Ahhh, the wondrous fun you can have with Sitemeter, when you’re bored enough to check the referring URLs to your blog.

Welcome to my blog, O Incontinent One! And let me say that I am flattered – nay, honored – to be Google’s #2 result for your search term today.

It just seems fitting, somehow.

Have a seat over there on the couch next to the guy that got here by Googling “MILF Fairy.”

Don’t worry, it’s Scotchguarded.

Watch this blog (and others) in the coming weeks. There’s gonna be something special.

Almost perzackly a year ago, a certain blogger came up with a novel idea for a series of linked posts, all telling of the same incident from the individual perspectives of the people involved. The idea was a resounding smash.

Thus, Perspectives was born.

Actually, it was about fifteen months ago when Matt G. came up with the idea. It just took him three months to actually write his post. [zing!]

We did an encore six months later, enlisting LawDog’s Perspective because presumably Matt was still cogitating over suitable subject matter for his sophomore effort.

Well, it’s been a year and Matt is probably still cogitating (it’s a weighty burden, being a tortured artiste like Matt G., but I’ve learned that you can’t rush genius), but I think it’s time we did another installment.

I offer no details as of yet, nor a firm deadline. I will tell you that the subject will be serious, and that the lineup promises to be quite fantastic.

Stay tuned.

I’m a cellar dweller. There, I’ve said it.

They say that admitting the problem is the first step on the road to recovery, and in that spirit, I have decided to come out of the closet on my shameful record of obtaining refusals.

Now what is a refusal, you may ask? Good question.

Simply put, a refusal is a signed document stating that a potential patient (what exactly constitutes a patient is a matter of some debate) does not want an ambulance to transport him to the hospital for treatment of crotch rot demonic possession stubbed toe toothache for one month whatever ailment led to the desperate call to 911 for we stalwart EMS heroes to save the day.

The problem is, not everyone wants to go to the hospital in the bolance. Some indeed need to go, yet are reluctant for whatever reason, while others need an ambulance ride only slightly less desperately than they need forced sterilization and banishment to a deserted south Pacific island.

It’s the second category that I have a problem with.

I’m good at convincing those reluctant souls that need to go to a hospital. I’m a persuasive fellow. In the event that persuasion fails, I’m adept at documenting the considerable lengths I went to convince them that ambulance transport was in their best interest:

Ambulance Driver: Sir, in my professional medical opinion, you need to be evaluated by an emergency physician and perhaps a neurosurgeon for your injuries.

Head Injured Patient: Fuck you, Amma-lance Boy. I ain’t goin’ in no meatwagon. ‘Sides, it’s just a scratch. My cousin had the same thing happen to him, and he’s fine now. Ain’t that right, Cuz? Drool for the man!

AD: Sir, if that clear fluid were only draining from your nose, I’d say it was simply snot. But it’s draining from your ears, too. That’s not normal.

HIP: Jus’ a scratch, muh fucka. Y’all just want my money, thass all!

AD: Sir, The Borg requires no money up front for services rendered, and accepts all reasonable payment arrangements. You may even be able to break your $500 bill into 120 easy monthly payments, leaving you plenty of disposable income for spinner rims and a new diamond encrusted grill. We can also transport you to the charity hospital across town, but it is my duty to inform you that they have no neurosurgery capability and that their medical resources are slightly less extensive than Walgreen’s, Aisles 9-12. They do give out free condoms, though. Walgreen’s charges money for their condoms. It’s pretty much a tie.

HIP: Fuck you, man! I pays my bills!

AD: No doubt you do, Sir. You have ‘credit score of 800′ written all over you. Still, there is a growing puddle of brain matter on both your shoulders. I implore you, allow me to treat your injuries and transport you to an appropriate medical facility. Refusing medical care poses certain long-term health risks that – “

HIP: What kinda health risks?

AD: Seizures, permanent cognitive impairment, paralysis, blindness, deafness, possibly even death.

HIP: Fuck dat. Long as my dick works, I’m aight, boyeeeeeee!

AD: Erectile dysfunction has been identified as potential long term sequelae in 74.3% of head injury cases.

HIP: Huh?

AD: Your dick’s gonna fall off, dude.

HIP: Oh.

AD: Your stretcher awaits, Sir.

Nope, I’ll employ whatever means necessary, stopping just short of lying and outright coercion, to convince someone when I think they need to go to the hospital.

Now, I work a for-profit EMS company. Quite simply, we make our money by taking people to the hospital. I knew and accepted that when I signed on. Since we’re an employee-owned company, in a very real sense, I’m taking money out of my own pockets when I allow someone to refuse transport.

It’s a fine line I walk, legally and ethically. Statistically, upwards of 50% of civil litigation against EMS providers involved a refusal of care by the patient. It’s a minefield of potential liability. I’m cognizant of the dangers. Refusals usually require more documentation than if you had simply transported, so laziness isn’t a factor, either.

The problem is, when you start thinking that you have the knowledge and training to decide – for the greater good – whether an individual needs an ambulance or not, you take a long step out on a very thin branch. Taxpayer-funded systems see the ramifications of a bad decision more often than for-profit EMS, simply because when you take away the financial motive for the transport, that leaves you a good deal of leeway in deciding whether the patient actually needs that ambulance or not. Even if your system does not allow paramedic-initiated refusals, when no one is pressuring you to transport each and every patient, you’re less likely to expend great effort to enable a malingerer convince a patient with a minor complaint to take a ride to the hospital in the ambulance.

Such attitudes often become part of the departmental culture, resulting in the common stereotypes of EMS delivery systems:

For profit EMS = greedy bloodsuckers who transport anything to make a buck. Picture Snidely Whiplash twirling his mustache as he counts his piles of money.

Taxpayer funded EMS = stalwart heroes who stand resolutely like Horatio at the gate, keeping the malingerers and system abusers out of the ERs in our fair city.

Of course, like most stereotypes, neither is particularly accurate, but they first become stereotypes by having a grain of truth at their core. Many of my supervisors at The Borg look at transports as, if not the only relevant performance measure, certainly one of the most important.

And there I sit, month after month, down there at the bottom of the transport spreadsheet among the slackers and burnouts.

People like my partner, who envisions herself as heroic Horatio, but in reality is so burned out that if she were toast, I could scrape her over the garbage can until all the black crumbs are gone, and I’d be left with a wafer thin enough to read a newspaper through. She’s too young and inexperienced to realize it yet, but she’s not gonna be happy in any EMS system.

I think many of the higher-ups had heard the buzz about me, and perhaps hoped in vain that I’d be able to teach her some people skills. Heck, so did I.

We have abandoned that faint hope.

Her problem isn’t lack of people skills, at least not compared to the Higher Beings on that transport rankings heirarchy. They both pretty much act the same, albeit directed in different ways:

Burnout Partner: “What is this bullshit? I can’t believe you called us out here for your fucking gunshot wound! For p
ity’s sake, man the fuck up and get over it! What was it, a nine millimeter? You pussy. You gonna let a little nine millimeter hole in your thorax stand in the way of rubbing out the fucker who shot you? Suck it up, dude. Your homies are watchin’.”

Transport King: “What is this bullshit? Somebody called 911 for a stubbed toe. I got out of bed for a stubbed toe. I’m fucking taking a stubbed toe to the hospital. What’s that? You didn’t call 911? What the hell do I care? Somebody called 911, and I’m not leaving until somebody gets on my stretcher. If I have to, I’ll park my ambulance in your driveway and sing Henry the Eighth, I Am over the loudspeaker until someone gets in my rig. Don’t test me, I’ve done it before. You know, last week we had a lady with a stubbed toe who refused to go to the hospital. Turned out the toe was broken, gangrene set in, and it mutated into some weird airborne strain. Killed her whole fuckin’ family. Swear to God, dude.”

Call me a namby pamby waffler, a fence-sitter if you will, but I kinda like to split the difference between those two extremes. This means that I will not likely get my company sued in the near future, because I don’t get inappropriate refusals, and my documentation is thorough…

…but I probably ain’t gonna wind up in that upper tier of performance appraisals, and thus my raises will be less, and I will be stuck in a dead-end field job in Crack Central for the foreseeable future.

That I can deal with. What is mildly irksome is that I will be regarded by some of those less-enlightened supervisors as an inferior medic to Transport King. The reality is that I daily flush more EMS knowledge into the sewer system after my morning constitutional than Transport King currently possesses.

My problem is that I’m a salesman who doesn’t believe in his product. In high school, my distributive education teacher, Mr. Kilpatrick, used to say, “you sell the sizzle, not the steak.” He’d go on to wax eloquent about the steroid-laden, semi-charred hunk of animal flesh and sinew we were supposed to be hawking:

“Mmmm, smell that? That’s the smell of certified Angus beef grilling over a hot hickory fire, my friend. A nice thick porterhouse -why have just the filet or the New York strip when you can have both, am I right? – rubbed with sea salt and a secret blend of seasonings, seared to utter perfection, thirty seconds on each side. Just enough to seal in that rich flavor, lock in those juices…and when you cut into that steak, my friend – your fork is all you’ll need – those juices run across your plate, right into that heaping mound of garlic mashed potatoes and crisp, steamed fresh vegetables, grown right here in our own garden. In fact, the only thing not grown right here is the fine German beer that we serve with it – dark, thick and yeasty. I tell ya, friend, it’s the perfect complement to a fine American steak. You owe it to yourself to have a meal like this, my friend. You’ve worked hard all week. You’ve earned it.”

And if you’re a carnivore like myself, you can picture it. Hell, you can probably even do a better job of describing it, because you believe the pitch.

When I try to convince a patient to go to the hospital when they really don’t need an ambulance, I come off like a gay vegan waiter trying to sell that same steak to the Marlboro Man.

What’s that, Sir? Don’t find that appetizing? Me neither, Sir. Perhaps some tofu, then?

Shoot, they make a lot more than just camo baby bloomers, Epi. I’ve got an entire wardrobe of camo baby clothes for KatyBeth.

Dangers of having a redneck Daddy, I suppose.

…for a warrior for peace.

If you don’t read Bayou Renaissance Man, I urge you to read his latest post. Then, blogroll him.

When I was a teenager, I had the great fortune to have a friend and mentor of sorts, an Episcopalian minister named Frank Swindle. He was a gentle man, soft spoken and cultured.

He was also a son of an oilfield roughneck, earthy and bull strong like his father. He could be intimidating when he wanted to be.

In a time when my rifts with my father deprived me of his influence, much of what I learned about strength, and kindness, and manhood, was guided by Frank Swindle. When I was a lonely and confused teenager, he gave me encouragement and direction. What little I know of God, he opened my eyes to. And what goodness there is in me today, much of it was shaped by his example and influence.

Well, my friend Peter is exactly the same sort. Go give him a read, and see what I mean. He, and his friend of whom he so touchingly writes, are remarkable men.

“Okay, if you say so,” he shrugs dubiously as he helps me to my feet. “Swear to God, Mister, my wife didn’t see you. She’s real sorry.”

“You’re the people in the car?” I asked, fighting back anger. “You didn’t see me flashing my fucking lights at you as I approached?”

“Swear to God, Mister,” he repeats, “she didn’t see you. We’re real sorry. My wife is hysterical. She won’t get out of the car. She thinks she killed you.”

“She damned near did, man.” I spit, then immediately regret it. What purpose would anger serve at this point?

I gesture for him to help me up the steep ditch bank. When I reach the shoulder of the road, I turn on wobbly legs and look back at the wreckage of my bike. One saddle bag is off, lying next to the road sign I apparently took out as I left the road. The other is hanging by one tie, and my backpack is shredded, leaving a debris trail of personal belongings behind the bike. All the signal lights are gone, the seat is broken off, as is the windshield and my accessory driving lights. The highway crash bar is demolished, but it looks like my engine and frame might be intact. The gas tank is punctured and leaking gas.

“Say man, you wouldn’t have a pocketknife on you by any chance?” I ask the man who helped me up. “I need someone to cut my saddlebags off the bike and gather up my stuff.”

The guy forlornly pats his pockets for a knife he doesn’t have, when another voice breaks in. “I’ll get ‘em for you, son,” an older man says gruffly. He looks down at my bike and shakes his head. “Goddamn shame what it did to your bike. You’re lucky to be alive.”

“I guess so, but I really – ” I start to say, but am cut off by the blaring of a car horn. A pickup truck flashes by, the driver ’s head turned toward us with an angry expression, running his mouth.

“We need to get the cars off the road,” I say to no one in particular, “or we’re gonna wind up causing another accident.” No one responds. “Hey!” I bark to the woman driving the SUV. “Can you tell everyone to move their cars onto the shoulder, or pull onto the side road? Somebody’s gonna wind up getting creamed here besides me.”

She covers the mouthpiece of her phone with one hand and explains in a stage whisper, “I’m on the phone with 911.”

“Give me your phone,” I order, holding out my hand. Bewildered, she hands me the phone as ordered. I take it, cover the mouthpiece and shout to the bystanders, “Everybody, I appreciate you stopping, and if you could stick around to give your statements to the cops, I’d really be thankful. But for now, we need to get all your vehicles pulled onto a side road before someone gets hit.”

Everyone seems to snap out of their fog en masse, nod in agreement and pile back into their cars. Satisfied that the road is being cleared, I put the phone to my ear. “Hello? Hello?” the 911 dispatcher is saying…

“Hi, this is the victim of the accident, ” I say agreeably into the phone. “Who am I speaking with?”

“Confederate President Parish 911,” comes the befuddled reply.

“Howdy,” I grimace, massaging my left leg, which by now is starting to protest violently. “Look, if you haven’t already dispatched The Borg –

“We have.”

“Okay, get back on the line with The Borg’s dispatch center,” I direct, “and have them cancel AirMed. They automatically dispatch them to this type of call in rural areas, and I don’t need a helicopter. Tell them to have their ground unit respond non-emergency, and have them call the southwest Louisiana area supervisor and let them know that Ambulance Driver is the victim, and will not be in to work tonight. Have the supervisor meet us at Big City Memorial ER.”

I wait patiently while the dispatcher repeats all that back to me, assure him that I am indeed not going to expire immediately, and give him the location of the accident. It would seem that the lady driving the SUV is from out of state. “Intersection of Highway 101 and Highway 3909,” I recite, looking at the road sign laying on the ground a few feet away. “Tell your Sheriff’s Office and the State Trooper that the road is not blocked, and there is one victim with injuries.”

I fold up the lady’s phone and hand it back to her, thanking her for her help. “Maybe you should sit down,” she says, concerned. Her lips quiver and her eyes tear up, and she says, “I thought for sure you had wound up under my car. I just knew you were dead. I can’t believe she pulled out in front of you like that!”

“Me neither,” I smile ruefully. “And I’d appreciate it if you told the State Trooper everything you saw.”

“Honestly, Mister,” the guy protests again nervously, “she didn’t see you. We’re both real sorry. We have insurance.”

Thank God for that. You’re gonna need it.

“I believe you man,” I try to smile reassuringly, but my heart isn’t in it. “Where’s your wife right now?”

“Still in the car,” he gestures. “She won’t get out. She’s sure she killed you.”

“Well, let’s go over there and assure her that she didn’t,” I grunt. “Give me a hand if you would, please.”

The guy solicitously drapes my left arm across his shoulders and helps me limp across the road. He offers a running apologetic commentary that frankly, I’m too drained and sore to pay much attention. When we approach the car, a woman in her fifties pops out of the driver’s seat and runs to me, sobbing brokenly.

“Oh thank God you’re okay I thought I killed you I didn’t see you coming and I’m so sorry and are you sure you’re okay and I swear I didn’t see you I’d never pull out in front of someone like that I have a very good driving record and good insurance and I…” she babbles hysterically.

“Very good driving record prior to today, you mean,” I correct gently, and smile. I want to be furious with this woman, but I can’t. She wasn’t drunk, wasn’t yakking on a cell phone, and wasn’t being reckless. She just had a bad case of craniorectal inversion at the worst possible time. It happens.

She looks at me, dumbfounded, and her mouth works silently, and again she dissolves into tears. I shrug and wrap my arms around her and let her s
ob into the tatters of my riding jacket, and smile bemusedly over her shoulder at the absurdity of the moment.

Here I am, damned near killed, out of a bike and God knows what else, and probably off work for a week at least, and hurting like hell, and I’m standing here consoling the woman that caused it all. AD, you are indeed a sucker.

As her sobs wane, I hold her out at arm’s length and smile reassuringly. “Hey, that’s why they call ‘em ‘accidents’ and not ‘on purposes’, right?” She smiles through her tears and nods uncertainly, and I continue, “Why don’t you dig out your insurance and registration for the cops, okay? I’m just gonna stand here and lean on your car for a moment. I don’t think my leg is gonna hold me up much longer…”

I stand there with my arms folded across the roof of her car, resting my head on them until I hear sirens wailing in the distance.The wailing gets closer, and the guy standing beside me announces, quite unnecessarily, “the ambulance is here.”

Gee, ya think?

I hobble over to the ambulance and greet the driver as he bails out of the rig. He stares at me in surprise for a few moments, then shuts his mouth with an audible snap.

“Howdy, Dino,” I greet him tiredly. “I take it The Borg didn’t tell y’all to back down to non-emergency?”

“Well, they canceled AirMed, but you know how dispatch is sometimes. I decided to keep running hot, just in case,” Dinosaur Medic explains. “Jesus Christ man, what happened to you?”

His last question is echoed by his partner, Cajun Hottie, as she comes around the side of the rig. They’re both flabbergasted in stereo.

“Lady turned left in front of me, and I laid it down,” I reply, giving them the short version. “My leg’s fucked up, Dino. I don’t think it’s broken, and it bears weight, but something’s wrong. I need an ER.”

“AD, you know with this mechanism of injury, we have to – “

“No spinal immobilization, Dino,” I tell him firmly. “My neck ain’t hurt. I’ll sign a refusal just for that, if that’s what it takes. Just give me a ride to the ER, please.”

“Good enough for me,” he grunts, gesturing to the stretcher Cajun Hottie has lowered at the rear of the rig. “Your chariot awaits, AD. Too damned hot out here to be boarding someone unnecessarily anyway.”

That’s what I love about Dinosaur Medic. A rookie would be shitting his pants, worrying about disregarding protocols. Dino just takes it all in stride. He loads the stretcher aboard the rig and CH clambers in beside me, taking my vital signs. Dino closes the rear doors and disappears for a moment. I lay my head back against the stretcher and close my eyes.

“You all right, AD?” CH asks, concerned, stethoscope poised just over my arm. “Did you lose consciousness at any point?”

“Nope, clear as a bell the whole time. I’m just a little drained. The adrenaline is starting to wear off.” Dinosaur Medic reappears, climbing back into the rig and shouting up front, “Let’s roll!”

“What the hell are you doing on duty, Dino?” I ask curiously. He’s my opposite number at our station. Today is his day off.

“You know me, I’m an overtime whore,” he chuckles as he settles into the jump seat behind me. “Saw the opportunity to make a little extra cash, and CH over here needed a preceptor for her paramedic clearance, so…”

“So who’s driving the truck?” I ask as Cajun Hottie deftly cuts my pant legs. I grab her hand before she reaches the crotch. “Easy there, CH. I go commando, you know. It’s a mite cool in here to be exposing The Boys unnecessarily. I understand, what with my raw animal magnetism, you’d want to see my junk and all, but…”

Dino laughs uproariously, and CH barely stifles a spit take. She finishes exposing my leg, clucking professionally at the injuries there. “Commando, my ass, AD. By the way, love those boxers. Every guy needs a pair of Heineken drawers with ‘Brilliant!’ scrawled across the ass.”

“How did you – “

“Your pants are shredded, including the ass,” she explains with a smirk. “Everyone can see your underwear, including the fact that they’re clean. Good planning, AD. Your Momma would be proud.”

“Were clean,” Dino corrects with a wink. “And to answer your question, we’ve got a new girl driving. Hopefully, she won’t get us lost on the way to the ER.”

“Hopefully,” I agree, then levitate six inches off the cot as CH irrigates my road rash with saline.

“Sorry AD,” she says, not sounding sorry at all. “You know it’s necessary. Now roll over and lemme see that ass.”

“The ass is just fine, CH,” I demur, and she raises one eyebrow dubiously. “Seriously,” I continue, “my boxers weren’t shredded, right? And if I were scraped up, I’d be feeling it by now.”

“Fair enough,” she grunts. “Anywhere else you’re hurting that we need to check out?”

“Well now that you mention it, my left foot ain’t so hot. If you can get my boots off without cutting them, give it a look, would you?”

CH obligingly cuts only the laces of my boots, gingerly slipping them off. My left great toe is swollen and angry looking.

“Yup,” she says coolly, “looks like your big toe might be broken. It’s already turning black.”

“I don’t doubt it,” I agree. “It hurts like hell. Whatever you do, don’t – aaaaaaauuugggghhh!”

“Does this hurt?” she asks innocently, wiggling my toe.

” – palpate it,” I finish with a whimper. After mentally counting to ten and playing the Carpenter’s Close To You in my head, I manage to quell the urge to kill. Almost.

“I think if you do that again, you will be seeing his ass,” Dino observes dryly, “when you pull the stretcher sheets out of it. You all right, AD?”

“I won’t hit her,” I promise, “but only because she’s a girl.”

“Sorry, AD,” she apologizes. This time, she sounds sincere.

The rig lurches and the back up alarm chirps, announcing our arrival at the ER. Dino’s new partner slowly backs the rig into the ambulance bay.

“I wonder how she’ll like taking the remedial driving class?” Dino wonders. “She knows better than to back up without a spotter.”

The question of a spotter is answered when the rear doors open, and Stuporvisor greets us with a concerned look. “How you doing, AD?” he asks without preamble.

“Been better, Stupe,” I answer. “This ain’t like the last time, though. I ain’t dusting myself off and coming in to work after this one.”

“He’s damned lucky to be alive,” Dino agrees grimly. “I took a look at his bike while CH was getting vitals. It’s totaled. About a hundred feet of skidmarks, leading all the way into the intersection before the pavement gouges start. If I had to guesstimate, he – his body, that is – stopped rolling maybe 250 feet after he first got on the brakes.”

“Almost makes you want to choose a safer mode of transportation,” Stupe hints as they wheel me through the ER doors.

“Fuck you,” I retort agreeably. “As soon as I can get my bike replaced, I’m riding again.”

“Uh…this can’t be good,” the ER charge nurse observes as we approach the nurse’s station. “You’re supposed the be pushing the stretcher, AD, not riding it.”

“High-speed motorcycle wreck,” CH reports professionally. “Helmeted rider, no loss of consciousness, left leg injuries. Vitals stable.”

“Room Eight,” the charge nurse points. Everyone is staring at me curiously, expressions running the gamut from outright concern to bemusement. I’m sitting up and talking, so it can’t be all that bad. It takes a lot to shake an ER nurse. No doubt they’ll all be filing into my room later to hear the story.

CH and Dino lower the stretcher, and I scoot gingerly over to the ER bed. It takes longer than it should, because my leg is beginning to swell dramatically, and the adrenaline rush has long since abandoned me.
I’m shaking like a dog shitting roofing tacks. I lay back on the bed and close my eyes, trying to will my hands to stop trembling.

It doesn’t work.

Presently, the admissions clerk and an ER tech walk into the room. The admissions clerk asks timidly for demographic information, and I wordlessly hand her my driver’s license and insurance card. “His phone number is 867-5309,” the ER tech recites from memory, and I open my eyes to discover Phil, a former co-worker from PGHNSTRACH. He was our ER admissions clerk before he started nursing school and got the itch to provide direct patient care.

“How you doing, AD?” he asks, wrapping a blood pressure cuff around my arm. I shrug in reply. He pops a thermometer in my mouth, pauses a moment and asks, “Say, does that thermometer taste funny to you?”

“That’s my line,” I chuckle. “I have copyrighted the rectal thermometer gag.”

“Just figured you needed a laugh,” he grins. “So how bad is your bike?”

“Totaled, I’m pretty sure,” I sigh. “Phil, I thought KatyBeth was gonna have to grow up without me today. It was bad.”

“Scared you pretty bad, huh?” he commiserated.

“Not until it was over. I didn’t have time to be scared while it was happening, but I’ll confess…when I was tumbling across the pavement and I saw the SUV bumper looming at me…yeah, man. I thought I was going to die.”

“Well, it could be worse, man,” he says darkly. “You could be in Wanda’s situation right now.”

“Wanda?” I ask, confused. “What’s wrong with Wanda?”

“Doc just called the code on her kid. He didn’t make it.”

“Wait a minute,” I stammer, pushing myself up into a sitting position, “you’re telling me that Jaden, Wanda’s little boy, just died? What the fuck happened?”

“The Borg just brought him in, working a full arrest. Doc just called it maybe five minutes ago. He came around a blind curve on an ATV, and ran head-on into his brother in a pickup truck. He’s dead.”

“Dead?” I repeat numbly.

“I’m sorry, AD,” he says, mortified. “I don’t know why I figured you already knew. It was your truck that brought him in. I guess subconsciously I just figured since you were on today, and it was your truck…shit man, I’m sorry. I shouldn’t have said anything.”

“Do me a favor, Phil,” I say hoarsely. “Step outside, and shut the door behind you.”

“Sure thing, AD,” he says softly, backing out the door. “I’m sorry I was – “

“Just shut the fucking door, Phil.”

Jaden LeGrand was six years old, but looked twelve. He was a huge kid for his age, physically capable of driving an ATV, or pushing the damned thing all the way home should it break down. He was a big kid.

He was spoiled, unruly, often petulant, with a healthy dose of Mama’s Boy thrown in. Jaden didn’t have ADHD; he had Chronic Hickory Deficiency, a condition Wanda readily acknowledged. Didn’t much matter to her, though. He was her baby, and her dosing regimen was the one she thought best.

He also loved to color, had a weakness for stickers, and would play Slapjack with you until you got tired of playing. To Jaden, any face card was a Jack. That’s just how you played. He’d do anything, including behave, for a Coke and a bag of Skittles.

And he’d hold your hand on the way to the vending machines, because his Mama had told him that big boys held a grownup’s hand whenever they walked somewhere, and they always looked both ways before crossing intersections – even if the intersection in question happened to be a rural hospital hallway. Thanks to Jaden, we never got run down by any speeding gurneys on our walks to the vending machines.

And as exasperating as he was, every time his mother brought him by the hospital, whether it was just to pick up her paycheck or to help one of the less-experienced admissions clerks resolve a computer issue, Jaden would greet you with a squeal and a healthy thump against your legs as he wrapped his arms around your waist in a fierce bear hug. He’d shyly offer you his hand, pump it enthusiastically, and run off to find his Mama again while you staggered back to the Nurse’s Station and contemplated your bruises.

And now he was dead.

I should have been there. I should have run the call. If I had run the code, he might have…

…what, survived? You know better than that. What would you have done differently?

Doesn’t matter. I could have been there for Wanda. I’m the pediatrics guru. I could have…

…what, performed a miracle? Besides, he was big enough that he’d have been treated like an adult. And would you have worked the code, or consoled Wanda? Can’t do both, AD.

I sit up in the bed and stare hollowly at my shaking hands until my eyes grow hot with tears, filling until they march down my face. Reason and intellect tell me it’s a stress reaction, the natural comedown after the high of a fight or flight reaction, coupled with the emotional hit of unwelcome news, but…

…my emotions refuse to bow to reason, and that is the most distressing of all. Try as I might, my hands will not stop shaking and my shoulders will not stop heaving and the tears will not just dry up and I’m afraid someone will walk through that door and discover me blubbering and think it’s just because I’m an emotional little pussy who can’t handle being in a motorcycle wreck, and damn it, stop all this…

A few minutes later comes a knock on the door and the doctor peeks his head in. By then, I have my mask back on, and I can matter-of-factly, emotionlessly relate the details of the wreck. I can cooperate with the physical exam, even joke with him about the overrated preventative properties of wearing clean underwear. No one suspects that I’m a wreck but me.

“You know, there are only two types of bikers…” Doc observes dryly.

“…those who have been down, and those who will go down,” I finish. “You’re not going to hit me with the whole ‘donorcycle’ and helmet argument next, are you?”

“You’re familiar with the spiel, then,” Doc chuckles.

“I have given the spiel,” I assure him tiredly.

“Well, it doesn’t look like anything is broken,” the Doc reassures me, “even though that’s not going to matter much to you for the next week. You had a 500 pound bike land on your leg at highway speeds. By all rights, it should be broken, and it’ll probably feel that way for at least a week. You’re not going to be walking tomorrow, or even the day after, and you’re going to feel – “

“-sore in places I didn’t even know I had,” I finish. “Sorry Doc, I’ve given that spiel, too.”

“Anyhoo, we’ll shoot some films of your leg and foot just to be sure, update your tetanus and give you something for pain. Is there someone who can drive you home?”

“No one. No family to speak of.”

“No friends or co-workers?”

“I can probably have The Borg supervisor give me a lift home, Doc. If you’ll just have someone give me 60 milligrams of IM Toradol, I’ll be fine.”

He looks at me like I’ve just sprouted a second head. “You’re sure you don’t want something stronger?”

“Nope. I’ve got Demerol and Phenergan in the medicine cabinet that can’t be more than, oh, five years old,” I wink. “I’ll take some of that if I need it. If you don’t mind, I also need a scrip for CPAP set for ten centimeters of water pressure.”

“You’re sleep apneic?” he asks, flipping through the chart.

“Yep,” I confirm, “and judging from the p
ieces falling out of my saddlebags, my unit is toast. I’m gonna need a new one tomorrow. I’ll just have to choke and snore tonight, I suppose.”

“I’ll take care of it, AD. The nurse will be in here in a minute with your shots, and then we’ll get your x-rays.”

True to the Doc’s word, in five minutes the ER charge nurse comes in and give me my tetanus and Toradol injections. If I didn’t know better, I’d feel flattered that the charge nurse is personally taking care of me. In reality, he probably assigned me to one of his rooms because I’m an easy case.

Five minutes after that, they’re wheeling me to radiology. I discover just how sore I am when they manipulate my leg and foot for the x-rays. Barely thirty minutes later, the ER nurse shuffles back into my room, followed by The Borg Stuporvisor.

The charge nurse fits me with an ortho boot, hands me my prescriptions and discharge orders, and informs me that nothing was broken other than my left great toe. Stupe, on hearing that, looks dubiously at my left leg as the nurse struggles to fit the boot around my swollen calf.

“That’s not broken?” he mutters unbelievingly. “AD, you’re not gonna be able to work on that this weekend.”

“I know Stupe,” I sigh. “Just get me out of here and back home, man. I’m about to hit the wall.”

The ride home is quiet, for the most part. Stupe gives me some good, if unsolicited, advice about filing a lawsuit against the other driver, and thoughtfully swings through the drive-through at Wendy’s when he finds out I’ve had nothing to eat since noon. On the way home, he stops by the wreck scene and combs through the weeds by flashlight, managing to find my MP3 player, my station keys, and the remnants of my cell phone.

We pull into my driveway just short of midnight, and he solicitously helps me up the steps and into the house, depositing all my shattered bike gear in the garage. Before he leaves, I beg the use of his cell phone for a few minutes, and make a private phone call.

“Hello?” a sleepy, confused voice answers.

“Hey, it’s me,” I tell The Ex. “Did anyone get in touch with you?”

“Dino Medic called me,” she replies, now wide awake. “He said you were banged up pretty bad, but nothing really serious. I’ve been worried sick, AD. I told him to have you call me when you could. Have they discharged you? Do you need a ride home?”

“I’m home now. Stupe gave me a ride. I’m sorry they worried you. You were the only person I could think of as an emergency contact.”

“Don’t worry about it,” she assures me. “Do you need me to send one of Husband-In-Law’s kids down there for a few days to help you with things? Or we could drive you up here and you could stay with Mom, or – “

“I’ll manage by myself,” I interrupt. “There is one thing you can do for me, though. I…I know she’s already asleep, and you don’t need to wake her up…but if you could, I’d really appreciate it if you could look in on her. Maybe give her a kiss and tell her I love her. Would you do that for me?”

“I’ll do it right now, AD. I promise,” she says softly. “Are you sure you’re okay?”

“I’ll be fine. Goodnight.”

I end the call and step back outside, giving Stupe his phone back. I close the door without bothering to explain why I’m crying again.

Broke down and cried in the ER today.

The ER tech, a former co-worker, came to my room and gave me the news. One of PGHNSTRACH’s other ER clerks lost her six year old son today.

ATV accident, head-on collision with his older brother. Some of our medics brought him to the ER, desperately working to resuscitate him. If I hadn’t been in my own ER room right about then, it may very well have been me working the code – it happened in my response district.

And I might have kept it together too, if I hadn’t had a serious case of the shakes resulting from coming off my own adrenaline high.

In case you missed the reference, I was laid up in the ER myself this afternoon, brought in by yet another of The Borg’s ambulances. A lady from Texas driving a beat up Chevy Cavalier tried her best to kill me on the way to work today.

She damned near succeeded.

I’m banged up, folks, but reasonably intact. I cannot say the same for my bike, my cell phone, my laptop, my CPAP, and my uniform. All are totaled.*

I’ll post more on it later, but right now my friend and co-worker could use some prayers. When you pray tonight, if praying is something that you do, might you ask God to look down with some special mercy on a grieving mother in southwest Louisiana tonight? She needs it.

Right now I’m going to go hobble to bed, pop a handful of Motrin, and cry myself to sleep. I’ll blog tomorrow.

*For those of you well-meaning and not-so-well-meaning commenters who are tempted to use this as a platform to decry the inherent danger of motorcycles and ATVs, save it. I’m hurt, and upset, and not in the mood to read it, well-meant or not. I’m not going to stop riding.

You get to pick the topic of a post of your very own, and if you shoot me an a-mail with your addy, I’ll send you a signed copy of The Book!

That’s 535 posts in 19 months, and over half a million freakin’ hits.

You guys rock! Seriously, thank you all for reading.

Those of my readers who work in healthcare or EMS know that I lecture at various EMS conferences around the country, maybe sign a few books and generally just hang out and swap war stories. It’s not a full-time job for me, but it’s a nice sideline, and it’s always nice to meet EMTs in a new city and share experiences.

And it is a huge kick in the pants to meet a reader of my blog at one of these things.

Well, in August and September I will be speaking at a couple more conferences that are, shall we say…unique.

They are unique in both atmosphere and approach to EMS education, and in the quality of the presenters featured there. Aside from the head-scratcher of a decision that led these guys to booking me (seriously, what were y’all thinking?), you will find a distinguished faculty at these conferences normally only seen at the major national conferences.

The first conference is the South Carolina AHEC Emergency and Disaster Medicine Summit on August 15-16 in Charleston, SC.

I was looking at the brochure – you know, for the cheap thrill of seeing my name somewhere in print as someone my fellow medics might actually want to hear talk – and I also discovered that no less than three med-bloggers on my blogroll will be speaking there as well, all three of them good friends of mine.

I won’t mention them by name so as to protect their sooper seekrit blogging identities, but suffice it to say that you will rarely see such a talented roster of speakers - yea, a veritable cornucopia of razor sharp snark and profound EMS wisdom! – for the absurdly cheap registration fee of $100.

So, if you’re from that neck of the woods (or even if you’re not), make with the clicky and sign up, and when I see you there, the first adult beverage will be on in me.

The second conference is EMStock on September 25-28 in Midlothian, TX.

EMStock is the most unique EMS educational offering you will ever experience. Held almost entirely outside in air conditioned tents on Bryan Bledsoe’s ranch, EMStock features nationally known EMS educators – including some of those snarktastic med-bloggers I mentioned earlier – speaking on a variety of topics you will find at no other conference in the country. In between continuing education sessions, you can browse the vendor booths, network with other EMTs, and even contribute to the Double Wide Fund.

There will be chili and barbecue cookoffs, you can listen to live bands on the EMStock stage every night, or just drink beer and swap war stories around the campfire.

Yes, there will be beer and campfires in abundance, and most certainly at my tent. If camping out in RVs or tents isn’t your cup of tea, you can stay in one of the local hotels, and drive over to the conference grounds after a leisurely breakfast at Denny’s just up the road in scenic Burleson, TX.

Although personally, I’d suggest you skip the Denny’s Cholesterol Slam, and instead pack some snacks and an ice chest of drinks, drive on over and follow the smell of frying bacon and bum breakfast off one of the many kind souls there who always seem to be cooking for the entire gang.

After breakfast, you can wander over to watch the paramedic scenario competition to see my partner and I defend our 2005 EMStock Games title, where we edged out squeaked by managed to overcome beat an international field of teams like they stole something.

Okay, so the field was only six teams, but one of them was the London Ambulance Service team that placed second at the JEMS Games that year…and we did offer up a Texas-sized margin of victory.

And what, pray tell, does such a unique EMS educational experience cost?

Only twenty measly bucks.

Honestly, if you’re an EMT from Texas, Oklahoma or Louisiana, why wouldn’t you come? At the last EMStock, we had EMTs from England, fer Chrissakes.

Sign up, and I’ll see ya’ll there.

Trigger finger suitably healed, I took the Taurus out for a little therapy practice at the range. I burned a hundred rounds of cheap 180 grain Blazer ammo, with slightly more satisfying results than the first time I shot it.

First target of the day, five rounds at fifty feet.:

Last target of the day, same distance:

Roughly 2.75 inch groups at fifty feet range. A good many of the groups toward the end were printing a little low and left, which tells me I need to work on trigger squeeze. The finger wasn’t so bad that I could use it as an excuse, but the Taurus did beat up on it a bit. It was sore by the time I was done.

A couple of observations, and a couple of questions:

First, the trigger I can deal with. Lots of takeup, but the pull ain’t bad. Second, the Heine sights take some getting used to.

Actually, scratch that. They take a lot of getting used to. The more I shoot it, the more I think they should be spelled Hiney…as in sucks ass. Maybe they work great for most, but for me…meh.

Which of course leads me to my questions for the pistol aficionados out there. First, what aftermarket sights would you recommend? More to the point, any dovetail sights that specifically fit the Taurus? There ain’t a lot to be found on teh Intarwebz.

Second, how badly do these groups suck? I’ve shot far better, but a Hi Standard .22 target pistol or a .38 K frame Smith with a 4 inch barrel is a far cry from a subcompact auto with a 3 inch barrel.

If I shoot 25 or 50 straight at trap or in the high 30s or low 40s in a round of sporting clays, I know how well I’m doing. I’ve done enough of it to know what good is, plus I can always look at the board and see how well I’m doing compared to other shooters, or compare my score to those of my buddies.

Frankly though, I’ve never compared my handgun shooting to anyone’s but my own. I just haven’t done enough of it, and I don’t have the luxury of having a knowledgeable buddy to shoot with. There was a pleasant older fellow shooting a CZ 83 in the next lane today, and he was all over the page. We exchanged pleasantries and admired each other’s weapon, but that was the extent of the conversation.

He seemed to think I was doing well, but then again…he was all over the page. I’m not sure I’d take his word for it. Like Speaker Tweaker said in my last post, as long as my groups are “Minute of Bad Guy” that’s all that counts, but I’m enough of an ego whore to want to know how I stack up against other shooters.

Or maybe not, if these groups really suck.

…three motorcycle accidents, two of them fatalities.

In all three instances, it was idiots in cars at fault, turning left in front of oncoming bikers.

A couple of days ago, an oncoming compact car crossed the center line, aiming for me.

Yes, I said aiming for me. It was not random inattention. He saw a biker, and was determined to fuck with him. I eyeballed the bastard for several hundred yards and held course, all the while making plans for evasive action. A good lean and a lot of throttle when he got close (too close for him to react), and I missed him by a wide margin. He was damned near all the way in my lane, and sneering right at me as he flashed past.

I’ve often said that my ambulance would be better equipped with twin watercooled .50s and a snowplow bumper than it would with lights and siren. The same goes for my bike. In a just world, the compact driver should have been greeted with a 180 grain salute to his driving habits, right betwixt the headlights…and I think we know exactly what headlights I’m referring to.

But that would have meant shooting with my weak hand, and lots of ambulance paperwork, and I don’t do ambulance paperwork on my day off.

*sigh*

If I hadn’t spent the past fifteen years dodging idiots who do stupid things – both purposely, and by accident – when they see an ambulance with its lights on, it would be enough to make me paranoid.

That is, more paranoid than I already am.

I figure that’s a good thing, if not an entirely equal tradeoff for the lack of protective sheet metal around me.

Update: Make that five motorcycle accidents, and three fatalities. Same cause as before, except that the last two bikers’ reaction time was not helped by the alcohol n their systems. I took care of the lucky one, if you could call a mangled leg that’ll likely never allow him to ride a bike again lucky.

…which I am working on, honestly, I direct you over to Pink, Warm and Dry for the Ballad of Hilda and Oscar. Be sure to follow up with Part Two.

I’ve said many times before, that I’d rather teach a hand holder to function under pressure than to take an adrenaline junkie and try to teach them compassion.

Epi Junky (a misnomer if there ever was one) gets it:

I can’t help it. I’m a hand-holder.

When I see someone truly hurting, physically or emotionally, it’s in my nature to want to help if I can. Even if it’s just to hold their hand, stroke their hair, or listen. It’s part of being human. I believe that most of my patients really just want someone to hear them.

Read the whole thing, and get a glimpse of a particularly rough day in the life of a transfer medic. They don’t get the props that 911 medics get, but I’ve long believed that they know a lot more about caring for people.

For most of our patients, the warmth of a human touch trumps mad IV skillz on 99 calls out of 100. The chance to save lives comes but all too rarely, but the chance to touch a life comes far more often than we may appreciate.

You keep going like you are, Epi. Don’t get hardened. EMS needs a lot more hand holders.

Verily, I say unto thee…it doth not suck.

After taking the advice of most commenters, I shot a few mags through the pawnshop PT145.

The gun in question is a third-generation Millenium Pro, and as commenter 2nd to One pointed out, the triggers (which was most of the negative comments about the gun) have improved significantly. The SA pull wasn’t bad at all; Very little creep, fairly crisp, but with more takeup than I prefer. Something just bugs me about pulling a trigger for a half inch or more before it even engages the sear.

But hey, it shot well, and felt good in the hand. Noticeable muzzle flip, but not overwhelmingly so.

So, satisfied with the trigger, I cleaned it and took it back to the pawnshop to cogitate a bit on the purchase.

And as it so happens, I saw the exact same guns a few days later, brand new, at Academy Sports for significantly less than the pawnshop wanted. WTF???

So, I wound up purchsing the .40 caliber version of the gun for fifty bucks cheaper than the pawnshop wanted for a used one.

I took it out and shot it today. Before you go to giggling about my shitty groups, keep in mind that, other than 50 rounds a few days ago, this is the first time I’ve even picked up a pistol in almost six years. Plus, I was shooting with a tringer finger that looked like this:

This somewhat blurry cellphone camera photo is an object lesson in what a right index fingertip looks like after it has been shut – and locked – in a truck door for two minutes.

The two minutes was roughly the time spent turning the air blue with foul imprecations, praying to various deities, calling for Mommy and just general craven whimpering…all while doing considerable gymnastics trying to reach my keys, which happened to be zipped up in my backpack…

…in the bed of the truck.

After demonstrating flexibility that would qualify me for a job with Cirque de Soleil, I managed to extract my keys from the backpack, vainly thumb the keyless remote for several seconds before remembering that the lock solenoid on the driver’s side is broken, and finally insert the damned key in the lock and free my pinned finger.

I’ll tell you, by the time I got it loose, I was shaking like a dog shitting roofing tacks.

All this happened Friday before work. The tiny little circled area in the photo is where I drilled an 18 gauge needle through the nail in the ER between calls Friday night, in an effort to drain the hematoma that had my finger turning purple and hard as a rock.

So, now that we’ve established that my trigger finger was only in marginally better shape than Tom Berenger’s in Sniper, and thus firmly established my excuse, let’s look at the targets, shall we?

That’s a standard 25 yard pistol target, although I was shooting at only 15 yards. The uppermost hole is my first shot, with the remaining four in the string grouped a little low and left. The figure eight sights were a little foreign to me, but not hard to get used to. Honestly, the biggest hurdle was finding a way to shoot that didn’t make my trigger finger feel like it was wedged in the truck door again, and I wound up shooting the next 20 rounds squeezing with the middle joint of my trigger finger rather than the fingertip like I’m used to. That was only marginally better, with the added risk of jabbing the sore tip of my index finger against the thumb of my support hand and making me piss my pants in the process.

The final five-shot string – I could only grit it out for 25 total rounds – was this one:

The hole at the bottom of the target is where I pulled the staple loose, by the way, not a bullet strike.

All in all, a high degree of suckitude I am not happy with – me, not the pistol.. That target more resembles what I’d consider a mediocre group at 25 yards, not my best at 15. But considering the fact that it was a brand-new gun straight out of the box, and that I was shooting with a useless trigger finger, I’ll take it.

If I’m still grouping low and left with a healed trigger finger and a few boxes through the gun, I’ll adjust the sights. I can’t help but think that with a couple hundred more rounds and a healed trigger finger, those groups will be much tighter.

Now the only thing left is a decent concealment holster. Any suggestions?

…EMT-G.

That’s Emergency Medical Technician – Ghoul.

And if you guys haven’t linked my brother from another mother at Too Old To Work, Too Young To Retire, you’re missing something. He always has something intelligent to say, and says it well.

Link him under medblogs, political blogs, or gunblogs. He’s a worthy addition to any of the above.

…I give you the second installment of AD hatin’ on the fire department my take on the fundamental differences between providing EMS care and fire suppression.

And contrary to popular belief, I do not dislike, nor lack respect for, fire department paramedics.

On the other hand, neither do I insist that the two professions are a seamless match, and that everything is rosy in dual role departments.

If you’re an EMT, particularly a firefighter/EMT, give it a read and tell me what you think, either there on EMS1.com, or here.

Part Three comes next month, where we let the healing begin.

And hey, everybody knows I’m all about the healing.

…and I stumbled upon a Taurus PT145 Millenium Pro in .45 ACP. Holds ten rounds plus one in the pipe, feels solid in my hand, and is very compact. I like it.

The pistol is in like-new condition, bore looks clean, and the price is pretty attractive.

Any of you guys have any opinions on this piece, based upon direct experience?*

Ahab, you’re a Taurus guy. Whaddaya think?

* Fanboy opinions that offer nothing beyond “forget that piece of shit, buy the Glock/1911/H&K!” will be summarily ignored.

Many of you may have heard of the EMS helicopter midair collision near Flagstaff, AZ that killed six people a couple days ago. A day before that, another EMS helicopter crashed landed hard in Phoenix, severely injuring two crew members and slightly injuring the pilot.

I have a good friend who, until just recently, was a flight medic in Phoenix. If memory serves, one of the three helicopter EMS services that crashed was a former employer.

You cannot imagine the dread that passed over me as I dialed JB’s cell phone, hoping like hell he’d answer. He didn’t, but (thank God) later checked in with his friends via e-mail.

So instead of JB getting killed, six people from the midair collision died, and a flight nurse critically injured. Six people I don’t know and had no connection to, other than by chosen profession. That includes two patients, including one who had no damned business being flown in the first place.

The wildland firefighter who was being transported in one helicopter had been treated for an anaphylactic reaction to insect bite antivenin.

There is ZERO reason to transport an anaphylactic reaction by helicopter, people.

It’s like crushing a roach with a steamroller. There’s nothing that the flight crew does that a ground crew can’t, and once that treatment is started – on scene – the transport isn’t that time sensitive. Moreover, my sources have it that the insect for which he was given antivenin was a spider.

There is no bite from a North American spider that requires antivenin, and EMS crews certainly don’t carry it. That means this poor man was given the antivenin – possibly inappropriately – in a hospital, and then put in a helicopter and flown to another hospital.

When I was working at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut, we were quite capable of dealing with anaphylactic reactions, and the term definitive care and PGHNSTRACH rarely met in the same sentence. We’d never even think of flying out one of those patients.

It’s just…STOOPID.

*sigh*

I tell you this now…if we in EMS dont find a cure for our Rotoriasis – and that includes ER physicians and trauma surgeons – and start utilizing medical helicopters appropriately, the .gov is going to tell us how to do it, for our own good.

And you know how that usually turns out.

For a more measured take on the subject, go check out Rogue Medic and Too Old To Work, Too Young To Retire.

They do measured responses so much better than I.

…then you know the pain Phlegm Fatale is feeling right now with the loss of her best friend, Valentine. Babs lost her longtime companion Ben recently, too.

I’ve been where they are, and it’s never easy. One quote I have always admired comes to mind:

“If I have any beliefs about immortality, it is that certain dogs I have known will go to heaven, and very, very few persons.” – James Thurber

Wherever Val is right now, Phlegmmy, you can be assured that it’s a sunny place where the squirrels are slow and stupid, every other dog’s butt smells like lilacs, and every street corner has an automated stick-throwing machine and a Snausage dispenser…

…and she’s still curled up in God’s chair, refusing to leave the warm spot she’s created until He gives up and takes a spot on the sofa.

And He ain’t mad at all. As a matter of fact, He knows how to rub her belly just like you do, and does so daily.

You can count on it.