tell her. “So were you ever worried about him? Scared he’d get shot down?”

“Every day,” she sighs with a half-smile. “But I figured the good Lord would bring him home, and he did.” She closes her eyes and stops talking for a while, but the smile still hovers around her lips.

“So you took a few years off to help save the world for democracy,” I prompt teasingly, “and when he came back you got back to the serious business of populating Podunk Parish. How long before you had the other three kids?”

“Just about nine months from the day he came home,” she laughs, her eyes twinkling. “Leo came next, then Eli and James. All of them born and raised right here. The oldest three were born right there in our house.”

“So you and Melvin managed to build a house, run a farm and have four kids, and all that before he fought in a World War. That’s a lifetime’s worth for most people. I’m impressed.”

“Well the house was there before we got married, or some of it was,” she allows. “It was his folks’ old home place, and we moved in there when we got married. After his parents died, we stayed in it and built on as the kids came. It’s the only home we’ve ever lived in.” Her voice breaks and tears come to her eyes. I simply sit beside her and wonder what to say.

And now that house is empty except for you, and you’re scared you’ll never see it again. Either that or you’re not interested in living there without your husband.

“So his parents took you both in after you were married?” I ask, searching for a way to keep her talking. “That was generous of them.” She blinks her eyes several times and looks at me. She gives a shuddering sigh and pats my hand.

“It was during the Depression. We didn’t have it so hard as some. Money never was in great supply in my family or his, and his family owned all this land free and clear. The farm used to be a lot bigger than it is now. Took a lot of people to work the land.”

“So you had all those kids for the free labor,” I reply, winking to show her I was joking.

“Oh, I don’t know about that,” she chuckles. “It might have been cheaper in the long run to hire some hands.”

“But hired help can’t give you grandkids to spoil. Or great grandkids,” I point out.

“Or great-great grandchildren,” she agrees. “I have four of those. Or is it five? I can’t seem to remember some times. No,” she says firmly, nodding her head. “It is four great-great grandbabies. I’m sure.”

“So the grand total is…how many?” I press.

“Seven children, twenty-nine grandchildren, sixteen great grandchildren…” she recites, her eyes closed in concentration.

“And four great-great grandchildren,” I finish. “I’m impressed, but not nearly as impressed as I’d be if you could name them all,” I challenge. She looks at me in surprise and I hold her gaze for a few moments, then wink.

“Lord no!” she laughs. “We haven’t got enough time for that!”

“We have five minutes or so,” I say looking out the window. We’re entering the outskirts of Big City. Pardner and Elaine are still chatting animatedly up front. “If it takes longer than that, we’ll make the block a few times. I could talk to you for hours.”

“I’m too tired,” she sighs, closing her eyes, “nothing much more to tell anyway.”

“Still, it sounds like a good life,” I say. “One anyone would be proud of.”

“Yes, it was a good life,” she agrees, her eyes still closed, but with a wispy smile on her lips. “It was a life well-lived.” She says nothing else for the next several minutes, and I am alone with the steady beep of the cardiac monitor. Presently, the rig lurches as we back into the ambulance bay at Big City Regional Medical Center. Pardner opens the back doors, still laughing and talking over his shoulder to Ela
ine.

“I called report,” he says. “Looked like y’all were having a deep conversation back there.”

“We were,” I assure him. “Thanks for doing my job for me, anyway.”

“If I didn’t look out for him, Miss Lillian, he wouldn’t be able to function,” he winks at my patient as he rolls the stretcher out of the rig. “I swear, that boy gets to talkin’, and you can’t shut him up. Prob’ly drove you to distraction all the way down here, didn’t he?”

Lillian opens one eye and looks at me, then winks. We both break up laughing. Pardner and Elaine stare at us both as we wheel the stretcher inside, trying to get the joke. After we move Miss Lillian to the ER bed, Elaine thanks Pardner and hugs his neck as if they’re old friends. Somehow, I’m not surprised. Lillian and I just share a smile, and she clasps my hand and nods before I leave. I hope for the best for her. I hope she has another ten years of good health and watching her brood grow older and larger, but I wouldn’t be surprised if she never made it out of the hospital.

Five days later, I read her obituary in the Podunk Journal. Lillian Abshire, age eighty-nine, preceded in death by her loving husband, Melvin. Survived by numerous children, grandchildren, great grandchildren, and great-great grandchildren.

I read closer, and it turns out she was wrong.

There were indeed five great-great grandchildren.

Until next time…

New to the blog roll are Ventricular Entropy and Dragonwatch. Some good medical stories, a few miscellaneous commentary, and a peek into the psyche of a couple more medics. God, people are fascinating.

A few notes on the blog roll – I read a lot of stuff when I’m not at work Saving Lives and Thwarting Natural Selection. Some I visit often, some I can’t do without. The folks I link on the blog roll are sites I check every day. If you’ve linked to my blog, many thanks. If I haven’t reciprocated, it’s because I’m trying to keep this thing from looking too busy, not because I think your stuff unworthy of reading or recommendation. I figure most folks Google subjects that interest them, just like I do.

That is all…

You were Visitor #6,000!

Actually, you were 6001, but the guy before you had no geographical information. So YOU win the cement bicycle and the right to choose the topic of my next post!

Nice to know out of over 6,000 visitors in less than a month, I’ve only had three folks who just didn’t get it. Well actually, maybe only two who didn’t get it. Anonymous’ take on my nursing home post actually had some good comments to add.

More snark and stories a comin’ folks.

Until next time…

*Sigh*

I have found a new critic. Recovering Paramedic writes:

Holy HIPAA, Batman. Calling "Gary," even if his name is "Ed," and known only to "locals," is still disclosure of individually identifiable health information. And even if the address on "Highway 808" is really "Highway 80," which gives a good address for that number... do you not understand what confidentiality means? Or does the US Department of Health and Human Services Office of Civil Rights not havejurisdiction in your parish?

I know what HIPAA means, Recovering. Do you? Actually, it relates to electronic storage and transmission of patient records. Patient confidentiality laws were in place long before HIPAA. And yes, the details, times, addresses and even the major players in each story has been purposely muddied, obfuscated and downright changed to make it impossible to identify the players. And those players who ARE identified by name have signed releases. 

I did this primarily to protect patient confidentiality while at the same time telling entertaining stories, and secondarily to protect myself from semi-informed guardhouse EMS lawyers like yourself.

And yes, I read your other comments as well. They read like stereo instructions. So much so, that I fear you miss the point entirely.

So either develop a sense of humor or go troll someone else's blog, goober. 

Disclaimer: I hunt. I shoot. I believe fervently in the right to keep and bear arms. At last count, I owned seven shotguns, five rifles, four handguns and a perhaps a dozen assorted air rifles, muzzle loaders and antique pieces. And a couple of compound bows. Maybe a blowgun. Enough edged weapons to skin a brontosaurus. I think there’s even a sharp stick (Urg the Neanderthal Signature Model) that I won at auction at the last Pterodactyls Unlimited banquet I attended. Hey, I was drunk and the thing had nice engraving.

That said, I think that any EMT who believes they need to pack heat while on duty has his head up his ass. You do not need to wear a gun while on duty. You need situational awareness, verbal de-escalation skills, and a well-honed sense of when to bug the hell out. Remember the Three R’s – Retreat, Radio and Reassess.

And don’t feed me the old cliche “I’d rather be judged by twelve than carried by six.”

I’m not saying EMTs shouldn’t defend themselves. I’m not even opposed to the abstract idea of CCW while on the job. It’s just that most EMTs I know who insist on carrying weapons are just the sort of EMTs who shouldn’t…well…be EMTs. Much less armed EMTs.

They cannot communicate effectively. They lack empathy and compassion. They’re hotheaded. Every patient encounter is an adversarial relationship. They conduct patient interviews like police interrogations. When the feces strike the thermal agitator, they’re the type who thinks shouting orders and throwing their weight around constitutes effective leadership and good crisis management. They’re just not…reasonable people. A reasonable person with a concealed weapon is one of the safest people you will ever meet…and one of the most dangerous, depending on how you approach him. An unreasonable person with a firearm is just plain dangerous, regardless of whether you’re law abiding or not.

Here’s a hint: if you have shown off your carry weapon to your co-workers, you’re just the sort of goober I’m talking about. And here’s the sad thing – most law enforcement agencies wouldn’t have you either, Sergeant Tackleberry.

Both LawDog and Matt G. have spoken about the combat mindset far more eloquently than I have, and they have training in the use of force continuum. Any cop worth his or her salt will tell you that the most effective weapon is the mind. And the most effective conflict resolution tool is talking. Talk, talk, talk.

Keep your wits about you, and keep talking. We as EMTs have an advantage over cops – we have the luxury of being able to disengage from a threat, and most critters view us as non-combatants.

Relax, EMT Tackleberry – I said most, not all. But that line gets dangerously blurred when you start carrying a weapon. For the same reason, I won’t work at an EMS agency that insists on outfitting us in cop-like uniforms and badges.

I want the ability to be able to get a patient in the back of the rig and say conspiratorially, “Relax, bro. I ain’t the fuckin‘ po-leece. But if you want me to help you, you gotta level with me and tell me what you took.”

Call it the EMS version of Good Cop, Bad Cop. I’ll use whatever means necessary to get the information I need to treat the patient. The cops I know respect and understand this.

But unless you are God’s Honest, Truly Prepared mentally and emotionally for what it will mean to take the life of the psychotic/chemically enhanced/angry person whom you were initially called to help, just leave the piece at home.

I invite your comments…

First off – apologies to my non-EMS readers. I’m going to bitch at my brethren a moment. Feel free to eavesdrop if you’d like.

I fully realize that taking care of surly drunks and crack addicts at 3 am is not what you may have envisioned when you signed on for the job, Little LifeSavers. And while giving a little old lady a ride to the ER to have someone replace her PEG tube may not be a worthy use of your prodigious skills, it IS your job. And if you want to use words like Gomer Tote and Foley Patrol when it’s Just Us Guys, I’ll chuckle right along with you and commiserate. I’ve been there, probably far more often than you have. But if I hear ONE MORE medic refer to a patient in derogatory terms when that patient or a family member is within earshot, I’m going to snatch a knot in somebody’s ass. That applies even when I happen to agree with your opinion of the patient. Be professionals, and maybe one day the rest of the healthcare industry will treat us like professionals.

And when you call in a patient report, have something coherent to say. My colleagues used to wonder at how I got orders from Docs when no one else could, or get away with doing things without orders that would see any other medic get disciplined. It’s very simple: I try very hard not to sound like an idiot when I pick up the phone. Try it some time. You might be surprised.

And here’s another one – no one deserves to be in pain if it can be avoided. And while you may be reluctant to medicate an assumed drug seeker, there always exists the possibility that your assessment and assumptions may be flawed. Look carefully. And when you bring me an eighty year old man WITH AN OBVIOUS FEMUR FRACTURE, he damned well better be medicated. I don’t give a rat’s ass if the nursing home is two minutes away. I don’t care if he fell in my fucking parking lot. Before he is moved from his position on the ground, you had better get an IV and get him some pain relief. The splinting alone is painful enough, let alone the ride to the hospital. We don’t get a chance to save many lives, and there are damned few studies out there that show that a paramedic is any better than an EMT for the average emergency call. But pain relief is something we can do.

On that same note, 99% of EMS protocols were written to ensure that Mongo the Knuckle-Dragging Medic renders the same basic, minimum care as Johnny Gage the Super Medic. If the only justification you can offer for performing a procedure or administering a medication is the phrase, “it’s in the protocol,” guess which one you are? A good medic knows when to deviate from protocol.

Keep this in mind too – strapping someone to a board is not always necessary. In fact, spinal immobilization is rarely necessary. A simple physical examination of the patient is more accurate than a cervical spine x-ray at ruling out a cervical spine fracture. That’s right kiddies, I said more accurate. EMTs throughout Maine do it with great accuracy. If your system requires you to regularly strap some frightened osteoporotic grandma with absolutely no sign of neurological deficits or cervical pain to a hard plastic board, solely because she rolled out of bed, you have two choices: Either blindly do something stupid like Mongo Medic, or call the ER for permission to deviate from your protocols. If that doesn’t work, Google NEXUS some time and look at the studies. Better yet, send me your e-mail addy and I’ll forward a bunch to you. That way you’ll have some ammunition when you pose the question to your medical director, “Why do you write protocols that require us to do painful, unnecessary procedures with no proven medical benefit?”

And if you still have no choice but to immobilize the patient, or in your heart of hearts you feel that he really needs it, for Gawd’s sake do it right. Rob straps from your other boards if you have to, and tear up your membership card in the No Neck Fits Everyone Society.

And here’s another tip – by the time your hyperventilating patient is having carpopedal spasms, their CO2 level has already dropped to the point where re-breathing into a paper bag or an oxygen mask with the flow turned off is pointless. They just aren’t exhaling enough CO2 to re-breathe any. Better to turn the lights down, speak soothingly to them and coach their breathing down to a normal rate, and sedate ‘em to the eyeballs if necessary. And no, telling the patient to Cowboy Up does not qualify as coaching.

If you tell me the patient has had a syncopal episode after spewing various gastric fluids from both ends for the past few days, please obtain a set of orthostatic vital signs prior to arrival. That provides us a clue as to why they fainted, boys and girls. It also lets the ER staff know that you have functioning synapses and are thus more worthy of trust than your co-workers. If you give me the eye-roll and world-weary shrug and tell me, “The nursing home got a BP of 70 over Taiwan, but we got a BP of 120/70, chuckle chuckle…” and I wind up finding significant orthostatic changes in vitals…guess what? You just placed your knowledge level directly below that nursing home nurse. How’s that feel, Mongo?

Until next time…

Now there’s a question guaranteed to raise an eyebrow when asked in the women’s clothing section at Wal Mart – particularly when the question is asked by a 6’2″ man who weighs 300 pounds on the hoof – give or take a Taco Bell value meal and a pair of trauma shears.

“Uh, excuse me Miss? The only thing I could find in my size was nude. Do you have anything in taupe? Maybe something in a control top?”

Now all the women over in the pharmacy and cosmetics department already think I’m a deviant because I shop for a lot of my moulage supplies over there. Nothing beats the look on a cashier’s face when you slide a few Maybelline concealer sticks, lipstick tubes in red, purple, black and green, and neutral foundation powder across the counter…and when their eyebrows inch upward, go ahead and slide across a jar of Vaseline, some unflavored Knox gelatin and a box of food coloring… and then wink.

Priceless.

And in my married days, I had already run the Emasculation Gauntlet and been sent on a douche shopping mission to the drugstore. (Here’s a hint, guys – never request a specific “flavor.” Those chicks at Walgreen’s have no sense of humor.)

Suffice it to say I considered myself embarassment-proof. Yet there is something about shopping for Frilly Things that just…does something to the male psyche. Particularly when you’re accompanied by your wife, who passes female judgment on every selection.

“Nope, honey. Not good with your skin tone.”

“Won’t work. Doesn’t go with your shoes or your handbag.”

“You’ll be the biggest woman on the stage, sweetie. We need to find something slimming that emphasizes your best features…like maybe a cardboard box that leaves your feet sticking out.”

“Blue eye shadow is a no-no. Yes, I know your eyes are blue. Just trust me on this. You look like that Mimi chick on the Drew Carey Show. Now go wash that stuff off and let me show you how to do it.”

Honestly, it was enough to damage a guy’s self esteem. I still bear the psychological scars, but then again so do the women who sold me my dress at Lane Bryant.

Now I should explain why I was taking this walk on the Wild Side. Although I have always described myself as a lesbian trapped in a man’s body, my orientation has always been fervently heterosexual. (grabs testicles and spits for masculine emphasis)

Nope, I was doing this for a Good Cause, specifically to raise money for a scholarship fund for widows and children of EMTs killed in the line of duty. One year during EMS Week, the Powers That Be decided that a Womanless Beauty Pageant would be an excellent fundraiser. The call went out for male medics who possessed certain attributes, like beauty… poise… intelligence… charm… talent.

Or failing that, at least find a couple of dozen exceedingly ugly, hairy male medics without absolutely no sense of decorum or self-respect. Naturally, I was one of the first ones approached.

So on the day of the pageant, I submitted myself to several hours of primping, preening, spackling, cinching, spraying and various other indignities at the hands of my wife, who pulled away the drape with a flourish and presented me with a hand mirror so that I could gaze upon the image of myself as…my mother.

Not my mother back in her youth when she was a knockout. Noooo, this version was of Mom after five kids and menopause, only with a five o’clock shadow and hairy legs.

It was a Norman Bates Moment.

Adding to the indignity was the fact that the banquet hall had no room for the boys to do their makeup on site. Nooooo…all we had was a ready room in which to congregate before our turn on the catwalk, necessitating every one of us to make the drive from our hotels to the banquet hall in full drag. I must confess that the drive over was made somewhat more entertaining by blowing kisses to every redneck at every stoplight. The Missus was driving, so I was even able to rub my hooters against the glass.

The ready room was packed with guys in various degrees of drag, each sizing the others up with a critical eye.

Not bad Bob, but my wig is better.

Geez, tweeze those eyebrows Larry!

Love the satin dress, Jason, but the panty line ruins it.

Got a little lipstick on your teeth there, Hank.

Boy these heels are tough to walk in, but DAMN don’t they make my calves look defined!

A concealer stick would cover those circles under your eyes, Frank.

Now whilst we were waiting, it would be fair to say that a fair amount of Liquid Courage was consumed. And while we were re-affirming our own masculinity, let’s just say that the language and the behavior got a little…coarse. At one point, a number of us noticed a rather attractive, statuesque blonde sitting quietly off to one side.

“Oh, sorry Ma’am, we didn’t realize you were sitting there. We didn’t mean to…Myron??? Is that YOU??? Damn, but you look HOT!”

At that point we all knew we were vying for second place.

Knowing that my hopes for winning hinged upon the talent competition, I decided to pull out all the stops. So I gave a lap dance to…this guy.

You EMTs may recognize the face of John Roquemore, former President of the National Association of EMTs. Needless to say he was less than enthused about a 300 pound drag queen gyrating around on his lap while singing Happy Birthday Mister President in the breathiest Marilyn Monroe voice I could muster…

…but he was a good sport about it, and I got First Runner Up. Raised $500 for the scholarship fund, too.

And rumor has it that Rocky spent his own money to buy up all the photo negatives taken during that event, so there is little chance any photos of my sexy self will make it onto the internet. Thank God.

Until next time…

Funny tale over on Mr. Fixit’s blog about a man with chronic LMC (Low Marble Count).

EMTs and cops, let’s raise a glass to all those folks in the Kiddie End of the Gene Pool. Without ‘em, we’d all be out of jobs.

Until next time…

I was paying a visit to Rocky Mountain Medic’s blog yesterday, reading about the ultimate EMS Nirvana experience – the Strip Club Call. You know, law enforcement has its badge bunnies, firefighters are the object of both male and female adulation, but medics just don’t have that many groupies. The ones we do have are not named Candy or Porsche or Jasmine. We have seventy year old groupies named Mabel, Gladys or Ethel, and they all trail fifty feet of oxygen tubing behind them all day.

But I did run one call where I might have been the object of a Sweet Young Thang’s admiration, however fleeting. Enjoy…

“Dispatch to Unit One,” the radio crackles, “Priority One call at the Lake Podunk Spillway, on the Hooterville side. Unconscious person.” Satan’s Minion never fails to interrupt our meals.

Rob sighs, stuffs his mouth with the last of his French fries, and looks at me.

“Unit One responding,” I grunt in acknowledgment, extricating myself from the cramped booth at McDonald’s.

“That’s a twenty-minute drive!” Rob splutters angrily, his mouth still full. “We’ll have to go all the way around the lake!”

“Maybe not,” I reply. I’ve got an idea forming in my head, so I key the radio mike once again. “Dispatch, is the patient at the spillway itself?”

“10-4, Unit One. The caller advised that a fisherman had collapsed at the spillway.”

“It’s only six minutes to the Podunk side of the spillway,” I suggest to Rob. “We could push the stretcher and the gear across.”

“I like it,” he grins, warming to the idea. “We’ll have the guy back across the spillway to the rig before the Hooterville volunteers even get there.” With that, we take a hard left turn onto Highway 21 for the brief run to the spillway access road. In less than five minutes, we’re there.

Damn, I’m a genius! We’d still be fifteen minutes out if we’d gone the long way around.

We pile the medic bag, oxygen and cardiac monitor onto the stretcher and duck under the chain stretched across the walkway at the top of the spillway. In the summer months, the walkway is packed with fishermen, shoulder-to-shoulder with their beer coolers and bait buckets. One hundred yards down the walkway, the flaw in my brilliant plan becomes apparent.

The walkway is only four feet wide, and our stretcher takes up two feet of it. We apologize repeatedly, pushing our way past pissed-off fishermen, knocking over bait buckets and coolers, tangling lines and generally making asses of ourselves. I look back and the sea has closed behind us, with most of them still directing angry looks our way as they untangle themselves.

We’re going to have to bring the patient back through that gauntlet, too. We’re screwed.

“Ohhhhhh shit,” Rob mutters softly, and I look up to see what has him so spooked.

There she is, about thirty yards ahead, The Immovable Object set to collide soon with our Unstoppable Force. A huge black woman is perched on top of a five-gallon bucket. She is so large, she has two smaller women in a satellite orbit around her. I would say they’re small, but only in comparison; each of her two satellites would weigh maybe two-fifty, but she’s much bigger. The walkway at the top of the spillway is only four feet wide, and her ass easily takes up three feet of that. She looks like a grotesque toadstool, perched there on her bucket. To make matters worse, she’s giving us the evil eye, and she doesn’t show any sign of getting up to make room.

“I don’t like this,” Rob whispers out of the side of his mouth. “You and your brilliant ideas…”

“It was your idea, too!” I whisper back. “Just relax. Maybe she’s friendly. Just reach out your hand and let her sniff it…”

“Fuck you!” Rob retorts, edging warily closer.

This is like a scene out of a bad western. ‘This walkway ain’t big enough for the both of us, sister.’

“You don’t still have the smell of food on your hands, do you?” I warn. “And be brave. They can smell fear.”

“Why don’t we just back away and call it a day?”

“Too late, partner. We’re already in her gravitational field.”

Rob turns his head and shoots me a dirty look as we approach the woman. “Uh, excuse me ma’am…” he begins hesitantly.

“What you want?” The woman demands, a hostile gleam in her eye. Her satellites take up flanking positions, forming a virtual wall of cellulite.

“We need to squeeze past you nice ladies,” Rob blurts.

Great choice of words, partner.

“We have an emergency on the other side of the spillway,” I explain politely. “If you ladies could just step aside, we’ll be on our way.”

At that, all three of them glare at me and turn their attention back to their fishing bobbers floating in the current thirty feet below us. If anything, their asses stick out even further.

Dropping our cot to its lowest position, Rob and I reluctantly prepare to run the Gauntlet of Goo. Picking our way past the acres of ass in front of us, we manage to lift our stretcher over our heads as we side step through the narrow gap between them and the railing. It’s a tight fit, but we aren’t forced to lubricate with KY to slip through, and we even manage to negotiate the passage without knocking a single floppy straw hat into the water.

The walkway is mercifully clear on the other side, so we are able to set down our burden after fifteen feet or so. Apparently, their combined gravitational pull sucked in any fishermen within fifty yards. We cross the rest of the walkway at a brisk trot, still looking for our patient, who is supposedly just on the other side.

“Awww, Goddamnit!” Rob whines pitifully, pointing. I look to see what he’s pointing at, and immediately feel like crying myself. Our patient is not at the spillway. He is well downstream, at the end of a 400-yard hike through pea gravel six inches deep. With big rocks. And gullies. And driftwood.

Did I mention the fucking pea gravel?

He’s lying supine amidst a crowd of onlookers, all of them flashing the gang sign of the International Bystander Society; one finger pointing at the ground, the other arm waving overhead, beckoning frantically. Some of them are even shouting the IBS secret code phrase, “Hurry the fuck up!”

By the time Rob and I get to the patient, I want to get on the stretcher myself. Our patient is an old man of maybe seventy, lying on his back with his head propped on his soft-sided tackle box. A bystander is helpfully giving him a big sip of water. He’s pale, but still sweating. From the number of empty Coors cans lying around his fishing spot, it’s pretty obvious what happened to him.

“What happened, sir?” I ask him, kneeling beside him and checking his radial pulse.

“Got plumb dizzy,” he answers, “then I woke up with all these people standing over me.” His pulse is rapid but strong.

“How long have you been out here?” Rob asks as he wraps a blo
od pressure cuff around the man’s arm.

“All morning,” the man replies. “Caught a few good catfish, too. It’s hotter’n Hell, but I been drinking plenty of fluids.”

I hold up one of the empty Coors cans. “These fluids?” I ask, grinning. He grins back.

“Hell yeah, son! That’s the real reason I fish. Gives me an excuse to drink beer!” This earns a chuckle from the crowd.

“That’s as good a reason as any,” I laugh, “but the problem is, alcohol dehydrates you faster. Plus, it’s 94 degrees out here, and you’ve been out here for five hours and drunk what…a six pack? That isn’t enough to keep you hydrated, even if you were drinking water.”

“I was about to go on a beer run in a few minutes,” the old man explains. “I ran out, but the fishin‘ was too good to leave.”

The crowd chuckles collectively. I’m pretty certain this a garden-variety case of heat exhaustion, but I ask him all the standard history questions anyway. He’s a reasonably healthy old man, his only medical history an enlarged prostate and an allergy to, as he puts it, “bitchy wimmen.” He’s an entertaining old codger, but we’ve got to get him out of the heat soon, so we cut the comedy routine short and ease him into a sitting position.

Immediately, he turns a pasty white and nearly passes out. His head lolls around drunkenly, and his eyes lose focus. When he comes around, he’s looking into the faces of two concerned EMTs, one of whom has noticed that his pulse rate jumped over twenty points when we sat him up.

“He’s orthostatic, Rob,” I observe. “Let’s get some fluids started and get him on the stretcher. Cardiac monitor, too.” I look back up at the spillway in dread. If anything, it’s packed with even more fishermen now, and the Cellulite Sisters are still perched there on the rail like gargoyles looking for a meal.

“Hey folks,” I say to the crowd in general, “why don’t y’all try to flag down a boat for us?”

Immediately, they hustle en masse to the shoreline and start flashing their IBS gang signs at the boats anchored below the spillway. I’d flag one down myself, or have Rob do it, but neither of us has the knack. It’s a lot like a tourist vainly trying to hail a taxi in New York City. Only the locals really know how.

Presently, an expensive bass boat pulls up to the shore. The captain jumps to the ground and swaggers over. He’s a fifty-ish man in an advanced stage of midlife crisis. He’s got all the signs – expensive boat, hair graying at the temples, beer gut, bottle tan, mirrored sunglasses and enough gold chains to make up a Mister T Starter Kit.

His first mate looks all of twenty-five, and she has some rather spectacular pectoral ornamentation, no doubt paid for by our new friend.

I’ll bet that if she fell out of the boat, there’s no way she’d drown. But I’d damned sure try to help her.

“Y’all need some help?” Pimp Daddy asks brusquely.

“Yes sir,” I nod seriously. “We have a very sick man here, and we’d like to use your boat to take him back across the spillway. Could you do that for us?”

“All three of you, plus your gear?” he asks dubiously. “I suppose I could carry that much weight. Better still, why don’t I just stay ashore and let my fiancé drive you across?”

The girl flashes a winning smile. I smile. The clouds part and a shaft of heavenly light bathes us in a comforting glow. Angels sing.

Thank you, Lord. Your blessings never cease.

“Would you?” I gush. “Thank you so much!”

Without further ado, Rob and I load our patient onto the casting deck of the boat and pile our gear aboard, and the girl slowly backs us out into the current. I was just about to start an IV on the old man when our savior arrived, so I take the opportunity to finish my task as we bounce across the waves. The girl smiles appreciatively at my obvious skill.

She digs me. I can tell.

All too soon, the trip is over and the boat is beached on the opposite shore, a bare fifty feet from our rig. We unload our patient and our gear, and I shake the girl’s hand before she leaves.

“Thanks for the assistance,” I tell her. “We’re grateful.”

“My pleasure,” she breathes seductively, winking at me as she backs the boat off the beach. Her voice is every bit as sexy as the rest of her.

Come back, gorgeous! I never even got your name! We’ll take Pimp Daddy’s money and run away together!

On the way to the hospital, I give our patient nearly a liter of Ringer’s Lactate solution. His pulse and blood pressure remain unchanged, but he’s talkative and alert. He tells me his name is Grady, and we chat about the best places to fish along Bayou Podunk. He knows a few good spots I haven’t tried, and even better, they’re all easily accessible by ambulance, and within our coverage zone.

“That gal drivin‘ the boat sure was a looker,” he observes, his eyes twinkling. “She’d be worth taking a Viagra for!”

“Yeah, she was pretty hot,” I agree. “She’s too young for you, though.”

“You see the way she was lookin‘ at me? She’s partial to older men,” Grady winks. “I can tell.”

I chuckle and shake my head, disconnecting the cardiac monitor leads and oxygen as Rob pulls into the ambulance bay at Podunk General Hospital, Nail Salon and Crawfish Hut. Later, after we’ve given report and handed Grady off to the ER staff, Rob looks smugly at me as we head back to the station.

“You see the way that girl winked at me before she left?” he smirks. “She dug me. I could tell.”

Until next time…

Ever feel like you’ve been shot at and missed, but shit at and hit?

Well, it seems I’ve been splattered by the meme too, courtesy of LawDog and Matt G.

*sigh*

I suppose it could have been worse. They could have showed up at my door with an offer to sell Amway. Folks, normally I’m a skeptic. I have Snopes on my favorites list. But being the new kid on the blogosphere playground and desperately wanting to fit in, I will bow to peer pressure and play along.

As the meme goes (tangential thought – what the hell does “meme” MEAN, anyway?):

“share five off the wall, strange, unusual or just little-known facts about yourself. Then you “tag” five other bloggers who are supposed to do the same thing.”

1. Before my career in EMS, I was a professional dog trainer. I learned the craft from my brother as a very young teenager, and he turned the business over to me at age nineteen. I worked more-or-less full time training retrievers for hunting and field trials from age 13 to age 24. I made more money doing that (in the good years, at least) than I ever have in EMS. I miss working with the dogs, but not the owners.

2. I’ve written one book, co-authored another and am working on a third. I speak at EMS conferences around the country. I don’t advertise my identity on my blog, but the clues are there. My posts here are the manifestation of my Id, and sometimes what I say here isn’t appropriate for polite company.

3. I killed the very first critical patient I ever had. Well actually, I didn’t kill him, but I didn’t do him much good either. He was far too unstable and difficult to manage for one paramedic to handle, but fatigue, inexperience and ego got the better of me, and I took the transfer when I shouldn’t have. And he still visits me in my dreams occasionally, even 13 years later. But at least I’ve made friends with his ghost.

4. In my late teens and early twenties, I could toss an aspirin into the air and powder it with a pellet gun maybe 8 times out of 10. I’m also a fair shot with a handgun or rifle, but nothing spectacular. But I still win my fair share of wagers with people who think skill with a shotgun and precision shooting are mutually exclusive. It’s nice to be underestimated.

5. I am one of those “integrated brain” people that uses their right brain and left brain to complement each other. I have a measured IQ of 152 and despite all that, am still the most math phobic dude you will ever meet. I sit in math class and understand the concepts and work the problems…but I find it so insanely boring that I’ve never gotten better than a C in any math course I’ve ever taken. Every other subject always came so easily to me that I never developed the academic discipline needed to excel in math. It’s a big part of the reason the name of this blog isn’t called A Day In The Life Of An Emergency Physician.

6. Once while duck hunting, I killed a pair of black ducks with my waders at half-mast and a turd hanging out of my ass. Always bring your gun with you on the potty breaks, boys and girls.

Okay, maybe that last one was an overshare. Shoulda stopped at 5. *grin*

So now it’s my turn to fling the shitball at:

Flying Flo
The Hammer (You have to visit his blog. He’s funnier than a snort of nitrous oxide)
Rocky Mountain Medic (Who just joined a select EMS fraternity)
Holly
Mr. Fixit

Cheer up, guys. I could have been offering to get you in on my Amway deal.

Until next time…

Many of you EMS types have browsed through the House of DeFrance at one time or another. If you haven’t, you are missing out on hands-down, without a doubt the best EMS website on the internet.

The owner of the site, Valerie DeFrance is a paramedic from Hope, Alaska. In addition to being a talented paramedic and EMS educator, she is a web designer of some renown and no small talent. Several years back, she designed my business website and has since steadfastly refused to accept any payment, and I’m not the only friend she has gifted in this way.

Valerie lost her husband Ray today after battling a long illness. While I never had the honor of meeting Ray, I think it safe to assume that any man who can command the love and loyalty of Valerie DeFrance for 30 years is a special man indeed.

If any of you folks have ever visited Valerie’s site, drop her a line and pay your condolences. Let’s show her how popular and admired she is in EMS.

Until next time…

I think I used to work with this guy. Last I heard he had been promoted to Operations Manager, but from the video he looks like he’s back on the streets. Nice thing is, he works for peanuts.

Until next time…

Some years back, Podunk Ambulance Service was shopping around for new cardiac monitors. Being the Education Director and Medical Device Guru at this little service, it fell upon me to solicit product demonstrations and sales bids from various manufacturers.

Now my boss at this service was a nice enough fellow to work for, but he was…how shall we phrase it…cheap.

Not that he wasn’t willing to spend money – no, he’d shell out big bucks for the newest gee-whiz cool computers and office productivity software. It was just on the salary and patient care equipment side of the biz that he tended to cut corners. Add to this the fact that he was the Ultimate Impulse Shopper, and it came as no surprise that Wal Mart was by far our biggest vendor.

The man loved a bargain. He’d come back to this office, flush from prowling the clearance aisle at Wallyworld, and proudly showing off his latest steal.

“Hey AD, I’ve got a project for ya…”

Please God no, not another Project. The crews at Podunk Ambulance Service learned to fear that innocuous little phrase…

“Ummm… sure, boss. What did you have in mind?”

“Well, I was just prowling around Wal Mart…”

“Yessir, I can see that. Uh, boss? Is that what I think it is?”

“Yep,” he’d grin proudly. “And 40% off regular price, too!”

“Outstanding! You know, I never knew Wal Mart sold Shetland Ponies. What are we going to do with this one?”

“Well, that’s where you come in. I want you to develop a protocol on how best to utilize a small, man-portable Rescue Horse.”

“I see. And do you have wee little saddlebags for this Rescue Horse? Anything that can carry medical equipment?”

“That’s the dispatcher’s Project!” he’d exclaim, proudly displaying a Slightly Damaged portable sewing machine and several yards of Cordura nylon. “I got the fabric at half-price because of this teeny little flaw here, see?”

And off he’d go to ruin the day of Satan’s Minion in dispatch…

Like I said, the man was cheap. But somehow I had finally convinced him to stop browsing E-Bay for obsolete museum artifacts and actually try some of the current technology available.

So having gotten a number of new monitors to play with for a short while, I naturally wanted to put them through their paces.

Literally.

You EMS folks may know which company I’m talking about, but one company makes these outrageous claims that their external pacemaker works at half the energy settings of their competitors, and not even painful, by golly.

Now normally I regard such claims in the same light as when some fuzzy cheeked gun store clerk tries to tell me that Boomtech’s latest belted magnum will smite a brontosaurus with nothing more than a grazing shot in the foreleg, all due to it’s Awesome Knockdown Power.

That is to say, total bullshit.

Problem is, I’d seen it demonstrated. Go to an EMS trade show and hit the hospitality suites hosted by the major vendors, and often you could see the more zealous sales reps of this particular company offer to demonstrate their pacemaker. On themselves.

Far be it from me to suggest that often these folks had imbibed far more John Courage than was good for them, but hey…the demonstrations were impressive.

So there I sat in my office with the device on my desk, fevered mind whispering the question…

Really, how tough could it be?

I unbutton my shirt and attach the pacer pads to the machine.

What the hell, there are six medics less than fifty feet away. What better place to try Something Stupid than at ambulance headquarters?

I carefully apply the adhesive pads to my chest, taking care to avoid the Hairy Places.

On the other hand, they are OUR medics. Maybe this isn’t such a good idea after all.

I take a few deep breaths and set the rate at 120 or so, just to make sure the thing would actually fire. Judging by my heart rate, it would be fair to say I was just a wee bit…apprehensive.

Cowboy up, AD. You’ve seen a ninety-pound girl do this with nary a whimper. Our Father, Who Art in Heaven…

I dial up the current to ten milli-amps, then twenty.

Hey, that’s not so bad. Just a little stinging. No bright light, no Heavenly Choir…and no whiff of brimstone either. So far, so good.

I dial the current up to thirty milli-amps. My chest muscles start twitching with the current.

Hey, I can make my pecs bounce! There’s muscle under those Man Boobs!

I dial the current up to thirty-five, and notice a change in my heart rhythm.

Holy Moley, is that electrical capture?

I check my pulse, and sure enough, there it beats in time with the pacemaker.

I’ll be damned! That IS electrical capture! And it feels no worse than a case of hiccups!

So there I sat, pecs bouncing, being paced merrily along at 120 beats a minute. And the salesmen were right, folks. This thing didn’t hurt at all. It was tolerable enough that I wouldn’t lose any sleep over pacing a patient without first sedating them. And as I sat there, The Voices started whispering again…

Sooooo, AD…how much juice CAN you take?

So I cranked the thing to sixty milli-amps.

O-o-o-kay. That’s not so b-b-bad. Like a real-ly b-b-bad case of huh-huh-huh-hiccups. B-b-b-but I can t-t-take it…

Sweat broke out on my forehead, but I cranked it to ninety anyway.

Uh-uh-uh-uh o-o-okay…S-s-start-ing to s-s-smart a lit-tle. F-f-f-fun-ny, b-but I d-d-didn’t know I c-c-could do the f-f-fun-ky ch-ch-ch-chic-ken…

I felt the gorge rise in my throat, but the masochist in me whispered, “Max it out, AD. You can take it, baby.”

So I cranked the thing to 120 milli-amps, Max Power.

Huh-huh-huh Holy SHIT! Mom-mom-mommy, m-m-make the Bad Man s-s-stop! M-M-MUST T-T-TURN IT OFF!!!

Shaking like a crack baby, I reached out a palsied hand and cranked the dial back down to zero. The current immediately ceased and I oozed out of my chair into a puddle of quivering protoplasm on the floor. After I lay there a few minutes, I sat up, checked my britches for telltale stains, and vowed never to be so foolish again…

…Until I got the next monitor to evaluate.

I know some of you are thinking, “So AD, how did the other pacemakers measure up?”

Well kiddies, I regret to say I never reached my capture threshold with any other pacemaker, and I never got any of them beyond thirty milli-amps. Every attempt left me huddled in the corner, whimpering and sucking my thumb. So I can honestly say, XYZ Monitor Company does indeed have the best damned pacemaker on the market.

Too bad The Boss found a sweet deal on six obsolete torture devices on E-Bay.

Until next time…

I’m considering having this tattooed on my chest. To hell with the tribal emblem or barbed wire across a bicep…I’m having the Tramp Stamp For Geezers emblazoned across my hairy man boobs right where the defibrillator pads attach.

Back when the Missus and I were together, I halfway jokingly told her that on the day I start eating my salads from the roots up, I wanted every useful organ and tissue from my body to be harvested and donated, and everything else was to be cremated and my ashes reloaded into shotgun shells. Just sift what’s left of me into the shot hopper and run up a special case of AD. Distribute the boxes of shells among my surviving buddies with the instructions that I be the first volley of every duck season until the shells are all gone.

Use light loads and improved cylinder choke, boys. I’m claustrophobic.

However I go out, one thing will be for certain. No one will be pumping my chest and breaking my ribs, no one will put me on a ventilator, no one will be feeding me through a tube and turning me every two hours to keep my body from breaking down, and my daughter will not be faced with the horror of making those decisions for me.

There will be no Terry Schiavo debate. No scum-sucking, bottom-feeding, synaptically challenged politicians – on either end of the political spectrum – will hijack my decision to die or live for the purpose of galvanizing their voter bases.

And no nurse, doctor or EMT will be forced to inflict unspeakable indignities upon my body in order to preserve a life that is failing. I can think of no more unspeakable perversion of the phrase “life saver” than to be the one to resuscitate a 90 year old woman after 25 minutes of CPR.

And what makes it worse is to have a family who doesn’t know better thank you for having done it.

I’m going to go drink myself to sleep and cry now.

First things first…new to the Blogroll is Mugwug over at Moral Flexibility.net. To say he’s a little…tetched…would be an understatement…but in a good way. If, like me, you have pondered What To Do should the zombies attack, then seek no more. Mugwug has a number of Zombie Survival Tips for your edification. Rule #1: Shoot ‘Em in the Head. Center mass simply won’t do. But they’re slow and sluggish, so you oughta be able to take your time and get a really good sight picture…

Hey Mug? I got news for ya. They’ve already infiltrated society. Just check out the staff at the nursing home of your choice.

Ooooohh, I’m gonna get flamed for that one.

Now on to my main subject…

One of the things I’ve always liked about working rural EMS is the autonomy I had. We may not run many calls, but when the nearest trauma center is an hour or more away, the calls you do get tend to be a greater test of your skills. I got to practice some real medicine out in the sticks.

Urban ambulance services are the Wal Marts of EMS – volume, volume, volume. We ran lots of calls, but more often than not the most useful treatment I rendered was a Rapid Diesel Infusion. Not that urban EMS doesn’t require skills – it’s just that when you’re in an environment where you can throw a rock most any direction and hit a big hospital, certain things, like rapid transport, tend to take precedence.

So being used to a great deal of autonomy, I approached working in an ER with some trepidation. I am NOT used to asking for permission and orders to treat a patient. Luckily for me, I’m one of the very few critical care medics working this part of Loozyanna, and I had the added luxury of writing my own job description.

Plus, I was witness to a certain conversation between nursing managers and the hospital administrator about a certain Doc (no longer there) that had failed miserably at running a pediatric resuscitation.

“Well I’ll tell ya, CEO…he’s damned lucky AD wasn’t there that day. Then he’d have really gotten his feelings hurt, because AD would have given him about 30 seconds to take charge and then he would have butted him out of the way and taken over himself. And I’d have supported AD 100% if that had happened.”

*sigh*

Such statements kinda warm your heart…

Anyhoo, my fears were not to be realized. When it’s just you, the RN and the Doc on duty at Podunk General Hospital, Hair Salon and Crawfish Hut, you’re pretty much left on your own when the feces strike the thermal agitator.

Not being one for small talk, the RN skipped the Mandatory Stammering Phase and went directly to the Run Like Hell To The ER While Screaming Like Mad For Help Phase.

Had she waited for me to finish chewing my popcorn, I could have instructed her in the proper way to do it. In any case, I followed not far behind her in a moderately speedy mosey. Paramedics do not run. Running is for probie firefighters and green EMT partners. I prefer being a Stand Back, Big Picture, Direct The Work of Others, Non-Interventional Paramedic.

(plagiarized another saying from ya, GaryS)

On the way into the Code Room, I had the presence of mind to grab the Broselow tape off the wall and roll the pediatric crash cart to the bed.

While the RN starts ventilating the kid (who was beginning to look decidedly Smurf-like), I lay out the tape, getting a color range and a guesstimate of the kid’s weigh at roughly 20 kilos according to the tape. So I reach into the Blue drawer on the crash cart, pull out the vascular access kit and set one of the acute care nursing rubberneckers to work.

“Get us a line, would you?” I ask politely. I snap my fingers in front of her glazed eyes and ask again, and she comes to and starts hunting for veins.

That’ll teach her to come down here to see what all the excitement is about.

Meanwhile, I mosey to the med room, sign out a vial of Versed and get a mucosal atomizer, draw up an appropriate dose and squirt a load of anticonvulsant up the kid’s nose.

EMS kiddies, if your service doesn’t have these doohickeys, bitch and complain until they buy some. It’s the easiest way to give Versed, Narcan or Fentanyl. The cops in Albuquerque use ‘em to bring the ODs around before EMS arrives. I’d say idiot-proof, but then they’d start breeding better idiots.

Anyhoo, by the time the Doc arrives the kid’s seizure has started to abate, but his oxygen saturation keeps falling without artificial ventilations and he’s running a 101 degree temperature. Plus, he’s got this weird petechial rash spreading over his upper body and arms like wildfire. />
While Doc ponders the rash and the seizure activity, he asks for an IV access and gets blank stares from everyone. Before he can get the word intraosseous out of his mouth, I’ve got a needle inserted in the kid’s right tibia.

Doc’s lips twitch just a little bit and a facial tic appears near his left eyebrow, but he manfully chokes it back and just mildly remarks, “Actually, I was going to do that.”

My pleasure, Doc. Don’t mention it.

About then, the RN brings it to the Doc’s attention that the kid keeps desaturating and isn’t breathing effectively on his own.

“Let’s intubate,” Doc says decisively. Note the operative word there – let’s. As in we, or us or whoever’s handy. So while Doc is frantically digging through the airway box looking for the appropriate endotracheal tube, I lube up the tube I’ve already pulled from the airway module in the aforementioned Blue drawer. By the time the Doc turns around and asks for the laryngoscope, I’ve already secured the tube and resumed ventilation.

The facial tic starts again with a vengeance and his lower lip starts to quiver. Funny, but he doesn’t seem to recognize my appreciation for linguistic nuance.

Uh oh. Methinks I have pissed off the Doc. Again.

But again, he manfully keeps his cool and simply repeats, “Actually, I was going to do that. But thanks.”

Impressive self-control, this Doc. Most surgeons I know would be throwing sharp instruments by now. Aside from the heartbroken quaver in his voice, he was cool as ice.

Anyhoo, to make a long story less long, we get the kid sedated, paralyzed and on a ventilator, CT scanned, labbed up, get some intravenous antibiotics into him, and get him shipped to the Big Hospital in a little over an hour. Not too shabby for Podunk General Hospital, Nail Salon and Crawfish Hut.

And with nary a bobble, either…unless you count the part when the Doc was rummaging through the crash cart for another piece of equipment and our unit clerk shouted helpfully across the room, “He’s blue!”

After we picked the Doc off the floor, we kindly explained to her that such things are Never To Be Said with an intubated patient…unless of course he is. Better to say something like “blue drawer!” or “aquamarine receptacle!” or “next drawer down, Doc!”

Pretty much pick any phrase, but be specific. We need our Doc with his wits about him, not huddled in a corner sucking his thumb.

After it was all over with, Doc pauses from his charting and looks over at me and winks.

“Kinda stole my thunder in there,” he chuckles. “Good job.”

And THAT is why if I needed a doctor, I’d probably pick him.

Until next time…

A couple of weeks later, we get another Gary Call. It’s 10:30 at night, and Allan and I haven’t rolled a tire all day. We’ve washed the rig. We’ve waxed the rig. We’ve restocked the rig. We’ve emptied the rig and rearranged the shelves. We’ve cleaned the station. Don’t get me wrong – it’s not like we’re just killing time. We’ve done some productive things, too. For instance, we loaded Reggie’s toothbrush with benzocaine gel. For good measure, we’ve also loaded the toothpaste tube with it – it’s the gift that keeps on giving. Mike likes to monopolize the bathroom fixing his hair, so we’ve loaded his hairdryer with baby powder. Reggie and Mike fancy themselves as practical jokers. Last time we were on duty together, they painted my fingernails while I was sleeping. They will regret that nefarious deed. The next step is to rub down their bedding with fiberglass insulation.

When we get the page, it’s an almost welcome diversion. There’s nothing on Skinemax, so I’m kind of wondering how Gary is going to liven up a dull evening. Dispatch calls it an “unknown medical emergency,” which, in my experience, is the dispatcher code phrase that means “riot in progress,” or “please respond to the thermonuclear detonation.” At Gary’s house, his unknown medical emergency turns out to be testicular pain. He isn’t forthcoming with much information. He just groans and doubles over.

“I hurt!” he says, over and over. He is obviously – big surprise – drunk as a boiled owl. Wanda, his common-law wife, fills in the blanks.

“His balls hurt,” she says matter-of-factly. “They been hurtin’ all day.”

“Is that true, Gary? Is it your balls?” He nods in affirmation, groaning.

This conversation has definitely taken a turn for the surreal. In what other profession can you say ‘so how are your balls’ in casual conversation?

“Are you having any problems urinating?” His reply is a blank stare.

Very well, Your Honor, I’ll rephrase the question.

“Does it hurt to pee? Any burning, lower back pain, anything like that?”

“Nawsuh, I just hurt. I hurts bad!”

“I tole you, his balls hurt!” Wanda offers helpfully.

Duly noted, Wanda. Do you think that might have something to do with a three-hundred pound wife who smells like a decaying codfish? Were you asking for sex when the ball pain started? I’d fake ball pain, too.

“Well Gary, are they swollen? Are they tender or anything?”

“I don’t know!”

Wait a minute. What do you mean you don’t know?

“You don’t know if your balls are swollen or not?”

“Nawsuh, I don’t know.”

“Well for fuck’s sake, Gary!” I explode. “They’re your balls! How is it that you don’t know if your balls are swollen or not?”

“I didn’t check. They just hurt.”

“Goddamnit! I think that if my balls hurt, I’d damn sure feel them to see if they were swollen before I called an ambulance at ten-fucking-thirty at night!”

He breaks into tears. “I’m sorry, mistuh AD. I just hurts so bad, I needed some help!”

He truly looks pitiful. Now I’m ashamed, like my mother has caught me torturing a puppy or something.

Okay, time to stop breaking Gary’s balls…

“All right,” I say, softening. “Get up and let’s get in the rig.”

He struggles to his feet, hobbling outside. Poor guy, he really looks like he’s in pain. It’s a chore for him to climb into the back of the rig. I’m actually starting to be a bit concerned that there might be something to this.

“Hold up, Gary,” I tell him. “Before you sit down, drop your pants and let me take a look.”

I cannot believe I am doing this. However, knowing Gary, he’ll either have a strangulated inguinal hernia, or a testicular torsion, or the partially absorbed skeleton of his unborn twin down there. And I’ll look like a chump if I didn’t assess him and find it.

I gently palpate Gary’s balls as he stands there placidly, happy that somebody is taking him seriously. I can feel no swelling, and Gary doesn’t act like they’re tender.

Yep, this is the pinnacle of my EMS career. It just doesn’t get any better than this. This is a Rescue 911 episode for sure. I will inspire a generation of future sparky little EMTs. “Save lives! Help people! Fondle a derelict’s genitalia!” I am indeed a worthy successor to Johnny and Roy…

“Does any of that hurt, Gary?”

“Nawsuh, it don’t hurt no worse.”

If he says it feels good, I’m gonna kill him.

“Okay, now turn your head and cough,” I tell him, which he does obediently.

Not like I really know what I’m supposed to feel, but that’s what the doctor does when he checks me for a hernia. Come to think of it, I was about this uncomfortable when the Doc was doing this to me. That, of course, is where the similarity ends. I’ll be damned if I’ll check his prostate!

“All right, Gary. Zip it up. I’m done.”

“Yessuh,” he says, pulling up his pants. “Was they anything wrong with ‘em?”

“Not that I could find. Maybe you need some x-rays or something.”

And I’ll be damned if I’m going to check anything else. Conscientiousness only goes so far.

I spend the rest of the trip in silence. I hand Gary off with the briefest of reports to the nurse. I don’t tell her of the examination findings, or lack thereof. I’m back at the station by eleven-thirty.

I still have to figure out how I’m going to document this call… I can see it now: “Patient complains of testicular pain for twelve hours. Denies fever, back or flank pain, denies difficulty urinating. Vitals within normal limits, testicles soft and non-tender to palpation….”

Until next time…

Okay, I’m getting worried. LawDog seems to be channeling SnoopDog and even worse, he called me a poser!

Here’s hoping we won’t soon see him with his britches at half mast and his hair in braids.

Dawg, I know you have a BBQ gun, but have you gotten a BBQ grill? Remember – tasteful, and not too gaudy. I recommend silver with diamond inlays in the shape of a star or the state of Texas. And if the mental image of a fair-skinned, red-haired Texas lawman in braids, with his duty belt cinched six inches below his ass doesn’t give you the willies…

Holly, Mair and Flo have embarked on a quest for dryer balls.

Ladies, if only you had asked me. I embarked on the very same quest back in my late teens, and finally found my Nirvana when I switched from briefs to boxers. Now this dried them out, but I’ve found that the only way to make them static-free is to wear all cotton – no silk boxers, period. And no nylon hose, either. Even on those days when a guy just wants to feel pretty, I have learned to just Say No. Sundress and sandals, at most.

On another note, being a neophyte blogger, I am only just now discovering the tricks to increase my hit count. So without further ado, here goes:

Harry Potter, Iraq war, naked webcam, big tits, Hurricane Katrina, Brittney Spears, Paris Hilton, blah blah blah blah…

Let the search engines digest that. We’ll see how it goes.

Until next time…

An excerpt for you folks. If you like it, buy the book. The Double-Wide Fund needs an infusion…

“Unit Two, Dispatch. Respond Priority One to 2354 Highway 808, man trapped in a car.”

My partner whoops excitedly as we pull out of line at McDonald’s to take the call. It’s two in the afternoon, and I haven’t gotten my burger yet. This is not good – I need my burger.

We haven’t eaten since last night, and right now my bellybutton is rubbing a blister on my spine. Well, not quite. My bellybutton hasn’t been within a foot of my spine in five years, but you get the idea. I am fucking hungry, and in no mood for the bullshit we’re about to encounter.

We haven’t been all that busy, but we started running transfers before breakfast this morning, and every time we’ve had a chance to stop and eat, Satan has chimed in with “Dispatch to Unit Two…”

To top it off, I didn’t have time to get a shower, so I’m driving around with a serious case of bed-head and trying to cover it with a ball cap. Shannon looks at me quizzically as I groan despairingly and bang my head repeatedly on the window.

“What?” she asks. She doesn’t know who lives at 2354 Highway 808, but I do.

Gary is one of our frequent fliers. He’s an alcoholic and chronic malingerer, but he’s got enough legitimate medical problems that you can’t just dismiss whatever he’s saying. For some reason he likes me, probably because I treat him with respect and listen to what he has to say. Some of my co-workers have a hard time hiding their exasperation with Gary. Not me – I find it easy to smile on the outside while I’m mentally strangling the fucking life from his body.

Shannon is still a fairly new EMT, and this is her first Gary Call. She’s envisioning generators humming, the Jaws of Life snarling, and a life-or-death battle to snatch an innocent victim from the Grim Reaper. She’s got a sparky little grin on her face, and obviously loving this. She’s gotten kind of possessive of the siren and lights, as if the console is her personal domain, the exclusive realm of Queen Shannon the Sparky.

I don’t really mind – let her have her fun. As long as she wakes me up when we arrive at the scenes, she can do whatever the hell she wants. She’s still got the naive idea that the dispatch information actually has something to do with what we’ll find at the scene. She’s about to discover otherwise. I don’t know what we’ll find at 2354 Highway 808, but I’m betting it’s going to be unusual. Gary Calls are kind of like “vujá dé” – you get the feeling that nothing like this has ever happened before.

When we get to the scene, there are no fire trucks, no generators, no Jaws of Life, and no excitement. Shannon deflates before my eyes. What we do have is one bemused sheriff’s deputy, and one very drunk Gary. The deputy, a buddy named David, is smiling and shaking his head.

“Well, he’s been there since this morning,” he says, nodding his head toward Gary. “Watch your step when you go over there. He’s sitting in a puddle, and it ain’t water.”

Gary greets us cheerfully, giving us a bleary, alcohol-fogged grin. “I sho‘ glad ya’ll here. I’m real thirsty, and I cain’t get loose!” He has his left arm jammed in the glove compartment of his car, and apparently can’t pull free.

On closer inspection, I can tell he has shoved his hand behind the back wall of his glove compartment, wedging it between the dash and the back of the compartment. Whenever he pulls his arm back, the glove compartment opens fully, and the back wall pinches his arm against the dash. If he tries to push it further in, the glove compartment door closes, pinning his arm.

He’s apparently been there a while – at least long enough to finish a twelve pack of Schaeffer. Apparently he had to urinate as well, and since he couldn’t get loose to go to the bathroom…

“Uh, Gary? How in the hell did you get your arm caught that way?”

“Well, ya see, I dropped my blood pressure pills. They done fell back behind the box. When I tried to get ‘em, I gots my arm hung up! I been out here all day, and it’s so hot. I done drunk all my beer…” he trails off, his voice breaking.

He looks pitiful, sitting there with tears in his eyes, with his arm caught in the man-eating car, sitting in a big urine mud puddle. It’s a real tragedy. David stifles a giggle.

“Well Gary, you certainly called the right people. Did Wanda call 911 for you?”

“Yessuh, she did. She ain’t mechanical. She don’t know what to do ’bout this stuff.”

“Well, this young lady here is our finest EMT,” I say, pointing to Shannon. She shoots me a dirty look. “She oughta be able to get you out of there. She’s mechanical.”

I motion her over to the trunk of David’s cruiser. I smack a Phillips screwdriver into her palm, just like in the movies where the surgeon asks for an instrument. “Your extrication tool, Madam. Now go over there and save a life.” David nearly swallows his dip of Copenhagen.

In a few minutes, Shannon has
the glove compartment dismantled, and a grateful Gary is rubbing his numb, but uninjured arm. Shannon doesn’t look quite as fresh as she did a while ago. Apparently, it was a bit hot in that car. I doubted she wanted to snuggle up next to Gary to dismantle the glove compartment, so she probably had to lie across the front seat to do it. Gary’s front seat holds enough dirt to grow a respectable garden. David and I saunter back over.

“Ooh, my arm numb!” Gary wails. “I cain’t feel nothin‘!”

“Well, Gary my man, that is to be expected. It’ll wear off. Now all you need to do is sign my form and we’ll let you get back inside…” I’m sending out the most powerful Refusal of Care vibes I can generate. It usually works – my Refusal Mojo is powerful.

“Do you think it might be broken?” Shannon asks, concerned. “Would you like us to take you to the hospital?”

Noooooo! She didn’t just offer to take him to the hospital! What is she thinking?

Gary brightens up considerably. “Yes’m, as a matta fack, I would like to go to the hospital. I think I needs my arm x-rayed.” Not coincidentally, Gary’s house isn’t air-conditioned, but the hospital is. If he milks it long enough, he may still be in the ER when the meal trays come around.

“Okay, Gary. To the hospital it is. Shannon will take care of you till we get there,” I tell him, concealing my dismay.

I motion Shannon closer, so I can whisper in her ear. “I think you should take this one. Gary doesn’t normally cooperate with us like this. Apparently, you’ve built quite a rapport with him. Can I trust you to ride in with him if I drive?”

Shannon puffs up considerably at the prospect. She’s actually honored that I’ve entrusted her with such responsibility, bless her sparky little rookie heart. “And while you’re at it, you better splint that arm. When you’re done, you can even do the run ticket. You write it, I’ll sign it.”

When we get to the hospital, she has Gary’s arm splinted and in a sling, just like she was taught in EMT class. Gary’s happy, Shannon’s proud, everybody’s happy.

Well, everybody except the nurses. We’re kind of on their shit list right now. Before we leave, Gary gives Shannon a hug. He reeks of urine and alcohol, and if he’s bathed this week I’d be surprised. But Shannon doesn’t shy away, and the smile on her face is genuine. “No problem, Gary. That’s why we’re here.” Bless her sparky little rookie heart, she may actually have what it takes.

Part two in a couple of days. Until next time…