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I blog about going naked under my jumpsuit…toilet humor aplenty…even blatant sexual innuendo…and a drunk driving post that everyone liked was what finally boosted me beyond a PG 13 rating.
*sigh*
Some people just don’t understand my art.
Philistines.
Some of you know I’ve written one book. Some of you have read it, and I thank you for your kind words and your contribution to the Double Wide Fund.
I started this blog as an additional creative outlet, a way to hone my writing craft as I compiled stories for my next book. A great many of the posts in this blog will be in that book, along with stories you’ve never seen before.
I like to think I’ve become a polished enough writer that this book will be better than the first. When I look back at my earlier stuff, many of the stories in Life, Death and Everything In Between now seem a bit raw and amateurish…
…which brings me to the subject of this post, something really raw and amateurish. Last year I started on another book, a work of pure fiction.
Folks, fiction is hard. The characters I’ve developed have their real-life counterparts, and much of the plot is based upon my own experiences, but taking these characters off on a path I’ve not yet tread is proving to be a challenge.
The Publisher is a bit cool on the prospect of publishing this project, and I totally understand. It’s really not his niche.
I started this fictional novel with the assumption that its words would never see print, and my expectations haven’t changed. I do plan to finish it, however, and it has languished in a folder on my laptop for too long.
So let me introduce you to Star of Life, my fledgling attempt at EMS fiction. The prologue is already up, and I intend to post a new chapter each week.
Y’all give it a look, and tell me what you think.
The sorting hat says that I belong in Ravenclaw!
<
Said Ravenclaw, “We’ll teach those whose intelligence is surest.”
Ravenclaw students tend to be clever, witty, intelligent, and knowledgeable.
Notable residents include Cho Chang and Padma Patil (objects of Harry and Ron’s affections), and Luna Lovegood (daughter of The Quibbler magazine’s editor).
Take the most scientific Harry Potter
Quiz ever created.
I have only read one Harry Potter book. Never really understood the Harry Potter phenomenon, to tell the truth.
So tell me…is Ravenclaw a good house to be in? Are they popular with hot sorceress chicks? What are their keg parties like? Do they have lots of smart Asian students to copy spells from?
“G’day mates, and welcome to Dumbass Huntah! Oim your host, Ambo Droivah, and t’day we’re goin’ aftah one of the most dangerous species of dumbass on the planet, Phencyclosaurus methamphetamii, otherwoise known by natives as Angel Dustah! Let’s go!”
[cut to the interior of an ambulance, cruising slowly through the Hood, Ambulance Driver enthusiastically narrating from the front passenger seat]
“We’re now enterin’ the ghetto, proime habitat for Angel Dustah! Afta dahk, these pahts are choc a block full of Homo sapiens addictus and their close cousins, Homo sapiens rockslingah. Now normally, Dustahs are oidentical in appearance to the dominant addictus, and some biologists believe them to be the same species. But late at noight, once they pahtake of their fav’rite treat, PCP and crystal meth, the relatively hahmless addictus can morph into a ragin’, bloody aggro Phencyclosaurus!
[camera pans slowly from right to left, revealing sullen young men glaring suspiciously at the passing ambulance, some of them flashing gang signs, when suddenly a nude blur flashes across the screen]
“Now you’ll notice most of these blokes wearin’ gold chains and joolry, which the natives call bling. Apparently, this helps attract the females of the species and – ‘ello, what’s this?”
[cut to a closeup of Ambulance Driver, excitedly pointing out the window]
“It’s a Phencyclosaurus, right across the road!”
[cut to jerky, unsteady shot of a naked man running through a vacant lot, Ambulance Driver and two EMTs in hot pursuit]
“Now you’ll notice that Angel Dustah is roight down to ‘is birthday suit! That’s because when he morphs from addictus, it causes ‘im to molt straight away, and this one has already shed his duds!
[Ambulance Driver takes down naked man with a flying tackle, grunting and wrestling around in the mud...]
“Easy there, big fella! You’re alroight, mate!”
[...struggling to roll Phencyclosaurus into a prone position, motioning the EMTs to pile on, Ambulance Driver cinches in a headlock.]
“Now you’ll see here that Angel Dustah’s choppahs are worn down and eroded almost to nubbins! Now normally, we’d take that as a sign of a much oldah and more mature Dustah, one well past ‘is proime! But you can see here [pointing to the critter's snapping teeth] that he’s still very physically fit, and still in proime breeding condition, so this Dustah probably also supplements his doiet with methamphetamine, and this condition is known as meth mouth!”
“Now it’s important that we’re very careful with this fella, and troy to restrain ‘im as humanely as possible! [grunting and struggling for leverage over the thrashing Phencyclosaurus, pointing to where the EMTs should position themselves] We absolutely ‘ave to control ‘is head, cause Angel Dustah boites! Now I’ve got ‘is head, and – whoa now! Easy there, fella! You’re alroight, mate! – we’re gonna just get him safely secured and – grunt, scuffle, pant – on my count, fellas, we’re gonna move ‘im to the stretcha! Everyone ready now? Alroight, one…two…three!”
[Ambulance Driver and the two EMTs stagger to their feet, struggling to hold onto a sweaty, slippery Phencyclosaurus, who is thrashing, growling and snapping like a, well... Phencyclosaurus. They unceremoniously dump the thrashing critter on the stretcher and struggle to tie him down.]
“Now, we’re gonna transport this big fella to the hospital, where we can continue our scientific study of Phencyclosaurus methamphetamii, the most fearsome member of the Addictus subspecies! But first, we’re gonna have to sedate this fella, before he injahs ‘imself in our ambo!”
[draws up a syringe of several medications and plunges it into the critter's thigh]
“Now Oi’ve just given ‘im a B52, which oughta calm him down straight away! Then, I’m gonna put an oxygen mask ovah ‘is face, to keep ‘im from spitting on me!”
[Right on cue, Phencyclosaurus horks up a big one, which Ambulance Driver deftly dodges. An oyster-sized loogie splatters the camera lens.]
“Ah, no worries, mate! [cleaning the loogie off the lens and giving the cameraman a reassuring, manly chuck on the shoulder] Phencyclosaurus saliva isn’t like venom in its purest sense, but you wanna be careful, because Angel Dustahs often carry diseases!”
[cut to shot of Ambulance Driver wheeling a stretcher into a hospital ER, Phencyclosaurus dozing peacefully. Ambulance Driver narrates in a stage whisper]
“Now, we’re gonna run a few labra’try tests on old Angle Dustah, then we’ll tag ‘im and release ‘im back into the woild! Hopefully, we’ll find out just what it is in PCP that makes a relatively hahmless addictus morph into a bloody aggro Phencyclosaurus!”
“Now normally, we’d put this fella in captivity, but the jails zoos are all full, so this one we’ll release back with a radio trackin’ collah, cleverly disguised as bling!”
[holds up a gold chain and pendant that says "Playah."]
“Now normally, being in captivity will cause most Homo sapiens to be shunned by the rest of their social and family groups! Like any animal, once you’ve got the scent of The Man on ya, the rest of the bunch don’t want anything to do with ya!”
“But Phencyclosaurus an
d the othah addictus subspecies operate unda a very complex social struckcha! Dustahs throive in captivity, and there may actually be more of ‘em in jails zoos than in the woild! We’re still tryin’ to undastand it, but apparently some toime spent in captivity actually enhances the males’ desirability to receptive females, and increases their standin’ in the pecking ordah!”
[Pointing to the gang tattoos and scars on Phencyclosaurus' torso]
“Now most of these scahs he prob’ly got from dominance foights with other Dustahs, but see these tatts here? The ones that say, ‘Amekah, Amiah and Little T’ are most loikly tha names of ‘is offspring, so this Phencyclosaurus may also be a babydaddy, probably even one of those rare ones that has actually had contact with ‘is children! And these scahs here, they – ‘ello, what’s this? – look at these, mate! [excitedly waves the camera in for a close-up of a pair of tiny scars on the chest] These came from Tasah bahbs! This fella’s been tagged befoah! If we ‘re lucky, we can entah this fella’s tatts and scahs into a database and get an Oy-Dee! The hahdest paht about identifoying Dustahs is their complete lack of duds! No place to tote a wallet when you’re in your bloody birthday suit, mate! Hopefully, we can get an Oy-Dee and maybe track this fella’s moygration pattens!”
[Cut to shot of a police cruiser, Phencyclosaurus cuffed in the back seat. Ambulance Driver kneels in front of the car, narrating.]
“Now we’ve got old Dustah tagged and Oy-Deed, and we got ta witness ‘is transfamation back inta a hahmless addictus, and now it’s toime to release this fella back into the woild! Turns out this fella is from a few hundred kilometers from heah, a member of a peculiar tribe called Katricians. Most of the Katricians scattered after a bloody ‘urricane destroyed most of their natural habitat, but lately they’ve been migratin’ back in greata numbahs, and they’ve almost bloody well taken ovah the place! Hopefully, our radio collah will help the authorities track this Angel Dustah’s moygration pattens, and he may even ‘elp us locate and capcha a few of his Rockslingah mates!”
[Police officer boots Angel Duster to the curb, leaving him standing bewildered on a street corner in the hood, ass shining from the open back of his hospital gown. Police cruiser slowly drives away, and a little green dot on the cruiser's mobile data terminal slowly wanders across the screen, tracking Angel Duster's every move. Police officer taps the signal strength meter on his screen, grunts in satisfaction, and eats a donut.]
“That’s all for this week’s episode of Dumbass Huntah, and oim your host, Ambo Droivah, sayin’ avagoodweegen, mates!”
[fade to black]
So that’s my pitch. I’m thinking this one has HIT written all over it.
First of all, I’d like to thank all of you who have visited the blog and left comments over the past few days.
I’m trying to talk Matt and Babs into more of the Perspectives posts, and I think I’ve got the big guy almost talked into it. Maybe we can do a series of them.
My regular readers know what a narcissistic little approval whore I am sometimes, and you should know that your kind words are all fueling my raging megalomania like never before.
I’m sure that was your intention, right?
*grin*
I’d like to thank all of you who read this blog, many of whom who leave comments every bit as emotionally compelling as my current scribblings. You make writing a pleasure.
So thanks, and I’ll be back to my usual fare of unbridled arrogance, sarcasm, whimsy and toilet humor shortly.
Maybe later today, even.
This is what we do, and working with nurses and cops like these is part of the reason we do it.
“588, major accident,” comes the voice over the police channel. The voice is matter-of-fact, professional, cool as smoke off dry ice. But something in the tone makes me perk up and take notice. I look over and Bodie is listening too, head tilted toward the scanner, his thumb poised over the mute button on the TV remote.
“Unit 588,” the dispatcher acknowledges.
“County Road 234, about twelve miles west of town. Serious MVC with multiple injuries. Roll EMS and Fire…uhhh, Care Flight too, Dispatch. I’m gonna need at least two ambulances here.”
“That’s us,” Bodie sighs, already moving. We’re both tired. We’ve only run four calls today, but it’s the second day of a 72 hour stretch, and in the hill country, where bigger hospitals are few and far between, one call can keep you tied up for a couple of hours. We’ve only just stopped rolling.
“It’s bad, whatever it is,” I predict grimly as I hurriedly stomp my feet into my boots. “Matt doesn’t get flustered easily.”
“Yeah, something in his voice…” Bodie agrees.
We are already in the truck, strapping in and flipping switches when the tones come across our pagers. “Small Town EMS, Small Town Fire Rescue, Priority One call, westbound on County Road 234, rollover MVC with multiple patients. Care Flight has been notified.”
“Small Town Medic One, rolling,” I acknowledge, stifling a yawn. “County, can you give us a better location on this accident?”
“Small Town 588 is out at a rollover about 12 miles west of town limits, Medic One. Officer advised three patients, all of them serious.”
“Ten-four, County.”
“Time out 03:15 hours, Medic One.”
Shit. Wrecks after midnight on Saturday are never good things. Not out here.
“We callin’ for mutual aid?” Bodie wants to know. “Next closest one of our units is forty miles out.”
He’s right. EMS units from the neighboring county could get there five minutes quicker. That is, if they were already rolling.
“It’s a toss-up,” I judge. “Medic Two is probably already headed this way to cover. Just have them step it up to Priority One until we say otherwise.”
Bodie grunts in affirmation and keys the mike as I stare at my reflection in the side window. The strobes cast weird flashbulb patterns against the occasional scrub oak. Cattle eyes in pastures wink like a constellation of stars as their heads turn toward the sound of the siren.
“Prob’ly not as bad as it sounds,” Bodie muses hopefully. “Cops always think the injuries are worse than they are.”
He’s whistling through the graveyard.
I say nothing, my reply evident in my facial expression.
“Yeah, you’re right,” Bodie grunts in resignation. “He don’t git shook easy. On the other hand, we got fire and Care Flight already on the way. Be plenty of help when we git there.”
Keep whistling, Bodie. Matt called for two ambulances, vehicle rescue and a helicopter. On his own. He didn’t make that call for no reason. It’s going to be bad enough when we get there. And fire rescue is at least five minutes behind us. Add another fifteen for the bird, minimum.
“588, County,” the radio crackles again. Matt’s voice is clipped, terse. “ETA on that ambulance?” There is another sound in the back ground. Something gurgling. I switch to the County Sheriff’s Office channel and key the mike before their dispatcher can respond.
“Medic One to 588, ninety second ETA,” I answer. “What have we got?” I wait twenty long seconds for an answer.
“Rollover with an ejection,” comes the clipped reply. “Two critical, one moderate, one unaccounted for.”
Bodie and I trade a look.
Unaccounted for?
We crest a low rise and see the rear flashers of Matt’s duty cruiser in the distance. As we draw closer to the scene, a waving flashlight paints a pattern across the night sky like a searchlight beacon at a Hollywood premiere, beckoning us to a spot in the weeds some distance off the road. A debris trail punctuated by shards of taillight glass and scarred swathes of ground culminates in a wrecked Toyota 4Runner straddling the remnants of a wire fence. The Toyota looks like it has rolled over multiple times, the windshield gone and the driver’s door sprung. The cattle held in by the fence stand huddled in a far corner of the pasture, unaware of their new path to freedom. Maybe thirty feet beyond the SUV, Matt is kneeling in the grass near something we can’t see.
“I’ll check the truck,” Bodie offers, heading toward the Toyota and the shirtless man sitting dully on the ground at the open driver’s door.
I find Matt kneeling in the grass at the head of a young man of maybe eighteen years, holding a jaw thrust as the kid struggles to breathe. Every spasmodic breath is an all-too-slow, gurgling fight for air. Both of his arms are curled to his chest in decorticate posturing, his face a bloody wreck.
“I think this one was thrown clear,” Matt says grimly. “Two more in the truck – one trapped in the back seat and busted up pretty bad. He said there are two more, but this kid is all I’ve found.”
“Hey AD, I got a bad one over here!” Bodie calls urgently. I look over my shoulder to find him leaning in the back passenger window of the Toyota, tending to someone I can’t see. The shirtless guy is standing up now, staggering around with the remnants of a bloody shirt held to his head.
“This one needs help,” Matt reminds me urgently. “He can’t breathe.”
Which means he probably isn’t going to make it. And I need to decide which kid gets my attention. So which one do I let die?
“Let him go,” I tell Matt. “He’s gone.” Matt doesn’t move, just looks at me. “You’ve got a wreck scene to work, and I’ve got two patients that can be helped,”
I reason.
“But he’s breathing,” Matt protests.
“Not for long, and I have two critical patients and one other we still haven’t found. He’s not the priority, Matt.”
“He’s breathing.” Still Matt hasn’t moved, his elbows on the ground on either side of the kid’s head, stubbornly holding the jaw thrust that keeps the kid from ceasing his breathing efforts altogether. He stares up at me defiantly, the kid’s blood smeared up his forearms well past the protection of his nitrile gloves.
“Shit,” I relent, “you win. I’ll be right back.” I sprint for the rig and return with my portable suction unit. I kneel next to the kid, suctioning his airway with one hand as I dig through my jump bag with the other. I insert an oral airway in the kid’s mouth and hand Matt a BVM. “You stay with him,” I direct. “Bag him twenty breaths a minute or so. Fire Rescue oughta be here in five minutes or so, and the bird should be here in twenty. I’ll send you some help as quick as I can.”
I turn back to the SUV to help Bodie, and run smack into the shirtless guy. His eyes are glassy, his breath reeking of alcohol. The bloody shirt he is holding to his head glitters with broken windshield glass. Glass fragments are imbedded in his forearms, and blood runs down his elbows to drip onto his bare feet. The only item of clothing he still wears is a dirty pair of cutoff jeans. Vomit streaks his bare chest, collecting in the front waistband of his jeans.
“Whoa, partner,” I tell him, cradling his head in my hands, “I need you to hold still. What’s your name, man?”
“James Ashley Heaton,” he slurs, trying mightily, and failing, to carefully enunciate every syllable. “I don’t gotta talk to nobody ‘thout my lawyer here,” he states.
Riiight. Something tells me James has heard the words “Will the defendant please rise?” before.
“Fine with me,” I tell him as I steer him back toward the SUV. “Sit here and don’t move.” Thankfully, James complies without much in the way of protest. I ease him to a sitting position against the driver’s front tire and wrap a cervical collar around his neck.
“Wasn’t driving, neither,” he volunteers to no one in particular as I poke my head through the open driver’s door.
Bodie is kneeling on the console between the front seats, assessing a young man with his face pressed against the front passenger seatback. The kid’s legs are folded back underneath, the lower legs lost in seat cushion and twisted metal. The impact has caved in the passenger side of the SUV, buckling the rear passenger seat and pushing it forward and left. Our boy was apparently sitting in that seat, buckled in.
“Just hold on, son,” Bodie soothes. “He’p is gonna be here right quick. What’d you say yer name was? Tony? Just breathe that oxygen Tony, and we’ll git you outta here in a jiffy.”
“Where’s Bobby and Arnold?” the kid whimpers. “You gotta help Bobby and Arnold!”
“We got people doin’ jest that, son,” Bodie assures him. As they talk, I scan the interior of the SUV.
Both airbags deployed, front windshield gone. Driver’s door sprung, and maybe thirty inches of intrusion on the passenger side. Blood on the front passenger airbag.
I lift the driver’s airbag and peer underneath.
No steering wheel deformity, no axle displacement. All of the side windows are shattered, and the roof is caved in several inches.
“Where were Bobby and Arnold, Tony?” I ask him. “Which one was driving?”
“Jimmy was driving,” Tony answers in a half-scream, half-groan. “He was drunk, wouldn’t let me drive. He won’t let anybody drive his truck. God man, this hurts! You gotta get me out of here!” he pleads.
The kid in the field must be Bobby or Arnold. So someone is still missing.
“I’m going to go look for the other one,” I tell Bodie. “You got this?”
“Nothing else we can do until we get him extricated,” Bodie shrugs. “His legs is busted up pretty bad, and his pulses are thready. Prob’ly got some internal injuries, too.”
“And I’ve got the driver out here, drunk off his ass and maybe with a head injury,” I tell him, “and Matt is bagging one that’s circling the drain. Plus, one still missing. When the fire guys get here, we’ll get this one extricated and fly him to Big City Memorial.”
“We still need Medic Two?” Bodie asks as I back out of the SUV. By way of reply, I take the portable radio off his belt.
“Medic One, Medic Two,” I radio. “We’re going to need you here. We’ve got two critical, possibly three critical, and one moderate.”
“Ten-four, Medic one,” they answer. “Thirty minutes.”
I walk around the SUV, my flashlight playing across the broken ground, looking for a broken body somewhere out here in the tall weeds, afraid I’ll find the lifeblood of yet another young life ebbing into the sandy soil. Thankfully, I find no one, and the sirens of the Small Town Fire Rescue interrupt my cursory search. A rescue truck and a small tanker pull to a stop behind Matt’s cruiser, and a string of wig-wag headlights in the distance herald the arrival of even more help.
I approach the ta
nker just as Mr. Clean climbs down from the rig. A brawny six-four, with a cleanly shaven head, Mr. Clean strikes an imposing figure. He gives the SUV a glance and then turns to me. “How many, and how bad?” he asks tersely.
“Bodie has a bad one in the back of the Toyota with lower extremity trauma and internal injuries,” I tell him. “We gotta get him extricated first. Life Flight is inbound, and we need an LZ set up and marked. The driver is sitting over there with a C-collar on, and he’s doing the Sergeant Schultz routine – he don’t know nothin’ about nothin’.”
“Just those two?” Mr. Clean wants to know. “County said three, maybe four.”
“Matt has one that probably ain’t gonna make it,” I answer, “and we haven’t found the fourth one, if there is a fourth one. Can I get a couple of your guys to help me get Matt’s patient packaged?”
Matt’s patient. Damn. But that’s what he is right now, until I can take over for him. Not the kind of thing they prepared him for in First Responder class at the academy all those years ago.
Mr. Clean nods curtly and starts barking orders. Not bothering to wait for my helpers, I trot to my rig and fetch a spine board and the ALS airway kit. As I trot back over to the kid in the grass, I find my two helpers have somehow beaten me there and have already taken over for Matt.
“Still hanging in there,” one of them informs me as I kneel beside him. “The cop was doing a good job of ventilating him.”
“Keep ventilating a little bit longer,” I tell him as I assemble my laryngoscope. “Let me get his airway secured, and then we’ll get him secured to the board.” I toss a pair of trauma shears to the other firefighter. “Get him exposed, would you? Try to get me a quick set of vitals, too.”
“Where do you want me?” the ventilating one asks. “Should I move?”
“Just keep bagging,” I direct. “I’ll need you to hold spinal alignment while I intubate, so you’ll have to scoot over a bit once I’m ready. Once I’ve got the tube in, hook the bag back up and start ventilating.”
I lay my tube restraint and CO2 detector on the kid’s chest, grab the tube in my right hand, and nod for him to scoot over. I lay down on my belly at the kid’s head, sliding the scope in for a quick peek. Gravel digs painfully into my elbows.
The kid’s arms reflexively contract in decorticate posturing, drawing towards his chest as his back arches. The firefighter grunts and shifts his body, trying to hold the kid still. There are remnants of blood and vomitus in the back of the kid’s throat, but I manage to get a fair view of his epiglottis and the lower border of his glottic opening. Delicately, I slide the tube in and sit back up. Before I can tell him, the firefighter has the bag reattached. I inflate the cuff and secure the tube. As he ventilates – way too fast – I check breath sounds.
“We’re in,” I decide. The CO2 detector turns a cheerful yellow with every exhaled breath. I look up to see the other firefighter attempting to straighten out the kid’s left arm, a blood pressure cuff dangling from it.
“Pulse 64, BP 108 palp, as best I can tell,” he informs me. “I was trying to auscultate one when he started bucking.”
“A palpated pressure is good enough for me,” I grunt. “Let’s get him packaged and loaded.”
The firefighters and I finish stripping and assessing the kid. Aside from a few smaller abrasions and lacerations, his injuries seem to be limited to the head trauma. His face is a wreck, however. From palpating his head, it feels as if his upper jaw and nose are fractured. Thankfully, there is no blood in the ears, and no CSF in the blood coming from his nose.
But still the posturing. And at least a LeFort II fracture as well, maybe worse. I was damned lucky to get him intubated. He’s damned lucky to be alive.
Oh, who am I kidding? This is the worst kind of luck. This kid is dead. He just doesn’t know it yet. If he does survive, he’ll be a vegetable.
I keep my thoughts to myself as we carry the kid to the ambulance on the spine board. I notice Matt and a DPS trooper interrogating the driver as we walk past. He’s standing up against the SUV, shaking his head belligerently despite the best efforts of a firefighter to maintain some semblance of spinal alignment.
“I wudden even inna Goddamned truck!” he shouts defiantly. “You sumbitches ain’t got no right to hold me!”
“Listen asshole,” Mr. Clean growls over the shoulder of the DPS Trooper as Matt looks on. “We know damned well you were in the truck. Were you driving, or a passenger? How did you get out? Were you thrown clear? We need to know this shit for medical reasons…”
I stop listening to Jimmy bray drunkenly about his fucking rights as I climb into the back of the rig.
Fucking coward. We’ve got one mangled kid in the truck who only wants to know if his buddies are okay, and another one probably going to die, and the bastard who caused it all is only worried about beating a DUI charge.
I pull the tattered remnants of the kid’s jeans from underneath his hips and toss them on the floor of the ambulance. One of the firefighters grabs a blanket and covers his nakedness while I search for a likely vein. I can hear the thump of a helicopter rotor in the distance
One quick poke inside his left elbow, and blood quickly fills the chamber of the fourteen gauge catheter. I tape the catheter in place with the Ambulance Driver Gorilla WrapTM; three wraps with three-inch tape. It’s ugly, but strong. I’m drawing up the succinylcholine and etomidate when the distant thumping rapidly morphs into a roar and a downdraft that rocks the ambulance.
A few moments later, a firefighter pokes his head through the open rear doors of the ambulance. “Helicopter’s on the ground!” he announces unnecessarily, a sparky little rooki
e grin on his face. He looks about fifteen years old, excited as hell that Mommy let him go Save Some Lives tonight. His veteran brethren just roll their eyes and grin.
Ah, to be young and sparky, where you look at wreck scenes as exciting and not the future site of a forlorn white cross.
I push the sedatives and paralytics, and within seconds the kid is flaccid, no longer arching against the straps. I take the time to attach monitor electrodes and the capnograph lead and take a quick automatic blood pressure.
104/56. Not perfect, but good enough.
I nudge the firefighter standing beside the stretcher. “You mind staying here and ventilating him for a bit?” I ask him. “I gotta go talk with the flight crew.”
“Sure thing,” the firefighter nods, glad to be of some help.
“Just keep this number hovering around 30,” I instruct, pointing at the capnograph tracing on the monitor. “Maybe sixteen breaths a minute or so. If anything changes, send somebody for me. I’ll be back in a minute.”
I step out of the truck and trot back toward the knot of people gathered around the SUV. The flight medic meets me halfway, greeting me in the universal language of flight crews:
“Whaddawegot?” he asks.
“One severe head injury in my rig,” I tell him, not breaking stride. He falls into step beside me. “We have one being extricated with lower extremity fractures and probable internal injuries, and one walking wounded,” I finish, gesturing at Jimmy, still being interviewed by Matt and the DPS Trooper. Jimmy could not be described as compliant.
“Git that fuckin’ light outta my eyes!” he roars belligerently. The cervical collar is askew on his neck, and a piece of tape across his forehead has pulled loose at one end, causing the gauze pad placed there to dangle wildly with each turn of his head. “I already tole you Tony was drivin’!”
“If you’re talking about the kid pinned in the back seat,” the trooper mutters in disgust, “I ain’t buying it.” He reaches behind his back, producing a pair of handcuffs from the pouch on his belt.
When Jimmy sees the handcuffs, his bravado fades and he wilts against the truck. “Hey man, my head hurts,” he whines. “I think I broke something. I need to go to the hospital.” Disgusted, Matt turns to me, one eyebrow raised.
It figures he’d have a stainless steel allergy. Don’t think you’re getting off easily, scroatbag. I’d bet my life that Matt will be waiting at the hospital when you’re medically cleared.
“Fine,” I hear the DPS trooper say. “Just walk with me over to this ambulance over here…”
I watch as Matt and the trooper escort Jimmy over to Medic Two’s unit, just arrived on scene. Mr. Clean trails behind them, grinning as if he’s watching something fun. I shake my head in disgust.
“You want us to take the head injury?” the flight medic asks as we watch several firefighters sliding a spine board into the back seat of the SUV. Bodie, still in the back seat, barks orders.
“Actually, take this one,” I reply. “Mine will most probably arrest in your bird before you get there. You might be able to do this kid some good, though.”
The flight medic nods his understanding and waves his partner in toward the SUV. She kneels down and flips back the straps on their litter. The firefighters, shuffling in step with the board carried between them, back slowly out of the SUV, feet first. Bodie follows them out, still holding spinal alignment. He grimaces and straightens painfully. They gently lower Tony to the litter and strap him into place. His color is terrible, and he can only manage a slight moan. His belly is distended, grossly out of place on his frame. Both legs are broken in several places.
Good luck, kid. Try to pick better friends next time.
“Ever find the other one?” I ask Matt as I pass Medic Two’s rig. He’s standing on the rear bumper, looking in through the windows. Mr. Clean is standing by the curb-side door, looking disappointed. Matt shakes his head.
“We got this one if you want,” Reggie, the paramedic on Medic Two, offers.
“Nah, he’s just got minor injuries, and we need y’all to cover the city until we clear. Just bring him over to my rig once Matt and the trooper get their info.”
Reggie nods his understanding and climbs into the rig through the curb-side door.
“Is he gonna make it?” Matt asks, jerking his head toward my rig. I step aside as Medic Two’s rear doors open and the DPS trooper climbs out. Reggie unloads the stretcher, and his partner digs through Jimmy’s shredded jeans, tossing Matt his wallet.
“Probably not,” I tell him honestly. “But you gave him the only chance he had. We’ll do what we can.”
“Shit,” he breathes, and I watch the gentle giant deflate just a little bit. “Well, I’ve got a scene to work and a family to notify.” Without another word, he turns and walks back to the SUV where the DPS trooper is making notations on a clipboard.
We wheel Jimmy to my unit and secure him to the squad bench. Reggie slams the rear doors, makes a “wind it up” motion Bodie can see in the rear view mirror, and presently I can feel us pull back onto the road, swing around and head back toward Small Town ER. I kneel between the stretcher and the squad bench on the ride in, setting up the portable ventilator on the kid and trying to ignore Jimmy heaping torrents of verbal abuse on my back. He’s much braver now that the prospect of jail has dimmed, however temporarily.
What’s that, Jimmy? You don’t even know my mother, so how can that be possible? You’re what? Gonna kick my ass? Maybe I should loosen the straps and let you give it a whirl.
I plunk wearily into the captain’s chair and thumb the speed dial button on the cellular phone, bracing myself against the sway of the truck. I have to raise my voice to a near-shout to be heard over Jimmy and the sirens.
“Hey Babs, it’s AD on Medic One. We’ve got a 15 minute ETA on two victims from a rollover MVC. Victim #1 is a 17-year-old male who was apparently ejected. Initially agonal respirations on scene, unable to maintain his own airway without positioning. He’s tubed, with bilateral breath sounds and initial etCO2 of 32, spO2 91% on high flow oxygen. GCS is 1, 1, 3. Left pupil is blown.” Vitals 86/40, HR 52, RR 20 (ventilated)…”
“Lines?” she wants to know. “Cardiac rhythm?”
“Fourteen gauge, running a bolus now. Sinus brady on the monitor. Victim #2 may be the driver, apparently self-extricated at the scene. Apparent ETOH on board, uncooperative with history and exam. Numerous small lacerations and abrasions, the worst of which is a 4 cm forehead lac. We have him immobilized as best we can, PMS intact x 4, no neuro deficits. GCS 15. Eyes – PEARL. Vitals 136/74, HR 112, RR 14. See you in fifteen minutes.”
At Small Town ER, Babs greets us with a wry smile that quickly changes to concern with my handoff report. I can see her thoughts, like a cartoon balloon over her head:
Shit. What are we supposed to do with this kid? He needs to be in a big hospital.
I really didn’t think he’d make it this far, I answer with thoughts of my own. Otherwise I’d have called another bird. If he makes it, it’s because Matt gave him a chance.
I can hear Jimmy howling his displeasure in the suture room as I complete my report. Moonlighting Paramedic is working him up, using the version of tender loving care that MP uses for belligerent drunks. One long stream of profanity is cut off by a piercing screech.
That must have been the Foley catheter. Go get him, MP.
Bodie and I finish cleaning the rig, clear from the hospital and send Medic Two back to their station. By the time we settle onto the couch, it’s close to four am, and we’re both still too keyed up to sleep. American Pie is playing on cable, and we sit and watch numbly without laughing.
All the kids look so damned young.
I ask myself sometimes…
Why write?
Why blog?
Why do people even like this crap?
What is it that draws readers to my blog every day?
That’s why, baby.
You are an Anti-government Gunslinger, also known as a libertarian conservative. You believe in smaller government, states’ rights, gun rights, and that, as Reagan once said, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’”
Take the quiz at www.FightLiberals.com
Heh.
I’ve pretty much voted Republican in most elections, even though I’ve had to hold my nose a few times. Then again, there are a few times I’ve voted Democrat.
Before my initial foray into the blogosphere, I cooden even spel Libertarian, and now I are one.
Like The Hammer, I refuse to be nailed down with labels.
Hat tip to Chromed Curses.
Hosted this week by Monkeygirl at Musings of a Highly Trained Monkey. It’s the nursing medblog carnival, full of excellent stories from the ER and elsewhere.
Give it a read. You’ll enjoy it.
…go on over to Scully’s blog and give her a read. There’s a reason this woman made it straight onto the Blogs I Read Every Day.
She’s got warmth, wisdom, and heart.
Go. Read. Then add her to your blogroll.
She’s magnificent.
#1 Dinosaur has an excellent post on his blog about the differences between drug seeking behavior in Emergency Departments versus physician offices. He writes:
Most of the (blog) “literature” on drug seeking comes from the ER and pre-hospital bloggers. To them, seekers are all stupid, lazy, unwilling to confront their demons/addictions, often belligerent and overall pains in the ass.
I read his blog because he invariably posts a well-reasoned discourse on the things that simply induce a vitriolic rant from the rest of us. He makes me think, and his post on the subject illustrates the lengths to which a conscientious physician will go to identify, and treat, what he believes is a legitimate pain complaint. Knowing when it’s the Real Deal boils down to one word – relationships.
The more you know about that patient, the more likely you are to treat any of their ailments appropriately. Pain is just one example, and Dino Doc pegs it – the patients who are unwilling to do their part to develop that trust between physician and patient, are most likely there just for a fix.
Unfortunately, we don’t have much opportunity to develop patient relationships like that in EMS or Emergency Departments. What relationships we do develop are weighted toward the type of people who won’t make the effort to gain the trust of their primary care physician. When we see people repeatedly, it is almost always for one thing – drugs.
It bothers me a bit, however, that I’d be characterized as he does in his post. I don’t pigeonhole patients that neatly, although I can see how you’d get that impression from some of my posts. The particularly cutting remark came from Cathy in the comments section:
I also agree that after reading some of the ER blogs, I NEVER want to ask for pain control while in their ERs.
Now there is a shaming comment if ever I heard one. Cathy, you should never be ashamed to ask for treatment for a legitimate complaint. If you’re hurting, a competent clinician can usually tell.
If you read this blog, you already know the types of patients who earn my scorn. What you may not know is that, everywhere I have worked, I have been the Candy Man.
When I worked for Huge Soulless Corporate Conglomerate EMS, I routinely administered more narcotics than any other medic, save one. That particular fellow jumped at the chance to give any medication, often on the flimsiest of pretenses, and quite often he’d exaggerate clinical findings in his reports to get the orders he wanted. His nickname in the local ERs was “Overkill.”
I’m aggressive with the use of some medications and reticent with others, but I believe that benzodiazepine sedatives and narcotic analgesics are some of the safest drugs we carry.
Yeah, I said the mind-altering, potentially addictive drugs are the safe ones. In EMS and the Emergency Department, in the doses and intervals we typically use, these drugs are very safe, and not likely to result in addiction. The potentially harmful side effects are short-lived and relatively easy to manage.
Prescription narcotics and sedatives however, well that’s an entirely different kettle of fish. There is a much finer line to tread there.
Oxycontin? There’s a reason they call it Hillbilly Heroin.
Prescription Xanax? A scourge. Hate that stuff.
It doesn’t take an open femur fracture or organs falling out to get pain medication or empathy at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut. We get our drug seekers like everyone else, but if the story is even remotely plausible, they’ll get medicated – even if we think they might be seeking. What they usually won’t get is a prescription to take home.
A sample of a few of the patients I’ve advocated for in the past weeks:
For the eight-year-old with a dislocated shoulder and a major fear of needles:
AD: “Hey Doc, how about intranasal Versed and Fentanyl for the kid before you do the reduction? It’ll kick in faster than the IM morphine, and we’ll save him a needle stick.”
Doc: “Doesn’t the conscious sedation protocol require an IV?”
AD: “Yeah, but it doesn’t say you have to have an IV first. I’ll stick him when he’s nice and relaxed.”
For the sixty-year-old woman with chronic knee pain who insists on using us as her primary care clinic.
Doc: “She ain’t getting squat. She’s in here every month. Give her a 10 mg Toradol tablet and send her home.”
AD: “Just go look at her, Doc. She’s really hurting.”
Doc: “She has a phone. She could have called her own doctor for a refill.”
AD: “So she’s stupid. Doesn’t change the fact that she’s hurting, and besides, stupid people keep us in business.”
Doc (sighing): “Okay, fine. Give her 60 mg of Toradol IM, and an extra-strength Vicodin. But no scrip!”
AD: “You are truly dripping with the milk of human compassion, Doc. If calculus hadn’t kicked my ass, I’d have wanted to be a doc just like you.”
For the 26 year old Iraq war vet, discharged last year and literally trembling from head-to-toe with the DTs:
AD: “Hey Doc, aside from the banana bag and the thiamine, how about some sedation for this guy?”
Doc: “Not until we get his drug screen back.”
AD: “It’s been back for twenty minutes.”
Doc: “Okay, I’ll go see him in a minute.”
AD: “You know I love you Doc, but you’re not the one in there retching his guts out and shaking like a crack baby. The guy quit drinking cold-turkey and came to us for help. Let’s try to make him comfortable.”
Doc (sighing again): “Fine, 2 mg of Ativan IV push. Any other orders, Doctor AD?”
AD (blowing kisses): “Well, now that you mention it, some IV Zofran for his nausea would be just swell.”
For the girl with polycystic ovary disease, a UTI and way too many abdominal problems to mention:
Doc: “Are her abdominal CTs back yet?”
AD: “Nope. Probably take another thirty minutes. She says she’s still in severe pain.”
Doc: “She’s already had 10 mg of IV Morphine.”
AD: “And she’s still hurting, as evidenced by the piteous moans, writhing around and the BP of 160/94, heart rate of 126, and respirations of 28. Something tells me we ain’t making a dent, and that hypotension and respiratory depression are a long way off.”
Doc (rolling his eyes and writing the order): “Okay, 5 mg more of Morphine, and repeat it in ten minutes if she hasn’t gotten relief. And you are really starting to chap my ass.”
AD (winking): “Damn, that sounds painful. Would you like me to ask the doctor to order something to take the edge off?”
…and wait, and wait, and wait.
But, like Michaelangelo brushing away the last remnants of marble dust from somewhere near the vicinity of The David’s talleywhacker, Matt G. has finished his masterpiece, and shall unveil it Friday morning, along with Babs and Yours Truly.
In between pauses to learn how to ride a unicycle, moving his household, inventing cures for cancer and learning fluent Kurdish in Four Easy Steps, interspersed with bouts of existential angst – why am I here? What’s my purpose in life? Why the hell didn’t I write my part before I proposed the idea to AD? – Matt has finished his part of our little collaboration.
And a shaft of ethereal light pierced the darkness, angels sang and a booming voice announced from on high, “It is done.”
But that might have been Matt. Couldn’t really tell.
In any case, on Friday, July 27th, you’ll be able to read a story from three different perspectives – an ambulance driver’s, a cop’s, and an ER nurse’s. It’s a story we’ve all lived at one time or another, based on real people we’ve all encountered, and events we’ve all experienced.
Stay tuned. It’s gonna be good.
I straighten and turn to the woman standing behind me in the doorway, supporting herself on a walker with tennis balls on the legs.
“Is there anything that can be done?” the woman asks, her voice every bit as frail as the rest of her.
“I’m afraid not,” I tell her gently. “Nothing we’d try would work. He died sometime during the night, in his sleep.”
She nods silently as she looks at the body in the bed, her husband of fifty years. Behind her stands the staffer of the assisted living home who called us. She looks more emotional than the old woman.
The old woman lets out a ragged sigh and turns back to the living room, pausing to give the aide a gentle, sympathetic pat on the arm as she goes. She putters around the small kitchenette, arranging mail, placing her breakfast dishes in the sink, emptying coffee grounds and her husband’s uneaten breakfast into the trash.
I watch her as she moves about the kitchen as if no one else is there, as if her husband weren’t lying dead in the next room. She pours a cup of coffee, turns around and offers it to me.
“I suppose I need to call the funeral home,” she muses, speaking to no one in particular. I take the cup from her and pass it to Pardner, and steer the woman to the couch.
“I need to tidy this place up before the funeral home boys get here,” she mutters. “So much to do…”
“Ma’am.” I lay my hand gently on her arm. “Why don’t you let us do that for you? You shouldn’t have to worry with all this,” I tell her softly, gesturing to the nearly immaculate apartment behind me.
“If not me, then who?” she asks hollowly, looking me in the eyes. Pardner clears his throat.
“Ain’t there somebody we can call, hon?” he asks. “Family, maybe? A preacher?”
“No, there was nobody but us. He was all I had left.”
And then the tears come.
We sit there with her and wait for the coroner to arrive, me next to her on the couch and Pardner sitting in a chair, for the better part of an hour.
Not a word is spoken. But we stay anyway.
Her face is misshapen, the blonde hair plastered to her skull, still wet with blood. Her tongue is bloated, her face purplish. She had run straight through the stop sign, striking a pine tree head-on. She lay slumped over the steering wheel, pinned between it and the seat, her blood pooling on the deflated air bag. Her shoulder restraint is still in place.
“Goddamned prom parties!” he shouts, gesturing to the pinkening sky behind us. “Why the fuck else would she be out at this time of the morning?”
I say nothing, walking around the wreckage, playing my flashlight over the ground.
“Probably drunk off her ass,” he continues, veins bulging in his neck, “seventeen Goddamn years old and now her life is over before it even started!”
“No alcohol evident in the vehicle,” the deputy points out quietly. “You smell anything?”
“No,” I answer.
Did you know you can smell the alcohol in someone’s blood? You can.
“No skid marks, either,” the deputy sighs, pointing his flashlight back up the road. “She never even hit the brakes. Besides, she was a responsible kid. I’m thinking she fell asleep at the wheel.”
“You knew her? I asked.
As if on cue, a pair of headlights appears over the crest of a hill and grows steadily closer. The deputy removes the flashlight from his belt and signals the truck to go around us. As the pickup pulls abreast of the scene, passing just feet from the deputy, he freezes. The truck continues on for a few feet, and then skids to a stop with a screech of brakes.
A man and a woman bail out of the truck and run back toward the wreck. The deputy intercepts the man, and PTP and I are left to deal with the woman. I step in front of her and catch her before she reaches the car.
“That’s my baby!” she screams frantically as I try, and fail, to wrap my arms around hers. “Let me GO! Let me see my baby!” she screams as she flails at me impotently. There is nothing I can say to her, so I lower my head and let the blows rain down. None of them do any damage anyway. She’s not trying to hurt anyone. PTP moves behind her and tries to grab her hands.
I look over her shoulder and see the deputy with his hands on the father’s shoulders, forehead to forehead, saying something I can’t hear.
PTP and I manage to walk the mother over to the front of our rig, and she collapses in a heap, still crying and screaming “my baby!” hysterically. PTP’s eyes are moist and his jaw muscles bunch as he kneels next to her, one hand laid gently on her shoulder as she wraps her arms around her chest, trembling violently.
I walk to the side door of my rig, open it and pull the drug box across the floor to me. I withdraw a 5 cc syringe, fish the Valium out of the narcotics pouch on my belt, and draw up a full ten milligrams.
By the time I walk back around to the front of the rig, the father was there, sitting with his back against the front bumper of my rig, cradling his sobbing wife in his arms. His eyes run with tears as he holds his wife’s head to his shoulder, but he says nothing. The deputy and PTP stand there, watching mutely as I kneel next to her, lift the hem of her khaki shorts, and plunge the needle in her thigh. She doesn’t even flinch.
The husband meets my eyes as I stand up. I say nothing to him. I don’t have to. I just stand there quietly until the woman’s sobs start to wane. It takes longer than I thought it would.
The sun is shining and the wrecker has arrived by the time I can help the husband to his feet. His wife just sits limply against the bumper of my rig, eyes vacant and moaning tonelessly. We try to help her to her feet, but her legs are too unsteady. Her husband picks her up and cradles her to his chest and walks to the back of the rig. He doesn’t even wait for us to unload the stretcher, just climbs into the rig and gently deposits her on the cot.
I wipe the tears and snot from her face and brush back the wet hair plastered to her cheek, and spread a blanket over her as her husband sits on the bench seat and holds her hand, staring blankly at his reflection in the plexiglass cabinet doors.
“Where will you take her?” he asks, breaking the silence, his voice low, harsh and strained.
“I meant my wife.”
I blush in shame and mentally kick myself.
“I’m sorry, Sir. We’ll take her to Podunk, if that’s all right with you. They’ll keep her overnight, keep her sedated. I’ll get you some contact info for some grief counselors, if you’d like.”
He doesn’t answer right away, just stares down at his wife. After an uncomfortable silence, he speaks again, still processing information from five minutes ago.
“An autopsy? Why do…I mean she’s still in her…how do they get her…”
“We’ll take you and your wife to the hospital, and another crew will get your daughter out of the car. The fire department will come, and they’ll extricate her. Afterwards, one of our ambulances will take her to Bossier.”
He nods silently, and I watch as his lips start to quiver. He squeezes his eyes shut, and huge tears roll down his cheeks in single file, and drop onto his knees one by one.
“I don’t want strangers seeing her,” he says pleadingly. “Will you ask Danny to stay with her?”
So that was the deputy’s name. I can never remember.
“She won’t be gawked at,” I promise him. “The men that will get her out all have families, daughters of their own. They’ll be gentle, I promise. And I’m sure Danny will supervise things.”
“Insurance cards.”
“Excuse me?”
“No, Sir.”
You will never see a scrap of paper from our ambulance service to remind you of this day. I’ll lose the run report entirely, if it comes to that. But it won’t. The Boss understands things like this.
“Who is going to take my little girl to…Bossier, you said? Do you know who it will be?”
“If you’d like, I’ll take her there once we get your wife settled in at the hospital,” I offer. “I’ll do it myself.”
Thanksgiving Day, 2001
“Can you think of anything else?” I look around at each face surrounding the man’s body. Everyone shakes their head.
“Four epi, three atropine, fluid bolus, tube placement is good even though end-tidal CO2 never got better than 10,” Paramedic Student Partner summarizes as she does compressions. “Blood sugar is okay, bicarb did nothing, and she’s got a purple face and shoulders. I’m thinking pulmonary embolus.”
PSP is showing promise, and she’s starting to put it all together.
“And still asystolic after twenty minutes of working it,” I finish. “Okay, I’m making the call.”
I flip open my personal cell phone and call Dispatch for a patch to Podunk ER. We always do things like this over a recorded line. I walk to the far side of the living room and turn my back to the family.
“Hey Doc, this is AD on Medic Four. We’re on scene with an asystolic arrest, been working it twenty minutes now. Down time prior to our arrival was over ten minutes, with no CPR. Got a tube, got two good lines, four epinephrine, three atropine, and one bicarb on board. Rhythm never changed from asystole. I’m thinking she threw a clot. Requesting permission to terminate efforts.”
“What’s her history?” Doc wants to know.
“Non-insulin dependent diabetic, hypertensive, smoker, age fifty-four. Not much else, according to the family.”
“Helluva a way to celebrate Thanksgiving,” Doc grunts. “All right, call it. Family taking it okay?”
“We’ll see,” I answer. “We may be calling you back.”
“Just put me on the phone if you have any problems,” Doc offers, then Dispatch breaks in on the conversation.
“Coroner’s been notified, Medic Four,” she offers helpfully. “They’re en-route to your location.”
“Thanks, Dispatch.” Not all dispatchers are like Satan.
I tuck my phone into my pocket and walk over to the woman’s daughter, standing there in the doorway between the dining room and the den, the food still on the table in the room behind her. She has stood there and watched the entire scene without changing her expression; eyes red-rimmed and tearful, hands clasped over her mouth, she has leaned against the door frame and watched in mute horror as we tried to resuscitate her mother. Her son-in-law had taken the woman’s hysterical granddaughter to another room shortly after we arrived.
I place my hand on the daughter’s arm and can feel her trembling. She tears her eyes away from the EMTs and firefighters doing CPR and looks at me questioningly.
“I’m sorry, Ma’am,” I tell her gently, “but there’s nothing else we can do. Anything else we could try would be fruitless.”
She looks from me to her mother’s body, and back. “That…that’s it?”
“Her heart had stopped beating before we got here,” I explain. “By the time we started CPR, there was no electrical activity in your mother’s heart. If there had been, maybe we could have revived her. Maybe not. But when there is no electrical activity, there’s not much medicine can do to fix that. We’ve tried all the drugs we can, the same ones used in the hospital. Nothing has worked. At this point, we’re just abusing her body.”
“No…no chance at all?”
“No Ma’am,” I say softly, and then I say The Words. “I’m afraid she’s dead.”
At that, she walks back into the dining room and collapses into a chair, folding her arms on the table and burying her head. Her shoulders shake with sobs. I motion for PSP and the firefighters to stop what they’re doing, and walk down the hallway in the direction taken by the son-in-law. I find him in a room at the end of the hall, sitting on a brass daybed, stroking his daughter’s hair. She is almost asleep, her cries slowed to the occasional snubbing of a heartbroken child.
“I’m sorry,” I whisper, answering the question in the man’s eyes. He nods sadly, looking tenderly at his daughter. He sighs and gingerly gets off the bed, successfully avoiding waking his daughter. It’s a little girl’s room, but not this little girl’s. From the looks of the photos, stuffed animals and 80’s vintage posters on the walls, this was once her mother’s bedroom.
“I figured she was gone,” he tells me quietly as he shuts the door behind him, “but thank you for trying.”
“I wish the ending could be different,” I offer. “Sometimes it is, but most of the time we can’t get them back.”
We pause at the entrance to the living room, and he watches as PSP and the firefighters gather up the assorted detritus of a resuscitation and rearrange the furniture we moved.
“We have to leave the breathing tube and the IVs in place,” I explain, “until the coroner gets here.”
He nods absently and looks at his wife, still with her head down on the table. “What happens now?” he wants to know.
“The coroner comes and does his investigation, and then he’ll call whatever funeral home you request. We have to stay here until he arrives. We can call a family member or your minister if you’d like.”
“Okay,” he nods.
“We’ll wait outside,” I offer. “Give you some time alone with your family.”
“Thanks,” he sighs, looking at his mother-in-law’s body lying on the living room floor under a sheet, “but I think we’ll wait outside instead.”
Jeremy Dodge was close to my age, just twenty seven. He had suffered a devastating brain injury in a motorcycle accident when he was sixteen. The strain of caring for Jeremy had taken its toll on JoAnne Dodge. It very nearly ruined her financially and broke her marriage. Through it all, JoAnne cared for her son with an unwavering faith.
We first met him when the home health agency had called us to transport him to the hospital.
“What for?” we had asked.
“He needs an IV access,” the nurse had explained, “and I can’t find a vein.”
“He’s going to the ER just to get an IV line? What if we can get one right here? Can he stay home?”
“Well sure, if you think you can get one,” the nurse had said dubiously.
One stick later by my partner, Vascular Access Wizard, and we had made a new friend. Even the home health nurse had been grateful.
We cared for Jeremy Dodge for five years. On duty or off, day or night, one of us would run over to the Dodge house when they called. We only transported him when we had to, and we got to know JoAnne and her other children, Jeremy’s half-sisters.
The official medical opinion was that Jeremy Dodge was profoundly brain-damaged, and only minimally aware of his surroundings.
We knew better. We could tell when he was happy or sad, and all of the pretty nurses had learned never to lean over Jeremy too closely. Even contracted as he was, he could grope a boob with unerring accuracy.
Eventually sepsis took him, as it does so many bedridden patients. JoAnne had called, desperation in her voice.
“He can’t breathe!” she had blurted desperately. The home health nurse had taken the phone from her and told us what was going on. So Pardner had swung by my house and picked me up, and we had beaten the ambulance there by ten minutes. Even then, we weren’t quick enough.
Heather, the home health nurse, had cleaned Jeremy up by the time we arrived, and the look in her eyes told me all I needed to know. JoAnne and her daughters had composed themselves, and Jeremy was no longer breathing. A quick pulse check of my own confirmed what Heather’s eyes had told me, and I tucked the kid’s arm back under the covers.
“I’m sorry, JoAnne,” I said as I knelt next to her rocker and hugged her. “I wish I knew something more to say.”
“Sorry for what?” she asked, a warm smile breaking through her tears. “This is a time to rejoice, not grieve. I’ve grieved for my son for eleven years. Now he’s sixteen again, healthy and whole.”
“I believe that,” I tell her honestly.
“Are you a Christian, AD?” she asks. “All this time, and I’ve never asked.”
“Yes, Ma’am,” I answered. “I am. Not as good a Christian as I should be, but I believe, yes.”
“The doctors all say that Jeremy wasn’t aware of anything. He had never been Baptised before the accident. I didn’t find my faith until after it happened. He was born out of wedlock, you know.”
“Yes Ma’am, you told me.”
“Do you believe people can go to Heaven if they’ve never accepted Jesus as their personal Lord and Savior? My religion says no.”
“I believe in a loving and merciful God,” I tell her, “one who wouldn’t condemn Jeremy as he was. So yes, I believe he’s in Heaven.”
“So do I,” she smiled with utter conviction. “So do I.”
“Tell ya’ what I believe,” Pardner broke in laconically. “I figger Jeremy wouldn’t be sittin’ here gettin’ all weepy like this, wonderin’ if he’s with Jesus or not. He’d be up, actin’ up and bein’ a sixteen-year-old kid. Then he’d grab Heather’s boob.”
And we all laughed uproariously and listened to funny stories of Jeremy’s childhood, many of which we had heard before. When the coroner arrived, he thought we were all nuts.
Not that I wanted to touch her. She was smeared from head to waist with AIDS infected blood. In 1994, during the height of AIDS hysteria, death lurked behind every exposed needle, every splash of blood or bodily fluids. People believed you could get HIV from a toilet seat or an infected mosquito back then. I wasn’t taking chances, not at first.
She had contracted the virus from a boy she met in college. Her parents, highly religious people, had shunned her when they found out she had AIDS. Her first inkling she had the disease was when she got sick for the first time. That cough and the weight loss…well, it wasn’t just HIV, it was full-blown AIDS.
So she sought solace from her family, and her parents cast her out like so much garbage. Not only did their daughter have that homosexual disease, she had fornicated with a man outside the bonds of matrimony. She was dead to them.
And they were probably right, if a few years premature. The cocktail wasn’t widely used back then, or at least I hadn’t heard of it. So she had tried to speed things along in their front yard, by taking a knife to her wrists. For a first-timer, she did a pretty fair job.
I’ll never forget the coldness of her father as he had stood there behind that screen door and watched his daughter lie bleeding on the lawn.
“Get her out of here,” were the only words he had said, a curt directive before closing the door in our faces.
I learned all of these things about her on the thirty minute trip to the Big City, in between her broken sobs and her whispered conviction that she was going to Hell. I don’t remember saying a word. What was I going to do, tell her she was wrong? Her entire religious upbringing told her otherwise.
Her own father had told her she was damned.
So she sobbed and she talked, and she begged me to understand, and I tried to smile comfortingly and answer with my eyes.
Kind of hard to do that behind a mask, though.
Somewhere along the way, she grabbed my hand and held it, and I resisted the urge to pull away. So I put away my forms and my clipboard, and I sat there next to the cot and I held her hand all the way into the ER.
Held her hand all the way through the hand-off report, too. I had to pry her fingers away from mine. I wished the gloves hadn’t been so thick.
The nurse I handed her off to was one of those stern old battle axes who had known Florence Nightingale personally and been working the ER since Hippocrates was an intern. Frankly, she scared me a little.
But when she leaned over that stretcher, there was no judgment in her eyes, and she was as soothing and motherly as the girl’s own mother should have been. An angel, if a stern one. She took her vital signs and cleaned the dried blood off her face and arms and disposed of her bloody clothes and put her in a gown.
I stopped in the EMT lounge before I left and grabbed a couple of Cokes from the ice chest. I ducked into her room, opened one of the Cokes and sat it on the procedure tray next to her bed. I still don’t think I said anything.
But she was able to see my face and eyes, and I clasped her hand again before I left.
Without the gloves.
You’ll read the words of Elizabeth Kubler Ross, if you haven’t already, and you’ll be taught how to recognize and deal with the five stages of grief. You’ll be taught to use words like “death” and “dead” and to avoid platitudes and euphemisms like “passed on” or “in a better place.”
And all of that will fail if you do not feel compassion. If you do feel compassion, most of that knowledge will be rendered irrelevant. Don’t let the grind of your education beat the compassion out of you.
Compassion is the one thing that traverses all cultural and religious boundaries. It is universally understood, be you atheist, Christian, Muslim, Hindu, Buddhist or Pagan.
And it need not always be expressed in words.
Hope that answers your question.
Ripped Dumbass Medic a new one, that is. Had a clash of wills with Glacier Doc as well.
As promised, the dressing down of Dumbass Medic was loud, verbally eviscerating, humiliating and embarrassingly public.
It was also very wrong and unprofessional of me.
*sigh*
Folks, I let my temper and my unreasonable standards lead me to commit a Cardinal Sin of health care the other night.
You never question another provider’s treatment of a patient* in public, and you never, EVER do so in front of the patient.
I did both.
Never mind that Dumbass Medic’s testicularly-deficient decision to bring the patient to Podunk General ER rather than a stroke center thirty miles further away virtually assured the patient of a bad, permanently debilitating outcome, it was the epitome of arrogance to state so in a hallway in full view of a dozen witnesses and the poor patient.
Understandably, Dumbass Medic did not react well to the public humiliation. An argument ensued, and the Ex-Missus had to step between us. Twice.
Occasionally, my arrogance can lead me to be an utter ass.
After cooling off and taking care of the patient (like I should have been doing in the first place) I approached DM and apologized. I had already tried once, which led to the second time we had to be separated.
“Stay the fuck away from me, AD,” he warned. “We’re gonna have this out between us, but right now I’m too mad to talk to you.”
I didn’t say anything right then. I walked down to the vending machines, bought us a couple of Cokes and came back. I remembered the times I’ve sweated my ass off working to stabilize a patient by myself and then had some pompous asshole in the ER look down his/her nose at my efforts.
“Look,” I told him. “I’m an arrogant prick, and what I did was wrong. I have my differences with the decisions you made, but it was wrong and extremely unprofessional of me to do that to you in public. I’ve been in your position when some prick dressed me down over my patient’s stretcher, and I came damned close to knocking the stupid out of him. I’m sorry for how I behaved, and it’ll never happen again.”
He just looked at me for a moment.
“The apology stands whether you choose to report me to my supervisor or not,” I continued. “My supervisor already saw the whole thing. I’m not saying this because I’m scared of the repercussions. I’m apologizing because I was wrong and I want you to know that.”
At that, he just sighed and shook my hand.
“I don’t make these policies, you know. I just have to follow them. I know just as well as you where I should have brought that patient, but unfortunately that isn’t where I could bring the patient. I don’t like it any better than you do.”
Fair enough, I suppose. I still don’t think much of Dumbass Medic’s EMS chops, but on that night, he was more professional than I was.
Back in the nurse’s station, I plopped down next to Ex-Missus to catch up on some charting.
“That was completely unacceptable, and it had better never happen again,” she remarked calmly, without taking her eyes off the chart she was updating. “Do we understand each other?”
“Completely,” I told her. “So do I get a verbal warning, written warning, suspension, or what? I’ll take whatever I have coming. I’ve already apologized to DM.”
“This is all I’m going to say on the matter,” she answered, “and I knew where you were going and why when you walked down the hall. I do know you better than most, you know.”
“I was wrong in the way I handled it,” I tried to point out, “but I wasn’t wrong about what he did.”
“You know what your problem is?” she sighed. “You insist on holding everybody to your standard, and that’s not one many people can meet.”
I chewed on that one for a while. It’s not the first time she has pointed that out to me.
I was spoiled in that I helped build a system in which the EMTs and medics were expected to use a great deal of clinical judgment and were afforded much more trust and responsibility than at just about any ambulance service in Louisiana. It was a great place to learn and grow as a medic.
Not every place is like that. A great many systems do not trust their medics to use their brains, and to be fair, often for good reason. I worked in such a system in my years at Huge Soulless Corporate Conglomerate EMS.
“This is not about you being a good medic, this is about you being a good employee,” was a refrain I heard rather often from the Operations Manager, who was an excellent employee, but a piss-poor medic. At that agency, the two terms were mutually exclusive.
Still, I quite often ignored our more inane policies and cookbook protocols and did what I thought was best for my patients. My trump card was that I was almost always backed up by the doctors, virtually all of whom I knew. They held me to a higher standard than the other medics.
Such trust is flattering, to be sure, but other medics I know, worthy medics, have gotten into trouble for doing some of the exact things I routinely get away with, simply because the doctor does not place the same degree of trust in them.
And then of course, they got beaten over the head with the same unyielding policy and procedure manual that I routinely flouted.
Not exactly fair, I know, and expecting other medics to operate the same way I do just rubs salt in the wound.
The nickname “Doctor AD” got stuck on me early on. About 75% of the time, it’s a term of respect.
The other 25% of the time, it means, “AD thinks he’s better than the rest of us because he’s so chummy with the doctors, they’ll let him get away with anything.”
They have a valid point there, and as I proved the other night, sometimes I’m just not worthy of the respect I get.
Glacier Doc knew he wasn’t liked by most of the staff. After taking every little miscommunication as a personal affront to his intelligence, religion or manhood, he had vowed never to work here again. We were fine with that. The feeling was mutual.
Like many ERs, we use a physician staffing agency. Unlike many ERs, we have a good deal of influence over who gets assigned to work here. Glacier Doc got a second day at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut because of a glitch in the schedule. The agency was unable to fill his remaining shifts there.
Fine. I can work with any asshole for one shift, and despite the fact that he’s all about politeness and civility as long as you’re not a woman or disagreeing with him, I had not yet gotten on his bad side.
That changed the other night. After a night of his patented forty-minute patient histories, ridiculously extensive workups and utterly unnecessary consultations, all our nerves were on edge.
We had already had four LWBS (left without being seen) patients due to his leisurely pace, and at Podunk ER, LWBS patients are a Bad Thing. Administration gets cranky.
He had already flung the pink leg* on me by demanding that I chart that one of the LWBS patients had been sitting in the waiting room for three hours because there were no available ER beds.
I told him I would, when I got around to c
harting. At the time, I had an acute stroke patient in one bed and an active MI in the other – both of whom I was solely responsible for, other than the occasional look-see by the equally harried nurse with equally sick patients.
But nooooo, this Asshat demanded that I do it right then, because he was leaving in two hours, never to return, and he didn’t want me to leave him hanging out to dry on it.
One does not accuse Ambulance Driver of lying, or creatively charting to paint a poor picture of someone else. It ranks right up there with questioning my intelligence in the Things That Get Your Ass Whipped pantheon.
But I counted to ten, took a few deep breaths, sang Kumbaya with my Inner Child, and did as he requested. With a smile, no less.
Not ten minutes later, the clerk informed us of the fourth LWBS patient.
Glacier Doc slammed his palm down on the table and said, “This is an Emergency Department! We take care of very sick people here! You people must move faster! I am tired of being the only one doing any work here!”
I put the ER nurse at Big Chest Pain Center on hold, duck-walked my chair over to his until we were sitting knee-to-knee, and leaned very close. If I had violated his personal space any more, we’d have been French kissing.
“You slap that fucking table one more time and snap at anybody here, and I’m going to snap back. You will find out very quickly just how fast I can move. I suggest that for the next two hours, if you want anything from me, you will write it on the order form and put the chart in the appropriate slot in the chart rack, and I will carry out the orders. Do. not. open. your. mouth. again.”
And he didn’t.
*when the standard red-ass becomes so bad that it creeps down into your thighs.
You might want to check out Blue Ridge Medic’s blog:
“I opened the drivers door, got in and shut it. I put one hand on the key to start the truck and the other underneath the seat. When the door opened (I had a feeling it would at any minute), I was ready. It was yanked open and there he was, the same motherfucker that I just gave money to. I yanked my peace and stuck it about 1/2 inch from his beady little eyes. It’s amazing the amount of white that I could see. I don’t remember the color of his eyes, but I do remember the acres of white as he stared into the barrel of my 40 cal.I wished I could have come up with something catchy to say. Something like Bruce Willis or Clint Eastwood would have said. But this is the real world and I am not afraid to say that I was scared shitless. The only thing I could say was “I don’t want any trouble.”
Guess what? He didn’t find any.
Had he not been armed, I’d bet it would have been otherwise.
When mean nurses and doctors cast aspersions at your competency and character, I defend you.
When they ask why you bring obvious surgical patients here, instead of the hospital with a frickin’ surgeon that is only ten minutes further away, I say, “Perhaps he thought the patient was hemodynamically unstable, and thus had to choose the closest hospital.”
When they deride the vital signs and physical examination findings you report, I reply, “Have you ever tried to take a blood pressure in a moving ambulance? It sounds like Powerstroke diesel engine.”
When the patient presents with an altogether different complaint than what you reported, I remind everyone of the times when, after calling report, aliens have kidnapped my patients and replaced them with an exact duplicate with an entirely different chief complaint.
When we catch something crucial that you have missed, I remind everyone that history rarely repeats itself, especially Patient History.
When they question your education, I remind everyone that Former Student often does the same things you do, and we all know he had a world class paramedic instructor.
When they say, “Dumbass Paramedic would eat a shit sandwich,” I jump to your defense and say, “I have first-hand knowledge that he abhors the taste of bread.”
When you bring in patients and have no clue what is wrong with them, I remind everyone that many patients are poor historians.
When you botch the intubation, I point out that adequate ventilation is the Gold Standard, and that you should be commended for resorting to a Combitube so quickly.
When I overhear you remark to your partner, “AD has forgotten what it’s like on the streets,” I refrain from pointing out to the impressionable EMT that each and every time I get off the toilet, I flush into the sewer more EMS expertise than you currently possess.
When you miss an IV twice, yet I, with my meager IV skills, am able to dart the patient with a 14 gauge from across the room, I remind everyone of the Three Attempt Rule, which states that if two providers have unsuccessfully attempted a procedure, the third provider, regardless of skill level, will be successful on the first try.
But when you bring me an obese patient with a known history of gastric reflux and inability to lay supine, collared and boarded from a motor vehicle collision in which no damage occurred, which you yourself described as “a bullshit insurance wreck,” and the only justification you can offer me for the spinal immobilization is “it’s our protocol,” you mark yourself as a Dumbass of the First Order.
Not just ordinary dumbass behavior, but dangerous dumbassery.
And while I am busily trying to prepare suction and turn the boarded Land Whale onto his side to prevent him from aspirating his own vomit, it does not behoove you to stick your clipboard in my face and ask for a signature, no matter how politely you do it.
And if you ever do such things again, Dumbass Paramedic, I am going to come down on you like the Hammers of Hell. I am going to ridicule you loudly and publicly, and do so in front of the patient you coerced into a needless and uncomfortable procedure by scaring him with threats of death or paralysis.
I am not going to report you to your supervisor, Dumbass Paramedic, because a competent medic at your agency would stand out like a syphilitic talleywhacker at a short arm inspection, and all of your comrades, save one, are just as fucking stupid.
No, I’m going to expose you for the piss-poor excuse of a paramedic you are, to everyone in earshot. I may even take out an ad in the paper and hire a skywriter. Never again shall I politely, discreetly and privately take issue with your actions.
It’s going to be shockingly, embarrassingly public.
And then I’m going to rip off your head and eat ice cream from your empty skull, you synaptically-challenged, knuckle-dragging, mouth-breathing, retarded chimp wearing a paramedic patch.
Oh, and Glacier Doc? If you ever again order cervical and head CT scans for that patient with no loss of consciousness, no significant complaint, totally absent mechanism of injury, no clinical exam criteria indicating the need for radiology at all…
…while I’m trying to keep this guy from choking for the thirty minutes it will take for the radiology service to fax us a CT report…
You’ll be next.
Asshat.
I’ve been there before, and today I’m kicking myself for not linking and adding her to my RSS feeds way back then.
Y’all welcome Skywritings to the Blogs I Read Every Day.
Glacier Doc, despite his solemn vow to never again grace our hospital with his presence, and our earnest attempts to assure that would indeed be the case, is back.
First patient he saw tonight: non-traumatic lower back pain. Unremarkable history. Normal neuro exam. No motor weakness whatsoever. No significant previous medical history. Passes the “that chick doesn’t even look remotely sick” test.
Total time spent in the ER, starting when we put her in a room?
128 soul-searing, teeth-grinding minutes, 35 of which were spent doing the initial history and physical exam. One x-ray of the lumbar spine. One shot of Toradol. One entire page of instructions that boils down to “apply moist heat, take ibuprofen for pain, see your personal physician to schedule an MRI if symptoms do not improve.”
I overhead him apologizing to the DON for some issues we had with his not knowing what the fuck he is doing approach to patient care, and he earnestly assured her that he would not be so aggressive in the future and would resolve to take a slower, more thorough approach to patient care.
Yeah, you read that right.
He plans to work slower.
That sound you’re hearing right now is me methodically beating my head against the desk.
From Reuters:
Scans of the 44-year-old man’s brain showed that a huge fluid-filled chamber called a ventricle took up most of the room in his skull, leaving little more than a thin sheet of actual brain tissue.“He was a married father of two children, and worked as a civil servant…”
Heh. Uniquely adapted to his job, I’d say.
A little more fluid, a little less brain tissue, and you’ve got Jacques Chirac. I wonder what his CT scan would look like?
Edit: I had no intentioning of impugning civil servants, of course. What I meant to say, he was uniquely adapted to be an elected civil servant. Either that, or one of those fine civil servants who work at France’s version of the DMV.
Never before in the recorded history of man has baby talk been delivered with such gravitas.
Go. Read.
There is a Beverage Alert in effect.
While you’re at it, welcome Queen of Dysfunction to the Blogs I Read Every Day.
Your spirit animal is the noble elk. They are the most adaptable of all, and only guard those with great wisdom and understanding. The elk is a highly noble creature, and has a strong spiritual force that will guide and protect you well. You are truly blessed to have such an amazing and mystical spirit animal. It is extremely rare to have an elk as a spirit animal.
***Wondering how this animal was chosen for you? These questions were carefully thought out to see how important you hold certain virtues such as: humanism, self-knowledge, rationalism, the love of freedom and other somewhat Hellenic ideals. Some of the questions were very subtle. Your score was then matched with an animal of corresponding nobility. However, you shouldn’t think this was a right/wrong sort of test, but more of an idealistic values test. It’s ok to not hold these values, you’ll just get an animal spirit of lower stature if you do!***
| Link: The What is Your Spirit Animal Test written by FindingEros on OkCupid Free Online Dating, home of the The Dating Persona Test |
Will I go to Hell if I plant a 170 grain bullet just behind the shoulder of my spirit animal, cut him into freezer-sized pieces, and enjoy a medium-rare steak of his flesh as I gaze upon his majestic head mounted over my fireplace?
Just wondering.
If you throw this blog down a well, and have someone hold you upside down and look down the well with a hand mirror…
…you can see Jude Law and Nicole Kidman doing really bad Southern accents.
That’s because this is a Reflective Blog, and I’m not referring to the Scotchlite trim on my snazzy jumpsuit.
Seriously though, it’s a honor to be considered a Schmoozing, Thinking, ROFLing, Reflective blogger, and I’d like to thank all the little people I’ve stepped on to get where I am today, especially John, the faithful reader who tagged me.
So far, the only one I haven’t received is the Rocking Girl Blogger award, and qualifying for that one would require surgery.
[cue all the de rigeur sarcastic comments about it being microsurgery]
Besides, I make a pretty convincing woman with the right makeup and ensemble.
Now the rules of this meme award require that I actually post the rules, so here they are:
“This award should make you reflect on five bloggers who have been an encouragement, a source of love, impacted you in some way, and have been a Godly example to you. Five Bloggers who when you reflect on them you get a sense of pride and joy… of knowing them and being blessed by them.”
Well first of all, I’m not passing this one on. Of the bloggers I name, whether they choose to accept it is purely voluntary, so I’m not going to leave comments on their blogs, either. The most reflective bloggers I know are also the least likely to pass on the award. They may not even share all my religious and political leanings. But what they do, without fail, is make me reflect on my own beliefs, and people like that are inspirational to me.
Yeah, I know that violates the rules, but I’m a rebel that way. That’s just how I roll.
Hear that ladies? In addition to being Thinking, Schmoozing, ROFL funny, Reflective and knowing twenty different ways to make your heart race and just as many to slow it back down, I am also a Bad Boy.
Think Winnie the Pooh in black leather. Rowr.
Now I normally pass these on to the less popular names on my blogroll, but this time I’m bucking my personal convention somewhat.
LawDog comes first. I have no idea of the religious beliefs of the Blogfather, nor do I care. But he has been an inspiration, and continues to be. He’s principled, thoughtful, a gifted writer, and laugh-out-loud funny. Any of his readers know that.
Matt G., despite being the world’s worst freakin’ procrastinator, is another source of inspiration. He’s a Southern Gentleman in the classic sense of the phrase. Matt just gets it. Doesn’t even matter what subject it is, Matt always has something insightful to say. Yeah, he may look like a hairier version of Bull Shannon from Night Court, but he’s a deep thinker, make no mistake.
Marko, like LawDog, is another enigma wrapped in a riddle shrouded in mystery. I have no idea of his religious beliefs, and again, I could care less. The man’s humanity and strength of character are obvious when you read his blog. It also helps that he’s a talented writer with a gift for debate. He’s so damnably logical that I think of him as the Mr. Spock to my Bones McCoy, but it’s nice to know that he’s also subject to the baser emotions that rule the rest of us. Just makes him all the more interesting, in my opinion.
#1 Dinosaur is, in his own words,
A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I’m not dead yet.
I’m Christian, and unless I’m mistaken, Dinosaur Doc is Jewish. No matter. We worship the same God, and both share the opinion that medicine is a higher calling, and not just a job. He’s the kind of doctor I’d go to myself, and that is praise not lightly given. His blog always has something insightful or inspirational in some way. As case in point, read this post reflecting on the perception of beauty, and if you don’t think that child is beautiful just as she is, you just won’t get it.
And finally, there’s Janean. Hers is just a simple blog, populated with the vignettes of her daily life. No high-minded political commentary, no rants, no lowbrow toilet humor. Just the miscellaneous musings of a single Mom living her life out there in the Pacific Northwest.
So why do I read it? Well, if you point your gaze toward the upper left corner of our country, up there among those rain clouds, fog and perpetual drizzle, see that bright ray of sunshine up there in Williamette Valley, Oregon?
That’s Janean.
…alternatively titled “AD Lays The Smackdown On A Snurse Manager.”
Snurse = Stupid Nurse, in case you were wondering.
For the past two weeks, I have been teaching classes every day I haven’t been working, which explains the dearth of posting over the past five days. Fatigue, coupled with not seeing KatyBeth nearly as often as normal, has had me totally drained.
I’ve been so tired that even the prospect of sitting nekkid in the beanbag chair, watching Skinemax and eating Cheetos hasn’t seemed appealing.
So the Cranky Switch was set on HI this weekend for the PALS class I was teaching. To make matters worse, my lead instructor’s truck went Tango Uniform one day prior to class, another instructor’s Mom had a heart attack, and that left your humble scribe teaching Pediatric Advanced Life Support to 16 eager students all by his lonesome.
*sigh*
Now all it takes these days to teach an American Heart Association class is a brainstem and an index finger to push the PLAY button on the DVD player, but I still like to, you know, teach during those moments when they allow us to pause the Boring and Absurdly Simplistic(TM) video and discuss things.
Normally, with the appropriate cadre of instructors, I’d have broken the class into three or four smaller groups to cover the material. Small groups make for better discussions and interaction anyway. Unfortunately, aside from about three hours generously provided by the Ex Missus, I had them all in one big conference room.
Now I’m a fairly entertaining speaker. I can hold the attention of a few hundred people and get my laughs along the way. I can usually draw even the shyest, most timid new nurse grad into the discussion, or pique the interest of the grizzled dinosaur who has taken the same class ten times before…
…except for that one person, the one that doesn’t want to be there.
Those people generally fall into the category of Turds. They tend to stink up the entire class.
I have an educational philosophy that simply states: You Can’t Polish A Turd.
Any attempt at polishing will only serve to smear feces on you and the rest of the class. Turds should be flushed, and quickly.
This particular Turd was a nurse manager for a med-surg unit at Nearby Big Hospital. She was being required to take the class for work, and didn’t see the utility of knowing anything about pediatrics. Her unit doesn’t do kids, but the class was required of her for one reason or another.
To top it off, she was forced to travel an hour or so to take the class at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut, rather than take the pathetic exercise in rote memorization quality class typically offered by her own facility.
And when she gets to class (ten minutes late), she discovers, much to her chagrin, that the whole thing is being conducted by a – *gasp* – Ambulance Driver!
I recognized the Turd stench the moment she walked in the room, but I gave her the benefit of the doubt. I am not one of those Old ACLS Biddies who likes to walk into the room and imperiously announce before class begins, “Some of you are not going to pass this class!”
Oddly enough, the majority of Snurse Educators I’ve met believe such statements to be an excellent motivational tool.
So throughout the first couple of videos, I tried to ignore the Turd’s not-so-whispered conversations with her neighbors. I even ignored the bored and disinterested expression and disdainful looks she gave to her classmates whenever they tried to contribute something meaningful to the dialogue. I tried all the commonly used tactics they teach you in those superficial little AHA instructor courses about how to engage the Bored Advanced Participant.
Problem is, she was definitely bored, but she certainly wasn’t advanced, and calling her a participant stretches the definition of the word.
I played nice, right up to the point she started casting those disdainful looks and sighs in my direction. I can deal with the fact that her facility made her come against her will. I can commisserate that they’re holding her incentive pay as ransom.
But one does not exude an air of intellectual superiority to this Ambulance Driver, particularly when he is trying to teach you something, because unless you are a pediatric intensivist or a grizzled PICU nurse who has been there and done that, I can almost certainly guarantee that I know more about the subject than you.
So I got medieval on the heifer.
AD: “Snurse Manager, why don’t you expound on seizure management for the class? I’m sure you have something to add to the discussion. Tell us the clinical presentation of a patient with complex partial seizures, as opposed to say, simple partial seizures or tonic-clonic generalized seizures.”
Turd the Snurse Manager: “Huh?”
AD: “I’d like you to share your experience with the class. What’s the difference between a simple partial seizure, a complex partial seizure, a generalized absence seizure, and a generalized tonic-clonic seizure?”
TSM: “Uh, what happened to grand mal and petit mal seizures?”
AD (rolling eyes and sighing): “Timid New Nurse Graduate (who had been paying attention), educate your colleague.”
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