“I don’t need to be here. I wouldn’t be here at all if she hadn’t made me.”

He’s short, stocky and just a little belligerent. The kind of belligerence that hides fear. He wouldn’t have let his wife browbeat him into coming to the hospital if he wasn’t scared.

“So tell me what’s going on with you today,” I suggest gently.

“Chest pain,” his wife says flatly. “He’s been having it for three weeks.”

“I have not,” he denies hotly. “It hardly hurts at all. Now.” He turns toward the door as if he’s trying to leave. I shift just a little to block him.

“Now? Has the pain gone away?”

“Yeah, hardly feel it at all now,” he nods, sneers at his wife. “I told you it was a false alarm.”

“He’s lying,” his wife rolls her eyes. “He’s been bitching about his chest hurting since he was in here last. When he gets to working in the yard, it takes his breath away.”

“That true?” I ask him, and he nods grudgingly. “So why don’t you tell me about this pain,” I suggest. I guide him toward the bed and pull up a rolling stool for myself.

“It’s hardly nothing,” he sighs. “Kind of like an ache. I’m just sore.”

“Where, exactly?” He grimaces, makes a vague movement over the left side of his chest.

“Over here. And in my left shoulder. Left side of my neck, too. But it ain’t bad. Doesn’t even hurt worse when I move. Like I said, just an ache. No big deal.”

I sigh. “Define ‘no big deal’, Mr. Robichaux. On a scale of 1-10, how does it rate now?”

“A three,” he tells me, with a triumphant glare at his wife. She doesn’t respond, just looks at me with a plea in her eyes.

“Uh huh. And how about earlier, when the pain was worse?” His bravado fades.

“Maybe a seven.”

“Riiiight. Well Mr. Robichaux, we’ve got some things to do,” I tell him as I begin attaching monitor leads and applying oxygen. He immediately rebels, pushing the nasal cannula away from his face.

“Whoa, whoa, whoa. I ain’t staying in no hospital.”

“Who said anything about staying in the hospital?” I ask reasonably. “Just let me get these things done while we do a few tests to see if we can figure out what’s going on with you.” I’d rather not have the confrontation just yet, but he doesn’t give me much choice.

“Why do I need oxygen for a bunch of tests? And this monitor thing? And you ain’t sticking me with a bunch of needles.”

I sigh, and look him directly in the eyes. “You need oxygen because you may be having a heart attack. The monitor is so we’ll know immediately if you should go into cardiac arrest. And yes, I will be sticking you with needles. How do you think we get the test results? Magic?”

“Shut up Lenny, and let the man do his job,” his wife warns. She and I have had to tag team Mr. Robichaux like this before. He doesn’t like hospitals, which is understandable. Neither do I. But I’m not having angina right now, either. He is.

Mr. Robichaux acquiesces. He plops down on the bed, folds his arms across his chest like a petulant child, and submits to the indignity of admitting he’s sick. Within a couple of minutes, I’ve gotten a 12-lead EKG, given him some aspirin, and smeared a little Nitro paste on his chest – all with only the most grudging cooperation from the patient.

“So what does that say?” he asks, nodding at the 12-lead.

“It says you have anterolateral ischemia right now. And a previous heart attack at some point in the past.”

“I’ve never had a heart attack in my life!”

“Oh really? And who told you this, your cardiologist?”

“He don’t got one,” his wife chimes in accusingly. “He ain’t even seen his regular doctor in ten years. Told him he had high blood pressure, told him to go on a diet and quit smoking, and put him on blood pressure pills. He quit taking the pills after three weeks and ain’t been back to the doctor since.”

“I ain’t ever had no heart attack,” he insists doggedly.

Well, I’m no Elizabeth Kubler Ross, but I recognize denial when I see it. So, being the tactful, caring professional I am, I knew the right approach to take with Mr. Robichaux.

I hit him over the head with the cold, hard facts. Repeatedly.

“Yes, you have had a heart attack,” I tell him bluntly. I point to the large Q waves on his EKG. “See these things, right here? Consider those the Grim Reaper’s calling card. ‘Sorry we missed you, but Death called on you today. We’ll return on insert date here.’ Only, you were too busy being fucking hardheaded and telling yourself it was indigestion. Just like you’re doing now.“

“I’m healthy as a horse. I know my own body.”

“You’re a horse that’s one step away from the glue factory. Unless you wise up and start listening to these warning signs. Anybody in your family have heart disease?”

“All of ‘em. My father and uncles, my mother, both my sisters. None of the men in my family have lived past fifty, except me. I’m healthy.”

“Yeah, you’re real healthy. You have high blood pressure that you ignore, you smoke like a chimney, and you can’t walk from the wheelchair to the bed you’re sitting in without getting winded. You have a family history of heart disease, and instead of trying to dodge that genetic bullet, your lifestyle might as well be putting the muzzle against your head.”

“I don’t smoke that much.”

I lift his fingers and inspect them. “Unless those are iodine stains on your fingers, I’d say you smoke what, maybe two packs a day, at least?”

“Sometimes three,” his wife furnishes helpfully. He shoots her a dirty look.

“Like you said, it’s genetics. If I’m gonna die, I’m gonna die. Ain’t nothing I can do about it.”

“Bullshit. That’s a weak argument. You can do something about it. You can start by admitting that you’re having a problem right now that needs treatment. Were the rest of the men in your family so stubborn?”

“Daddy denied he had heart problems till the day he collapsed from a massive heart attack, right in front of me in my k
itchen.” Tears are welling in his eyes.

I’m getting through here, I know it.

“Congratulations Lenny, you are your father’s son. And pretty soon, your kids will be able to experience the same nightmare – their Daddy dead on the floor from a disease he could have controlled. I hope you taught them enough of life’s lessons now, because you won’t be here for them in five years. Maybe less than that.”

I feel like a real bastard when I talk to patients like this, and you guys need to know that I don’t treat most of my patients this way. But for Lenny Robichaux and men like him, this is the language they use and understand. They’re strong and simple people, and they appreciate honesty and straightforwardness. They don’t pussyfoot around. Neither do I when I deal with them.

Lenny sighs heavily, deflating before my eyes. Tears well in his eyes, and his wife pulls her chair closer to the bed and grabs his hand. Someone steps around me, and I turn to see his kids enter the room. How long they’ve been standing behind me, I don’t know. From the tears in their eyes, it’s been long enough to hear most of the conversation. Doc is back there too, standing in the doorway taking it all in. He winks at me and walks back into the nurse’s station.

I drop the chart on the desk in front of him, sigh and prop my elbows on the desk, massaging my eyeballs. “The guy in Bed One is having chest pain – “

“I heard all of that. Let’s go ahead and order the usual, see what we’ve got.”

“He needs a little prodding. Maybe you could go in there and -”

“Why?” Doc asks reasonably as he signs the order sheet. “I heard what you said. Sounds like you pretty much laid it out for him. Oh, I’ll go in there and talk to him in a bit, but let’s get the labs cooking in the meantime. Maybe his family can soften him up a bit, too.”

“Okay,” I sigh, “CBC, lytes, chest x-ray, cardiac enzymes and a coagulation panel. You got it.” I drop the order form off with the ward clerk and walk back into Mr. Robichaux’s bed.

“Time to start that IV now, Mr. Robichaux. When I start it, I’ll draw blood from the catheter hub and save you an extra needle stick.”

He bitches impotently, pisses and moans and keeps making noises like he’s leaving. When I make the stick, he jerks his arm and says “Goddamn! You trying to kill me?” Only my grip on his elbow keeps me from losing the line. I bite off my reply until I get the line secured. It’s not the needle stick that bothers him. He just needs something to bitch about.

“Yep, that’s the goal. We make it a point to kill as many people as possible when they come in here. That’s what hospitals do – we take perfectly healthy people, kidnap them, and make them sick.” I wink at his wife and kids, who smile in return. The sarcasm sails ten feet over his head.

“Hospitals!” he snarls. “Half of my family has died in hospitals. Once they get you in the bed, you never make it out alive.”

“Gee, ya’ think that might be because, besides heart disease, being mule headed runs in your family too, and they deny they have a problem until they’re too damned far along to be helped? You know, kinda like you’re doing.”

“You’re a real hardass, you know that? You talk to all of your patients like this?”

I sigh, and soften my tone a bit. “No, just the ones that need to hear it. Lenny, how many times have you been in here lately?”

“I dunno,” he shrugs. “Four or five. This is the first time with chest pain, though,” he adds, almost defiantly.

“You’re a mechanic, right?” He narrows his eyes, nods at me suspiciously. He’s not sure where I’m going with this.

“What if someone brought you a car…someone with no mechanical experience…and told you the thing wasn’t running right? Let’s say you notice the engine is missing, smoking a little. Not much power. Let’s say maybe you figure it’s a burnt valve.”

“Uh huh.”

“So what do you tell this person?

“I’d tell him that he’s got a problem, and unless he fixes it now, he’ll have a new engine to buy pretty soon.” He’s refusing to meet my gaze now, looking away with his hands folded across his chest. He knows where the simile is going.

“Excellent. And if this guy told you ‘I know my own car, I drive it all the time, and you don’t know what you’re talking about’, you’d think he was a hardheaded fucking idiot, wouldn’t you?”

“Probably.”

“You’re being a hardheaded fucking idiot, Lenny.”

His head snaps around and he looks at me in surprise.

“Right now, your engine is knocking, smoking and losing compression. If you start to baby it and do some preventive maintenance, maybe a light overhaul, right the hell now, you might be able to keep it from seizing on you and drive it for another hundred thousand miles. If you wise up and listen to the mechanics.”

“I ought to whip your ass,” he retorts. But he says it with a grin.

“You’re a heart patient,” I shoot back. “If I can make you miss the first couple of swings, you’ll be easy to take. You don’t scare me.” He shakes his head and chuckles. So does his teenage son. I turn to leave, saying, “We’re still waiting on your labs, but it shouldn’t be more than a few minutes. When we have the results, Doc will be in here to explain ‘em to you. Listen to what the man says, okay?”

“Yeah, well tell him this damn IV still hurts!” he yells after me. I shake my head and ignore his bitching. His IV site is still patent. Five minutes later, his lab results are back. Doc peruses the report, clucks his tongue and clips it to the chart.

“So, what are they?” I want to know.

“Cardiac panel’s okay. Chest x-ray looks like early emphysema. We need a repeat 12-lead. How’s his pain right now? More importantly, how’s his mood?”

“Well,” I say wryly, “with a little gentle prodding from Yours Truly, he’s moved from Denial, to most of the way through Anger. We may even be nibbling at the Bargaining stage right now.”

“Well, go get that 12-lead,” Doc chuckles, “and we’ll see if we can tag-team him into Acceptance.”

I’ve left the EKG machine attached in anticipation of doing more 12-leads, so all it takes is a press of the button to acquire another one, perhaps an hour after the one we took when he first walked in. The report rolls off the printer, with Lenny Robichaux watching suspiciously the whole time. From where he’s sitting, he can see the words ***Normal ECG*** printed at the top of the report. He sighs explosively, but says nothing. The relief is palpable on his face.

I walk back to the nurse’s station and wordlessly hand the report to Doc. He looks at it, grunts and stands up. “Well, that’s good news. No heart attack.”

“No heart attack now,” I qualify. “We may have averted something.”

“Right you are,” Doc agrees. “That’s why I’m going to recommend he stay overnight for serial EKGs and cardiac enzymes. Come on with me and we’ll face the dragon togeth-”

Right then, he’s interrupted by the ward clerk, pushing a woman in a wheelchair. She’s gasping for air, and her hands are retracted into gnarled claws. “Gotta woman who can’t breathe!” the clerk announces unnecessarily.

I sigh, pointing to Room Three. “In there. I’m right behind you.” I turn to the Doc. “I’ll take care of this new one. Good luck. He’s a hardheaded bastard.” Doc nods understandingly and goes into the room alone to tell Lenny Robichaux the Good News and Bad News.

My new patient has nothing more than an anxiety attack and hyperventilation syndrome, but by the time I’ve given her oxygen, dimmed the room lights, sat by her bed and soothed her, coached her in slowing her breathing and convinced her family that she’s not dying, twenty minutes have passed.

I find Doc back in the nurse’s station, filling out AMA papers. “Your unstable angina patient in Room One is leaving against medical advice,” TAN informs me matter-of-factly.

Damn. And I thought I had gotten through to him.

I look at Doc expectantly.

“Don’t look at me,” he protests. “I’ve been arguing with him for fifteen minutes, but he’s adamant. He doesn’t trust doctors. You can give it a try, but I’m all out of arguments.”

Damn. Double damn.

I walk back into the room to find Lenny sitting with his legs dangling off the bed, ripping off the monitor leads. He looks up at me defiantly, but says nothing. His wife and kids are crying.

“So I take it you’re leaving? Nothing I’ve said to you makes any sense?”

“Doc said the last EKG was normal. I ain’t hurtin‘ no more. I told you all it was just a false alarm.”

“Maybe, Lenny. This time. But all that means nothing if you don’t listen to the signs your body is giving you. If you stayed here, you could see a cardiologist first thing in the morning. A good cardiologist, and he comes by here twice a week.”

“I don’t need no cardiologist. I ain’t hurting no more, and the Doc said all my tests were normal.”

Damn, we’re right back to Denial.

“Ever stop to think that the reason you’re not hurting is because of the nitroglycerin and oxygen you’ve had for the past hour and a half? Which, by the way, usually only works on someone with genuine cardiac problems. That should tell you it’s your heart.”

He wavers a bit. “All the cardiologist is gonna do is tell me what to do with my life. Tell me to stop smoking. Tell me I cain’t work. Tell me I cain’t provide for my family.”

“No, what he’s more likely to tell you is stop smoking, and recommend a few things to do to make sure you can keep working and providing for your family. All you have to do is follow his advice.”

“I like smoking,” he says plaintively.

“As much as you like being there for your kids? Hunting and fishing with your son? Working in your shop? Are a few cigarettes worth all that? You’re making this into a smoking issue, and it’s bigger than that. We both know it.”

“I ain’t staying in the hospital,” he says adamantly, holding out his arm. “Are you gonna take this fucking IV out, or do I need to rip it out myself?”

I meet his gaze, shrug and start removing the IV catheter. After I’ve bandaged the site, I try one last time.

“It’s four o-clock. Still time to catch the cardiologist in his office. Let us at least make an appointment for you.”

“I got too much stuff to do this week,” Lenny shakes his head. He sees the scorn in my eyes, and relents a bit. “Okay, if you give me his number, I promise I’ll make an appointment as soon as I can.”

“No you won’t,” I say, looking at him appraisingly. “You’re gonna walk right out of here, light one up, have a big old greasy burger for dinner, and keep on doing what got you in here in the first place. Don’t blow sunshine up my ass.” He knows he’s lying, and I know it.

“Look, I appreciate everything you done,” he says sincerely. “And if it gets worse tonight, I promise I’ll come back in.”

“Bullshit,” his wife spits, still teary-eyed. “I’m calling an ambulance next time!” I look at the address on his chart and sigh.

“You live in Hooterville, right?” He nods. “The closest ambulance to you is fifteen minutes away. If you go into cardiac arrest at home, no ambulance in the world can save you. I know, Lenny. I’m a paramedic. It won’t matter how much CPR your family does and how hard the paramedics try, you will die. If you have a heart attack, by the time they get you to the cath lab at Big City Memorial, you’ll have lost so much of your heart muscle that the life you’re living now will just be a fond memory. You’ll be a cardiac cripple.”

He says nothing, tries to meet my gaze, and his eyes wander away.

I shrug, and offer my hand. “Good luck, Lenny Robichaux. You’re gonna need it.” He grips my hand hard and walks away down the hall.

He’ll be back. I pray he’ll be alive when it happens.

and regaining some of the respect of this gun owner.

Jim Zumbo writes an open letter to Congress. Go here to read it.

Hat tip to Quidni Pro Quo.

Laid Back Male Nurse: Is that the urine on Bed Four?

Ambulance Driver: Yep.

LBMN: Doc wants a urine glucose on her.

AD: Okay. (dips finger in cup and licks it) Pretty sweet. I’d definitely say she’s got the osmotic diuresis going on.

Thin Anemic Nurse: (Speechless. Just looks horrified)

LBMN: Nice try, but Doc wants a quantitative analysis.

AD: (takes a healthy slug, swishes it around like mouthwash. Swallows) I’d say about 456.

TAN: (Running to the bathroom to spew)

LBMN: Amazing what you can do with a little apple juice and a urine cup.

AD: Yep, good for hours of fun and enjoyment.

1. Patient rapport. I just know how to talk to people. I can’t explain how or why, but I just instinctively know the right tack to take with people. My speech patterns and demeanor change with every patient. I can keep it real with a thug from the block and then, without missing a beat, walk across the hallway and have an erudite discussion with the white-collar professional about his abdominal symptoms – and each one of them will swear that he’s seen the Real Me. I wish I could explain how I do it, because then I’d be able to teach it to my students. I don’t know whether it’s the ability to read people or whether it’s all in my delivery, but I can get away with saying things to patients that no one else would dare. Like my mother once said, “If you can’t save ‘em, at least you’ll convince them what a privilege it is to die while in your care.”

2. Airways. Any airways. All airways. I can fall down a flight of stairs and accidentally intubate five people on the way down. I am Ambu-dextrous – I can hold the mask seal of an Ambu bag with both hands and squeeze the bag under my arm without breaking a sweat. I’m confident administering paralytics (well, as comfortable as anyone can be when giving a drug that converts a compromised airway into none at all), yet I’m not too proud to drop an oral airway and BLS it if that is what’s necessary. Managing airways is my thang.

3. Calmness and choreography. I always tell my students that the choreography of a code is just as important as the skills and knowledge of the people working it. To choreograph the intricate ballet that is a resuscitation or a chaotic scene, the leader has to remain calm and thinking three dance steps ahead of everyone else. Sometimes it seems that everything else slows down while my mind tends to speed up. My decision making is almost languid.

Things I’m Not So Good At:

1. IV access. If I’m Supermedic at everything else, I am Clark Kent with an IV needle in my hand. Frightfully, shamefully, disgustingly average. Whenever I feel my ego growing out of control, all I need do is find the nearest fat lady who needs an IV right now. Four sticks later, I’m humble again, and the aides are pulling the bedsheets out of her ass. On the other hand, I’m really good at sticking kids. That whole patient rapport thing, I guess.

2. Understanding metabolic disorders. Not that they’re beyond my grasp, but I need to be better.

3. Disagreeing with someone when I *know* I’m right, without sounding condescending to that person. And yes, I do take time to reconsider the rightness of the position I’m defending. But when I *know* I’m right, it’s a struggle not to behave like an arrogant ass. Yeah, it’s shocking, I know. Me, an arrogant ass?

Things I REALLY Suck At:

1. Reasoning with drunks. Psych patients I can deal with. Despite my professed cynicism and world weariness, I’m an empathetic fellow. I’m like Bill Clinton, except that I really do feel their pain, and I’ve never tried the disappearing cigar trick. And I’m reasonably honest. And decidedly un-liberal. And a gun nut. Okay, let’s just scratch the whole Bill Clinton simile.

But while I can empathize to a certain extent with the anxious/depressed/mentally disturbed because I’m good at the aforementioned patient rapport, I can neither speak nor understand drunkese. Moreover, I have no desire to learn. Mugwug said it well in his blog:

I’ve found over time that I don’t actually talk to the problem children, drunk-ese is my second language, but my comprehension of it is limited severely by my characteristic apathy. Drunks tend to spin tales of woe filled with serpentine logic and non sequiturs that would leave me scratching my head for hours if I was actually listening. I simply nod, make the odd concerned noise and return to the point in the script where we left off before the drunk wandered down fantasy lane.

I’d rather just keep ‘em paralyzed, put ‘em on a vent and park ‘em in a dark corner somewhere until they sober up and start speaking in anything but Jim Beam. But that would be unethical. Instead, I just get short and ill-tempered and entertain dark fantasies about punitive Foley catheters.

2. Empathizing with malingerers. I don’t even include drug seekers, at least initially, in this list. Withdrawal hurts, and I can understand to a certain extent the lengths that a seeker will go to for a fix. I believe that drug and alcohol use is ultimately a personal choice and not a disease, but then again I’ve never been addicted to anything. I may be full of shit. So I take the middle ground – I empathize, but I don’t necessarily feed the addiction.

But while a chronic pain patient who is out of his Lortabs may be stupid for not getting his prescription re-filled in a timely fashion, it doesn’t change the fact that he is still hurting. So I have no problems giving them a narcotic to tide them over until they can see their Doc. Doesn’t bother me in the slightest.

But if I see them continually for the same problem, they get lumped into the Malingerer category with all the other oxygen thieves who insist on using EMS and the ER as their personal 24-hour free clinic/pharmacy/confessional/medical advice/taxicab/group therapy.

My personal mantra to these people: “If you want sympathy, look between shit and syphilis in the dictionary.” I may have to treat them, but I’ll be damned if I’ll pretend to like it. And I let them know I don’t like it.

In a nice way, of course.

For those of you who don’t follow the gun blogs, you may not know this guy:

Allow me to introduce you to Christian Trejbal, Asshole Extraordinaire. Mr. Trejbal is a columnist for the Roanoke Times who apparently had no personal qualms about printing the names and addresses of all CCW permit holders in the state of Virginia.

Aside from his willingness to violate the privacy of citizens for no other reason than that he disagrees with their opinions on the right to keep and bear arms, it also turns out that Mr. Trejbal is an equal opportunity asshole. To wit:

When I see a car plastered with stickers promoting candidates or views with which I disagree, I treat them just like the gas-guzzling, road-hogging sport utility vehicles I find equally morally bankrupt: I don’t yield to them.

When someone throws on a turn signal indicating he wants to break into traffic, in most circumstances there is no obligation to give way. If a vehicle sports one of those ironically misguided fish-eating-the-fish-with-feet, forget it. If it has the “Coexist” sticker with all those different religious symbols for letters, well, then I’ll make some room.

Heh.

Well, I have been known to drive a gas guzzling SUV, and at work I drive a diesel-guzzling, smoke-belching, screeching behemoth of an ambulance that rides like a gravel truck, stops like a freight train and has the neck-snapping hole shot of an ocean liner. It’s a real rolling ecological disaster, complete with on-board biohazards aplenty.

And it’s folks like Mr. Trejbal that make me wish that I had twin .50s in the grill and a snowplow bumper instead of a light bar and a siren.

And after I have walked a burst of rounds into his cute little Prius and plowed his arrogant little ass into the ditch, he can look up and see this bumper sticker on my rig as I continue on my way:

Coexist, indeed.

AD: Hey, Thin Anemic Nurse?

TAN: Yeah, Ambulance Driver?

AD: Any particular reason you have a space heater running in here when the ambient temperature is 80 degrees?

TAN: I’m cold.

AD: Okay. Any reason the rest of us have to stew in our own juices because your personal thermostat is stuck on LOW?

TAN: I’m cold.

AD: We’ve established that. I was just wondering why four people in this room have meat falling off the bone so the fifth one can be comfortable. Maybe you could like, maybe, wear a sweater or something.

TAN: Sweaters don’t go with my scrubs.

AD: Then perhaps you should come to work in a snowmobile suit on those frigid days when the mercury drops below 85.

TAN: Are you trying to tell me you want to turn on the air conditioner? Because I can’t work in here with it that cold.

AD: Heaven’s no! I’d never suggest that you sacrifice your comfort for all of us. As a matter of fact, we’re all going to chip in together and buy you a new hypothalamus for Christmas. We love you that much. Crank up the sauna, girlfriend!

She didn’t think it was near as funny as the rest of us did.

A timely excerpt, and not just because I’m feeling lazy today:

His name is Frankie Maryland, and he’s 25 years old. He comes around to visit me occasionally, usually when I’m feeling pretty cocky. He reminds me that I’m fallible, that I make mistakes.

I believe that every paramedic has his own personal cemetery, a dark little corner of his psyche where he stores the faces and memories of people he wished he had served better…things he wished he had done differently. The rest of the calls you run, good or bad outcomes, blur with the years until you’re lucky to even remember the vaguest of details. The faces and the names fade into half-remembered diagnoses – Diabetic Lady, Homeless Man, The Kid in The Rollover…

But occasionally, in the wee hours when you’re alone and nagged with self-doubt, some of the faces materialize with startling clarity, phantoms from the past come home to haunt you. You never really get rid of them, the ones you killed. All you can do is hope to make friends with their ghosts.

Frankie is black, well over six feet tall and 250 pounds, and a pretty good linebacker during his high school days. His friends will tell you he’s a funny guy, the kind who is quick to loan money to a friend, and then forget about the debt. His friends aren’t the most reputable people around, but Frankie is extremely protective of his younger brother and sister. He doesn’t bring his friends around the house, and he’s pretty strict about who his brother and sister run around with.

Frankie and his siblings live with their aunt, a single woman with no kids of her own. Carlotta has raised Frankie and his little brother and sister since Frankie was eight years old, when their mother abandoned them and ran off to Detroit with her dealer.

I first met Frankie on his 25th birthday. He wasn’t having much fun, the festivities interrupted by gunfire from persons unknown. Frankie took a round in the belly. I was called to Podunk General at 3:30 am to transfer him to Big City Regional Medical Center for exploratory surgery. I am tired, groggy, and in a foul mood. They’ve called me from Quaint Little Hamlet to make this transfer while the Podunk crew sleeps comfortably, less than a mile from the hospital. I’m only half listening as the nurse gives me report.

Blah, blah, blah…BP 100/52…blah, blah…two IVs, good for you…blah, blah, blah…oxygen at two liters, yeah you people think oxygen is a poisonous gas…blah, blah…combative, huh? Well, can’t blame him. I wouldn’t be happy about being in this fucking Band-Aid Station either…blah, blah, blah…restrained on a long board…blah, blah…yeah, you too. Thank you for calling the big white taxi.

Fifteen minutes into the trip, I’m taking vital signs and I can’t get a blood pressure.

No big deal. It’s hard to hear in the rig. I’ll just palpate one.

While I’m trying unsuccessfully to palpate a blood pressure, Frankie moans and says, “I’m gonna puke.”

“Just hold on,” I tell him, scrambling for an emesis basin. “Take deep breaths.”

He does just that, as I find an emesis basin and set it beside me on the seat.

We’re evaluating a new vital signs monitor, so I figure now is as good a time as any to try it out, and I wrap the cuff around his arm. As the cuff is inflating, Frankie moans again and vomits before I can get the emesis basin under his chin. It’s pure, bright red blood, and there’s a lot of it. Frankie heaves again, and more blood fountains out.

Holy shit! Where is all this blood coming from?

I scramble to loosen the straps and tilt him on his side with one hand, while reaching for the suction with the other. He’s too big to tilt with one hand, so I yank at the suction tubing to untangle it, then drop the suction tip on the seat. I grab him with both hands and roll him onto his side, and the blood drains out of his mouth and puddles on the floor. His eyes are rolled back, and he’s making horrible gurgling sounds.

God, he’s aspirating this stuff right here in front of me!

I jam the rigid suction tip into his mouth and flip the switch, but nothing happens. In my haste, I’ve pulled the tubing loose from the suction canister. I hurriedly reattach it as Frankie vomits again. I am having trouble tilting him and working the suction unit at the same time. I apply suction, and watch the blood creep up into the suction canister at an agonizingly slow rate. Frustrated, I yank the catheter tip off and stick the hose in his mouth and breathe a sigh of relief as the blood clears. He’s still got a nasty rattle when he breathes.

I look up at the vital signs monitor, and the blood pressure is only 72/40. The cardiac monitor shows a sinus tachycardia at 130. I pull my knee from under the board where I’ve been attempting to prop him on his side, and put a non-rebreather mask over his face. I open up both the IVs wide open, but they seem to be running awfully slow. I look carefully at the lines and at both sites. Both of them are 22-gauge catheters – in the antecubital veins, no less.

“Fuck me!” I blurt in frustration. “Goddamnit!”

Who is the idiot snurse who put 22-gauge catheters in a trauma patient?

“Everything all right back there?” asks my partner, Marlboro Man. Aunt Carlotta is riding in the front passenger seat, and she has turned around in her seat, watching through the small window between the box and the cab.

“No, everything is not all right!” I shout back at him in frustration. “Step it up! And call Big City and tell ‘em he’s crashing!”

“That all you want me to say?” he asks as he hits the lights and siren.

“No, but I’m too busy to talk right now. Just drive!”

I manage to see a little stretch of vein above the IV site in his left arm. I delicately insert a 14-gauge and switch the IV line over, and it flows quickly with no swelling.

So far, so good.

I’m taping down my second line when Frankie vomits again. It’s more blood, and it keeps on coming.

Oh no, not that again! Please, please stop this. Where in the fuck is all this blood coming from?

I stick the suction tubing back into his mouth and reach with one hand for the airway kit. I grab a tube and stylet and assemble my laryngoscope, and without warning the suction unit stops working. It’s still making noise, but it’s not clearing his airway anymore. I look disbelievingly at the full canister.

“Goddamnit!” I shout. “Don’t do this to me!”

Jesus Christ, that’s what, more than a liter of blood in just a couple of minutes? And his heart
rate is only – Oh God – forty-four beats a minute! What do I do now?

I’m not sure if I’m screaming at Frankie or fate, but I keep shouting as I hurriedly try to intubate. “Frankie! Frankie! Can you hear me? Stay with me, man. Hang in there!”

I can’t see the airway through all the blood. I try to scoop out as much as I can with my fingers, but it only wells back up as soon as I scoop it out. I try to empty the suction unit, and dump the entire canister into the biohazard bag, but when I reassemble the unit, it doesn’t work. Apparently I’ve put it back together incorrectly in my haste, and I snarl, “Fuck me!” as I give up on using the suction unit. Frankie still has a pulse, but it’s a faint one. He’s not breathing any longer.

“Frankie, stay with me!” I shout at him, my voice rising. Even I can hear the fear and desperation in my voice. Aunt Carlotta is sitting in the front seat, watching, but I can’t seem to shut up. “Goddamnit, don’t you give up! Hang on! Damn you, you sonofabitch, you will not die on me!”

I try again to intubate, and still can see nothing.

Fuck it! I’ll blindly insert the tube. If it goes into his trachea, I’ve got an airway. If it goes into his esophagus, at least the blood goes out the tube and onto the floor.

Sure enough, the tube winds up in his esophagus. The blood isn’t coming as quickly as it was before, just slowly oozing up out of the tube, but then I don’t imagine there is too much blood left.

I feel for a pulse as I reach for another tube. He’s got one, I think. The cardiac monitor shows a rate of 36 in an ugly idioventricular rhythm, Death writ large on the monitor screen in a lazy scrawl. I’m just getting ready to try another intubation attempt when the back doors fly open. We’ve already backed into the ambulance bay, and I haven’t even noticed. Marlboro Man looks scared. I can’t even imagine what I look like right now. Carlotta is standing off to one side, sobbing uncontrollably. I toss the tube, BVM and laryngoscope onto Frankie’s chest, as MM gets the IV bags. They’re both nearly empty.

The doctor meets us right inside the door. I don’t recognize him, but he doesn’t look pleased with me. Right now, I could care less. The doctor looks at me, at Frankie and at the tube and starts yelling. “What the hell is going on here? What happened?” He hooks up the BVM and squeezes it once, auscultating Frankie’s stomach as he does. “This tube is in the stomach!” he says angrily.

“Wait, don’t pull the-” I start to say as he snatches the tube out, but I am too late. “Well, that’s just fucking great! Now try to get an airway! Fucking idiot!” I scream at him, spittle flying as MM wrestles me away.

The doctor and several nurses wheel Frankie hurriedly into a room. I calm down enough to see that everyone has stopped what they were doing, staring at me uneasily. I look down at myself to see that I’ve got great smears of blood all over my uniform shirt and pants. There is blood all over my forearms. Aunt Carlotta acts like she hasn’t heard a thing, standing behind us sobbing quietly.

“Come on, AD. I’ll buy you a Coke,” MM says quietly as he steers me into the nurse’s lounge. He says nothing to me as I clean up at the bathroom sink. A nurse walks in a bit later. She hands me a scrub top.

“Here. It’s about the only thing we have in your size.” I nod gratefully and duck into the bathroom to change. My eyes are red, as if I’ve been crying. I can’t remember. When I come back out, the nurse is still there. “You okay?” she asks me, concerned.

“Yeah, I guess so,” I sigh shakily. “Is he gonna file a complaint?”

“Nah, I doubt it. He’s not really a bad guy. You just took him by surprise. I think he thought you were gonna flip out and whip his ass. We all tried to convince him you weren’t really unstable.” She grins at me and winks. It works – I feel a little better.

“Thanks. How’s my patient?” I ask her, dreading the answer.

“We called it about five minutes ago,” she says softly. “Never did get an airway,” she adds, as if this will make me feel better.

“Yeah, I figured that. Well, thanks for the scrubs. I appreciate it,” I tell her as I turn to leave.

She shrugs as if to say, “don’t mention it.”

Outside, Carlotta is leaning against the wall, smoking. She has stopped crying, but I can’t face the look I’ll see in her eyes. I try to slip by her as if I haven’t seen her, but I feel her hand on my arm as I walk past, and she gently turns me to face her. I just stand there, afraid to say anything.

She reaches up and pulls my head down to her shoulder, and puts her hand on the back of my head. “It’s okay,” she whispers in my ear. “You did all you could. I know you did your best.” She holds me there for a few seconds longer and then grasps both of my arms, forcing me to meet her gaze. “Really,” she says seriously. “Thank you.” I nod dumbly and walk away.

Marlboro Man and I don’t talk on the ride back to Quaint Little Hamlet. The sun is coming up as we pull into the station. I walk alone into my bathroom, turn on the shower and sit down under the spray, arms wrapped around my knees, rocking and crying uncontrollably. I rock and shake and weep for I don’t know how long, then quietly dry off and climb into bed.

Frankie Maryland died on his 25th birthday, thirteen years ago this week. It was my fourth call as a paramedic.

Marko at The Munchkin Wrangler graces us with as sensible, reasoned and civilized argument for an armed populace as I’ve ever read. Go give it a read.

The reciprocal blogroll has gotten longer, and many thanks to folks who have linked me.

I’ve added two links to my daily reads list. Medic scribe’s first book sits in my bookshelf, and at first read a number of years ago, I was struck by the fact that it is a true representation of EMS, and darned little “look at me, I’m a hero” blather. Me likey.

It shows his growth as a medic, warts and all. When I wrote my book, I endeavored to do the same, albeit with my own twisted and admittedly profane sense of humor. If you’re an EMS professional, give him a read. Heck, even if you’re not an EMS professional, I still think you’ll find it a realistic, altogether human peek at what we do.

Now if you like guns, humor and snarky political commentary, pay South Park Pundit a visit. Me, I cain’t get me enough of all three. He’s a daily read. Pay him a visit – you won’t regret it.

That’s the official Christmas carol for narcissists, by the way.

And speaking of narcissism, here’s a great rant on John Edwards, Husband of The Year.

Love that hair, John.

Hat tip to Dad Gone Mad. It’s one funny blog.

Posted near the entrance of any Emergency Department, you will find the pertinent language in EMTALA that notifies all patients of their right to a medical screening exam. Most hospitals have two notices, one in English and one in Spanish.

Found scribbled on our Spanish language notice today were the words:

*sigh*

While we’re clamoring to pass laws making English the official language of our Great Melting Pot, let’s take a little time to teach it to our home bred ignorant and unwashed as well.

I read PawPaw’s blog fairly frequently. He’s got a lot of good gun stuff, political commentary and just observations on life in Louisiana. But I suspect somewhere along the way, he got a raw deal from the health care system and it left him with a bad taste in his mouth about health care providers in general. He vents some serious vitriol in a recent rant, and I despair of ever trying to change his mind. We see the same things wrong with the health care system, we just disagree on the reasons.

All too often, I rant about what ticks me off, and unleash my snark on the things and people I dislike in my profession, and my persona on this blog is far more cynical than me in real life.

Okay okay okay…maybe just a little more cynical than me in real life. But I still get a charge out of what I do. EMS has never filled my pocketbook, but it has filled my soul, so to speak.

But occasionally, you question why you do what you do, and how somewhere along the way the honor of your profession and the healing arts got perverted into something like this.

After you read about Crack City Doc’s day, you’ll know how easy this job can crush your spirits if you let it.

An email from Philip Romano:

Dearest friends,

I am writing to you to ask for your help in shedding light on a perplexing situation I find myself contemplating. I have selected you as a group to aid me because you have known me for years and I value your opinion. Your religious experiences are varied and that is important to the problem I am faced with.

Over the years, we have all observed the seemingly random factors that affect all of our lives, sometimes without apparent rhyme or reason. We have seen some marriages dissolve over nothing and others grow stronger under adverse conditions. We have seen fate play a role in who survives critical illnesses and who succumbs to them. We have all seen good people suffer great misfortunes while some people of low character thrive. In our lifetime, we have seen Churches and Religious institutions all around the world become revised, televised, energized and even scandalized. We are all well aware that a higher power has control of nearly all things. Personally, I have stood a block away from a 7-11 in Dallas, amid a shootout between the police and a gunman and walked away unscathed. On a golf course, I saw a lightning bolt strike a man nearly dead while those of us nearby where untouched. We all watched as Hurricane Katrina ravaged some areas of the coast and left other nearby homes standing intact.

The enormity of these random and seemingly unfair applications of good or bad fortune is at the core of my dilemma.

I have studied sacred writings of all major religions searching for an answer, and now I pose the question to you…………………………..

I cannot fathom that the highest power in this universe could take Anna Nicole from us and leave Hillary behind……..

Philip Romano

Hat tip to Wes, my favorite lawyer/EMT/cynic.

I’m watching CMT and I see a Crossroads episode with Bruce Hornsby and Ricky Skaggs. I’ve never been much of a Ricky Skaggs fan, but I loved Bruce Hornsby and The Range back in the day. Anyhoo, Bruce and Ricky do this bluegrass cover of That’s Just the Way It Is, and I have to admit it was pretty good. A total reinterpretation of the song, and not a bad one either.

And so I go looking for it on YouTube and find this instead:

I don’t know whether to be amazed or horrified, y’all. I’ll never look at Ricky Skaggs as being a one-dimensional bluegrass artist again, but he ain’t Rick James, beeyotch!

Holly wrote in the comments section of my post about missing The Kid:

And that is a beautiful girl-child there, I hope your shotgun is in workin‘ order. She’s gonna be a heartbreaker for sure.

*grin* I always knew she was an uncommonly perceptive woman.

Let it be known to any single women out there – I’m available, and obviously I throw a pretty kid. I’m even partially housebroken.

You know what they say about your kids and dating – when you have a boy, that’s only one penis to keep track of. When you have a little girl, you have to keep track of them all.

Now, The Kid is not going to date until she’s thirty four, when I finally decide to release her from her hermetically sealed bubble room and let her see the world. So I have plenty of time to plan my strategy vis a vis allowing someone to date my daughter. It’s not that I don’t think she could take care of herself. I just live in fear of her meeting someone like…me.

And back in the day, I was a persuasive bastard.

So, I practice my lines, just like I rehearse what I’m going to say at a lecture or seminar. The scenario plays in my head something like this:

Suitor (looking suitably scrubbed and bearing flowers): Good evening Mr. AD! I’m Bobby and I’m here to take out your daughter!

Me: Welcome to my home, Billy. Come on in and sit a spell. The Kid is still putting on her face.

Suitor: Uh, it’s Bobby, sir.

Me: Don’t correct me, Barry. I’ve got pocket lint older than you. Have a seat and let’s chat. Hand me that can of Break Free and the chamber brush, would you?

Suitor: Yessir.

Me: (running a brush through the slug barrel of my 870) Why thank you, son. So, where are you kids going tonight?

Suitor:Well, I thought we’d go see a movie and grab a bite to eat.

Me: Excellent choice, Benny! There’s a Shrek marathon playing at the Cineplex. Last show lets out at 9:45. Have her home by 10 sharp. Say, hand me those patches, would you?

Suitor: Uhhhh…Shrek? Sir?

Me: Yeah Shrek, Blinky. You got something against PG rated movies? You a Goddamned sex crazed pervert or something??? Huh? HUH??? (Screws end cap on magazine tube and racks slide)

Suitor: No! I mean, no Sir! I, uh… I like Shrek! (gulping) Yessir, 10 sharp.

Me: Good answer, Bucky. Incidentally, did you know that slugs from shotguns are virtually untraceable?

Suitor: Untraceable, Sir?

Me: That’s what I said. You got wax in your ears, son? Yeah, as long as you pick up your brass and recover the sabot, there’s no way to trace the slug. No extractor marks, no telltale rifling marks. No nosy investigators wondering why my back lawn is so green and why my wood chipper is sitting disassembled in a vat of bleach.

Suitor: (laughing nervously) Oh, I get it , Sir…

Me: Get what, Boris? Are you laughing at me, boy? The last boyfriend laughed at me, too. Once. See that picture hanging on the wall behind you, son?

Suitor: The one with all the drunk looking guys holding weapons?

Me: Yeah, that’s the one. See the third guy from the left? The one with the beer can hat and the AK-47? He’s the lead investigator for the Coroner’s Office. Groomsman at my wedding, too. My little girl’s Godfather, even.

Suitor: Uuuhhhh…

Me: See the one holding the pistol to the head of the Tickle Me Elmo? Yeah him, the one with the deranged look in his eyes. The guy pretending to lick his face is his brother-in-law. When those two aren’t working as Sheriff’s deputies, they own a little dirt contracting business. They’re never too busy to loan a backhoe to a friend in need.

Suitor: Mr AD, I promise I’ll be on my best beh-

Me: Yep Bonzo, of all the lunatics there in my closest circle of friends, I’m the only one who isn’t a law enforcement officer. But we still think of each other as family. You know what I do for a living, right?

Suitor: Uh, a paramedic?

Me: That’s right, Biff. You’re not as dumb as you look. Yeah, I tell ya…I bring in dead bodies in to the Emergency Department all the time and they pretty much accept whatever story I give ‘em. On the odd occasion where there is some question as to why the deceased got that way – like say, a tragic hunting accident involving a sixteen year old boy – my bestest buddy the Coroner’s Investigator takes over and decides whether an autopsy is warranted. Yeah him, the guy who swore an oath before God to protect my daughter should I not be able.

Suitor: 10 sharp, Sir?

Me: 10 sharp, Boopsie. You kids have fun.

My favorite professional ghoul has his very own blog, and didn’t even tell me. If you’re a fan of drunken Irishmen and motorcycles, he’s got you covered on both counts.

And in an unsolicited Public Service Announcement…

If you ride – heck, even if you don’t – seriously consider signing an organ donor card AND letting your family know of your wishes. I’ve already made my wishes known. Organ donation is the ultimate act of altruism, and it may get you a Mulligan with St. Peter for that whole drunken episode with the donkey and the eggbeater when you were on spring break in Tijuana.

I’m just saying…

**EDIT** P.J. replied: “Tell your legion of viewers to check out Donatelife.net to see how they can sign up to meet me & my peeps at the end of their days. Happy St. Patrick’s Day to all!”

Y’all heard the man, go check out the site. And while you’re at it, recommend this blog to a friend so you all can eventually qualify as a legion.

Doctors have come
from distant cities
just to see me
stand over my bed
disbelieving what they’re seeing

they say I must be one of the wonders
of God’s own creation
and as far as they see they can offer
no explanation

I believe
fate smiled and destiny
laughed as she came to my cradle
“know this child will be able”
laughed as my body she lifted
“know this child will be gifted
with love, with patience
and with faith
she’ll make her way”

I’m sitting at the airport in Las Vegas waiting for a flight home, and this song came on and it’s all I can do not to cry. I’ve been up for 36 hours. I gave a talk at a seminar in Utah and although they seemed pleased, I don’t think I brought my “A” game. The airline broke my CPAP machine, so I’ve had no restful sleep, and it doesn’t look like that will change until Monday when I can get a new machine.

And all that I can tolerate. Just another day in the life of an ambulance driver. But I haven’t held my kid in six days, and work and travel virtually assure I won’t see her until next weekend. I don’t know if I can take it.

Back a few years ago, me and The Missus decided to have a baby. We tried hard, and eventually she got pregnant. When I got the news, I pulled out the waistband of my shorts in front of 20 people at the hospital ER and whooped, “Way to go boys, you do work after all!”

And we did all the things expectant couples do. I was a good deal more excited than The Missus, but it took her a while to get past the intimidation of impending motherhood. I, on the other hand, have always wanted to be a Dad. When my friends were terrified at the prospect of fathering a child, I was the one secretly wishing I’d find the right girl and do just that. Kids and I get along.

Methinks it’s because they instinctively recognize the fact that I’m stuck at their level.

But it wasn’t long before The Missus began to suffer complications. I had long teased her that she’d have ten pound twins. Big babies and twins run on both sides of the family. I’m a twin, and my sister (The Goblin) and I weighed eight pounds each. The Missus and her siblings all weighed 10+ pounds, as did my siblings. Heck, my brother weighed just over 13 pounds, and her brother weighed close to fourteen. And nary a Caesarean section to be found between either of our mothers. Big, sturdy wimmen with child-bearin‘ hips were those two. My frame of reference lumped six pound babies into the “scrawny” category.

My perspective changed with a 1 pound, 14 ounce baby. In the space of two weeks, we went from excited and eager prospective parents to the most unimaginable terror of our lives. It made it a little easier that most of the nurses and a few of the doctors at the local NICU were folks I worked with on the local transport team. I had even taught most of them a class or two, so I felt confident in their abilities.

What I didn’t feel confident in was my ability to handle it. I had talked our OB Doc into letting me actually do the delivery with him looking on. I had pointed out the fact that it wasn’t my first delivery under much less controlled conditions, and that I had also taught neonatal life support to a number of his staff. So he said, “Fine with me AD, as long as you’re willing to step out of the way if something goes wrong.”

Well, something went wrong, to the tune of fetal distress and an emergency C-section. I went from anticipating the singular honor of bringing my own child into the world, to being a frightened spectator at her resuscitation.

28-week-old babies don’t breath real well, if at all. They don’t have fingernails, or nipples, or the ability to suckle. Their nervous systems are literally raw and unfinished. The slightest noise or stimulus can cause them harm.

Knowing all these things just worsens the fear, and believe me, we were scared. At the time, she didn’t know I was scared, because I was doing The Man Thing and putting on a brave face. I had a wife to comfort and protect.

But in those dark hours between signing the consent forms and prepping The Missus for surgery, I slipped down to the hospital chapel, locked the door and laid myself bare.

I’ve been shot at and narrowly missed. I’ve been in more than a few situations when the feces have struck the thermal agitator and everyone else was lost in the fog of panic, and I like to think that I rarely lose my cool. I’ve always thought of it as my gift.

But I found out I can be paralyzed by fear. And so on that night, I laid my head on that communion rail and I wept and I made bargains with God and I promised that if He would let my kid live, I’d do anything that He asked.

And He kept His part of the bargain. When they removed her from my wife’s womb, she was about the size of a 20 ounce Coke bottle and blue as a Smurf. Within a few seconds, she began to wail. I kissed The Missus on the forehead and gave her a play-by-play of the resuscitation. I whispered to her that she had turned pink within just a few moments and was breathing on her own. Apparently, The Kid hadn’t gotten the memo about what she was or was not capable of doing at that gestational age.

She thrived. She was Wonder Baby. She was so strong and vigorous that were were able to hold her within a week – still the longest week of my life. We humans, being social critters, seem to develop better if we have some physical contact. Usually, the mothers get the honor of doing most of the baby cuddling when they’re that young, but I was not to be denied. I shaved my chest hair so I could hold her close to my skin, and I spent many an hour rocking her in that NICU. I’d get off after a night on the bolance, and I’d let myself in to the NICU and badger a nurse until they let me hold her, and I’d rock her we both went to sleep. After a bad night, holding The Kid centered me. It kept the demons at bay. Eventually, the nurse would wake me up, shoo me home for a few hours, and I’d pick up The Missus to go back and visit again the next morning. We thought the worst had passed.

Alas, then we got the news that she had suffered a severe intracranial bleed in the womb. Grade IV- the worst kind. They used words like cerebral palsy, seizures, severe mental retardation and blindness. “Take heart,” the Docs pointed out. “She looks great, and we treat babies here, not test results.”

The Missus was a little hard to convince, but I wasn’t worried. I’d gotten my assurances that night in the chapel. We were fully expecting to see better news from the results of the CT scan a few weeks later.

But better news was not to come. If you look at The Kid’s films, virtually the entire right side of her brain is one big cavity, filled with blood. Now they assured us that eventually her body would absorb that blood, but we both picked up on the fact that they quit using words like “possibility” and “might” when they talked about cerebral palsy,
retardation, seizures and blindness. The Missus was a wreck. I stayed strong for her.

But on the drive home by myself that night, I laid it all out again. I laid my head on the steering wheel and bellowed my rage impotently into the night. I cursed God. I blamed Him for punishing my child for my sins. I questioned His very existence. And I challenged Him to show me that there was a purpose to this pain, and to give me some sign that The Kid would be okay.

And at that very moment, the song at the beginning of this post appeared on the radio.

I can be a bit obtuse at times, but even I got that hint.

And since that day, I’ve come to realize that along with the blessing of fatherhood, I was entrusted with the task of raising a special child. I could have been a good Dad to a healthy child, but God apparently expected more of me.

And that is something I have kept in mind since that day. On the days when I push her to try harder, I remind myself that taking it easy on her isn’t helping her become the woman she is destined to be. On the endless nights when I stretched her stiff little legs while she screamed in pain, I cried as I did it, but I held in my mind’s eye the image of her walking down the aisle in her wedding gown. In heels, not braces.

And in the four years since, she has taught me life lessons about hard work, perseverance and determination. She worships her Daddy, but she doesn’t understand yet that she is my hero, and my teacher in more ways than one.

And on that night over four years ago, while The Missus was recovering from the anesthesia and The Kid was getting settled in the NICU, I wrote a letter to my child, to be delivered on her eighteenth birthday. I told her how scared I was the night she was born, and the bargain I had made with God, and what a special person her Mommy was, and all of my hopes, dreams and aspirations for her. I promised to chase the monsters from under her bed, to kiss her boo boos when she got them, to pick her up when she fell, but also how to find the strength to stand on her own. I promised I’d try not to be overprotective, and I’d let her fight her own battles. I told her that parents sometimes screw up, and that sometimes I’d do things that she wouldn’t like or understand, but that I would always love her. I wanted her to know how honored I was to be her Daddy.

You know, just in case I screw it up and she winds up being a clock tower sniper or something.

And right now, while I’m trying to get home, Daddy is trying really hard to be as brave as you, but I could really use some snuggles to keep the demons at bay.

Waaaa….Tam’s getting older. Let’s see, she’s got looks, brains, an extensive library, her very own arsenal, and the admiration of a gazillion fans on the web. The only thing that keeps her from getting more marriage proposals is the fact that she has yet to mention her liquor store, bass boat and hunting lease.

But hey, I’m willing to compromise. I’ll even subordinate my own capacious ego and consent to being Mister Tam.

But it’s nice to see that one gray hair can induce a case of Vanity Panic in the Gun Goddess. Makes her all accessible and human, like. Maybe even warm and fuzzy.

Naaahhhh. She’s still a Valkyrie.

Meanwhile, my own age keeps creeping onward. There is an increasing amount of salt around the temples, my knees creak, there’s enough hair on my back to weave an Indian blanket, and last week I sat in the tub and my nuts floated to the top. I am becoming my father.

I want to look like this guy again, and it doesn’t seem so long ago:

*sigh* I’m still 25 at heart, though.

If any of you aspire to win the lottery, give me a shout. I know a sweet 80 year old lady who could pick the winning numbers for you right now. Her luck is that good.

How else to explain how a woman in the early stages of dementia could hop in her car, drive roughly 280 miles towards no particular destination, run her land yacht off the road and travel over 356 feet through a muddy field, launch herself over an earthen dam and travel an additional 182 feet in the air, jump a river and land nose first into the steep bank on the other side, totally demolishing her vehicle, which then slid into the river and somehow bogged in the soft mud without slipping into the deeper water…

…and come away from it with nothing more than a fractured sternum.

If, in the near future, you should see a heavyset but devastatingly handsome paramedic whooping it up at a casino, a shallow but surgically enhanced supermodel on each arm, lighting his cigars with $50 bills, you’ll know some of her luck rubbed off on me.

"

Did someone write STOOPID across my forehead when I was sleeping?"

"It wasn't me, I swear. So, are you coming?"

"No Paul, I'm referring to your invitation. You've got to think I'm a Kentucky Fried Idiot to show up for another dinner at your house. Without a gun."

"Awwww, man! Don't be like that. It wasn't that bad."

"For three days, I could have laid on my stomach and shit into a martin box. Three. Whole. Days. Yeah, it was that bad."

"So you're still pissed."

"Pissed? Pissed?? Now, why would I be pissed? Every time I even look at red beans and andoullie sausage, my sphincter threatens to rebel. I spent three days stapled to the toilet seat, Paul. Three days of volcanic, canned-chili-through-a-leaf-blower shits. My ass was literally chapped. I prolapsed my anus on the second day and had to tuck it back in myself. Do you know what it's like to perch on the toilet like a cat and hold your innards in with one hand while you direct fire by sound? It's messy, Paul. Very messy."

*sounds of stifled giggles*

"Hey man, I'm sorry. Really." Insincerity oozes through the phone receiver.

"Do you have any idea what undigested rice looks like when it passes out the other end? No? It looks like tapeworms, Paul. That's very disconcerting to a dog trainer. I even started wearing shoes again."

*more giggles*

"Hey man, it wasn't my idea. Old Coot did it. And I promise I won't pull anything this time."

"Then Old Coot has an ass-whipping coming. I don't care if he's a senior citizen with one arm. I'll circle to his left and throw lots of right hooks. He won't stand a chance."

"You'll never get close enough. He's so paranoid that he sleeps with one eye open. He keeps that Detective's Special in an ankle holster, and you know how quick he is."

"You're right. So maybe no ass-whipping then. I'll just pour dish detergent in his windshield washer reservoir or something. But that still leaves you."

You ain't got a chance of whipping my ass!"

"Don't be so sure. But I'll get you back one way or another, and when you least expect it. I've got those suture kits the vet gave me for stitching up the dogs. You'll pass out one day and wake up with your fucking earlobes sewn to the mattress."

"Dude, are you coming or not? It's gonna be a good fight."

"No!"

"Jerkoff."

"Dipshit."

"Asshole!"

"Dick cheese!"

"Bedwetter!"

"Dog masturbator!"

"Paul, that was a joke. I can't believe you fell for it. Do you actually believe I'd whack off a dog as a reward?"

"Dog masturbator," he repeats. Doggedly.

"If I actually had whacked off the dog, he'd be begging you for a hand job after every retrieve. That oughta tell you something."

"ARE YOU COMING OR NOT???"

"ALL RIGHT DAMMIT, I'LL COME TO YOUR FREAKING PAY-PER-VIEW FIGHT! ASSHOLE!"

"Click."

Thus goes the story of how, against my better judgment, I agreed to show up at Paul's for the Mike Tyson-Razor Ruddick rematch. I fully intended to stiff him on my share of the fee, though. I have my principles.

On the night in question, I showed up at Paul's to find everyone already there. Long-Suffering Wife greeted me at the door and kissed my cheek.

"Come on in, DT. We're having gumbo."

I went by Dog Trainer in those days. I warily stepped across the threshold, looking for tripwires. Paul greeted me at the kitchen door with a full bowl of gumbo.

"Hey brother, make yourself at home! Grab yourself a brew and the gumbo's on the table."

"You eat it first."

"Jesus Christ! Paranoid bastard." He rolls his eyes and eats a few spoonfuls. "Satisfied?"

"Nope. Now eat a few spoons right out of the pot."

"Goddamn! I told you I wasn't going to pull anything!"

"Goodnight, Paul." I turn to leave.

"Okay, okay, okay." He eats a few spoonfuls from the pot. "Satisfied now?"

"I will be if you get me an unopened beer from the fridge and give me that bowl you're holding."

"Deal."

I take my un-tampered-with gumbo and beverage and settle into a recliner a safe distance away from Old Coot and Paul. I still don't trust the bastards. After a few fights on the undercard, I'd had a few brews and another couple of bowls of Long-Suffering Wife's famous chicken and sausage gumbo – all opened and dipped by Yours Truly, of course. I stopped drinking beer after a six pack or so and started drinking tea.

Halfway through the main event, Tyson is beating Ruddick like he stole something, and I feel my guts rumble. I clench my butt cheeks and look around to see if anyone is watching. No one is.

Again with the gut rumbling. There's some magma down deep in those bowels, and it's beginning to rise to the surface. I break out in a cold sweat and try to keep my expression neutral as I start to mentally retrace every step since I entered Paul's house. Then it hits me.

The tea. The fucking tea. They knew I'd cut myself off after six beers, and the gumbo is spicy. The tea was already made. I surreptitiously look around the den. Not a fucking tea glass in sight besides mine.

*sigh*

June 28, 1991. Mark that date down, folks. The day Ambulance Driver fell for the same gag. Twice.

Manfully retaining my composure, I casually get up and saunter to the bathroom. Slowly. Behind me, someone stifles a giggle.

I barely get the door closed and get my pants down before I evacuate my bowels in a virtual torrent of shit. It was one of those feet-straight-out, all-over-body-spasm, water-splashes-out-of-the-toilet dumps, people. I must have been in total body tetany for five minutes. I could feel myself mummifying as my body purged itself of all fluids. My anus was the Old Faithful of feces.

After it was over with and I felt like I could break contact with the seat without triggering another spasm, I reached for the toilet paper.

There was none. Not even the little cardboard tube.

Okay, don't panic. They just forgot to replace the roll. Look under the sink.

Nada. Not a single roll. Not even a scrap of facial tissue, makeup sponge, printed douche directions…nothing.

Okay, NOW it's time to panic.

I feverishly scan the bathroom for anything absorbent and foldable. Not only are there no paper products, there are no washcloths, no hand towels, not even a loofah. I whimper just a little bit.

Bastards. They got me good. I'm going to have to sacrifice my shorts.

I fight back tears and cast my gaze around the bathroom, steeling myself for what is to come, and then inspiration strikes. I smile beatifically, duck-walk across the bathroom and Do What I Have To Do.

I flushed the toilet afterwards, opened the door and moseyed back into the den. I said my goodbyes and ignored the guffaws of Paul, Old Coot and just about everyone else in the room. Everyone refused to shake my hand. Long-Suffering Wife hugged my neck before I left. I strongly suspect she wasn't in on the joke.

Fast forward a few days and the phone rings at the office.

"Chauvin Kennels," I answer.

"&*^%*$# son-of-a ^&%*$#!"

"Well hello, Paul! And how are you this lovely Sunday afternoon?"

"$%#^!!"

"You kiss your mother with that mouth, boy?"

"^&%$^&***"

"Put your wife on the phone, Paul. Wipe the slobber off the mouthpiece first." I hear the receiver bounce off of something, and a stream of profanity is cut off abruptly by the slam of a door.

"Hey DT, how are you?" Long-Suffering Wife inquires. She's trying not to giggle loudly enough for Paul to hear.

"Thinner, LSW. How's the hubby?"

"You heard him. He's really pissed. How did you do it?"

"You should tell him that the next time he gives someone a boxful of laxative and hides all the toilet paper, that he should remember to lock his closet door first."

*more giggles*

LSW says something else.

"You were running late this morning, so he just grabbed a shirt and put in on as he was running out the door?"

"Yep. He looped a tie over his neck, threw on a jacket and we went straight to church."

"When did he notice?"

*openly chortling now. maybe a snort or two as well*

"Later, in the fellowship hall. He took off his jacket when he got hot. You know how much he sweats."

"Even better," I grin evilly.

"The best part was, the shit had dried on his shirt so it didn't smell. When he got to sweating, though…" LSW dissolved into a fit of laughter. I can barely make out the rest of what she says.

"What's that? Oh, someone else noticed the smell first. And they pointed it out to Paul. Who noticed?"

"The rector."

"I'll bet that was an interesting conversation."

"It was. You got him back good, I'll say that."

"My pleasure, LSW. By the way, you want to be careful when you go back into that closet. There are three more shirts in there just like that one."

Checked out Speaker Tweaker over at his blog, and he has a nice peaen to John Moses Browning, one of my favorite Murkins.

Also, El Capitan has a nice post over at Baboon Pirates on his fevered pursuit of the Oscar Meyer Weinermobile through the neighborhood. Somehow, I keep getting the mental image of this guy shouting, “Franks and beans! Franks and beans!”

I check out Baby Medic’s site from time to time, just to see how he’s progressing as a medic. Turns out he probably walked right past me a few times at the JEMS Conference. Anyhoo, I see that he has linked me, so I’m reciprocating the linky love. Check out the ambulance pic on his blog and you’ll see he’s been having a little fun in the snow.

And last but not least, Morpheus has linked me as well. Back atcha, Morpheus. Y’all check out the Star Wars parody he found on YouTube.

You were visitor Number 20,000!

Columbus, the cement bicycles haven’t been too popular and since Land O Lakes, FL and Salt Lake City, UT haven’t claimed theirs, you can have ‘em both. Please come and get them soon, because the garage is started to look cluttered.

Or, you can choose the topic of a blog post. Hey, it works for Hammer, and I am nothing if not shamelessly derivative.

Thanks to all who have visited!

Thanks for all your comments, folks. I still haven’t convinced The Publisher that the blog is a good thing, but at least he’s not totally opposed to the idea, either. I just got a few copies from the second printing of The Book, and it looks like we’ve managed to fix the few little continuity errors from the first edition that have nagged at me for the past 16 months.

The Publisher is a great guy but he’s also a bit nearsighted, and he became somewhat enamored of the paragraph formatting in the original manuscript of The Book, where I spaced the lines out a bit to make it easier to edit. You can imagine my surprise when I saw the galleys…

“Uh Boss? You didn’t change this paragraph formatting before it went to print?”

“Nope, looked fine to me. Why?”

“Well, I spaced it out that way so you and The Editor could you know, edit things and make comments between the lines and in the margins.”

“Wasn’t that much editing to do. Plus, I think it’s fine.”

“But it looks like the Reader’s Digest large print edition!”

“Exactly! Ain’t it great?”

So The Publisher and I have been chuckling over that little lapse in judgment at his home in Maryland while I attended the EMS Today convention in Baltimore, and thankfully, now the book looks a little better than it did before. Plus, I no longer refer to a partner by one pseudonym in one chapter and another pseudonym 100 pages later, and all the fictitious highway numbers now match. Most of my readers probably never even noticed, but for me it’s like having your kid inherit the same ugly little birthmark you had as a child, and you obsess that the neighbors will never notice how cute she really is.

On another note, soon you will see a different look to the blog here. As soon as I can find someone who can do HTML scripting fairly well, you’ll see some links and such that are near and dear to the heart of The Publisher and me, like this one. Fear not though, people – I’m still a reluctant advertising whore, at best.

The Publisher is one of the pioneers of EMS. He was there to see the beginnings of the Shock Trauma Center as one of R. Adams Cowley’s original EMTs. His insider stories of the early age of trauma resuscitation are fascinating.

Among The Publisher’s many other exploits, he taught paramedicine to many of the Maryland State Police, and was the EMS officer for the FBI’s inaugural Hostage Rescue Team. He trained with all of HRT’s original shooters, making The Publisher the original Tactical Medic. And this man is my publisher and friend.

Yes, you may touch me.

So that’s what I’ve been doing the past few days…making a few new friends, reconnecting with a few old ones, absorbing a few history lessons, and helping The Publisher set a few more claymores to ward off the skateboarders that continually bedevil him at work. (side note – that whole “this side facing enemy” thing makes it fairly simple. Easy Peasy.)

So here before the day is through, I shall regale you with the tale of The Retaliation as promised, and only one day late. You may stop hyperventilating now, HollyB. Perhaps in so doing, I can shame the LawDog into finishing the mustache story or perhaps the teenage moonshiner story. What say you, Dawg?