I was paying my daily visit to The LawDog Files this morning, browsing through some of his archives, and came across the post about Benny and one of his numerous suicide attempts while Fooblicly Intoxidated.

Heh heh heh. Dawg, there is indeed a critter cloning device and like you said, the sodding thing is set on “high.”

EMS has its critters as well. Call ‘em what you will – frequent fliers, trolls, gomers or the Foley Patrol – they give this job its flavor. Whether they are the lonely old grandmother who calls 911 because she is lonely, or the chronic inebriate who always seems to get sick right before the meal trays are distributed at the local hospital, more often than not they are the EMT’s raison d’être.

If nothing else, they provide us with fodder for war stories and an excuse, however flimsy, to use a cool word like raison d’être.

Go ahead, look it up. You know you want to. Feel free to drop it into casual conversation at the next cocktail party.

Sooooo, I thought I’d pen a missive to the much maligned, unappreciated frequent flier.

Miss Clara, maybe one in fifty of your calls to our dispatch center was a legitimate medical emergency. But in between bowls of sugar free ice cream and teaching you how to program your VCR and speed dial, I learned about your kids, grandkids, what it was like during the Depression and scores of other things. You took a green paramedic with more ego than knowledge and taught him a life’s lesson on compassion. And if heaven is truly the place where we’re most happy, there’s a television parked right in front of your recliner, and it’s playing a 24/7 Jerry Springer marathon. Enjoy today’s episode of Lesbian Stripper Midgets and The Men Who Love Them.

Joey, cerebral palsy kept you chained to a bed for your entire life. Yet not once did I see anything but a smile on your face. You and your mother taught me lessons about resilience that have served me well in raising my own daughter. And for the medical professionals who called you mentally retarded – well, I’ve noticed that you never tried to grope the ugly nurses when they lean over you. You’re a kid after my own heart.

Tank, alcohol is not a recognized seizure medication. Look it up. And while I can look back fondly now at the times I’ve dealt with you, I think both humanity and my nerves would be in better shape if you just took your freaking Dilantin. And try to remember to keep your pecker in your pants, Big Boy.

Gary, Gary, Gary…where do I begin? I promise never again to hand you a box of EKG electrodes and tell you they’re aspirin patches, but you had it coming at the time.

Next time I post, I’ll tell you all about my love-hate relationship with Gary, the big turd floating in the Gene Pool.

Until then…

“I couldn’t do what you do.”

I get variations of that quote from most of the people I meet, from John Q. Public to doctors and nurses. Invariably they wax poetic about the drama and romance of Saving Lives and being on the front lines of medical care…

Never mind that the job is rarely dramatic and almost never romantic.

Now, after professing admiration for your altruistic bent and your Life Spent Thwarting the Reaper, many of them will lean in with a feral gleam in their eye and ask in a conspiratorial whisper, “Sooooo…what’s the grossest thing you’ve ever seen?”

Sigh…

There is a little rubbernecking adrenaline junkie in all of us.

Folks, I’m going to let you in on a little industry secret, one that will surely offend many of my colleagues and shock the rest of you. It runs contrary to the image we try to cultivate, both in our own eyes and with the public.

We don’t save lives.

Oh sure, that’s why most of us get into this business – dreams of heroism, snatching people from the Jaws of Death at least twice a shift. Public adulation and all that, you see. But the reality is that the chances we get to actually Be The Difference Between Life and Death comes but rarely in a career. Ask any experienced EMT how many times they can count where they have actually saved a life, and the numbers will be damned few. Folks, cardiac arrests make up about 1% or fewer of the run volume in the average EMS system. And of those 1 in 100 cardiac arrests we work, the very best EMS systems in the country fail to resuscitate them 75% of the time.

Anyone that tells you he has saved many lives is either lying, or still deluded with rookie ideas about his own importance in the patient’s outcome.

A good friend described it this way:

EMS is the Special Teams of health care. In the Great Game of Saving Lives, our job is to field punts and kickoffs and advance the ball as far as possible, so that the offense is in a better position to score. Not that our job isn’t important – no team can consistently win if they don’t have good field position.

Occasionally if we’re very good or very lucky, we run one in for a touchdown all by ourselves. It’s exciting, and rewarding. But it ain’t the norm. Not at all.

The norm is dialysis transfers…old folks with bedsores…hemorrhoids at 3am…scared little kids with minor illnesses…rude people with acute Samsonite Syndrome…minor accidents with lots of whining people with advanced Allstate-itis…the scared old woman who lives alone and calls 911 just because she’s lonely…and obnoxious drunks with no visible means of support who insist that they pay YOUR salary…

And I gotta confess…I love it all. Aside from my professed world-weariness and cynicism, this is what I was born to do. So if you want a real Day In The Life of An Ambulance Driver, here is what we REALLY do…

We make far less money than our health care brethren with similar education. And the sad fact is, a whole lot of us do not even deserve the pittance we’re making.

We bitch and moan about low pay, yet we steadfastly oppose any attempt to advance our profession through higher educational standards.

We make a Big Deal of the whole lifesaving myth, smugly convinced of our own inflated sense of worth, yet we ignore the actions of the untrained bystander who probably made the greater difference.

We eat our own young.

We attract the wrong kind of people to our profession. I’ve often wondered what would make a better EMT- teaching an adrenaline junkie some compassion, or teaching a compassionate person how to handle themselves in a crisis? For my money, it’s Option Two.

At our best, we ease someone’s pain and suffering a little bit, and perhaps intervene in a critical event at a crucial time.

At our worst, we’re condescending, arrogant and rude, especially to people we deem Not Worthy of Emergency Care.

For 75% of those people, we are an entry point into the health care system of the world’s greatest nation, yet we fail to recognize the importance of that simply because the patient’s condition doesn’t fit OUR definition of an emergency.

Sigh…

People ask me what makes a good EMT…and here it is:

If you can be the island of calm when the feces strike the thermal agitator, and keep your wits about you when everyone else is losing theirs…and then turn right around on the very next call and do nothing more than gently hold a frightened old lady’s hand on the way to the hospital and perhaps coax a smile from her…and realize that BOTH are equally important skills…then THAT is what makes a good EMT. Even if they never saved a single life.

Until next time…

I was digging through some old clothes last night and found an unexpected treasure – $40 in an old EMS jumpsuit I have not worn in ten years. God indeed does truly love me.

Flush with my new found fortune, I proceeded forthwith to the nearest convenience store and bought more beer, corn chips and Vienna sausages – you know, the Essentials.

Now this is not the first time I’ve found unexpected treasures in this jumpsuit. It was issued to me on my very first shift at Podunk Parish Ambulance Service, and it seemed every time I wore it, I found a new pocket. For those of you with a law enforcement bent, it was a Topps T-24 tactical jumpsuit, a model that, to Topps‘ everlasting shame, they have since discontinued.

No doubt because nobody ever wore it as well as I.

I wore that jumpsuit for six months before I figured out that the model number referred to the number of pockets. From that day forth however, I was never without my trusted equipment.

Need a pair of trauma shears? No problem, I had ‘em on me.

Window punch? I carried ‘em in black and polished aluminum.

Tape? Pshaw. How many rolls do you need, and what size?

Pens? On my breast pocket AND the sleeve. I was the object of Pen Envy.

IV catheters? No problem. I could reach down into a hidden crevice and voila! A smorgasbord of steel and Teflon in every color of the rainbow.

Now this jumpsuit wasn’t simply a utilitarian garment, Nosirree. It had style. My partner Mike and I had matching jumpsuits with spiffy mock turtlenecks with our service logo tastefully embroidered on the collar. Depending on our mood, we might blouse our pants inside our boots, or simply go for the slacker flight medic Baggy Look. Complete the ensemble with a pair of Oakley or Gargoyle shades, and we were every bit as steely-eyed and square-jawed handsome as the models in the Gall’s Catalog.

Thus attired, we were among the most sartorially splendid EMTs you will ever encounter. Patients and family members alike were impressed. Nurses swooned. Women wanted us, and men wanted to be us.

Now one fine day, I was taking the opportunity to grab a quick shower while Mike was asleep.

Why wait until Mike sleeps, you ask? Simple. Mike, while being a superlative EMT and a partner whom I’d trust with my life, was also an Evil Bastard when it comes to practical jokes. Our station had a plumbing quirk whereby one could turn on the hot water in the kitchen sink and instantly cut off the hot water supply to the shower. Knowing this, Mike took the opportunity to make Little Ambo Driver retreat to warmer recesses whenever possible.

One could not always hear the stealthy footsteps approaching the kitchen over the sound of running water. Thus, the following scenario played itself out at least twice a week:

Me: Heartily singing my favorite selections from K-Tel’s Rock Hits Of The 70s, soothing hot water rinsing the shampoo and soap from my eyes…

Mike: Approaching the kitchen like a silent assassin. He’s a SWAT sniper now – always has been a stealthy bastard.

Me: “Baby, when I think about you, I think about loooooooooove…”

Mike: Quickly turning the hot water on and waiting in anticipation…

Me: (playing shower air guitar) “Feel like makin‘ love! FEEL LIKE MAKIN‘ LOOOOVE! FEEL LIKE MAKIN… Wha… whoooeee… aaaarrgghhhh… HOLY FUCKING SHIT!!!! WHO TURNED ON THE HOT WATER IN THE SINK???”

Mike: Sinister giggle.

Ahhh, the things EMTs will do to entertain themselves.

But this day, I managed to complete most of my shower when I was rudely interrupted not by Mike, but by the pager tones. Apparently, some idiot had the incomparable rudeness to fall ill while I was attending to my personal toilette.

I managed to rinse the soap from my eyes and run my fingers through my hair, and discovered that my socks, skivvies and the aforementioned tastefully embroidered mock turtleneck had fallen to the floor and gotten soaked by the shower spray.

Sighing, I quickly donned my jumpsuit commando-style and stomped my bare feet down into my boots. Mike met me at the curb, blooped the siren a couple of times and off we went to drag some hapless idiot back to the Kiddie End of the Gene Pool.

After the call, Mike and I hung around at the ER nurse’s station visiting, flirting and what-have-you. After regaling the nurses with the story of how our patient Came to Need Emergency Medical Care (it’s been so long I’ve forgotten the actual call), I noticed that I had attracted quite an audience.

Too big an audience, in fact. Somehow most of the nurses from the floor had managed to infiltrate themselves into my audience as well. Not knowing What Was Up, but unwilling to disappoint such a bevy of attractive females, I plunged on with my story until one of them interrupted me.

“Hey AD?” she inquired sweetly. “By any chance were you in the shower when the call came in?”

“Uh, yes I was,” said I, rubbing my still wet hair sheepishly. “Is it that obvious?”

“Only when you lean forward against the counter,” she informed me with a devilish grin. “You’re not wearing anything under your jumpsuit, are you?”

“Well actually, I’m…hey, wait a minute! How do you know that?”

“Well, whenever you lean forward, we can look from the sides and see ALL THE WAY THROUGH those front slash pockets. We’ve been wondering for ten minutes when you were going to notice a draft.”

Gulp. I manfully suppressed the urge to bolt from the ER, and even more manfully suppressed the urge to adopt my usual casual posture of hands thrust into my front pockets.

Cool and casual, AD. Never let ‘em see you sweat. Just stand up from the counter REAL casual-like, and find a graceful way to make your exit.

“Hey AD,” chortled Mike. “You feeling all right? You look a little flushed.”

“Well from the looks of things,” opined the ER nurse as she looks significantly at my crotch, “he’s cold. Really cold.”

Pride abandoned me at this point and I fled the ER in shame. For weeks afterward, I got furtive glances at my crotch whenever I wore that jumpsuit, to the point where I abandoned wearing the damned thing altogether.

Pity, though. I looked gooooood in it.

Until next time…

Seems my rant on nursing homes got someone’s knickers in a bunch. Ahhh well, such is life. Actually, the poster had some pretty good points to make and offered some salient advice of his or her own…gender unknown because the person did not see fit to sign with a name. Should be easy to recognize though…look for a nondescript person with an enormous stick in their butt.

No apologies forthcoming, Anonymous. I didn’t expect everyone to be pleased. And really, the world would be pretty boring if we all agreed, wouldn’t it?

That said, everyone with elderly family members should read Anonymous’ take on my post. There’s some good stuff in there, if you can wade past the sanctimony.

And yes Anonymous, the title of the post was disparaging. It was intended to be. Neither was my opinion meant to be a definitive treatise on elderly care and the nursing home industry.

One last thing. While statistics may show that increasing staffing has not been shown to improve care practices, you quote no studies to back it up. Therefore I am forced to regard your statement as opinion and anecdote, and will thus counter with opinion and anecdote of my own:

For John Q. Nursing Home Owner (or non-profit agency operating a nursing home), do a salary survey of the nursing homes in your area. Find out how much the LPNs and aides are paid. Hire an extra aide for every shift. Pay your aides oh…say 20% more than your competitors, and pay the LPNs about 10% more.

Establish a comprehensive CQI and education program. Offer incentive pay for professional education. Weed out your deadwood through attrition or through CQI.

Within 2 years you will have the best nursing home in the area, and still have enough profit left over to get that swanky cabin cruiser you’d been pining for. I’d bet the farm on it.

Anyhoo, thank you for the criticism, Anonymous. All sarcasm aside, it was well heeded.

Until next time…

Reading LawDog’s latest up date on his Nana, I was reminded of my distaste toward nursing homes. I challenge you to find an EMT anywhere, or for that matter, anyone working in an Emergency Department, who does not rank nursing home care as being only one slight step up from no care at all.

I have seen nurses busily bathing a dead lady at a nursing home, blissfully unaware that the poor lady had expired. I can think of one nursing home in particular where one can see people shuffling around with vacant stares, food caked around their mouths, with feces and urine stains on their clothing…and that’s just the nursing staff I’m talking about.

The reasons for this are many. First of all, nursing homes do not attract the best and the brightest nurses. They get the incompetent, the lazy and uninspired. Good nurses simply do not want to work in nursing homes. If a good nurse DOES go to work in a nursing home, he or she will soon be broken by a system with too many patients and not enough staff, ridiculously low pay scales and backbreaking labor, only to eventually become…a lazy, uninspired and burnt-out nurse. Only in the nursing home industry is 40:1 considered an acceptable patient to caregiver ratio.

That is not to say however, that there are no good nurses to be found in nursing homes. Occasionally you find one who genuinely cares for elderly people and finds their life’s calling in ministering to them. My mother was one. She was a talented nursing student. She could have had her pick of jobs anywhere. Yet she told us one day that the statue of Jesus outside the nursing home had told her that she should devote her career to caring for the elderly. And that was that. At the time, we all thought mom was a bit…tetched, but there was no denying she was good at what she did. The point is, she and nurses like her stand out from the rest of their colleagues. They are a rare breed indeed.

Now if you’re a nursing home nurse and you’re offended by reading this, you will find no apology here. If you don’t feel I’ve described you, then perhaps you’re one of that rare breed of which I spoke. But I’ll betcha your best pair of orthopedic stockings that the description matches the majority of your colleagues.

Don’t get me wrong – I’ll question no one’s decision to put their loved one in a nursing home. It’s a difficult and painful decision to make. It is however, worth noting that my mother swore to haunt us after her death if we ever put her in a nursing home.

If you are ever faced with the Decision No Child Ever Wants To Make concerning their parents, here are a few suggestions.

1. Nice facilities do not equate to good care. Good staff does. You will be wooed with promises of arts and crafts and an in-house movie theater and delicious meals. They mean nothing if Grandma is bed-bound with a feeding tube. In my experience, the primary difference between the fancier nursing homes and their older, more run-down competitors is that the patients fall and break their hips on carpet rather than linoleum. The best nursing home I’ve ever experienced had the oldest facilities and the poorest patients. 80% of them had Medicaid only, but the patients were treated with respect and TLC.

2. Do not be fooled by the name. “Oaklawn Manor” or “Shady Oaks” both have a rather pastoral ring, but they could hardly call it “Chateau de Staphyloccocus Aureus” or “Our Lady of The Clogged Feeding Tubes” or “Bedsore Village,” could they? Even if it does accurately reflect the care your grandparents will receive.

3. Do your research. What is the patient to caregiver ratio? How many nurses and aides are on duty at one time? How do their wages compare to the staff at other nursing homes? Show me a nursing home that employs more nurse’s aides and pays their staff substantially more than the other ones in the area, and I’ll lay odds it’s the best one around, regardless of the state of their facilities.

4. Get to know the staff, particularly the aides. Not so much the nurses, but the aides. They may have a questionable command of the English language and barely hold a GED, but I guarantee they know more about Granny than the nurses do. In a typical 3pm-11pm shift at a nursing home, the nurse makes a medication pass at 4 pm and 8 pm. By the time they set up their cart, give all the meds and do their charting, they have laid eyes on your loved one maybe a grand total of 20 minutes in an 8 hour shift. This is not the nurse’s fault – it is simply the nature of the beast. So it is little wonder that they either A) panic and send your loved one to the hospital at the slightest sign of illness, or B) miss the problem entirely until it is too late.

EMTs, take note of this next time you are tempted to talk smack about a nursing home nurse who was clueless about her patient’s condition. There’s a reason.

5. Show up often, and unexpectedly. Drop off a fruit basket for the staff if things are up to snuff. Raise Holy Hell if they are not. Pitch a fit. Threaten to sue. Threaten to turn them in to the state regulatory agency. Take your complaint to the ombudsmen. Whatever it takes. The point is, the staff should quake in fear and fall all over themselves to make you happy, and they should never know when you’ll show up. That way, they’ll neglect everyone else’s family member to lavish TLC upon yours. It ain’t fair and it ain’t right, but that’s the way it works.

6. Finally, take an active role in their care. Don’t abdicate the responsibility of caring for your loved one simply because someone else is being paid to do it. Educate yourself about their medical care. No one should EVER become dehydrated with a gastric feeding tube in place, yet I see it all the time. Bed bound patients should be turned every 2 hours to help lessen the chance of bedsores. Urinary catheters should be changed regularly, not just when your loved one is sent to the hospital with an infection. Believe me, if nursing homes ever learned to do proper catheter care and wound care, the hospital industry would collapse within a year from lack of patients.

7. People die of old age every day. They die because their bodies have worn out. They die from complications resulting from shoddy care. And they also die because they feel they’ve been forgotten and they Give Up. Don’t let this be the reason it happens to your loved one.

Now on to lighter fare…

I was flattered to notice on Tamara’s blog a new link to my scribblings. Her tagline says it all – Books, Bikes and Boomsticks. Sigh…

I think I’m in love. Now I ask you – why can’t those be the interview subjects in the Miss America pageant?

“W
ell Bob, I’d strive for world peace…through fire superiority of course. And I’d make it an essential part of my platform to add the faces of John M. Browning and Bill Ruger to Mount Rushmore. Maybe Jack O’Connor and Jeff Cooper, too. And I’d lobby for Winchester to bring back the pre-1964 Model 70…”

That would be MY Miss America right there…

Until next time…

Heh heh heh…I’m evolving.

Apparently, both of my readers were ex-girlfriends. How else to explain being rated as an insignificant microbe in the TTLB Ecosystem for the past week?

Well, I am proud to note that I have moved up the evolutionary ladder to Multicellular Microorganism in one short week!

TTLB didn’t specify what kind of multicellular critter, so I’m assuming that my humble little blog is still in the blastula stage. Those of you with a working knowledge of embryology will realize that simply means that I will soon become even more of an Asshole than I am now.

Bwaaaahahahaha!!!

Till next time…

One of my daily quandaries involves what to put in my blog and what to put in the new book. For those of you keeping score at home, the Last Book is selling well enough that I soon will be able to move into that swanky double-wide I’ve long had my eye on.

Yeah, like maybe 2009.

I started this blog less than two weeks ago, much to my publisher’s chagrin, who thinks I should be pouring my energy into stories for The Next Book. Well Boss, soon you can stop rolling pennies to pay the printing costs of the last humble tome, because both of my faithful readers seem to be discerning literary connoisseurs who enjoy a tale well told. It strikes me that you guys would be the perfect reviewers to tell me whether these stories should make the cut for the second book. So without further ado, tell me what ya think…

There are 60 seconds in a minute. That’s 3600 seconds in an hour, and 43,200 seconds in a twelve-hour shift. Given the fact that our parish has a population of roughly 150,000, and there are usually at least four ambulances on duty at any one time, dividing a daily call volume of fifty or so calls between them, the chances seem infinitesimally small that I would constantly get called out while I am on the toilet. Yet here I sit, wrestling with a pager and my pants, desperately tearing one square at a time off a toilet paper roll that refuses to live up to its name – roll – trying to get back to my rig where my partner eagerly awaits the opportunity to rescue some helpless little old lady who has fallen and can’t get up.

I’m stapled to the toilet in Taco Bell, fighting with the vindictive byproducts of two combo burritos with extra sour cream. Right now, Taco Bell is winning. Every time I get zipped up and my hand touches the bathroom doorknob, my guts spasm again and I find myself scrambling to make it back to the toilet in time. Each time my ass touches the toilet seat, my pager buzzes in an angry snarl, reminding me that time’s a wastin’ and Grandma’s hip is just getting sorer. I feel like I’m stuck in a game of Operation. I sigh and check my pager again. It’s a Priority Two, just a lift assist, at a residence just a few blocks from here.

Thank God. My response time will suck, but at least nobody’s dying. You know, I could just plug myself up and refuse to shit ever again. Now that would be a valuable public health initiative. Nobody would fall, or have strokes, go into cardiac arrest and die, or have asthma attacks. People would manage their blood sugar appropriately, and would drive safely and never have accidents. I’d be the modern day Jonas Salk. Nah, it would never work. I’d swell up and explode, and the greater patient populace would be forever deprived of my many talents.

I sigh and switch the portable radio to the talk-around channel before I key the mike. “Control, this is 306. We’ll be on that call in just a couple of minutes.”

“We’ve been holding that call for ten minutes now, 306. What’s the holdup?” comes the impatient reply.

Ten minutes, my ass. You only paged it to us three minutes ago.

I wait until my bowels stop rumbling before I reply. Gastronomical sound effects would be embarrassing right now. “Control, I’m uh, a little indisposed at the moment. I’ll be 10-8 in a minute.”

“How are you indisposed, 306?” the dispatcher presses. I can just see her smirking at her console. Sweat breaks out on my forehead, and my guts twist into a knot.

“If you must know, I’m on the shitter!” I blurt. At that precise moment, my bowels burst forth like a volcano. It sounds like the nature show footage of male elephant seals fighting for mates.

“Ten-four, 306. Let us know when you’re en route,” comes the strangled reply, amid raucous laughter. Several laughing voices, in fact.

Well, there’s one dispatch tape that will be played again and again for the entertainment of the crews. I’ll have to run the ridicule gauntlet at shift change.

“Everything come out all right?” my partner smirks as I climb into the rig. Dusty Jensen has been an EMT for eight months. EMS hasn’t had the time yet to turn him into an out-of-shape old man with stiff knees and hemorrhoids. Right now, he’s twenty-three, blonde and having the time of his life. He lives for the bad calls, drives like the NASCAR fan that he is, shamelessly flirts with every unattached nurse in every Emergency Department, and is young and naïve enough to think that he invented the practice.

“Everything coming out is not the problem. That stuff punishes me every time I eat it.” I settle uncomfortably into my seat, buckling my seatbelt.

“So why do you insist on eating there?” he asks as he pulls into traffic.

“Other than the fact that it’s half-price?” I retort. “I have no idea. Taco Bell is my weakness.” Dusty says nothing, just gives me a sideways glance that communicates quite clearly that food in general is my weakness.

“Yeah, laugh it up rookie, “ I sigh, shifting gingerly in my seat as my guts start to rumble again. “When I got into this business, I looked like you. Twelve years of ambulance calls and fast food will do this to you.”

“We’re five minutes late responding to this call,” Dusty points out as he crosses Harrison Boulevard and turns left onto Donovan Circle. “They’ll probably have something to say about it.”

Nothing compared to the razzing I’m going to take from everybody in the control center. I’d much rather suffer through an ass-chewing for the late call.

“I’ll take the responsibility,” I assure him. “You can’t control the fact that your partner was on the shitter when they gave us the call.”

“You can’t just hold it?” he asks like the rookie he is, having never experienced hemorrhoids, gastric reflux, heartburn or indigestion. He is bright, eager and in disgustingly good shape. Right now I freaking hate him. He makes me feel old.

“No, I can’t just hold it,” I explain patiently. “Always take the opportunity to piss or take a
dump when it presents itself. All too often, you’ll need to but won’t have the opportunity. Besides, holding in a dump is unhealthy. It eventually backs up into your brain. That’s where shitty ideas like System Status Management come from.” I grimace and try to think about dams and brick walls as I feel my guts rumble ever more insistently.

By the time Dusty pulls to the curb outside 1512 Donovan Circle, my digestive system is in revolt. I am able to hold it in only through a supreme act of will and years of practice. We knock on the door and get no answer. I do a little potty dance on the doorstep, shifting uncomfortably from one leg to the other. Dusty cautiously opens the unlocked front door and calls out, “EMS! Somebody call an ambulance?”

“Back here,” a frail voice answers. “I’m in the bedroom!”

Dusty and I weave our way through the house, occasionally calling out “Where are you?” and being answered with “back here!” It’s an EMS version of Marco Polo. Eventually we find ourselves in the rearmost bedroom. There is a frail little woman sitting on the floor next to her wheelchair, looking very much embarrassed.

“Thank goodness,” the woman sighs happily. “I was beginning to think you weren’t coming.” The woman self-consciously arranges her housedress to cover her exposed knees.

“I’m sorry, Ma’am,” Dusty says sympathetically. “We were tied up on an emergency call,” he lies with a sidelong glance at me, “and we hurried just as fast as we could.”

“But we’re here now, so why don’t we get you off this hard floor and back into the bed?” I offer quickly. “Did you injure yourself when you fell?”

Please God, say no. The last thing I need is to be tied up with her for the next thirty minutes.

“I don’t think so,” she answers. “I forgot to lock the wheels on my chair, and it just kind of squirted out from under me,” she says, extending her arms to us. “If you young men could just help me up…”

“Don’t move, Ma’am,” Dusty says gravely, looking back at me and grinning evilly. “You may have injuries that aren’t immediately apparent. At least let us assess you before we move you.”

Goddamn you, Dusty Jensen. You’ll pay for this. I say nothing and just smile and nod, afraid to move suddenly.

“Well yes, I suppose that’s a good idea,” she agrees, pleased that this handsome young man is so solicitous. After this call, I’m going to going to beat the handsome young man’s ass, if I don’t wind up shitting myself first.

Dusty slowly and gently palpates her hips and lower extremities as I feel the sweat break out on my forehead. It’s the most thorough assessment I’ve ever seen him perform. I surreptitiously look around for a bathroom.

You are the master of your own body. Your sphincter is under your control. You are the master of your own body. Your sphincter is under your control. You are the master of your own…

“And does any of this hurt?” Dusty is asking as he flexes her feet and knees. If he had a reflex hammer, the little bastard would be checking her deep tendon reflexes.

Brick walls. The Hoover Dam. Fort Knox. Nuclear reactor control rods. Blast doors at NORAD…

“Any history of osteoporosis? Degenerative joint disease? Ever have a hip, knee or shoulder replacement?” Dusty is asking as he palpates the woman’s shoulders. I almost whimper as I shift from one leg to the other. My ass cheeks are clenched so tight I could squeeze a diamond from a charcoal briquet.

Setting concrete. Death Valley. Dry riverbeds. Intravenous infusions of Lomotil. Molasses in the wintertime…

“Okay Mrs. Perkins, I think we can safely help you up,” Dusty pronounces, motioning me over. “If you’ll just plant your feet firmly on the floor and take our hands…” I fix a pained smile on my face and bend over slightly, offering my hand.

Mudslides in Colombia. A tsunami in Sri Lanka. Lava flowing from a Peruvian volcano… Focus, man!

Dusty and I manage to help Mrs. Perkins back into her wheelchair. Dusty takes one of our run tickets from the clipboard and turns it to the refusal of care page. “Mrs. Perkins, if you’ll just sign here, signifying that you were not injured and did not want an ambulance to the hospital…” He trails off, patting his shirt pockets. Glaring, I grimly hand him my pen.

A fireworks factory explodes in China. Champagne corks popping. A horrific explosion in the Jello pudding factory. Oh Lord, I ain’t gonna make it…

“Thank you so much for your assistance,” Mrs. Perkins is gushing, shaking Dusty’s hand gratefully. As she turns to me, I grasp her hand and nearly double over. “Are you all right, dear?” she asks me, seeing the look on my face.

“Uh, could you point me to your bathroom?” I blurt in desperation. Bewildered, she points down the hall. Without another word I bolt in that direction, opening doors until I find the right one. Slamming the door with one hand, I fumble with my belt with the other, dropping my pager into the toilet in the process. I barely make it onto the toilet in time. I swear they can hear the elephant seals fighting all the way down the block.

Until next time…

Having been beset by Darwin Award candidates for the past three days (with two more to go), I feel the need to vent. So without further ado, I present to you the Rules for Seeking Emergency Care, plagiarized from some long forgotten soul in an e-mail received in the distant past. If you recognize your work here, please post a note in comments and I’ll give ya credit. Do try to forgive me for modifying your opus so liberally, because frankly…some of your rules are too bitchy and cynical even for me.

1. Sick people don’t bitch. Ask for help, blankets, pain meds, an assist to the bathroom, and many other requests, yes. Bitch and complain, they do not.

2. The rule we follow is not First Come, First Served. It is Worst Come, First Served. If you are still in the waiting room and the three people who arrived after you have already been seen, it is because we have determined that they are Sick and you are Not So Sick. Probably from your incessant bitching and complaining.

3. Never start out by saying “I was searching the Internet…”

4. Just because you came in on an ambulance stretcher, we are not impressed. It only demonstrates the fact that you or a family member are able to dial 911. Whether you go straight to a room or not will depend on how Sick you are.

5. One complaint or ailment per visit, please.

6. If you are currently under treatment of a specialist for your chronic complaint, please go to the hospital where that specialist practices. We have no specialists at Podunk General Hospital. Our best ER contract Doc is a retired proctologist. If your problem requires a rectal exam, he can probably oblige you.

7. Even if you came to the ER in an ambulance, that doesn’t mean you’re going home in one. Better start making plans now for how you will get home, and I am far too busy to be your travel agent.

8. If you have one of the following: flu, stuffy nose, stomach virus or a chronic migraine – go see your personal physician in the morning. Exception – if you are like LawDog and stubbornly ignore your minor illness until it blooms into a raging case of pneumonia, we will treat your illness. We will also giggle at your stupidity. If this is your first migraine, or if you JUST ran out of your migraine medication (like within the past 24 hours), we will treat you. If you have chronic migraines and have been out of your meds for a week, shame on you. If you want Sympathy, you will find it somewhere between Shit and Syphilis in the dictionary.

9. If your child has a fever and you have not given him Tylenol or Motrin, you are too stupid to have children. Please get yourself sterilized immediately and give your kids to a childless couple looking to adopt. One dose of Tylenol an hour ago does not count.

10. If your child does have a fever and you have either put him in an ice bath or rubbed him with alcohol, see my recommendations in #9.

11. If your mother is a patient and we ask her a question, please let her answer it.

12. Do not utter the words, “It’s all in my chart.” I don’t have your chart. Probably won’t get your chart within the next hour. Just answer the question. On a similar note, don’t utter the words, “Dr. So and So knows all about it.” I got news for ya. Doctor So and So ain’t here. Shoulda gone to his office instead of the ER.

13. If you have more than five drug allergies, you are automatically a psychiatric diagnosis.

14. We can spot a drug seeker from a patient who is really in pain within 5 minutes of meeting you. How we tell the difference, I will not share with you. We are not in the business of educating drug seekers in how to be better actors. If we have refused to manage your complaint with the narcotics you seek, guess what? You’ve been spotted, Seeker. Now go bug some other ER.

15. If you meet the ambulance at the curb with your bags packed, you are not Sick enough to need an ambulance. We call it Samsonitis, and every EMT who deals with you holds a special dark place in his heart for you.

16. Do not lie to me. Ever. Once I catch you in a lie, I will assume you are lying about everything else. If there is something you don’t want to admit to in front of your boyfriend/parents/priest/parole officer – tell me so or just give me The Eye. What you tell me when they are gone, I will not share with them. It’s my duty, and it’s the law.

17. If you have diabetes and do not control it, you are committing slow suicide. Don’t get me wrong – I can sympathize with even attempted suicides. My sympathy lessens dramatically after I’ve seen you eight times in a the past two weeks.

18. If you are a female between 16 and 42 and your last menstrual period was between 28-35 days ago, and you have vaginal bleeding and abdominal cramps, guess what? You got your period. Again.

19. Do not bring your entire posse with you. One person at the bedside is all you need. If your child is dying, I will allow you to be at his side IF YOU ARE NOT INTERFERING WITH THE RESUSCITATION. If you insist on behaving like a fool, you will be escorted out.

20. At the first sign of Tachylawdia (more than 100 “Oh Lawdy” prayers a minute), we will escort you outside, regardless of how sick your family member is.

21. Every time I ask you a question, I learn more about what is wrong with you. I don’t care if I have asked the same question, phrased slightly differently, four previous times. I am asking for a reason. Please answer the question.

22. Politeness and manners beget politeness and manners. If you insist on behaving like a prick, I will still be polite and mind my manners because my Momma raised me right. But I will not be Gentle. Believe me, you want me to be Gentle.

23. “Clear” means “CLEAR.” If I have been compassionate enough to allow you to stay in the room when your family member is being resuscitated, please pause the Laying On of Hands long enough for me to defibrillate the patient. If you refuse, you may well arrive at the Pearly Gates together.

24. If you came in to the ER beaten/shot/stabbed…within 5 minutes it will be obvious to us why you were beaten/shot/stabbed. Yes, we know you were just sitting there on your front porch minding your own business while drinking a wholesome glass of milk and reading your daily Bible verse, when all of a sudden and for NO reason, Sumdood just beat/shot/stabbed you. We’re sure you are the .01% of assault victims who didn’t richly deserve your ass whipping. We believe you. Really.

25. If the thermometer tastes funny, I probably got the rectal and oral probes mixed up again.

Happy New Year, everybody! Until next time…