Be well. Practice big medicine.

Music, EMS and memories (good and not so good)

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 seven 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.

Leave a comment