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Newbie Essay Contest: The Deadline Approacheth!

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And the newbie prayed, "Please, Flying Spaghetti Monster, reach down and touch me with your noodly appendage, bless me and send me to Las Vegas for EMS World Expo…"

… and a small voice in his head said, "You know, Confessions of an EMS Newbie is having an essay contest. First prize is a trip to Vegas, and the chance to meet Ron Davis and Kelly Grayson and appear on their podcast. You even get to follow Dr. Bryan Bledsoe around for a shift in the Emergency Department. Maybe you could win that!"
 

… and the newbie exulted, and said, "Oh, that would be SWELL! Please, please, PLEASE let me win that essay contest! In FSM's name I pray, Amen."

… and that same voice said, louder this time, "I mean, winning that contest would pay all your expenses except food, booze and hookers. EMS World will cover the conference registration, Cielo Azul will provide your lodging, and Emergency Training Associates will cover your airfare. You'd be all set! And the second and third place prizes are pretty schweet, too!"

… and the newbie nodded fervently, head bowed, and said, "I know! I'm praying! Pleeeeease let me win that essay contest!"

… and the voice, which may have been FSM but sounded suspiciously like Ambulance Driver, said impatiently, "Dude, at least meet me half way. Write a friggin' essay!"
 

Submission deadline is in 12 hours, people. Get your essays in!

Nice Ride

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Got off work Saturday morning and took the jet ski for a leisurely little ride on the waterways around Borg Hive Southwest. Since Saturday was the day of our annual employee crawfish boil, it didn't make much sense to waste a two-hour round trip back home, then come back for the crawfish boil and hang around for a few hours until my shift started.

So, I towed my ski to work Friday night, got off the rig bright and early Saturday morning at 0700, and headed straight for the boat launch. I figured I'd plug my iPod into my ears, point the Kawasaki's nose south, and see what I could see.

I made it all the way to the Gulf of Mexico, about 35 miles south of my launch point.

If that's not the Gulf, it's close enough for government work. I actually got a couple miles further out than this, but the wave action was bad enough that it required both hands and all my concentration just to keep the ski upright, much less snap any photos.

Further inland, the water is much more placid.

The water's brackish here, and this far south the spray certainly tastes like sea water when it hits you in the face. It's not as pretty as the Ouachita River near my hometown of Monroe, but it'll do. On a typical ride, I'll see alligators, tailing redfish, ibis, snowy egrets, great blue herons, roseate spoonbills, brown pelicans, ducks and gulls aplenty, and once, what I'm pretty sure was a bull shark almost as big as my ski.

Turns out my Kawasaki has pretty good legs. At full throttle it'll haul 400 pounds of me and KatyBeth at 60 mph, but it sucks gas. If you keep it below 5000 rpm, though, it'll still do 30 mph, and will make the 70-mile round trip on one tank.

Unfortunately, I didnt consider that doing the trip at half-speed also exposed me to the sun for twice as long. Right now, I'm about as red as the crawfish I ate later that afternoon.

Ouch.

It Puts The Lotion On My Skin, Or It Gets The Hose Again.

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I've got a wicked sunburn, a tube of aloe and lidocaine gel, and places I can't reach.

I've also got a brand new partner whose ink is barely dry on her EMT card, who has the endearing habit of calling me "Sir," and constantly seeking my guidance.

So you tell me, should I take advantage of her eagerness to please, or should I suffer through it in penance for my stupidity in not wearing sunblock?
 

Vote in the poll on my left sidebar.

Still Trending Down…

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… despite a couple of days of indulging myself. I didn't pig out, mind you, but I did go over my calorie count on couple of occasions.

For those of you keeping score at home, that's down 5.9 pounds from 10 days ago, and 48.1 pounds overall since February 1.

Memorial Day

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Monday is Memorial Day.

Most of us will spend the weekend grilling burgers and visiting with relatives, or lounging on a beach somewhere, or watching a baseball game in an opulent stadium, overpriced beer and hot dog in hand. And most of us will have forgotten the meaning of the day.

So when you partake in your Memorial Day festivities this weekend, try to remember a few things.

When the smoke from the grill blows into your eyes, try to imagine the terror of the young pilot as the smoke fills the cockpit of his F4 Wildcat, spiraling into the sea off Guadalcanal.

When you sample those pork ribs, remember the Iowa farm boy whose life blood stained the surf at Normandy.

When you eat a bite of potato salad, think of an Idaho preacher’s kid who died with a prayer on his lips, asking God to forgive him for the enemy soldiers’ lives he had taken.

While you enjoy the warm summer sun on your face, take a moment to think of the frozen bodies of American soldiers strapped to jeeps and tanks at the Chosin Reservoir.

When you welcome your niece’s new boyfriend to the table, remember the black kid from Mississippi who died right beside his white buddies in Vietnam, though he wasn’t even allowed to eat in the same restaurants back home.

When you scold your misbehaving grandchild, think of the little boy whose only knowledge of his father will come from stories told by family, because Daddy died on a dusty street in Fallujah while he was still in the womb.

When you fetch your wife another glass of tea, think of a young wife living in base housing at Fort Benning, as she hears the news that her husband died at Ia Drang.

When you invite Grandpa to say grace before the meal, think of young men cut down by a hail of fire from a Maxim at Belleau Wood.

When you reflect with pride on your daughter’s recent graduation, think of a young woman cartwheeling into the sea in her F14 Tomcat after a failed carrier landing.

When you look with distaste at the tattoos on her new boyfriend, think instead of the former gang kid from Detroit who found a way up and out of poverty in the Army, only to die from an IED blast in Baghdad. And remind yourself that what matters is how he treats your daughter, not the ink on his arms.

Whilst you enjoy your beer and bratwurst, remember the 19 -year-old Army private who died in a training accident in Grafenwohr in 1960, one of  many young men who knew they’d be little more than a speed bump should the Russians ever come pouring through the Fulda Gap. Yet still, they served.

When you sit at the table, think of a Navy Captain, a husband and father, who died at his Pentagon desk on September 11. His death was no less honorable.

If you’re traveling today, think of the passengers of United Flight 93, for in a field outside Shanksville they became the first soldiers in our war on terror.

When your boys fight, as boys will do, remember the boys on both sides who died at Gettysburg.

If a loved one can’t make it to the gathering today, think of Mrs. Bixby and her five sons.

While your kids play in the pool this afternoon, think of other kids not much older, trapped below decks as the Arizona went under at Pearl Harbor.

If you have bemoaned the layoffs of friends and co-workers in the recent economic crisis, think of the Navy SEAL who lost every single one of his teammates on a rainy night in Kunar Province, Afghanistan.

When you take a shower tonight, think of young men reeking of machine oil and sweat, desperately trying, and failing, to surface their wounded submarine somewhere in the Pacific in 1943.

**********

I tell you of these things not to spoil your appetite or your day, but to remind you that the things we enjoy in our lives are made all the sweeter when you consider what made them possible.

Remind yourself also that your sacrifice is infinitely easier. All you need do is sacrifice a moment of your time every few years to pull a lever. The way to honor a dead soldier is not simply to fly a flag on Memorial Day. Vote to preserve the freedoms they died defending. Elect leaders worthy of those rough young men and women who stand ready to do violence on your behalf.

And stop by your local Veteran’s Cemetery and put out some flowers on the grave of your choice. It need not even be the grave of someone you know.

Bring your children along, and explain to them why. It’s important.

Nurses: Not So Different From Us After All

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One of the most ludicrous assertions in the endless Nursing vs EMS debate is that paramedics are somehow more skilled than nurses. It's simply not true, and just as insulting to the nursing profession as it is to us when some snurse calls us ambulance drivers.

I've lamented before on the skills-centric thinking endemic in EMS, and how it holds us back. Go read that post, and come back.

The truth is, nursing is much farther along the path to independent practice than EMS, and we'll never draw abreast of them unless we increase our educational requirements and start producing medics who can not only do things, but understand why they do them.

Sadly, that does not describe the majority of paramedics I know. They can recite the indications, contraindications and dosing of, say, lidocaine, but damned few of them will be able to articulate how lidocaine suppresses ventricular ectopy, and why it might be a bad idea to give a dose of it to their patient with left bundle branch block and frequent PVCs.

In many states, mine included, registered nurses can do every skill in the paramedic arsenal. The fact that they don't is a function of hospital policy and protocol, not scope of practice.

They can intubate, and even administer sedatives and paralytics to facilitate it. 

They can needle chests.

Cardiovert or pace.

Even do a needle cricothyrotomy.

And yes, they can even do these things without a direct physician order…

… if written protocols allow it.

Paramedics often fail to recognize that, even though they may not have to call and say "Mother, may I?" to employ some of those skills, they are not doing them independently. They do them under off-line medical control in the form of written protocols. Nurses can operate under the same type of arrangement.

Question is, are those written protocols necessarily a good thing?

Today, I am somewhat saddened by the current state of the nursing profession. Don’t get me wrong: I love what I do. I am so thankful for the opportunities set before me.

But whatever happened to “nursing judgment.” Or “nursing decision.”

I can’t tell you how much recently I’ve heard the phrase, “It is hospital policy that…” “You can’t do that, it is protocol that…”

Read the whole thing. Insert "paramedic" wherever it says "nurse," and it could easily be one of Rogue Medic's rants on absentee medical directors and restrictive protocols.

Well, without the sarcasm and meticulous annotation, that is.

If you've ever worked in one of those systems where the protocols leave you feeling as if you're practicing with one hand tied behind your back, then you should be able to sympathize with that nusing home nurse that our profession enjoys ridiculing so much.

When the default policy decision to every problem is "Call the doctor," or "call the ambulance to take them to the hospital," you can either get out of that environment, or stay in it and become accustomed to the fact that your superiors don't trust you to think for yourself.

And after a while, you stop thinking for yourself, because after all, if your superiors don't think it's necessary, why should you? If you've ever been tempted to not even ask for orders because you already know what the answer will be, then are you so different from that nursing home RN who just calls the ambulance instead of giving a Tylenol to their febrile patient?

Nurses chafe at the same silly restrictions on their patient care and decision-making that we do. Maybe they're not so different from us after all.

 

Damn. Just… damn.

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Transport Jockey loses the love of his life.

Go by and show an EMS brother some support, and while you're at it, let those closest to you know how much you love them.

It may be your last chance.

EMS Expo Essay Contests

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All right, Newbies, we're getting close to that end-of-the month deadline for the EMS World Expo Essay Contest! If you're an EMT student or EMT with less than two years of experience, you've got until midnight, May 31 to submit your essay. Just so you know what you stand to win, let's review the prizes and schwag Confessions of an EMS Newbie and our contest sponsors have lined up for you:
 

1st Place: All expenses trip to EMS World Expo in Las Vegas. A 3-day conference registration and three show events (provided by EMS World), and a shift shadowing Dr Bryan Bledsoe at University Medical Center ED. Airfare supplied by Emergency Training Associates, and lodging supplied by Cielo Azul Publishing. The winner also gets a 1-year subscription to EMS World magazine, and appears on one of our live webcasts from the conference.

2nd Place: 1-year subscription to EMS World and fully stocked first responder BLS trauma bag.
A customized Confessions of an EMS Newbie case for your iPhone, or other smartphone. A signed copy of En Route: A Paramedic’s Stories of Life, Death, and Everything in Between by Kelly Grayson.

3rd Place: 1-year subscription to EMS World and fully stocked first responder BLS trauma bag, and a signed copy of En Route: A Paramedic’s Stories of Life, Death, and Everything in Between by Kelly Grayson.

Go to the contest page for more details!

If you're not an EMS Newbie, and you'd still like a chance to go to Vegas, EMS World magazine is providing two winners from the Robert G. Nixon Memorial essay contest with free registration to EMS World Expo, and $1000 in travel and expense money. Deadline is June 30. Go here to read about the contest rules and submission guidelines.

Get to writing, and hopefully we'll see y'all in Vegas, baby!
 

For You EMS Newbies…

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… Episode 48, the Listener Question Episode, is up on Confessions of an EMS Newbie.

It's Confessions of an EMS Newbie, where the only question that stumps us is, "Explain the universe, and give two examples."

And it wasn't the question that proved difficult, it was coming up with that second damned example…

A Likely Story

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Truck driver said he blew up like a balloon when he fell onto the fitting of an air hose that pierced his buttock.

Oh suuuuuure, that's what they aaaaaaall say.

Although I'll have to say, he did pick a unique twist on the "foreign objects impaling the backside" story. Usually, my victims just fall off a ladder onto a paint roller while painting their house in the nude, or slip into the shower onto a conventionaly shaped shampoo bottle…

I'll bet this poor guy will be a popular fellow on teaching rounds for the next week or so, with an endless stream of young residents and medical students traipsing through his room while the attending says, "This is what subcutaneous emphysema feels like…"

Pucker Factor

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You know, I'm a pretty placid guy. At this stage of my career, nothing much fazes me. Give me a bad scene, and I'm usually the island of calm in the sea of chaos.

I'm not one to transport lights and siren, either. I think the woo woo box and cherries tend to create more problems than they solve, and I usually only use them if the patient's condition is time sensitive and there is nothing I can do to stabilize it. If The Borg didn't require me to turn the damned thing on when responding to an emergency, it'd get used maybe a dozen times a year.

But when my patient is Gravida 7, Para 4, carrying twins at 28 weeks gestation, and she tells me she didn't carry any of her surviving children past 30 weeks, and the contractions are now three minutes apart… two things occur to me:

  1. It's time to stop screwing, or learn to use contraceptives.
  2. I can't get you out of my ambulance fast enough.

Medics, when you have such a situation on your hands, once you've established your IV, maybe given a little supplemental oxygen, given them a big bolus of fluid to perhaps slow those contractions, and administered whatever you have in your drug box that can be used as a tocolytic, it's time to use the Rickey Butts* Labor Management TechniqueTM:

Take a sheet, roll it lengthwise, thread it between the patient's legs, grab both ends…

… and run to the front of the rig, screaming for your partner to drive faster.

 

 

*Named for the inventor of the technique, a friend and medic who knew less about about birthin' babies than Butterfly McQueen.

 

Reason #6587 Why My Kid Rocks

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She finished the second grade with a 3.88 GPA, despite having to work far harder than her classmates, and was still bummed because she didn't get the Most Improved Student award for the second year in a row. I had to explain to her that it's hard to show dramatic academic improvement when your baseline is general ass-kicking excellence.

 

Yo, that's one proud set of parents right there.

For You EMS Newbies…

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… Episode 47 is up on Confessions of an EMS Newbie.

Ron takes his final exams, and we look back on a semester of paramedic school. We also answer a few listener questions, including debunking one of the stupidest internet memes on emergency care I've ever read.

It's Confessions of an EMS Newbie, the podcast that's just like Mythbusters, only without the explosions and production values. Or Kari Byron. Or a cool workshop.

So yeah, not like Mythbusters at all, but we'd still take Kari Byron if she ever needs a second gig.

I’m a Dodge V8

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Specifically, a 318, but not that deer-smashing wildcat cartridge, the .318 Dakota.

 

Yeah, I know the scale says 317, but I typically have another pound of EMS paraphernalia in my pockets when I weigh in. That's two more pounds down, and now that KatyBeth is out of school, there will be a lot more days of hiking, swimming, and jet-skiing. In a few more weeks, I might even match the weight printed on my driver's license!

 

For You EMS Types…

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I Am The Cliff Claven of EMS

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Conversation from the ED last night:

Dr. H: "Any shortening or rotation?"

AD: "None that I noticed."

Dr. H: "Any crepitus or deformity?"

AD: "She was in too much pain for me to really palpate it, and I didn't see the point of hurting her just to test for the presence of crepitus. But no, I didn't see any deformity."

Dr. H: "Well, we'll get some films and we'll know if it's fractured soon enough."

AD: "Oh, I'm pretty sure it's fractured. Femoral neck, probably."

Dr. H: "Oh really, how do you figure?"

AD: "I auscultated over her symphsis pubis while percussing her patellas, and there's almost no sound conduction through her left femur."

Dr. H: "Okay, well that makes… wait a minute, you auscultated what?"

Heh, I love it when I get to teach even the doctors about auscultative percussion. There's also a neat case report on the technique here.

And yes, it turns out she had a femoral neck fracture. The diagnosis was informed speculation based on a thorough assessment, but I got lucky on the exact location.

Even better, Hottie Temporary Partner was duly impressed with the technique, and now knows how to use an upside-down KED as an improvised hip splint and lifting device. She thinks I'm the EMS Yoda, but EMS Cliff Claven is closer to the truth.

"Ya know, Normie, an elk can't pronounce 'lasagna' because of the way his esophagus is shaped…"

Who’s More Racist: Newt Gingrich or David Gregory?

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*Sniff* They Grow Up So FAST!

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Doug E. Fresh, having earned his paramedic clearance a couple of weeks ago, can now fairly be called Doug E. Ripe.

Despite his official status in the Hive Mind as Drone, Paramedic Entry Level, for the past two weeks Doug and I have worked out a call rotation system in which continued to attend all the emergency ALS calls and transfers, and I handled all the routine BLS emergencies and the critical care transfers. It made for a nice way for him to gain some valuable experience while still having a more experienced senior medic to bounce ideas off of, or bail him out if things got hairy – not that such measures were ever necessary.

But now, the time has come for him to leave the nest, spread his little paramedic wings and fly, and take over his own truck. No more safety net, he is now The Man.

This also means, unfortunately, that I go back to running all but the routine BLS emergencies and transfers, with all the attendant paperwork.

Ugh.

On the bright side, my current (temporary) partner is hotter than Doug by a couple orders of magnitude, bright and capable, and she drives like buttah.

 

 

You're the king of your own truck now, partner. Try to be a wise and benevolent one.

“Look Out Shrek, He’s Got A Piece!”

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A Cleveland, TX man is airlifted to Memorial Hermann Medical Center in Houston after an encounter with a feral housecat:

At some point during the attack, the man and the cat reportedly were injured by a knife the man was holding. The man was taken to Cleveland Regional Medical Center before being transported to Houston.

Thus disproving the theory that a litte pussy never hurt anyone.

So the guy was so severely injured that, even after being evaluated and presumably stabilized by a physician at Cleveland Regional Medical Center, he was still so bad off he needed a helicopter? But hey, I'm also the guy that personally took care of a double-fatality ostrich attack, so I suppose anything is possible.

Based upon my experience with Houston rush hour traffic, a 49-mile ambulance trip could easily take 3-4 hours, so maybe it was necessary.

I think the lesson we can all draw from this is that, when dealing with strange pussy, condoms are not enough.

Wear Kevlar.

 

 

 

 

 

Hat tip to reader Matthew Woelfersheim for bringing this to my attention.

For You EMS Newbies…

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… Episode 46 is up on Confessions of an EMS Newbie!

Ron and I answer some listener questions, spitball ideas about how post-certification training and internship should be handled, and whether yu should do your clinical shifts with your own service, or seek a little cross-pollination from another service.

And next week folks, we're recording a Listener Question Episode. If you have a burning question about EMS, and would like to hear me talk out of my ass explain it better, go by and post your questions!

It's Confessions of an EMS Newbie, the only podcast so starved for content that we'll make YOU the star! Give us your listener questions, and if we can't make you famous, we'll at least make you notorious!

Ripped Straight From The Irony Files

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Conversation from an hour ago:

Patient (alternating breaths from her hand-held nebulizer with drags from her cigarette): "I… can't… figure out… *pant pant*… why I… can't… catch… my… breath!"

Ambulance Driver: "Ummm, I might have a couple of clues, but I doubt you'd understand either of them."

She couldn't breathe, so she took her albuterol nebulizer, which made her a little anxious and tachycardic…

… so she smoked a few cigarettes to calm her nerves.

Something tells me that a lecture on the pathophysiology of chronic obstructive pulmonary disease, healthy lifestyle choices and smoking cessation would have been, if you'll pardon the pun, wasted breath.

The Test Bed For Obamacare…

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… does not look good.

Oh, but it's gonna be so much better when we apply it federally.

The Mound Builders of Louisiana

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Back in the late 80's, when I was a student at Northeast Louisiana University (now ULM), the second floor of Hannah Hall housed a motley collection of rocks, artifacts and preserved specimens named, somewhat grandiosely, the "Northeast Louisiana University Museum of Natural History."

Back then, it was just a collection of display cases that lined the halls between offices and classrooms, and whose main claim to notoriety was the world's largest collection of preserved freshwater fish. They did have one exhibit, however, that managed to catch my attention; the skeleton of an Native American female, excavated from a burial mound.

NLU's researchers had long been denied access to the site by the landowners, but the floodwaters of the Ouachita River one year had eroded the mound somewhat, partially exposing the skeleton and a treasure trove of artifacts. Faced with the reality that another rise in the river level would likely wash it away altogether, the landowner allowed the university team to excavate the site. I can't recall the exact age of the skeleton, but I remember being powerfully intrigued that, right there in my home town, there lay archeological remains of former civilizations that predated the European exploration of North America, and possibly even predated the birth of Christ.

Nowadays, my alma mater has a different name, different mascot, and a new home for it's Natural History Museum, but my fascination with the mound building people of Louisiana remains unchanged.

Dotted across northeast Louisiana, and extending as far south as the river parishes, lie remnants of some of the oldest civilizations in North America. This weekend, I taught a PALS class at a rural hospital in far northeast Louisiana, and afterwards I had the chance to take KatyBeth and her stepsister to the most famous of these sites, Poverty Point. From the Wikipedia article:

Poverty Point (French: Pointe de Pauvreté) is a prehistoric earthworks of the Poverty Point culture, now a historic monument located in the Southern United States. It is 15.5 miles (24.9 km) from the current Mississippi River, and situated on the edge of Maçon Ridge, near the village of Epps in West Carroll Parish, Louisiana.

Poverty Point comprises several earthworks and mounds built between 1650 and 700 BCE, during the Archaic period in the Americas by a group of Native Americans of the Poverty Point culture. The culture extended 100 miles (160 km) across the Mississippi Delta. The original purposes of Poverty Point have not been determined by archeologists, although they have proposed various possibilities including that it was: a settlement, a trading center, and/or a ceremonial religious complex.

The site gets its name from the nineteenth century plantation upon which the earthworks were discovered. With a few thousand years of erosion, agricultural cultivation and native plant growth since its construction, most of the original earthworks are indistinguishable from natural terrain features. Indeed, unless you know what you're looking at, it is rather unimpressive:

 

At its discovery in the 1930's, Poverty Point was considered little more than a neat place in the woods to collect pottery shards and arrowheads. No one had any idea of the scope and size of the civilization that dwelt there, until aerial surveys of the site revealed the complexity of the earthworks:

 

 

It soon became apparent that those terrain features were the ruins of an ancient civilization, and the site is now a national monument and a state park. Over the years since its discovery, seven mounds have been discovered, in addition to the man-made ridges you see in the photo. It was at one time considered the oldest civilization yet discovered in North or Central America.

Prior to the discovery of Poverty Point, North American natives of the Archaic period were considered to be little more than loosely-banded tribes of hunter gatherers, with no defined culture or religion. An artist's reconstruction of the site puts the lie to that incorrect assumption:

 

To give you an idea of the antiquity, size and scope of Poverty Point, consider the following:

  • The earthworks at Poverty Point rival the size of the Great Pyramid of Giza, except that the ancient peoples there moved soil, not stone. And they did it without wheelbarrows, pack animals or sophisticated digging implements. They used their bare hands and woven baskets.
  • Tutankhamen was ruling in Egypt.
  • Hammurabi ruled Babylon.
  • Stonehenge was still under construction.
  • The Olmecs were only just ascending to power in Mexico, and there were no Mayans.The pyramids of Chichén Itzá did not even exist.
  • The cliff dwellings of the Anasazi in the southwestern United States wouldn't be built for another 1500+ years.

There is still some debate whether Poverty Point was a trade center, settlement or a religious ceremonial site, but due to the dearth of human remains, none of the mounds were believed to be burial mounds. Magnetic resonance imaging of the site indicates a number of circular depressions on the earthen ridges that were believed to be building foundations. Cooking stones and charcoal found in these areas support that assumption. It is estimated that over 700 dwellings occupied the ridges at Poverty Point, and at the height of the civilization, it was used or inhabited by as many as 23,000 people.

Non-native artifacts found at the site indicate that trade from Poverty Point extended as far as the Appalachian Mountains, the Midwest, and the Great Lakes region – pretty damned impressive for a people once considered to be hunter gatherers.

For years, Poverty Point was considered the oldest archeological site in North America, but the 1981 discovery of the Watson Brake mounds, an interconnected complex of eleven mounds arranged in a 900 foot oval, proved even older. Located near my home town of Monroe, LA, Watson Brake represents a settlement  some 2000 years older than Poverty Point. The site dates back to 3500 BC, which makes it older than the Great Pyramid of Giza by a good thousand years.

Despite its antiquity, Watson Brake lacks the sophistication and evidence of trade of the Poverty Point mounds, and was believed to be a communal gathering place for early hunter-gatherers. Unfortunately, most of Watson Brake is privately owned, and off-limits to the viewing public.

Before my Ambulance Driver days, way back when I trained retrievers professionally, I took over my brother's training kennels, located at the mouth of Bayou DeSiard where it empties into the Ouachita River. Directly across the bayou from my kennels was a wooded area very popular with the local kids because it featured a number of steep hills just perfect for catching some serious air on their BMX bikes. I doubt many of those kids knew they were riding their bikes over ancient burial mounds, but plenty of adults did, because the area was a popular site for illicit pagan and Satanic cult rituals. More than once, while washing down my kennels at dusk, have I seen people in black robes filtering silently through those woods, or heard their chants drifting across the water.

Now, I don't know much about pagan rituals, much less Satanic worship, but apparently one distinguishing feature of many of the cults in the area were nubile priestesses that liked to prance around nekkid by firelight. As such, all the kids I hired to help me around the kennels were instructed to come get me if they saw any nekkid women in the woods on the far bank of the bayou.

You know, so I could… investigate, and stuff.

Nowadays, that area around the Pargoud Mound has been turned into a subdivision full of million dollar homes, all situated within site of an ancient burial mound. For all I know, given its proximity to the Ouachita River, it may be the mound that housed the skeleton I saw in the NLU Natural History Museum all those years ago.

Since that picture was taken, a rather large and ostentatious McMansion was built there, with the mound situated literally in its back yard. Given a big push on the swing set, the kiddies can almost drag their feet over the remains of ancient Meso-Americans.

And you thought it was creepy having a cemetery next door.

If you're an anthropology or archeology geek, and you ever visit north Louisiana, you can take a driving tour of some of the earliest civilizations of North America.

Not a bad way to spend an afternoon, really.

Overheard On a Skype Chat

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While getting ready to record this week's episode of Confessions of an EMS Newbie, Ron Davis and I had the following exchange:

Ron: "So man, how was your weekend?"

AD: "Not bad. Taught a PALS class on the other end of the state, went jet-skiing on Lake Bruin, took the kids to Poverty Point…"

Ron: "Poverty Point? What's that, some kind of amusement park with a homelessness theme?"

AD: "More like a drive-through safari park, except the animals rush the car with squeegees and beg for spare change."

And now he's got my mind awhirl with what kind of rides a homeless-themed amusement park might have…

Joyce Grayson, January 1934 – May 2000

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Happy Mother's Day, Mom. I really wish you could have known your grand daughter.

**********

A Love Song For Joyce

 

There are few things more dismal than an ICU waiting room. People gather in familial clusters, keeping vigil against the specter of death. Books and blankets abound, snacks and cups of stale coffee cluster on tastefully appointed end tables, and the soon-to-be bereaved seek to mask their uncertainty and seek diversion in months-old editions of news magazines. Huddled together for support and security, they share the fear among them, as if spreading it around lightens the collective burden.

But there is always enough fear to go around.

And here I sit in an ICU waiting room, keeping my own vigil. Privacy is something I can only wish for, even here. Some of these familial clusters I have met before, in different circumstances; living rooms, bedrooms, breakfast nooks. Their fear was more visceral, more raw then, not the kind of settled-in dread they’re feeling now. Some of them come over to say hello, perhaps to thank me, only to realize I’m here for my own personal reasons, and so they beat an embarrassed retreat back to their own clans. Others keep their distance, looking at me with accusing eyes.

I sit here surrounded by the members of my family, alone yet not allowed the comfort of solitude. I am not one of these people any more. I divorced myself from them long ago. My sisters are here, and their families. My oldest sister is sobbing piteously, a crying jag that has lasted for three solid days. Sometimes it seems as if she has been crying for most of her forty-four years. She has always been ruled by her emotions. My father is here as well, looking forlorn and feeble. He sits there next to my aunt, lost in his own private Hell. His hands sit limply in his lap, trembling with Parkinson’s disease.

Inattention tremor, my education and training tells me. Inattention tremor, bradykinesia and hypophonia, all caused by loss of dopamine-producing cells in the substantia nigra. Replacement therapy with Sinemet or similar drugs will only slow the progress, not cure the disease. Eventually, he’ll become bed bound and rigid, and the disease will settle a blank mask over his features.

A different part of my brain tells me that he’s not there yet, because the fear on his face is palpable. He’s wondering what he’ll do once Mom is gone. That part of my brain is wondering where my Daddy went, the Daddy of my childhood, the Daddy that used to quiet my fears. That man isn’t here any more, either.

I want to go to Dad, to comfort him in some way, but doing so would only bring on more crying, more unwelcome histrionics from my sisters. I want to get Dad out of here, if only for a little while, but that will have to wait until Terry gets here, if he indeed gets here in time.

My mother is dying.

My mother has been dying for thirty years, if you listen to her talk. Throughout my childhood, it was her children who were killing her. Occasionally, it was her grouchy husband. Other times, it was life in general. Mom was an extraordinarily persecuted woman. She was, among other things, a Professional Martyr.

But this time it’s for real. My sister Sheri had called me a month ago, breaking the news. At the time I had chalked it up to Sheri being Sheri. Like I said, she has always been ruled by her emotions. Genetic traits in my family are strengthened with each successive generation, not diluted. In the case of fucked up X chromosomes, my oldest sister rolled snake eyes in the DNA craps game. Every bad trait of Mom’s, she inherited in spades. Mom was worse than Grandma.

I suppose we should be thankful Sheri has birthed only boys. A daughter would be too frightening to contemplate.

But a second call from Sheri three days ago made it real. Aside from being an unwelcome second phone call in a one-year span, it also bore the unsettling news that Mom had been admitted to the ICU.

Okay, so apparently a doctor also thinks Mom is sick. Sick enough to need intensive care.

I walked into the ICU maybe 12 hours after Mom had been admitted following her lung biopsy. The Missus and I walked right past the waiting room, avoiding my family gathered there. I knew the security code to get into the ICU, so I let myself in even though it wasn’t normal visiting hours.

“Well hello there, AD!” one nurse greeted us cheerily. No one even questioned my presence there, despite the fact that I was not in my uniform. Several nurses asked about upcoming ACLS classes. Everyone was perky and cheerful.

“Actually, I’m here to see about my mother,” I told them. “She’s in Bed Six.”

“Oh. I’m…I’m sorry. I didn’t connect the names,” the charge nurse stammered, embarrassed. No one else said anything, and an awkward silence followed.

“Can we go in and see her?” I asked politely. “I know it isn’t visiting hours…”

“No, go right in,” the nurse interrupted. “I was just going to bring her a popsicle, but I’ve got some charting to do here…you can just bring it to her yourself. Take all the time you need.”

If it can make an ICU nurse somber and solicitous, it’s bad.

“Well, look who’s here!” Mom greeted me with a grin. “My prodigal son and my favorite daughter-in-law! How long has it been since I’ve seen or talked to you, five years?” Despite the hearty greeting, her voice was harsh and strained, muffled by the oxygen mask.

More like three years, Mom.

“How ya’ doing, Mom?” I asked softly, pulling a chair next to her bed. I stole a glance at the telemetry monitor mounted above her bed.

Atrial fibrillation. Since when did she have atrial fib? Pulse oximetry is only 84%, despite the non-rebreather mask. BP only 90/50.

“I’m dying,” she said matter-of-factly. “I won’t make it out of this hospital. You kids have finally killed me.” The last sentence delivered with a wink and a grin.

“Want something cool to wet your whistle, Mom?” The Missus asked tenderly, sitting beside her on the bed and unwrapping the popsicle. Mom nodded weakly and The Missus gently slid the mask up onto her forehead and fed her tiny bites of the popsicle.

She leaned close to Mom, winked mischievously and whispered, “Remember the first time I ever saw you eat a popsicle?”

Mom’s eye snapped open wide and she chuckled. The laughs began as the big, rolling belly laugh that I knew so well, and ended with painful, wracking spasms of wet coughing. A suction unit gurgled quietly in the background, and I could see a chest tube draining bloody pus into a collection chamber.

I remember that day. It was maybe thirty minutes after you met her for the very first time. She was the first, and only, girlfriend I had ever allowed to meet my parents, and then only because she insisted that my parents be a part of our wedding. In ten minutes you were cackling like old girlfriends, and then you proceeded to show The Missus how a wife pleasures her husband, using a popsicle to demonstrate. The Missus had been shocked at first, then you both dissolved in a fit of giggles. She told me later that now she knew where I had inherited my sense of decorum and my internal censor.

“I won’t be doing that any more, I’m afraid,” Mom had answered hoarsely after the coughing fit had passed. “I’m too old for that, anyway.”

“What did the doctor say, Mom?” I pressed. “Sheri didn’t make much sense when she called me, and she doesn’t understand medical terminology.”

“He said I’m dying,” Mom repeated, as if I were still a child. “I believe his exact words were ‘advanced pulmonary fibrosis of a particularly aggressive nature’ or some such bullshit.”

“Did you get a second opinion?” I asked desperately. “Maybe another doctor might – “

“Charge me money to tell me I’m dying, but using different language? No thank you. I know I’m dying. I’ve felt it for the past month.”

“Maybe another doctor somewhere else, Mom,” I argued. “Somewhere with better hospitals. I can arrange an ambulance to take you to Houston – some of the best hospitals in the country not eight hours away. Hell, I’ll go with you myself…”

Listen to me.” she scolded. “I have less than 30% of my lung capacity left. I’m taking steroids in doses that would kill a horse, they have my stomach so irritated I could shit through a screen door, and I’m only getting worse. So grow up and accept it. I. Am. Dying. I’ve already signed a DNR, so it’s out of your hands.”

“You’re giving up, Mom. Don’t give up. Not while you’re still strong enough to bitch at me like I’m a five year old.”

“What should I do,” she coughed, “Wait until I’m too weak to make my wishes known, and rely on my kids to make the right decision? You might be perfectly willing to let me die, but Sheri won’t. You know it and I know it.”

I said nothing. She was becoming angry, and all too many of our conversations for the past twenty years have been angry. I just held her hand and sat by her bed until she dozed off, and then The Missus and I slipped quietly out of her room.

I made my entrance into the ICU waiting room, greeting relatives with whom I felt no kinship. I was struck by how frail and tiny Dad felt when I hugged him. I hugged or shook hands with everyone, pretended to be interested in family gossip, and prayed for it all to be over soon so I could get away from these people.

I settled into my own isolated niche with The Missus at my side, who was wise enough to leave me alone with my thoughts. She stayed next to me, squeezed my hand occasionally, and allowed me my silence.

Later that first day, Bodie, Mike and Reggie showed up. I was comforted by the fact that my family was there – the family I had chosen. My wife, and my partners. They spent the next three days keeping vigil with me, missing work and family commitments, losing salary money. God I loved those guys.

I spent those days sorting through my feelings for my mother, and by extension, my entire family.

You see, as my mother went, so went our family.

My father worked long hours at his small business when I was growing up. He always came home tired and cranky. In my teen years, we rarely got along.

My mother was the one who taught me how to catch a baseball. My Mom taught me how to ride a bike. My Mom taught me how to swim.

My Mom also taught her children that mediocrity was acceptable, and that excuses were more valuable than doing the work. She taught us that our failures were always someone else’s fault, and in so doing, taught us how to repeat those failures for the rest of our lives.

I made straight A’s throughout school. When I was a kid, Mom used to reward me for those A’s – a dollar here, a quarter there, more when Dad’s business prospered – until one day in the fourth grade when the rewards stopped. She needed the money to reward my twin sister for B’s and C’s. Her reasoning? “It comes so easily for you, and you don’t need the motivation.”

She was right about that. There would soon come a time when everything I did was entirely self-motivated. I craved neither my mother’s approval or even her acceptance.

She taught us how to laugh. There was much joyful giggling in my childhood.

She also taught us emotion without reason. That lesson crippled my sister Sheri, who learned it all too well.

My Mom taught me how to stand up to a bully. When I was eight, the neighborhood bully beat me up and stole my new Boy Scout knife. It wasn’t the first time he had beaten me up. I still bear an inch-long scar on my right temple as testament to his cruelty.

“You go over to his house, and you get that knife back, or you will deal with me,” Mom had ordered. “You better decide who you’re more afraid of.”

I marched tearfully over to the bully’s house, knocked on his door, and dealt out the worst fear beating I’ve ever administered. How bad was it? I beat a ten-year-old unconscious, that’s how bad it was. But I got my knife back, and I was never afraid of David Young again.

My Mom was also the one who invited that enemy into our home and gave him the opportunity to steal my knife in the first place. She invited him to join our Cub Scout den, and this after he had left me with seven stitches in my temple.

My affinity for people and my love of medicine, I got from Mom. I inherited those gifts from her. She was a fifty-year-old housewife with a GED who decided to go back to school and become a nurse. I used to proofread and edit her essays when she was in nursing school.

I learned CPR by playing hooky from junior high school and tagging along with Mom to LPN class. The nursing students used me as a practice assessment dummy for an entire summer.

When I was a high school sophomore in 1984, I used that knowledge to help revive a man who had choked and arrested at a hotel restaurant. It was my very first save, and the very first time I saw paramedics in action.

When Mom took her licensing exam that year, back in the days before electronic testing, she got a perfect score. One of only eight people to have ever done so in this state, I might add.

Mom also taught me the value of sarcasm. Our car stalled once at a red light in rush hour traffic. A jerk in the car behind us kept leaning on his horn while Mom vainly tried to start the car. Eventually, she got out, walked back to the man’s car and knocked on his window.

“Sir, I was wondering if you could help me,” she said politely, in her best helpless Southern belle voice. “You see, my car won’t start…and I was wondering…if you might come up and see if you can get it started…while I sit back here and honk your fucking horn for you.”

The guy apologized for being an ass, helped Mom push the car off the road, and stayed there with us for thirty minutes in the July heat until we got the car started.

Mom could also be a profane, shrieking harpy who could be heard cursing like a sailor throughout the entire neighborhood.

She rented a house trailer to a black woman in the 70′s, and then stood up to our all-white neighborhood association who demanded that she terminate the lady’s lease.

When I was seven, she caught me with a Chick O Stick I had stolen from the neighborhood grocer. She marched me back down there and made me confess my crime and promise to sweep his store after school for a week to make restitution.

When I was fifteen, I also watched her purloin the seat from a toy tractor at Wal Mart, because the one she had bought for my nephew was missing the same part.

My cousins always adored her because she was the crazy Cool Aunt who let them get away with stuff.

To her kids, she’d deal out syllable whippings when we misbehaved. Ever had a syllable whipping? Imagine someone grabbing you by one arm, and whipping you with a switch with the other hand, all while you run in a circle, desperately guarding your hindparts and trying to get away. She’d swing with every syllable, and when Mom was mad, she had a bad tendency to get long-winded.

Many was the time I ran in a circle through the disciplinary equivalent of Hamlet’s Soliloquy – “Don’t- you- e- ver- do- that- a- gain- do- you- hear- me- you- lis- ten- to- me- while- I’m- talk- ing- to- you- I’m- your- moth- er- damn- it- and- I- will- be- o- beyed…”

There were also many times where I had to intervene for fear she’d beat my demonic twin sister to death.

She told riotously funny jokes until we‘d collapse in giggle fits, laughing until our stomachs hurt.

She’d also sit alone in the dark for days on end, eating white bread and staring vacantly at soap operas. And some days, she’d contemplate suicide.

My mother was the Barbara Mandrell of psychiatric disorders. She was bipolar before bipolar was cool.

She’d let my twin sister get away with murder, because she was a Troubled Child.

She also had an aggravating tendency to walk in at the culmination of hours of torture at the hands of my twin sister, at just the precise moment I’d finally snap and retaliate.

“Oh, so you two wanna fight, huh?” she’d muse. “Well, I’ve got the cure for fighting. When you get done, you won’t wanna fight any more, believe you me!”

She’d then proceed to the hedge and gather three diabolical switches, test them for proper flexibility and tensile strength, and then hand one to each of us.

“Go ahead and fight,” she’d exhort us. “Work out all that aggression. And if you don’t fight, you get a whipping from me.”

I’d spend the next five minutes getting lashed by not one, but two psychotic females.

She would mortify me in front of my friends with her mouth and her antics…

…but they kept coming back because I had the coolest Mom in the neighborhood.

She taught my Cub Scout den how to dance. We were at that socially awkward age where you first start to notice girls, but still haven’t figured out how to approach them. We had a school dance, and all of us were stressing because none of us knew how.

“Dancing is easy,” Mom had said, “just pretend you’re drying off after a shower.”

“Huh?” said a dozen eight-year-old boys.

“You just do The Towel,” she explained, and then proceeded to demonstrate, to my utter mortification. My five-foot-nothing, 300 pound mother grabbed an imaginary towel, stood up and showed us how.

“You pretend you’re drying your lower back, like this,” she said, while shimmying her hips.

“Mom, please don’t…”

“And then you pretend you’re drying your shoulders,” she said, striking a disco pose straight out of Saturday Night Fever.

“Okay Mom, I think we get the idea…”

“And then you dry between your legs,” she’d say, doing a pelvic thrust.

MOM!”

Mom was also a noted philosopher, quoted by no less an American luminary than Paul Harvey:

Joyce in Louisiana writes:

“I’m just a simple woman, unable to grasp the nuances of science, geopolitics or world affairs. We are embroiled in a war in Vietnam that I do not understand, and we are impeaching a President whom I no longer trust.

Yet this I do know: Why, in a country that has been able to land a man on the surface of the moon, must we continually be forced to purchase hot dogs in packages of ten, while hamburger buns come in packages of eight?”

Who says all the world’s great philosophers are dead?

My Mom said it first, folks. And she changed the world. You can now get hot dog buns in packages of ten.

Three years earlier, my Mom took me out for dinner on my birthday. We didn’t talk much even then, but after dinner she took me for a drive. She had something to say.

She told me that night that my twin sister and I were not our Dad’s biological children. Our father was her teenage sweetheart, a man whom she had an affair with after she married Dad.

My twin sister had known for fifteen years. My entire family had known, except me. And now she wanted me to build a relationship with this man.

“There’s no hole in my life he needs to fill,” I told her nastily. “I know who my father is – the man who fed me, clothed me and disciplined me when I needed it. The man who has been here for thirty years. Don’t expect me to feel some kinship with a man just because he fucked another man’s wife over thirty years ago. I don’t even feel a kinship with you.”

We didn’t speak again until that moment by her hospital bed, three years later.

I spent the next three days reliving every memory of my childhood – good and bad. I found some forgiveness in my heart, and mom granted me her own. In the balance, the good times outweighed the bad.

The day before she died, she had my Dad and her teen sweetheart to her bedside, and made them reconcile their differences. She told them she wanted the only two men she had ever loved to find some common ground with each other, to harbor no bitterness after she was gone. Because they both loved her, they agreed.

Mom grew steadily weaker, but kept her sense of humor until the very end.

In one moment when we thought she was too far gone to hear, Terry and I stood on either side of her bed holding her hands, both of her estranged sons come back home. Terry whispered, “Mom, I sure wish I could switch places with you.”

Mom cracked one eye open and whispered back, “Yeah, I wish you could switch places with me, too.”

Those were the last words I heard from her before she died.

After her funeral, The Missus and I took her nieces skiing on the lake. The eldest of them was celebrating a birthday, and I couldn’t see canceling a birthday party. The kids deserved their fun.

“Are you sure you’re okay with this?” The Missus had asked me as we lay there on a beach towel, basking in the sun.

“Yeah, I’m okay with this,” I assured her as I watched the kids trying to dance to some hip hop music I’d never heard before. “Mom would roll over in her new grave if I canceled a kid’s birthday party.”

You’re sure?” she asked, squeezing my hand.

“Yep, I’m positive,” I replied firmly, getting to my feet. “and I don’t know about you, but I’m tired of watching those spastic nieces of yours try to dance. You really are some countrified white girls. Somebody needs to teach them how to do The Towel, and I’m just the man to do it.”


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