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Real Men of Genius: Mr. Fixit

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Okay, somebody with video and audio editing talent has got to do this.

I hereby challenge my readers: Do a good version of this commercial and YouTube it. Send it to me directly if you wish. Post it on your blog and send me the link. I don’t care how you do it, I just wanna hear it. It is just too damned funny to pass up.

Don’t just do it for me, do it for the entire blogosphere! If you do, not only will I shamelessly pimp your blog, but I’ll link the commercial permanently in my sidebar. I’ll link it in my comments on other blogs when someone has been troll-bitten.

Do it, and I’ll soon have you wearing diamonds bigger than cow turds.*

And Mr. Fixit is indeed a genius for coming up with the concept.

* Okay, maybe not that, but I’ll be grateful.

This One's For Kate

16 comments


If you despair of the human species at times, as I do, then head on over to Rigel’s Wheel for your feel-good fix. Altruism is not dead, and people still can be kind to each other. All you have to do is look for it.

And Kate, here’s that picture you wanted to take. She’s about a month old here, but at birth she was just like the baby you described.

Sumdood Sightings…

21 comments

Since I came face to face with my nemesis, LawDog has noted a number of his nefarious deeds. MonkeyGirl has laid eyes on him (or one of his doppelgangers. Sumdood knows I’m after him, and isn’t above using decoys), and Tigger recently cared for a couple of wannabe thugs who thought they were tough enough to tangle with a Master of Evil.

Recently however, Generic ER Nurse stared evil in the face, and lived to tell the tale. In so doing, she discovered a chink in Sumdood’s armor:


I once looked Sumdood right square in the eyes on the street, and he started to come at me. I didn’t have my nunchucks on me, so, in an act of desperation as my life flashed before my eyes, I opened my purse and flashed my health insurance card…that made his skin slough off and he ran away into the night. Apparently, Sumdood can’t hold nor possess a health insurance card.


Before you go doing something stupid and voting Hilary into office so we can all have free health insurance, just remember that Sumdood already qualifies for Medicaid, so he’s obviously not affected by government-sponsored healthcare coverage.

It's Like Being Nibbled To Death By Ducks…

70 comments


Ambulance Driver: So what brings you to the ER today?

Mouth-breathing parent: My son brokeded his toe.

AD: Ouch, I’ll bet that hurt! Which toe was it, sport?

Banjo-picking kid from Deliverance (holding up left foot and wiggling toes): This’n rot cheer.

AD (holding breath and looking closer): Which toe?

MBP: He droppeded a flesh lot on his panky toe.

AD (mentally engaging internal censor and accessing the translator neurons from my ‘family tree does not fork’ database): You mean he dropped a flashlight on his little toe, and you think it’s broken?

MBP: (grunting and shrugging shoulders, which I took to mean ‘yes’, but could have just as easily meant ‘get offa me Daddy, yer crushin mah cigarettes’)

AD: Does it hurt, son?

BPK: Naw. (manipulating toe with his fingers for emphasis)

MBP: I figgered it mot be a good idear to brang ‘im in and git it x-rayed.

AD (politely): Why?

MBP (condescendingly): Cuz it’s brokeded.

AD: Generally speaking, if a toe has no visible injuries and is not painful in any way, it’s pretty safe to say it’s not broken, and really doesn’t need to be x-rayed.

MBP: Are yew thuh doctuh?

AD: Nope, but I did stay at a Holiday Inn Express last night.

MBP (missing the de rigeur sarcastic pop-culture reference because no doubt it is not played during Dukes of Hazzard and Hee Haw reruns): I wone-a heah whut thuh Doctuh says.

AD: Have a seat in the waiting room, Ma’am. The doctor will see you soon.

*****************

*ring ring*
AD: Good afternoon, Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut. This is the Emergency Department. How may we alleviate your pain and suffering today?
Caller: My daughter slammed her thumb in a car door and I’m pretty sure it’s broken. Can y’all fix it there?

AD: We can assess and stabilize here, but if she needs the services of an orthopedist, we’ll have to transfer her elsewhere.

Caller: But y’all can fix it there, right?

AD (banging the phone receiver against the counter): We can x-ray it and perhaps splint it, but if it requires more than that, she’ll have to go to another hospital from here.

Caller: So can you fix it or not?

AD: If it’s a boo boo, we can fix it. If it’s badly broken, we’ll send her to a bone doctor at a bigger hospital. Either that, or we can amputate it here. We do have a physical therapist who can teach her how to use a prosthesis. He’s here three times a week.

Caller: Huh?

AD (sighing): Just bring her to the hospital, Ma’am.

Laid Back Male Nurse: Who was that?

AD: Wrong number.

**********

AD: Whoa buddy, that’s a nice wasp sting ya’ got there! Does it hurt?

Brave Little Kid: Not really.

Panicky Mom: He was stung by a big ole’ red wasp! Not a black wasp, but a red wasp! You know, the really bad kind?

AD: All hymenoptera stings are about the same, Ma’am. What time did this happen?

PM (checking her watch): Oh, maybe seven hours ago. But the swelling is going up his hand into his wrist!

AD: That’s the nature of swelling, Ma’am. I can give you an ice pack while you wait to see the doctor.

PM: How long will that be?

AD: How does Tuesday sound? We can see him sometime between the hours of noon and 7:30 pm.

PM: Excuse me?

AD (winking): Sorry Ma’am, I used to work for the cable company. We’re kinda full up right now, but if you’ll fill out the ER form and have a seat in the waiting room, we’ll be with you as soon as we can. It may take a couple of hours.

PM (catching on): You’re telling me this isn’t really an emergency, aren’t you?

AD (in mock horror): Heavens no, Madam! It is your right by law to receive an examination by a physician and stabilizing treatment, which in this case would be about 50 milligrams of Benadryl, just like you’d buy at Wal Mart.


PM (sheepishly): I gotcha. If it’s all the same to you, I think we’ll just run to Wal Mart on the way home.

AD: Bless you, Ma’am. Y’all drive safe now!

***************

COWMAS Sufferer: Aaarrrggghhhh! Oh, the pain! The humanity!

AD: Just where does it hurt, Ma’am?

CS: All over! It hurts in my side and it goes down my left leg into my knee and when I raise my left arm like this it hurts and I can’t get comfortable and I’m running a fever and my joints ache and I couldn’t even get out of bed this morning and it hurts to lay down –

AD: So why were you in bed?

CS: Huh?

AD: Never mind.

CS: I need something for the pain! I can’t take this!

AD: So are you allergic to anything?

CS: All NSAIDs, Ultram…

AD (continuing writing, because I know what comes next): …aspirin, Tylenol, pretty much anything that’s not an opiate…

"color:rgb(0,0,153);">CS: apirin, Tylenol, Tramadol, and a few others I can’t remember. About the only thing that works is Demerol or Dilaudid.

AD: And how long have you had fibromyalgia?

CS: Four years…hey, how did you know that?

AD: Lucky guess.

CS: And I have chronic migraines, too. Be sure to put that on there.

AD: Certainly, Ma’am. Allow me to compliment you on your cardiovascular conditioning, by the way. You don’t find many patients who hurt as badly as you who have a heart rate of 66 and a BP of 108/64.

CS: How long will it be before I’m seen? Sitting in this chair is killing my back.

AD: I thought laying down made the pain worse.

CS: Huh?

AD: Never mind.

CS: Look asshole, I don’t much appreciate your smug attitude. I’ll have you know that my cousin is the chief of staff here, and he’ll have your fucking job!

AD: You’re a cousin of Dr. Y? Really?

CS: Yes I am, and you can bet your ass I’ll report this!

AD: Have a seat in Room Four, Ma’am. I’ll be right back.

[I walk to the ED nurse's station and pull up a chair]

AD: Hey Doc, you never told me you were raised in a trailer park.

Dr. Y: Huh?

AD: Fess up, Doc. You were raised in a trailer park, and somehow you managed to overcome your humble beginnings. Poor boy makes good, and all that.

Dr. Y: What the hell are you talking about? My father was a surgeon, and so was my grandfather.

AD: Sure, that’s what you say. But if that’s true, Grandpa had a wandering eye and a weakness for white trailer trash booty. The woman in Bed Four says she’s your cousin.

Dr. Y (looking at the specimen in Bed Four wearing a wifebeater shirt and high water sweat pants): Oh really? What’s she want?

AD: Demerol and my fucking job, more or less in that order.

Dr. Y (chuckling): Tell her I’ll be there in a moment.

AD (sticking my head in the door of Room Four): Dr. Y says that he’s always suspected he had white cousins, but has never actually met any. So naturally he’s eager to make your acquaintance, and he’ll be here in a moment.

CS: Oh. Well…thanks.

*five minutes later*

Dr. Y: Looks like your patient in Bed Four eloped.

AD: Imagine that! And I so wanted to witness the family reunion.

***************

**ring ring**

AD: Good afternoon, Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut. This is the Emergency Department. How may we alleviate your pain and suffering today?

Paramedic With Potential: Howdy, AD. Can you copy patient report?

AD (banging head on desk and whimpering): Go ahead.

PWP: We’re bringing in Hypochondriac Coonass Lady…

AD: God, please no. She’s been in every day this week!

PWP: And once earlier today. Three guesses as to her complaint.

AD: Chest pain and difficulty breathing? With perfectly normal vital signs, normal 12 lead EKG and absolutely no outward signs she’s having the big one?

PWP: You are wise beyond your years, AD. I wanna be you when I grow up.

AD: Put her in the Chronic Chest Pain Room when you get here. It may be a while before we can see her.

PWP: AD says ‘put her in her usual seat in the waiting room’. Got it.

***************

Clerk: Reagan is back.

AD and Laid Back Male Nurse (in unison): Who?

Clerk: You know, the one who is possessed by the devil and likes to masturbate with whatever’s handy in the room?

AD: Seeing snakes again?

Clerk: And Jesus, who is apparently very disappointed in her for being in league with Lucifer.

LBMN: How about I get the paperwork started, and you do the exorcism?

AD: No way. She thinks I’m cute. I ain’t going in there.

LBMN: I’m senior.

AD: And I’m teaching your ACLS course next month. Don’t make me get medieval on your ass.

LBMN (accepting the inevitable): Fucking cheater.

Welcome to the Blog Roll

2 comments


He’s funny, bombastic and more than a little twisted. Plus he’s a gun and knife nut, not to mention a real ambulance driver.

He’s The Armed School Teacher, and he’s here to kick ass and chew bubble gum…

…and he’s fresh out of bubble gum, people.

And he looks just like a former ambulance driver student of mine, right down to the hat and the red goatee. He’s even from Illinois, Don. Y’all might have been twins separated at birth.

I have a saying for days like these…

10 comments


…and it basically goes, “Shot at and missed, shit at and hit.”

Read about a Respiratory Therapist’s splatterific day.

A Day Well Spent

136 comments


“You spot for Daddy while I back the trailer down into the water, Sweetie.”

“Okay, Daddy!” she says excitedly. She’s a big girl and likes to help out with these things. So I let her out of the car seat and let her stand up in the back seat.

Both hands on the seat back, Stinkerbell,” I remind her. “I don’t want you falling over if I have to stop suddenly.” Dutifully, she raises her stiff little left arm and slowly, agonizingly extends it, propping it on the seat back.

I’m not going to be stopping suddenly, and she can hold on just fine with one hand, but that’s not the point. She needs to work on arm extension.

I back the trailer into the water, set the parking brake and get out. I let her out of the back seat and lead her to the water’s edge. She sits down in the shallows as I wade out and pull the jet ski back to shore.

“Catch the rope, Sweetie!” I call out, tossing her the tether line. The coiled line splashes her and she giggles. I tossed the line to her left, so that she has to twist her torso to the left and rotate her weight over her left hip to reach it. That’s why I threw it where I did.

She reels in the line, hand over hand, because that’s how big girls do it. At least that’s what I tell her. The alternating movements help her build coordination.

She can’t really grasp the line in her left hand, the fingers clenched in a tight, spastic little fist, so she compensates by pinning the line to her left thigh and dragging it back with her clenched fist. She’s a smart little girl, and thus very good at finding ways to compensate. She’ll always figure out the easy way to do something.

But easier is not always better, and so I’m always after her to do things the right way. It tries her patience sometimes.

Hauling in the rope soaks the splint on her left hand, but I don’t much care. It’s made of neoprene, after all.

Not fifteen minutes ago, the clerk at the convenience store asked her about the splint. The clerk, like everyone else who meets KatyBeth, was taken by her blue eyes, politeness and infectious enthusiasm, and cooed sympathetically when she saw her splint. “How did you hurt your hand, sweetie?”

“I have cewebwal palsy,” KatyBeth said matter-of-factly. “I have a bwace on my weft ankle, too!”

The clerk closed her mouth with an audible snap and blushed like a tomato. I winked at the clerk as I took my change and turned to go.

“Thank you, Ma’am!” KatyBeth called out as we left. “Me and my Daddy are gonna go wide the jet ski and cut up!”

And just like that, the clerk went from embarrassment and pity back to being totally enchanted by my kid. She’s good at that.

I gently beach the jet ski on the shore next to the landing and urge KatyBeth up the steep concrete ramp. It would be easier for her if I held her hand as she walks. It would be easier for me to just put her back in the truck for the drive back to the parking area. But walking this incline works her leg muscles and encourages her to shift her weight forward over her pelvis.

“Hurry up,” I chide teasingly, goosing her in the left butt cheek. She giggles and totters faster. For her, it’s a goose in the hiney and a fun game. I happen to know that a simple physical cue like that promotes better hip and leg extension, and lengthens her stride. Her limp becomes less noticeable.

At the top of the landing, I park her on a picnic bench and hustle back down to my truck. I quickly pull the truck up to the parking area and choose a space. I have my pick of spots because we’re the only people out here today, but I pull well down the parking lot anyway.

I park the truck and lock the doors, and call KatyBeth over. “Time to put on your life jacket!” I call out. “Get your little booty over here!” I watch as she slowly pivots around and worms her way backward off the bench. She has to extend both arms in order for her feet to touch the ground.

She totters across the rolling lawn, carefully negotiating the uneven ground. There are closer parking spaces, ones that would have necessitated only a short walk across dry pavement, but the uneven grassy surface is more of a challenge. Besides, KatyBeth likes the grass.

At the truck, I pull off her tee shirt and shorts, and quickly remove her shoes and ankle brace. On go the Dora the Explorer aqua shoes and sunglasses to match her Daddy’s. I make her lift her arms over her head to slip the life jacket on. It would be just as easy to work around her left arm, tucked in at her side as it is, but this way we have to do arm extension. Always, always we work on arm extension.

I take her hand as we walk down the ramp. Her aqua shoes don’t offer the best ankle support, although the sole of the left shoe is a bit stiffer, thanks to an insert I fashioned for it. Her life jacket makes her a bit top heavy as well. Falls are things we expect her to deal with, but I’m not going to set her up for one.

We wade out into the water, and I stow the collapsible cooler in the storage compartment, zip my keys and wallet into a Ziploc bag and toss them in on top of everything else. KatyBeth stands in the water, holding on to the aqua-step on the back of the jet ski. She looks pensive.

She’d rather not climb onto the jet ski herself. She remembers what happened last summer, when she lost her footing on the step and bashed her mouth on the boarding handle. We both remember the terror in her cries as the blood ran down her chin into the water.

But picking her up and carrying her around does not teach her independence, and so we will do this the hard way. She has to reach up with both hands and grasp the grab rail, and lift one foot and place it on the step. From there she can step up into the foot well and make her way along it to her spot up front.

I carefully open her left hand and wrap the fingers and thumb around the grab rail, and hold it in place as she boosts herself up. I cried harder than she did the last time, because I knew that she had fallen because I got careless.

I will not be careless again.

I lift her onto the seat and get her settled in, and push the jet ski away from the landing. I clamber on board behind her, fit the lanyard of the kill switch around my left wrist, and turn on the choke. KatyBeth wants to work the throttle, as usual.

Instead, I make her press the start button, as usual. I know her right hand works just fine. She needs to use the left hand. So I encourage her to extend her hand and engage the starter, which she does, laboriously extending her left arm and pushing the button with the knuckle of her index finger. Opening her hand all the way requires supreme concentration. I am happy if she simply tries.

The jet ski roars to life and she squeals in delight. I let her work the throttle now, since she’s itching to do it anyway. It’s her reward. She pauses and looks back at me. “Say it, Daddy!” she prompts.

I grin as I wrap her left hand around the handle bar and fit mine over it. I plant my feet, pull her close against me and say what I always say.

“Git it, Katy!”

Cackling gleefully, she gooses the throttle, my jet ski rockets forward with an angry snarl, and soon we are scooting down river at nearly fifty miles an hour. Katy’s grin meets in the back, and her ponytail whips at my face.

I let her steer, taking care to keep her left palm firmly pressed to the handlebars. The vibration is good feedback for those dormant nerve pathways we’re trying to awaken. We do lots of right turns to, once again, extend that left arm, and we also do plenty of flat spins to the left, to teach her to shift her weight.

And for the next few hours, I am alone on the river with my daughter, and we play with a purpose. We do flat spins. We do 360′s. We leap
our own wake. We nose dive and the water cascades over our knees before the Kawasaki overcomes its downward inertia and leaps from the water like a broaching marlin.

And my daughter laughs.

We zoom about, and I let go the handlebars now and then and let her steer. We go left, and we go right. Occasionally, she cuts it a little hard, and we wipe out.

But that’s okay, because then we can swim for a little while, and then practice getting back on. Sometimes she’d rather swim when I’d rather ride. She always wins.

It’s hard for KatyBeth to swim wearing this life jacket. The thing is designed to roll her onto her back and support her head, and it takes some doing to roll onto her stomach. When she kicks, she gets excited and the spasticity kicks in, and she just turns in a circle, one leg madly kicking while the other just sticks out rigidly.

So, we play in the shallows a lot, where I can hold her and coach her. When she’s calmer, she can exert some mastery over that uncooperative left leg and arm. Right now, she frog kicks. Once she has mastered that, we’ll work on a bicycle kick.

And when she’s ready, we climb back on the jet ski in search of another stretch of river to explore. We stop and let a water moccasin swim past, not twenty feet in front of the jet ski. I point it out to Katy, and reassure her that there is nothing to fear. “You don’t have to fear a snake you can see,” I tell her. “Just be careful, and give them room.”

On another bend down the river, a six-foot alligator suns himself on an inviting white sand beach. I cut the jet ski off and drift in the current. I poke Katy and point, and she squeals in surprise, and then starts edging backwards, snuggling closer to me.

Her grandmother has taught her that snakes and alligators and dogs and rambunctious children and God knows what else are things to fear. Things that can knock her down are things to fear. Rough housing is frowned upon, because after all, my daughter is delicate, and handicapped to boot. She could get hurt.

I will not allow my daughter to learn fear.

And so we sit and drift with the current, and I point out to her that snakes and alligators are to be respected and given their distance, but not feared. Strange dogs should be given their distance too, until you know their intentions, but not feared. If a rambunctious or rude child knocks her down, we go play with someone else. But we do not fear them.

And as we get closer, the alligator swims away, just like I told her it would. “Because it’s more afraid of us,” I explain.

And on another stretch of beach, we bury our toes in the sand and have a picnic. We eat fruit cups and ham sandwiches and her favorite, peanut butter and cheese crackers.

I toss a few crumbs into the water, and KatyBeth watches in fascination as the bream swarm from the deeper waters and devour the remnants of a cracker.

I coax her to hold one under the water, and the bream swarm around us like piranhas, eating a peanut butter and cheese cracker right out of her hand. She giggles and squirms as the bolder ones nibble at her feet and legs.

It’s days like this on the river that I live for; a chance to teach my kid what every kid should learn in childhood. Life’s little lessons that she misses out on, because everyone insists on treating her like a China doll.

Puppy teeth are sharp, but puppy slobber possesses magical healing properties.

Trees are a joy to climb, even if it means falling out of them occasionally.

Mud pies are fun to make, but not edible. But go ahead and taste it if you must, Little Miss Hard Head.

Snakes and lizards and alligators are cool, when viewed from a distance.

The outdoors offer a world of wonders to explore, but pack your skeeter repellent and sunscreen.

Peanut butter and cheese crackers are even tastier when you eat them on a beach in the middle of nowhere, and share the leftovers with a school of hungry fish.

Pain only lasts a little while, and bruises fade, but regret lasts a lifetime.

She doesn’t look it, but my daughter is much tougher than people realize. She’s much tougher than she realizes, and that’s what I try to show her. My daughter is the toughest person I know.

She just happens to have a left leg and arm that don’t work so well, but we’re working on that. Probably always will be.

And as the shadows grow long and the crickets start singing and the sun sinks behind the trees, I tell KatyBeth it’s time to go. Naturally, she whines and frets, and she cries when I load her onto the jet ski, but by the time we reach the landing, she’s fast asleep, head resting against my left arm.

I manage to beach the jet ski at the landing, tote her to the truck, remove her life jacket and buckle her into her car seat without even waking her. The drive home is quiet, giving me time to contemplate the sunburn I’m going to have in an hour or so. My shoulders are already tightening. To make matters worse, I discover that I’ve had my cell phone in the pocket of my swim trunks the entire time. It’s ruined.

At the house, I manage to back the jet ski trailer into the garage without KatyBeth for a spotter, and I tote her inside like a sack of potatoes, limp and still sleeping soundly. I lay her on her side of the bed, remove her swimsuit and dress her in panties and the SpongeBob EMS tee shirt she likes to sleep in.

As I tuck her in, she opens her eyes and yawns sleepily, and murmurs, “I want Dora, Daddy.” I fetch her Dora the Explorer doll from the floor beside the bed and she sleepily takes it from me…

…with her left hand.

And that was my day yesterday, well worth the price of gas and a new cell phone.

Just Call Me Faust

10 comments

Damn, How Did They Know?

38 comments
Ambulance Driver –

[noun]:

A person of questionable sanity who starts their own cult

‘How will you be defined in the dictionary?’ at QuizGalaxy.com

These things are so accurate it’s spooky.

Now someone go peel your Divine Leader a grape. Chop chop!

Medblogging Censorship…

2 comments

Fathers and Sons

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When I was five, my father knew everything.

When I was fifteen, my father knew nothing.

When I was twenty five, I was amazed at how much my father had learned in ten years.

When I was thirty five, I realized my father had known these things all along. And I hoped that one day, I would be as wise.

Go on over to The Fixit Shop and read about a father and son, and all the emotions that each experience as one teaches the other how to be a man.

If you have a son, or if you’ve been a son, you’ll know exactly what this moment is like.

Ambulance Driver Answers: An Update on QuikClot

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In regards to my (mis) information about QuikClot, the CEO of the company e-mailed me and filled me in on some changes to their original product, to wit:


“I’d love to update you on the new QuikClot® brand hemostatic agent products we’ve got. The exothermic reaction is gone and they are packaged in such a way that you can apply them to a still pumping arterial wound.”

Best Regards,
Raymond J. Huey
Chief Executive Officer
Z-Medica Corporation


Well, that effectively addresses the two misgivings I and others had about the QuikClot, and apparently my knowledge of your product was a bit outdated. My apologies.

Thanks for the correction, Mr. Huey. I appreciate it.

Clarification: The update was completely voluntary on my part. Mr. Huey was most polite in his e-mail, and in no way requested I post a retraction. This does not reflect my endorsement of any EMS product. It is merely a clarification of a previous statement.

America's Got Talent

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Guy gets committed to an long-term inpatient psychiatric facility. After a few days there, he began to notice a pattern among the other patients. Every so often, someone would stand up in the common room, get everyone’s attention and shout out a number, followed by uproarious laughter from the crowd.

Guy watches this for a couple of days – someone shouts out a number, everyone else laughs. Finally, curiosity overwhelms him and he asks an orderly for an explanation.

“Oh, most of these guys have been here for years and have very little contact with the outside world,” the orderly explained. “They’ve heard all the jokes over and over, so they finally came up with a numbering system. Somebody shouts a number, everybody remembers the punch line of that particular joke and gets a good laugh. Saves time.”

So over the next few days, the guy gets brave enough to overcome his stage fright and decides to tell a joke. He stands up, clears his throat loudly and gets everyone’s attention.

“Sixteen!” he hollers. No one laughs.

“Uhhh, eleven?” the poor guy ventures uncertainly.

Crickets chirping.

Humiliated, the guy sits back down. Later he snags the same orderly and asks what he had done wrong.

“You know how it is,” shrugged the orderly. “Some people can tell ‘em, some can’t.”

The other Sunday night it was rather slow in the ED at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut, and Thin Anemic Nurse was working the night shift – not her usual gig.

Of course, TAN had the heat in the ED nurse’s station cranked to twenty degrees above ambient (ambient in this case being 80 degrees) to compensate for her non-functioning hypothalamus. Rather than stew in my own juices or beg her to turn off the %^$&# space heater in freakin’ JUNE, I chose Option C, which was to wander across the hall to the psychiatric unit and enjoy the weekly episode of Thorazine Idol.

I apparently missed the memo, however, informing the staff that this week’s episode had by preempted by a special treat.

A talent show.

Now, you may wonder what can possibly top the entertainment value of a 50-year-old housewife with chronic depression, clad in a hospital gown and wearing Tweety Bird slippers, belting out I Will Survive.

Two words: Interpretive dance.

Even better, interpretive dance fueled by mood-altering medications. The only thing closer to entertainment Nirvana would be sitting in on a group therapy session at Promises. Lindsay and Brittney can’t be much more effed up than these folks.

I’ll not mention any of the specific acts lest it too closely identify any of our patients, but suffice it to say I haven’t been this weirded out since my last visit to a county fair.

Only this time, you’d have to imagine the bearded lady doing a stand up comedy routine and the two-headed calf riding a unicycle while juggling male urinals.
While watching this Theatre of the Bizarre, I was struck by a couple of realizations – the only major difference between many of our patients and your average Hollywood starlet is a boob job and a sizable entourage.

Adding to the surreality was the fact that most of the female staff were apparently channeling Paula Abdul at her gushiest.

I resisted the urge to play Simon Cowell because frankly, it does not behoove one to criticize the performance of a 300 pound behemoth with homicidal tendencies, even if the behemoth does think he has found his inner Shirley Temple with his captivating performance of The Good Ship Lollipop.
Unless of course, the aforementioned behemoth is in six-point leather restraints and you have a loaded Haldol syringe. Then by all means, speak your mind. It’s for his own personal growth.
I had a psychiatric patient once who kept hallucinating skulls floating in the air around him. Leering human skulls with red flames for eyes.

This would have been the perfect outlet for him. He was depressed, homicidal, and paranoid. In other words, Hamlet. Give him a cape and a cardboard sword, and he could have held up one of his imaginary skulls:

“Alas, poor Yorick! I knew him, Horatio.”

We’d have a method actor to make Lee Strasberg proud.

These guys need talent coaches for the next competition, a professional muse who can tailor their acts to their own individual psychoses.

Like perhaps a ventriloquist act for the guy with Multiple Personality Disorder. He wouldn’t even need a dummy.

Or maybe our manic guy could spin plates. While juggling something. Yeah, that’d be cool, and right up his alley!

Our escape artist could actually get style points for wriggling out of his straitjacket!

All the megalomaniacs and people with God Complexes could stage their own musical! The title?

Jesus Christ Superstar, of course.

The narcissists could all paint self portraits.

The hallucinating patients could all be taught mime routines. Walking in the wind? Trapped in a box? No problem. They actually feel the wind and see the box!

Clearly I’m on to something here. Methinks the psych unit needs a part time activities coordinator, an idea you can be sure I’ll bring up at the next staff meeting.

I smell me some overtime!

Thinking Blogger Linky Love

24 comments


If you’ll look on my sidebar, you’ll see a little icon for the Thinking Blogger award. It’s a meme of sorts that circulates around, but flattering to receive nonetheless. I’ve been tagged a couple of times since the original, the latest time from Chas Clifton of Letter From Hardscrabble Creek.

I’m going to eschew linking the obvious choices of people like Tam, Lawdog, Kevin or Marko. Good reads, all of them. Hell, pretty much everyone on my Blogs I Read Every Day fits that description. Matt G tells a good story, and for the life of me I can’t figure out why he doesn’t get 500 visits a day. Perhaps it’s because he procrastinates on following through with a really good idea. *wink*

Instead I’m going to direct you to some of the lesser known names on my reciprocal blogroll. All of them are thinking bloggers, and deserve a wider readership than they get.

Bonnie of Squeaky Wheel Seeks Grease is enjoyable. Libertarian, sarcastic and always good for a rant. Check her out.

Musings of a Dinosaur
is a physician of the dying breed – a family practice physician in solo private practice. If you want intelligent discourse on current issues in health care and medicine, I’d highly recommend him.

Gay Cynic has a blog called Free Thinker, in which he discusses politics, gun rights and issues concerning the gay and lesbian community. If you believe in stereotypes, don’t bother visiting. If however, you’d be interested in a peek at the life and cares of a perfectly normal, intelligent and well-spoken individual who *gasp* just happens to be gay, give him a read.

Bob G always has some good commentary on his blog, Near The Salty City. Politics and guns. Good stuff.

Baby Medic and MedicMarch are both new medics, and both of them know how to tell a story. Give ‘em a read, why don’t you?

I'm Like Brittney Spears…

24 comments


…insofar as we’re both semi-trashy Louisiana rednecks who have recently shaved their heads and have a history of showing their genitalia in public.

I think I look better with the chrome dome than she does, though. Now all I need is a record deal and groupies.

No Surprise There…

36 comments


Your results:
You are Leonard McCoy (Bones)

Leonard McCoy (Bones)
65%
Beverly Crusher
60%
Worf
60%
James T. Kirk (Captain)
55%
Mr. Scott
55%
Uhura
55%
Will Riker
55%
Deanna Troi
55%
Chekov
50%
Mr. Sulu
50%
Jean-Luc Picard
45%
Geordi LaForge
40%
Spock
39%
Data
21%
An Expendable Character (Redshirt)
20%
You are a pessimistic and bitter doctor,
but you are skilled in the ways of medicine and science.


Click here to take the Star Trek Personality Quiz

Dammit Jim, I’m a paramedic, not a magician!

Stolen from TrekMedic

Ambulance Driver Answers

34 comments


Marooned in Massacusetts writes:


When you’re in the ambulance, and there’s some braindead mouthbreathing shmuck completely ignoring the sirens and lights, do you ever wish there was a Browning .50 cal machine gun mounted to the hood? Or do you subscribe to the rocket-propelled grenade school of gene pool cleansing through idiot removal?

Dear Marooned, you have unwittingly described the First Maxim of Emergency Driving, which states: When on responding with lights and sirens, any motorist traveling slower than you is an idiot. Any motorist traveling faster than you is a maniac.

Personally, I think twin water-cooled .50s mounted on the grill and a snowplow bumper would work better than lights and sirens, and provide us much-needed stress relief and practice in hand-eye coordination, to boot.


A
round here, most of the brain-dead, mouth-breathing schmucks fall into the maniac category. You can easily spot them because they drive new black Dodge Ram pickups and constantly curse their fellow motorists. What kind of vehicle do you drive, by the way?

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Cat Herder writes:


My wife is sometimes very moody — yelling at me, finding fault, just not able to be happy. We’ve been married ten years, and I’m thinking of leaving her. My question: Is it really, really fun to drive that truck fast?


Dear Cat Herder, running off to the EMS circus will not solve your marital problems. Besides, our profession already has enough clowns.

I’d recommend that you honestly consider what it is about you that bugs her so much, and work to change your behavior. Try paying her little compliments and doing thoughtful little things for her, just because. Take the vacuum cleaner from the closet, plug it in and park it right next to her side of the bed so it’s the first thing she sees when she wakes up in the morning. When she’s mowing the lawn in this summer heat, get off the couch to bring her a refreshing glass of lemonade now and then.

Chicks dig chivalrous shit like that.

PS: Yes, it is fun to drive the truck that fast.

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Pixie Dust asked:


What is your opinion on patients’ labs being drawn in the field? In the county where I run, we don’t draw labs in the field; in the county where I work in the ED, EMS does draw labs, and we do use them in the ED for analysis. However, we’re the last hospital under our parent system to do so, and the OMD has had to fight with our lab to keep the practice going. I gather the issue is that we in the ED weren’t there when the blood was drawn, so we can’t swear it’s from the right patient … WTF? EMS does have a procedure whereby they apply an armband with a unique identifier to the patient, and stickers from the armband are applied to each tube … seems sufficient to me. Is it a lack of trust in the EMS system? Seems to me that the patients get results and therefore treatment a little more quickly this way, if there labs are already drawn upon arrival …

Dear Pixie, I feel your pain. When I was on the rig, I routinely drew a rainbow of blood tubes whenever I started an IV, if time and circumstances allowed. Most hospitals accepted the blood willingly for their own lab to analyze, but a few holdouts stuck in the last century routinely discarded the blood.

I believe to a large extent it does exhibit a lack of trust in the EMS system. Whenever I encountered such ignorance, I did my best to educate the ED and laboratory staff by stomping my feet, holding my breath, and loudly demanding “You will respect my authoritay!”

Because, you know, nothing spells R-E-S-P-E-C-T like righteous indignation and behaving like a petulant child.

I’d ask your laboratory director how he ensures that labs drawn from nursing home patients or any other out-of-hospital setting is actually from that patient, since he wasn’t actually there when it was drawn. Laboratories do assays every day on blood drawn at remote sites. The “we didn’t draw it ourselves, so how can we insure the integrity of the sample?” argument is a straw man, much like some ED’s practice of restarting all prehospital IVs because they are inherently “dirty.” That practice is based on some rather flawed and very outdated research, by the way. What they’re really saying is, “Blood draws and laboratory analysis is our turf, and EMS should know its place.”

I’d suggest organizing a little CEU session on blood draws for the local medics. Have the EMS services education director organize it, and have the lab staff at the hospitals teach it. It’s a win-win situation: the medics get CEUs and the hospitals still get to protect their turf because they control the curriculum.

If the EMS system resists the blood draws because of cost issues, inform them that the hospitals can resupply them with Vacutainers, needles and other supplies, and still bill for the procedure just like they normally would. Check out the latest OIG opinion regarding ambulance restocking and safe harbors.

I hope this helps. I’m in favor of anything that saves the patient an extra needle stick and speeds their door-to-needle time.

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Forlorn Boater asks:

Do you think the hemostatic agents like Quikclot are useful for (1) EMS (2) police (3) just plain folks?

I think I can see their usefulness in a military setting (the Blackhawk Down scenario) and, where the situation allows, for a popo who is first on the scene at a trauma. (I don’t know what magic the EMS folks bring for trauma, so I don’t know when / if you would need it.)…

Dear Boater, to answer your question in order:

(1) Yes

(2) Maybe

(3) No

I don’t want to sound like Joseph Mengele by saying this, but Operation Iraqi Freedom is proving to be one huge, immensely valuable field laboratory for research in trauma care. Never before in recorded history have soldiers had such good chances of surviving their initial battle wounds. Many of these advances have EMS applications, not the least of which are hemostatic agents like Quikclot, and the re-emergence of tourniquets.

You may not know this, but for a long time in EMS, tourniquets were a Bad Thing, and only to be used as a last resort. The experiences of combat medics in Iraq have taught us that often tourniquets should be the first resort for life-threatening bleeding. The tourniquets used by combat medic today are of a far superior design to the improvised jobs we used back in the day. It’s not your Daddy’s tourniquet any more.

Hemostatic agents like Quikclot and Celox serve to stanch blood flow by rapidly forming an artificial, external “clot.” In the case of Quikclot, the clot is formed by means of an exothermic reaction, which has been shown to cause thermal burns and tissue necrosis in some patients.

Celox doesn’t cause an exothermic re
actions, but in any case, these agents both require that the bleeding first be controlled so that the agent can stick to the wound.

In other words, you first have to use the tried-and-true direct pressure, elevation and arterial pressure points to slow the bleeding enough so that the arterial spray doesn’t simply wash the agent away before it has a chance to work. Some of the Marines who used Quikclot in Iraq were unimpressed because without direct pressure and tourniquets, Quikclot wound up everywhere but the wound. For the average citizen and most cops, the usual methods of hemorrhage control should be sufficient until the arrival of EMS. Modern tourniquets are extremely effective, but require a little training to use effectively and safely.

One promising development is the advent of chitosan bandages, which use a bandage impregnated with chitosan from shrimp shells to form a clotting matrix. When last I checked, they were only available to the military, but the manufacturer had plans to market them for civilian and EMS use as well. Buy yourself a few of those.

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UK Wheezer writes:


What are your views on expert patients? By that I mean the people who suffer from a chronic condition like asthma that requires emergency care by you guys. Do you listen to what they have to say about the treatment they require. For instance the size of cannula you can use. Or do they just plain bug you?

Dear Wheezer, the only expert patients who bug me are the ones with nebulous pain complaints who happen to be allergic to Toradol, Tylenol, Ibuprofen and aspirin, who then proceed to tell me precisely what narcotic analgesic and dosage to use to alleviate their suffering.

Strangely enough, those patients are experts on their symptoms, but not expert enough to read a calendar, count their pain pills, and arrange for a refill in a timely fashion.

However, no one knows the effects of the disease like the patients themselves. I pay very close attention to most patients in regards to what works and what doesn’t, and the severity and progression of their symptoms. Only a callous, jaded fool of a medic wouldn’t.

*******************************
Hootie Mac writes:


What is the most efficient method of communicating medical information when you cannot speak for yourself? The medic alert bracelet? A card in the wallet? Do you really need to put ICE number on your cell phone? Give us some basic guidelines to use.

Dear Hootie, try all of the above. Modern technology has also come up with an answer, in the form of an implantable chip that can be read with a special scanner. They’re not readily available yet, and there is still a great deal of justifiable concern about abuse of patient privacy.

If you’re a little afraid of Big Brother being able to potentially track your movements (not a legitimate concern with this device), or having your records placed in some vast database with questionable security (BIG concern), you might try the Vial of Life, particularly if your medical history and medication list is rather extensive. You put a copy of your medical history, allergies, medication list, DNR, old EKGs or whatever in a ziploc bag and stick it to your fridge. Then you put a decal on the fridge and your front door to tell the paramedics where to look. A similar arrangement in your car with decals on the glove compartment and rear window is a nice touch.

Speaking of rear windows, I loved Cracked Rear View. How are the Blowfish, by the way?

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Sleepy in South Carolina asked:


Do you think it’s about time that “Paramedic” in it’s broadest should become an (AD- lol) Associates Degree and be a Licensed Program as opposed to a Certificate. In our Urgent Care we used to start IV’s – now someone pitched a fit jealous nurse) and it has compromised patient care – our Nurses are all for us doing as much as possible) and now we can”t. Walk outside an you can do an EJ stick or run a full code—But IV’s? Come on!! Anyway- Question- Associate Degree vs. Certificate and expanding scope of practice to help fill the Nursing Shortage?

Dear Sleepy, I am somewhat lucky in that, at Podunk General Hospital ER, I can function under my full scope of practice as a Critical Care Paramedic. We accomplish this by making the medic directly answerable to the ER doc as a physician extender, thus bypassing the delegation of practice issues the state board of nursing is so snippy about.

It’s pretty short-sighted to deny medics the opportunity to practice in the ER, particularly in light of the current nursing shortage. Incidentally, the nursing shortage is a bit of a fallacy. There are plenty of registered nurses to go around. What is lacking is a number of them willing to actually practice direct patient care, rather than education, administration or case management.

To be fair, however, for a medic to think he can function at the level of an experienced RN in an Emergency Department shows a lot of hubris, in my opinion. We are effectively a comparable skill set without a nurse’s knowledge base. I’m not saying one is superior to another, but as far as initial education is concerned, nursing is both broader and deeper.

To answer your question directly, I see eventually all paramedic programs moving to a minimum of an Associate Degree. I think that’s the direction we need to go. That’s not to say that there aren’t excellent proprietary, certificate paramedic programs out there, because there are. Some of them produce better medics than the college programs. But for our profession to achieve the pay parity and recognition we feel we deserve, we must improve our stature among the rest of the health care professions. The first step in that is improving educational standards, and it needs to be a college program if we’re to achieve any semblance of legitimacy as medical providers.

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Ray in West Texas asked:

When is a person declared dead? Does it have to do with heart beat or brain activity? Example, a person is declared brain dead and on a ventilator and the family wants to pull the plug, I argue that if the heart is beating without the aid of a machine then the brain is functional as it is telling the heart to beat. I look forward to your answer.

Dear Ray, the heart does not require signals from the brain to beat. Cardiac muscle possesses a special capability known as automaticity, which is the ability to generate its own electrical stimulus, and thus a heartbeat, independently of any input from the nervous system.

As long as the heart remains oxygenated, it may continue to beat on its own. This may require an artificial ventilator to breathe for the patient in the event that the brain is not generating any breathing impulses, or there may be enough brainstem function to maintain spontaneous breathing.

The brainstem cont
rols our basic, most primitive bodily functions such as breathing and blood pressure, and some limited control of the rate and force of the heart’s beating, but rest assured that it is not absolutely essential to maintain a heartbeat. It is not at all uncommon for a patient with a devastating brain injury to have preserved vital functions, but be incapable of higher brain functions. They cannot see, think, communicate or sense pain.

I have seen a suicide patient who had blown his head completely off with a shotgun, who still had a pulse, a blood pressure and respirations for several minutes. There was just enough of the patient’s brainstem left to stimulate these functions, but by no reasonable measure was he alive. He was, at most, a candidate for organ donation.

Brain death can be confirmed by clinical exam and several diagnostic tests. Some people may not be brain dead, yet have no hope of recovering higher brain function. Many people, in those situations, choose not to be kept alive by artificial means.

I don’t know your personal ethical and religious beliefs, but mine tell me that death is sometimes a mercy, and many people do not wish to live in a persistent vegetative state with no hope of recovery, even if they are not technically brain dead. I have a hard time believing that “pulling the plug” in those instances is a sin in the eyes of God. I also believe God wouldn’t want us wasting organs that are in short supply.

Hope that answers your question.

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Outside of Apex asked:



Are you guys really busier during a full moon or what?


Dear Outside, the idea that call volume, patient acuity , and the oddity of EMS calls is somehow tied to the lunar cycle is a myth. Pure fallacy. There is no scientific evidence that the number of EMS calls or ED visits increase during the full moon, nor do we see a higher number of psychiatric patients.

Now if you’ll excuse me, I’m going to go chant, burn some incense and sacrifice a small nurse to the EMS Gods, lest they smite me for my blasphemy.

******************************

U.P. Medic has a twofer, which I will answer in order:


Your thoughts on physician assisted suicide. With Dr. Jack getting out of prison soon, just wondering your thoughts on the subject.

Here’s my Libertarian, lapsed Episcopalian, bastardized medic view on the subject:

1. The government has zero business deciding life or death issues for its citizens. You want to die, off yourself. It’s not for man to judge your actions.

2. Death is sometimes a mercy, and nobody should suffer needlessly if there is no hope of recovery. If death is their choice, so be it.

3. Jack Kevorkian went from noble advocate for suffering, terminally ill people who needed a voice, to a zealot who crossed the line into murder. In his zeal, he assisted in the deaths of a few people whose conditions were not foregone conclusions. Some of those people had options other than suicide. Jack Kevorkian was too focused on his quest to help them explore those options.


Second, your view on the scope of practice for medics (in the hospital).

Personally, I think medics should operate as they were intended, as physician extenders. They should not be subordinate to nurses, nor dependent upon them for delegation of practice. They should work with nurses, as equals. That means they be allowed to utilize their full scope of practice.

That said, it’s pretty arrogant of a medic to assume that he can work in an ER with no additional education or training. Imagine how you feel when you hear of nursing organizations advocating nurses staffing ambulances, without any requirement of additional education in prehospital care.

In a broader sense, I kind of like the way Texas addresses the scope of practice for its EMS providers. The scope of practice for the EMTs, of any level, is limited only by how much liability the physician is willing to accept for the EMTs he directs. Theoretically, an EMT-B in Texas can start central lines, insert chest tubes, and perform a surgical cricothyrotomy, provided the medical director accepts the responsibility and trains the EMT in the procedures.

That’s one reason I dislike the new National EMS Scope of Practice model. We need a nationwide scope of practice for all levels that defines the minimum education, training and skill set for a particular level. In other words, a floor, not a ceiling. As currently written, the National EMS Scope of Practice is a de facto ceiling that will prevent our profession from growing and adapting to future changes in the health care environment.

I’d like to thank all of y’all who submitted questions to Ask Ambulance Driver. If my answers provided at least a modicum of education and entertainment, let me know if you’d like to see more. Feel free to submit more questions, and as always, comments are welcome.


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