Singin’ to me in my sleep...
Original Post Date: 5/25/08

To dismiss the importance of music in the history of mankind is to be the guy that believes this American Idol thing will never catch on. Or maybe those folks that wrote the bible really missed the mark with their "joyful noise". Music is everywhere, including my ears right this second, and it punctuates everything we do, whether we notice or not. Most of us sang along in preschool and bible school, fell in love or fell to our knees to just the right melody at just the right moment. Some danced all night, others danced in the rain, still more wish it would rain down; but we all know a song that opened a door or pushed down the wall between who we want the world to see and the reality of our soul.

Just about anyone who spends a measurable amount of time in my life gets a song attached to them. Many get more than one, like my Cookie. Other's songs change as their role in my own story changes. This is how I remember my friends at their best, and how best I capture the moment in time when I knew that someone was going to be important in my life. And, I suspect, I'm not alone. Sure, every couple has "their song", but I think so does every union, no matter how simple.

But what about every career? Just about anything that evokes or involves emotion has been romanticized in song. So where, you ask, are al the EMS songs? Few jobs are capable of producing such a complex range of feeling in a matter of seconds as the boredom and terror associated with playing chicken with death. Then, ask again, where are the EMS tunes?

Friends, they surround us.

Hollywood doesn't write a lot about ambulances or paramedics for plenty of reasons, but the biggest is that no one really cares. Honesty, EMS work is interesting chiefly to EMS people, and there aren't enough of us to sell a whole lot of CD's. (I must confess when I first wrote this, that said "records", as in vinyl….I am so old) What the big shots do write about; however, is raw feelings – love, pain and guts, and EMS is full of all three. The soul of EMS is not in the ambulance, it's in the EMT's heart on his first call. It's in the paramedic's bloodshot eyes at 4am on her 20th call in 20 hours. It's holding a new baby, it's holding a dead one. Nobody does emotion like a medic, and our songs are out there waiting to be sung.

For your homework this week, find all of the following songs, or even one, play it and think. Of your worst call, your best day. The day you fell apart in a pool of tears and blood and came out whole at the bottom. Whatever day that made you feel like you couldn't win or couldn't be stopped. Maybe you'll find meaning or peace, maybe not. Whatever you find, take comfort knowing that the right song will find you.

The List:
Turn the Page (Seger): "Out there in the spotlight, you're a million miles away. Every ounce of energy you try to give away."

Good Run of Bad Luck (Clint Black): "Gambled on a third time, fool'll tell you it's a charm"

Better Life (3 Doors Down): I'm about to see just how far I can fly, surely you're gonna break my fall"

The Space Between (Dave Matthews Band): "The space between the tears we cry is the laughter that keeps us comin' back for more"

Long Day (Matchbox 20): "Reach down your hand in your pocket, pull out some hope for me"

Wild Ones (Waylon Jennings)" Straight outta nowhere, and a little bit out of our minds"

Fire and Rain (James Taylor): I've seen fire and I've seen rain. I've seen sunny days that I thought would never end."

We Can be Heroes (David Bowie or The Wallflowers): "We can be heroes, for just one day"

Just About Right (Blackhawk): "Your shiniest day might come in the middle of the night, that's just about right"

There are a thousand more. Go find yours.

My trip to the River was incredible. Spectacular weather, good fishing and food that doesn't end. Ever. Nothing major happened, but that is after all sort of the point. I see my family so irregularly these days that the idea of doing it on purpose is no longer foreign to me. Probably something to do with getting older, too.

Speaking of getting older, just had a birthday. Thanks for all the well-wishes!

Big story in Newsweek about the rescue and recovery effort in China after a series of earthquakes and aftershocks. The article opens with a two-page photo of a soldier carrying a toddler from the wreckage on his back, the anguish on his face unmistakable.

I was reminded then of Oklahoma City and the fireman carrying the baby from the rubble of the Murrah Building in 1995. Not only the victims of this disaster need our thoughts and prayers, but also those tasked with restoring order to chaos. Those folks over there may pray to a different god than ours, but I bet they're both listening.

And finally, Hillary, if you 're reading this, let me give you some advice...
STOP IT!

Do good things with the week to come, and thanks for reading.

A little something different...
Original Post Date: 5/18/08

We're going to try something new for this week…a multi-part blog. The usual dose of cynicism tempered with some current events and a personal note. Enjoy.

Blah, blah, blah…

After I quoted a line from a movie to a new friend the other day, she asked "Don't you have any lines of your own?" I said something about my talent being the ability to choose the best from wiser people, but that isn't all of what I believe. The truth is, I really wonder who is listening. Not just to me, but at all.

Of course, you need only watch a campaign commercial to understand the majority of why that is, but it's not all political. A lot of it is plain rudeness and ignorance.

I am an exceptional listener. Letting people talk is a big part of my job, and I've learned that you can extract all sorts of useful information from a single simple question if you'll just ask it and shut up. Usually, folks can't wait to tell you 100 things they screwed up if you'll only get out of their way.

The Pareto Principle states that 80% of the effects come from 20% of the causes. You can further extend this to simple conversation: Do 80% of the listening and 20% of the talking. Believe it or not, this is vital to EMS success.

In education, the teachers and students both usually fudge the ratio. It isn't necessary for the instructor to do all the talking. Most times, the students understand where he's trying to lead them and can probably get their on their own if they just had the chance to say it out loud. So many times I've talked to students who understood something very complex, yet they had allowed themselves to be talked out of it because the instructor read the whole thing to them in some sort of convoluted terminology that the student didn't grasp. Learning takes a lot longer this way and is not nearly as effective.

Paramedic school is all about learning to ask the right questions. Honestly, you could teach an 8th grader to do most paramedic skills in a weekend, so why spend 14 months in school?

Complaint-centered assessment.

In order to treat patients, you have to know where it hurts. And, unless they have an arrow sticking out of their chest, this usually requires a properly worded question or two and the patience to let them answer. A common failing, especially with new technicians, is to spew forth their newly acquired knowledge like a bad Mexican meal stirring around inside of them just waiting for the right place to spill. The truth; however, is that most patients prefer empathy over the display of adequacy, and empathy requires honest listening, not just waiting to speak. If you have to prove to everyone that you know your business by speaking it out loud, you probably don't.

So, for those who wonder if I have an original line, here's one:

Shut your mouth.

This week in sports.

The Cubs are off to a great start, holding a 2 game lead in the NL Central at press time and just finishing up an 8-2 homestand. It's only May, but things look really good if we can just keep the injury bug away.

In other sports, is it just me or are the NBA playoffs the longest, most useless waste of network airtime on TV today? How about we cut a few games out of this thing, eh? As it is, the new season will start about 45 minutes after the last playoff game.

This past week, I was reminded yet again what good technicians we have where I work. I've very pleased to say that little of the ranting I do through the blog is about the folks I currently work with.

The week to come looks to be fun. Only three days to work before I head off to the mountains for some much needed R & R. Hopefully by the time my birthday rolls around on Friday I will be waist-deep in a mountain stream looking for trout. Wish me luck....turns out I'm a far better medic than I am fisherman.

Oh, and for those wondering about my profile picture. Somebody recently referred to me as short and fuzzy, so I wanted to find the best possible example. He shoots...he scores.

To borrow a line (there I go again) from Garrison Keillor, "Be well, do good work and keep in touch."

Daily wisdom
Original Post Date: 5/15/08

Got this in an email today and thought it was worth preserving for posterity.

'Political Correctness is a doctrine, fostered by a delusional, illogicalminority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end.'

I will add comments later, though I'm not sure what I can do to make that any better.

Those little things...
Original Post Date: 5/11/08

I was recently told by a friend that I sounded like an "angry little man" when I write. So, in the spirit and in spite of that all at the same time, I am posting my list of things that just piss me off. Some funny, some serious, but all responsible for my acid reflux.

1. People who insist they "need" the Ford Gigantor SUV because they have to take Ashton and Chandler to soccer practice, Ruffton to the vet and then stop at Le Markete for organic broccoli and scones. Trust me; you can accomplish the same things in an Accord with room to spare

2. Same people in 1 who always say "Why do you care, I pay for the gas!" You know what, lady? I'm paying for your gas, too. Because you're willing to pay $4.00/gal X 46 gallons to fill that monstrosity that you NEED to do the same things that I can do in a PT Cruiser, the bar of demand is set by you. Indulgence is truly as American as baseball, footlong hot dogs and heart disease.

3. Oil company execs who try not to look like the bad guys. Granted, oil is a global market, but enjoying unadulterated profit at the expense of others is an American pastime. Energy giants are selling their product for 3X what it cost 4 years ago, but their productions costs have not gone up one penny. There is truly nothing oil companies can do about the global unrest that destabilizes energy markets, but there is plenty they can do about the ancillary areas of their businesses. Profit may not be a dirty word, but Greed is a deadly sin.

Moving on...

4. People with piss-poor speed control on the interstate. Cruise control...look into it.

5. People who laugh at things that aren't funny, and become frustrated with me because I don't.

6. Those who insist on listening to your conversation, even if it doesn't involve them. Worse still when they insist on your repeating something in said conversation.

7. People giving the ghost of Steve Irwin a hard time. He died doing something he loved...we should all be so lucky.

8. People who are upset about the way you react to a certain situation, even though you've behaved the same way in the same situation for as long as they've known you. "Why can't you change?" Why can't you learn?

9. Said people who are surprised by the consistent behavior of everyone they know. You knew they were snakes when you picked them up...don't bitch when they bite you.

10. People who live in my (old) apartment complex and drive 100ft from their apartment to the pool. Refer to 2 for why this pisses me off.

11. Paramedics and students who have no intention of practicing any longer than it takes them to get into nursing school. That school is across campus...save us all some time.

12. Paramedics who insist on dazzling everyone on scene with their diagnostic prowess when they should be getting themselves and their very sick patient to the hospital. Got a little piece of news for you...sometimes, we truly need to be just ambulance drivers.

13. Any care provider who overtreats because they can.

14. Any care provider who undertreats because they fear litigation.

The list is much longer, but no need to wax sarcastic. I throw these out there as a counterpoint to the wonderful week I had. I celebrated my anniversary, got to be with some friends I rarely see anymore and held my best friend's brand new baby boy. Amongst all that, I attended class with some educators who are clearly as frustrated as I at the state of things. In this, I found hope; not because misery loves a quorum but because there are plenty of folks out there who care enough to do the work it takes to make it better.

Angry is my tone, but it gloves the left hand of hope that reaches beyond what I can see into a future that is clean, light and full of chance.

Pride goeth before the ambulance...
Original Post Date: 5/4/08

Pride is the double edged sword of any subculture. And, make no mistake, paramedicine is clearly a subculture. There is the pride that drives one to step forward for a difficult assignment because he knows he can handle it and can prove it. This is the William Wallace brand of pride. Then there is the darker side of pride; the kind that goeth before the fall. This pride tricks the tragic characters in our lives into stepping up for the tough job without the skills and without disclosure because they think they can do it and WANT to prove it. Sadly, the latter brand is far more common.

Paramedics are very proud of what they've done and where they've done it. So proud, in fact, that they often find themselves in over their heads because someone trusted them with a patient they've no business caring for and too ashamed to ask for help. Then who pays?

The patient.

I borrow a line from ER (the show) here: It is never about us! Our patients deserve the best care – they demand it, and they don't care who it comes from. And, this is the part that sticks in everyone's craw: we shouldn't care either. If we, anyone, cannot handle what we've been given then it is up to us, everyone, to say so. I find this especially important when charged with caring for patients between medical facilities. On scene, we skillfully bring our patients from no medical care into our charge and off to the hospital. In the case of a transfer; however, we purposefully remove them from a medical facility with the express purpose of delivering them to another one in as good or better shape as when we left. The worst possible action is for an incompetent technician to take this patient knowing they cannot care for them and not say so.

The long view of the solution is education. Learning really is power. But the solution at the bedside is to step back and let someone else take over. What stops us from doing that? You guessed it….pride's ugly, villainous twin.

To err is human; to err on purpose is negligence.

But what of the good pride? The kind that gets you to work 15 minutes early. Or, the kind that helps you find the time to press your shirt the night before your shift. Or, even better, the brand of pride in yourself and your career that drives you to get more than the minimum amount of con-ed and look really hard to find good education even if it means you have to pay for it yourself. And maybe, just maybe, if you cannot afford to pay for quality training you should reread paragraph 3 and study on the pride that keeps you comfortably living within your means, but that is an entry for another day.

Recently, I attended a paramedic graduation at a local community college, and I was surprised to see that the paramedic students were graduating alongside other program participants who had made a much lesser commitment in terms of length and intensity. The college seemed perfectly comfortable putting paramedic students behind graduates of programs that were less than one tenth as long. Paramedic school is fourteen moths full of lectures, labs and hundreds of hours of clinical skills rotations; yet this institution made them feel as though their accomplishment was no different than that of someone that had completed six weeks of school and a few hours of OJT.

How do we honestly expect to grow pride at the grassroots if there is none coming down from the top?

If we choose to treat ourselves with no respect as a matter of policy, we should expect no more from our colleagues in medicine as a matter of course.