Don't Worry, I'm Here To Save Your Life

No Glory, Lots of Ickiness

2007-12-19T21:36:00.001-08:00

In the golden days of EMS the most common uniform for the "Ambulance Attendant" was a nice white jacket worn over a white shirt, in turn tucked into some white pants. All of this was carried around on a pair of nice white shoes.

Of course, this was also the point in EMS history where the "ambulance" was really the hearse from the funeral home with a bubble light strapped to the top, and if you punched out on the way in they just diverted back to the base and thanked you for your business. (Posthumously)

As time has gone on, and patient care in EMS has evolved past "scrape 'em off the road and haul ass", the chances for those nice pristine white uniforms to lose some of that sheen has increased. Our contact hours with blood, vomit, piss, shit, and "Oh my God, what is that???" have skyrocketed. As a result, most agencies have gone to a uniform that screams a little less "naughty nurse" and a little more "durable and stain-proof".

Alas, my primary agency disagrees with this philosophy and continues to dress us in white button-down shirts. As such I've had 3 shirts ruined by stains of varying grossness.

One of my shirts bit the dust when I was stupid enough to offer my help to an ER nurse I particularly like. Suzy was taking care of a patient I'd just brought her, and couldn't quite get the charcoal down the NG tube. You see, my patient had decided for the 3rd time that she didn't want to live any longer, and was thus going to swallow every pill in her over-medicated life. Some combination of the multiple very dangerous drugs she'd been prescribed by her multiple not-so-bright physicians were doing their best to kill her. In trying to avoid that eventuality (though I'm of the opinion that when people try this hard, we oughta let 'em) we'd placed a tube into her stomach and were attempting to administer a solution of charcoal that binds to the medications and prevents their absorbtion.

Suzy was trying her best to push the charcoal through, but it's a fairly viscous solution that's prone to clogging the small diameter NG tubes. I offered my slightly larger biceps assistance, and managed to push about 100cc into the tube without a problem.

It was during the third round of 50cc that I mentioned to Suzy that everytime I administer charcoal some sort of mishap occurs that ends up with me covered in the black goop. At about that moment a final, momentous clog occured in the NG tube. (one so severe they ended up replacing it) As a result of the incredible pressure exerted by my manly arms the charcoal literally exploded out of the tube, and did it's damnedest to coat myself, Suzy, and the entire room.

My dark pants, belt, and stethoscope all survived, but for my shirt there was nothing to do but sigh, and let it slip into retirement.

Sometimes though, it's not something so easily replaceable that you want to get rid of. In an entirely different sort of "bleeehhhhh" moment I considered amputating my foot.

We'd been re-dispatched to a location that another paramedic had just cleared from stating that the patient met him at the door and denied needing any assistance. About fifteen minutes after he'd left some well-meaning neighbors (God bless 'em) had called back and said that the same patient was screaming for help next door.

We arrived onscene to find a woman in her sixties with an extensive medical history hyperventilating in a chair,\ and refusing to even acknowledge our presence. After 30 minutes of trying to calm the woman down and get any sort of response out of her we finally decided to just pick her ass up and go to the hospital to let the overpaid physicians figure her out.

Unfortunately for us, this woman weighed somewhere around 350lbs and hadn't bathed for several months at least.

Her hair was matted to her head, and she was covered in pustulating sores. The odor coming off of her body was similar to what 4 day old road kill smells like if you shit on top of it. She'd peed somewhere in room in the recent past, and the old food sitting throughout the room should be advertised as a diet plan- no one wanted to eat for days after being in there.

What turned out to be the worst part of the equation was that she'd dressed herself as far too many old ladies do. At some point (probably within this century) she'd thrown a mumu over her impressive figure, but then neglected to don any additional garments.

We brought our stretcher into the cramped living quarters of her apartment, and slid it as close to her chair as the old KFC buckets would allow. We then picked her up by her limbs, trying to avoid the sores, and tried to slide her over to our bed.

During the course of this move my partner lost his grip on the patient. In one of those slow-motion scenes that you can unfortunately relive for the rest of your life I watched as the woman slid rapidly towards the floor. While she collapsed downwards her mumu ballooned upwards- exposing a vagina that could turn Ron Jeremy homo.

I started to shield my eyes from that sight for fear I'd melt like the Nazis in Raiders of the Lost Ark, but widened them in horror instead when I saw the trajectory she was taking. As she slid off the side of our stretcher the gaping maw of her ass set its sights directly upon my right foot. Before I could react, or even vomit, I felt my foot settle into the gentle hug of her copious buttocks.

Then she farted.

I swear I began praying right there, silently: "God? It's Chris. I don't know if you're listening or not, but if this is supposed to be funny, I hate you. If this isn't your idea of a grand joke, then please, please let that have been just a fart, and not a shart. I'll give anything for that to have just been a fart. Thanks."

As far as I could tell after I got my partner to stop laughing and help me get Shamu up on the bed, it had been a clean fart- devoid of even a skid-mark. I doused my boot in anti-bacterial solution at the hospital, and thanked God ever so much for the invention of the steel toe.

Then I turned to my partner who was still giggling and threatened him with the same treatment the patient got if he didn't shut his mouth.

Auras

2007-12-17T19:03:00.000-08:00

There's a woman I work with who we call "Moonbeam". We do this because she's a shameless hippie.

Honestly I love her for it. Moonbeam spent entirely too much time in California during the 90s, and partied like a rockstar, with rockstars. She's seen it all, and forgotten most of it in a smoky haze. As a consequence of all of this, she's big into the organic food, eastern philosophy, aura reading semi-counter-culture movement that still manages to hang on amongst certain populations to this day. If she could wear Birkenstocks and tie-dye to work she would.

Lately though I've been wondering if maybe Moonbeam doesn't have the right idea. I've begun to believe that there really are people who's entire role in your life may be a positive one, or a negative one with very little space in between.

This comes down to more than just attitude- I can't say enough for the power of positive thinking, but in the end it takes more than that to affect me. I'm sure if you think long enough you can come up with a few names for both categories in your life: people who build you up and make life better, and people who tear you down and make your world miserable.

This has 2 real effects when it comes to my life on an ambulance. First- it defines the mood that I'm going to be in for 24 hours at a time. I hate to admit that I'm so easily influenced, but my partner's psyche has an incredible amount of control over my perspective on how I deal with things. Second- it determines how I'm going to react to what we in emergency services know as the "bullshit factor".

It's a dirty little secret to people who don't work in emergency services, and/or don't read this blog that most of the work we do has very little to do with saving lives. Most of the time when you see us tear-assing down the road with lights and sirens blaring we're more likely to be going to someone who's just really drunk than to someone who's having a genuine heart attack. The question all of us have to continually ask ourselves is whether or not we're willing to put up with the bullshit for the sake of that small percentage of calls where we get to make a legitimate difference.

On a recent call though I realized that the lines aren't always so clear-cut, and a lot of what we'd call "bullshit" depends on your perspective.

We were dispatched to a sick call, non-emergency for a lady with a blocked foley catheter. A foley is a urinary catheter that is inserted through the urethra and sits in the bladder, passively draining urine for people who would otherwise be incontinent. They're also belligerent little bastards that get blocked, break, and are a positive breeding farm/superhighway for the sort of bacteria that cause urinary tract infections.

We arrived onscene to find a well-kept house in a nice neighborhood. After sprinting inside through the rain (remember that part of my job? It's 3am and thundering outside) we're ushered to the living room by a gentleman in his early 70s who appears to be his wife's primary caregiver.

His wife has multiple medical problems- one of which has left her incontinent and paralyzed below the waist- thus the offending catheter. I assessed the lady and found absolutely nothing medically wrong with her save the fact that her bladder was now uncomfortably full. After trying my damndest to flush the offending blockage out of the foley while still maintaining modesty for this woman (please God...) I finally had to give up. That thing was blocked.

Now came decision time- this was absolutely not a medical emergency. There is no doubt in my mind that she would certainly have survived the hour or two it would have taken a non-emergency service to arrive and transport this lady to the hospital for a catheter change.

But as we sat there onscene, on of the medics I work with who I have the utmost respect for posed a simple rhetorical question: What's best for her?

Shamefully, I remembered that was the reason we supposedly got into this job in the first place. We're here to help people. Not just really sick people. Not just people who don't smell bad. Not just people who can afford to pay us.

Just people.

I imagined what it would be like to sit for a couple of hours with a painfully full bladder, and no way to empty it. Just sit and consider that for a second- not fun at all. In the end we took her to the ER to have the catheter changed. It's a simple procedure, and one I'm even qualified to do but don't carry the equipment for. Our decision logjammed the ER with an extra non-emergent patient and took one of the few 911 resources we have in this system offline for about an hour.

But it was the right thing to do, and I think my aura shined a little brighter for it.

There Is No Failure

2007-04-18T20:12:00.000-07:00

Dale Carnegie, an American author best known for his book How to Win Friends and Influence People once said: "“Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.” I can't speak to the context of his statement, but regardless it strikes me as profound.

I'll eventually get around to why, but it might take a while, so bear with me.

I went to see my girlfriend's brother speak today. He was in town to speak to a group of InterVarsity students on the biblical implications of Justice, and Mercy. Believe me, they're capitalized for a reason.

Typically, the spiritual side of my life is a little meager in its day-to-day implications in my life. I spend very little of my time contemplating any or all greater forces that may be in play in the world around us. Don't take this to mean I don't believe in something beyond and above humanity, but this blog was never intended to be an outlet for my personal beliefs on such things.

I do, however, pay attention to the world around me, and so I'm not blind to the fact that sometimes things just seem to work out in ways that are just too good to be coincidental. I find it easier to believe that there's a universal benevolence in play that to believe that happy circumstance is at the root of the many inexplicably good things that have on occasion happened to me.

And believe me- many, many wonderful things have happened to me. I have a job that I love, and a life I'm happy living. Most importantly though I have a concept of what's truly important in being a good person. That's not to say I'm perfect. Far from it- typically I'm kind of an asshole. But I can say this- When I die, there will be many people who will be better of for having known me, than if I'd never existed.

Before I go much further I want to re-emphasize the point about my being an asshole. This is not a self-congratulatory piece, but rather a call to arms for those who are better people than I.

Onwards and Upwards-

The truth of the matter is this: regardless of your background, race, religion, color, or creed we as humans should be able to agree on one simple truth- it is good to help one another.

Philosophers disagree on why this is true. Some argue that the drive for goodness (or less abstractly in the forthcoming example, justice) are desired by humans because of a Divine Command. In other words, we see things as good, or evil- just, or unjust because one deity or another has commanded it so.

Others argue that these concept come forth from natural law. They say that in order for a species to survive such notions must eventually come forth. No population can survive without a codified theory on right vs. wrong.

Finally, there exists the theory that goodness, and justice are social creations- societal necessities without which the very idea of humanity cannot exist. Language, companionship, arts and sciences simply cannot exist without regulation of human behavior through moral codes.

I admit that I'm simply not smart enough to tell you which of these theories is correct. I advise you to be very suspicious of anyone who tries to convince you absolutely of the validity of one or another. I can however, tell you that it doesn't matter.

Regardless of the reasons for their existence, goodness and justice are not as impalpable as they may at first seem. You can feel injustice when you watch the pictures of starving kids on TV. You can feel the evil inherent in the act of gunning down 32 people in Blacksburg, Va. You can feel the goodness still untainted in young children.

And yet here we sit in a world that seems to contain more bad than good. One has to wonder why, if it's so easy to feel these things we still must sit and ponder the human condition. Surely the essence of people, the soul- yearns for goodness.

As far as I can tell, the answer is simple. Good is hard. Good and evil are as far apart on the easiness spectrum as light and dark.

The world is thus a harsh place. Many people, including myself, would often rather take the easy road than do what is just. In this, we are evil. I say Not grandly evil in the tradition of murderers and child molesters, but evil nonetheless. What could be more evil than leaving a person hungry and alone in the cold? Yet I've done that no less than 10 times in the last week alone as I've driven by the camp of homeless that live just up the road from me.

Surely my time and money are a futile effort. No matter what small things I accomplish, the world will be a bad place. I won't even argue that if everyone just did a few little good deeds, everything would be grand- I assure you I'm not that stupid. This isn't supposed to guilt you into handing the next panhandler you see $5.

Instead, recognize that there is no hope in you alone making a difference, and that the world is far from being the idyllic place we'd all like it to be. There's no shame in this.

Instead, recognize the nobility in striving for a goal that may never be accomplished, but is nevertheless good, and just.

Evil Genius

2007-04-10T18:20:00.001-07:00

Word Power

2007-04-09T23:21:00.000-07:00

The trouble with words is that it takes so many of them to describe the most minuscule things. If you listen to the old adage, it's a minimum of a thousand to capture what you can do with a millisecond's worth of shutter and some 35mm film. Part of my job is to take words- written or verbal, and turn them into a picture for whoever reads/hears them. Doctors, nurses, and likely non-existent internet folks have nothing but my subjective interpretations on which to base their clinical (and humorous-ness) judgments.

With my current employer I'm given a space about the size of 1/3 of a sheet of college ruled loose-leaf paper in which to write my full clinical narrative, and document my history and physical assessments, treatments, and transport decisions. There are always supplemental sheets available, but this leads to some interesting thoughts.

Anyone who's ever called 911 for a medical emergency can likely recall the scene in striking detail- sights, smells, and sounds will live on unfaded in their memory for a long time. Traumatic events impress people, and your average joe doesn't come across life-altering moments everyday.

For the first several weeks I worked in EMS I could remember patient's names, vital signs, medications, faces- everything for weeks after the call. I was struck by the absolute humanity of this job, and the universality of the human experience. For the most part racial, cultural, gender, and age boundaries melted away in the face of crisis.

Now however, I struggle to remember what patients I treated less than 24 hours ago. Former patients will walk up to me in public and fully expect me to remember their particular medical emergency. For many people, even the nearest brush with death is enough to leave them with a permanent picture of every single responder on that scene burned into their brains. For me to remember you even 24 hours later, you've got to be a frequent flier calling 4 times a week.

Personally- I hate this. A lot of people who work in EMS, or in very acute clinical settings like the emergency department enjoy the lack of memory. They don't want the follow up, and associated personal investment, that follows getting to know your patients. People die, and it's a lot easier to deal with that if their name is just something that you write down, rather than something you know.

If you think I'm wrong ask a paramedic what the name of their last dead patient was- or their last major trauma- or their last burn patient. Then ask about the name and/or birthday of any baby they've delivered. All of those events are relatively similar in terms of life-changing events. They all leave an indelible impression on the parties involved, but one event is associated with the beginning of life, hope, and all things wonderful and soft. The others kinda sit on the other end of the spectrum.

My point is this- when you're numbed to the shocking nature of life you miss out on the details. You don't understand the humanity anymore, and you learn less from the experience. The disconnection from people- turning them into patients, only hurts the provider.

I'm just not sure if the alternative is better.

Dueling Banjos

2007-04-08T12:29:00.000-07:00

When the directions to a call include "The house is a blue single-wide across from a double-wide, and should have 3 Confederate Flags hanging outside" you know you're in for an exciting experience. Yesterday was no exception.

At about 5pm we were dispatched to a hemorrhage call out in the sticks. Hemorrhage calls suck for a few reasons, but first and foremost they suck because people generally only call 911 when they're bleeding from one of two places- their ass, or their va-jay-jay. Believe me when I say this- nothing will kill your sex drive faster than some of the va-jay-jay I see doing this job.

Sure enough, while we're enroute to the call communications radios us with the additional information they've gleaned from the caller: "1464- you're patient is going to be a 42 year old female, passing clots from her vagina" It's rare for me to put on a pair of gloves before I even see a patient, but I figure this time it's justified.

Pulling up to the "house" I'm suddenly frightened for my life- I can hear the lines from Deliverance repeating over and over in my head. I wondered: Do I have a pretty mouth? What would it be like to kill a man with a bow and arrow? And where's the creepy kid with the banjo?

Oh- there he is.

Seriously. Sitting on the front porch is an blank-eyed youngster holding a banjo. Cornhole tightened, I approach the house.

As I walk toward the front door, I'm forced to shimmy, shake, and rock the stretcher past a few junked cars, through a fence gate, and up a ramp to the flimsy door of the trailer. One of the Confederate flags gets caught on the side rail of the stretcher and rips nearly in half. Apologizing to the strumming youngster, I'm just glad that neither my partner nor I are African-American. There are enough hillbillies here to pull of a lynchin'.

I start to open the front door, but pause as I'm informed that there's "No smokn in the hous". Verbatim. It's been written carefully on the front door in magic marker. At least twice. Underneath the current black letters the former iteration of this message is still visible in a more cerulean shade.

The living room of this house looks like a tornado of all that is redneck struck less than fifteen minutes ago, and since this is a mobile home, that's not all that unlikely. The room is covered in naked baby (and child- remind me to call social services) pictures, and all the kids are indistinguishable from one another. They all have broad, flat, blank faces, with narrow-set blue eyes, and a gap mouthed, gap toothed smile. When the final count is in, it appears that no less than 12 people (at least 11 of them related to one another by blood... I think the black guy might've been a friend) are living in this 2 bedroom trailer.

The kids range in age from a couple of years, to somewhere around my own age (21) and all seem to share approximately the same education level. While trying to assess my patient, I got the best answers about her medical history from a child who looked to be about 11.

That reminds me- after pausing to admire the NASCAR collectible plate series displayed on top of the mantle, (I still giggle when I see Dick Trickle's name) I finally managed to get to my patient, and begin the process of figuring out just what the hell was wrong with her.

The "42 year old female who was passing clots" is lying on a hospital bed in the middle of the living room. She's lying on a plastic sheet, and is wearing nothing but a hospital gown, and a urinary catheter. She's had her right leg amputated below the knee, and just from looking in her eyes you can tell she's gorked.

Her husband is standing by the bed and furiously working the wad of tobacco in his cheek. I begin this assessment the same way I begin every assessment, asking- "What's going on today, sir?"

"Well- she bleedin 'gain"

"Ah. And how long has she been bleeding?"

"'Bout three hour"

"And is this abnormal for her, or does she normally have a menstrual period?"

"Well- she do, but this is differin. She passing big clots- 'bout fo, five, an las' time she did this, they had to give her blood an clean her on out in there."

"Okay- so when did this last happen?"

"Hmmmm- prob'ly been 'bout a year now."

"Okay- does she have any other medical problems?"

"She jus had an infection"

"What was infected sir?"

"She was."

"Ooookay. Why does she have the IV in place?"

He tells me that the hospital sent her home with an IV in place so that he (or rather, the 11 year old who understood the instructions) could administer Vancomycin everyday for 14 days. Vanc is a powerful anti-biotic used to combat very specific, and very contagious staph infections that are usually picked up in the hospital.

"Sir- has your wife always been- er- uh- Non-verbal?"

"Do what?"

"Has your wife always been unable to speak, or move?"

"Oh- no. That happened last year."

"Sir, what happened last year?"

"Oh- she had 'bout eight strokes an five, six heart attacks. Doctors dunno why. But we're gettin her better here now."

Shaking my head and wondering how eight strokes and five heart attacks don't constitute "medical problems" we move the woman over to our stretcher. Throughout this entire process she screams like the monsters from Scooby-Doo, and tries to claw anyone who touches her with her overgrown and yellowing nails.

As we pick her up to move her over, I notice an enormous decubitus ulcer (GRAPHIC!) on her buttocks, and I ask her husband about it.

"She had that oh... three, fo, months now. You can stick your fist in it!"

"Sir- have you been sticking your fist in it?"

*shuffles feet* "Naw... naw... but you could."

Throughout the entire ride to the hospital, the woman continues her monster-moans, and makes any true assessment impossible with her attempts at clawing us. I'm ecstatic when the relatively short drive is over. Wheeling the woman into the ER, we're forced to wait 30 minutes for a room since their renovating the entire emergency department. This leaves the nurses short on beds, and shorter still on temper.

I drop off my report with the doc, and laugh as I hear him interviewing the husband:

"Sir- about this ulcer on her buttocks"

"Yeah! You can stick your fist in it!"

"Sir- have you been sticking your fist in it?"

Education

2007-02-20T20:52:00.000-08:00

Every city, town, or loose affiliation of residents has them. They’re the group of streets, homes, and businesses that smart people who want to keep what belongs to them avoid. Ghettos, slums, projects, ‘hood- those are all just different names that describe the same place.

If you’re from one you’re proud of your roots- right up to the point that you manage to escape. You still might mention it on your album for street-cred purposes, but everyone knows you didn’t build your new million dollar home down the street, and you don’t park your Mercedes at the curb- whether you’re rollin’ on dubs or not.

Residents of the surrounding area who aren’t sentenced to a life of poverty inside these places do their best to turn a blind eye to the goings-on therein. For the most part the gentrified population outside the ‘hood ignore the area and it’s denizens unless their car has been broken into. At this point they’re usually quick to suggest a location where law enforcement officers might find a few suspects to question.

I can even admit to myself that in my day-to-day I try to avoid these places, and the people who live there. Life is just easier when you’re not faced with the reality that there are people in America whose lives are just as bad as those of war refugees. They may not have television commercials pleading their case, and the kids tend not to be so skinny (thanks WIC, school lunches, and Food Stamps- now lets make things healthy so they’re not fat and diabetic instead) but the filth and squalor is no less prevalent. Avoiding them means I’m not wracked with guilt over what I don’t do.

It’s not always possible to avoid though- especially when people call 911 and you’re expected to respond.

Most of the people (students) in Chapel Hill don’t know it, and the locals who do try to keep it out of their minds, but there is a ghetto in Chapel Hill- two really. Just off of the main north-south street in town there’s about an 8-10 block area that stretches towards Carrboro. It’s full of low-income housing occupied mostly by African-Americans. Carrboro has several apartment complexes that cater to the lower end of the socio-economic scale, but they tend toward the Latino demographic. Interestingly even when segregated, people segregate themselves.

For the most part I think I do a decent job of treating everyone equally. No one ever manages to be perfectly fair in their dealings with people- we’re all human, but I feel like most of the time I’m as close to equal in my treatment and actions with everyone. Last night though, I was tested.

There’s nothing more frustrating than a patient, or a patient’s family, or both in combination, who just don’t get it. No matter what you say, or how you say it they’re just not going to listen to you. I’ve actually come close to turning away from a patient to argue with the wall under the hope that the wall might be more receptive. Unfortunately this tends to happen most often with patients who are uneducated, or undereducated. Most of what they understand about medicine comes from daytime TV reruns and overworked, under trained public health clinic staff.

Working against my feelings of equality, and non-prejudicial assessment and treatment is the unfortunate truth that a majority of the people who lack education and opportunity in this county are minorities. Even if you’re intelligent enough to understand the socioeconomic reasons for people’s lack of resources and education, with enough exposure you still eventually find yourself seeing color.

I was called yesterday to Chapel Hill’s main ghetto. Just down the street from a police substation, this is a neighborhood where we turn the lights off on the ambulance to avoid drawing a crowd. If a crowd forms they tend to get angry, and try to do bad things to you. You plan your escape route ahead of time, and park the truck in such a way as to facilitate egress. We run more drug overdoses, shootings, stabbings, and assaults in a 4 block radius around here than any other place in the county.

We were called at around four o’clock for respiratory distress, and found the “patient” to be in anything but respiratory distress. She was a 72 year old woman with a myriad of health problems who was crying with her nephew as we walked in. I couldn’t help but notice that the nephew was sporting gang tattoos, and looked to be all of 20 years old. He didn’t look like much of a gangbanger sputtering over his aged aunt.

I asked the family what was going on:

“She ain’t breathing right. Her sugar been up and down all day, and now she sweaty and ain’t breathing right.”

After hooking the patient up to a pulse oximeter, and listening to her breath sounds: “Ma’am, she looks to be breathing fine- I can understand why you wouldn’t think so with her crying like this though. Just what got her so upset?”

“Well- we told her ya’ll were gonna take her to the hospital.”

“You told her this before she was having trouble breathing?”

“Uh-huh”

“So why, at that point, were you planning on calling 911?”

“Well her sugar been up an’ down over the past day or two- she got the sugar” (diabetes)

Needless to say, we made our best effort to make the family understand what constituted a true emergency, and why it was inappropriate to call 911 and say that a patient was having trouble breathing when they really weren’t.

What many people don’t realize is that when they call 911 and ask for an emergency medical response they’re putting many, many more lives at risk. Driving with lights and sirens is simply not a safe activity, and when this woman’s family called to say she was having trouble breathing they put 3 firefighters, a paramedic, and two EMTs at risk of great bodily harm- not to mention all the other people on the road.

Of course, we accept this risk when we sign up for the job. We understand that what we’re doing is not a safe activity, and we’ve got no guarantees against injury. Attached to that knowledge though is the expectation that 911 callers give us a good faith report of the situation and allow us to judge the appropriate response. This family just lied. This woman wasn’t sweating, wasn’t changing colors, and wasn’t having any more trouble breathing than a two year old who’s crying.

We discharged the lady with instructions to watch her blood sugar (even though it hadn’t really been out of control at all) and to report any changes to the doctor she was scheduled to see in the morning. This patient had no priority symptoms, and zero need to be evaluated by an acute, emergency facility. After a full assessment, and plenty of patient education everyone cleared up, and we were on to the next emergency call.

I walked away feeling like we’d managed the call well. We saved the patient’s family money. We’d saved the hospital a bed, time, and effort on the part of many staff members. The emergency units that would have been tied up wasting time taking this lady to an ER visit she didn’t need were available to respond to any other true emergencies, and the family had a report of our assessment and findings to discuss with the patient’s physician.

Just as with every other shift, that patient quickly faded from memory as we went from call to call. Another respiratory call: anxiety attack that resolved with some careful words. A back pain call: a young worker who’d injured her back previously and probably came back to work too soon. A minor traffic accident with a single patient complaining of neck pain.

Eventually the buzz of life around town calmed to the point of manageability and the pace of our responses slowed. Just as everyone else around town was getting ready for sleep (or bar hopping- this is a college town) we were getting around to postponed paperwork, station duties, and getting ready for bed ourselves. Since we work 24 hour shifts we’re allowed to try to sleep between 10pm, and shift change at 6am, although we rarely manage more than a couple of hours on any given night. This night turned out to be one of the good ones. After bedding down just a little after midnight, I wasn’t disturbed until just after five.

The lights come on with a shrill shriek, followed by the dispatcher announcing an address you’re supposed to remember perfectly. Within 5 seconds of being shocked awake from a deep sleep, you have to be able to think clearly enough to remember the address, acknowledge the call, and get out the door within the next 55 seconds. Needless to say this is an experience that takes some getting used to.

This particular instance offered little challenge in the “Just where the hell is that?” department though. You see- I’d visited this particular location less than 12 hours previously.

Once again we were on our way (lights and sirens) to the address in the ‘hood for respiratory difficulty. Driving to the call, all I could think about was how much time and effort had been wasted in trying to educate these people. We’d spent time, and resources in trying to teach them about the patient’s conditions, and tried to save them money by avoiding unnecessary tests and treatment.

We arrived on scene to find a direct repeat of the scenario from the previous afternoon. The patient was in no distress, and actually stated several times that she was without complaint except for something she could only describe as “balling in her stomach”. Despite multiple attempts at different lines of questioning, I still have no idea what she meant by that.

When I get called back to patients we’ve previously discharged, I tend to do what is known unofficially as a “Grab n’ Run”. Recognizing that if the family didn’t get the message the first time around, they probably won’t get it this time either, I prefer to just take the patient to the hospital and let a doctor tell the patient there’s nothing wrong with them.

We had one responder there with us who hadn’t been on the previous call though, and thought he might be able to convince the family of the true nature of this woman’s condition. Watching this happen was like watching a train wreck- I couldn’t look away.

“Well you see- the ER can’t do anything for her. There’s nothing actually wrong with her, and they’re just going to tell her to see her personal doctor”

“Uh uh! That’s what that other man said, but you don’ see her when you ain’t here! She ain’t breathin’ right, an’ she getting all sweaty all the time. She sick!”

“But ma’am-“

“No! You takin’ her to the hospital, and that’s it! She sick!”

It was then that it happened. I was listening to this woman who was just too stupid and belligerent to understand that we were trying to do her a favor and ensure the best care for her mother. No matter what we said, this woman knew better. Her education from General Hospital and Oprah’s “Medical Miracles” had given her knowledge far above and beyond what I’d managed from any training I’d received. I was listening to her talk, and in my head all I could think was “Just shut up you black bitch!”

Not stupid bitch. Not poor bitch. Not disenfranchised, mistreated, uneducated bitch. Not bitch-who-society-has-ensured-will-not-successfully-navigate-her-way-out-of poverty. Not even just plain ol’ bitch. Black bitch.

I hadn’t even said anything out loud- this was all in my head, but I felt sick at the line I’d crossed. Suddenly my problems with this woman were due to her skin color, and I felt like a terrible person. I knew better, but after being exposed to this situation over, and over, and over again some tiny little part of my brain had forgotten what I knew, and started making assumptions.

I felt terrible, but it wasn’t like I could really apologize, and I figured that my feeling bad was probably penance enough.

We ended up taking the woman to the hospital, even though there was nothing for us to treat. The charge nurse at the hospital looked at me cross-eyed when she asked what the patient’s chief complaint was and I said “Balling in her stomach”. I was pleased to see that the doctors were unable to get any more explanation of this condition out of the patient than I was.

We signed our truck offline from the ER, but all the way back to the EMS base, all I could think about was who I didn’t want to be. We have paramedics who base their treatment decisions on the color of a patient’s skin. I don’t want to be like that. I don’t want to judge a person based on something they can’t control. Doing that makes you as stupid as the woman who wouldn’t listen to the medical professionals she called to her home, and I never want to be that stupid- regardless of what color her skin was.

Scene Hazards

2007-01-29T20:37:00.000-08:00

Over and over again in EMT classes, we teach people to constantly be on guard against all the various dangers we face in our day-to-day activities. Sometimes though, you just don't see it coming. Old ladies are sneaky like that.

Friday night marked my first night of paid work with the county in almost 2 weeks thanks to various scheduling conflicts, and an all too full clinical schedule. Even though I had to work in Hillsborough I figured it would be a pretty good night. My partner wasn't hard to work with, and David was the medic up there. On top of that, Jordan was riding one of his clinical shifts that night with David, so I really had quite a few people around who I like working with.

We decided to try to start the night off right and headed over to a local restaraunt. The food isn't good, but it's not that expensive, they give you a lot of it, and it's fried. Small wonder I'm getting fat. (Pun intended)

As we walked into the restaraunt, I noticed David had stopped to speak with an older lady sitting at the table directly across from where we'd been seated. She had her head wrapped in a bandage, and I made some quip about David creating patients everywhere he went.

He explained that the 83 year old lady had fallen down in her driveway that morning as she went to retrieve her newspaper. She'd denied any loss of consciousness at the time, though she bled like a stuck pig, and said she'd just tripped as she bent over. Her grandson had been onscene, and after a fairly thorough exam David agreed to let her go to the hospital in her personal vehicle.

So now here we are 10 hours later, laughing and joking with this woman and her family about how our bandaging job was better than the hospitals's, and how if they'd just let us suture folks in the field, we could put the ERs out of business.

We sit down to our dinner, and I manage two quick glasses of tea (hey- this is the south) while dreaming of all the fried goodness that awaits me. We're in the middle of listening to David tell some utterly disgusting and morally reprehensible story when suddenly, this lady's family turns around and says: "Hey, would you fellas mind helping us for a minute?"

I looked past the family, and there sits grandma. The lights are on, but nobody's home. She's officially zonked.

And then the puke started. Nasty, copious, thick, head bleed puke.

David called communications to let them know what was going on, and I started moving family members out of the way and dragging grandma to the middle of the dining room- all the while with her spewing her half-digested food across her lap. Luckily I actually had a pair of gloves in my duty belt, instead of the empty pouch I come across about half the time when I reach back there.

I gave her mouth a quick sweep to clear out the few remaining chunks she was trying to choke on, (much to the delight of the crowds gathered round) and tried to get a decent look at her pupils while simultaneously staying out of the line of fire.

By now Jordan and my partner had returned with oxygen, and the rest of the equipment. We put the lady on an oxygen mask, and the cardiac monitor, and took her out to the truck to thunderous applause. Well- everything except the applause is true. Mostly people just kept eating.

Out in the truck Granny started to come around a little bit, though she was still confused, and never believed that she'd experienced the total unconsciousness we were relating to her. She also continued to puke in that manner particular to people with large amounts of blood pushing on their cerebrum.

Once we got to Duke (because this lady was stupid and wanted to go there- quick sidenote: I wouldn't tell my worst enemy (likely a dook fan) to go to Duke University Medical Center's ER. It's terrible.) the nurse managed to blow us off since he recognized the lady from earlier in the day. You know- the first time they didn't scan her head.

So he assigned us to a hall bed because he was too busy not listening to our report to figure out what the hell was going on. So there we are trying to move this lady over to her new bed, while David gives a report to the nurse and doctor. Seeing that we're not getting through to them, the patient decides to make our point for us, and experiences another little period of unconsciousness, followed by still more impressive vomiting.

Finally getting the HEAD BLEED!!! memo we've been sending, our LOLFDWB (little old lady fell down went boom) gets whisked off to room 1 for an MRI and full stroke workup. Funny how things work huh?

Lesson learned? When you spot a former patient, run away.

PS- The lady's grandson tried to pay for our dinner. I thought that was a really classy move, even though we couldn't accept. Thanks dude.

Long Time, No See

2007-01-18T21:32:00.000-08:00

Been a little while... sorry.

I'm a busy boy. I've finished my paramedic class, and the clinical time is coming along nicely. I should be completely done in time to test in March. After that- I don't have a clue.

One problem is that I'd love to keep working in the system I'm currently employed in, but they'll only hire paramedics with extensive experience. Thing is, I work in this system, I know this system, and I've been told by more than one person who works here that I'm perfectly qualified. For now I think I'm going to let other people campaign for me if/when I manage to impress upon them that I know what I'm doing.

This morning we got hit with a surprise couple of inches of snow, and some freezing rain quickly followed. If there's one thing I know about drivers in North Carolina, it's that we don't have a clue about what to do with 4 wheels and an engine when there's wintry weather about. The good news is, if you do end up in a ditch in your new Toyota hybrid, stay calm. There will be 4 rednecks in a big truck along shortly to pull you out.

Thanks to the snow, and all the inherent emergencies created thereby, the EMS system was stretched just a little bit thin today. At about 9:30 this morning when the county ran out of ambulances for the 3rd time, they decided to put out a page for extra help, and I ended up going in to staff a truck on my day off.

After making a few phone calls to find myself a partner we quickly ended up running several calls in succession. Even with 2 extra ambulances online we were still stacking calls and patients were waiting for long stretches without help.

Finally at about 11:30 we were dispatched to a cardiac arrest at one of the local assisted living faclities. Most folks would call it a nursing home, but it really isn't. There are no skilled medical personnel on staff at these places- just people to help with cooking, cleaning, laundry, and things like that.

This lady had just gotten up from lunch (quite the accomplishment at 94 years old) and was walking out through the lobby when she either threw up a little bit, and sucked that back down her windpipe, or she choked on a little morsel she'd been saving for later. Either way, she managed to completely block her airway.

So tearing across town we go. Lights, sirens, and all the bad drivers of the general public combined with icy roads combined to create a sure use for the "Oh shit!" handle. (You know, the handle that hangs down from above the window?)

We got onscene just a little while after the fire department, and walked in to find a dead lady. Surprising because so many of our dispatched cardiac arrests aren't.

Anyway, as I walked up the FD folks handed me a yellow sheet of paper with a big stop sign, and the words DO NOT RESUSCITATE written on the front. With that, the deceased was no longer a patient, and would remain "the deceased".

Unfortunately for her, that meant that all dignity was now gone. Flown the coop. I opened her shirt to check for heart tones, and in doing so exposed her 90 year old breasts to the 15 or so people in the lobby. Deaths outside of a medical facility have to be investigated by law enforcement, and reported to the medical examiner. Alas, this means that you cannot move a body until law enforcement arrives, and again due to the snow, CHPD was certainly running a few more calls than usual.

Even after they finally arrived, CHPD had sent their best and brightest officers- which meant that they had no clue what they were supposed to do. After 20 minutes of debate and conversation with the Medical Examiner they finally came to the conclusion that it was okay to move this old lady out of the busy lobby of this assisted living facility. I think the manager breathed the largest sigh of relief I've ever seen. I thought I'd heard her mention something about a scheduled tour a few minutes before.

Further proving the "there's no dignity in death" theorem, "the deceased" leaked some sort of liquid onto one of the people tasked with getting her upstairs.

The lesson?

Die before you hit 75. Trust me on that one.

Time Management

2006-11-09T21:58:00.000-08:00

Halloween this year was a bust- sorry.

I treated one girl who was so drunk that she literally couldn't even remember her name, and had collapsed in Time Out, but she was the only patient I laid hands on. I only had my picture taken once this year- waaaaay down from last year, but my fellow subject was cute so I won't complain.

I also got flashed which was a nice change of pace from the sort of boobies I usually see on duty. To whoever you are: (yes you, Pirate Gal) thanks for brightening up my evening. I think your piercing is lovely.

This last week has been incredibly busy for me. Between work, and work, and work, and work, and class I haven't had a stretch longer than about 4 hours to myself. Normally I consider this a pretty good thing since I function much better when I'm busy. Being this busy however, is pushing the limits of this policy.

It does lead to some soul-searching though, and I've been doing a lot of that recently. Questioning where I'm going, and how I'm getting there. Anyone that actually knows me may or may not know that this is a fairly regular occurence, but there's a difference this time.

Come January- with the completion of this paramedic class (spit spit- like the gypsies!) I'll actually be able to do pretty much whatever I want.

Consider that for a second:

-I'm 20 years old (21 in January)
-I'm unmarried (great girlfriend though)
-I'll be able to get a financially stable job pretty much everywhere I go

This knowledge weighs on me. I have no plans to go anywhere, and I love Chapel Hill. I even like my life as it stands now, but still...

There's a pull. I don't know where this pull is actually pulling. That knowledge would solve many problems for me, and certainly settle some of the funny feelings I have so much of the time. I want to go places and do grand things. I want to be 80 years old, still working, and look back and say "Yeah. You managed to do some good along the line."

There's a guy- I may or may not have written about him before, I can't remember. His name is Paul Farmer, and he started an organization with the goal of providing health care and social justice the people that the rest of the world tends to fuck over. Google him, or read Mountains Beyond Mountains by Tracy Kidder. It'll inspire you too- promise.

I want to go to Haiti and help. I want to go to Africa and help. I want to go to Key West and build boats. I want to go to Alaska and work as a bush medic. I want to see the entire world.

People tell me that I'm only 20, and that I have time.

I tell them that the only time I'll have time is when I'm 20, and it's rapidly being filled.

Consider that for a bit, and see what kind of pulls you feel.

Halloween

2006-10-30T20:32:00.000-08:00

Halloween in Chapel Hill tomorrow night. If you don't know what this is all about, read this.

Expect a good story or two.

Death Schmeth.

2006-10-27T08:48:00.000-07:00

People my age are notorious for having a firm belief in their own invincibility. We're known for our thrill seeking behavior, strong in our knowledge that there are no closed doors for us, and the future holds only promise and opportunity.

A lot of people would assume that the repeated exposure to mortality and morbidity that this job provides would lead a person to reexamine their life and try to cut out the risky behaviors. It should make you want to ive a safe life free from potential for harm, safe in your knowledge that death can come for any of us, and only by remaining vigilant can we hope to avoid t for as long as possible.

In my case at least, the exact opposite is true.

Growing up, I was the picture of "The good boy". I worked hard, and did well in school. I volunteered incessantly from about age 10 on. I was involved in church, and after-school activities. Leadership. I did everything I was supposed to.

I can't say that starting to work in EMS is the lone factor responsible for the changes that have occured in my life, but they both started at about the same time, and I can't chalk that up to coincidence.

Yesterday I read Tuesdays With Morrie for the first time. I'm late on the bandwagon, I know, but like most people the book struck a chord in me. The surprise was that the chord struck was one of affirmation rather than need for change.

The overwhelming message of the book is that as a culture we place emphasis on all the wrong things. Money, "power", influence and property are our culture's golden calves. The pursuit of these things has become the pursuit of happiness. Today's Declaration of Independence would guarantee the unalienable rights of Life, Liberty, and a Flat-Screen Plasma TV.

But as Morrie said- "Once you learn how to die, you learn how to live."

The knowledge that death isn't a mystical, far-off potentiality, but rather a guarantee with no expiration date changes the way you look at the world. Who gives a shit how big your house is, or how fast your car is when you could keel over in the next 5 minutes?

Some of you have read, or know about the story from my first night on duty. I'm not gonna write about it again here, except to say that finding six people with nothing more in common than a desire to help their fellow man dead in the middle of the road is one helluva wakeup call.

We're asleep for so much of our lives. We live safely in a cocoon of things that don't matter. When our lives have no importance- when our lives don't matter, who's afraid of dying? Take away the value of our lives, and death is no longer a worry, right?

This falsitude seems to be what most of us really believe. "Everyone knows they're going to die, but no one believes it."

Then you have the people who seem to have figured it out. They work jobs that make them happy. They have lives that mean something to them, and to other people. They have meaningful relationships with people who are important to them. They take risks, and live.

I went skydiving. I'm buying a motorcycle. I drive too fast. I drive an ambulance too fast. My job puts me in bad situations.

But I'm happy. I matter to people. I'm doing good things for people I don't know. My life is far from perfect, but if I die tomorrow, I don't think my last words will be "Damn- if only I'd..."

You want that peace of mind? You want to live your life instead of just waiting to die?

Take Morrie's advice:
"Do what the Buddhists do. Everyday have a little bird on your shoulder that asks: "Is today the day? Am I ready? Am I doing all that I need to do? Am I being the person I want to be?"

And I'll add this:
Help your fellow man. Give a shit about each other. Work to make the lives of the people around you just a little bit better.

Then go skydiving. It's the risk of death that makes life matter.

Can You Give My Daddy New Teeth?

2006-10-23T18:51:00.001-07:00

Sunday was one of the worst days I've ever had working in this county.

It was also one of the best.

When it comes down to whether or not you're going to enjoy this job, the real question is how much time you're willing to spend dealing with bullshit as a trade-off for the rare moment when you actually have something to do with saving a life.

Quite literally saving a life.

Yesterday, I collected some back pay in my "rare moment" account.

We started out well- the first three hours of the shift we didn't run a single call. My partner and I were on the peak hour truck, so we didn't even have to come on duty until 9am, versus the usual 6. Alas- the peace was not to last. My partner and I made one crucial karmic error:

We didn't go to Breadman's for breakfast.

The shift's sergeant had cooked breakfast for the shift, and we naturally indulged in her delicious selection of cinnamon rolls, eggs, bacon, and english muffins. Who wouldn't? We of course couldn't foresee that this was really just the beginning of the end for us.

You see, in EMS breakfast is a sacred thing. Something to be shared with your partner. A meal to be lingered over and enjoyed. The knowledge that this is likely the only meal you'll make it through uninterrupted for the next 24 hours is always near the forefront of your mind, and even with breakfast such good fortune is far from guarannteed.

Thus the gods of EMS- whatever form they may take- tend to frown upon the hubris that's inherent in not enjoying the lone chance for a hot, sit down meal that you can both enjoy.

Our penitence began innocently enough with an easy call at a local old folks home. This 90 year old woman was having difficulty breathing- at least that's what her family said. Our patient seemed to think she was fine, and was really not happy to see several strangers strolling into her bedroom on a Sunday afternoon.

Whine, bitch, and moan she did, but we couldn't seem to get the least bit annoyed with her. You see she was not only 90 years old, but also British. Her every complaint seemed so polite, and was enunciated with such diction that there was really no way to fault her for being a bit bitter at the whole process.

The highlight of the day was her statement as we moved her to the hospital bed:
"I don't believe I've ever been so uncomfortable as I am now. Even during the bombings when I was in London during the war I believe I was more comfortable than this."

The Luftwaffe ain't got nothing on me. I goose-stepped out of the room.

Our next several patients were far from taxing, but we were still running our asses off. Our truck was supposed to be stationed in Chapel Hill, but we found ourselves continuously running to Hillsborough, and Efland when things were busy, and we transported more people to Duke than UNC. That's a very bad thing. All basketball rivalry aside- I hate Duke hospital more than I hate their basketball team.

Late in the afternoon we had our first "Holllllllyyyy shiiiiiit!" moment of the day. A wreck was paged out in Efland with no ambulances within about 10 miles. We were the second closest truck, and we were about 19 miles away.

As nearly as I can remember, this is the page:

"Communications Medic 1, 1463, Efland Fire Department, Efland first responders, Rescue: Blankety blank Rd at Ican'ttellyouwherethishappened Dr. 10-50 PI. Ejection. Possible pin-in. Multiple patients. All units respond code 3."

The gist of that is that there's a big wreck in Efland. Report of one person thrown from the vehicle. Report of another person stuck in the vehicle. Drive fast, with lights and sirens.

A short time later my truck was dispatched as the second in unit once someone got onscene and confirmed that there were as many hurt people as was initally suspected.

One patient had a potentially broken arm, and not a whole lot else wrong with him.

Two patients I know nothing about, because I never saw them, and never treated them.

Our patient had what looked like a depressed fracture in his forehead, lacerations to his face, and glass in his eyes. He was also pinned in his vehicle by the crumpled dashboard for about 20 minutes after the collision.

We literally got him out of the car, put him on a backboard, and got moving. AirCare wasn't flying due to bad weather, so we had a minimum 17 mile trip to Duke before this guy was going to be seen by a trauma team. Our medic had to start an IV, perform a full assessment on this guy, and get him on oxygen, the monitor, and every other analytical tool we have while bouncing along the highway at about 85mph.

By the time we got to Duke we'd pretty much figured out that this kid was very lucky, mostly uninjured, and that "depressed skull fracture" was just a kid with some goofy looking bone structure. He had one helluva cro-magnon looking brow ridge.

After we managed to clean up, and clear from that call, we started to head back to Chapel Hill. Unfortunately as soon as we crossed into the city limits and checked back in the county, we were dispatched to another nursing home just down the street.

We were called for respiratory distress, and just like every other call in the OC, we had a medic dispatched with us. He just didn't make it there very quickly.

My partner and I went inside and assessed the patient, only to find that she was febrile, had junky lungs, and may or may not have been having a stroke. She was weak on her left side, but the staff was unable to tell us if that was old, or new. Big surprise.

We put her on o2, packaged her on our stretcher, and headed outside. Still no medic. We put her in the truck, switched the o2 over, got a good set of vital signs, and went through her paperwork. Still no medic.

Turns out that the paramedic assigned to the call, who is brand new, and on his first shift by himself- managed to go the wrong way down a looooooong street, and had to turn around. Eventually though he managed to get to the call, the lady got the IV and treatment she needed, and we were on the way to the hospital with another notch on our guns. I mean stethoscopes.

We cleared from that call and began to head back to the station with dreams of getting off duty and putting this long day behind us dancing through our heads. We were awakened from that lovely dream by the piercing alarm that is the priority dispatch tone in this county. I think that when Jim Carrey did his "Most Annoying Sound in the World" bit in Dumb and Dumber what he really wanted to imitate was this shrill "beeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeep" that jolts you into a response regardless of your previous state.

"Medic 3, 1464, New Hope Fire Department, New Hope First Responders, Rescue: MajorhighwaythatrunsthroughOrangeCounty at mile marker such and such- 10-50PI, reported head-on collision. Units respond code 3."

Read the translation from before, and you can figure that one out.

Needless to say, we hauled ass.

We were told just before we got there by our dispatcher (Who was doing an awesome job while getting slammed with radio traffic.) that to approach the scene we were going to have to travel down the westbound onramp, turn around, and drive back east in the westbound lanes.

Folks- assuming that someone is actually reading this- when you see flashing lights on your side of the highway SLOW THE FUCK DOWN. Move as far away from the lights as you can, and slow to a crawl. I don't want to die on the side of a highway because you were too busy talking on your phone and driving to the Waffle House.

We eventually manage to negotiate our way down the shoulder of the road, and pulled in behind the New Hope enging that had just arrived onscene. Sure enough, someone had actually managed a head-on collision on this divided, guard-railed, interstate freeway.

The 20 year old girl who was driving the vehicle that was now on the wrong side of the road had been travelling east when she "swerved to miss a deer." She ended up crossing the median, and somehow managed to go under the triple guard wire that I've seen stop tractor trailers.

Once on the wrong side of the highway she slammed into a late model SUV that was carrying a father and son home from a day visiting family.

I stepped out of our ambulance, and had another "Holy shit!" moment. There was debris scattered across the entire highway for about half a mile. The New Hope engine was blocking the right lane of travel, but traffic was snaking by in the left lane. The girl's car was absolutely destroyed, but the passenger compartment looked to be mostly intact. The driver's side door wasn't going to open, and the engine was gone, but the girls inside were awake, oriented, and not complaining of anything. The driver was pinned, but mostly unhurt. The rescue guys got to work cutting them out, and I turned care of them over to the second ambulance to arrive.

Meanwhile my partner and one of the medics were attending to the father and son in the other vehicle. Dad had absorbed most of the impact, and he'd done it with his chest and face. They were both restrained by their seat belts, but there were no airbags in this vehicle, and Dad's face had slammed full into the steering wheel.

Next time you get in your car try to bend your steering wheel. Hit it pretty hard. They're actually very strong. This guy's steering wheel was bent to hell, and he had a FORD logo impressed on the top of his sternum. He was a little bit confused, and bleeding into his airway, but mostly stable. His main concern was his son, who was for all intents and purposes the luckiest kid on Earth.

He was sitting in the passenger seat, apparently asleep at the time of the wreck. He'd been wearing his seatbelt, and it saved his life. He was essentially without complaint, but we backboarded him as a precaution, and got him into the ambulance while they cut the car up to free his dad.

This kid was the bravest child I've ever met. As the firefighters and I were pulling him out of the car he never so much as whimpered. He answered all of my questions, and did everything I asked him to do. I explained that we were going to pull him out, and put him on a board, and that his dad would be with him again in just a minute or two. He nodded that he understood, and away we went.

When I got him into the truck I told him what was happening with him, and with his dad, and that we were going to go to the hospital to take care of everybody. This kid is still completely calm, and cooperating completely.

He asked about the people in the other car.

This kid is 8 years old, has just been involved in an incredibly traumatic event, and was concerned about the people in the OTHER car. I was blown away.

Then he looked up at me, and for the first time he cracked a little bit. He asked me as honestly as he knew how: "Are you gonna be able to give my daddy some new teeth?"

How do you respond to that? What do you tell a kid who's 8 years old whose father is potentially dying from a head injury or internal bleeding when he asks you if his dad is going to be okay? He wasn't really asking about his dad's teeth. He was asking if he was ever going to have the same dad that he used to. He saw that his dad had lost some teeth, and it was the most obvious change for him.

I told him that yes, we'd make sure his dad got some new teeth.

Then he started to cry.

The paramedic who I was working with came into the truck and tried to help me calm him down, even though he was far from hysterics, and told him that his mommy would meet him at the hospital.

Then he told us that his mom was already dead.

Jeeeeeeesus Christ.

We eventually got his dad into the truck too, and they were able to talk to one another, which calmed them both down. I tried to start an IV on the dad, who had a great vein in his arm that I hit, and the catheter threaded fine, but it wouldn't flow. I hate 16gauge catheters. Luckily the medic onscene hit a vein, and got a line in.

The whole way in to the hospital dad and son held hands, and talked when they could.

I have no idea how things turned out for the dad. Things didn't look that bad with us, but a lot of serious internal injuries don't show up for a while, and we don't carry a CT scanner in the back of the ambulance. Everyone else involved in the wreck was essentially okay, which is nothing more than a testament to seatbelts and airbags. Without those, everyone in this wreck is dead, no question.

My partner and I cleaned our truck, and started to head off duty, but ended up having to stay another 3 hours extra when a mobile home caught fire in Mebane, injuring no less than 9 people. I don't know anything about the call, so I'm not writing anything about it. I'm sure it was in the news somewhere.

I made it home a little after midnight, said hello to my girlfriend who I hadn't seen in 4 days, and collapsed into bed.

I love my job.

Woohoo for Partners!

2006-10-21T12:33:00.000-07:00

Life partners, sexual partners, creative partners, drinking partners... you pretty much choose those.

EMS Partners are assigned, and therein lies the fun.

In the particular system I work in, it's a game of chance each time you show up for a shift as to where you'll be assigned to work, and who you'll be assigned to work with. Some days, the chips are up. You get a great partner, and you're working in Chapel Hill on a 75 degree Thursday night in early fall when the full female population of this wonderful university town takes off their clothing, and heads to the bars.

Then there are the days you're assigned to work with the biggest fucktard on God's green earth, and you're sent to the asscrack of Orange County- Hillsborough. Really- look at a map. It's pretty much where the asscrack oughta be.

Hillsborough bashing aside, even working in that redneck haven is easily passable provided the person you're being forced to spend 12-24 hours with is something close to personable. Alas, all too often this field seems to attract personnel of less than stellar personal attributes.

Highlights From Recent Years-

A full-time employee tells a local gas station attendant just what he'd like to do to her while bending her over the counter, then proceeds to stalk her. Suspended for a month. Eventually fired for same offense with same victim.

Same employee helps teach a new class of EMT students. When showing the students how to move a patient, he sticks his hands down the pants of a female student. When the student questions his actions, he states "That's just how EMS is". Wish I'd known that earlier. Yaaay sexual assault!

Crew of 2 EMTs walks into what sounds like a bullshit call with literally no equipment, only to find their patient is in cardiac arrest. Whoops!

Sometimes though, it's nothing obvious or overt. Sometimes your partner just grates on your every nerve by their very presence. In these cases, what's the right course of action?

Really though, when your partner is about as useful as a doorstop, it hurts everyone involved. Your workload is doubled, or even tripled, because on top of doing al the things that you'd have to do, and all the things that they're supposed to do, you're also babysitting your idiot partner.

If your partner happens to be the dangerous sort of stupid- ie the type who drive recklessly, or ask the big angry man who denies drinking anything what he's really had to drink, then your equation is complicated by mere survival. Believe it or not, statistics show that grabbing the "Oh Shit!!!" handle (the little handle above the door that normal people hang their laundry on) will probably save your life in the event that your moron partner runs through a red light at the busiest intersection in town without even a cursory glance at cross traffic.

At least it makes me feel better anyway.

Tonight however, I have hope for greatness. Chapel Hill, with good partners.

Let's Clear That Up

2006-09-20T23:32:00.000-07:00

Tonight in class we were discussing an interesting topic, and it actually sparked a little bit of debate. We were talking in general about behavioral and psychiatric emergencies, and eventually got around to the topic of restraining patients.

There are a few schools of thought on the proper process for doing this, and we were all discussing various techniques. One overwhelming theme was consistent though: no matter what you planned, you needed some serious manpower to pull it off.

The problem with that is obvious- at least to me. You just don't always have all the resources you want in this job. It's what sets us apart from doctors and nurses. Where they have a nice sterile, clean, stable work environment we have a muddy ditch on the side of the highway in a thunderstorm with a drunk who just killed 3 people and wants to fight all of us next.

It leads to misconceptions. Even other healthcare workers have no idea what we do out there. I took a patient to the Labor and Delivery floor at UNC a few weeks ago, and while I was up there they called a code blue in another one of the rooms on the unit.

26 people, and believe me I counted, ran down the hallway to this small delivery room. Most of them ended up clustered outside the room trying to peek over one another's shoulders to get a view. Residents, nurses, NAs and all sorts of other folks came flocking to this code.

A few seconds later a nurse poked her head out and declared a false alarm. As the crowd dispersed I remarked on the rather large number of people who'd literally stampeded down the hallway in an attempt at making it in for a resuscitation.

A nurse, apparently hearing my comment and taking it to mean I was an idiot, turned around and remarked rather snarkily (yes that's a word)- "That's what happens when they call a code!"

At this point I'm sure the disdain in my voice became evident, because my reply was more than a little snarky itself.

"Forgive me for not recognizing it. You see, when we run a code we get a paramedic, and maybe a volunteer firefighter."

The point buried in there somewhere is that nurses know what they do, and they know what everyone else in the hospital does, but they don't know what we do.

My roommate was on a clinical shift at one of our local hospitals when one of the nurses assumed he wasn't allowed to administer Valium to a patient. When he asked her how she thought we stopped seizures, she said she thought we just threw them on the stretcher and drove to the hospital.

Of course the misconceptions of our "colleagues" are nothing compared to that of the public-at-large.

Most of what your Average Joe knows about EMS comes from TV.

Back in the 70s you had Johnny and Roy in Squad 51 on the Jack Webb show Emergency!. They called the hospital for everything, and by today's standards the medicine is laughable, but this was probably some of the best exposure the field has ever had.

In the 80's William Shatner hosted Rescue 911 and showed millions of Americans just what was available to them if they called 911. Most of the time you got a couple of volunteers in blue jeans and sweatshirts who meant well, but generally weren't well trained. Of course outside of major metropolitan areas, you were still lucky to even have an ambulance with trained personnel at your home in less than 30 minutes.

Today we learn about EMS from shows like Saved, and Third Watch- shows that are far more concerned with drama and suspense than with portraying the job with any sort of accuracy.

Not that I'm complaining too much. At least people don't just assume everything is done by the Fire Department anymore.

Here's your job- before I finish out this post with what I originally intended it to be about, whooping ass, figure out what exactly EMS is all about. What do paramedics do, and why is it so important? Call me out. Tell me if you think this is bullshit and I'm tooting my own horn. Let me know what you find out. I bet you're surprised.

PS- all this is lame, and will get edited, but it's late and I'm tired. Figure the last third of this will be removed.

Stress Debriefing

2006-09-18T00:28:00.000-07:00

A wise man once said: "Those who work hard, party harder."

That wise man may or may not have been me- I can't say for sure because I was probably blitzed at the time.

Everyone seems to reach a point in their lives when they realize that if the world is handing you lemons you should forget all about the lemonade, and squeeze that juice into a vodka tonic instead. Sometimes making your problems disappear for a few short hours is a thousand times more effective than actually dealing with them.

This universal truth seems to be even more apparent when you work in a high-stress field. From coke heads on Wall Street to nurses stealing narcotics- one way or another folks are finding a way to numb themselves.

But let's be honest. For the most part people stick with vices that aren't illegal, or are maybe just a little illegal. As for me, I hope my surgeon is nothing more than a raging alcoholic, but if he tokes on the ganja every once in a while to mellow out then so be it.

Personally, I stick to the booze, and I've never had much of a desire to cross that line. I can come off from a 24 to 36 hour shift, drink a beer, and pass out for 12 hours at a time ready to go again.

But sometimes you need a little bit more "oomph" to your stress blowoff. Some explosive decompression. Sometimes you need actual explosives.

Some of you may not know this, but North Carolina restricts the sale of fireworks to what essentially amounts to- well, shit.

If it flies up in the air, explodes, shoots flaming balls, or does anything more than sit on the ground and weakly emit sparks while pitifully shrieking then it's just too dangerous for the Tar Heel State. Now I can see the General Assembly's logic here- we do have more drunkass rednecks per capita here than any other section of the Union, but Natural Selection is natural.

Anyway, the result of this harebrained ordinance is that if you want explosives worthy of the glory and grandeur of your alcohol induced fantasies (drunk ideas are always good ideas.) then you have to travel for around 2 1/2-3 hours to South Carolina.

Ahhh South Carolina. Haven for all that is drunk, southern, and probably dangerous. Home of Myrtle Beach- the Redneck Riviera, and South Of the Border- maybe the single greatest tourist trap ever constructed.

However, for my moeny there's no clearer vision of heaven than that of Shelton's Fireworks in Blacksburg, SC. Here you will find the "World's Largest Selection of Consumer Available Fireworks". That's right bitches, world's largest. (Side-note: If you want to see what a South Carolina website looks like, then look no further. I played with the fireworks box at the bottom of the page for 5 minutes)

As a result of a night of drinking, and disappointment in the piss-poor offerings of NC's fireworks distributors a group of my friends and I decided that a road trip to Blacksburg was in order, and made plans post-haste.

The morning after we formed our plan we called one another with fuzzy heads and tried to remember the actual details of the plan, and whether or not we were going to actually follow through. In short order we decided that with nothing stopping us,we had no choice but to fulfill what was obviously pre-ordained.

3 Uneventful hours later we arrived at our Mecca. You could see the tall, red, glorious site from a couple of miles off, and even though we were a mere twelve miles from the border of my home state the missing teeth, mullets, and excessive camoflage clothing of the local residents really did leave me feeling like a secret agent on a confidential mission among an alien populace.

$80 poorer (no shit) but much more excited about the trip home, my friends and I spent the next 5 hours joyriding through the various rural counties off the interstate between SC and Chapel Hill, and passed the time by throwing bottle rockets out the window and guessing which direction they'd fly.

We only had one explode outside the window.

We stumbled into our beds that night giddy with joy at the thought of what was in store for the following night. I planned my speech accordingly.

"Good morning. In less than an hour, aircraft (rockets) from here will join others from around the world. And you will be launching the largest aerial battle in the history of mankind. "Mankind." That word should have new meaning for all of us today. We can't be consumed by our petty differences anymore. We will be united in our common interests. Perhaps it's fate that today is the Fourth of July (23rd of June), and you will once again be fighting for our freedom... Not from tyranny, oppression, or persecution... but from annihilation. We are fighting for our right to live. To exist. And should we win the day, the Fourth of July (23rd of June) will no longer be known as an American holiday, but as the day the world declared in one voice: "We will not go quietly into the night! We will not vanish without a fight!" We're going to live on! We're going to survive! Today we celebrate our Independence Day!"

The night of our penultimate celebration was in a word- awesome. We drank, and danced, and drank, and talked, and drank some more. I got rave reviews for my speech, but when the critics are all lit that's pretty easy.Cheap vodka, and cheaper beer (we're college students, and work EMS part-time. What did you think we'd drink?) flowed like water, and I could feel my worries and concerns floating high into the sky.

Then they exploded.

Bottle rockets, mortars, other flashy boom-boom things- they all rocked our world. Our retinas were scarred, and our eardrums buffeted by one pounding blast after another. These things were awesome! South Carolina was the best!

Even better, we only set the woods on fire a few times, and when that did happen we had plenty of beer- either in cans, or our bladders, to put it out. In short, this turned out to be the greatest drunken idea of all time.

We stumbled out of the woods, and up the porch into the closest apartment we had a key to, and just in time.

A fire engine and a battalion chief had been roused out of bed at 3 in the morning thanks to our drunken bacchanalia. Some caring, concerned citizen had detected a hint of smoke from our less-than-legal activities and decided to call 911. Remember kids- only you can prevent forest fires.

Needless to say, we sobered up rather quickly and scrambled inside to safety. We watched, and giggled, as the poor firefighters we work with everyday stumbled around in the brush looking for a fire that never existed. Or if it did we peed on it pretty quick.

That night saw birthed one of the most influential new theories in human history. Since I was drunk I only remember part of it, but I'm currently working on my dissertation, and I hope to be published in a few years.

You see, it's a study on what I call the "Circle of Stress for Emergency Providers" and what it basically outlines is the fact that when off-duty emergency workers seek to relieve their stress they end up causing more stress for their on-duty colleagues.

Brilliant, I know.

Thank God I'm talented enough to do more damage than I absorb.

Remember One Thing

2006-09-15T23:09:00.000-07:00

The problem with being prejudiced isn’t that you’re going to offend someone else- it’s that you’re going to kill someone. At least if you work in this field.

Making snap judgments is a fact of life. There’s no sense denying that. It’s even more a part of life when you work in emergency services. There’s just no time to sit, think, ponder, and deliberate your actions. You’ve got to move, and move now.

90% of the time, that’s a very good thing. It saves time, it saves lives. But there are other times when your snap judgments not only don’t help a situation, but they make matters worse, and put a patient in danger.

Truth be told, you needn’t work in emergency services to have a negative effect on people with your snap judgments.

At least 4 times a week the wonderful emergency responders in the city of Chapel Hill are dispatched to a cardiac arrest somewhere in the vicinity of the main intersection downtown.

Wonderful! It’s what we’re here for right? Saving lives, and doing it right out there in the streets. Right there in the nitty gritty world. Real, honest-to-God street medicine.

Except that’s never the case. Despite being dispatched to countless cardiac arrests on Franklin St, I’ve yet to work one. Why? Because these people aren’t dead. Many times they’re just sleeping. Sometime’s they’ve passed out in a drunken stupor.

So how do the well-meaning do-gooder citizens of Chapel Hill confuse these widely differing conditions?

Because they refuse to approach, talk to, or even just nudge these people with their toe. They’re most often dirty, smelly, drunk homeless people, and the altruism of these erudite allies in healthcare ends with anything actually approaching physical contact with these individuals.

Honestly- if you think someone really is dead or dying, and all you do is call 911 and look at the person, then you’re an asshole. Hold their hand? Do CPR? Just say “Hey, things will be okay”? No. You can get AIDS from that.

So instead a crew of 3-4 firefighters, 1-2 paramedics, 2 EMTs, and police officers come flying across town emergency traffic to wake up the same guy they get called for 12 times a week. Thanks for the assistance there Mr. Eagle Scout.

Don’t get me wrong though- the folks with lights and sirens on their vehicles aren’t beyond reproach by any stretch of the imagination. Take tonight for example:

While standing in front of a local gas station watching the world (read: girls) go by, a couple of people advised us that there was a man passed out in the parking lot next to us.

The people I work with everyday proceeded to walk over to this person, smell some alcohol, and assume he was nothing but a drunk.

I don’t have the time or the desire to explain why the way this “call” played out was so wrong, but NO ONE cared about anything more than getting away from this person as fast as possible. NO ONE had his best-interest in mind.

Why? Because we see it everyday. We see the same people, making the same destructive decisions. They ruin their lives and they ruin the lives of everyone around them. They ruin my night over, and over, and over again when they call us for nothing but bulshit at 3 in the morning. There’s no denying that.

But you know what? It doesn’t matter. They’re people and patients first. It’s your job to look beyond the drunk homeless guy who likes to fight you in the back of the ambulance. No matter who they are they deserve the same treatment that you’d give your own mother.

We all know this.

Some of us remember it more often than others.

Explanation

2006-08-31T22:42:00.000-07:00

I like to think that everyone has a portion of their lives that they feel like no one else can understand. I like to think this because there are large portions of my life that I don’t feel like I can explain to anyone else, and if I’m the only person who feels that way, then I’m insane.

Maybe for you it’s an indiscriminate love for all things associated with My Little Pony. Maybe it’s wearing lingerie underneath your clothes, even if you’re not a woman. Maybe you just really enjoy doing naughty things with the whisk your mom keeps in the kitchen. No matter what it is, you feel like no one else can understand it.

You know what? You’re right.

You see, there’s nothing wrong with having some section of your life reserved for just you. Some little portion of your soul that you never even try to explain to the public at-large. Why is it okay? Fuck if I know, but it is.

What I do know is that it’s impossible to explain certain experiences to people that haven’t lived them. Sometimes you can’t even explain an event to someone who’s been through a similar experience. You just had to live that particular moment, at that particular time, with those particular people to get it.

People talk about skydiving like this: “You just can’t explain the rush man! It’s like nothing else!” Bullshit. I’ve been skydiving. You want to know what it’s like? Stick your head out the car window at 85 miles per hour, and drive over one of those “lose your stomach” bumps. Oh yeah, and make sure that the driver is drunk and blindfolded so there’s that “I could die at any moment” thought racing through the back of your head. That’s basically skydiving.

What I can’t explain, no matter how hard I try- is what it’s like to feel like someone might actually owe their life to you. Like maybe you really made a difference, and for one second the fact that you were here on Earth meant something to someone else- someone totally disconnected from you. Want to talk about an ego rush? Be able to point at some poor fuck and say “Without me, he’s dead.”

It’s rare. 99% of my job is bullshit. Someone calls 911, and we drive them to the hospital instead of them taking a cab, driving themselves, or having someone else drive them. But that remaining 1% makes up for all the rest. Most of the time.

The last time I managed a 1% call was several weeks ago, but I just went upstairs to the Surgical Intensive Care Unit where he’s still a patient. He didn’t remember me- not that I’m surprised. He’d taken a pretty good whack to the head.

This kid was driving down a country road around midnight and by all estimates was hitting about 85mph. Somewhere along the 300 foot debris trail he’d left (My guess- the beginning) he’d lost control of his vehicle and God only knows what happened from there.

To this day I couldn’t tell you what kind of car he’d been driving. It was a sort-of turquoise color, and completely demolished. The roof had been peeled off, and was lying next to him on the ground. The car was up mostly on it’s left side, and I could literally touch any portion of the interior that I wanted to while standing outside the vehicle. He was lying at the rear of the car, on his back, with no idea what had happened. He was lucky to still be alive.

He couldn’t move his legs, was complaining of abdominal pain, had a closed head injury, and had managed to take off all of the skin on his left leg from the knee to the ankle. All the skin. But he was alive.

This was a bad call- mostly for reasons I won’t go into here, but we got him to the hospital alive, and that’s what counts when the counting’s done.

The kid is paralyzed from the waist down. 18 years old and he’ll never walk again. He ended up with a total of 6 surgeries. 4 on his leg and abdomen, and another two on just his leg. He was kept in a coma for 2 weeks. He may still lose his left leg. But he’s alive.

He’s brain damaged with some pretty severe deficits right now, and the doctors aren’t sure how permanent they’ll be. Chances are he’ll never regain full functionality again. But he’s alive.

After 3 weeks of intensive care, at an average cost of between $200,000 and $250,000 a day, his parent’s have now got a bill of at least $4.2 million dollars, and he’s not out of intensive care yet. Then there are the bills for the rehabilitation hospital, the phyical and occupational therapy, and the potential costs for years of caretaker service assuming those mental deficits don’t resolve. But he’s alive.

And that’s a good thing. Right?

So tell me- how would you explain all of that?

On Duty

2006-08-29T23:25:00.000-07:00

Have you ever found yourself looking around at the group of people you're standing in, only to realize that you're a strange bunch of losers who normal people are probably staring at? And then you look around and see people staring at you?

Yeah, me neither.

Honestly though, my profession seems to attract a rather motley crew, (Dr. Feelgood jokes aside...) and I'm starting to become concerned that I'm guilty by association. I feel that rather than following the "natural" maturation path that young men should progress down I'm instead regressing. I find poop jokes funnier every day, (reference my last post) and I've begun to enjoy mooing at cows as I drive an ambulance down the road. Now truthfully I doubt that many of you could resist similar behavior if you had a powerful PA System attached to your vehicle, but all the same- I'm concerned.

Let me be clear in this though: I have no problem whatsoever with placing full and complete blame for this on my coworkers. 99% of them are older than I- in some cases by more than 30 years, and yet most of them laugh at the word "Duty" for it's homonymity to "Doody".

*Note to the reader: If you just giggled at either word, stop reading. This post is not for you. Also, if homonymity made you laugh, you're mispronouncing it, and should also consider not reading any further.

You see when I was growing up my mother enjoyed telling me that I was "4 going on 40". I was a generally mature little bastard who relished showing everyone else just how mature he was by being an arrogant little prick most of the time. It's a habit I've yet to outgrow. I enjoyed reading, and other generally erudite hobbies. I couldn't understand the kids who listed "reading", and "science", and "learning" under their "dislikes" in all of those wonderful Get-To-Know-You activities we had to perform in grades K through Oh My God-They never ended did they?

These days however I find I've migrated from The New England Journal of Medicine to Uncle Charlie's Bathroom Reader, and from Hamlet's "What is a Man?" soliloquy to quoting Ricky Bobby's dinner time prayer.

The only stimulus I can attribute my descent into the ever growing land of fart noises to is the constant contact with my various coworkers. Take this as a for-instance.

This past Saturday my partner and I were going to dinner with another crew. Both ambulances had a cadet riding along that shift, so there was a total of 3 people on each truck. Following a complicated game of Rock-Paper-Scissors, my partner was relegated to riding in the patient care compartment for the trip to dinner. Motorcyclists would refer to this as "Riding Bitch".

Never one to let his circumstances dictate his life, my partner decided to make the best of his situation. His solution? Moon the 19 year old girl in the front seat of the other ambulance.

Yes, you read that correctly. At the first red light I pulled up to I heard what sounded strangely like a person unfastening their belt, and unzipping their pants. Never being one to let something like that just slide by me I asked my partner what exactly he was doing.

His reply?

"Oh nothing. I was just going to moon the other truck."

My world froze. I was on the tipping point. I had a perfect opportunity to prove to myself, and to the world that I wasn't a one dimensional, shallow character. Here was my chance to show that I was more than bathroom humor and a pretty face. So what did I do?

I said "Hang on. I need to move the truck a little bit so I can see their faces in the mirror."

You know what though? I don't even feel bad. I kind of enjoy slipping down this long, dark slope. Maybe it's just because my higher brain functions have stopped working, but suddenly things don't seem so bad down here. I mean, let's face it. Is there anything funnier than watching your friend react to someone's ass being pressed against the back window of an ambulance?

Take it from me- the answer is no.

Old People Smell Funny

2006-08-28T22:41:00.000-07:00

It's a fact of life. The older you are, the funnier you smell. Everyone remembers wrinkling their nose at the occasional malodorous burst that your grandfather would emit from his recliner. We all have that one Great-Aunt who never quite got the message that bathing in lilac perfume not only didn't make her attractive, but was also socially inappropriate at funerals and baptisms.

Eventually though we're all going to reach the age when our olfactory abilities are no longer quite up to snuff, and then we too will join the ranks of the Funny-Smelling-Old-People. In the hopes of brightening the lives of all of the various and theoretical individuals who will be involved in caring for us though, let me offer a few ground rules that I've thought up during the course of my intensive studies of the aged human.

Rule Number 1:
If you piss yourself, change your garments and/or bed sheets immediately. If unable to fulfill this task immediately alert your caretaker to the problem. If caretaker is a lazy fatass NA in a nursing home, threaten to cut some bacon off that bitch's ass if she doesn't get you some new drawers.

This may seem like a no-brainer, but when you have no brain (quite literally, as the Alzheimer's disease has put millions of little holes through yours) you might need a little reminder now and then. This is a bigger problem with little old men than with little old women. These 80+ year old gentlemen have worn the same pair of tighty-whities since Churchill was smoking cigars and fending off Nazis, and by God you're not going to change that habit now. True, the tighty-whities would now be more appropriately called tighty-yellowies, tighty-brownies, or tighty-WHAT THE FUCKies, but the stench of old ball sweat, urine, and last weeks nursing home brand chili-con-carne is appealing and soothing to the most ancient of men.

All the same- fellas, change it up every now and then. If for no other reason than to spare the young paramedic who's come to pick you up off the floor the overpowering stench of your manly musk. The gentleman I picked up last night had been on a "Nothing but asparagus, and garlic" diet for about a week based on the incredible odor that was released every time he spread his sizeable thighs.

Rule Number 2:
If you have a colostomy bag, wear it. ALWAYS.

According to Wikipedia, a colostomy is "a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. This opening is formed from the end of the large intestine drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the stoma, and collect in a pouch attached to the patient's abdomen which is changed when necessary."

I don't know how much more detail I need to go into on this one. The implications of not following my rather simple directive are obviously severe, but sadly it's a problem that millions, if not billions of Americans face everyday. At least it seems that way to me. Letting shit literally run down your entire body, including into the open, gangrenous wound on your foot is just bad form. There's nothing at all Christian about doing that. As a matter of fact, didn't Jesus say "Thou shalt not let shit run down thy body", or something like that? I'm pretty sure I read that in Gastrocnemius 13:4.

Of course if you do let all of this happen to you, you're probably crazy enough to latch onto the railing of the staircase with your old-lady claw hands, and contort yourself into an ungodly position. And did you just manage to get your head stuck between two of the support posts for the railing? You did? Good. Time to call the Fire Department.

Rule Number 3:
Do not, at any time, place your nasty old-lady hands anywhere near the paramedic's genitals.

"Ma'am, with all due respect- please stop cupping my balls. I don't care if I do look like a guy you fucked in 1928" Yeah, I'd hoped to make it to at least 21 before I had to use that line, but unfortunately my chosen profession will afford me no such luxury. This rule doesn't have as much to do with terrible smells as the others, but it's still an important announcement for the geriatric population. Once you top 60 (and I'm being generous there) it is imperative to the psychological well-being of those around you that you adopt a perfectly asexual lifestyle. IMPERATIVE. To the younger folks reading this: work hard in school, and develop the anti-Viagra. Work hard to pass a Congressional measure requiring all old folks to take said pill.

Rule Number 4:
Ladies, take care of your teats. Everyone likes American Cheese- nobody likes Boob Cheese.

There is nothing worse than boob cheese. It ruins my days, and haunts my dreams. It stalks me in my nightmares- sneaking up behind me all curdled and smelling like a septic tank with a yeast infection. It's a known fact that failing to lift up your titties and clean underneath (especially if they hang to your knees) will result in the spontaneous formation of boob cheese. Now before you get all spiritual and assume this is some sort of divine creation of new life let me assure you that if I didn't wash parts of my body all sorts of little creepy crawlies would grow there too, and I'd have no part in their creation.

Now many of you may be wondering why I'm dealing with old lady funbags in the first place. Well sadly enough a few years ago they decided that paramedics were intelligent enough to apply a few stickers to a patient's chest, look at a few wavy lines on an ECG, and determine whether or not someone was having a heart attack. This would be a good thing, if placing some of those stickers didn't require diving into the heart of darkness that is the underside of a 94 year old woman's 37lb breast that you have to start lifting from below her shin. I kid you not; this woman was scratching her left nipple with her big toe.

So there you have it. Rules for not smelling terrible in your old age, and for making the life of your medical care provider that much better.