…not only because I’ve been up to my eyeballs in doing final edits on a book that sat on the publisher’s back burner for nearly two years before it became a priority in the past two months*…

…but because my blog-daughter, and one of my favorite bloggers on the web, is hanging it up.

If only I could get Matt G. LawDog to finish his part of our planned Perspectives post, then Peter could write his, and we we could all give her an epic send-off.

Yeah LD, I’m calling you out. But only in a non-threatening, I-know-you’re-a-busy-man, do-a-favor-for-me-pal, kind of way.

*No, not that kind of book. This one would only interest you if you’re studying for a critical care paramedic exam.

…I’ve got a new Top Ten List up on EMS1.com.

Enjoy.

It’s dark outside, although the clock reads just past six. Outside the narrow hospital windows, the sodium lamps in the parking lot glow yellow through the fog. My partner Seth Barnes has a new baby in the NICU, and we’re hiding out there, cooing over his little girl as we try to duck the inevitable call for yet another drunk. It’s Christmas Eve, for pity’s sake. You’d think people would go a little easier on the eggnog.

Wishful thinking, of course. The good citizens in our response district are wont to partake of a bit much holiday cheer this time of year, and their eggnog is a usually a little light on the egg.

And the nog.

In fact, it looks and smells a lot like Boone’s Farm or Mad Dog 20/20, but there’s no doubt it’s quite a festive libation. The last patient sang carols to us all the way to the hospital, in fact; a lively holiday medley of “silent nights and holy muhfuckin’ nights and God rest ye merry gentlemen cuz I’m gonna sue all you sonsabitches…”

… and apparently there are more out there who can’t wait to spread some holiday cheer to the staff at the local ER, because Podunk Ambulance has called us twice on the radio, asking when we’d be back in service.

“We’re out of service for OSHA cleanup,” I lie. “My rig is a mess. We’ll let you know when we’re ready to go.” I wink at Seth and his wife as he rocks his little girl.

“We may get to bring her home tomorrow,” Seth whispers. “Some Christmas present, huh?” I nod and look pointedly at the clock on the wall. “I know,” Seth sighs. “We gotta go.”

“Sorry Melissa,” I apologize as he hands the baby over. “There are little old ladies out there who have fallen and can’t get up.” She says nothing, just smiles and hugs Seth with one arm.

Later that night, we get called to stand by while the local police deal with a hostage situation. Seth parks the rig on a side street several blocks away, turns off the lights and settles back into his seat. After a while, he turns to me and asks, “How long you been a medic, AD?”

“Fifteen years,” I sigh. “It feels like more. It seems like I’ve always been a paramedic.”

“What did you do before you got into this line of work?” Seth asks curiously.

“I was a professional retriever trainer, if you can believe that,” I laugh. “Some switch, huh?”

“I’ll say,” Seth chuckles. “What keeps you doing it?”

“The great pay and the chicks, of course,” I say, deadpan. Seth just frowns.

“Come on man, I’m serious,” he says. “I mean, here we are sitting in the dark on Christmas Eve, waiting for some guy to either shoot someone or get shot by the cops. Today an alcoholic nearly puked blood on us. You deal with drunks and derelicts and drug users. You pull broken bodies out of wrecks. You do boring transfers, shuttling little old folks back and forth between the hospital and the nursing homes. How do you do it without getting burned out?”

“Why are you a cop?” I retort. “You see most of the same things, and you just took an EMT class. Why do you do it?”

He pauses, reflecting. “I guess I just want to help people. But I’ve only been a deputy for two years. I haven’t even taken my EMT exam yet. But you’ve been a medic for ten years. So stop avoiding the question.”

I stay silent for a while, unsure how to answer.

Why do I do it? Not for the money, certainly. I make good money for a paramedic, but it’s hardly what I’d make as a nurse or physician’s assistant. I dropped out of college, and I keep finding excuses why I can’t go back. So why do I do it?

“I’ve been burned out,” I begin, not sure of what I intend to say. “Maybe six years ago. The job just wasn’t fun any more. I didn’t feel appreciated, I wasn’t getting paid much, and I didn’t feel as if I made a difference. I took some time off, and I got over it.”

“How?” Seth presses, unsatisfied by my answer.

“I figured out that I don’t save lives,” I explain. “Sometimes I get lucky, and we resuscitate someone successfully. Mainly it’s luck and good timing”.

“I came to realize that what we do isn’t life saving. My job isn’t about blood and guts. It’s about helping people just like you do as a deputy. Your job isn’t all car chases and armed standoffs. You may go your entire career and never fire your weapon. There’s more to it than the adrenaline rush.” I look at Seth and see that he still doesn’t get it.

“Look, two weeks ago I delivered a baby in the middle of the ice storm. It wasn’t fun. The fun part was seeing the mother’s face after I handed her the kid.”

“Two days ago, I took an old lady to the clinic for wound care on her bedsores. They stunk, Seth. She stunk, and she knew it. But I cracked a joke or two, made fun of her nurses, and I made her laugh. I held her hand on the way to the clinic, and she smiled at me when I dropped her off.”

“I started an IV on a six-year-old kid yesterday, and he didn’t even cry. He was more scared of the needle than his broken arm, but I talked him through the stick, and he figured out that the needle wasn’t so bad.”

“We picked up a combative Alzheimer’s patient this morning, and the nurses were sure we’d have to restrain her, that she’d fight us. We talked to her for a bit, and she went with us without a fuss. We earned her trust.”

“Today I got to teach you something. That’s why I do it, for stuff like that.”

“And what about the ones without happy endings?” Seth asks darkly. “What about the ones that you can’t do anything for – the ones that die?”

“Well, you remind yourself that it isn’t your disease,” I answer. “You do the best you can. And you don’t let the things you see harden your heart.”

“Base to all units, stand down,” the radio crackles. “Repeat, stand down. Suspect is in custody. Channel is cleared for non-emergency traffic.” Seth grunts in surprise and flips on the headlights.

“But that stuff will just eat you up,” he protests as we drive back to our station.

“I didn’t say let it eat you up, Seth. I said don’t let it harden you. You know those big, tough Paramedics that don’t let anything bother them? They never last, or they stick around but nobody wants to work with them. They never cry, but they forget how to smile, too.”

“Keep looking for the good stuff,” I advise. “You can always find something good, if you just take the time to look.”

Just then the radio crackles, and an anonymous voice floats over the airwaves:

“And lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them, and they were sore afraid.
And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people.
For unto you is born this day in the city of David a Savior, which is Christ the Lord… Merry Christmas, everybody.”

The radio clicks again and again as units around the parish key their microphones in response. I look at my watch. It’s just past midnight. The dispatcher transmits a moment later, adding only a quiet “Amen.”

“See what I mean?” I smile. “Merry Christmas, partner.”

Two years.

639 posts.

And as of midnight, 703,216 unique visits.

I can’t even count the friendships, blog children, blog grandchildren and pleasure you guys have provided by stopping by my little corner of the blogosphere.

You guys rock.

In honor of this inauspicious occasion, here’s the post that started it all:

The wonders of medical science never cease to amaze me. Since the days of of post-WWII, we have ushered forth the Age of Penicillin, followed soon thereafter by the Rise of Resistant Bugs, only to be followed by the Super Antibiotics, and of course The Super Bugs. Like the age-old battle between armor and projectiles, every medical advance seems to only bring forth a newer, meaner strain of Super Cooties.

Back in the day, strokes were just things that happened to old folks, and were simply To Be Endured. After the big event, we turned Grandpa toward the sunlight and kept him watered, and hoped like hell he recognized you when you visited. Maybe, just maybe, he learned to feed himself again, and then only if you (and he) were lucky. Now, we have vascular Drano that can circumvent that whole horrific process, if the Drano itself doesn’t finish Grandpa off in the process.

When you’re having a heart attack, you can go to the Roto Rooter man…excuse me, I meant interventional cardiologist…and have the old pipes cleaned out.

If your goober doesn’t work, we have pills to fix that. Ladies, if you weren’t visited by the Titty Fairy in your adolescence, the wonders of breast implants can fix that. Yet, given the paltry funding for Alzheimer’s research, we will soon have a generation of geezers with perky boobs and big erections with absolutely no recollection of what to do with them…

…but I digress.

My point is, we learn more about disease and disability every day. Yet I find myself highly suspicious of some of the latest medical conditions to be identified, not sure if they are legitimate disorders or just the feverish ramblings of Uncle Melvin locked somewhere in the basement at the CDC… you know, perhaps he has gotten out and and has found a forum.

As case in point, I give you Premenstrual Dysphoric Disorder.

I suppose a name like Mad Cow Disease was already taken. Ladies, pardon my dragging knuckles here, but what about this syndrome is any different than PMS?

Bloated? Check.

Bitchy? Check.

Wild mood swings? Check.

Persistent anger? Check.

Fatigue? Check.

Spouse walking on eggshells and offering you large quantities of chocolate? Check.

Spouse whimpering incoherently and bunking with his hunting buddies? Check check.

So what here is so radically different than good ole garden variety PMS? Is it possible, that like alcohol, PMS merely magnifies your less-desirable personality traits? Like, if you are already a wee bit bitchy, does PMS make the fangs come out? Or is it a clinical syndrome beyond your control, the dreaded PMDD????

Like a Mel Gibson apology, I ain’t buying it.

Don’t get me wrong. I’m a sensitive fellow. Warm and fuzzy, even. I like sunsets, long walks on the beach, puppies and poetry. I’m also fond of slaying God’s furry little creatures with projectile weapons, but that’s the predator in me. Man can become too civilized, you know.

And lest the distaff persuasion think I am merely picking on them, I also highly skeptical of any child with a diagnosis of ADHD. Don’t get me wrong, I know it exists. Many of us in EMS have all the symptoms – restlessness, need for constant stimulation, inability to focus and complete simple — Hey! A Butterfly! C’mere Mister Butterfly! Hey guys, let’s catch the pretty butterfly! Guys? Uh, guys? —

Oh yeah. Sorry, where was I? Right, ADHD. Even though it may be a legitimate medical disorder, I see mood-altering drugs prescribed to waaaaaaaaaay too many kids with a “diagnosis” of ADHD made by doctors too lazy to truly assess the child, or too scared to deny Mommy and Daddy a panacea for bad parenting.

Back in the not-too-distant past, when I was a schoolboy, parents and school administrators knew exactly what was wrong with Little Johnny when he exhibited disruptive behavior, fighting, talking back to the grownups and poor impulse control. Little Johnny suffered from Chronic Hickory Deficiency, a malady easily cured by liberal topical applications applied by the parents at home. If needed, my principal kept a large, highly polished Hickory Booster hung on the wall behind his desk, and he was not afraid to use it. And it worked. And they hadn’t even heard of things like Ritalin or serotonin levels…

Of course, I’d rant more but I’m sure I’ve already offended enough people, besides which I’ve always been easily distracted. And I have a hyperactive child to beat. Or I could just let the Ex-Missus dole out the beatings. She’d enjoy it. It’s that time of the month.

…is things like these:

Item #1: This morning she invites two new friends to breakfast. The fact that they were DOC inmates sent to empty the trashcans at our campsite was lost on her. They said the bacon smelled good, and she automatically offered some.

Keep in mind that my 48 pound child will easily eat a pound of bacon if I let her. If you are what you eat, KatyBeth is made up of chicken nuggets connected by strips of crispy bacon. And maybe a handful of Cheese Nips.

So yeah, she was being generous when she offered up her bacon. The trustees appreciated it, and the scrambled eggs, too.

I was proud of my kid, and told her so. I’ll save for later the lesson that she should generally avoid guys in orange jumpsuits unless her daddy is around.

Item #2: On the way back from Academy Sports -buying some kiddie-sized thermal underwear for Katy because it’s supposed to be cold tomorrow night – I happen upon a hit-and-run MVC right after it happened. So I hit the hazard lights, pull over and bail out with my Thomas Pack.

Dude’s circling the drain, closed head injury and all that, bleeding from both ears, and I’m struggling to maintain spinal immobilization and get an airway with no succs, and wishing to hell I hadn’t pulled my King airways and my Combitube out of my bag to give my EMT students something to practice with between classes…

…so I put a couple of bystanders and the state trooper to work, sending them each to my truck to get gloves. We do a fair job of stabilizing the guy until my fellow Borg drones arrive, and we hand the guy off to the crew and they whisk him away.

Afterwards, the trooper pokes me in the shoulder with his pen and says, “That’s a cool kid you’ve got there.”

“I know,” sez I.

“She introduced herself to me when I opened the truck door, and asked if I was gonna give you a ticket,” he chuckled. “I told her no, I was getting some gloves so I could help her Daddy help the hurt man.”

“And what did she say?” I grinned.

“She said, ‘gwoves are in the center console, and do whatever my daddy tells you. He’s a pawamedic.’”

That’s my kid.

I’ve got a good friend, a very intelligent and erudite fellow, who is about as far from me on the political spectrum as one can get.

And yet, on all the important things, our views are pretty much identical.

He’s a tie-dyed in the wool hippie.

He’s an avowed atheist, or to use his term for it, a non-theist.

He’s a Godless pinko liberal Democrat* who voted for Obama.

Yet common ground is easier to find than one might think.

He’s actually more libertarian than liberal.

He doesn’t actually wear tie-dye. His wardrobe is more rural west Texas shitkicker than Berkley tofu-eater.

He cooks a mean chili and an even better steak, and he keeps Coors and Shiner Bock on tap at his house.

He’s a shooter, and a biker.

He’s an old-school paramedic.

He’s a huge sci-fi and history fan, and he reads obsessively.

He is, to borrow a phrase from our mutual friend TOTWTYTR, “wicked smaht.”

Above all else, he’s a true Texas gentleman, and a man I’m proud to call friend.

And now he has a blog. Y’all welcome Of Mule Dung and Ash to the blogosphere. Bookmark him. You may not agree with everything he writes, but it’s always worth reading.

*Sorry, Mule Breath. Couldn’t resist the characterization. *grin*

I get frequent e-mails requesting product endorsements, or that I link to commercial blogs or websites.

I usually don’t, for the same reason that I don’t do blog ads. This blog is my creative outlet. It’s nice that I have readers, and I appreciate all of them, but I figure people would rather not wade through a million ads and banners to read my stuff.

Of course, that doesn’t apply to the book link, or to my Ambulance Driver products on Zazzle, because those things are my stuff. Buy them if you like, or not. I’ll keep posting regardless.

[side note: And why haven't you ordered your Ambulance Driver shirts or mugs, you slackers? Christmas is almost here!]

But I’m going to include a link to the ex-publisher’s website fairly soon, because I do believe that just about any EMS, fire, nursing or law enforcement-related book, tee shirt or collectible you could want, he can probably provide at a better cost than you’ll find anywhere else.

Also, I’ll point you to another website at the request of its owner, not because I have a financial interest in the business, but because I think they make an eminently sensible product.

Bullet Blocker makes bullet resistant backpacks, bags, portfolios and such. Rather than send your kid to school sporting one of those silly transparent backpacks many schools require (as if that would have stopped Cho Seung Hoi or Eric Harris and Dylan Klebold), it makes better sense to equip them with something that may provide a little protection.

All their products are manufactured to provide Threat Level IIIa protection, and while the price may be a bit stiff, it’s still pretty reasonable, and you can’t hang a price tag on better peace of mind.

Between a backpack with built-in ballistic protection and teaching your kids not to be sheep, you may increase their chances immeasurably should the unthinkable happen.

Now if I could just get ‘em to make one in pink, or retrofit Katy’s Disney Princesses backpack, I’d have the kid’s Christmas all worked out.

Woke up this morning to a lovely accumulation of white stuff on the ground. Now, for Nurse K or LL, this would qualify as “Awwwww, how cute! They actually call that a snowfall!”

But in Louisiana, this is considered a Big Deal. Now, further north where I grew up, it wasn’t uncommon to get a dusting every year, and every three or four cycles through the calendar, an honest-to-goodness snowfall.

Well, if you consider 6-10 inches a snowfall.

But down here in Cajun country, even a dusting this light makes motorists, public safety officials and school administrators lose. their. freaking. minds.

So, KatyBeth is home with me today, even though she would’ve been anyway due to a upper respiratory infection.

I took the opportunity this morning to introduce my daughter to the fun of snowball fights, snow ice cream, and making snow angels – although the snow angel morphed into a mud angel after only a couple of swipes with her arms.

Even Boots got in on the fun. I’ll bet when Babs rescued him from that south Georgia puppy mill, he’d never have imagined this:

Poor thing. I gave him a full body clip not a month ago, and now we’ve got snow on the ground. Guess he sleeps inside tonight.

…to be found here.

Ron Davis always has photos of gorgeous women (and tastefully work-safe, to boot) at his photography website, but this time he goes all Oleg Volk on us and poses a smokin’ hot model with his new AR 15. Non work-safe photos (but still tasteful) can be found here.

I’ve perused each photo carefully, but I’m still having trouble finding the AR15…

…who practiced in a small town in Louisiana. As doctors go, she wasn’t likely to be the one named by most medics as “the only doctor I’d want taking care of me if I’m brought to the ER.”

In fact, she was just the opposite. Advances in medicine had passed her by a good fifteen years before she retired, and emergency medicine was never her strong suit. She was out of her depth in an ER. Colds and sniffles, earaches, and the typical fast-track kind of cases she could handle, maybe suture the odd laceration here and there…

…but don’t ask her to put in a chest tube, or sink a central line, or intubate someone. God forbid she’d have to run a code. She just wasn’t up to the task.

But she had a healthy practice, and her patients liked her, and she treated them well. And she kept a small, rural hospital going, almost single-handedly, with her patient admissions.

She was Romanian by birth, married to an ethnic Greek, and she reinforced every negative stereotype of foreign medical graduates.

And she also was the embodiment of every positive stereotype of immigrants. She came to America to make a better life for herself, and with hard work and perseverance, she achieved it. Along the way, she enriched the community in which she practiced medicine immeasurably.

In that regard, she was more uniquely American than many of us native-born. She understood what America stood for – a land of glorious possibilities, where opportunity is limited only by your willingness to pursue it.

Around fifteen years ago, she graced me with more trust and respect than any EMT can hope for from a doctor, and almost certainly more trust and respect than I was worthy of at the time. She’d let me perform any medical procedure short of opening the cranial cavity, no questions asked.

But still, I appreciated the trust. Other medics looked upon her with derision, as the doctor who knew less than any good medic.

I knew better. I ran her codes, and I did things with her permission that no doctor in his right mind would entrust to a medic these days, but I never kidded myself that I was her equal. She was simply wise enough to realize that some things she was not good at, and was perfectly content to let others handle those tasks.

And as a result, I became a far more knowledgeable and skilled paramedic than I would have become otherwise. Even today, many of the doctors I work with who trust me implicitly, do so because fifteen years ago, it was me interacting with them in her stead. More than once she handed me the phone to give report to the accepting ER physician for whatever patient we were transferring.

I’ve been told by many doctors that I should go to medical school, but she was the first. When I got into a pissing contest with the charge nurse at that rural hospital, and my employers moved me to another city to defuse the situation, this doctor went to bat for me. She wanted me back there, and she wouldn’t take no for an answer.

She told the hospital administrator that she would refuse to admit patients or take ER call until I was moved back.

It was soon made clear to my employers that if they wanted to keep their transport contract with that hospital, they’d move her favorite paramedic back to his old shift.

They gave her what she wanted.

Ten years later, on the other end of the state, I was having problems with another ER doctor, the kind who denied every medic’s request for orders, no matter how trivial. To her, we were simply ambulance drivers, not medical professionals.

Seething with frustration after being denied orders for the umpteenth time, I tried making friends with her. No easy task, that. She was very class conscious, and paramedics were the lowest tier on the medical pecking order.

I recognized her accent, though, and in an attempt to establish some kind of rapport with her, I casually mentioned, “I know another doctor from Romania, who works down in Quaint Little Hamlet. You’re the only two doctors I’ve met from Romania.”

She cocked a skeptical eyebrow at me, and asked the name of my Romanian doctor friend. When I told her, her expression grew even more dubious. She knew this doctor too, and couldn’t imagine her consorting with a lowly paramedic.

But the next time I brought a patient to her ER, not four hours later, she treated me with something akin to outright deference. She was friendly, and listened to my report with interest, and after that day, never denied me orders again. Heck, I didn’t even have to call and ask.

There was no question in my mind that she had called QLH Community Hospital and checked me out. And neither was there a question in my mind that my doctor friend there had spoken of me glowingly. The fraternity of Romanian doctors practicing in Louisiana is undoubtedly a small one, and she was no doubt one of its elder members. Her word carried weight.

She retired from medicine over ten years ago, a full fifteen years too late if you go by current medical standards, and far too early if you take the word of her patients. She was old and tired when we first met, but she still worked grueling hours. Her health deteriorated pretty quickly after she retired. I think practicing medicine was what kept her going. It was her purpose in life.

So when I got a call from Effeminate Partner the other day, telling me she had died, I’ll confess I shed a small tear or two.

Rest well, Dr. Polly. You will be missed.

…the voters down there in Fallujah on the Mississippi ousted one crooked politician and installed a Vietnamese American in his place – the very first one elected to Congress, no less.

We have an Indian American conservative Republican governor, and now a Vietnamese American Republican congressman.

Remind me again…which party is it that is supposed to be all about inclusiveness and racial diversity, and which one is supposedly run by rich white guys in suits?

h/t to Mostly Cajun.

I spent last night in a tent, with the outside temperature hovering in the low thirties. It was cold enough that I could leave my six pack of beer just outside the tent within easy reach, rather than be forced to hike across the campsite and fish one out of the ice chest every time I got thirsty.

And where was my six year old daughter during this frigid night in the woods?

Lying on an air mattress right beside me, warmly ensconced in her Disney Princesses sleeping bag, that’s where.

Right now, I’m sitting in front of a roaring campfire, waiting for the coals to get ready to grill a steak and a couple of hamburgers. We’ll get up at 0530 tomorrow, get dressed, and go try to kill a few tasty arboreal rodents for tomorrow night’s supper.

Before we went to bed last night, KatyBeth rolled onto her back, clasped her hands behind her head, and sighed, “Aahhhh, now this is the life.” Her breath hung in the air like a plume of smoke as she said it.

And her grin met in the back.

That’s my kid. Frilly dresses and Disney princesses…and hardcore camper.