Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

Bradycardia and The Cough

TINS©, TIWFDASL©, nursing in the ED of this community hospital in Northern The Un-Named Flyover State. A gentleman arrived, somewhere in his forties, and he told his tale of chest pain. He shortly thereafter sported the latest fashions in IVs, EKG monitoring, oxygen, and much blood drawn and sent to lab for analysis.

Two things you should know about me. I am a bottomless well of generally useless trivia, for one. For example, the relevance of which will become apparent shortly, I read a bunch of stuff, including a report, years and years and years ago which asserted that individuals undergoing a cardiac catheterization would be instructed that, should they be commanded to do so, they should cough vigorously and repeatedly. This would, or so the article asserted, increase pressure inside the chest, compress the heart, and thereby expel blood from the heart. This was important because occasionally the catheter, introduced into the heart, could produce irritation sufficient to produce fibrillation. (an uncoordinated trembling of the heart, which produces no blood flow. A Bad Thing.)

Once they drew in another breath preparatory to coughing once again, the negative pressure inside their chest so produced would encourage their heart to again fill with blood, which would be expelled with the next cough. This could temporarily produce enough blood pressure to keep things idling along, until the cath lab staff could intervene and set things right.

The other thing about me, is that I am somewhat chatty. (“No! Say it isn’t so!”). Okay, very chatty. So, there I was, chatting with this gentleman, and noting his cardiac rhythm and heart rate as displayed upon his cardiac monitor.

I noticed that his heart rate, originally in the 90’s, was trending downward. (normal is around 60-80). Once it dropped below 55, I stopped congratulating myself on wonderful patient care, and began to worry.

He began to report feeling dizzy and weak. I directed him, “When I tell you to cough, do not ask any questions, simply do it!”

He, of course, asked me why, but at that point his heart rate had dropped below 30 (Very Not So Good!), and I was a bit terse. “Stop talking, and cough!…Cough!…..Cough!….”

I repeated myself at about one second intervals. Now, I am sure that the other nurses heard me, and wondered what variety of insanity had afflicted me. Once they came in to investigate, and I waved my hand at the monitor, continuing my coxswain like commands of “Cough!….Cough!….Cough!….”, they noted his very, very slow intrinsic heart rate. That, coupled with this guy, eyes fixed upon me, coughing every time I commanded him to do so, told them everything that they needed to know, and things got considerably more active in short order.

He soon received a temporary external pacemaker and and an ICU admit.

And we all lived happily ever after!

Fun And Games Off Duty · Having A Good Partner Is Very Important!

Duck Butter

So, TINS, there I was, sleeping my ass off, and NOT saving lives, because my employer had laid me off due our low (read: nonexistent) census. As had become my routine, I awakened promptly at the asscrack of noon, and stumbled to the kitchen, blearily admiring the Hot! Coffee! Pot! That TDW-Mark II had whipped up. As I was preparing my offering to Saint Arabica, Patron of the Sleepy, she was saying something, probably related to planning for activities later in the day. I was not paying much attention, grunting affirmatively from time to time, when a lull in her soliloquy indicated the need for some sort of response from me.

I had completed mixing my coffee and replacing the fixings, when she observed that she had included on her list, and I swear that I am not making this up, “…and we need some duck butter, so that’s on the list.”

THAT captured my attention. “What? Duck butter? Why do we need duck butter? What is duck butter, anyway?”

As is likely no surprise, she gave me “THAT LOOK”, the one learned in wife school, and generally displayed when the husband displays some new peak of stoopid.

“Duck butter? I said ‘cat litter’! How on earth can you get ‘duck butter’ from cat litter?”

I deliberated on this question for a moment. “I dunno. Squeeze it really hard?”

Protect and Serve

What is this “Memorial Day”?

While my blog is commonly about lighthearted things, irritants, and such like fluff, occasionally I have to pause, and honor better folks than I. This post, which I placed last year, is here again.  Haerter and Yale are emblematic of those who go in harm’s way, on behalf of their buddies, on behalf of  people that they will never know. 

Those MEN (and, nowadays, WOMEN) need to hold a place in our hearts.  

This is Memorial Day 2020.  This the day set aside, to contemplate, to remember, those who have stood in harm’s way, have said to Evil, “you shall not pass!”, and have died so doing.

Today we recall those immortalized in Francis Scott Keyes’ fourth stanza, opening,

“Oh! thus be it ever, when freemen shall stand
Between their loved home and the war’s desolation!”

I want to repeat a story.  I first encountered it on the “Never Yet Melted” blog (https://neveryetmelted.com/). I’ve re read it multiple times, yet it still moves me to tears. Here’s the source: https://www.businessinsider.com/john-kellys-speech-about-marines-in-ramadi-2013-6

 

Contemplate the picture, above.  

 

Then, read the story. Lifted directly from Business Insider. This–THIS–is how MEN face DUTY. I pray that, should the need arise, I can be worthy to stand in their presence.  Corporal Jonathan Yale, Lance Corporal Jordan Haerter. This is what we remember, on Memorial Day. 

via Marines Magazine

Five years ago, two Marines from two different walks of life who had literally just met were told to stand guard in front of their outpost’s entry control point.

Minutes later, they were staring down a big blue truck packedwith explosives. With this particular shred of hell bearing down on them, they stood their ground.

Heck, they even leaned in.

I had heard the story many times, personally. But until today I had never heard Marine Lt. Gen. John Kelly’s telling of it to a packed house in 2010. Just four days following the death of his own son in combat, Kelly eulogized two other sons in an unforgettable manner.

From Kelly’s speech:

Two years ago when I was the Commander of all U.S. and Iraqi forces, in fact, the 22nd of April 2008, two Marine infantry battalions, 1/9 “The Walking Dead,” and 2/8 were switching out in Ramadi. One battalion in the closing days of their deployment going home very soon, the other just starting its seven-month combat tour.

Two Marines, Corporal Jonathan Yale and Lance Corporal Jordan Haerter, 22 and 20 years old respectively, one from each battalion, were assuming the watch together at the entrance gate of an outpost that contained a makeshift barracks housing 50 Marines.

The same broken down ramshackle building was also home to 100 Iraqi police, also my men and our allies in the fight against the terrorists in Ramadi, a city until recently the most dangerous city on earth and owned by Al Qaeda. Yale was a dirt poor mixed-race kid from Virginia with a wife and daughter, and a mother and sister who lived with him and he supported as well. He did this on a yearly salary of less than $23,000. Haerter, on the other hand, was a middle class white kid from Long Island.

They were from two completely different worlds. Had they not joined the Marines they would never have met each other, or understood that multiple America’s exist simultaneously depending on one’s race, education level, economic status, and where you might have been born. But they were Marines, combat Marines, forged in the same crucible of Marine training, and because of this bond they were brothers as close, or closer, than if they were born of the same woman.

The mission orders they received from the sergeant squad leader I am sure went something like: “Okay you two clowns, stand this post and let no unauthorized personnel or vehicles pass.” “You clear?” I am also sure Yale and Haerter then rolled their eyes and said in unison something like: “Yes Sergeant,” with just enough attitude that made the point without saying the words, “No kidding sweetheart, we know what we’re doing.” They then relieved two other Marines on watch and took up their post at the entry control point of Joint Security Station Nasser, in the Sophia section of Ramadi, al Anbar, Iraq.

A few minutes later a large blue truck turned down the alley way—perhaps 60-70 yards in length—and sped its way through the serpentine of concrete jersey walls. The truck stopped just short of where the two were posted and detonated, killing them both catastrophically. Twenty-four brick masonry houses were damaged or destroyed. A mosque 100 yards away collapsed. The truck’s engine came to rest two hundred yards away knocking most of a house down before it stopped.

Our explosive experts reckoned the blast was made of 2,000 pounds of explosives. Two died, and because these two young infantrymen didn’t have it in their DNA to run from danger, they saved 150 of their Iraqi and American brothers-in-arms.

When I read the situation report about the incident a few hours after it happened I called the regimental commander for details as something about this struck me as different. Marines dying or being seriously wounded is commonplace in combat. We expect Marines regardless of rank or MOS to stand their ground and do their duty, and even die in the process, if that is what the mission takes. But this just seemed different.

The regimental commander had just returned from the site and he agreed, but reported that there were no American witnesses to the event—just Iraqi police. I figured if there was any chance of finding out what actually happened and then to decorate the two Marines to acknowledge their bravery, I’d have to do it as a combat award that requires two eye-witnesses and we figured the bureaucrats back in Washington would never buy Iraqi statements. If it had any chance at all, it had to come under the signature of a general officer.

I traveled to Ramadi the next day and spoke individually to a half-dozen Iraqi police all of whom told the same story. The blue truck turned down into the alley and immediately sped up as it made its way through the serpentine. They all said, “We knew immediately what was going on as soon as the two Marines began firing.” The Iraqi police then related that some of them also fired, and then to a man, ran for safety just prior to the explosion.

All survived. Many were injured … some seriously. One of the Iraqis elaborated and with tears welling up said, “They’d run like any normal man would to save his life.”

What he didn’t know until then, he said, and what he learned that very instant, was that Marines are not normal. Choking past the emotion he said, “Sir, in the name of God no sane man would have stood there and done what they did.”

“No sane man.”

“They saved us all.”

What we didn’t know at the time, and only learned a couple of days later after I wrote a summary and submitted both Yale and Haerter for posthumous Navy Crosses, was that one of our security cameras, damaged initially in the blast, recorded some of the suicide attack. It happened exactly as the Iraqis had described it. It took exactly six seconds from when the truck entered the alley until it detonated.

You can watch the last six seconds of their young lives. Putting myself in their heads I supposed it took about a second for the two Marines to separately come to the same conclusion about what was going on once the truck came into their view at the far end of the alley. Exactly no time to talk it over, or call the sergeant to ask what they should do. Only enough time to take half an instant and think about what the sergeant told them to do only a few minutes before: ” … let no unauthorized personnel or vehicles pass.”

The two Marines had about five seconds left to live. It took maybe another two seconds for them to present their weapons, take aim, and open up. By this time the truck was half-way through the barriers and gaining speed the whole time. Here, the recording shows a number of Iraqi police, some of whom had fired their AKs, now scattering like the normal and rational men they were—some running right past the Marines. They had three seconds left to live.

For about two seconds more, the recording shows the Marines’ weapons firing non-stop…the truck’s windshield exploding into shards of glass as their rounds take it apart and tore in to the body of the son-of-a-bitch who is trying to get past them to kill their brothers—American and Iraqi—bedded down in the barracks totally unaware of the fact that their lives at that moment depended entirely on two Marines standing their ground. If they had been aware, they would have know they were safe … because two Marines stood between them and a crazed suicide bomber.

The recording shows the truck careening to a stop immediately in front of the two Marines. In all of the instantaneous violence Yale and Haerter never hesitated. By all reports and by the recording, they never stepped back. They never even started to step aside. They never even shifted their weight. With their feet spread shoulder width apart, they leaned into the danger, firing as fast as they could work their weapons. They had only one second left to live.

The truck explodes. The camera goes blank. Two young men go to their God.

Six seconds.

Not enough time to think about their families, their country, their flag, or about their lives or their deaths, but more than enough time for two very brave young men to do their duty … into eternity. That is the kind of people who are on watch all over the world tonight—for you.

 

 

 

Here’s what it looks like when MEN face duty, in the last seconds of their lives


I just now, again, re read this tale.  

I just now, again, teared up. 

And prayed that The Almighty grant these heroes, eternal peace. 

And smile upon their families, that their loss may be lightened. 
Fun And Games · Having A Good Partner Is Very Important! · Life in Da City!

“Fittin To Throw Down!”

When I worked the road for Da City’s EMS, several of my colleagues were simpatico with the majority of our service population. So, the habits and mores of the folks on the street were not much of a novelty for several of my colleagues.

Indeed, one gentleman who was my partner for a schedule or two told a tale of a cousin of his who, exchanging words with another soul, found their conversation adjourned outside the bar in which they had crossed paths. Words grew more and more heated, in my partner’s telling of the tale, and the party of the second part drew, displayed, and announced his intent to employ, a handgun.

My partner described subsequent events. “Well, my cuz stood up tall, and challenged the other guy, saying, ‘Well, hell! SHOOT me!’. Which he did. My cousin did not survive the exchange.”

Tough crowd.

So, TINS©, TIWFDASL© with my regular partner, Doug, and we (of course) had our squelch open so we could hear radio chatter from other medic units. If one of them got into trouble, well, THAT might be a handy thing to know, so we could begin to sidle our happy asses over closer to their scene, to lend a hand should medical hands be required.

Over the radio came the memorable tones of Abbie Smith. He was able to recreate the richly evocative tones, rhythm, and nuance of the patois of the street. Partly this was due to the fact that he was of the street, and partly because he was an old hand on the job, and therefore wise in the mannerisms of the citizenry from that perspective as well.

So, anyhow, he drawled out his greeting: “Dispatch, this is Medic Nine!”

The dispatcher on duty that night was another old hand, who had been dispatching since Marconi had first dispatched “S” from Cornwall, England. He, in contrast to Abbie, was an old white boy, who was renowned for knowing off the top of his head where every ambulance was, and what they were doing, at any given time. When you are in a tense, hostile scene, is is reassuring to have a sort of radio bodyguard looking over you!

So, he acknowledged Medic Nine’s call: “Medic Nine, go!”

Dispatch, could we get the po-leece out here?”

Very good, Medic Nine. Why do you need them?”

Dispatch, these folks are all hot and bothered, and they fittin to throw down!”

Remember, our dispatcher was a white boy. He had not immersed himself in the vibrant, and ebonics speaking, culture of the street. In contrast, our friend Abbie, had. Dispatch sought some clarification.

Medic Nine, what are they going to throw down? And, from where?”

We could hear the sigh from Abbie, before he even keyed up the microphone. “Dispatch, this is Medic Nine! They fittin to throw down! You know, get it on! Fight!”

That cleared things up for our friend the dispatcher. “Are you involved in this fight, Medic Nine?”

Naw, we down the street. But, they gonna get to fighting pretty soon!”

Dispatch got it. “Medic Nine, clear that scene! Clear that scene! Police are on the way, repeat, police are on the way!”

Dispatch, this is Medic Nine! We clearin the scene!”

Again proving the importance of speaking, so that they can understand you!

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City!

Sleeping With a Chainsaw

A long, long time, in a galaxy not so very far away, I was working for Da City’s EMS. Since I was in school during the daytime, I worked nights.

So, TINS©, TIWFDASL©, and it was my turn to take the detail. In those days, several of the medic houses on each shift had three medics assigned. In the event that another unit had a sick call, or somebody off injured, well, “Tag! You’re IT!”, and somebody got to pack their crap up, drive across town, and work an unfamiliar house with a (occasionally) unfamiliar partner. The night of this tale, it was my turn.

EMS, in those days, was sort of a small town. There were around 160-170 personnel on the rolls, and what with shift rotations, details, and commonly running into a couple of the dozen or so hospitals in Da City, well, nobody was an unknown quantity. For example, during several of the years I was on the road, I was dating one of my nursing school classmates. She was, let us say, “of the African persuasion”, whereas I am purely white bread. One fellow, who I was acquainted with only in passing, had occasion to work with one of my former partners, and was quoted, by that partner, as inquiring as to the status of my relationship with my classmate. The exact quote was relayed to me as “Is McFee still seeing that (‘N-word’) bitch?”

(clears throat) Uh, well, ya see, (a) the pejorative referenced nowadays by the circumlocution “The N-Word”, was not acceptable among persons of education or pretense of good upbringing, even in those benighted times. (b) My girlfriend was in no way, shape, manner or form “a bitch”. Indeed, the time we shared lifted my own life in ways that, now, nearly 40 years later, I am still discovering. And, of course, (c) My partner stood up for me, inquiring of Mr. “More Mouth Than Sense”, if his mother was still employing her skills as a practitioner of The Oldest Profession. For some reason, in my partner’s report, further conversation ended right about that point.

So, nearly everybody on the job in those days either knew everybody else, or knew of everybody else. So, it came to pass that I was detailed out to work with Lonnie Evans, let us call him. He was renowned as working two, perhaps three, full time jobs. This led to his reputation as the soundest sleeper in the department. In addition, since it seemed that he was acutely-on-chronically something like 2500 hours in arrears on his sleep allotment, well, when you add obstructive sleep apnea to that recipe, stir lightly, and allow to rise overnight, you get to observe what 40-60 seconds between breaths sounds like. And, due to the fact that he snored with a sound like a tractor trailer starting up on a very, very cold morning, well, if your 8th cranial nerve was functioning, you were not going to miss it.

I had a sleepless night, with only a few runs. (talk about mixed blessings!). The next night I reported to Medic Four, and regaled my partners, Doug and Andy, with a review of my night across town. Andy had had a similar experience, a few weeks previously.

He reported, “Yeah, Lonnie snored like a chainsaw starting up, alright. That wasn’t the bad part! Every time he stopped breathing, I snapped awake, wondering if I would have to start coding him! After considering this possibility for several minutes, I decided that I was NOT going to do mouth-to-mouth on him, so I got the bag-valve-mask, an oral airway, some tongue blades, and positioned the handie talkie where I could reach it in a hurry. While I did not sleep any better, at least I knew I wouldn’t have to wind up kissing his wrinkly ass!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

“Social distancing”, before it was KEWL!

So, TINS ©, TIWFDASL ©, working midnights in a little ED in a little hospital, Up North. One fine day, I awakened at the crack of noon, only to find that TDW-Mark I had my afternoon planned out for me. Our little town had a poverty of grocery options, so every so often, TDW-Mark I would venture over to the next county (or two), shopping in the Mega Mart found there.

This was a sort of yin/yang experience. Yin: inconvenient drive, dragging young children along, considerable time devoted to the expedition. Yang: better selection, better prices, and Family! Bonding! Time!.

So, off we went. TDW had a list, of course, and she was mission focused. That left me to corral the kids, and prevent them from adding unauthorized items to the cart. (“No, Adam! You cannot get marshmallow cocoa sugar treats for breakfast! No, I do not care what all the other kids eat, you are not all those other kids, and your parents are ogres, who insist that you eat something in the same phylum as wholesome, when you eat!”)

As I hovered, redirecting my children, I noticed that this particular store seemed infested with bovine obliviots. I reached this conclusion after several near collisions wherein Obliviot A would nearly run one or the other child over, and then look at me irately when I intervened, and noted that striking my child with a cart would result in severe injury. To the obliviot.

Whatever. I figured it ranked up there with a “beware of dog” sign. Likely, my jury would think that I had an obligation to warn the lowing masses that there was a ravening dad about, and they might want to take suitable precautions. Before I did.

So, after several near misses, I decided that I had had enough. Most of the traffic went this way up this aisle, and that way down that aisle, a fact that I capitalized upon. I settled myself, straddle gaited, in the very middle of the aisle, upstream from my wife and children. Yes, I effectively blocked the entire aisle. That, was, in fact, my “plan a”. My intent was that, succeeding in “plan a”, I would not have to implement “plan b”, which would be accompanied by shrieking and blood, both emanating from the inattentive obliviot who succeeded in striking, and hurting, one of my children.

So, there I stood, colossus like, and, of course, one of the bovine meandered down the aisle. Finding me in her way, she spoke. (surprise!) “You are blocking the aisle!”

I smiled, a smile that in no way reached my eyes. Indeed, most of my teeth showed. “That is correct.”

She advanced, as if to strike me with the cart. I smiled wider. “You have to move! I cannot get past you!”

“Yep! That’s sort of my plan!”

She was not taking in the entire picture. “But, you have to move!”

More teeth on my part. “Well, ma’am, why don’t you just move me? If, that is, you think you will survive that encounter, uninjured?”

Unwilling to take that bet, she continued her protests. I glanced over my shoulder, noted that my charges were rounding the corner, and clearing this aisle. I waved, cheerily, and made my way to the next aisle, which I then blocked.

Soon, TDW-Mark I asked me what I was doing. I replied, “Have you noticed the folks who nearly struck the kids with their carts?”

“Yes! That is so rude!”

I agreed. “Yep. Do you know what is successful in preventing that?”

“No, what?”

“My convincing them that, yes, I am crazy enough to put a beat down on them, should they successfully strike my children! It turns out, if I look crazy enough, they shop in some other corner of the store, and my children are not gonna get struck by an idiot with a shopping cart!”

Gratitude

WuFlu outcomes: a coupla thoughts

As I loll away my days of enforced indolence, I contemplate things. Of course, the WuFlu/Wuhan Coronavirus/Novel Coronavirys/C.O.V.I.D. (Wait! Wasn’t that the name of a Bond villain?) is on my mind. It’s easy to see over reach, as well as dilatory responses. All of which illustrates the fact that governors and mayors have a sort of “stool smorgasbord” of options, wherein every choice that they make, every action that they will take, will be wrong. If they lock the state down hard, people will die of depression, untreated addiction, consequences of delayed diagnosis, treatment and management of illnesses ranging from cardiac disease to cancer. If they leave things open, settling for public service announcements of individual mitigation measures we each and all can take, people will contract the illness, presumably in greater numbers than they might in other circumstances, and some of them will require hospitalization, and some of them will die.

So, the negatives are easy to see, and folks are out there who will cheerfully bring you up to speed in the event that you do not wallow in sufficient negativity.

I’d like to illuminate a potential upside to this pandemic scare. I have seen, here and there, genuine gratitude. Folks being thankful for truckers, who deliver EVERYTHING that we take as if granted to us.

Folks being appreciative of physicians, nurses, and everybody else who keeps any and every hospital operating.

People performing small, and heartfelt, acts to help protect others (I’m looking at YOU, all you home mask crafters. As well as y’all shopping, so elderly/vulnerable neighbors don’t have to go out.) And very one of these acts touches the vestigial organ where my heart used to be.

Folks being grateful for the efforts of grocery clerks.

Dare I hope that we learn to appreciate everyday small blessings, out of these changes?