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November 10, 2009
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VIEWS: NORM ROOKER
Editor's note: He's been a long time gone, but now he's back. Norm Rooker returns with this great piece that stitches the soundtrack to a lifetime spent in EMS. Enjoy. - HN
[July 17 2009]
A couple of weekends ago I was driving across the New Mexico high desert and singing along with the Village People for all I was worth with a big ole grin on my face and joy in my heart. The reasons were many and involved both past and present. I was returning from a family farewell sendoff for our oldest granddaughter who is married to Steve, an Air Force “wrench turner”. They were being transferred from Kirtland Air Force base to Germany for a four-year tour and we had a family get- together to say our goodbyes and wish them well.
Vicki and her sister Katie decided to use the trip down to Albuquerque as the first leg for a five state road trip out to California and back. As I had a watch to cover the next day, I drove down separately and thus, was able to play “my” music and sing along as best I could on the way back.
Which isn’t always pretty as I have trouble carrying a tune in a bucket. If I can’t hit a note, I simply change to a key where I can. Its rare to get through an entire song in less than 4 or 5 keys.
But that was not the sole reason for the smiles. Rather it was for the memories I had attached to many of the songs. Like running hot to a cardiac arrest call to Jefferson Starship’s “We Built this City”.
It was early 1986 in east San Jose. Cindy Petretto and I were running hot through mid afternoon traffic for a cardiac call, CPR in progress. And what job isn’t made better without a good sound track in the back ground?
We had a classic rock station cranked up, radio KOME (yes, that is a real call sign and they’re still on the air) and while they played a number of rock classics as Cindy threaded us through the just out of school afternoon traffic, the song that was playing as we pulled up on scene was that Starship classic.
Like so many of our cardiac arrests, first responders were already on scene and CPR was in progress. The patient was in a coarse v-fib so we did what we always do, gave her a 200 watt second ride on the lightning and, surprise of surprises, shocked her right into asystole.
Unfortunately a not all that an uncommon but unintended outcome for this V-fib treatment. So now our patient is flat lined and we were attempting to stimulate her heart back up with various chemicals so we could shock it again. Hopefully with a different outcome.
I was on my A game that day and not only got the tube on the first shot but also turned around and sunk an EJ, as the patient had nothing for veins peripherally and Cindy wasn’t having any luck in either arm.
We worked that code to the point of calling it and Cindy was on the telephone with a Base Station Attending getting permission to do so when the patient’s heart said “enough already” and decided to rejoin us. I have never seen this before or since but our patient’s heart spontaneously converted from Aysytole to a perfusing sinus tach. (4 rounds of Epi 1:10,000 and 3 mg of Atropine tends to make the heart beat a little faster, when it chooses to respond.)
“Wait a minute doc! Forget the pronouncement, I need a Dopamine order!”
Cindy and I brought our patient into Valley Medical Center, The Big Valley, where she was admitted to ICU but did not survive her event and passed away for good two days later. We received a nice thank you note from the family not only thanking us for our efforts, but also for giving their family a chance to get together and say their good byes to their mother, grandmother, sister, beloved wife, etc..
It was signed by what we guessed was the entire family. While Cindy and I had succeeded in telling the Grim Reaper “Not Today!” for our patient, and had a fantastic, make that great field save, we were humbly reminded both that it is not a true save unless the patient is able to resume their normal life and that we had not anticipated how many lives our efforts were actually making an impact on.
Or another rock classic, Lou Reed’s “Walk On The Wild Side”. Vicki and I had quit our jobs with St. Louis EMS and were working for Medevac covering the southern half of the City of San Jose and Santa Clara County while we were waiting to get hired by the City of San Francisco Department of Public Health Paramedic Division.
Anyway, back in 1985 we had a pair of young medics, Ramon & Terrel, who were decent medics but just a little to full of themselves. (Those of you who know me will realize that this is somewhat akin to the kettle calling the pot black but trust me on this one.) They always acted “cool” and called themselves Ghetto Medics.
While east San Jose certainly had its rough and lower economic neighborhoods. There was no way either Vicki or I could classify them as ghetto. Especially after having done my paramedic training in Detroit and working for the City of St. Louis for five years.
So when the two of them would get a little too wound up in some story of their exploits I would start singing, actually chanting, this Lou Reed anthem.
“I said hey babe,
Take a walk on the wild side.
Where all the colored girls go doot, ta doot, da, doot, doot...”
They would eventually give me a puzzled, slightly frustrated look and change the subject.
Eventually these two young studs decided to really earn their self anointed title and left us for employment with the private ambulance service that had the 911 contract for the City of Oakland. I ran into one of them several years later when he was going through his check rides to be hired on with the City of San Francisco.
After catching up with each other’s lives I asked him if he understood now why I was always singing Lou Reed’s greatest hit around them.
He looked me dead in the eye and said Vicki and I were right, they had no idea what a ghetto was until they went to Oakland.
Or another 80’s rock classic Glenn Frey’s “The Heat Is On”, a great song to run code to. It was the late 80’s and my partner and good friend Mike Whooley and I were working nights in the Tenderloin and Mission districts of San Francisco. Mike and I were the “can do” crew. We also had developed the reputation as the attitude adjustment crew as well and were frequently tasked with those “problem” calls.
“Fine! You want paramedics. I’ve got just the paramedics for you!”
We always knew when some caller had really cheesed off dispatch when we would be dispatched to “adjudicate” a situation.
I was a bit of an adrenaline junkie and liked to let the momentum of the calls carry me through the watch. After working 24s in east San Jose where I was lucky to get 2-3 non-consecutive hours of sleep a watch, working 8s, 10s and later 12-hour watches were a breeze. Beat me, whip me, don’t even have to feed me as long as I could swing by a 7-11 for my Big Gulp Diet Coke. Just give me the calls and get out of my way.
Fortunately Mike humored me by trading the quiet districts of the city to the other night crews so we could stay down town where most of the action was.
He always went along with my efforts to poach other crew’s calls if they sounded like they were good ones and on more than one occasion on slow nights he would turn and smilingly say to me that he could see keeping me entertained was going to be a challenge.
Yeah, I was a red hot medic and this was one of the reasons I earned the moniker, the 911 Cowboy, as we were riding herd on society in the ‘loin. (The Tenderloin district of San Francisco. Allegedly so named because during the hey day of the Barbary Coast days the police were reputed to be so on the take that they could afford to purchase tenderloin for their meal breaks.)
Anyway, the testosterone and adrenaline flowed, people were rescued, at least from their immediate circumstances and occasionally, lives were even saved. The truth of EMS is that the vast majority of our patients are going to live in spite of us, not because of us. However, our efforts can have varying degrees of impact from just simple acts of kindness to significant mental and physical impacts on the healing and recovery post event that caused 911 to be called in the first place.
The action, adrenaline and sometimes the down right “You are never going to believe this” stories that went along with all of this were just icing on the cake. Fortunately, Mike, while a good deal more cynical and realistic than I was, felt the same way.
Back to Glenn Frey, Mike and I were having a kick ass night on the ambulance. A “big sick” Cardiac Asthma call that we, actually Mike, recognized and treated appropriately with Nitro and Lasix rather than flog the failing heart harder with an Albuterol treatment. This was followed by several assaults and one very drunk but highly entertaining street denizen who initially wanted to kick our asses. Either together or one at a time, our pleasure.
Digressing slightly but still keeping with the theme of music and EMS, I was driving and Mike was attending and we “assisted” this citizen into a sitting position on the squad bench of the ambulance and seat belted him in. Mike chose to ride in the Captain’s chair as I drove us to San Francisco General Hospital. The patient kept up a running but losing tirade with Mike who was letting out some rather pithy lines that had me chuckling.
At one point the patient started complaining that we didn’t like him and we were just picking on him.
That’s when I jumped in with my contribution to the show. It had only been a couple of years since the movie TOP GUN had hit the screens. My wife Vicki’s favorite scene from that film was the volley ball game. She wanted to put a drip pan beneath the movie screen to catch all the excess testosterone flowing from those glistening bodies.
Mine however was the initial bar scene where Tom Cruise makes his opening moves on Kelly McGillis. With that in mind I chimed in, “Oh Mike, I think our friend has lost that loving feeling.” And then the two of us started singing.
“You never close your eyes ...”
At first our patient protested that we were making fun of him but we said no and that we were sure he knew the words and to join in. By the time we arrived at the hospital we were all in harmony, mostly on the same key and having a good time.
As we escorted our patient into the hospital he was thanking us and telling us we were the first people in a long time to just treat him like a person. Amazing the unifying power of music can have when applied judiciously and at the right time.
We were laughing as we cleared the hospital and headed back down town. We tuned in to an oldies station and had just parked the ambulance in a dark parking lot when we heard my wife Vicki calling the ambulance that was responsible for covering the Mission district for a stabbing. The call was at the northern edge of the Mission not to far across the border from downtown and me being me, well actually us being us, we jumped the call.
As I lit it up and came charging out of the alley onto Polk Street the oldies station chose that moment to drop “The Heat is On” into the play list. One cool sound track to be running hot on.
The streets were empty at that early morning hour and the song was still playing as we arrived on scene two minutes later. A back alley parking lot with two lone police officers and a large black man laying in a pool of blood with five stab wounds to the chest. He was unconscious and not quite at the Guppy breathing stage (agonal respirations) but was definitely spiraling down.
As I bagged the patient, Mike cut the guy’s shirt off, being careful not to cut through any of the stab holes and did a quick assessment. He then cut the rest of the guy’s cloths off to ensure that we didn’t miss any other injures and then sealed his chest wounds.
Mike shot the ET tube and we had a police officer bagging the patient as Mike and I loaded him onto a back board. Just as we horsed this guy onto the gurney and were fastening the straps, Engine 36 arrived on scene.
Quick load and with a firefighter driving the ambulance and a second one in back bagging the patient, Mike and I each got a large bore IV going and secured by arrival at the hospital. From time of dispatch to arrival at the hospital was 11 minutes.
We were definitely all over that call. Between us and trauma services at SF General our patient survived his injuries and now every time I or my crews have a “kick ass” watch, the sound track in my head always starts with “The Heat is On”.
But not all my music EMS memories are the happiest. While it sounds cliché, several of them are bittersweet. Like the Village People’s song “YMCA”. And to a lesser extent their other two big hits, “In The Navy” and “Macho Man”.
To set the stage, when these songs were first top 40 hits in the late 70’s, my first wife and I used to Roller Disco to them at the World of Wheels skating rink in Ann Arbor, Michigan. No, we didn’t wear tight polyester jumpsuits with sequins or anything like that.
For one I was a hard working EMT and we were putting me through paramedic school. But we owned our own skates and the rink only charged us $4 as a couple because I was an EMT with the understanding that if anyone took a tumble, I would go over and initiate assessment and care.
So for us it was an inexpensive date and clad in sweat pants and sport shirts, we did our “thing” beneath the swirling lights. Including doing the YMCA.
Flash forward 7 years to San Francisco. We had four large male nurses working primarily swings and nights at San Francisco General Hospital’s ED, Mission Emergency. These guys were all big, I mean pro football linebacker big. And gay. Big John Taylor, Vinnie, Tony and Mark. Collectively they called themselves the Four Queens. And they were a blast to work with.
Because back then, nights and swings was where it was at to work EMS. No bosses or brass around. No stick up their butt lifers or sycophants. Just folks with medium to high energy who wanted to get the job done, and generally wanted to do it well.
But the pace was also fairly frenetic. We never had enough resources, either in the pre hospital, ED or crisis mental health to meet the demands/needs of the public we served. So we had to help each other out to get the job done and make it through to the end of the watch.
And humor was a frequently employed tool. For instance, John had a button collection and wore a different one every day. Buttons with phrases like, “your lack of preparation does not constitute an emergency for me” or “you must have mistaken me either for someone who cares or has the power to do something about your problem”. Or one of my favorites, especially in light of the frequent surrealistic nature of some calls, patients or turn of events, "I don’t think we’re in Kansas anymore Toto”.
Sometime during a busy watch, we would seek John out just to see what the button/ message de jour was.
And if some patient tried to get rough with one of the staff or our medics, everyone jumped in. Well almost everyone. Some of the med students hadn’t got it yet. We restrained so many patients or brought in so many patients in four-, six- and sometimes eight-point restraints that we would sometimes get “judged” on the quality of our work.
Back then, DPH medics were authorized to carry handcuffs. We had in-service training and SOGs that essentially stated that if you had to take a patient down and restrain them, go to the steel to get them under control and then as quickly as possible, switch to soft restraints.
We carried the sheepskin-lined soft tie restraints. The kind you can still find in Adult or Marital Aid catalogs marketed under the title of pleasure restraints. On more than one occasion after we and some SF Police officers or firefighters had tied down a patient acting out or chemically out of control due to alcohol or some other mood altering substance we would have one of the officers inquire if we had an extra set as he/she and his/her wife/husband, boyfriend/girlfriend had some special romantic event coming up.
Generally we were able to accommodate and would give a quick in-service on how to utilize them appropriately. Both for restraining and how to do so in a way that was safe and the “patient” couldn’t undo them yet could be quickly released as needed.
I took it as high praise when on one particularly busy full moon weekend night I brought in a very loud and obnoxious QID, Queen In Distress, having a hissy fit enhanced by meth, in six-point restraints and Tony announced in a voice loud enough for everyone around to hear that I tied them down so good that he was making me an honorary Bondage Queen.
Or at the end of one busy night watch when I was held over by a late call and was in the nurse’s lounge writing up my chart when Big John came in wearing civvies. I had actually never seen him before in anything but his clogs, scrubs and button de jour.
So it was with a little surprise when I looked up and observed him in motorcycle boots, starched blue jeans and a tight sports shirt. But what really caught my eye was that he had a bunch of colored bandanas in his back pockets. I don’t mean just stuffed in a pair of multi-colored wads but rather precisely folded, starched and neatly stacked exactly an inch apart so you caught the full spectrum of colors.
There was a yellow, white and red one in his left hip pocket and a red and purple ones in his right. Big Vinnie walked into the room somewhat similarly attired and also sporting multiple but different colored bandanas similarly stacked in each of his back pockets.
As the two of them talked I finally screwed up my courage and asked a question that I knew the two of them would end up giving me way more information on than I wanted. But self restraint had never been one of my stronger points so I stumbled ahead.
“Ah, John, Vinnie, I know you guys can’t have such runny noses that you need to carry all of those bandanas. Um, do they have some significance that I’m not aware of?”
Vinnie laughed as Big John turned and flashed me his classic smile and stated “Norm, you have to remember, you’re not in Missouri anymore.”
From there I learned that in the gay community at that time there was an entire color code to sexual acts. And that what was displayed in the left pocket was what a person liked to receive and what was worn in the right pocket was what an individual liked to give.
As they went on at great length to explain what each color represented I was thinking that this was actually a pretty neat system and would have made the dating scene a whole lot easier in the hetero world as well. Especially back in those awkward junior high and high school days.
While I was thinking this Vinnie piped in that this also held true for the S&M leather set. That if you wore a pair of handcuffs through the left epaulette of your leather jacket, that meant you liked to be on the receiving end vs. through the right which indicated you preferred to be the dom.
As I was taking this all in I suddenly realized that I wore my handcuff case on my left hip because I started out in this world left handed before my first grade school teacher, a nun who had left the order to have children but hadn’t left her iron ruler behind “encouraged” me to learn to write right handed.
I blurted out to both of them. “Guys, don’t get the wrong idea, I wear my cuffs on my left side because I’m left handed!”
They laughed and told me I was safe as my “reputation” as an honorary Bondage Queen was well known.
They left me to finish my report as I, now almost beet red, hustled to finish my PCR and make relief before the day time dispatchers decided to abuse us again.
Or the time when Mark took it upon himself to inform me that the Village People were a gay group. Naively and incredulously I exclaimed “No! How can that be? My wife and I used to roller disco to them.” As I quickly demonstrated my mastery of the YMCA arm movements.
Again I got the “You’re not in Kansas anymore.” speech and eye roll. I learned that in most big cities YMCAs were where young men of the gay persuasion would go to when they first hit town to meet similar interested men and to learn the local lay of the land. That the Y was considered a hot pick up spot for the new in town gay crowd.
Through all of this I was flashing back to my membership as a kid to our local YMCA and attending two separate YMCA day camps and wondering if I had missed something. I sure didn’t remember any of those kinds of activities going on.
As Mark went on to describe each of the stereotypes of the Village People in the gay culture suddenly their song Macho Man took on a very different perspective. And even though I was a veteran medic of four major cities I was feeling very naive.
(Now in my defense, I didn’t watch VH1 or music videos so I actually never saw the actual videos till I looked them up for this piece. If I had seen them there was no way I could not have known.)
Or the time Big John embarrassed the snot out of a new group of doclings. San Francisco General Hospital was a teaching facility, so it was institutionalized that each July 1st a new group of first year med students would arrive from all across the country. Many of them equally or more naive then I apparently was.
We nick named them doclings both because they were not full fledged doctors yet, just as a paramedic intern is not a full fledged medic, and because they would follow their respective attendings like ducklings following a mama duck. Looking for guidance, reassurance and protection. Hence the term, doclings.
So one late hot July night, Mike and I had brought in a particularly obnoxious drunk in six-point restraints. The SF General Institutional Police assisted us in transferring him over to a hospital gurney and re-restraining him before we brought him into triage where he was evaluated and triaged to the “male ward”. The name was a hold over from a previous era but had now come to mean the non-acute medical ward. Regardless of gender.
So Mike and I parked our still verbally abusive patient who was taking full advantage of a phenomenon we came to call “the freedom of restraints”. We hypothesized that an individual, when interacting with the public at large had to exercise a lot of self control in what he or she said or did as the consequences for saying some things could lead to a serious "butt whoopin’" or worse. Consequently, some patients would maneuver events or the situation to the point where they would be tied down. Now they could say anything and no one would assault them or exact retribution as they were tied up. They were free to let their mouths run wild with a fair degree of impunity.
Such was the case for this one individual. He must have mixed his booze with meth or coke as he kept up a running tirade all night into the wee hours of the morning. It was now 5 AM and Mike and I were bringing in hopefully the last patient of the night. Who was triaged to the Male Ward.
As we walked into the ward, we observed our mouthy patient still going at it. There were three doclings working at the table in the middle of the ward, attempting to catch up on their charting before morning rounds and each would periodically look up with an annoyed expression when our earlier patient would spout off.
As we were taking all of this in, Big John entered the ward from the opposite door to share some information with the Male Ward charge nurse. As soon as he entered, our restrained patient started in on him by shouting “Faggot!” “Faggot!” “You F***ing Faggot!”
To which John stopped mid floor, stared at the patient and then turned to the table full of doclings, put his hands on his hips and called out in a loud voice, “All right! Who told?!”
Mike and I burst out laughing as all three doclings turned beet red, ducked their heads and began scribbling furiously into their respective charts.
Through the years there were many more supporting and entertaining interactions. Us against management. Either ours or theirs. Like the time a new ED director decided that he was going to get control of the ED nurses and they responded by wearing large buttons or white scrub shirts with the phrase “No Handmaidens” emblazoned on them. Or when one of us got injured in the field.
However this was back in the late 70’s through the 80’s. And the medical and gay communities did not know what we know now about AIDS. We lost all four, John, Vinnie, Tony and Mark, over the years to that nasty disease.
At Big John’s wake, Tony brought in a shoe box full of John’s button collection and each of us was allowed to take one as a keepsake for John. Vicki and I still have ours in a nick knack box on a dresser.
So every time I hear the song YMCA, I smile and when possible sing or dance to it with great enthusiasm. The lyrics and tempo remind me of those past friends and fellow “Code Warriors”. Especially the way the voices, still singing enthusiastically, never stop but rather just fade off into the distance at the end.
Take care & be safe everyone and I promise not to go so long between essays.
YouTube links for the songs referenced by Norm:
[June 9 08]
This was the key phrase that averted a minor catastrophe and put the best end to that was playing out to be one of those "you'll never believe this" mini-dramas at two in the morning last fall, around a tree, in downtown Ouray, Colorado. My bride and I had been peacefully asleep when one of Ouray PD's finest special-called me.
To set the stage, in the City of Ouray, population 973, we had been having periodic problems with marauding bruins coming into town and going dumpster diving. To compound the problem, somehow the bears seemed to know that this would be a particularly long and cold winter for them. How they knew we would end up receiving 178% of normal snowfall science has yet to figure out. Anyway, throughout the month of October we were having even more than the usual number of marauding bear "visits".
Like any fine somewhat inebriated self
respecting Texan would do, they ran out and gave chase to said bear.
Frankly, if the bear had hauled off and decked them, it would have served them right but then the bear would have had to been put down by the Colorado Dept. of Wildlife. So our smarter-than-average bruin turned and high tailed it towards the hillside.
The boldest or drunkest of the group
had climbed up the tree after the bear because, and I quote, he was
going to "Whack it in the butt!".
You can't make stuff like this up.
So why was I special-called? Well the
telephone conversation went something like this..."This is Norm." I
have long had the ability to sound like I'm wide awake when awakened
from a sound sleep by radio traffic or a phone call, even while the
brain is still rebooting up.
"Norm, I need you right now." Officer
Biggs informed me in a tone of voice that spoke volumes.
"Ahhh, Nicole... Why?"
"I'm finally going to get to tase
someone and I want you here when he falls out of the tree."
Over the top of voices shouting in the
background and Nicole telling someone to get down now, right now and
she wasn't fooling, she went on to tell me, "I'm the only one from
my academy class who hasn't tasered anyone yet, but that is about to
end tonight so get down here now."
More shouting in the background and
other noises I couldn't quite identify and Nicole ordering someone
down again. "Look, just get here." And she hung up.
As I struggled out of bed, disturbing
our cat who let me know that she was annoyed, my bride asked what
the call was about. I told her I wasn't quite sure but it sounded
like Nicole was about to taser someone.
Vicki called it right as she rolled
back over, "Probably some drunken Texan. This time let the police
take him down."
OK, you can take the medic out of the
city, but some of those muscle memory instincts don't always stay
behind. There had been a couple of calls over the past three years
where I had "adjudicated" a situation and then realized that law
enforcement was there and it was in their job description to do so,
There was Nicole on one side of a swaying 45-foot pine tree and two fellows on the other hollerin' up to their buddy about 20-feet or so up in the tree who was still insisting that he just wanted to "Whack it in the butt!".
The Ouray County Sheriff's deputy was
responding to back her up but he was way up in the north end of the
county and still about 10 minutes out.
Nicole had her taser out and little
blue flashes of electricity were arcing between the dry stun
electrodes as she gave several warning cracks on it to let everyone
know she was serious.
She gave one last command for the
fellow to come down now. Right now or she was going to fry his butt!
It was then that one of the buddies
let out with the telling phrase.
"You better come down now Cody, she
really means it and she's more than pissed. She's Mama Mad."
Apparently the term "Mama Mad" caused
some preconditioned survival neurons to kick-in and take over. All
of a sudden our belligerent tree climber turned docile as a boy
scout, climbed down and stood in front of Nicole, all five foot four
of her. With his head hung down and in a soft voice totally
different from his early hollerin' he apologized.
"Sorry ma'am. I guess I got carried
Nicole said a few more things. All
three of the now humble and chagrined Texans stood towering over her
with their heads hung down and mumbling a chorus of "Yes ma'ams" and
"No Ma'ams.". Nicole ended up taking a field report and let him off
with a warning.
Our young tree climber and his buddies
promised to never, ever, ever chase a bear again or otherwise make
rowdy in town and walked back to their motel.
Nicole turned to me and instead of
saying thanks, said "Damn! I'm still the only one from my academy
class that hasn't tased anyone yet."
I said something about better luck
next time and got back into my buggy and headed back home. On the
way home I started playing the little mini-drama back in my head.
The obvious turning pint had been the phrase "Mama Mad".
I got to thinking about the power of
Obviously this has to be a conditioned
response. My dad had a phrase that he would use, "You better" fill
in the blank, "or heads will roll and tears will flow like rivers."
When my brother and I would hear this we knew there was only one
correct response and everything else would result in pain or worse.
This wasn't an immediate response the
first time we heard those words. We had learned over the years, the
meaning behind them. Good judgment is what you get for surviving bad
judgment. Yours or someone else's.
But our mother, she had various levels
of, shall we say, force escalation.
But when those didn't work, or we had
just plain ticked her off most royally or had otherwise pushed her
past her limit, well then, the game was on. And Mama Mad was just
not a good time for bonding.
Not that I ever got a whoopin' I
hadn't earned, with one exception, it was just that when mom got to
that point, even if my brother JD or I held perfectly still, it was
only a 50/50 chance that the swat, shot with the wooden spoon or
swing of the belt would actually land on our butts. I understood
'Mama Mad' all to well. Having pushed her to that a time or two
And speaking of games, how many of you remember the 1992 movie A League Of Their Own'? My friend Kenny Darenzo's mom was one of the women who played in the women's professional baseball league during World War Two. She had one heck of a throwing arm.
Kenny took one look at her as she was
making for the front door, threw open the window and yelled "Run
Bill. She's got a potato!"
Bill turned around and started beating feet but he wasn't quick enough. She caught him at almost a hundred feet away right between the shoulder blades, bringing him down in a cloud of dust. She then turned and glared at Kenny.
She fixed us with a look that said
"Uh, no ma'am. I think we'll just be
going home now."
As I grew up and left home to follow
the medic trail. I encountered numerous examples across the races
and religions in various parts of the country that reinforced the
old adage, "If Mama Ain't Happy, Ain't Nobody Happy".
Whether in the poor or working class
neighborhoods of St. Louis or the blue collar neighborhoods of
Ypsitucky. That's actually Ypsilanti, Michigan. So many southerners,
especially from Kentucky had migrated north to work at the GM
Hydramatic Plant in Ypsilanti that in the 70's it had earned that
nickname by us emergency responders.
From there to the multicultural
neighborhoods of south San Jose to the streets of San Francisco, one
thing was constant. In most families, single parent or both, gay or
straight, the mother, or the person in the mother role, was the
driving force for the family the vast majority of the time.
On more occasions than I can
accurately recount I managed to talk my partner and I out of trouble
or calmed down an explosive scene by identifying the alpha female
and working with them. Once she was with the program, the rest of
the family generally calmed down. Or at least stopped venting on us.
This wasn't always possible though.
One call in particular stands out. It was a late spring night 22
years ago. 1986. My partner and I had been dispatched to an assault
in a low-income apartment parking lot. It was one of those East San
Jose surrealistic calls that sort of defied logic.
For one, the Santa Clara Valley had
been developed so quickly in the 60's & 70's that there were miles
and miles of low and middle income housing in what had only a decade
or so before been fruit orchards. Each developer, in turn was able
to assign street names to their developments. This resulted in some
really interesting themed names for various neighborhoods.
One neighborhood would have wine
related themes. Chardonnay Way, Cabaret Lane, etc.. Another was
named after various agricultural products.
Anyway, this low income apartment
complex was located in a neighborhood where all the streets were
named after Disney characters. So we were responding to the
intersection of Bambi Lane and Cinderella Court for the assault.
We arrived with a two-man fire unit and two police cars to find a big 16 year old Samoan kid laying unconscious in the parking lot. He had obviously been in a fight and come in second. We c-spined him, backboard, c-collar, sandbags and tape. A nasal pharyngeal airway and high flow oxygen via a non-rebreather mask completed the ensemble.
She threw herself across our patient
who turned out be her son and started crying.
I was just about to step forward and
reassure her that he would be all right when she started shouting "I
told you not to hang out with those boys!" And started punching and
slapping her unconscious son.
The oxygen mask and then the c-collar
went flying in different directions as she continued to chastise and
otherwise vent her frustrations to her unconscious son. I started to
step in to intervene when I felt a large hand on my shoulder.
One of her older sons leaned down and said in a low and actually very kind voice. "Don't. When she gets like this it's best not to get in the way."
We hustled our patient to the ambulance before she had a chance to change her mind and repackaged the kid enroute. Documentation? It began with 'the patient was the victim of several assaults' and then went on to describe his injuries, treatments and response to those.
[Apr 29 08]
Just what is the correct response when this is the initial greeting from someone who knew you from back when? The occasion was the 2008 Fire-Rescue Med Conference in Las Vegas. I was attending the national roll out for the Ambulance Strike Team Leader class. (A good program and one well worth taking by EMS supervisory and middle management types.)
One of those ahead of me turned out to be a coworker for a service I worked for back in the late 70's after graduating from paramedic school and prior to being hired by the City of St. Louis EMS. After he introduced himself and I was thinking that he looked familiar he turned to me and uttered those words.
Afterwards I pondered my former coworker's statement. This was not the first time I had heard this sentiment. Fourteen years earlier at my 20 year high school reunion I ran into Mr. Petty, one of my senior year English teachers. He was walking towards me and when we got close but before I could say hello he stopped dead in his tracks.
He looked at my name badge. After all
I had filled out some since graduation and was well on the way to
balding, make that bald. Some of that by nature and maternal
genetics and the rest enhanced by an ambulance accident where I flew
head first into the front cabinets and avulsed the top of my head
down to the skull.
While I had serious railroad tracks
and a growing yamaka spot, I still had hair on top of my head until
that moment. They had to do a skin graft to cover the wound and I
was darn lucky that I hadn't broken my neck. I still have an
arthritic thoracic vertebra from that accident. But that was five
years prior to the reunion and I was healed up now.
Anyway Mr. Petty looked at me, looked at my name tag again, sighed and stated something along the lines that I was one of the ones that he was sure would be listed as among the honored dead by this reunion and that he had actually been surprised to see me at the 10-year reunion.
I attribute this to the times and to my parents. And for that matter my grandparents. My maternal grandmother was an active young lady who lived in the fast lane of her times. Think of the musical CABARET. Grandma Stamat was a flapper and was living the Berlin cabaret and nightlife scene when Hitler's Brown shirts did Krystal Nacht. Being an American citizen she was able to get out but almost my entire maternal family line for her side of the family was lost to the Holocaust.
This was during the mid to late 60's and race relations weren't exactly all they could be in that locale back then. One or the other of my parents had to get up early every morning and accompany us four boys to the beach or to the bay to ensure our safety.
That old cliché about being careful
about what you ask for comes back to mind as I was sat down and
learned way more than I ever wanted to. At least at that time in my
My sophomore year of high school I was on the wrestling team. After a long six weeks of hard practices I had made the decision that it was time for me to bring my jock strap home and wash it. (You know it's got to be bad when a 15-year-old boy decides this garment is to gross even for him.)
This is where being a creative smart
butt sort of got me into trouble, again. As I was moving my crusty
bit of athletic apparel to the whites pile I said something along
the lines about putting a bra and a jock on a poster with something
My mom yells "Brilliant!" and snatches this stained and crusty item from my hands. My pleas to at least let me wash it first fell on deaf ears and that is why my jock strap along with one of my mother's black brassieres and the words, "Ratify the ERA, Connecticut NOW" appeared in what turned out to be one of the most photographed posters of the rally with numerous shots of it in the New York Times and the New York Daily Post.
The upside was that all of these
activities led me to be selected for the second pilot EMT course
they ran in the State of Connecticut in 1973 over the summer between
my junior and senior years.
One of the downsides was that I sometimes clashed with or challenged authority. Never, ever in a destructive or mean spirited way. Well, I was suspended for fighting once my senior year but that was a provoked situation and testosterone rather than thinking things through got me in trouble on that one. I made the best of it and spent my entire suspension teaching PE over at Western Junior High School.
The fall of 1974 I reported to Ripon
College, in Ripon, Wisconsin. A small enough school that it was
possible to be a walk-on and actually make the football team. I had
never played organized football before but I was just big enough and
apparently just good enough to make the team.
I was a nose tackle. I had never
thought of myself as being particularly small but I quickly learned
that at 5'10" I was shortest lineman on the team. It turned out I
was the shortest defensive lineman in the entire conference.
I learned very quickly, actually with the "help" of my philosophy instructor that physical size was only part of the equation when it came to battle on the line. You see, my Introduction to Philosophy professor also happened to be the offensive line coach.
If I "discussed" an opposing point of view too much in his class that morning, that afternoon he would "borrow" me from the defensive line unit to run what can be best described by Gary Shaw's 1972 book, MEAT ON THE HOOF: The Hidden World of Texas Football, as Shit Drills.
I would be pass rushing against five of them protecting the coach who would toss the football just over their heads. I would have to leap up and catch it and they would have to react to my "interception" by stopping me from gaining any yardage. I crawled home from those practices.
For that matter only two of our
cheerleaders were my height or shorter.
As a lineman I was mediocre at best. But I learned how to hold my own and think through ways to use what I had to my advantage. And I never did seem to learn the other lesson my philosophy instructor was attempting to teach me.
Most people don't want to be hit. No matter what their size. They would rather push and shove. Fortunately I played for a pretty good team and was able to put my theory to test in the next quarter. I picked the biggest guy on the receiving team and cleaned his clock.
After that I would just sail down field, pick my target and take them out -- opening up a hole in the wall for the other members of my team to take down the ball carrier. I never once directly tackled the receiver, although one time I did hit a blocker with enough force that he took out his own ball carrier.
Staying below the radar just wasn't in
I never abused patients or derelicts.
I never picked fights. For that matter, I never, ever punched
anyone. That is an offensive tactic. My father taught me that there
will always be someone bigger stronger or faster so fighting is
always an option of last resort.
But if you do take that course. You
don't do it to come in second. And you never do it to showoff, or
This has been my philosophy throughout
my career on and off of the streets.
That included Special Operations such
as rope rescue, structural collapse rescue, firefighting, Tactical
Medic, etc.. Along with some of the interactions at certain fire
houses after our "merger of equals" where the Paramedic Division was
removed form the San Francisco Department of Public Health and
inserted into the SF Fire Department in 1997.
But getting back to last week's Fire-Rescue Med Conference, I ran into another former coworker, Jonathan Chin, who Vicki and I had worked with at Medevac in Santa Clara County, CA back in 1985/86 while we were waiting for the City of San Francisco to pick us up. Medevac had the contract to provide EMS for the southern half of the City of San Jose and Santa Clara County.
"You Gook", F***ing Gook", "You slimy Gook", 'You..", well, you get the picture.
"Help! He's going to kill Jonathan!"
Paperwork went flying as my partner
and I and another crew from SCV, the company that had the EMS
contract for the northern half of San Jose and Santa Clara County
beat feet for the room while a nurse called security.
I was first through the door and there
was Jonathan trapped in a corner between the walls and a hospital
gurney. His angry patient was towering over him. But Jonathan wasn't
cowering or blustering. He was standing tall in a neutral stance
looking up at the belligerent biker.
As I started to take my leap to tackle
this guy high I heard Jonathan say, "Lets get one thing straight.
It's not gook, it's Chink!"
Now that's being calm under fire. Jonathan has since gone on to obtain his master's degree in administration of EMS, has been the EMS Director for the State of Oregon and now runs EMS for a large county in northern Oregon.
[Mar 16 08]
It has been a long winter up here in the mountains of southwestern Colorado. 158% of normal snowfall and it's still coming with another 12-16 inches predicted for tomorrow. I was talking to one of my neighbors this afternoon and he mentioned that he was ready for this winter to end. That he was about out of tough.
We talked some more but his words kept echoing in my mind. Sort of like when you hear an insipid song and can't get the lyrics out of your head for the rest of the day. Which got me to thinking, just what is my definition of tough?
Over the years one hears numerous trite clichés for toughness. You know, "Cowboy up!" "When the going gets tough, the tough get going." "Soldier on", "Quit your crying and put your big girl panties on!" I actually overheard one of my volunteers say this to a whining patient last year and if it wasn't for the fact that it was both true and my volunteer was also a woman, I might have had to act on that last one.
Some other clichés we've all heard include "Don't be a wuss" and "Don't be a puss."
Digressing here for a minute on this last one. Puss, short for pussy which actually has nothing to do with either a feline or a part of a woman's anatomy. According to one of my former partners and longtime friend, Russ Zimmerman, a high-speed, low-drag medic of the old school variety who also has a fascination with words and word origins, Pussy is slang for Pusillanimous. Which means to be faint-hearted, cowardly or afraid.
But one of the most recent terms I've heard that while I can appreciate the sentiment behind it, rubs me the wrong way is "Man up." Used in a sentence like, "C'mon and man up!".
The reason for my annoyance, aside from the shear sexism of it, is the toughest person I've known or worked with, indeed my definition of tough is a former partner of mine, Liz Crawford.
Set the way back machine for 1981. I was a newish paramedic employed by the City of St. Louis EMS. St. Louis was one of the oldest municipal ambulance services in the US. Created shortly after the end of the Civil War. St. Louis was a tough city by anyone's definition. Heck, back then each police station, with one exception, had an ambulance assigned to it.
This was both because of the central locations in the various neighborhoods of the city, but also because back then, St. Louis PD had the culture of being pretty darn stick heavy. Dirty Harry would have been just an average member of the St. Louis PD.
On the negative side, St. Louis EMS was listed as one of the three worst municipal ambulance services in the US in a 1979 article in the now defunct EMT Journal. That same year the St. Louis EMS administration made the decision to make all the ambulance crews salt and pepper, so to speak.
Heck, I learned one of the main reasons I was hired on in January of 1980 was that I had done my paramedic training in Detroit so administration figured that I was one white medic that they would not have a problem placing in the north side of St. Louis. Which was true.
Racially St. Louis was a bit behind the times. In the fall of 1980 the courts were just getting around to ordering bussing to balance the racial make ups of the public schools. And while they were some mixed working class neighborhoods, there were still plenty of all black and all white neighborhoods as well.
So into this violent and racially charged mix, I began my civil service career as a paramedic. Heck my 4th night on the job I was in quarters at the 6th District Police Station with my partner Ace Boyd, an older EMT in his 50s who was trying to show me the ropes and explain how things really worked. Ace had been working for the city as an ambulance driver since the early 1960's, back when they ran one man ambulances and shared a lot of great stories about the system but I would be digressing again if I repeated them here.
Anyway, Ace was just telling about how he would drive the ambulance up to City Hospital Number One and ring the bell mounted on the ambulance one time if he needed a wheel chair and twice if he needed a hospital gurney for his patient when we heard a shotgun blast go off close by.
Make that inside the police station. A psych patient, or OBS as they were known in the local vernacular, had ripped a shotgun out of the rack of an unlocked police car and gone inside and shot the desk sergeant. The only other officer in the station was the lieutenant who fired at the fleeing perp with his service revolver.
The perp ran across the street into a cemetery while we were being dragged into the station to treat the sergeant. As he took his last agonal breaths, sirens were coming from everywhere. I intubated him, and he was my first ever field tube, and then began CPR on a chest that was mush from the blast while a major gunfight ensued. In the meantime Ace ran out and got the ambulance gurney and a backboard.
We worked the dying sergeant up a little more. Enough time to sink an external jugular IV, secure both it and the tube and then we loaded him into our ambulance for a wild ride to Fermin Desloge Hospital at up to 80 mph through city streets with a flying squadron of a police escorts clearing the route for us. All the time with me doing CPR in the back pausing only long enough to ventilate or push the occasional drug. It wasn't pretty.
This was a "Humpty Dumpty" resus. All the king's horses and all the king's medics could not revive this man and he was pronounced dead shortly after our arrival at the hospital.
The perpetrator suffered a similar fate with over a dozen gunshot wounds and two sets of tire tracks across his torso.
And as for me, I had definitely jumped into the deep end of urban EMS. It was sink or swim and as the ALS part of a one medic, one EMT unit, I had to either swim or drown. So swim I did. Not always gracefully or with style.
But we always made it while giving the best possible care we could for our patients. Although in retrospect, while I have to acknowledge that I learned my craft at some of their expense, it was never malicious.
What management hadn't counted on was that along with becoming a competent medic, I also both read the rule book and had a low tolerance for bad management and unequal application of the rules. The reward for being right and catching them out on a work rule violation, again, was to be moved arbitrarily during the next sign-up period to a day watch on Medic 8 with EMT Liz Crawford.
Liz was a few years older than me and had quite the reputation. She was known as the Black Widow among the paramedics, who were mostly white males, because she had a habit of eating male partners alive. She was also known by various other monikers such as "Dynamite Liz" because she was known to have an explosive temper. And by some shallow types as "Liz-a-bitch".
But in talking to my previous partners, all black, I learned that she was a good EMT who cared about her patients. Strongly. I figured that was all I really needed to form a good working team.
So our first couple watches together were interesting. And I'm not using the word in that east coast, New England way. You know. When you can't think of anything nice to say, you say it was, "interesting."
Getting back to the first few shifts with Liz and myself as partners.
Well, think pack mentality. Two alphas approach, circle, sniff and check each other out. The fact that I cared that the ambulance should be adequately stocked and after calls restocked, but didn't dump the entire responsibility onto her played into my favor. After checking each other out on calls we found we had a fairly similar approach to patient care and fortunately, I didn't try to boss her around or attempt to play para-god with her.
I also believe that the fact that I had a strong EMT background. Six years before going to medic school and then taking my first job out of school with a private ambulance service that had the 911 contract for Washtenaw County, MI that was about to go ALS but hadn't yet. At the time, as a paramedic all I could do above BLS was hook the patient up to a heart monitor, a LifePak 4, and once they went into cardiac arrest, insert an EOA. What this screwed-up system, that never did go ALS and ultimately went out of business did teach me was that the basics worked. With a paramedic education and the assistance of just a couple of tools, I relearned that BLS before ALS except in a very few circumstances, worked most of the time.
So consequently, by the time Liz and I were partnered up, I had developed the reputation as not being one of those paramedics that had forgotten where he had come from and didn't try to treat every problem by wanting to establish an IV or hook the patient up to the heart monitor.
But what sealed the deal for us was that certain elements of management liked to screw with Liz just to watch her get angry. Our fourth watch together Liz had relaxed enough around me to vent about the latest mind screwing, phrased differently at the time, she was receiving from a certain EMS supervisor and deputy chief.
A few minutes into this I learned that she had filed a written complaint and it had been ignored, again. I mentioned to her that according to the rules, that management had three business days to answer a complaint and if they did not, then the employee had the right to resubmit the complaint to the next level of authority along with a comment that the original complaint had not been acted on within the specified timeline.
At first she just looked at me like I was on drugs. But after we returned to quarters and I showed her the section in our employee manual, and then went on to point out that the bosses had to answer to their bosses as well and they could get in trouble for ignoring her, she shook her head and walked away.
I figured that was the last of it. When I returned from our three days off Liz had a big smile on her face and was waving both an acknowledgment of her complaint and a written apology from the same supervisor and deputy chief for not acting on her complaint in a timely manner.
The same portion of management that thought they were teaching both of us a lesson by putting us together suddenly were starting to have second thoughts.
In the mean time Liz and I, while opposites in many ways, became a tight crew and grew to be pretty good friends. We banged the calls out and would even jump other crews' calls. By God! We were getting paid for 10 hours of work per shift and nothing made the watch go by faster than banging out the calls. Especially the good ones. And in 1981 St. Louis had beat out Miami for murder capitol USA so there were plenty of hot calls.
(Miami, frustrated that we had snatched their 1979 & 1980 titles away from them, reclaimed the title in 1982. I would like to think that it was in part because we had a better EMS then they did and more of our victims survived the event then did theirs. But that is probably just fanciful thinking.)
I also learned first hand that Liz was tough. I mean pure mad dog mean and tough. There was no backing down with that EMT. We would roll up on a call and someone would start screwing with us. Usually by attempting to play the race card on me.
I never had to say a word. Liz would be up in their face. And size didn't matter, Liz was 5' 7" and rail thin but, well as that old cliché goes, "It's not the size of the dog in the fight..."
Before I could even say a word she would be cutting the line of racist drivel off. It usually went something like, "Look you called for a paramedic, well Mr. Rookah is a paramedic. If you are or whoever you called for is doing so well that you can run your jaws about his color rather than have him look at your friend, then your friend can't be all that sick!"
That's putting it politely. It was usually a whole lot more colorful and intense.
By now the hapless individual, usually a male, would be backing up and trying to figure out how they were going to get themselves out of this problem. She would be staring them down and I would step in and say something like, "why don't you show me where your mother is" or "why don't you get your wife's medications for me" or some such line.
These poor guys were usually in such a state of shock that they would mumble something like she's over here and all thoughts of race went out the window. Which was a good thing. Because if I didn't step in, about half the time, the hapless male who had started things would try to recover his dignity and the game would be on.
And it would pretty much always end the same way. Eventually he would get around to saying something along the lines of "You can't say that to me. I'm a man!"
I could be doing CPR and when I would hear those words I would leap up because I had another life to save. I would insert myself between the two of them and redirect the guy on to some task because if I didn't, the next words out of Liz's mouth would be, "Just because you got that between your legs don't make you no man!"
And then the fight would be on. And Liz would win and I would have a second, now wining patient to deal with and paperwork to fill out. I never got directly involved in these conflicts. There was no need to. I just covered Liz's back and stood down anyone else who attempted to jump in, which was infrequent and occasionally got it on with the rare fool who tried. As a crew we never picked a fight. But we never, ever came in second either.
We had a good working relationship with the coppers in our station. The way the system in St. Louis worked back then, we almost never ran with the fire department, unless it was for a fire or a vehicle accident. If we had a cardiac arrest we ran a two person code until a second ambulance arrived to assist with the code and transport. If we needed a lift assist, our district police officers would respond to help us out.
As I mentioned, we had a great working relationship with our police officers. Both on the street and in the station. Where we would frequently be called upon for a curbside consult on some injury or medical condition that one of them or a family member might be having.
Hopefully I have set the stage for the call where Liz went from being a tough partner in the good way to becoming my definition of tough.
It was a sunny late March weekday morning and we were dispatched to an apartment building to evaluate an elderly woman on an unknown medical. We were met at the door by one of our police officers who had just gotten off the night watch.
His mother was a widow and he usually called her each night and again in the morning when he got off before going to bed. He hadn't been able to reach her all night and when she didn't pick up the phone this morning he went over to check on her. And then called us.
Liz and I followed the officer into the very neat apartment to find a woman in her 70's laying on the floor, staring at us but unable to speak or respond to us. It was only 08:45 but her electric clock, which was unplugged and laying on the floor next to her read 9:17.
Just then she had a grand mal seizure. Liz and I rolled her into the recovery position and placed her on a high flow oxygen with a non-rebreather mask. The officer remained calm and told us his mother did not have a seizure history and the only medications she was taking was for high blood pressure.
The seizure quickly ended and she almost immediately returned to staring at us like she understood what was going on but could not respond or move. Her vitals were elevated and her BP was sky high. There was no doubt in either Liz's or my minds that this woman was having a stroke and it had started over 11 hours ago.
The officer and I sit-picked his mom and carried her into the front room of the apartment. In the meantime Liz grabbed the jump bag and ran out to the ambulance and single-handedly unloaded our Ferno two-man gurney, dragged it through the snow, up the seven front steps and in to us.
The three of us loaded the woman onto the gurney, who was starting to have another seizure, and made our way out to the ambulance.
Some of you may be wondering why we didn't start and IV and break the seizures with a dose or two of Valium. The answer is as simple as it was stupid. We didn't have any.
We carried it when I had been hired in January of 1980. But in 1981 it had been pulled from all of the units. Not because we didn't know how to use it or there were inventory control problems with it in the field. No.
It seems that five units of Valium went missing out of the drug locker in the EMS supervisor's office. Management's solution. Remove Valium from our drug inventory.
So we were back to the ABCDs for taking care of this patient. And unfortunately the D did not stand for Diazepam, but rather diesel.
We were at the back doors of the ambulance. We had just lowered the gurney down to the ground and were about to pick it up when our patient went into her third seizure. Liz and I picked the gurney up and had just gotten the front wheels up onto the ambulance deck when disaster struck. I felt the gurney start to pull back on me as I was pushing it in and out of the corner of my left eye I saw Liz's right knee buckle and bend backwards in way that it was not designed to do so.
I stopped the backwards movement of the gurney and shoved it in from my side dragging Liz up to the back ambulance door. I looked at Liz half bent over, clutching the door with her left arm to keep from falling over and her knee with her right hand. Her face was a mask of guarded pain.
I quickly made one of those medic decisions reformulating a course of action I thought would take care of both of my patient's problems. Like I was in charge or something.
"Look Liz, let me get a line started on our patient and then I'm going to put you in the captains chair. Just guard her airway and I'll have another crew meet us at the hospital."
Liz looked up and grabbed me by the front of my shirt with her right hand.
She was still hanging onto the ambulance door with her left hand and she fixed me with "that look". The kind where you suddenly start hearing the song from the final gunfight in the movie "The Good, The Bad and the Ugly" in your head. The kind that made me know that there was only right answer and everything else would be pain or worse.
"That lady needs a paramedic so get your paramedic butt in there and take care of her!" She gave me a shove and then turned to close the doors.
As I got our now postictal patient hooked up to the heart monitor and switched her over to the onboard oxygen I heard Liz clawing her way down the side of the ambulance, dragging herself by the rain gutter along the roof and painfully pulling herself half step by half step to the driver's door.
I listened as she let out a little cry/grunt of pain as she pulled herself into the driver's seat, start the unit up and proceed to give us a very smooth code three ride to Barnes Hospital. All the while driving and braking with her left foot.
I got two IVs established and radioed ahead for a crew and a supervisor to meet us at the hospital. That my partner had blown her knee out and that we were code three with a seizing stroke patient.
Liz got us to the hospital where we were met by two crews, followed shortly thereafter by both EMS supervisors, the deputy chief and the chief. Liz consented to let us unload the patient without her help.
After giving a quick hand-off report to the ED staff I left the other crews to move the patient to the hospital gurney, grabbed a wheel chair, because I knew Liz would not tolerate a hospital gurney, and went back out to the ambulance.
I would like to say that Liz started to pull herself out and this time I grabbed her by the front of her uniform with both of my hands and firmly pushed her back into the seat. "You're not going anywhere until I splint that leg."
And you know what, she let me.
I bound her good leg to her injured leg and then picked her up in my arms and set her down in the wheel chair. One of the other medics handed her an ice pack which she put on her knee and I wheeled her into the ED and over to a hospital gurney. I picked her and put her on it as gently as possible.
When the grimace cleared from her face she smiled at me and whispered, "Not bad for a white boy."
But that's not how it happened. I brought the wheel chair out and went to pick her up from the driver's seat to place her in the wheel chair.
She pushed me away while saying "Get your hand off of my butt." It was said with a smile through the pain as she lowered herself out of the ambulance and sat down in the wheel chair.
I wheeled her in to the designated ED cubical and she did consent to let me support her injured knee and leg while she climbed out of the chair and up into the bed.
But the call wasn't over. By now I had two other EMS crews and the entire EMS administration behind me. I turned around to the bosses and firmly but quietly stated, I was told later, hissed, that Liz was going to be taken care of right here. At Barnes Hospital. That I didn't care what the rules said, we were not going to transfer her to City Hospital Number One.
Apparently some of Liz's toughness and reputation had rubbed off on me and both chiefs quickly reassured me that this was exactly what was going to happen. And it did.
Two days post-surgery I brought 3 of Liz's favorite things up to her. A two-liter bottle of Pepsi and two large bags of bar-b-que potato chips. She was pretty doped up on pain meds but was with it enough to thank me.
But the best was the "IV". I had emptied a 250 cc bag of D5W and refilled it with a half pint of scotch and spiked it with macro drip tubing. I grabbed a medication label from the nurses station and marked it as such. I made sure all the nurses knew that it was scotch and not to plug the line into her and then hung it up by her bedside with the tubing within her reach.
I pretty much finished my career with the City of St. Louis on Medic 8 and worked with several more good partners but those are stories for other columns. Liz was a long time in returning to the street. We partnered up again for one watch and then went our different ways, me ultimately relocating out to San Francisco in 1985.
During the course of my EMS journey, I have had the good fortune to work on some good units with mostly good to some great partners. Along the way I also had the chance to become a SWAT medic, a structural collapse/USAR technician and medic, a surf rescue swimmer and a cliff rescue type. A lot of opportunities for testosterone and adventures.
But throughout my 34-year-and-still-going career in EMS, Liz Crawford stands out as my platinum standard for tough. Partner tough and loyal. EMS tough and getting the job done. Street tough without crossing the line and becoming a bully.
[Jan 7 2008]
I pushed Narcan the other day. The first time in over four years. Some of you may be thinking "So what." or "Big deal." Or even the more derisive "Big Whoop.". However, having provided EMS for the southern half of Santa Clara County and the City of San Francisco for over two decades where we used Narcan, almost by the gallon, this was a familiar flashback. Heck we gave it so many times back then that as an EMS system, we had gotten into the habit of "hot shotting" it. Bypassing the formality of establishing an IV and just injecting it directly into the patient's veins.
And for those of you who may be cringing at this, we were not a system out of control. Just efficient and expedient. Or so we liked to say. However we drew the line there. Unlike our brother & sister medics across the bay who developed the habit of giving Narcan sublingually by injecting it through the bottom of the patient's jaw.
But I am digressing.
Last week's run was a simple call really. We responded to the only trailer court, actually the house trailers, single and double-wides, are spread out over a ridge side. But when your jurisdiction is a glacial valley high up in the San Juan Mountains, that counts as a trailer court.
Getting back to the call, our intrepid local visiting nurse was checking up on one of her charges, a broken down cowboy and former champion team roper, a healer, who is only a few months older than me, when she noticed something was amiss. Actually Altered Mental Status.
Seems our cowboy had a medical history somewhat akin to that children's song, "I know an old lady who swallowed a fly". He had a degenerative back disorder that in turn led to immobility, which in turn led to the development of multiple bed/pressure sores and hot spots. One of which had been recently debrided almost down to the bone and he had a suction pump on over the wound site.
In turn he was prescribed a Fentanyl patch for pain control and after the debridement, also placed on Oxycontin, among other things. This is a Reader's Digest version of this man's med history but enough to set the stage.
So it seems that our cowboy was in significant pain and this particular morning he took not one but two of his Oxycontins. AKA, Hillbilly Heroin.
The prescription drug that conservative right wing radio commentator Rush Limbaugh became hooked on. Along with hundreds, if not thousands of North Americans north and south of the 48th parallel over the years.
Our patient was one we had seen numerous times over the past three years for a variety of problems. AMS secondary to alcohol to a fit of depression where he shot up his trailer court and held off emergency responders for several hours before being talked down and allowing us to transport him to the hospital. He was always initially angry on first contact but once we were able to talk our way through the anger, he was actually quite a charming and affable fellow.
This time he was in a recliner, snoring respirations of two to four with a room air sat of 61 percent and rouseable to moderate physical stimuli. Once roused he was lucid for 20-30 seconds but if left unstimulated, drifted back down to unconsciousness.
At my suggestion, my volunteer checked our patient's pupils, one of the most frequently overlooked or fudged patient assessment signs, and, you guessed it, they were pin point. My EMTs thought I was genius.
Truth is that I am just an old medic who has the benefit of working 20 years in the San Francisco Bay area, the heroin capitol of the US. I, like all of my bay area medic brethren and sistren have assessed and treated more opiate overdoses, straight up or in combination with other substances than you can shake a stick at.
As our volunteer EMTs and driver placed our cowboy on high-flow oxygen, which brought his oxygen sats up into the 90s, fantastic when your elevation is between seven and eight thousand feet, dozens of my former patients flashed before my eyes.
Like the time I was a new medic and was trying to figure out why my female AMS patient with pin point pupils had a huge wad of ice shoved down the crotch of her panty hose. Or the multiple times we had been called for the unknown medical eval in a hallway of an SRO apartment building only to find one, two and sometimes more patients, all in respiratory arrest and AMS.
It would turn out the patients had been in a "shooting gallery" and received a stronger dose of Heroin than they were used to. The fine operators of the gallery would dump the unfortunate user in the hallway or out on the sidewalk and call 911.
Probably the best war story about this type of call occurred to a brother San Francisco Dept. of Public Health Paramedic, Mike Tregassor, aka Tregasourous, back in the early 80's. Back then, after three in the morning, the City of SF would go down to five ambulances until the day units would start coming inservice at 05:30.
It was a busy night and all the other units were tied up on runs. Sound familiar?
Anyway, Mike's unit was dispatched to an apartment code two for a medical eval. Mike and his partner arrived and received no answer when they buzzed the apartment number at the door. Dispatch was unable to get anyone to answer the callback number.
Being resourceful medics, they went down every apartment number on the door panel until they were finally able to rouse one of the other building occupants to let them in. They trudged upstairs to discover the apartment door partially open.
Pushing the door open after no one responded to their knocking, they discovered that they had not one, but five patients scattered about the apartment. All unconscious and not breathing or grossly hypo-ventilating.
A shooting gallery that had the misfortune to be using a new shipment of Heroin that was stronger than the local junkies were used to.
My partner and I were just unloading an assault victim at San Francisco General Hospital when we heard Mike come across the air stating he had five H-ODs and needed at least two additional ambulances.
Dispatch acknowledged his traffic and then informed him that there were no available units and that they were on their own.
My partner and I just looked at each other and then informed the triage nurse that our patient was stable and that we had to go and we beat feet to the ambulance to back Mike up.
Mike in the meantime, I'm sure uttered a word or two of frustration but then became medic brilliant. He and his partner came up with one of those innovative solutions that they just don't teach you in EMT or paramedic school.
They dragged all the patients to the middle of the apartment and arranged them like spokes on a wagon wheel. Heads towards the center and feet out to the periphery. Mike's partner got out their only bag-valve-mask device while Mike hooked it up to their portable oxygen. The partner, I wish I could remember his name, then crouched in the center of the patients and ventilated each patient with two breaths before going on to the next patient.
Mike in the meantime ran back down to the ambulance and grabbed all the Narcan on the unit, which was a lot. He returned in time to help his partner disentangle himself from the oxygen supply tubing and continue to ventilate each patient in turn.
Mike then hot-shotted each patient with Narcan in whatever vein was most prominent. Whether it was the traditional anticubital, AC, or the less conventional external jugular. Every patient received 2-4 mg of Narcan.
Mike later stated that if he had needed to do CPR on all the patients, the way they had them arranged, he could have just literally jumped from chest to chest around the circle. Fortunately, this wasn't required.
The Narcan got all of the patients breathing again on their own. Two of them even woke all the way up. When my partner and I arrived we were greeted by the elevator door opening and Mike dragging a still unconscious, but now breathing patient by his collar and the two other patients who were now awake sort of assisting two other semiconscious patients.
We supplied some additional Narcan and helped transport all of these very fortunate folks to the hospital.
Ten years and dozens of Heroin overdose calls later, I was working the night watch with Vicki, my bride of now almost 24 years and sister medic.
In addition we had a ride along that evening. Lance Wright, an Auckland, New Zealand paramedic and friend, who was visiting the bay area and was spending part of his vacation riding with us.
It just so happened that a new shipment of Heroin had hit San Francisco that weekend and we were dealing with H-OD after H-OD the previous two nights. The hits just kept on coming.
I happened to be driving that evening and Vicki was attending, when we received a call for an AMS, possible H-OD in the 4th floor hallway of a Chinatown walkup apartment building.
We arrived ahead of the fire department but there were several police cars on scene. And of course the elevator was out of service. As we took to the stairs we heard a woman screaming and looked up to see a police officer's head pop over the banister and tell us the patient was not breathing. The head disappeared and then reappeared a second later with the statement.
"Oh my God! I can't believe my partner is giving him mouth to mouth!"
This had to be bad if the cops were doing a lip lock on a patient. So we chugged our way up 4 flights of stairs to find one officer with a screaming woman, she turned out to be the patient's wife, and a large unconscious male laying in the hallway outside of their apartment.
Lance lets out one of those cheery Commonwealth statements along the lines of "Oh goody, I've never seen Narcan given before."
We quickly explained as we started bagging (ventilating) the patient that we weren't going to give it right away. That the reason opiate overdose patients had the reputation of coming up combative after Narcan administration was not that we had ruined their high. It was hypoxia.
Opiates work by slowing everything down including the patient's respiratory drive. Opiate OD's die not because the drug kills them directly. Those patients who are found dead with a needle still in their arm, were not killed by the opiate, but rather what the drug had been cut with. Like Strychnine or something else equally unhealthy.
Deaths due to the opiates occur because the patient's metabolism and specifically respiratory drive have been slowed down to the point where they just forget to take their next breath. This is why your classic opiate overdose is AMS, weak, thready pulse, pinpoint pupils and either apneic or hypo-ventilating.
So we ventilated our patient with 100% oxygen. In the meantime we introduced Lance, who was wearing his New Zealand Ambulance Officer's uniform -- and as a station commander/senior paramedic had an impressive set of pips on his epaulettes. Our coppers were fascinated with him and proceeded to show him the patient's works set and other evidence to look for. It was all quite interesting and educational for Lance who asked a number of astute questions.
In the meantime, after two to three minutes of ventilating our patient, all the while accompanied by the rhythmic screams of his wife in the background, Vicki started hot-shotting Narcan directly into our patient's right anticubital vein. We gave all 8 mgs we had in our response bag. Spaced out one after the other waiting for the patient to recover in-between each injection.
Five minutes later our patient is still unconscious but at least is making some respiratory effort on his own. Man, this was some strong stuff.
Being the driver on this call, I was the one who had to trot back down four flights of stairs to retrieve more Narcan from the ambulance. On my way down I passed the fire crew arriving on scene and trudging up to the stairs.
After grabbing three more Narcans, I headed back into the apartment building and up the stairs. As I ascended, I noticed something was different but I couldn't figure out what. As I arrived on the 4th floor, doing that hypoxia breathing through clenched teeth, I handed the three Narcan preloads to my bride.
She handed one back and pointed behind me. That is when I figured out what was different. It was quiet.
Well except for the firefighter holding on to the upraised arm of our formally screaming wife who was now unconscious and in a crouched position.
She would have been passed out on the floor except for our firefighter holding her up by the wrist and shaking it saying "Lady. Hey lady. Wake up."
I walked over and hot-shotted her and fortunately she woke up with only 2 mg of Narcan. It was one of those surrealistic moments where she went from unconsciousness to looking up at me and stating, "I just had a baby."
Seems our couple had just had their seventh child, the other six already having been taken away over the years by social services, and were celebrating their latest child by sharing a fix. It was just a lot stronger than they were used to.
Both were taken care of by a total of 14 mg of Narcan between the two of them and pleasantly walked down to the ambulance for a ride back to the hospital.
Lance, in the meantime, was ecstatic, in that quiet British Commonwealth style. "Do you realize I've seen more Narcan pushed on this call then I've done in my entire career? Usually we just replace it because it has expired or the vial has broken. Thank you."
Yeah, like we scheduled this call just for him. But then again, we were somewhat blasé because this was typical for us but new for him. It was just another one of dozens of H-OD calls we had and would run during our almost 20 years with the city. The same basic theme but with varying subplots.
Like trying to coach a paramedic intern on the value of ventilating first.
Or put more simply, BLS before ALS. Yes, we know young Jedi medic that you have the silver bullet of Narcan. But let's treat the patient's hypoxia first and then see about administering it.
This has proved to be invaluable wisdom for multiple reasons. Like for those poly-drug users who use Cocaine or meth but hate the post-high crash so they snowball or speedball. Inject a combination of cocaine or meth and heroin. The stimulant for the desired rush and the heroin to ease the post high crash.
The problem, sometimes the heroin was too strong and they would OD. Our only clue was the patient's vital signs. Unconscious, apneic with pinpoint pupils but instead of a weak thready pulse, they would have a booming, bounding pulse and normal to high blood pressure.
These were the patients we would really ventilate well and then rather than blast the entire amp of Narcan in, would tease it in in small doses. Just enough to wake them up, but not enough to wipe out the chemical governor actions of the heroin, leaving us with a straight meth or cocaine patient bouncing off of the walls and ceiling.
Our airway adjunct device of choice for these kinds of calls was always the nasal pharyngeal airway. It accomplished the job and was well tolerated by the patients as they awoke. Frequently pulling out the NPA and staring at it with a puzzled look. More than a time or two a smart ass SF medic or firefighter would made the comment, "Hell of booger dude.".
We drilled this concept into one of our paramedic intern's head. We were running on his second or third H-OD call early in his internship. Again I was driving and Vicki was attending.
We arrived on scene and fire was already there and ventilating our female patient with their BVM.
Her boyfriend was quite amped up and talking away a mile a minute. His pupils were dilated big as saucers so I could tell his drug of choice was speed or some other stimulant. Being the good support medic, I culled him out of the scene and took him out into the hallway on the pretext of getting a good patient history on his girlfriend.
Over my shoulder I could see Vicki coaching our intern on getting the NPA ready. Selecting the right size, lubing it up with a water soluble lube and then he had fire stop ventilating the patient.
The boyfriend was proving to be high maintenance so he had most of my attention but I overhead our intern say, "Oh shit. Just keep ventilating her."
Turns out she was one of those folks that had established her individuality by having a septal nose ring and three additional rings on each side of her nostrils for a total of seven.
This turned out to be a good teaching call because without prompting, our intern went back to manual airway control and ventilating the patient up.
When he administered the Narcan, the patient woke up without a problem or a complaint.
In the meantime her boyfriend was becoming increasingly slow and slurred in his speech and when I rechecked his eyes, they were now pinpoint. I gave him 2 mg Narcan IM in the shoulder and we all walked out to the ambulance for the ride to the hospital.
There were many more H-OD calls. Especially around the Christmas Holidays.
As Vicki put it one Christmas Eve night after we had treated our 4th H-OD.
"There must be dozens of mothers across the nation who sent their son or daughter a check and said "here, buy yourself something nice for Christmas".
But the one Heroin overdose call that truly stands out in my mind, the one I learned the most from, and the one that I was humbled by occurred in 1992.
By 1992 I had been an EMT and later a paramedic for 19 years. I was more than a little jaded by everything that I had been witness to or participated in. And when it came to Heroin overdoses, I was more than a little callous.
Looking back, I was an arrogant schmuck.
(For those of you not familiar with this highly descriptive Yiddish term, it means a prick. As opposed to another great and equally descriptive Yiddish word, Putz, which means a limp dick. Used in a sentence like, "He's just a putz." or "Quit putzing around.")
My view on Heroin overdoses ran along the lines of the theme song from that 70's TV show, Baretta. "Don't do the crime if you can't do the time." So I didn't have a whole lot of sympathy or empathy for our H-OD cases. After all, just like the patient who drinks too much, they had chosen to do this to themselves. They rolled the dice and when I would see them, the dice had obviously come up snake eyes. Literally by the looks of their pupils.
Several times over the previous few months, my partner, Mike Whooley and I had responded to the same Tenderloin apartment for a 69 year old female H-OD. She had no veins to speak of and was skin popping the drug. We would ventilate her up and then administer the Narcan IM which would wake her up and immediately push her into withdrawal symptoms.
Pitiful and uncomfortable to witness, let alone experience. But it wasn't like I was pushing the Heroin on her. After the third or fourth time I had done this, while we were transporting her to the hospital, I asked her why she was doing this.
After all, the tradeoff with age for youth is wisdom over strength and endurance. And God Dammit! She was old enough to know better.
And that was when I was quietly knocked off of my arrogant high horse. She looked over at me on the squad bench and in-between dry heaves said to the effect.
"Sonny, I don't shoot that crap to get high. I have cancer of the spinal column. Two years ago the pain was so bad that even Laudanum wasn't touching it and I was in such constant agony that I was considering jumping off of the Golden Gate Bridge."
I was now feeling about two inches tall as she continued.
"My granddaughter, who had been the bane of my existence up until then came up to me and said, grandma, let me fix you up. And I was so desperate that I let her shoot me up. And you know what? It was the first time in over two years that I had been pain free. So I don't take this shit to get high.
I just take it to live."
"And I can't help it that this stuff isn't regulated by the Food and Drug Administration so when a new batch hits town every six weeks or so and is not stepped on enough for my usual dose, it knocks me out and you have to be called. So pardon me and get off your high horse."
I mumbled an embarrassed "Yes ma'am." And pondered her words for the rest of the transport. And Mike and I did see her several more times over the years. We adjusted the amount of Narcan we gave her IM, just enough to wake her up but not so much to push her into withdrawal.
Our system also did our own dispatching and maintained a frequent flyer book. After I completed the call, I went to dispatch and entered this patient's pertinent information and history so if anyone else had to respond to her they would go in with their eyes open and avoid my mistake.
And that lesson came back to me with my opiate induced AMS cowboy. I needed to rouse this fellow enough to breath on his own but not wipe out all of his opiate effects and either push him into withdrawal or slightly better, just put him back into a painful agony.
So after we ventilated him up to a 98 percent oxygen sat, I gave him 0.5 mg Narcan IM in his right shoulder. And within a minute he woke up and was not too unduly uncomfortable for our ride to the hospital.
Lesson learned. Mission accomplished.
[Sep 16 07]
How many of you are familiar with that Toby Keith song "Good as I once was" off his 2005 album, Honkytonk University?
The final chorus goes:
I ain't as good as I once was
my how the years have flown
but there was a time back in my prime
when I could really hold my own
but if you wanna fight tonight
guess those boys don't look all that tough
I ain't as good as I once was
but I was good once, as I ever was
I used to be hell on wheels
back when I was a younger man
now my body says, "You can't do this boy"
but my pride says, "Oh, yes you can"
I ain't as good as I once was
that's just the cold hard truth
I still throw a few back, talk a little smack
when I'm feelin' bullet proof
so don't YOU double dog dare me now
'cause I'd have to call your bluff
I ain't as good as I once was
but I was good once, as I ever was
maybe not be good as I once was
but I'm as good once, as I ever was
Last month, at age 51, I had this rather forcefully brought to my attention. I learned that I am no longer bullet proof. Or at least not cancer proof.
To set the stage, on and off for the past 20 months, I have been having blood and clots appear in my urine. At first my Dr. DX'd this as a "A silent Kidney Stone". We did several tests including an abdominal CT scan which showed nothing out of the ordinary. So I counted my blessings that it was painless and got on with my life.
After all, any of us who have been EMS for even a little while know that Kidney Stones are some of the most painful events known to mankind. Indeed, Dolorology, the study of pain, rates severe kidney stone pain as one of the top three pains. Rivaling only severe burns and severe labor pains.
So I put up with the inconvenience when these bouts, usually lasting 20-36 hours would hit. Over the months I did notice that they didn't just come out of the blue. They always seemed to follow heavy exertion.
This summer they were picking up in frequency. My Dr. an excellent and very experienced MD and good friend, revised his DX to a possible infection of the Prostate Gland and put me on a course of Cipro. The symptoms cleared up with in 12 hours and for the next month I had the added bonus of being bullet proof to Anthrax as well. But shortly after I finished the course I had three more bouts in two weeks, the last one being a heck of lot more intense and uncomfortable.
The most recent bout started Thursday, August 23rd, shortly after the completion of a three-day mountain/rope rescue refresher course. It just so happened that I had my annual physical scheduled the next day, Friday, the 24th, so when I went in and saw my doc, he agreed that this was looking a bit more serious.
We discussed the various possibilities or causes for having blood and clots in my urine from the most likely to more remote possibilities. Way, way, down on the list, so far down that my doc stated he was only mentioning it for the sake of being complete, was bladder cancer. However, since this is almost exclusively a disease for smokers and I have never, ever smoked or even toked (yes, I know, my mostly straight arrow boy scout past) that I practically had no chance whatsoever for this. He scheduled a cystcopy for me in a couple of weeks.
(A cystoscopy is where they insert a fiber optic camera up your urethra. Oh I was just looking forward to that!)
But wait, that very afternoon, I responded to a mountain rescue for a fallen hiker who had broken her leg. She was hiking alone on the Weehawken Trail and was about three miles in and a thousand feet up when a section of the trail gave out from under her sending her tumbling down a steep 400-foot drainage. Fortunately for her a sapling caught her about 20 feet down.
Unfortunately, she snapped her left tib/fib just above the ankle. Despite the fact that initially her foot was displaced laterally, she was able to crawl back up to the trail.
Being all alone and in an area with no cell service she popped several Advil and then proceeded to crawl down the trail for a half mile until she was able to get cell phone service and could summon help. Her call came at 16:25.
I was one of the first to arrive at the Weehawken trail head and immediately set off with my pack loaded with water, an IV, several analgesics, Benadryl in case she had an allergic reaction and Narcan in case I over-medicated her.
I may have been first up on the trail but over the next 2 and half miles, I was passed by a number of brother and sister rescuers. Part of this is just due to the fact that I am carrying a bit more weight than I should. And part of it was I was one of the older members of the rescue team. But I couldn't help but think that part of it was that I was a bit anemic from piddling out so much blood and clots.
I must have sounded somewhat like the Little Train That Could as I came slowly chugging up the trail to her and our initial rescue group. Like any of us would be in a similar circumstance, she was both grateful we came for her and somewhat embarrassed at the same time. I plopped down next to her and started both doing a medical history and working on addressing the fear that was behind her eyes and starting to show in her voice.
I learned later that she loved me for my calming and confident manner and the fact that I medicated her with Fentanyl prior to packaging her and then gave her a dose of Dilaudid for the carry out. Mountain Rescue loved me because, well as one of them put it "Gosh Norm, these things are a whole lot more fun without the patient screamin' or gruntin' with every step or bump."
I wish I could say that I assisted in carrying her out to the trail head.
But that would not quite be true. After assisting getting her litter, with litter wheel, over the first few obstacles, my own problems started to reassert. I found myself racing ahead of the carryout party, obstensibly to clear large stones off of the trail, but really to get far enough ahead to have some privacy. I suddenly was having to urinate bright red blood and small clots quite frequently.
So with a shuffling gate and consuming all the water I had brought up with me along the way, cleared obstacles off of the trail and watered numerous trees and shrubs along the way. Quite frequently.
We made it back down to the trail head just after full dark. I consumed a liter of water and then supervised the transfer of our patient from the stokes basket to our ambulance gurney and then on to the hospital. Which was over an hour away.
We were 7 hours on that very successful rescue from start to return back to county.
But I was a "hurtin' puppy" the next day and the clots got worse to the point that by Sunday I was clogged up and had to go to the ED myself to get catheterized. I am not going to say that a choir of angels broke out in rapturous song when the cath went in and everything came out. But it was close.
That was Sunday the 26th. My cysto was scheduled for Sept. 14th. Vicki, my bride of 24 years, sister paramedic and sword maiden, got on the phone with the Urologist on call for the group my scope was scheduled with and got that appointment moved up to Tuesday, the 28th.
So the rest of Sunday, all of Monday and Tuesday morning I was tethered with this catheter. Tuesday AM we go to the Dr. and within seconds of her removing the catheter and inserting this camera up my you know what she states "You have bladder cancer Mr. Rooker. We're going to have to operate right away."
My initial reaction was just a sigh and a resigned "This is going to be inconvenient." We found out that right away actually meant the next day.
So we spent the rest of the day finishing up various scans and tests for the next day's surgery, and notifying various family and close friends.
Oddly, several of my friends who are still working for the San Francisco Fire Dept. after expressing surprise, sympathy and wishes of good luck, mentioned that SFFD had just completed a department wide survey and sampling looking specifically for bladder cancer. So I am getting wired into that study.
(I also since have learned that bladder cancer is the second most common form of cancer for firefighters and is a growing international concern among the fire service world.)
The advantage of learning this suddenly and then jumping right on it are two-fold. One, it suits both my wife's and my type triple A paramedic personalities. Get it done and lets get it done now. Right now!
Two, I didn't have time to head trip over this. Everything was moving at just the right speed for us. Problem. We're doing something about it. No pussyfooting around.
So I show up for surgery at the Montrose Memorial Hospital. I had some excellent staff working with me on this. However, they weren't quite used to EMS humor or an old medic's insights on cutting through red tape.
This surgery was taking place on the Wednesday afternoon before Labor Day weekend. I am laying on the OR table, feeling mellow both due to pre op medications, and also meditation into a good space. I was going into this operation with a 100% positive attitude.
My Urologist comes in and after the initial chit chat including her informing that my tests from the previous day including a CT scan with contrasting dye revealed that the tumor was isolated to the wall of my bladder and had not spread to any other parts of my body.
I'm screamin' "YEAH BABY!" In my mind.
She then informs me that the pathologist stated that he would try to have the results of what they were about to remove from me back by Friday afternoon but it would more likely be next Tuesday because of the holiday weekend.
I looked up at here and in all seriousness requested she tell him that I would buy him the finest Scotch Whiskey of his choice if he would get the results back to us by Friday.
Everybody in the room laughed and the last thing I remember is the nurse anaesthetist saying, "Very funny Norm, here take a few deep breaths of this."
The next thing I know I am waking up in post-op feeling darn good. Make that perky. I knew without anyone telling me that everything had gone well.
The surgery, which was also done up through the ureter, went very well and I awoke with zero pain or discomfort. Not even that helpless, hungover feeling.
An overnight stay in the hospital and released the following morning being told I was looking entirely too healthy and perky to have had this disease and/or surgery. The only problem, I had to keep this darn catheter in me until the following Tuesday. The second problem. I felt too damn good.
I was placed on light duty restrictions, no heavy lifting and absolutely no, none, nada, nuca, mountain rescue until October. Vicki is all over me on this because, as she puts it, "I know you" and "after all, you're only just a man". I would be upset if both weren't true.
So Vicki put the word out service-wide. I show up on calls and I have a crew of EMS Sherpas/ porters to carry my jump kit and/or other stuff. And no patient lifting or movement. Which is hard for me because I always lead from the front. I have more experience with patient movement and safe lifting than my entire service combined. And I also feel like I am protecting them from possible injuries during patient movement/lifiting/loading by doing and making sure it is done right. So this is a tough head trip/battle for me.
However, I was good and stayed completely off the job, not even responding to calls until last Saturday, September 8th. Of course it didn't help having my 12-year-old nephew Thomas say every time the pager went off "Bet you wish you could go to that one Uncle Norm." Little butt head.
But I'm getting ahead of myself. Tuesday September 4th, I returned to the Urologist's office for a follow-up exam and to have the catheter removed.
It was a darn distraction and somewhat uncomfortable, except at night.
There is a lot to be said for being able to sleep all night without having to get up to go to the bathroom. The pathologist's report, which was supposed to have been ready Friday, was still not in yet. I learned that she had not taken my offer seriously and had not relayed it to him.
However, just having that thing removed and discovering that I am free and fully functional again was relief enough.
The next day, Wednesday the pathologist's report finally arrived. I had a Class 2, low grade, non-invasive tumor which had not penetrated my bladder wall and they had successfully and completely removed it. All of it.
So I am happy and healthy and this turned out to be just as I predicted, an inconvenient medical speed bump on my life's journey. However, my urologist and I have become friends for life. She will be doing a cystoscopy every three months beginning this November for the next two years. If everything stays good this will be cut back to twice a year for the next two years and then, annually till one or both of us dies.
And I am doing well, other than my stamina is a little low but slowly getting better with each day. I was lucky. I got away with ignoring a symptom my body was telling me for over a year and a half.
The final word from my urologist and another bladder cancer survivor, who just happens to also be a retired paramedic/firefighter, any painless bleeding in your urine should be considered a major warning sign of bladder cancer unless proven otherwise by tests and exams.
So take care everyone and be safe.
Editor's note: A great resource:http://www.firefightercancersupport.org
Just Another Day At The Office [Jun 5 07]
This August 23rd will mark my 34th year as an EMT and now, EMT Paramedic.
Invariably when I share how long I have been in EMS, someone, sometimes several someones, will say, "Wow! You must have seen just about everything!"
Nope! Not by half.
Why just last week I looked up from my desk and out the office door to spy a young man panning for gold. No, the EMS office is not on a river bank or lake side. The Ouray County EMS office is located in the basement of the county courthouse. However, only eight and half percent of the roads in Ouray County, CO are paved. And most of that is the two state highways that double as main street in the City of Ouray and the Town of Ridgway. Where the two come together is the site of the only traffic light in the county.
This means the other 91 plus percent of the roads, including both roads that border the Ouray County Courthouse are dirt. And this being a very wet spring up here in the mountains of southwestern Colorado, a spring popped up. Unfortuantely in the basement of a local residence.
The homeowner was able to funnel the water out to the street where the run off quickly clogged the upper storm drain system with debris. The City of Ouray's solution was to divert the water down 6th Ave. to a larger storm drain system while they made emergency repairs on the upper system.
Consequently for the past several weeks I've had a stream flowing in front of my office.
With each day of flow, the erosion carves deeper into the roadbed. It has become the science project for the local 7th grade. One afternoon the sheriff and I organized a rubber duck race down the causeway. (Well, it seemed like a good idea at the time. No alcohol was involved. Honest.)
So it really didn't come as any surprise to find a young man industriously panning for gold in what used to be my parking space. Just one of the many day to day events and adjustments that those of us who practice EMS in the rural/frontieer environment have come to expect and take into stride.
Like having to write a cattle drive response SOG. If anyone had even hinted that when I took the chief's job that writing a cattle drive SOG was in my future, I would have just smiled and responded, "Yeah, right."
Well as the old addage goes, never say never.
Twice a year several of the local ranchers move their herds from their winter pasture down in the valley to their summer pastures at higher elevations, and then back again in the fall. This is always an interesting event. Especially if there is a motorcycle tour or poker run attempting to take place at the same time on the same roadway.
The drive is scheduled well in advance. Waivers are filed for and received from the Colorado State Patrol and the Colorado Department of Transportation as traffic flow patterns on the state highway affected will be temporarily disrupted. (Not to mention that road conditions deteriorate a bit in the wake of four to six hundred cow/calf pairs. Not fun for thoses motorcyclists at all.)
On the day of the cattle drive local law enforcement provides lead and follow vehicles to handle traffic control. And the drive generally goes smoothly. So why an EMS SOG for this?
Well, if you have to get through one of these drives, it can be both a potentially frustrating and sometimes a quite "sporty" proposition.
Two summers ago, the Wolf Cattle Company was doing their fall drive down Highway 62. Everything was going according to plan. The Ridgway Marshal was bringing up the rear of the herd when an SUV full of semi sober Oklahoma Elk Hunters came roaring up behind him flashing their lights and honking their horn.
I must digress here to comment on the entertainment that drunken elk hunters from Oklahoma have been known to provide us emergency responders up here in the mountains. Our only "shooting" incident for that same year involved one of these types, definitely under the influence of alcohol, who was having a quick draw contest, fortunately just with himself. As is want to happen, he pulled trigger before he cleared leather. Luckily for him, his ego was hurt worse than his leg.
Back to our story. The Marshal got out of his vehicle to find out what the fuss was about and quiet these fellows down before they spooked the cattle.
He was greeted by four hunters, all in the "Bubba" size and category, one of whom was having a heart attack.
The Marshal quickly radioed for an EMS response. The problem was that the herd was between us and him. This then newly relocated urban medic learned several things that day.
One, cattle aren't particularly impressed by lights, sirens or even a honking horn. Horses on the other hand can get down right skittish and frequently spooked by the same stimuli.
Two, nudging a cow with your bumper just ticks her off. It also upsets the trail boss and cowhands attempting to manage the herd and their now skittish and spooked horses from your earlier efforts to make your way through the herd.
Three the footing can get quite slippery following a herd, especially if you get out of your response vehicle and push your way through the herd to get to the call.
As for the elk hunter, he went into cardiac arrest and took his last breath just as we were able to push our way through the herd. The crew had a heck of a time pulling him out of the Marshal's vehicle and initiating CPR.
There was more to this call, including dodging copious amounts of emisis prior to getting the patient intubated.
(Why does it always seem like these guys have just consumed massive amounts of beans and beer brauts just before these events?)
Anway, the Marshal, the EMS crew and a local MD did a heck of a job inspite of all of this. Their combined efforts resulted in a field save.
However our patient never regained consciousness, and was ultimately transferred a week later, still in a coma, to a facility close to his hometown in Oklahoma. This fellow's misfortune however has resulted in a fair number of changes to our local system.
The first is that OC EMS has since trained every law enforcement officer in the county to at least the first responder level. We have also provided every law enforcement vehicle with a first responder kit and portable oxygen set, which we maintain and restock out of OC EMS supplies. We are also pursuing a grant to purchase and place an AED in each of those vehicles as well.
The Marshal and I worked with the Ouray County Rancher's Association to develop a Cattle Drive Response SOG. Law Enforcement now includes EMS in the notification process for these events. On the day of the drive, the trail boss is issued a walkie-talkie tuned to the county emergency response frequency. If we have an EMS response through his drive, he and his drovers bring the herd to a stop and push it to one side of the road to open up a lane for us to get through.
And we have advised our drivers to proceed silently and with caution both when approaching, passing through the herd and especially after coming out the far side. That road conditions can become quite "slick".
So when folks ask me if I miss the excitement and action of the "big city"
I just smile and reply that no matter where you practice EMS, the entertainment factor is always pretty high. Take care and be safe everyone.
They call me Hawkeye [Jul 10 06]--How many of you remember the
old joke that goes something like...
My crew of paid staff, that would be Kim, and volunteers decided that this year’s entry into the parade would be a float involving my Tahoe. I come back to get one of those good news bad news announcements.
The good news, Ouray County EMS’s float took third place and we had even received a third place check for $25 which we immediately put towards the department Christmas party.
The bad news, Kim and the gang all were wearing Rudolph the Red Nosed Reindeer noses and had either doe ears or antlers on along with various appendages bandaged up.
this prominently featured in the local newspaper’s coverage of the parade.
thinking back to the opening joke about the Scotsman, there really are worse
things to be known for.
Beware when you battle monsters
[Jun 23 06]--I hadn’t realized just how much truth there was to the old
adage that if you battle monsters long enough, you are in danger of
eventually becoming one. This point was driven home to me this past New
Another day in paradise [Jun 13 06]--I received an e-mail this
evening from my long time friend and former partner, Mike Whooley. Mike is a
Rescue Captain (paramedic supervisor) for the San Francisco Fire Department.
Whooley is a Gallic word that translates to "a fun drunken brawl". Used in a
sentence such as "Aye, I love a good whooley." An apt description for my
friend and brother warrior medic.
The 911 Cowboy Rides Again [May 23 06]--Like all good paramedic war stories, this one starts with "So there I was..."
So there I was, driving to Ridgway through the tail end of a five-minute rain storm to meet the Ridgway Marshal, David Scott, aka Scotty, for lunch when word came over the radio that a herd of cattle was stampeding towards Hwy 550. I caught sight of Scotty turning off of 550 onto County Road 12 so I followed him to a cut off for some fields. There must have been 250 to 300 cows and calves sort of streaming, not running across a field and up on some people's houses and porches.
We blocked the exit road with our vehicles and then proceeded on foot to cut off the head of the herd that was meandering, make that moseying through people's yards towards the state highway.
Turns out that fast moving storm front that had passed through had a little lightning and thunder and the cows had spooked and broken through a section of fence about a quarter mile away. The report of running/stampeding cows had been for their initial escape. But hey, they were finding out the grass really was greener on the other side of the fence and they had slowed down to a slow, munching sort of meander.
So I trotted up the road and then west to head off the leading edge of the group that was scattered all over the place. I had three objectives in mind. Don't step in any cow patties, watch out for prairie dog holes and dodge through the mesquite, sage and other brush.
So an hour and a half later, I'm warm, not hot, dusty, and sore in the shoulders from waving my arms so much and yelling "Hey, Hey, Hey!" and "Move cow!".
When you have a herd that big, it really is like herding cats because you get one section or group moving and others try to slip out sideways. I'm running. Make that trotting around with a couple of short sprints thrown in for good measure to head off a cow/calf pair or two that decided to take a different path. All this with one hand on my hip to keep my walkie-talkie from popping off of my belt.
I sort of had fun. After all, I did help bring in the herd. Or at least help move them back about a half mile to the section of fence they had come through and then back through it so the rancher could then fix it and calm them down.
At one point I'm at a choke point moving a group past me towards the fence and I found myself saying "Come' on folks, move along. Show's over and there's nothing to see."
I thought Marshal Scott was going to blow his wad of chew he was laughing so hard when he heard what I was saying.
Anyway, like I said, I sort of had fun but I bet it would have been a whole lot easier on a horse or a 4 wheel ATV rather than afoot. But the herd was saved, the public made safe and a whole lot of terrain was freshly fertilized with cow pies. And as for me, nothing that Advil and a Tequila Sunrise won't take care of this evening.
Not bad for a 50-year-old urban medic who has recently relocated to the country.
Currently Norm Rooker is Chief Paramedic, Ouray County EMS in Ouray, Colorado.
He has also served as both a speaker and the
medical track leader for SAREX 2001, the California State Search and Rescue
Conference put on by the Governor's Office of Emergency Services.
He has been a Heavy Rescue Instructor for the California State Fire Marshal’s Office, an EMT-T and is a member of his department’s surf and cliff rescue teams and technical rescue committee.
He is a member of the NASAR External Affairs Committee, Chair of the Technical Affairs Committee as well as the chairman for the NASAR Flood & Water Rescue Advisory Group.
He is a past member of the NASAR Medical Advisory Committee and one of the developers of NASAR’s Search & Rescue Medical Responder, SARMR, Program including writing the chapter on burn injuries for the SARMR text book.
Previously on Norm Rooker: The 911 Cowboy
Not as good as I once was
Just Another Day At The Office [Jun 5 07]
They call me Hawkeye [Jul 10 06]
Beware when you battle monsters [Jun 23 06]
[Jun 13 06]
The 911 Cowboy Rides Again [May 23 06]
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