I want to borrow a piece of pop culture for my first point.

Here we have Princess Leia, telling Grand Moff Tarkin how it is, “The more you tighten your grip, the more star systems will slip through your fingers.”  This is true with just about any system which includes tyranny and injustice. And this is true of our own socioeconomic system. (BTW, there is actually a site called http://www.leiasmetalbikini.com. I found it while searching for the above Youtube clip, and it has changed my social and political views.  Every guy should have a girl who is willing to dress up in Leia’s metal bikini.  If I ever run for office, this will be the linchpin of my campaign.)

There is only so much debt a blue collar worker can incur before the average Joe wakes up and says, “Goddamn, I need to cut up all these cards and live within my means.”  As a country, we are there.  No amount of stimulus will replace the sinking feeling that comes with debt.  Yet all of our financial analysts who are smoking the crack of the ‘wealth without limits’ mindset still firmly believe in a model that includes an economy that expands forever without collapsing.

Here is where some of the common sense creeps in.  I am not an economist, but I am smart in other ways.  If you are an economist who believes in this ignorant pipe dream, can you please point me towards another system in the history of this planet that survived under the same parameters?  Please enlighten me and point to any ecosystem, any species, any economy, or any social system that was able to survive with constant growth and expansion.  So…you are unable to do this?  With all of science and academia at your fingertips, you are unable to show me one system that expanded constantly without collapsing or failing for hundreds of years on end?  Then why in the hell would you be so ridiculous as to consider that our economy could survive under a set of parameters where there are no other successful examples in the history of the world?  I’m sorry, but your own greed and egocentrism has gotten the better of you.  Not one scientist in America believes in the existence of a perpetual motion machine.  Why is it that every economist is convinced that our economy is one?

Jeff Jarvis is a very interesting pundit and analyst.  This blog post by him has been discussed all over the internet over the last few days.  This post makes the argument that the jobs that have been lost by this country have been lost forever.  Severe changes in the way we live, consume, and make a profit have marginalized a certain segment of our society, and these jobs will never return.  I couldn’t agree more, but the criticism does not end there.  He is just skimming the surface.  I would like to make a few points and illuminate a few truths that will never be discussed by politicians.  Why won’t these things be discussed?  Because it would be political suicide.  But I am not running for office, and I have nothing to lose.  So here it goes…

Truth #1: Not everyone in this country is bright enough to get a masters degree and pursue a promising career.  Some people have to mow the lawns and mop the floors.

I have been responding to 911 calls for sixteen years.  I have seen the not-so-well-to-do segment of our population.  You could get Ed McMahon,  (if he were alive) drive to the trailer park, knock on a door, and tell one of these families that they have won the education sweepstakes.  All the little kids in this trailer can go to school for free forever.  They can go to college, grad school, get PhD’s…the sky is the limit.  I don’t think anyone would take you up on it.  (I have often thought that the trick to fixing some of our nation’s woe’s is not to provide more services, but simply get the people living here to use the services that are already here. But that’s the source of another blog post.)  No politician will ever tell you this, but it is simply impossible for everyone in our country to be successful. Politicians have learned to soften the blow of this truth by painting Americaas a place where everyone has the possibility of being rich and successful.  And it is up to each and every one of us to maximize this possibility.  This is the same reason why the lottery is so popular with the poor.  Let’s all go to the convenience store to buy our beer, cigarettes, and lotto tickets.  Isn’t that productive?  But I have digressed a bit.

I hear entrepreneurs, politicians, and economists all talk as if there will soon be a day when everyone in America is well educated and working productively in the information sector. America will be a leader in technology and innovation, and we have no need to rely on production as long as everyone gets with the program.  I’m sorry, but I have run calls in the trailer parks and the projects.  Some of these people are simply not going to get with the program, no matter how free, advanced and wonderful it is.  The change you are suggesting would be nice, but it’s just not possible.

Truth #2: Infinite growth is not possible.

Every for-profit company I have ever worked for labors under the delusion that every year must be better than the year before.  The investors who own stock in these companies, and therefore a share of the profits, could care less whether or not the company is successful or not.  They just want to make sure the price of the stock goes up in a certain way that they can predict so that they can later sell the stock at a profit.  Therefore the long term success of the company is not a factor in any decisions that are made.  As a matter of fact, long term success may be undesirable when compared to a quick meteoric climb.  Whether or not the company can survive the meteoric climb does not matter.  If things start to go south, just sell the stock and move on to the next company that will make them a fortune.

Again, step back and look at this system for a moment.  The losers litter the base of this ivory tower.  The bodies are stacked deep and thick.  How many times do we have to see white collar crooks redline a company into the ground only to float away in their golden parachute just before impact?  How many times can we be fooled by this before attempting to regulate it?  But wait…everyone in America has a chance to be one of those successful executives.  If we regulated this, then the average Joe would no longer have the chance to make it big.  So let’s just look the other way so that we can continue to buy these lotto tickets.

Truth #3: The market will not successfully regulate itself.

Greed will always trump responsibility and accountability.  Have a look at Ralph Nader’s career before everyone labeled him as a crackpot for trying to create a third political party.  (The “I Actually Give a Shit About the American People Party.”)  If you ask the average guy on the street what he thinks about Nader, you will usually hear something like, “Oh, that guy is a crackpot.”  If you ask the same person what Nader did before he ran for president, that person will say, “I don’t know.”  If you don’t know either, I will tell you.  He was a tireless consumer advocate who shaped regulation and policy for decades.  Seatbelts?  That was Nader. Airbags?  That was Nader. Cigarette pack warnings?  Nader.  His work has literally saved thousands of lives.  And you know what?  American business fought him tooth and nail every step of the way.  Not just every step, but every millimeter.  Every nanometer.  Both Republicans and Democrats are responsible for the deregulation of mega corporations that sodomize you everyday.  People whose lives have been saved by Nader’s work call him a crackpot because he dares to try and regulate our precious church of Laissez-faire.

Mortgages weren’t regulated enough and look what happened there.  Derivatives?  Please.  So this is also something you will never hear a politician say: “We need more regulation.  No just a little, but a lot of regulation.”  Why won’t a politician say that?  Because his campaign is funded by business, and what business wants to be regulated more heavily?  Is there still anyone out there who doesn’t get this concept?

Truth #4: We have been living way beyond our means.  We are all going to have to dial it back and lower our expectations.

We are going to have to make do with less money, less services, less energy, and smaller houses.  No one wants to hear this.  Interestingly enough, Jimmy Carter once got on TV and told this to America during a national address.  So confident was he in his convictions that not long after that speech he fired his entire cabinet and replaced them with people who would help him convince the American people that they needed to conserve and live with less.  And you all know what happened to him, don’t you?  We got his ass out of office as fast as we could, and replaced him with the nearest Republican that would allow us to run up our credit cards again.  Hey, who is handy?  Some old actor?  Yeah, why not?  Let’s put him in office for the next eight years.  Whew…that’s better.  Man, that Carter guy…can you believe the nerve of that guy wanting me to live more responsibly and frugally?  Fuck a bunch of that!

Truth #5: At some point we are going to have to pay back every cent that we owe with interest.

In order to do this, we will have to sacrifice comfort and do without some things.  How many times have you heard someone bitch and complain about the deficit and in the very same conversation complain about taxes and budget cuts?  Have I missed something here?  Have the laws of physics and math somehow changed?  Can we actually expect to pay back trillions of dollars with nothing but procrastination and selfishness?  I can only shake my head at this one and say, “What the fuck?”  I have never had a bank loan me money and later tell me, “You know what, we were kidding.  Go ahead and keep that money.  We don’t need it.  You don’t owe us a cent.”  Yet most of the people who are reading this right now are somehow able to reconcile in their head the retarded notion that as a nation we can borrow trillions of dollars, and that will in no way impact any of us personally.  You would never vote for any politician who got up on TV and said, “You know what?  We’re boned.  We all need to raise our taxes a bit and do with less services and comforts until we pay off this debt and get the books balanced.”  Who the hell would vote for that guy?  Well…I would, but I’m weird.

The Point?

Okay, the title of this post is ‘Capitalism Without Consumers.’  I need to explain that.  Remember Princess Leia talking about star systems slipping through the Empire’s fingers?  Well, that is what has happened to America.  The banks, government, and big business have squeezed way too tight and millions of American consumers have slipped through their fingers.  You bled them dry, and they have no more money or credit, so they have stopped consuming.  And capitalism without consumers just doesn’t fucking work no matter how many pep talks you give or how much fuzzy math you apply to the numbers.

Banks make a profit by collecting interest on money they lend out.  So banks want to lend you money and charge you interest.  They want to do this as much as they possibly can.  So, they try to convince you that buying things you can’t afford and paying for them later is a good idea.  And they actually succeeded in doing that.  I’m so confused by this, that my confidence in humanity is gone.  If they can convince a nation of 300 million people that living beyond their means and paying 20% interest is a good idea, they can do anything.  What are they going to tell me to do next?  Periodically go out in the backyard, find a brick, and smash my junk with it?  Or maybe go find a stick and beat myself?  Cause that makes about as much sense as paying 20% interest for a bunch of shit I don’t need while my government borrows trillions of dollars without raising my taxes.  Sure, this will all work out.  We’re going to be fine.

There has been a lot of speculation as to why this bailout hasn’t worked.  Tax cuts and incentives haven’t worked either.  It’s all very simple.  Like so many people I know, I have stopped buying things I can’t afford.  I haven’t borrowed money or used a credit card in a couple of years now.  I stopped smoking the crack the banks were dealing and I have simply decided to go cold turkey and live within my means.  Every time I get a little extra money, I pay down debt.  I imagine a good percentage of us are doing exactly what I am doing.

And this is why the banks perceive this as not working: they make money by loaning money.  A bank’s idea of a stimulus is to get people to borrow money again.  But if any stimulus money trickles down to me, I take it and pay off debt.  By doing this I am actually reducing the amount of profit made by the banks by reducing the amount of revolving interest I pay to them.  And I am sure that I am not the only one doing this.  I have heard several reports that this is exactly where much of the stimulus went.

So isn’t that a good thing for the consumer at least?  Can we all finally say, “Yay stimulus!”  At least the part that trickles down to the consumer after executives skim their bonuses off the top is getting us out of debt, right?  Not exactly…you see that stimulus money gets transferred to the national deficit which is the equivalent of using one credit card to pay the bill for another credit card.  So, my own government has created a stimulus package that has reduced the amount of profit the banks are making and creates debt that I will some day be liable for in interest.  Make no mistake about it.  I will someday pay that debt either through higher taxes or a reduction in services.  Now I am no longer in charge of my own financial destiny.  The government has taken the credit card out of my wallet, ran up the bill, and handed it back to me.  Thanks.

The Solution

I have been losing weight recently.  Someone at work asked me what my secret is.  Here is what I told her, “I have been exercising a bunch.  I ride my bike to work.  I do crunches, leg lifts, and other strength exercises at least once, sometimes twice a day.  After I do those exercises I go walk for a mile to loosen up.  I have also reduced my calorie intake.  I eat very little meat.  I eat reasonable sized meals made up of mostly fruits and vegetables.”

“Fuck!  That’s not a secret.  That’s work.  Who wants to do that?”

“Well, I never actually said I had a secret.  You asked me how I was losing weight.  You expected and hoped that I had some secret that you could apply to your own situation that would make weight loss easy for you.  You didn’t want to hear that I lost weight through lots of self control, exercise, and diet.  You don’t want to hear it, but that’s what worked.”

Why should our accountability be any different with our failed economy?  As I said earlier, I have the answer.  No one wants to hear it, but I have it.  So here goes.

I am aiming lower.  I sold one car because it was too expensive to maintain.  I sold it and paid off more of my debt.  I have reorganized my life to where I work closer to home.  I ride a bike to work.  It saves me tons of money and makes me healthy.  We recycle and re-purpose just about everything we own.  We set the thermostat to 78 or 80 during the summer and 60 or 62 in the winter.  I think my government should raise my taxes and stop making bailouts for bankers.  We should stop invading other countries to turn them into puppet democracies so that we can insure a cheap supply of oil to our morbidly obese and unhealthy economy.  We should take all of the money we use to invade people and pay down our debt and try to refine alternate sources of energy such as solar power.  We should strive to pay a little bit more for locally produced goods so that we can support our own economy and communities.  There are plenty of people living all around us who are not capable of getting a masters degree and working for Google, but they can work 40 hours a week producing goods sold locally and make a living.  We should strive to provide healthcare and education for these people because generations down the road will benefit.  And if we don’t give them something to do they are going to start robbing us and setting up guillotines in the town square.

I’m not a socialist.  I’m a capitalist.  But you can’t have capitalism without consumers.  If the banks and the government would stop stealing the credit card out of my wallet to run up my bill, I might actually have more money in the future to spend on goods and services to support my economy.  The CEO’s of these corporations should think about making $250,000 per year for the next 20 years instead of making $3,000,000 this year and hiding it in tax shelters while they look of another job and another company to ruin.  Our economy will sustain a CEO that makes $250,000 per year if there are consumers who can actually afford to buy goods and services.  Our economy won’t support a $3,000,000 per year douchebag who turned all of his customers into unemployed debt defaulters.

You can’t lose weight on the “all cake and no exercise diet.”  You also can’t build a healthy economy by living beyond your means, borrowing money, lowering taxes, being wasteful and selfish, and basing everything on a fantasy perpetual motion machine.

But I know full well that none of you care.  So feel free to vote for the Democrat or Republican of your choice.  Keep going to Walmart so you can buy silly plastic shit you don’t need out of a sense of entitlement you don’t deserve.  Keep trading in all of your financial security for a one in a million chance at winning the lottery.  Keep swallowing that bullshit that the super rich are going to allow things to trickle down to poor little you.  By all means let’s keep invading other countries to secure expensive non renewable energy while free sunlight keeps baking the ground we walk on.  And let’s all keep going to the grocery store to buy shitty food that was shipped from thousands of miles away.  Let’s keep eating it until we become morbidly obese diabetics with vitamin deficiencies.  Oh yeah, and lets do all this on credit and run up the tab until the machine seizes and no one will buy anything.  Yep…capitalism without consumers…that’ll work.

Bookmark It

Hide Sites

“I have been a paramedic for 16 years. I have lost count of how many shootings I have responded to. All of these calls were crimes or accidents. People blow their toes off while cleaning guns. People shoot family members by accident. People kill other people during crimes. Not once have I ever responded to a shooting where someone successfully defended their home from a ‘bad guy.’ Not once.

“To continue with this…I now work for an organ procurement agency. It is my job to sit in a little room where hospitals are required to inform me of deaths. I take dozens of these calls each night. And as you can imagine, I get plenty of shootings. Again…accidents, murders, suicides…but not once has the gun related death of a ‘bad guy’ been reported here while I was clocked in.

“But wait…I’m not done. I also spent years teaching paramedic classes. I always loved to pose this question to the class: ‘Have any of you at any time in your careers ever made a run on a ‘bad guy’ who had been shot by the good guy?’ For years, everyone had to admit that this had never happened. Finally, during the last class that I taught an EMT became very animated while telling me about a call he ran where an intruder was shot. Since this was the only time I had ever heard of this in my entire career I asked some questions. Apparently an intruder was trying to forcibly enter a man’s home. So the home owner opened the door and shot him. Let me repeat this…opened the door…and shot him. So I asked the student why he didn’t just leave the door locked and call the police. I have had to do that myself when I lived in a shady apartment complex in college. It worked for me. Why did he have to aggravate the situation by opening the door and blowing someone away?

I always end my argument like so:

“So during my career as a paramedic I have responded to dozens…maybe over 100 shootings and none of them were for the reasons that gun owners cling to. Over the past couple of years I have taken hundreds of death referrals from hospitals and the same holds true. Out of all the experienced EMTs I have asked about this, only one time has anyone reported shooting an intruder, and that just didn’t need to happen. So its either 100’s to 1 or 100’s to 0. Either way, the numbers are ridiculous. This also seems to support and reflect data from real studies that have been done. So why in the hell do we allow people to own these things?

I would like to ask you the same question. If you think it is cool to tote guns around, I would like to ask you the following:

1. How many shootings have you responded to in your career? (This one is obviously for EMS folks only.)
2. How many ‘bad guy shootings’ have you run in relation to ‘oops I’m a dumbass who blew my toe off shootings’?
3. If you are a gun owner, have you ever even come close to needing to use it to defend yourself? (Really needing it, not just threatening to shoot a guy because you’re having an argument about basketball.)
4. If you never have had to defend yourself, how much money have you spent stockpiling things you have never needed?
5. If you have spent hundreds or thousands of dollars preparing for an emergency that has not happened yet, how much money do you spend preparing for other unlikely emergencies? Do you have a $500 lightning rod on your house? Is your basement stocked with MREs just incase you are cut off from food? Do you keep a wreath of garlic on your door to ward off vampires?

And before you answer these questions or comment you should know one more thing about me. Personally, I am not a pacifist. And I am not squeamish. If someone was threatening my life or the lives of my family I would not hesitate to act. A chair, a baseball bat, my bare hands…I would be willing to take a life with just about anything lying around if the circumstances necessitated the event. But I’ve been living in the same world that you have for 40 years and have never needed to use a gun. When I think of how dangerous guns are to me, how many lives they take, how many people they injure, how much money they cost…I might as well keep a rod of plutonium around my house. I’ll never need it for anything, the kids can play with it while I’m not in the room, I can slowly get cancer from it, and I would have to take out a loan to get one.

Hey, that brings up a point…are you paying interest on a loan to finance a gun you don’t need? Thanks! You’re helping our economy grow big and strong!

Here are my real views on gun control:

See link to the left for hate mail. Add angry comments below.

Bookmark It

Hide Sites

And now you are probably wondering how I broke my back, so I won’t leave you hanging.  When I was a child I was involved in a freak dodge ball accident.  This isn’t a joke.  I am being serious.

I was either in seventh or eight grade.  I can’t remember which.  We were playing a variant of the game called ‘Back Board Dodge’.  I won’t bore you with too many details, but there was a dead ball lying in our court.  There were only two or three boys left on our side of the court.  I really wanted that downed ball so that I could chuck it at someone and have a chance of throwing the winning ball.  Someone else on my team had the same idea.  We both ran for the ball and upon reaching it collided headlong into each other.  He was lower to the floor when we hit and stood up suddenly after reaching the ball.  This hit me at just the right moment and launched me into the air.  I fell from a height of about 6 feet in the air to the floor.  I fell flat on my back.

What came next was pain.  Real pain.  Pain like I have never felt before or since.  I am an atheist, but a shortcut to finding the words to describe this pain is to categorize it as “Old Testament Biblical Pain.”  As you might expect, I was unable to get up.  If you, dear reader, are a reasonable person you might think to yourself, “If I saw a young boy thrown into the air, land on his back, scream in pain, and then proceed to be unable to get off the floor, I would be concerned.  As a reasonable person, I would most definitely be concerned about this, and I would call for help and have the boy’s injuries assessed by a professional.”

Unfortunately, a reasonable person was not there.  The only adult present was our cro magnon redneck douchcanoe of a gym coach named Coach M.  There are many reasons to hate Coach M.  I have even started and stopped several blog posts about this man.  Why have I never published one?  Because every time I read my own work, I am unsatisfied with the results.  There is just no way for me to convey how stupid and worthless this man was.  There is also no way to convey how much I hate him.  So all attempts have failed me and I have never posted one.  Instead of letting words fail me yet again, I will just tell you what his actions were.  He rolled his eyes, slowly got up, walked across the gym floor, and stood over me.  He told me to get up and walk it off.  I told him I couldn’t.  He called me a pussy.  I told him I still couldn’t get up.  He had two other boys grab my arms and drag me off the court across the floor to the bleachers.  I laid there for the rest of the period unable to move.

I don’t think that one person in that gym considered for even a second that I was actually injured.  I am not sure why.  I never complained about anything.  In fact, I never really talked to anyone at all. Junior High was awkward for me, just like the rest of my childhood.  And to be honest I did not have one friend in that room.  And in the end, this is probably why it never occurred to anyone to attempt to help me.  No one there really gave a shit.

When the bell rang the coach slowly walked over to the bleachers, stood over me and said, “Are you going to continue being a pussy, or are you going to get up and go to your next class.”  A few of the other kids in the class laughed and called me a cry baby.

So I got up.  It was slow.  And it hurt.  But I got up went into the locker room, changed my clothes, and went to my next class.  I was late because I was walking so slowly, but I made it.

I went home and asked to see a doctor.  My parents didn’t honor my request for several days.  I had to pester them about it.  They told me, “I’m sure whatever you did hurt, but if you can walk on it there is no way you could have broken it.  So you are just going to have to take it easy for a few more days until it feels better.”

Over the next several days I complained enough until they arranged a doctor’s appointment for me.  I had to wait a couple of weeks until an appointment was available.  I told the doctor all about my accident.  He sat patiently listening to my story.  When I was finished he said, “Well…you’re walking around on it, so it can’t be broken.  We’ll try rotating some ice and heat to loosen the muscles up and you’ll feel better soon.”

That was about 28 years ago.  And my back still hurts.

But to be honest, after a few months it did feel better.  I learned to live with it.  At that time in my life I was very fit.  I lifted weights a lot and got tons of exercise.  After a while my muscles strengthened around the injury.  I also learned what aggravated my back and what to avoid.  But I was young and it didn’t stop me from doing stupid things.  I played soccer with that back.  I played football.  I wrecked a moped a couple of times.  I got in fights.  You name it, I did it.  And most of it hurt.

There is this weird bubble that exists around you if you say your back hurts.  So many people say their back hurts that people skim over it without caring.  I would often complain about it over the next few years to my parents.  This actually used to make my mother angry.  You see, she had suffered a real back injury.  She used to complain of back pain constantly.  When I was much younger she had surgery to repair a disc.  Recovery was slow for her.  I remember that my dad had a pool built in the back yard and claimed that it was tax deductible because of my mother’s back injury.  She also took a lot of pills for her back.  And knowing my mother, I sure most of them were pain pills of the ‘feel good’ variety.

But when I complained about my back I was told, “Now I don’t want to hear any more of that from you.  Your mother had a real back injury.  She needed surgery for it.  You’re young and strong.  There’s nothing wrong with you.  Now I don’t want to hear any more about this.  Just walk it off.  You’ll be fine.”

So for the next 28 years I learned to live with it.  As an adult I found that people cared even less when I mentioned it.  And there was a new problem.  My career.

Back injuries are the bane of everyEMSand fire service.  If you so much as mention back pain, many services look at you as a liability.  They see you as a potential money pit.  Who wants an employee on light duty drawing a check and not being productive?  And there has always been the problem that even though I have worked in healthcare for almost 20 years, I have never been well insured.  If you are an adult who works hard in a physical industry and relies on overtime, seeking treatment for an injured back is suicide.  High deductibles, apathetic doctors, and 40 hours of straight time each week is all that awaits you.  So for years I purposely hid the fact that I had back pain.  After I got married and had a child, it almost became imperative that no one found out about it because lost shifts and large bills would affect my family.

Thankfully, for the last few years my job has been less physical.  I found myself in the classroom more often than on the street.  And when I accepted a job in organ procurement I thankfully spent most of my time at a desk when I first started.

But recently the game has changed.  Two things have created a situation that finally made me seek treatment.  A few months ago I started recovering tissue.  This got me away from my desk and standing for many hours on a tile floor, bending over at the waste in a sterile field where movement has been limited to the point where I am not even allowed to scratch an itch.  To be honest its not very physical, but it is exactly the kind of thing that hurts my back.  I would rather dead lift over 400 pounds and climb ten flights of stairs then bend over at the waste for a few hours.  The second thing that has compounded my situation is that good old fashioned middle aged arthritis has set in.  I have always been careful about bending over with my back, but now I don’t want to bend my knees either.  If I drop a pencil on the floor, there are very few options for me to get to it.  Consequently I often just walk away from things I have dropped.  I give up.

A few days ago it got so bad that my wife demanded that I go see our doctor.  I put it off as long as possible.  I didn’t think it would do any good.  No doctor has ever cared before.  But I had an episode the other day where I tried to get on my knees to pull some weeds out of the garden and I wound up in bed for two days.  So I went to my current primary care physician and made my complaint.  She asked a few questions, and patiently listened to my answers.  To my shock and amazement she ordered a series of x-rays and an MRI.  I wasn’t sure what to think.  I had been complaining of the same damn thing for over 25 years, and finally a doctor did something besides explain the fine art of rotating ice and heat.

So I went and had my tests.  A couple of days later the doctor called me on the phone.  Not one of her nurses.  She called me herself.

“Do you know you’re back is broken?”

“Well…no…but it doesn’t surprise me.  I bet it’s an old fused injury.”

“You’re right.  It is.  Some time in your life you cracked one, maybe two vertebra, and you have a terrible disc that is trying to herniated into you spinal canal.  I’m sending you to a neurosurgeon.”

A few days ago I had my appointment with him, and was able to add some bad news to the mix.

“Yep, at some time in the past you cracked your vertebra.  It shows up as an old stress fracture now.  And yep, that disc looks like crap.  That has to hurt too.  But what I am really concerned about is the amount of slippage L5 has.  This old fracture and bad disc have caused a lot of instability.  And when you lean forward this bone slides back and presses on your nerves.  I’m sure it is hurting you.  I bet you hate to bend over forward.”

But his idea of fixing it wasn’t pretty.  Here’s what he had to say about that:

“I could fix it with surgery, but I am not going to lie to you.  It’s invasive and you don’t want me to do it.  To fix this I would have to open you up, break this process off, remove this disc, fill the void with a bone graft, then try and stabilize the moving bone with screws and rods, then fuse the whole assembly together.  It would hurt.  It would be expensive.  You would be off work for a long time, and recovery would be hard.  This isn’t fun.  And I won’t lie to you, in the end this may be something you seek.  But we want to avoid it if at all possible.”

“Alright, so how do we avoid it?”

“Exercise.”

“That’s all you got?”

“Like I said, we want to avoid this kind of surgery.  You’re walking around, and it’s obvious that this doesn’t bother you all the time.  It would be irresponsible of me if we didn’t exhaust all other possibilities before I did all that to you.”

“What kind of exercises?”

“Swimming…yoga?”

“Really?”

“Yep.  And you need to hit it hard.  You basically have to strengthen the muscles around this injury so that you can hold that bone in place yourself.  If you can lose some weight and strengthen those muscles, you might feel a lot of relief.”

“And if I don’t?”

“Well, we’ll talk other options if this doesn’t work.  But you are going to try this first.”

So here I am.  I have a broken back, a slipped disc, and a bone that keeps slipping out of position, and the best avenue for treating it is to go exercise with it.  That sounds…really fucking fun.

My physical therapist gave me even more great news.  He was doing his first examination and started tapping various parts of my legs with a mallet.  He lingered at my left ankle, banging away at it like he was dissatisfied or had missed something.

“The doctor did that too.  I forgot to ask him why?  What’s going on down there?”

“You have permanent damage to these nerves.  There are no reflexes down here.  I didn’t see you limping.  Do you have trouble moving that foot?”

“Nope,”  I said and started rotating my ankle to prove it worked.  “I ride my bike to work everyday.”

“That’s really weird,” he said, “Most people with this problem drag their foot around or have drop-foot or something similar.  You don’t seem to be affected.”

He went on in more detail than my doctor to show how my back was broken.  He told me that one of the processes had most likely broken off and is free floating.  Since that anchor was taken away from my vertebra, it just floats around banging on nerves.  He said something about how weird it was that I was just walking around.  Then I told him that I played football, and was a fireman with this injury.  He looked at me like I was from Mars.

So he prescribed all of these exercises which I diligently do twice each day.  I spend about 45 minutes doing all these leg lifts and crunches in various directions and positions.  It’s kind of gross, but some of these exercises pop my bone out of place in a way that is audible to my wife and daughter.  I get the occasional, “Gross…was that your spine?!”

So here I am with very sore tummy and back muscles.  This was way beyond the workout that once gave me a six pack when I was younger.  So…what happens when you get a six pack under a layer of fat?  I may very well be able to tell you that soon.  I promise not to post pictures of that.

I will be writing more on my blog though.  I have had a lot of inspiration recently.  A few people have noticed that I have kind of disappeared from social media lately.  Nothing could be farther from the truth.  I post mostly on Google Plus now.  I have to admit that Facebook is so mundane that I just can’t bring myself to log in there anymore.  And Twitter is just too limiting and vast at the same time.  G+ is more my speed.  You should give it a try if you are bored with other venues.

Bookmark It

Hide Sites

Why did I wait a year to do this?  Copy Code Three wound up being a much more time intensive project than I ever could have imagined.  Since I stopped producing episodes there has not been a week that has gone by without someone asking if the project would be revived.  This has really made an impression on me since most things on the internet are usually forgotten within five minutes.

Here is your official notice that the project has been revived.  There are a few ground rules though.  Copy Code Three will not be produced on a regular schedule.  It’s just too hard.  I will do it when I have the time.  I wish I could promise more than that, but sometimes life gets in the way.  And I have always promised myself that if any of my internet projects seemed too much like work that I would walk away.  This is why you sometimes only see a post once every few months.  I make money in other places on the internet, but not here.  Some people have suggested that I start producing regular content for Gomerville and Copy Code Three and then try to sell ad space and get endorsements.  I can’t really imagine anything that would be more distasteful to me than the thought of doing that.  If I invited some people over to my house for a cookout, would I charge them cover at the door?  Of course not.  I would offer you a beer and a brat, and have you enjoy my company.  And this is the way Gomerville and Copy Code Three will remain.

However, I might ask you to bring your own dish.  And in that spirit, if any of you have an amazing story, please let me know so that I can help you share it.  Consider it the podcasting equivalent of bringing some potato salad to the party at my house.

Special thanks to all of the wonderful musicians who have granted us permission to use their music for this project.

Ben Sollee is a local musician here in Louisville, KY that plays the cello in a blues and folk setting.  He very well may be the only person attempting anything like this and the result is astounding.

Ani DiFranco has been a music maverick for 20 plus years.  She started producing, distributing, and selling her own music long before artists had so many tools to do so.  She is one of the pioneers of self publishing, and everyone who benefits from this today owes her a debt of thanks.  She wouldn’t have been able to make a living like this for so long if she wasn’t so talented, so we are honored to have her.

David Wax Museum is currently my favorite new band.  They are at ground zero of what I have been referring to as the Nouveau Folk Movement.  David is a young man with a lot of energy who has blended Mexican folk influences into his own style.  And Suz is the lovely violinist and donkee jawbonist.  Is that a word?  I can’t describe it, so you are just going to have to listen to it.

Thank you for listening.

Bookmark It

Hide Sites

He was of Mexican decent. He was exceedingly proud of this and often referred to himself as the Emergency Mexican Technician. Raul was one of those Latino men who somehow got away with making jokes that were rife with racial stereotypes because he himself was a minority. He often liked to point out that he had married a white woman. He liked to tell people that he defiled her in ways that a white man just couldn’t do, and that she had married him because she was ‘nasty like that.’ He claimed that she cooked him rice and beans for every meal, even if they were having lasagna. And according to Raul, Emergency Mexican Technicians had to steal a car radio at least once every two years in order to recertify in the state of Texas.

He was one of the senior members of our flight team which was born from a contract with a large hospital chain in Dallas that demanded their own dedicated helicopter transport. There was a story that was often retold about a meeting that was attended by several hospital administrators and our management staff in which the radio call name of the aircraft was to be decided. Raul suddenly raised his hand and started bouncing in his seat. When he was called upon he stood up and spoke at length of his ideas for the naming and the paint scheme of their new aircraft. Raul argued that it should be named Selina One. Old English lettering would be the official font that would adorn the side of the aircraft and our letterhead. He further explained how one of his cousins owned a shop that did custom work. His cousin apparently had offered to airbrush Our Lady of Guadalupe on hood of the aircraft at cost. The final touch was that a CD should hang from the rearview mirror. Raul was quickly escorted from the meeting while several hospital administrators gawked at him, speechless.

One of Raul’s great pastimes was to scare trainees with strange behavior. This could be subtle or overt. For instance he liked to have fake phone conversations near the new employee, talking in hushed whispers about how he would pay the money that he owed as soon as he could. He pleaded that it would be unfair for them to come to collect while he was at work because innocent people might get hurt. He would hang up the phone and start pacing nervously up and down in hall. Then he would come out and quietly explain to his trainee that while she was riding in the back she should be mindful of any vehicles that looked like they were following the ambulance. As he ushered his frightened protégé out the door he would look back and give us a conspiratorial wink.

When he was promoted to critical care, he didn’t often get to train people anymore. This made him sad because according to him he couldn’t ‘fuck with anyone’s head.’ But his big chance came when a new medic in our organization named James was promoted to the Critical Care Team. James had been hired after Raul had moved to the team and so he never got to experience his antics. James was assigned to Raul for a month so that he could become acclimated to the new protocols and equipment before being released on his own. Raul immediately swung into action.

It was slow at first, almost imperceptible. We saw Raul and James making runs together. And James often looked uncomfortable. But whatever Raul was doing to him, James seemed to be suffering through it quietly. One day James came up to me and said, “Hey can I talk to you for a minute?”

James was an ex military man, short in stature and sometimes awkward around strangers. His mannerisms and nervous habits sometimes made people underestimate him. His southern drawl and lack of formal education often prevented people from realizing just how fiercely intelligent he was. And sadly, James himself often underestimated himself.

“Hey Buckman, do you know Raul?”

“Yeah, I’ve worked with him for a few years.” I was playing it cool. Like many senior medics, I appreciated Raul’s antics and tried to play along whenever I could. In my mind I was trying to figure out whether I was going to have to confirm that Raul was being chased by the mob, or whether he was working at night as an exotic dancer, or perhaps even that he was a schizophrenic who normally was able to function as a professional but had recently stopped taking his meds. I had rehearsed speeches for all of these personas.

“I think that Raul might be trying to…” James was obviously finding it hard to find the right words for this, “…trying to make a pass at me.”

Aha! So Raul was playing the homosexual gag. It had been a while, but I was ready for that one too.

“What makes you say that?” I asked.

“Well, I don’t want you to think that I have any problems with gay folks. It’s nothing like that. You know if Raul just came out and told me he was gay, I would be fine with working with him. But, there is something more to it. It’s the way he acts. It’s the stuff he says. It’s just inappropriate sometimes.”

“Be careful now. Raul is a good medic. If you want to go through the proper channels and make a complaint that he is creating a hostile work environment for you, you have that right. However, that kind of accusation is quite serious. I think if you do something like that, you should probably write it up and turn it into me so that I can give it the once over before you give it to management.” That’s how I usually played this one. One employee actually wrote it up once. Raul was laughing so hard that tears were streaming down his face as he read the heart felt complaint.

“Well, I’m not sure I want to go that far with it. I just wanted to know if my fears were warranted.”

I was just about to set the hook and reel James in the boat when Raul’s wife came walking in the door with all their children in tow. She couldn’t have timed it any worse. She had come to pick up Raul’s check. She noticed me as a familiar face and said, “Hi, we’ve met before haven’t we? I’m Raul’s wife. Is he around here, or is he out on a run?”

It took a moment to sink in, but I could see the wheels turning in James’s head. I told Raul’s wife that he was in a meeting but that she could pick up his check in support services if she wanted to. When I finally turned back to James, he was still trying to piece it together.

“So, let me get this straight. Raul is married?”

“Yep,” I replied.

“And he has how many kids?”

“Six,” I answered, “he’s prolific like that.”

“So…he’s not gay?”

“Not in the slightest bit. He’s been fucking with you as hard as humanly possible for about two weeks now.”

“Son of a bitch!”

I was expecting a pretty hard fallout from this, but James got an impish smile on his face. Raul’s wife was coming back down the hall with an envelope in her hand. James walked up and introduced himself.

“Hi, I don’t think we’ve met, but your husband is training me.”

“Oh, it’s great to meet you! We’ll have to have you over to dinner some night,” her face lit up and she seemed genuinely pleased to meet someone working closely with her husband.

“Well, I kind of had something different in mind. It seems that Raul has been playing a trick on me. Seeing you and your children just busted him.”

“Oh, is he doing that gay thing again? I’m so sorry. I’ve told him to stop screwing with people so much, its going to get him in trouble someday.”

“Well there’s no hard feelings, but can you keep a secret?”

James then explained what Raul had been doing and let her in on his plan for revenge. She seemed to relish this, and immediately agreed to tell Raul nothing.

* * *

Later on that night James and Raul were posting back at the tiny room the hospital provided. It was nothing more than a closet. They managed to fit a set of bunk beds in there and a small TV that set on top of a dorm fridge. If you were spending the night there with a partner, there was no privacy whatsoever. Raul was laying it on thick before turning it in for the night. James kept up the ruse and suffered the crass innuendo until it was time for lights out.

James laid in silence for a few minutes until he heard the rhythmic breathing that told him that Raul was finally asleep. Then James did something a bit unorthodox. He closed his eyes and thought happy thoughts until he was erect. He then got up and crawled into bed with Raul. As Raul started to wake up he was still disoriented. James whispered into his ear, “You know, I’ve been thinking about some of the things you have been saying to me, and well…I think it’s time to experiment.” That’s when James poked his fully erect penis into the small of Raul’s back.

“Oh, fuck, shit, no, goddamn, Jesus, fuck, shit, no!” Raul finally figured out what was going on and launched himself out of the top bunk crashing down onto the floor. “I’m not gay! I’m not gay! I’m not gay!”

“I know mother fucker! I had a talk with your wife earlier, you sick bastard! You’re busted!”

And so it came to pass that Raul had finally been beaten at his own game. He who lives by the sword, dies by the sword. Quite figuratively.

Bookmark It

Hide Sites

EMSEducast Episode 94

Bookmark It

Hide Sites

In 2005 the American Heart Association dropped a bomb on the whole resuscitation community: hyperventilation doesn’t work.  The very thing that had been drilled into every healthcare provider’s head since the first day of school just wasn’t true.  In 2005 the AHA published the ECC’s findings in Circulation.  Part 7.5 of the guidelines entitled ‘Postresuscitation Support’ had the following quote:

“There is no evidence that hyperventilation protects the brain or other vital organs from further ischemic damage after cardiac arrest. In fact, Safar et al³⁴ provided evidence that hyperventilation may worsen neurologic outcome. Hyperventilation may also generate increased airway pressures and augment intrinsic positive end-expiratory pressure (so-called “auto PEEP”), leading to an increase in cerebral venous and intracranial pressures.^35,36 Increases in cerebral venous pressure can decrease cerebral blood flow and increase brain ischemia.”

These new findings were sprinkled all throughout the new guidelines, student texts, instructor materials, and the videos used for ACLS and PALS.  The studies were irrefutable and the evidence was overwhelming.  We needed to stop bagging people so fast during the code and after.  Period.

So, back to this run that occurred in 2008 or 2009 well after these new guidelines were established and put into practice.  We rolled our cot into the ER, and we witnessed the usual amount of flurry and hubbub that accompanies a situation like this.  Our patient was unconscious, intubated, had multiple drips, and was on a vent setting that was way too high.  They were giving him 100% O2 at 20 breaths per minute with a tidal volume of 800ml.  A transport ventilator was unavailable, so it was determined that we were going to be bagging our patient on the way to the cath lab.  I immediately took this opportunity to disconnect the patient from the ventilator and bag him at a much more reasonable 10-12 breaths per minute.  His pulse ox stayed pegged at 100%, and there was no visible change in his condition after the decrease in ventilations.  There was no reason to think that the patient needed any more ventilation than this, and so I was going to go with the reduced rate to try and save some brain tissue.

A nurse that I had known for years appeared next to me and said, “They want me to go with, hon.  You mind stopping by the liquor store on our way out there?”  She was a wiry redhead who had been amusing me for years with her abrupt behavior and shall we say ‘colorful’ patient observations.  In fact, we had a running gag were each time she triaged a patient I thought was going to be trouble I would take the patient’s temperature with the red probe on the thermometer.  “Oh, it’s like that is it?” she would ask.

“Yes,” I would reply ominously, “it’s like that.”

Our patient was about as well off as you might expect for someone who was dead a few minutes ago.  I usually dislike nurses accompanying me on runs. (What exactly are they going to do?  They aren’t familiar with any of our equipment or protocols.  They are unable to bring any of their equipment or use their protocols.  They wind up being just another set of hands.  I might as well take an employee from housekeeping along for the ride.)  But I was familiar with Helen, and this was most likely going to be fun.

When we finally got all the various tubes untangled and got the patient loaded into the back of the ambulance, Helen took the head so she could continue bagging the patient.  My partner started us out of the ER dock code three.  I was fiddling with the monitor a bit, and when I looked up I noticed that she was bagging the patient even faster than the previous rate of 20 on the ventilator.

“Whoa girl, slow that thing down.  You’re not trying to inflate a balloon you know.”

“He needs oxygen.  As much as he can get.”  She mindlessly repeated the mantra I had heard so many times.  So many small minded providers had resisted the 2005 changes.  I was disappointed to find out that she was also an ‘oxygen zombie.’

“Now don’t tell me you haven’t had ACLS in the past couple of years.  You know as well as I do that hyperventilation doesn’t work.”  I was appealing to reason.

“I’ve heard all that crap, and I don’t care.  I was taught in school that resuscitation patients need oxygen, and he’s going to get as much as I can shove into him.”  She continued to bag him with a renewed vigor.

“Helen, you may not know this, but I am a paramedic instructor, and ACLS instructor, and a PALS instructor.  I am also a nerd whose has read all of the ECC Guidelines and there is a dog-eared copy of it in my bag.  What you are doing right now reduces venous return to the heart, it reduces cerebral perfusion pressures, and no one argues with this.  You are using out dated medicine, and you are hurting this patient.”

“I’ve heard all of that, and I could care less.  I was taught in school to bag ‘em fast, and by God that’s what I’m going to continue to do.”

It was at that moment that I lost all respect for that nurse.  I truly wish I had taken someone from housekeeping with me.  The chick who mops the floor could have followed directions better.  We bickered all the way to the hospital, and I was never able to get her away from the head of the patient.  Thankfully it was a short ride, and I didn’t have to watch her hyperventilate the patient too long.

And now it is 2011.  The AHA has published yet another set of guidelines that reaffirms those previous findings, and takes the philosophy further.  And even though it is 2011, we find our healthcare system full of providers that refuse to change their treatments.

Why are people so stubborn?  Why are people so attached to what they were first taught?  I have some thoughts on this, but I would like to provide you with another shocking example of this phenomena.

My wife is completing a degree in anthropology from the University of Louisville.  One of her instructors relayed to her an anecdote about a fellow anthropologist who was new to the field.  Apparently this individual used to be a paleontologist.  However, he had decided to go back to school and become an urban archaeologist.  Why?  Because he was having trouble reconciling his personal beliefs with paleontology.  To translate this for people unfamiliar with these fields, what basically happened was this: this guy was a 6000 year Christian who found himself in a field where he was constantly studying things that were older than the earth from his viewpoint.  So rather than change his viewpoint, he switched to a similar career that would not place him in contact with many things that were more than 6000 years old.  In other words, he stuck his head in the sand.

Why do people do this?  What makes a person capable of such a deep and elaborately constructed denial?  Why do so many people place so much importance on knowledge previously gained when new bits of knowledge are being dangled in their face?  What is so disturbing about change?  How can educated people reconcile such wildly different beliefs in their everyday lives?

There is a time in every young person’s life when their job is to be a student.  They learn full time.  Most people seem to really value what they learned during this period in their lives.  They refer to it.  They feel nostalgic about it.  They cling to it tenaciously.  Despite these positive thoughts and feelings about a person’s formative years, there are also some negative thoughts.  How many times have you heard someone say, “Whew, I’m glad school is over.  I could never do that again.”  Or “I can’t wait till I graduate.  I’ll never have to pick up a math book for the rest of my life if I don’t want to.”

So it would seem that although the average student values what they learned in school, they are also glad that it is over.  In the average person’s mind there is a threshold or a dividing line.  I truly think that most people believe that after a certain point, they have learned enough.  They are satisfied with this base level of knowledge, and from here on out most of their mental energy will be spent maintaining that hard fought knowledge and defending it from attack.  Where is this attack coming from?  The attack comes from new knowledge that conflicts with deeply held beliefs.

In years past, this was not so much of a problem.  Science was progressing at a slow pace.  What you learned when you were a child served you well for most of your life.  But the technological advances of the last century or so have really upset the apple cart.  My father grew up in a small farm in Texas where his primary modes of transportation were a horse and his father’s old Model T.  We now regularly get Twitter updates from astronauts orbiting the earth in a multinational space station.  When viewed from this perspective, it is not hard to see how technological advances can be disorienting for many individuals.

When I was younger, I used to keep hamsters as pets.  And just like everything else, I took this small hobby to its nerdiest extreme.  It wasn’t good enough to just keep a hamster or two in a ten-gallon aquarium.  I had to build something.  I would go to the garage and build these elaborate habitats, the largest of which was a six foot bookshelf converted into a multilevel hamster amusement park.  But I was always disappointed with this hobby.  Why?  Because no matter how big a space I built for a hamster, no matter how elaborate a habitat I designed, all they ever did was sleep in one corner and occasionally run in one wheel.  They found a comfortable nook in their cage and stayed there.

Most people are the same way.

In the end, this is what disappointed me about education.  (That and that little part about almost going bankrupt.  But that’s another post.)  I would spend so much time building this elaborate student amusement park, and all the adult student ever wanted to do was sleep in one corner and run in the wheel a bit.  Teaching something new to the adult learner is an exercise in futility that I couldn’t really fathom until I was at ground zero, looking at the detonation point of my career.

One of the things that has caused friction between me and other people is my inability to think this way.  Everyone has some capacity for denial, but I truly believe that if you charted the human race on a denial bell curve, I would fall on the farthest left point.  This point is where all us atheists, makers, and hackers put on our freak show.  The hard part is interacting with the rest of the people out there who are perfectly fine with reconciling conflicting viewpoints from day to day.

The really confusing thing for people like me is that a certain amount of this is expected in social interaction.  You’re considered a bit weird if you’re fine with change.  Continuing to learn new things makes you a bit odd and sometimes annoying.  It leads to beliefs that often offend other people, so you wind up keeping your opinions to yourself.  (Blogging not withstanding.)  You get labeled as a know-it-all or a nerd.  It is perfectly okay to work in the oil and gas industry and be a 6000 year creationist.  People will say, “Look, he’s so successful and yet he has always maintained his faith.  Isn’t that inspiring?”  Our hypothetical oil baron has gotten rich from a substance that by definition must be over 6000 years old.  He employs vast teams of scientists and technicians who use scientific principals he doesn’t believe in.  They toil away filling his bank account with dollars while he is in church discussing ideas that would make the very existence of his company’s product impossible.  Yet, his story is inspiring.  Am I the only one who has a problem with this?  Sometimes I feel like I am.

And looking back on it I think there are two things that happened during my formative years that made me the way that I am.  The first was my parents.  They are freaking nuts.  There is no other way to put it.  If I am on the far left of the denial bell curve, they are on the extreme right.  I have worked in a psychiatric hospital, on an ambulance, in hospitals, and in organ donation.  I have seen people at their worst.  I have seen people at their most desperate moment.  I have seen people dangling by a mental thread.  But to this day, I have encountered no one during the course of my professional career that has the capacity for denial that my parents do.  It is truly shocking.  The disorientation they feel from the changes that have occurred during their lifetimes is so profound that they have ceased to be functional.  Now if you are raised by people like this, one of two things will happen.  You’ll either be just like them, or you will rebel.  The fact that no one in the family talks to me anymore should let you know what happened there.

The second thing that happened to me during my formative years was the personal computer revolution.  Our first computer arrived in our home when I was 7 or 8 years old, and I was fascinated from day one.  And what are computers all about?  Change.  “Version 1.0 just came out, but version 1.1 will be out in a few months.  I hear an advance team is already working on version 2.0!”  Or how about, “This 9600 baud modem is really fast, but think of how deathmatches in Doom will be with a 14.4 modem!”  For over 30 years I have not just tolerated change.  I have welcomed it.  I demanded it.  It’s not disorienting.  It’s intoxicating.  It’s exciting.

So what are we going to do about this?  Do we give up and say that fifty million Frenchmen can’t be wrong?  Of course not, you should know me better than that.  Besides, have you seen my dad?  Denial leads to you being a senile old man who tries to tell anyone who will listen that “this DVD thing is never going to catch on.”  He’s a diabetic because he is obese, and according to him massive amounts of candy and desserts are great for that condition.  This has caused his teeth to rot out of his head, but he won’t go see a dentist.  He also smokes to relax and lower his heart rate, and takes aspirin to settle his stomach.  Yeah…that’s not working so much.

We need to do something to stop this.  Nip it in the bud.  Healthcare is a dynamic industry on the bleeding edge of science that is full of people who resist change.  This is probably why healthcare in this country is in the state that it is in now.  Well, that and blind greed and thievery.  But that’s another post.

The problem is faith.  Blind faith.  (Not the 1969 album by the band of the same name.  That’s actually quite good.)  The definition of faith I am referring to is “a belief that is not based in proof.”  For some reason, no matter how successful science appears to be, humans have this irrational faith in well…faith.  It’s what makes a Republican promote a policy of abstinence.  It’s what makes this idiot Democrat use taxpayer money to build a replica of Noah’s Ark.

I can honestly say that I have faith in nothing.  If I tell that to someone, they look at me all sad and suggest that I go to therapy.  But there is nothing wrong with me.  This allows me to have other qualities that people report to admire such as rationality and accountability.  I say ‘report to admire’ because this is only on the surface.  Most people want nothing to do with being rational or accountable.

So, for the few of us who want to fix this, what do we do?  We need to start early.  Kids need to be taught from day one that learning is something they will be expected to do until they are on their death bed.  Change is exciting, and they should look forward to it.  Advancement is a goal to constantly strive for because only through advancement can we heal more people and improve the quality of peoples’ lives.

What can an EMS educator do?  I’ve been wrestling with this recently.  I am working on a project to update a body of course work to the current 2010 ECC Guidelines.  Hence my mention of the AHA way back at the beginning of this rant.  It has been interesting to delve into education again, and it’s always fun to look at what clever people have come up with.  It was shockingly easy to get started with this project since the AHA makes all this information available for free in several formats including searchable PDFs.  So why not make a student go through the same experience?

Here’s the idea: if I was ever going to teach my own paramedic class again (which would never happen, I don’t want to have anything repossessed and I want to stay married) I would make every effort to incorporate new material such as these 2010 guidelines with the regular curriculum.

For example: your students are studying cardiology.  You have covered all the drugs and algorithms in the paramedic text.  Give the students some copies of the new guidelines and assign them a project such as updating a set of ACLS protocols.  Tell them, “Here are the protocols as they are now.  But the AHA has incorporated a lot of changes in their recommendations for 2010.  Your assignment is to update these protocols for your medical director.  Every change you make must be well documented with a rationale from these guidelines and any other sources you care to site.  If the AHA recommends a change and you do not adopt it, you had better be able to defend that decision as well.”

This can be done for just about anything.  Pharmacology is rife with changes.  Dopamine is still in all the protocols in my area despite the fact that many ICUs are discontinuing its use.  Assign some of these studies for reading and have your students decide to either defend or discontinue dopamine use in the field.

If the learning process of the student incorporates change and makes it obvious that medicine is a dynamic industry, the same student will be less disoriented by changes that occur in their field after graduation.  At least, that is my hypothesis.  This needs to be tested against a control group to see if it would really be effective because I will never have faith in this idea.  It must be proven.

And as for faith itself?  It has no therapeutic use and may even be harmful.  It should be discontinued due to its untoward effects on society.  Providers are to update their protocols accordingly.

So in an attempt to really confuse my readers, I will leave you with an old Blind Faith tune called ‘In the Presence of the Lord.’  Enjoy.

Bookmark It

Hide Sites

But back to the original question: Why don’t I ever write about my new job?

There are a few reasons for this.  The first of which is that the nature of my job is far too sensitive to just throw stories up on the internet.  By definition, every patient dies.  So the ante is raised just a bit at my new gig.  Not to say that what happens on an ambulance isn’t sensitive.  But I have been in the field for 15 years in various parts of the country.  This provides me with a shroud of obscurity if needed.  If I leave out a few details my readers will be unable to find out what state or decade the event happened in.  Not so with my new job.  I have been here about a year.  And there is only one OPO in Kentucky.  So you do the math.  If I go blabbing here about something that happened, a reader may be able to connect the dots.  So, although it may be tempting, you will find no stories about my new job here.

But there is also another reason.  And this one might seem a bit weird.  I am happy at my new job.  I have written before about what fuels my desire to rant and rave on this blog.  I tried for 15 years to make a career in EMS and it resulted in poverty, frustration, sleep depravation, weight gain, and more poverty.  Did I mention poverty?  Just checking.

This blog has always been my go-to place for catharsis and release.  I can sit down at a keyboard and floss my mind out.  And a couple thousand of you will commiserate with me.  I get support from comments, emails, Facebook, and Twitter.  It is simply fantastic.  I still work in the field part time, so I need that.  And I will keep doing it for the foreseeable future.  The EMS part of my mind is like an unseen part of the house that needs badly to be cleaned.  Like an attic full of crap.  Every once in a while on a day off you think to yourself, “Hey, I gotta get up there and clean that freaking pig-sty.”  So you trudge upstairs with a few trash bags and wander around cleaning.  But it is too much.  The project is just too big.  And once you get up there you just don’t know where to start, and no matter how much crap you clean it doesn’t even look like you’ve made a dent.

Such is my mind.

And sometimes I wonder what you all must think of me.  You probably think I am hold up in a leaky dark basement, stockpiling weapons and muttering to myself while I plan to blow up some nursing home.  I find time to blog only between bouts of binge drinking and beating puppies.

Nothing could be further from the truth.

I’m a very happy family man.  I love my wife and daughter to death.  There’s no money in the bank account, but we never need much.  The few days off that I have are spent playing with my daughter, cooking with my wife, exercising and delving into a number of hobbies.  And the farther I get away from EMS, the happier I get.  My wife says I’m a new man.  Sometimes she doesn’t recognize me.  I’m not angry and grumpy when someone wakes me.  I wake up from a deep sleep with a smile on my face.  She says that one fact alone speaks volumes.  I’m also losing weight at a steady pace and looking healthier everyday.  So far I have lost about 50 pounds and I feel great.

So why don’t I write about being happy and feeling great?  I do every now and then.  I have written a few articles about diet and exercise here.  The numbers are always in the basement though.  No one reads them.  However, I guarantee that if I named this post ‘CLUBBING BABY SEALS’ I would have 1000 hits inside of 24 hours.  People would run to their computers to see how I have gone off the deep end this time.  I have been typecast.  The Buckman trying to write a happy blog post is like Bill Murray playing lead in the Razor’s Edge.  The three people who watched it said it was alright, but it was a box office flop.

Part of my contentment with organ donation and my opposing discontentment with EMS boils down to one simple thing:  I really just want to help people.  That’s why I got into EMS in the first place.  I have these little rules that I live by.  At least that is what my wife calls them.  Perhaps axiom is a better word.  It really doesn’t matter.  Part of my system of rules and axioms for living my life is that money doesn’t matter.  Power doesn’t matter.  Fame doesn’t matter.  At the end of the day, can you look yourself in the mirror and say that when you left your family to go make money today that you either helped someone or made the world a better place?  If you can, good for you.  You’re doing the right thing.  Never mind the poverty, and the long hours.  You’re a good person and if you keep this up you may not be rich or even middle class, but all of your needs will be met.

So…no selling used cars for me.  No sitting in a cubicle trying to figure out how to sell more useless widgets to some target demographic.  No business deals meant to take jobs away from folks in the U.S. only to promote slave labor in some third world country.  Nope, none of that for me.  When I get home and brush my teeth and wash my face and look in that mirror I want to know that some person is better off because of what I did when I was clocked in.

I simply can’t do that with EMS anymore.

At the end of an ambulance shift I tally up what I have accomplished: I helped two drug seekers get to the hospital.  I helped one terminally ill GOMER get from one neglectful nursing home to an apathetic ER and back again with absolutely no definitive care taking place.  I got cussed out by a drunken trailer dweller who called 911 because their O2 hose doesn’t work.  Etc…etc…etc.

And I will admit, not all EMS districts are created equal.  Chris Montera and I became pretty good friends for awhile (I need to check in with that bunch more often) and he intimated to me once that he has never run a call in a nursing home.  He almost said it in a whisper, “I’ve never worked in a district that had one.  Everybody here is rich.  The average home value is something like $750,000.”  I almost hung up on him right then and there to catch a plane to Colorado to lay waste to his skinny ass.  But I couldn’t do that.  I love that guy.  And I wish him well.

The bastard.

But now I know what its like to have a job like that.  I can’t talk specifics, but last night I went home, looked in the mirror and said, “Good job Buckman.  You got a set of corneas that restored vision to someone who is blind.  You got bone which will help cancer patients and people in need of reconstructive surgery.  Good job.”  And tonight?  I can say all of that again.  This time I can even add getting a donation of skin to help burn victims.  Who in the hell could argue with that?  This is good.  This is progress.  This is helping people.  This is finally living up to the rules and axioms that run around in my cluttered attic of a mind.  And I wake up with a smile on my face.  Even on work days.  And by the way, my entry level position in this profession is more than any hourly rate I have ever received in EMS, including management positions.

But Chris Montera is still a bastard.  I’m not letting that go.

So now that I have wandered all over the place with this post, it’s time to get to the original reason I started writing.  Finally I have a reason to talk about organ donation.  Not only that, but EMS is involved as well.  So I just have to jump on this, don’t I?

Check out this link that explains the cutting edge organ donation program that is going on in New York.  (Do a search on Google too.  There have been many stories written about it.)  Manhattan now has a specialty truck that is staffed with a physician, a family support liaison, and two organ donation specialists cross trained as EMT’s.  Their job is to arrive on scene when resuscitation efforts of the NYFD have failed.  Someone went down, EMS was summoned, resuscitation has failed, and the crew has permission to terminate efforts on scene.  According to the numbers this happens about 400 times a year in that district.  When this happens, this special unit will roll up on scene and approach the family for donation.  If the family gives consent, the team can use some special equipment to continue perfusion until the patient has been transported to a recovery operating room.

This is a bold move.  And make no mistake, it’s outside the box.  Way outside.  But I commend them for their efforts and this has been a long time coming.  According to statistics 8000 people are on the list waiting for an organ in New York.  A lot of people don’t know this, but all those people will die if they don’t get that organ.  There have been a lot of crazy movies, stories, and urban legends that have placed false ideas about organ donation in the minds of even educated health care workers.  But I am here to set you straight.

The OPO I work for recovers six different organs through our program.  We recover heart, lung, liver, kidney, pancreas, and small bowel.  And make no mistake, if someone is on the list for one of these organs, their life is threatened.  We don’t look for this stuff just because someone feels like they have lost their freshness.  If you need a new heart, you are going to die without it.  If you need new lungs, it’s because you can’t breathe with the ones you have.  The human kidney performs over 200 known physiological functions.  If you’re asking for a new one you are probably laying around in the hospital with jaundice and ascites hoping against all hope that they find one soon.  If you are on the kidney list it is because you have gone down to 15% kidney function or less.  You are on dialysis.  A quick question to all of you EMT’s out there who have taken patient’s to dialysis: do they look healthy?  How many of them have you seen die?  Enough said.  Pancreas and small bowel are the less common and difficult to place, but you can bet that if someone wants a new one, the outcome won’t be good without it.

Every organ donor has the chance to save up to seven lives.  (Six organs, but you have two kidneys…that’s seven.)  Now you might have noticed that this program is only looking to recover liver and kidneys.  Why is this?  Those are the most commonly donated organs.  Those are the toughest organs that retain their viability for a bit without being perfused.  Many health care providers don’t know this but organ donors from the hospital have to be alive when the decision to donate has been made.  How can this be you ask?  Many patients have some sort of condition such as a stroke or trauma which renders them brain dead.  But even though they have no brain function, their heart is still beating and the patient is on the vent.  This is a difficult patient to find.  Most OPO’s don’t get many chances at this each year.  You basically have to find someone in a hospital with a magic condition that has rendered them legally deceased (diagnosed brain death) but their organs are still being perfused.  Let’s also add some complications to the mix like most ICU patients who meet these criteria get some sort of sepsis or organ failure to complicate things.

This is the reason why organ donation is so hard.  And this is the reason why so many patients on the recipient list die waiting for an organ that never comes.

So the fine folks who came up with this new program have tried just about everything they could think of to increase those numbers and save more of those 8000 dying patients.  They finally have had enough and decided to take their show on the road.  They will come right to you door to make this happen, and every time they do they have the potential to save three lives.  Count ‘em.  Three.  Two kidneys and a liver folks.  Three.

When’s the last time you saved three lives in one shift?  Yeah, I thought so.

And yet this program seems to be freaking people out.  There is already speculation that the familes are going to perceive that their loved one was allowed to die so that the organs could be recovered.  There is speculation that mistakes will be made…blah, blah, blah.  I’m sure the next step is some Republican in New York talking about ‘Death Panels on Wheels.’

One run…three lives people.  Don’t you think this team thought about this just a little bit?  I bet an experienced OPO in Manhattan didn’t just come up with this over the weekend and decide to pull the trigger for the project on Monday.  I’m thinking they probably gave it some thought.

So watch the news on this one.  Give them some support.  Get the word out.  And for crying out loud, go out and help some people.  You’re either part of the solution or part of the problem.

And Chris Montera is still a no-nursing-home-going-to-bastard.  Just saying.

Bookmark It

Hide Sites

“They’re all ramped up about something,” theorized my partner.  He was a brand new EMT but wise beyond his experience level.  Common sense goes a long way in being an EMT.  In fact I would rather work with a rookie with common sense than a veteran any day.  I’ve got nothing against veterans per se…well…that’s the subject of another post.  But there we were, just knowing that dispatch was going to tell us to go do something stupid any second now.

“Be enroute to a rollover county run, MVA with multiple patients,” squawked the radio.

“There it is!” proclaimed my partner as he lit it up.  “I knew we were going to get a piece of something.”

“A piece of what?” I asked, sounding a bit disgusted.  My partner’s enthusiasm was well received, don’t get me wrong.  And I did like working with him.  But sometimes I thought he was blinded by a bit of naivety.  “If we are playing second fiddle from this far away, all the good patients will be gone.  We are going to be left with the whiners trying to milk the neck pain so they can sue and go on disability.  I don’t exactly want a piece of that.”

But my partner, ever the optimist, was unfazed and drove us quickly to the scene.  Upon arrival we found two sedan type vehicles that had barely bent metal, parked cockeyed in the street.  It had been a fender bender.  The drivers really should have moved the vehicles from the roadway, but they seemed too busy arguing and hamming it up.

“Hey Redbag!  We have two for you right over there.  The pink and white shirts sitting over there on the curb.”  This paramedic was familiar with me from the old days and was using a nickname for me unknown to my partner.

“Long story.  Remind me later,” I said to him while I walked up to our patients.

She looked barely eighteen, if that.  She was a dirty died blonde wearing skin tight jeans that must have taken fifteen minutes to get on and button.  She was of course smoking and talking on her cell phone to a friend.  Whatever conversation she was having was far more important than talking to the paramedic who just drove code three all the way across town, so I turned my attention to her boyfriend.  He was a tall one, wearing stone washed jeans that looked a bit immature for his age.  He was about 6’ 4”.  His basketball shoes were snowy white and immaculate.  Gold chains accessorized a simple Fruit of the Loom white undershirt.  He was smoking as well and had just hung up from his cell phone conversation, so I was able to have a word with him.

‘Hey, I’m the paramedic that has come to look at your injuries.  Were either of you hurt in the collision?”

“What?” he fumbled for a moment looking slack-jawed, “Oh yeah, we were in that wreck, man.  We got to go to the hospital.  Hey look, it wasn’t my fault.  That lady was coming up the road right here…”

I interrupted before he got too far.  “Sir, I’m not with the police.  I am not here to assess blame of fault, I just want to know if you are hurt and whether or not you wish to go to the hospital.”

“Huh?  What?” he managed to get out while staring at me blankly.  “Like I said, we were coming out of this parking lot when this crazy lady came out of nowhere…”

“Sir, I don’t think you understand.  I don’t want to hear the details of the accident.  The cops will want to hear that.  I want to know if you’re hurt.”

“What?”

“Sir, are you hurt?  Are you injured?  Or did the seatbelts and airbags do their job?  Maybe you’re not hurt at all.”

“What?  I wasn’t wearing a seatbelt.  But yeah, the airbag went off,” again his jaw went slack.

“Sir, are you hurt?  Do you want to go to the hospital?”

“Yeah, yeah.  We both need to go.”  His girlfriend was still on the phone, paying no attention to us.

At this point he stood up as if to leave.  As he stood up his pants fell ever so slightly off his buttocks to expose a bit of his underwear to the world.  His appearance was carefully calculated to look like the black male stereotype that pervades TV so much these days.  I want to be very careful here.  This is a young white male trying to emulate his perception of a stereotype, not what black culture really is.  And that is the weird thing about so many young males in this part of Kentucky.  They love to emulate the ‘gangsta culture’ that has permeated into so much popular culture, but at the same time they are intensely racist themselves.  I constantly hear white people in this neighborhood dressing like what the consumerism pop-rap culture has marketed to them, but they fear and loathe black people.  It is not unusual to hear people dressed like this use horrible racial slurs and get in racially charged fights with young black members of the community.  There is a paper in this somewhere, but I am simply too tired to write it.  The immediate problem was that I had a patient who is claiming he wants to go to the hospital and getting up to walk away.

“Sir, where are you going?  If you want to go to the hospital then you need to sit right here and stop moving around.  We may need to splint some of your injuries.  You haven’t even answered me about whether or not you’re hurt.”

“I’m not going to the hospital on that thing!”  The girlfriend had finally spoken.  Actually she was screaming.  And of course it was over the top and overly dramatic.  She had found time in her busy schedule to get off the phone and acknowledge my presence.

“What do you mean that thing?” I asked.  “It’s just a cot.  And I haven’t even got to talk with you yet.  Are you even injured?”

“Of course I’m injured!  I’ve been in a car wreck!  I need to go to the hospital!”  Her face was frantic.  There was panic in her eyes.  She was shouting and on the verge of tears.  Her only visible injury was a small scratch above her right eye.  There was very little blood and it was already obvious that no stitches were needed.  I’m not sure it was even worthy or a band-aid.  Wiping the dried blood away with a wet 4 X 4 and letting it air dry probably would have been all that was necessary.

At this point I just wanted to turn around and walk off.  There was nothing wrong with these people.  They were just young and excessively dumb.  And this was the beginning of a chain of events that would do nothing but waste the precious time and limited resources of many heath care workers starting with me.  But I am of course not allowed to walk away.  I have to take all complaints seriously.  And saying things like, “What you two idiots need is a half a brain between you and maybe a band-aid,” is simply not allowed.  So I resolved myself to plowing through this to the end.

“Okay…the both of you…hang on just a minute.  You are crying like you just had your arm ripped off, but you wouldn’t even acknowledge my presence when I first got here.  And you,” I turned around to talk to the tall one who was still attempting to walk off, “you need to come back here, sit down, and talk to me.  Now, both of you have demanded to be taken to the hospital, but neither of you have told me just exactly where you are injured.”

“Well look at me!  My face is messed up!  I have to go to the hospital!”  The young woman whose voice was cracking while spittle flew from her mouth had managed to get a dried fleck of blood to stick to her finger and hold it out for my inspection.

“Ma’am, that’s a very small scratch.  It isn’t even close to needing stitches.  Are you hurting anywhere?”

“Of course I am,” she screamed.  Now she was crying uncontrollably.  “My face hurts!  And my neck hurts!  And there’s blood on my head!  And I have Bell’s Palsy on this side!  Am I going to die?!?!”

“No, you’re not going to die.  But, you want to go to the hospital.  And you are telling me that your neck hurts, so I would like to put a collar on you to keep your neck still, place you on a board and go get some x-rays…” I found my words being cut short by a shrill scream.

“You’re not putting me on that thing!  No freakin’ way!  People die on those!  I don’t want to wear anything!  I’m claustrophobic!”

“Okay, okay.  Just calm down.  There is no reason to get this worked up.  I’m not doing anything bad to you.  If you want to be seen by the hospital, which you say you do, then we need to take all the proper precautions and make sure nothing is broken.”

“Nothing’s broken!  My head’s messed up!  Just take me to the hospital!”

“Baby, you got to just calm down,” even the boyfriend had finally had enough.  “Mister, she’s just like this. She starts screaming at everything, that’s just how she is. She’s not making any sense and she doesn’t mean nothing by it.  Baby, just do what the man says and wear the collar.”

“Whoa, wait a minute,” I said.  “Ma’am, calm down and look at me.”  For the first time she quit screaming and gave me her full attention.  “Thank you.  Now didn’t you just say that nothing was broken?”

“Yes!” she said defiantly.  She wasn’t screaming anymore.  Now she was in pouting mode.”

“Okay.  If you don’t think anything is broken, then why do you want to go to the hospital?”

“Because my head’s bleeding!”

“Okay, like I said, that’s just a scratch.  I’m looking at it right now.  It you want to go to the hospital, then fine, I’ll take you.  But if you refuse to let us do any care for you and you don’t think anything is broken, I’m having trouble trying to figure out why you want to go.”

“What the hell does that mean?” her voice started to rise again.

“Look,” I was struggling to make this just a simple as humanly possible considering my audience, “If you think you’re hurt, you should let us take you to the hospital and treat you.  You say that nothing is broken, yet you demand to go and be seen.  But you won’t let me do anything for you.  That just doesn’t make any sense.  You are demanding to go to the hospital, but you are refusing all the care that goes along with it.  If you don’t want anyone to touch you or splint anything, why would you bother to go in the first place?”

“What?” she threw her hands by her sides in a gesture that was meant to convey exasperation.

“Look, the only reason to go to the hospital is if you think something is broken or you have a concussion.  If that is the case, then we need to splint everything so that you are still until we can take x-rays.  If you refuse this care, there is really no reason to go.  Moving your neck around like that when you are complaining of pain just doesn’t make any sense.  If you want it taken care of, let us splint it.”

“You are not getting me on that thing!”  Again with the pointing and the crying and the screaming.

“Alright, I give up.  Just sit there a minute.”  I turned my attention to the boyfriend who was still attempting to wander off, but my partner had blocked him and started doing what looked like an assessment.  Since he was taken care of, I turned back to the frantic young woman.  “You know what?  Fine.  I give up.  Just sit there for a minute, and we’ll put your boyfriend on the cot.  You can ride in a seat, but you are going to sign some release forms first.  For now, just sit there out of the way.”

But then it happened.  A do-gooder arrived on scene.  From the looks of her, she seemed to be a friend of the family or something.  She was a little older than our patients and talked to them with some authority, but not as a parent would.

“Honey, you need to do what this man says.  You need to get on that cot and go get checked out.”

The patient started crying again.  There was a new audience for her theatrics so she decided to turn it up a notch and start fresh with her histrionics.

“Whoa, ma’am.  I’m not sure who you are, but I had just about gotten her calmed down.  To be honest, now that you are here, perhaps she could go with you.”  I looked back at the patient.  “You don’t want to be in a collar right?  You don’t want any x-rays right?  You don’t want to lay on the cot right?  Then why don’t you just sign my form and ride up to the hospital with your friend here?”

“Oh no!”  The woman looked shocked.  “She needs to go get checked out.  Look, there’s blood on her head!”

This started a new level of uncontrolled crying that I did not know was possible.  It was even louder and more annoying than before.  I had finally had enough.

“Ma’am, I don’t know who you are, but you can stop right there.  She has a scratch on her head.  Do you hear me?  A scratch.  And she is refusing all care anyway.  Just about everyone here is demanding this and that except for the only one here who has any medical training which is me.  So please, okay, just back up a minute.”

I looked over at my partner.  He had gotten the other patient to actually sit down on our stretcher and was making some progress.  I looked over and mouthed the words “No backboard?”  He rolled his eyes out of sight of the patient, waved his hand dismissively and continued to strap him in.

“Okay,” I said with new authority to the ridiculous woman on the curb, “I’m going to load your boyfriend up in the ambulance.  You can talk to your friend here for a second and calm down.  If you want to come with me, then fine.  If you want to go with her, that’s fine too.  But we can’t stay here all day so you are going to have to make a decision by the time I come back.”  I left her in sight of the other crew working the scene, and they nodded that they would watch her.

We lifted the cot and I helped my partner load the boyfriend in the back.  He started to take a blood pressure and get some demographics.  With things looking sane in the ambulance I decided to go back out and see what the decision of the other patient was.

On my way back, the friend of the family intercepted me.  “Sir…sir?  I’m sorry about her behavior.  She’s always just been like that.  She tries as hard as she can.”

“Is she disabled in some way, or does she have any special needs that I need to worry about?”

“No, no, no!” exclaimed the woman, “No, she’s just high strung.  Let me talk to you for a minute to explain.”

I cut her short.  “I’m going to be honest with you.  Do you see that fire truck?  Do you see those police cars?  Do you see these ambulances?  There must be a dozen emergency workers here and over a million dollars worth of equipment.  This equipment, and personnel are for shootings, stabbings, burning buildings, robberies, murders, strokes, and heart attacks.  She has a scratch on her head.  If she wants to go to the hospital, then fine.  But I’m not going to waste any more time in the middle of this street talking about how mentally delicate she is.  I’m done and we’re leaving.”

I probably shouldn’t have been that blunt, but to be honest I do that more and more nowadays.  I’m not sure who did it, but somewhere back during the late 80’s or early 90’s someone walked to the backstage area of our culture and flipped what I sometimes refer to as the “Permissive Switch.”  If this were the 1970’s and someone was acting like that everyone on the street including the friend of the family would have been all over this girl.  They would have defended us.  They would have realized that a dozen personnel and over a million dollars worth of vehicles and equipment has no business catering to a hysterical girl with a scratch on her head.  I am not sure who decided that everyone needs to have their delicate feelings aired and considered no matter how whacked out they are, but I am done with it.  I want to find the person who went backstage to flip that switch, and I want to punch him in the gut.

“Okay.  Are you going with me or are you going with her?”  I folded my arms and waited for an answer.

“I’m going with you,” she said after a short pause.

“Okay.  Get up.  Let’s go.”

We walked back to the ambulance and I instructed her to sit in the captain’s seat.  My partner started to take her blood pressure and I rummaged around for a bit of paperwork.  Since I had both of them together and departure was immanent, I decided to tally the aches and pains.

“Alright sir, where does it hurt?”

“My back, and my neck, and my belly.”

I shot a look at my partner that was laser focused with anger and venom.  He looked mortified.  “He didn’t mention that before.  He was denying all that a minute ago.”

“Yeah.  Everything is starting to hurt now though.”

“That’s alright,” I tried to use a calm and soothing voice.  It was all an act.  Maybe they knew it.  Maybe they bought it.  I didn’t care.  “It’s never too late to package a patient.”

I winked at my partner to let him know that I didn’t want to drown him in a shallow bathtub.  We then proceeded to apply a board and collar while he was lying on the cot.  It wasn’t pretty, but it got the job done.

“And you,” I said starting towards the girl, “You need to sign and initial the back of this run form.  What this states is that I am a medically trained professional.  And in my opinion you need to be collared and splinted, but you are refusing.  Sign here…initial here.  I am also writing exactly what you have refused in the narrative.  I want you to sign this as well right here.  Alrighty then.  Now that that’s out of the way, let’s go to the hospital.”

We then started what for me seemed like the longest ride to the hospital in history.  This post is getting a bit long, so to save you from this turning into an epic novel, I will try to summarize the ridiculous events that transpired on that transport.

She of course started crying several times and asked me repeatedly if she was going to die.  I told her no, but I gathered from the sheer amount of times that she asked that she didn’t believe me.

Soon after that her boyfriend finally told her what he was so nervous about on scene.  (Remember he kept trying to walk off?)  He told her that one of the cops had looked him up and found out that he still had one warrant that was active.  Still being the operative word here.  I gathered from the conversation that ensued that he used to have many warrants, but had taken care of them somehow.

After that crisis was over she started complaining about lip and tooth pain.  I asked what this was about.  She said that the already had an abscessed tooth (dental hygiene not being one of her strong suits) and that the “gunpowder” from the airbag had inflamed it.  I attempted to explain that there was no gunpowder in the airbag.  She didn’t believe me.  Then she demanded Anbesol.  When I told her that we didn’t carry that on ambulances she was shocked.  She then called three different people until she found one that agreed to buy her a bottle of it and bring it to the hospital for her.  Then she asked if Chapstick would further inflame her lips that were already hurting from the gunpowder.  I again explained that it wasn’t gunpowder.  She again didn’t believe me.  Then she started to cry again and ask if she was going to die.

Soon after that she asked me if the hospital was going to charge them.  I told her that the hospital was going to charge them for care, and there would be a charge from the ambulance too.  She was shocked by this and said something to the effect of, “They are going to charge us again?”  I asked what she meant.  That’s when she told me the story of the other car accident they had a few weeks ago.  The hospital had charged them.  The ambulance had charged them.  I asked her why she didn’t think the same thing would happen again.  This seemed to throw her for a loop and she started crying again.  She again asked if she was going to die.  I had decided to stop answering that question.

Just before we got to the hospital, the boyfriend told me that he needed a copy of the accident report.  I again reminded him that I was a paramedic and not a police officer, and that he would have to contact the police to get a copy.  He became frantic and told me that he needed it tomorrow.  I thought about letting that go, but curiosity got the better of me and I asked why.  He stated that he needed it for court first thing in the morning.  I asked him why he was going to court in the morning and he became guarded.  Then I asked what possible bearing this unrelated accident could have on whatever was going on in court tomorrow.  He insisted that he needed it for evidence.  At this point I just stared off into space wishing that I would have a sudden stroke and lose consciousness so that this conversation would end.  I didn’t.  I had to keep coping with it.

As we went through triage the nurse became as confused as I was.  At first there were all the usual questions like, “Why isn’t she on a board and collar?” But after four or five attempts to gain information she looked at me in a way that let me know that she now understood how stupid they were, and just tried to get them in a room.  The nurse asked a few more questions about her medical history than I did and learned that she had just had a baby a few months ago.

I practically did a Sid Caesar spit take, “You’re a mother?!?!”

We finally got them to a room.  We laid him on a bed.  He immediately tried to get up.  I explained that no care had been done to him yet.  He needed to remain splinted.  He then told me that he didn’t need to be splinted.  I asked him why he let us do it in the first place if he didn’t need it.  This threw him for a loop long enough that we were able to exit the room while he was staring up at the ceiling trying to think of an answer.

As I was completing the two run forms for this mess my partner came up to me with a conspiratorial whisper, “Hey, look back in that room.  Be careful.  Don’t let her see you.”

I nonchalantly stepped to the side so I could view the room over the desk.  There she sat.  Our patient.  Sucking her thumb.

After I had finished the paperwork I walked outside with my partner.  He apologized for not immobilizing the boyfriend right away.

“Don’t worry about that.  There wasn’t a thing wrong with either of them other than the fact that they are both so fucking stupid I don’t know how they manage to continue walking upright.  No, what I want to talk to you about is your career path.  I keep hearing from you that you want to get off this transport truck and work in a real system.  A 911 system.  And I’m here to tell you that that’s it, what we did right there, that’s 911.  I’ve done that shit for years now and I can’t take it anymore.  You’re not going to be a hero.  You’re not going to save any hot looking women from certain doom.  No sir.  You’re going to do that shit.  Over and over and over again in what can only be described as a plane of hell reserved for retards and health care workers.  They’re doomed to keep getting hurt and calling 911, and we’re doomed to keep taking care of them over and over again.  Still want to do this?  Cut it the fuck out.  Go to college and forget this shit.”

“Man, I hear this from a lot of old timers like you.  But I still love it.  It’s in my blood I guess.  I still want to do it.”

“AAAARRRRGGGGHHHH!  What the fuck!  There is nothing in your blood but red blood cells, white blood cells, platelets, proteins and plasma.  There is no EMS in your blood.  Run from here.  Run from here screaming and lock your fucking door behind you.  I got news for you kid.  Every once and awhile…not often…but every once and awhile some innocent person gets a stroke or a heart attack or gets in a car wreck and needs help.  You know what they do?  Half of them don’t call 911.  They drive themselves in.  A quarter of them die.  And the other quarter of them are all pissy with you cause you’re not hopping fast enough for ‘em.  And that’s the innocent sick people.  The rest of them are guilty.  They shop at Walmart and buy crap.  They eat at McDonalds and fill their face holes with fat, salt, and sugar until they become obese.  Then they go to the gas station and buy cigarettes to ruin their lungs.  They get diabetes but never prick their fingers.  Then they abuse prescription meds spending hours and hours shopping doctors until they find one that writes that magic prescription that will get them high.  Why they don’t just go down the street and buy a bag of weed is beyond me, but they never do.  Then after a while they are so fat that they have to buy a rascal scooter.  And there they are, riding around in their house…smoking…with 60 feet of nasal cannula.  And one day the wheel to their rascal scooter rolls over their O2 hose.  They get short of breath.  So what do they do?  They light a cigarette.  And then when the really can’t breathe they think, ‘Damn!  I better go get a Twinkie out of the pantry.  That’ll make my fat body feel better!’  So they roll forward, and the O2 that was backed up in the line gets blown in their face while they’re taking a drag and now their fucking face is on fire.  And that my friend is when they call 911.  And you are just about to get off on time when those fucking tones drop, and you wind up missing dinner with your family for this patient.  This morbidly obese, prescription drug addled, diabetic Twinkie eating, emphysema chain smoking loser trapped under a tumped over rascal scooter with their face on fire.  That’s 911.  Fuck a bunch of that shit right up deep in the ass.”

There was a long pause.

“You still want to do this for a living?” I asked.

“Yep,” he said.

“Fuck it.  Let’s go get a taco.”

Bookmark It

Hide Sites

The question I would like to pose to you is this: “Exactly what is it that makes certain people physically incapable of wearing the uniform that is issued to them?”

It seems like something simple doesn’t it?  You agree to work for a company.  They give you clothes to wear while you are clocked in.  They pay you to do what they tell you to do.  You do those things.  The checks continue to clear the bank.  You get to buy things with that money.  Really, all in all, it’s a pretty good arrangement.

But this is EMS.  So you know right from the get-go that the maturity bar is set at a limbo height and the employees are going to test the boundaries of this arrangement that would be a no-brainer to someone in any other profession.

After thinking about his for a couple of days I have identified three types of employees who cannot follow their company’s uniform policy:

The Constant Fire Department Applicant

Any private ambulance service is going to have a certain amount of EMT’s that think that being an EMT is somehow beneath them.  These are usually fire fighters (whether or not they are actually employed by a fire department) who through the course of their fire training had to become an EMT.  They don’t want to be EMT’s, and they have no interest in it.  But they have the cert, and here they are.  But they want absolutely everyone to know that they are doing this job reluctantly.  Make no mistake that this is beneath them.  They are better than this, and at any second they are going to be told by X Fire Department that they have been hired, and their life’s dream will be realized and they can quit slumming it at this horrible place.

So, how does this protest usually manifest itself?  This employee will usually show up dressed in their official uniform.  But once they get out on the road and away from the base station, their standard issue uniform shirt magically gets replaced by some sort of fire department sweatshirt or hoodie.  It may be a sweatshirt from a service that they volunteer for, or it may even be one that they don’t work for.  It doesn’t matter to them just so long as it has the Maltese cross on it.  If a supervisor catches them wearing this they will claim that they got cold and had this in their bag.  If another employee asks, they will say something like, “Screw this place, I’ll wear what I want.  I’m not going to be working here long anyway.  When *insert fire department here* hires me, I’m gone man.  I’m number three on the list and they are hiring five.  It’ll be any day now…”

What would I like to say to this employee?  Here goes, “You know what pal, nobody cares what job you want to have.  All we care about is the job you do have.  And here you are, and here’s your damn shirt.  And I have a little piece of advice for you.  If you can’t be bothered to be professional here, then you probably aren’t ready for the so-called big leagues anyway.  This is why you haven’t been hired by your dream department yet, and won’t be any time soon.  Now take a minute to look at my resume.  Yep…there’s fire, there’s 911 services, there’s critical care, there’s management positions, all sorts of stuff.  Now let’s look at yours.  I see you worked at Burger King for the last few years, and have volunteered for Po-Dunk Fire and Rescue and you just barely have the 400 hours to call yourself a fire fighter.  Let’s do what I like to call the Old Spice Test.  It goes like this.  Look at me.  Look at you.  Look back at me.  Now look back at you. Now look at me again.  I’m wearing my uniform shirt.  Shut your useless hole and put yours back on.  See, isn’t that better?”

The Freelancer

This is a new category of which I have only recently been made aware.  When I started in this business, nothing like this existed.  But I have seen it, and it saddens me.  Again, this employee will come to work wearing the appropriate uniform.  And yet again, changes will be made after leaving the base station.  These folks like to accessorize.  So they pull over and replace all the various face piercings that aren’t allowed back into their respective holes.  Some even like to put on some sort of hat that displays the whimsy of their personality.  Sometimes it is a John Deere or camouflage truckers cap.  Sometimes it is an immaculately spotless basketball team hat with a brim that looks like it has been set with a laser level.  These hats are usually worn askew on the head to show off the jaunty style and impish nature of the errant employee.

The end result of this accessorizing is different for every employee.  For some the result is a goth appearance.  Some wish to be identified at a redneck deer hunter.  And one former member of the management team fired two crew members on the spot for wearing what he called a “Mr. T starter kit.”  Apparently an elderly patient called to complain that “Two thugs had taken over the ambulance and thankfully taken me to the nursing home before stealing the vehicle!”

What would I like to say to this employee.  Its not near as long as the last one.  Here goes, “FAIL.  Just…FAIL.  You’re fired.  Go home.  Go get your spatula and reapply for your previous position.  FAIL!”

The Disheveled

There is really no excuse for this category.  Some people come to work wearing their uniform, but just can’t be bothered to tuck their shirt in or tie their shoes.  Whenever I get one of these partners, there is always that uncomfortable period where I wonder whether or not they are going to neat themselves up before they go into a facility.  Even though I don’t agree with it, I can see someone coming to work looking a little rough.  I try and give folks the benefit of the doubt.  Maybe they were late and trying to get dressed on the way over.  Things do happen.  So they clock in looking like crap.  They check out the truck looking like crap.  And they get in the front and drive looking like crap.  After that?  Well in my experience over the years, there is about a 50% chance that once we get a call this employee will tie the shoes, tuck in the shirt, and quickly get it together before making their first scene.  And then there is the other 50%.

Sometimes they simply get out of the truck, walk around to the back, pull the cot out and start walking towards the door.  Actually, I should amend that.  They shuffle towards the door.  Their shoes are untied, remember?  This is where I intervene and tell them that if they are working on my truck then they need to get it together.  At which point they roll their eyes, give me a lot of grief, and then either comply or proceed to look like a moron.  My scorn usually gets them to tidy themselves up.  Only once did I get into a knockdown drag-out with someone over this issue that required a supervisor to intervene.

Who are these people, and why do they do this?  Well, this is going to sound odd, but after fifteen years of dealing with this there seems to be a very narrow band of people who do this.  I am reluctant to stereotype or profile someone, but the evidence is simply overwhelming.  These offenders are usually morbidly obese Anglo-Saxon women in their 30’s from a rural background.  Yep, it’s that specific.  Not to say that other people of all shapes and sizes don’t do this now and then.  And I am not claiming that every rotund woman of European decent is disheveled.  But the instances of this happening are so overwhelming that I can remark upon it as specifically as I have.

So what would I like to say to this employee?  Here goes, “Hey, we are trying to take care of the sick and injured here.  We aren’t making a midnight run to Wal-Mart for baby formula.  Damnit, I look better than you do when I go to get my paper out of the yard in the morning.  If you are unable to get to your shoelaces I could probably help you just this once.  But as soon as possible, I suggest that you get the kind of duty shoes that don’t require lacing.  As far as the shirt is concerned, there is no easy way out of that.  You’re just going to have to learn to tuck that thing in.  It would also help if your belt actually went through all the loops of your pants.  Perhaps you should try placing the belt through the loops before you put your pants on.  That way you could see and reach every part of your uniform before putting it on and would have a higher chance of avoiding looking like a clown.  If you can’t get this done, perhaps you should just give up, make a long term disability claim, and see if they will buy you a rascal scooter.  Then you can let yourself go as much as you want, and no one will be asking you to do such pesky things as fastening all of the clothing that you are wearing.”

In conclusion, this economy has made things rough on everyone.  We should all be thankful to have a job.  It’s not too much to ask to look presentable in uniforms that were given to us for free, is it?  I’m living in the same world you are, and I have been able to get this done for the last fifteen years.  Trust me.  Once you get in the habit it’s just not that hard.  You may even find people taking you seriously.  It’s just a thought.

Okay folks.  That’s about all the grumpiness I can stand.  I plan to have an awesome Thanksgiving with my family.  I hope you all do the same.

Bookmark It

Hide Sites