Uncategorized

Answering Machine Message

 

So, as I may have already made plain, a long, long time ago, and very far away, I was a medic for Da City. At that time, let us be generous, resources were poorly matched to demand. This was evident in every arena, from 30 minute EMS response times, to fire responses by engine companies several first alarm districts away, to police response hours after the call originated. Even the “Public Safety Answering Point” was over taxed, and under resourced.

On one occasion, I had need to call 911, myself. Imagine my surprise when the answer was a recorded message that stated, as nearly as I can recall, “You have reached the 9-1-1 emergency center. Please stay on the line! All of our operators are busy answering other calls. Your call will be answered.” Even more disturbing, this message replayed on a, seemingly, endless loop, auguring ill for the likelihood of a prompt response.

So, fast forward a couple of years. Poor Mallory, in a fit of bad judgment, had moved in with me in my house in Da City. She lived with me for several years, all the more remarkable when you consider how difficult it must have been to live with me (ask The Plaintiff!), layered upon the fact that Mallory was an exceedingly nice woman, from the suburbs of Da City. She appeared to grow accustomed to my habit of arming myself in my own home, for I had seen the results wreaked upon folks who had not done so, and had found it unappealing.

So, this was in the era of rotary dial phones, and tape home answering machines. A rotary dial phone is kind of like a cell phone, except that it did not cost you around $100/month, did not have an answering service built in, had no internet access (“Internet? What is this ‘internet’?”), and had no “apps” with which to clutter it’s screen, In fact, a rotary dial phone had no screen, simply a rotary dial (cleverly named, no?) which, when spun, turned back to the starting position and emitted a series of clicks, that by some Black Art, allowed The Phone Company (for, in these misty past times, there was only one Phone Company) to connect you with other people, with whom you could talk (kind of like texting, with annoying sounds, emotional subtleties and intonation thrown in).

This “answering machine” of which I speak, allowed the user to record a personalized message, enticing the caller to leave a message so you could know to phone them back.

Being a sarcastic sort, I recorded the following message on my personal home telephone answering machine: “You have reached the 9-1-1 emergency center. Please stay on the line! All of our operators are busy, answering other calls. Please leave a message at the tone. Your call will be answered….eventually……we hope.” (BEEP!)

Mallory was disturbed, to understate the thing, when she called me once and encountered my (I thought) clever message. She remonstrated with me, citing copyright violations among other concerns.

I responded, “Mallory, I really, really doubt that Da City wants to take this to court either as a criminal matter or as a lawsuit. Should they do so, be certain that I will do my level best to ensure that every single television station, radio station, and newspaper within hundreds of miles of Da City, knows of the court date, and is enthusiastically invited to show up. How do you suppose Da City will appear, with their transcript read aloud, under oath, in open court, against my parody thereof? That might be very, very entertaining!”

Besides the merriment it caused me, that message also had the not inconsiderable benefit of dissuading telemarketers from bothering me!

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Fun And Games Off Duty · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

The “Heimlich remover” in Song and Legend

 

So, TINS©, TIW(after)FDASL©, having been asleep for a couple of hours after another fun filled, exciting night of EMS in Da City. I was just about hitting my sleep stride, sleeping my ass off, when a commotion on my front porch awakened me.

I had bought a two flat in Da City, and lived in the downstairs apartment, renting out the upstairs to a fellow we can think of as The Clod. The Clod had roommates, who seemed unsavory. This appraisal developed as I noted one of these folks to have what we used to call, on the street, “lobster claws”. This alludes to the fact that IVDAs (pronounced as it is spelled, “iv-dahs”), or folks who spend their recreational time injecting street drugs intravenously, develop sclerosed veins, from the damage those veins sustain from the chemical irritation of the drugs, crappy needle technique, and repeated infections of the veins due to nonsterile injectate. It tuns out that the lymphatic circulation simply is not up to the task of returning all the fluid delivered by the uninjured arterial circulation, and so fluid collects in the downstream portions of the limbs, and the hands swell. When this process has advanced sufficiently, the hand(s) resemble the claws of a lobster, hence the appellation.

Now, some folks have stated their appraisal that my years on Da Streets have left their mark upon me. Indeed, my very own cherubic, innocent daughter, aged 20 something and mother of the sweetest, most wonderful children in North America, reports that I am “the most cynical human being that I have ever known.” (I can only hope so!) So, I had taken note of the fact that unusual sounds, seldom presaged Good Things in Da City. Therefore, awake, I put on some pants and a shirt, tucked a revolver into my pants, and laid my shotgun against the wall next to the door. Then, I peeked out the window to see what was transpiring.

My peek revealed an excited disturbance, featuring several folks unknown to me, and The Clod. I slowly opened my door, hand near revolver, and asked The Clod, “What’s happening?”

All a-twitter, he announced that “Luigi (not his real name) has swallowed a sandwich! Do you know the Heimlich Remover?”

Sheesh! The Heimlich Maneuver had been taught in every CPR class I have ever taken, since Desoto himself was in short pants and wondering why the pretty lights sparkled on top of the emergency truck. I moved closer, and noted that Luigi was coughing pretty vigorously, but, since he WAS coughing, it seemed pretty clear to me that he WAS moving air. This was not something I felt particularly enthusiastic about remedying, so I kept an eye on him, and asked, “has anybody called 911?”

I was dazzled from the glare of the metaphorical light bulbs illuminating over every head on that porch, all at once. The Clod noted that this was “A great idea!”, and bounded upstairs to make the call, leaving Luigi, and me, and Ghawd alone knows who else these bastards were, on the porch. Shortly after The Clod’s run up the stairs, Luigi stopped coughing, which I thought was Not Good. I asked Luigi if he could talk, to which he shook his head negatively. Not noticing any air moving in spite of his energetic attempts to do so, I elected to perform the Heimlich Maneuver.

He was sort of crouched over, which worked well for me. I reached around him, clasping my one fist in my other hand, and, planting the thumb of that fist into his stomach (just below the xyphoid, just above the umbilicus), I briskly lifted him off his knees, and settled him back down. I repeated this gesture several times until he coughed again, and produced a glob of half chewed sandwich about the size of my fist.

At this, he began to gasp and wheeze. The crowd started to thin out, as the sirens approached. Soon, it was The Clod, Luigi, and me left on the porch.

The responding EMS crew was a couple of guys I knew, and the one chatted with me while his partner checked Luigi, and obtained his signature refusing transport.

How long have you been working here?” I was asked.

What do you mean?” was my response.

Well, we all figured that this was some kind of adult foster care, because every time we drive past, there’s always a bunch of these guys hanging out. We figured that the residents had to get out of the house during the day.”

FML. Just what I wanted to hear.

 

Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Haldol “Seizure”

 

While I was in my two year RN program, I was working for Da City, on EMS. Once the program director had made sufficiently clear to me that, no, I could not skip lectures, and, since it was, ya know, spelled out explicitly in the program rules that I had to show my fuzzy butt up for all classes and suchlike, well, I showed my fuzzy butt up as directed.

Of course, this meant that I was acutely-on-chronically sleep deprived. I figure that, by the time I graduated, I was on the order of 2,000 hours short on sleep, maybe more. So, entertaining things happened.

Fer instance, TINS©, one day I had arranged for one of the day shift guys to arrive at around 0530, instead of 0700, because I had clinical at 0700. Imagine my disappointment when my friend did not arrive at 0530. or 0600. I called him, he apologized effusively, and rolled in around 0630. I, of course, unassed the fire house, and beat feet towards clinical.

I probably was going around 55 when I passed the patrol car in the 35 mile an hour zone that was East Vernor. He hit the lights, and initiated a traffic stop. I, no surprise, stopped.

At this time, this was the Seventh Precinct. I had caught a run with one of these crews, probably a couple of weeks prior to this close encounter with law enforcement, for a “seizure”. My partner, we’ll call him Johnny, was medic-ing that particular night. As we pulled up, one officer was excitedly directing us to “Hurry Up! She’s seizing!”

Once we made our way into the residence, there was, indeed, a woman on the floor who appeared very much like someone in the middle of a grand mal seizure. Johnny went to work, getting vitals, and I headed off to see if there were any medication on the counter, or other indications of what might be going on.

To my surprise, as I passed her head, her eyes tracked my movements. Startled, I knelt down, and asked her, “Ma’am? What’s going on?”

She spoke (surprising, as this does not happen in an individual having a seizure), saying, “I’m having a seizure!”

Since this was my semester in psych, I had been studying (again, surprising) anti psychotic medications and their adverse reactions. Therefore, I asked her, “Are you taking medicines for your nerves?”

Yep.”

Any new ones?”

Yeah, on my counter over there.” (still tonic-ing and clonic- away). I retrieved a nearly full bottle of haloperidol, and asked her, “Is this the new medicine?”

Yeah, that’s the new stuff.”

I looked at Johnny, and we nodded. “Ma’am, we’ll get you to TBTCIDC, and they will fix you right up! Some cogentin, and you ought to be as good as new!”

The cops looked puzzled. I explained. “Sometimes this sort of medicine causes this sort of reaction. There’s a shot to reverse it, and the doc will either change her dose, or her medicine.”

For the rest of that schedule, the officers in that precinct thought I could walk on water. This was A Good Thing, as I put on my 4 way flashers, put the car in park, and exited the car, hoping to make a rapid explanation, and skedaddle so I would not be too, too late for clinical.

Once I was clear of the car, still in my EMS uniform, the officer driving the car stood up, waved me off, and said, “Oh, it’s YOU. Go on, just slow it down, willya?”

Yessir, Officer! Will do! Tenkyouberramuch!”

Fun And Games Off Duty · Pre Planning Your Scene

The Electrician, The Waitress, and Making Snow Angels.

 

So, TINS, TIWFDASL…..OK, well, not so much. Long after I had left EMS in Da City, and was off FDASL in other climes, Da Darling Wife (before she had transformed herself into The Plaintiff) decided that family would take a trip, to Sault Sainte Marie, Ontario. In March.

For those who are unaware, Sault (pronounce it “Sue”) Sainte (abbreviated “Ste.”) Marie is just about as far north as you can go in the US, if you never visit Alaska. Winters are…remarkable. Typically, there are feet and feet of accumulated snowfall, and it gets mighty freaking cold, particularly if you are from, say Tennessee or that latitude, and your idea of “Oh! My! Ghawd! Cold! is, like, 35 degrees Fahrenheit (2 Celsius, for our European friends.) Yeah. In “The Soo”, as Michiganders call it, 35 degrees, in March, is nearly tee-shirt-and-shorts weather.

Our Canadian Friends and Neighbors have a railroad service, north (imagine that!) from Soo, Ontario, and it is called, surprisingly enough, “The Snow Train”. The Algoma Canyon Railway runs excursion trains during the winter, and travelers can admire winter beauty, clean running rivers and streams, and do so from the comfort of heated railway coaches.

At each end of every railway car, where it opens to a platform admitting one to the next car, is a sign, warning passengers that they are not to stand upon the platforms when the train is in motion. This seems particularly important at the last car, where the platform looks out on nothing but Nature. We were, all six of us, in the car that initially was right behind the locomotive.

The excursion arrives in Agawa Canyon, over a hundred miles north of Soo, Ontario, after something like 4 hours of travel. There, the locomotive switches ends, and, after a layover, begins the return trip. And, while the locomotive switches about, there is time to wander about the station and frolic in the snow.

So, there is a bar car, on this train. And, there were high spirited post adolescents aboard. Who had found the bar car.

Once the locomotive switch had happened, and the wandering-around-the-platform time had ended, everybody was summoned back to the train. We resumed our old seats, now at the rear of the train. Our kids admired the view from the platform, and returned. The post-adolescents likewise admired the view, and were still doing so when the train crew walked thorough, admonished the spectators to return to the carriage, and not return to the platform, and moved on.

Once the crew had departed, the youths returned to the platform. I gathered the children together, and motioned their mother closer. “Now, look through that door, at those geniuses, standing on the open platform of a soon to be moving train. What do you suppose is likely to happen when the train jerks into motion?”

13 year old Number One Son identified the problem promptly. “One or more of them are gonna topple over that low railing, into the snow or onto the track. That’ll leave them behind, and it’s kinda cold for walking back to The Soo, right?”

Their mother responded: “That, and/or somebody will smack their head, hard, onto the steel rails. Now, once the young geniuses are making snow angels, remember: I’m a waitress, and your dad is an electrician. Got it?”

The younger kids had not “got it”. One protested, “But, Mom, you’re a nurse, and Dad is a medic, right?”

“Not today, we aren’t. Remember, I’m a waitress, and Dad’s an electrician!”

The oldest boy, bless him, was quick on the uptake today. “Yeah, do you think mom and Dad want to mess around in the snow, treating people too stupid to follow directions, and who break their heads because of it? And, like, hundreds of miles from the nearest hospital? If Mom and Dad are busy doing that, who’s gonna watch us kids?”

Clever lad.

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

“Mister, I never seen anyone fall asleep standing up, before!”

 

So, TINS©, TIWFDASL©, and running on around 2 hours sleep a day, between work, school, studying and etcetera. One night, I was driving and Doug was medic-ing, and we caught a run for a sick person. Now, in Da City, it gets cold in the winter. In addition, in Michigan, in February, there’s this thing, the locals call it “snow”, all over the place. It’s cold, and, once it gets all over your socks, your feet get wet, and, being February in Michigan, they get really, really cold.

I had imagined that folks who lived there, would have figured that out, after a winter or three. I was mistaken. So there we were, in somebody’s living room around oh-dark-hundred, and folks were scrambling to find shoes, and coats, and ID, and medical cards, because, nobody had figured out, going to Da Hospital entailed exiting their warm, dry home, walking through the snow to the curb, and, once EMS had delivered you the Da Hospital, identifying yourself and providing such insurance documentation as you possessed.

Seemed like a new concept to these folks.

So, while the scramble happened, I found a nice cozy doorway, and leaned up against it, and went to sleep. Standing up. On a scene. In DaCity. With my partner next to me.

The next thing I knew, Doug was nudging me, and demanding the keys. “Why?”

Because I’m driving.”

Why are you driving?”

Because you are too sleepy to drive. Here’s the trip sheet.”

I don’t know the information to complete it.”

I completed it. While you were sleeping. Standing up.”

Recognizing when it was useless to argue (particularly when he was right), we settled the patient in to the back of the truck, I buckled myself in, and I tried to get my eyes to focus enough to make sense of the trip sheet. Out of the corner of my eye, I noticed my patient, an elderly grandmotherly type, looking at me peculiarly.

Can I help you, Ma’am?”

Mister, they must work you folks awful hard.”

Well, Ma’am, it gets kinda busy sometimes, Why do you ask?”

Mister, I ain’t never seen nobody fall asleep standing up before!”

Ma’am, it’s kind of a novelty to me, too!”

Sometimes You Get to Think That You Have Accomplished Something! · Uncategorized

DELAYED GRATIFICATION

 

I entered the PA world somewhat late in life. I had spent nearly 30 years toiling as a RN, in ER, as nursing supervisor and in ICU, when I decided that a change was in order.

For most of my nursing practice, I had counseled my patients that stopping smoking was in their best interests. Those that seemed receptive, got the entire “treatment”, recounting how my (now) ex wife, mother of my children, and an RN herself, smoked. I observed that, aside from marrying me (and subsequently divorcing me), she was pretty smart. In addition, she displayed a backbone formulated not from calcium salts, but rather from ordnance steel. As Mom, I am entirely in favor. (As the Plaintiff, I’m not such a fan) In either case, even in light of her own ICU experience, she persists in smoking. I shared that this illustrated that the difficulty of ceasing smoking was often understated. Worthwhile, but underestimated.

I regaled patients with this tale time after time, as each seemed receptive. I never received any feedback for these efforts. Yet, following the role of nurse as teacher, and later of Physician Assistant as teacher, as well as clinician, I persisted.

My first PA job out of school capitalized upon my years as paramedic, ER RN as well as ICU RN, and placed me in a rural hospital ER. I continued to insert smoking cessation teaching into my discharge instructions, even if I did not see it elicit any change in behavior. My nursing colleagues even observed that my time was not effectively employed, because, in their appraisal, folks would not stop smoking due to my efforts. I persisted.

One attraction of a rural community is that everybody is, indeed, your neighbor. You get the opportunity to practice community medicine, even as an ER clinician. The child whose sprain you treated last weekend, likely will be playing on the local school team alongside your own child the next. You are not anonymous, and neither are your patients.

That was brought home to me one evening, as I took my family out for dinner in our small town. It was some surprise to me, in spite of the foregoing, that our waitress approached us with the greeting, “I bet you don’t remember me, do you?” I admitted the truth, and asked how she was.

“My ankle is all better,” she prompted, and continued. “I bet you don’t remember telling me I had to quit smoking, do you?”

Again, the truth was told. She again prompted me, “You told about how smart your wife is, and how she is a nurse, but still smokes.” (THAT earned me a glare from the Loyal Opposition!) I allowed that I frequently offered such counsel, while attempting to non-verbally make nice with the mother of my children.

“Well”, she continued, “I really thought about what you told me, about emphysema, and leather skin, and throat cancers and all that stuff I was risking. I decided that I did not want to drag an oxygen tank around like my mother did. I quit smoking last week, and it is all because of you taking the time to tell me how bad it was for me!”

I responded with something encouraging, and in recognition of her own investment of energy, decisiveness, and determination, and she thanked me again and walked away to serve other customers.

I think about that woman from time to time. I realized that people will stop smoking, when they are ready to do so, for the reasons that matter to them. The only thing I can do is encourage the decision, and attempt to nudge it along.

Occasionally, I can nudge a decision. Then I must wait for the patient to make that decision, on their timetable, and for reasons that matter to them.

guns · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

Medic 5 Heart Attack

 

So, this one time, at band camp…..no, wait. That’s not quite right.

So TINS©. There I was FDASL©, detailed out to Medic Five from my home house. It appeared that I had offended the Patron Saint Of EMS and Street Medics, grievously, because I arrived to find Cletus, grinning widely, awaiting me. Shit.

I asserted The Prerogative of Seniority, and drove, leaving Cletus to medic. (Remember that. File under “Things That Come Back To Bite Me in The Ass”) The day passed pretty uneventfully, runs came in, patients got transported, and we, of course, fought disease and saved lives.

Now, at that time, nearly 40 years ago, Medic 5 was out toward the western margins of Da City. The firehouse called home was on Bliss Road, close by to the Western Expressway. Western suburbs included Gardenia and Westworld. Our hospital choices included a couple of small hospitals of the plethora that (at that time) dotted the city, or a couple of respectably sized facilities in those selfsame suburbs.

So, somewhat later in the afternoon dispatch invited us to respond to a “heart attack”. This took us nearly to the city limits. As we pulled up, there was a figure hopping around on the porch, arms a-waving, feet a-tapping, directing us to that dwelling. (Uh, you mean to tell me that every other house, lacking front porch frenetic interpretive dance performances, are NOT the scenes to which we were called? This is my shocked face!)

So, of course, Cletus bought into the pandemonium, whole hog. He leapt from the rig, just about as soon as I brought it to a stop, and beat feet into the house, leaving me, the handheld radio, and every other thing (except the medic bag) behind. I placed the ambulance in park, shut off the beacons, and radioed in to dispatch that we were on the scene.

I turned on the handheld radio, and followed him into the house. As the occupants opened the door, I was struck (nearly literally) by the pall of gunsmoke that wafted out into my face. Asking about my partner, I was directed into the rear of the house.

I reached the end of the hall, and, in the bedroom to my right noted my partner bending over a supine soul. I announced myself, and CLETUS TURNED ON ME, SNUB BARRELLED REVOLVER IN HAND. Of course, he was pointing the barrel at my belt buckle. I swept his hand over my head, removed the handgun from his hand, and asked him what the…er, fenomenon he thought he was doing.

“She had it in her hand, as I entered the room.”

“Uh huh. What else is up?”

“I dunno.”

“Howzabout you find out?”

As he turned to assess this lady, I figured that having a loaded gun, on my scene, and not in my control, was A BAD THING. I wasn’t about to remove it from the scene: that seemed to me to be very like tampering with evidence, so, instead, I opened the dresser next to me, opened the cylinder and dumped the bullets into one drawer, slammed that drawer shut, and tossed the revolver into another drawer, which I also shut.

I turned back to Cletus, and saw him reaching for the BVM (bag-valve-mask), as he evidently had determined that this soul was arrested. Hmmm. Trauma code. Kinda expecting a malign outcome.

I handed him the prep (handheld radio), asked what else he thought he would need, and ran to the truck for the cot. We wrestled the patient onto the cot, trotted from the house, and set Cletus up for a restful episode of solo CPR in the back of a moving ambulance. Yeah, totally.

I called to dispatch, asking the location of and directions to the nearest trauma center (it wasn’t my house, wasn’t my district.) I reported , “Medic Five, Code One, Westworld Hospital. GSW Chest, cardiac arrest. Notify police, no scout at scene.”

Sometimes, you can hear the double take over the radio. “Medic 5, did you say GSW?”

“Affirmative. GSW chest, cardiac arrest.”

“Medic 5, are you sure?”

“Yeah, dispatch, kinda sure. My partner retrieved the pistol from the victim’s hands, I tossed it into the dresser drawer next to her.”

“Very good, Medic 5. We’re calling the hospital now.”

So, I navigated the Tie Fighter that is an ambulance running code, through the suburban traffic. I was (pleasantly) surprised to see traffic moving aside, as if I were Moses at the Red Sea, as the siren and beacons made known our intent.

We arrived at Westworld Hospital, and turned our patient over to the ED crew who, unsurprisingly, called the code after a brief attempt at resuscitation. Cletus and I cleaned up the truck, and completed the trip sheet.

We were just about to head out, when dispatch called us, directing us to phone them.

Once I had done so, I was directed to phone another number, because the detective wanted to talk to me. Once I had identified myself, he launched into his inquiry.

“You the medic on the scene?”

“Yeah, me and Cletus.”

“So, this was a shooting, right?”

“Yep, gunsmoke and all.”

“So, where is the pistol?”

“I dumped the cartridges into the dresser drawer, and tossed the gun itself into the top drawer.”

There was a pause. “You know, you have messed up my scene, and tainted my chain of custody.”

I contemplated this for a moment. “Well, sir, there was no officer on the scene I could turn the gun over to, and I was reluctant to leave a loaded, unsecured, firearm floating about on my scene. I did not think it would be clever to (a) remove a gun from a likely crime scene, (b) have in my possession a firearm that had been implicated in a likely crime scene, or (c) carry said firearm into a hospital with me. So, I did not identify any better option, at that time and on that scene.”

Life Lesson Number One: Sometimes, you have to extemporize.

Life Lesson Number Two: to quote John Farnam: “You may be killed when you take decisive action. You may likewise be killed when you do nothing. Either way, dithering is toxic. Indecision and delay will prove fatal. So, size-up the situation quickly. Hit the “go” button. Don’t look back.”

http://defense-training.com/2018/who-dare/ (datelined 14 May 2018)