Be well. Practice big medicine.

Norm Rooker’s The Hammer & The Spoon

Intro from Hal: Norm Rooker’s been away from these pages for far too long. He’s back with this classic whitewater ride down the stream-of-consciousness.

When Norm reminisces about his early days it primes my own memory machine. So, here’s one that many of my colleagues like to dredge up each time we get together for a beer.

Back when I was a rookie paramedic, many moons ago, in the very fledgling days of full ALS prehospital care we rolled on a call for a cardiac arrest in a church. And not just any church. It was St Joseph’s Oratory – a great basilica with a giant copper dome reminiscent of St Peter’s in Rome.

We were in the midst of coding the patient right there in the pews when a priest approached and asked for the patient’s name. Not realizing he wanted to lead other parishioners in prayer, I was a bit too quick and far too loud with my response, “He ain’t yours yet, Father.”

That line has resonated for more than three decades and I suspect it still has a long ways to go before it finally fades into the background noise of a life spent in EMS.

Find a comfortable chair, prepare a mug of good coffee and enjoy some vintage Norm Rooker.

Norm Rooker’s The Hammer & The Spoon:

Last July Vicki & I drove back to California to attend the wedding of the son of my former EMS partner and best friend, Mike Whooley. Mike was officiating the wedding, having become an “ordained” minister for $42 for a religion that shall remain nameless. However, it was legal for him to perform wedding ceremonies and he was doing it for his son Jon and soon to be daughter-in-law Isabella.

Knowing Mike as well as I did and his sense of humor, I half expected a revival style religious ceremony complete with two costume changes, a gospel choir and possibly a couple of rattlesnakes to boot. However we all have mothers and Mike’s had “re-established” her own rapport with him and made it known that her grandson’s wedding would be short, sweet and calm. I guess Mike also had his own understanding of “Mama Mad”. [see]

The outdoor wedding at a former Boy Scout camp in Mendocino County was well done, nicely moving and under 20 minutes. Even with a last minute stall and need for parental navigational guidence by one of the flower girls.

The reception afterwards was also enjoyable and a chance for Vicki and I to catch up with Mike and another long time medic friend, Hans Enz and his wife Pam. After catching up with each others’ lives, the stories began to flow, some of them a bit embarrassing. Like being reminded that I had had a policy named after me almost three decades ago.

Having a policy named after you is rarely a good thing. I was driving into work, in uniform and happened onto a horrific rollover traffic accident right at the city limits. Actually it had begun in San Mateo County but the momentum and kinetics carried the vehicle and tossed the patient into San Francisco’s city limits.

Back then we all carried our own personal jumpkits. I had developed the habit of keeping mine in my vehicle as I had low seniority and was frequently detailed to different units. I got out, treated the patient, who was in full arrest with CPR being performed by a trio of vacationing MDs and a vacationing Iowa EMT.

There were also about 30-40 bystanders milling around on a 4 lane highway with traffic still whizzing by in the three open lanes. The patient, a young lady who appeared to be in her early 20’s had several laundry baskets filled with children’s clothing and an empty car seat in her vehicle.

I quickly organized the bystanders into a search line and had them do a line sweep along the side of the highway to make sure we didn’t have a second patient. This not only ensured that we had all the patients but also got everyone off of the freeway.

I then pulled my jumpkit from my car, intubated the patient and started a line. When the ambulance arrived to transport the patient I gave a quick handoff report. While the crew packaged and loaded the patient I filled out the intubation paperwork we had to submit as a separate form back then and sent it in with them to the hospital.

Later there was a fuss about an “off duty” paramedic carrying ALS equipment. Fortunately I was exonerated in the investigation and even commended for stepping up and doing the right thing and a good job. However the “Norm Rooker Intubation Policy” was created that stated that no ALS equipment, IVs, medication or intubation equipment was to leave the ambulances or stations.

I was also reminded in that medic tough love way that I had been known from time to time, to well, push the edge of the envelope, so to speak. As an inquisitive young man I learned at an early age that no, while it may frequently also remain as the end point, was just the opening position or negotiating point. This knowledge/belief allowed me to have some great adventures and experiences growing up and served me well as a young EMT and later medic as well as a field supervisor and later an EMS Chief.

Like the time back in 1995 when Vicki and I were attending the EMS TODAY Conference in Orlando, Florida and ended up having quite the adventure at Cape Kennedy. (I know, technically it is Cape Canaveral and the Kennedy Space Port but for those of us from a certain generation who grew up with the space race, it will always be Cape Kennedy.)

Anyway, two years previously Mike & I had attended the National Association for Search And Rescue’s annual conference in St. Petersburg, FL. One of the numerous presentations was by the then NASA Mode 7 Astronaut Rescue Team. It was impressive and Mike and I talked with the two presenters for some time afterwards and ended up exchanging business cards and receiving an invite to tour their fire station should we ever make it over to the Cape.

At the end of the EMS TODAY Conference Vicki & I spent a couple of days touring the area including driving out to Cape Kennedy. Vicki reminded me that I had met the Mode 7 members so I pulled into the entry check point on the causeway to see if their invite was good.

Needless to say the civilian security personnel had seen more than their fair share of visiting firefighters and medics attempting to visit the Cape Canaveral Fire Station. They initially informed us it wasn’t possible but when I mentioned that I had an invite from one of their fire captains they said I would have to first clear it through security and then the fire chief.

Well luck was on our side. The assistant head of security was on her lunch break, who I was later informed would most definitely have said no. Instead I was patched through to the head of security. After explaining who I was, how I had met a pair of their Mode 7 team members two years earlier and the invite, the security chief stated he had no problem with it if the fire chief said it was OK.

The civilian security guards were now perking up and starting to pay a little attention as I was then patched through to fire headquarters. The first fire officer I spoke to said the answer was no, that they received literally dozens of requests like this and besides I would need to be cleared by security first. I explained to him that I already had been cleared by the chief of security and he had patched me through to them.

All of sudden there was a pause, and then I was placed on hold for 5 minutes or so. The next person on the line was the Chief of the Fire Department. He asked me to run through the entire story again. After I shared my story and concluded by giving my affiliation as a paramedic/firefighter and rescue swimmer for the San Francisco Fire Department there was a long pause.

That pause was followed by laughter and the chief informed me that they normally never did this sort of thing but he had just returned from a fire chief’s conference and had been very well treated by a contingent from the California Fire Chief’s Association and today was my wife’s and my lucky day as he was going to return the favor. He had me put the now very attentive civilian security officer on the phone.

Fifteen minutes later both Vicki and I had our one day NASA photo ID badges, which we still have, and were picked up by a somewhat suspicious Battalion Chief. Initially he was very reserved as he sized the two of us up, both wearing shorts, sandals and sports shirts. He explained that they NEVER gave tours like this.

Gradually he relaxed as I explained again how this had all came to be and if he had somewhere to be we understood and would be grateful for just a few moments of his time.

It turned out he was in charge of the Astronaut Rescue Program. He had been with the Cape Kennedy Fire Service for almost three decades having been hired on in the wake of the February 21st, 1967 Apollo 1 fire that took the lives of astronauts “Gus” Grissom, Ed White and Roger Chaffee.

As a result of that accident the Cape Canaveral fire department’s role was significantly changed and three firefighters, one for each Apollo Astronaut were to be included as part of the final gantry crew along with three gantry technicians, in case another fire incident were to occur.

The astronaut escape sled was created on guy lines from the top of the gantry to sand pits on the ground as a rapid way to clear all the astronauts and gantry personnel away from a potentially explosive situation. However, once the system was put in place there was significant concern among the various people who might have to potentially actually utilize it that the G forces generated by such a rapid descent and deceleration would be too great for anyone who rode the escape sled to survive.

It turned out our tour guide was one of only three people/human guinea pigs to have ever ridden the sled. A test was done with a representative from the fire department, the gantry techs and the astronaut corps to ride the sleds. They all survived with little more than bumps, bruises, sore muscles and some serious bragging rights.

We ended up getting an almost three-hour tour and were shown some sights that we had only previously seen in videos. We also had a number of great conversations about our memories of the various space programs along with some inside accounts of various aspects from a rescue/fire suppression perspective.

We also discussed what went into training the rescue team, unique rescue factors like they all wore level B Haz Mat protection with the exception of wearing athletic shoes instead of rubber boots. I followed up with a question about maintaining safe body temperature and hydration if they were suited up for hours prior to a launch.

All in all we had an excellent experience that never would have occurred if I had assumed the answer was no or accepted the first no response on my request.

However, just as many times, no really does mean no. What follows is based on how one makes their request or receives the answer. Trust me; I have also had more than my fair share of disciplinary/ motivational conversations. Both from the giving as well as the receiving end.

On the giving end, I can’t begin to tell you how many times as an Acting Rescue Captain or later as a chief I have had an excited member of the service come up with some, well, very interesting requests or suggestions. For any management types or future supervisors, here’s one phrase that might come in handy down the line, “Well, that’s one option.”.

And on the receiving end, well let’s just say from a very early age I had learned via some of my southern relations, just what a “Come to Jesus” experience was all about. And it had nothing to do with going to church.

Moving on, Mike and I, along with working full time as paramedics for the City & County of San Francisco, Department of Public Health Paramedic Division and later, the San Francisco Fire Department, also used to do quite a bit of teaching on the side. Indeed, it is the rare EMT or paramedic that doesn’t or isn’t working multiple part time, side or “hobby” jobs.

For that matter, it is the rare child of an EMS parent or parents that hasn’t been “volunteered” to be a patient or rescue victim for any number of EMS training courses or exercises. Vicki and I knew we had done well when we came home from shopping one day just in time to overhear our than 15 year old daughter yelling at the TV set “That’s not how you hold c-spine!”.

Anyway, the numerous EMS & rescue related side jobs included just about everything from preaching the gospel of CPR with a near evangelical enthusiasm to teaching the various merit badge EMS courses; Advanced Cardiac Life Support, Pre-hospital Trauma Life Support, Pediatric Advanced Life Support, etc.. I also taught rope and several technical rescue programs for several community colleges and a private concern that catered to the oil refinery fire departments and brigades in the bay area.

Mike and I also taught for several paramedic training programs as lecturers, skills instructors and in Mike’s case for one program, as the lead instructor. Actually, that was how I first met Hans and Pam. Hans was one of the paramedic students in Mike’s class during his stint as lead instructor. Hans successfully completed the program and was eventually picked up by the City of San Francisco where he still works today.

As the wedding reception continued, between speeches, toasts, cutting the wedding cake, etc., more stories were recounted. Some good, some best forgotten but always with a bit of humor, some teasing and sometimes, irony. Towards the end of the evening Mike reminded me of one special lecture I had given for a private paramedic training program, METS, in Lodi, California.

Mike and I were “guest” lecturers from the “big city” brought out to provide the students with a dose of reality based EMS to these semi-rural EMS providers to be. That and also give the lead instructor, for this account, we’ll call him “Jeff”, a break.

My specialty lectures were EMS for the Elderly; Burns; and Special Operations EMS. “Jeff” was a grizzled medic who had provided EMS in the foothills area of California for a couple of decades. He was very experienced and ran a tight, regimented program. Indeed all of his paramedic students/puppies were required to attend every class in the school’s uniform. Each class looked very sharp in their powder blue shirts with the school patch on the right shoulder, a white t-shirt, navy blue uniform pants, a black leather belt and black combat boots.

“Jeff” also guarded his lesson plans fanatically. If you were going to lecture for his program, you had to develop your own lesson plan and submit it to him in advance for his approval/quality control. He was very careful about not only what information was shared with his puppies but also the professionalism with which it was done. Not to say that he had a stick up his you know what. Just that he was a very conscientious instructor. And I say that in all sincerity.

So it took me by surprise when “Jeff” called me one day out of the blue and inquired if I could do a last-minute fill in for him and give the Neurological Emergencies lecture. I explained to him that Neurological Emergencies wasn’t my strongest point and that I didn’t have time to put together a lesson plan to his/our standards.

My medic “Spidey sense” should have told me right then that something was amiss when “Jeff” offered to let me use his lesson plan. But with raising two daughters, there was always a need for a little extra income, so unsuspectingly and more than a little naively, I agreed to do the presentation.

Note to self, if something seems too easy, it probably isn’t. I should have known better.

I read through the neuro emergencies chapter of Dr. Bryan Bledsoe’s paramedic textbook several times and the following morning made the hour drive on “Blood Alley”, a notorious stretch of Hwy 12, running from our home in Suisun to Lodi.

Having successfully arrived in one piece despite several motorists attempts to make my journey more interesting, I quickly discovered my second clue that something might be amiss. Jeff was there to greet me.

I had assumed that he wouldn’t be there. A Doctors appointment, a meeting or something. But no, he handed me his lesson plan and stated he would be in his office on the other side of the skills lab which was between the classroom and administrative section of the school and without another word, turned and walked off

After taking a few minutes to review his lesson plan, I took the class roll and then launched into my best effort at sharing this information. Not quite lecturing straight out of the book, but following it pretty darn closely.

Like most everything else in EMS, there is an old philosophy that goes “See one, do one, teach one”. The instructors I admired most or who I had gotten the best learning experiences from were all of the style of interactive, feedback method of instruction/lecturing.

So about 10 minutes into the neuro-anatomy portion of the talk I paused to ask a simple anatomy question. Silence. No response. It was so quiet that I almost imagined hearing crickets in the background.

But being a good medic and instructor, I pressed on. I answered the question for them hoping that the silence was maybe because they weren’t used to being engaged by an instructor during a lecture. After another few minutes of presentation I asked a second question.

Again silence. After a long pause, I answered the question and continued for another couple of minutes and then asked a third, very simple question. Something akin to what part of the body is the brain located in?

Silence. Except for the sound of my own pulse in my head as my blood pressure rose. Working to keep control of my temper I asked one more very simple question.

“Have any of you even read the chapter?”

Again silence. Not a word. Just a room full of “puppies” staring at me.

Still struggling to keep my temper I then pointed to the first student in the front row and asked him point blank. “Did you read the chapter, yes or no.”

Seeing that there was no way he could get out of answering my question he lowered his head and said very quietly, “no”.

I went through the entire class, student by student and reiterated the question. All 23 of them gave me the same response, no.

My vision was starting to blur as I struggled to keep my frustration and anger, now bordering on rage, in check. But in a loud and firm tone, the kind that communicates, even if one doesn’t understand the words, “you have displeased me greatly”, asked them how they would feel if I had just showed up and hadn’t bothered to read the chapter I was supposed to lecture on or prepared a lesson plan?

I let that hang in the air until finally one gutsy female student from the middle of the classroom piped up and stated I had no idea what it was like to have to work to support their way through paramedic school and pay the large tuition.

That was it, control was lost. Well mostly. I fixed her with a laser glare that sat her back down in her chair. Fortunately I caught the words just before they actually came out of my mouth. Later, much later, like towards the end of the paramedic training program, a couple of the students told me I turned red, swallowed and made several attempts to speak before words actually started to come out of my mouth.

It took all of my then over two decades of street experience to keep from over reacting and just spewing anger and frustration on this class of paramedic wannabes. I calmed down enough to first inform the class that they had no idea of my past or my journey to becoming a paramedic. How I had quit the private ambulance service I had been working for because it didn’t pay enough to support my first wife and myself and pay for my paramedic training. How instead I took a factory job working a foot shear cutting perforated metal for a company that made filters of all sizes. How I worked full time and attended school & clinicals three nights a week, both over an hour’s drive away.

How I worked a half day of “overtime” each Saturday to make up for the time I lost during the week leaving early for school or clinical rotations so that I could meet the bills and keep a roof overhead for my wife and I. How our social lives were limited to almost nothing that cost more than a dollar or two due to poverty and lack of time. But how it been the route I had to take to advance from Basic EMT to Paramedic.

So don’t even think about telling me that I don’t understand the sacrifices that many students have to make to upgrade from and EMT-Basic to EMT-Paramedic.

This brought a little bit of shuffling and a whole lot of looking at anything in the room but me along with lots more silence.

I reached deep, deep into my bag of instructor tricks and made one final attempt to connect with these students and get them back on the right track.

I asked them one final, very easy question. “How much did you pay for this paramedic training?”

Boy that perked them up! It was like I had hit them collectively with a cattle prod.

Heads popped up and several voices almost shouted out “Twenty-five hundred dollars!”, accompanied by very enthusiastic affirmative head nods from the rest of the class.

“And what have you gotten for your two and half thousand dollars?” I responded.

Again I was greeted by silence. But this time it wasn’t the passive silence of earlier but more of confusion as the students looked at each other trying to figure out what it was I was asking them.

On the inside, I realized that I had them. That they were rising to the bait but hadn’t quite taken it yet.

One of them finally asked what I meant.

“Well for instance, you all look very sharp in your METS student uniform. Was that part of your tuition?”

“Oh hell no!” came several responses. “We were given the shirts but we had to buy our pants, boots and belts and name tags out of our own pockets.

Now they were all staring at me.

After a brief pause for affect I continued, “Well surely you received a paramedic text book?”

The class acknowledged that they had actually received several books. They went on to list each one of them. Nodding with each answer I continued down the list of everything they had received.

A Blood Pressure Cuff. Yes.
A Littman Stethoscope. Yes
A set of EKG interpretation calipers. Yes.

As I went through each item, more and more of the class were getting involved. Then I listed the final item.

Your official METS Spoon. Huh?

“Spoon, what spoon? We never got a METS spoon!” several of them uttered.

And that’s when I both set the hook and let them have it with both barrels as I slammed my hand down on the lectern. “THEN WHAT THE HELL MAKES YOU THINK I’M GOING TO SPOON FEED THIS MATERIAL TO YOU!”

I went on to point out that how the chapters in their textbook were organized. That the important information was contained in the lead sentence of each section of the chapter. That it was reiterated in bold in the margins of each page and how they should already be aware of this as it was explained in the introduction of their textbook.

I continued by explaining that I fully understood that they all had lives outside of METS but it was their responsibility to be familiar with the material BEFORE the lecture. That if they got jammed up for time that they should read the first paragraph of each section in the chapter, the highlighted statements in the margins and the captions under the photos and graphs as this would at least give them a frame work for the lecture and material to be covered that day in class.

I concluded by saying that I was giving them 20 minutes to do just that and when I returned their better damned well be class participation, even if it was just to enthusiastically and loudly state that they didn’t know the answer to a question.

Tenuously maintaining control I looked each of them in the eyes and then attempted to walk, not storm or stomp out of the classroom. I headed back to Jeff’s office to apologize for chewing out his class.

Jeff signaled me from behind his desk not to say a word. I stared curiously as this rather large man got up from behind his desk and literally tip toed to his office door and shut it. He turned to me with his fist in his mouth and his other hand holding his stomach as he not all that successfully attempted to stifle laughter for what seemed like a minute.

Finally he regained control and indicated for both of us to sit.

“Norm, I didn’t call you here to give that lecture because of your clinical expertise in Neuro emergencies. This class has been lazy about preparing for the lectures and I have tried for the past 5 weeks to get it through to them that they needed to come prepared. It seemed like nothing I said was getting through to them. So I dropped you on them.”

“They needed to be hammered, literally right between their eyes, by someone other than me that they have to start taking this seriously. I’m sorry I couldn’t warn you in advance but you needed to see what I was dealing with and you handled it just the way I was hoping you would. Although that bit about the spoon was priceless. I will be using that again. Thanks.”

We spent the next 15 minutes calming me down and discussing how we were going to proceed for the rest of the program. When the 20 minute time period was up I went back into the classroom.

My talk must have had an impact as the entire class was in their seats, with their textbooks open and watching my every move. No “EMS” 20 minute break with maybe half the class back and the rest strolling in as they felt like it over the next few minutes. No they were all in their seats and ready to do business.

Just as importantly to me, I noticed that as I was sizing them up, they in turn were doing the same to me. After every treatment/action, reassess the patient or scene before continuing.

An unintended but good medic lesson that these puppies were utilizing, whether they were consciously aware of it or not, early in their training.

I began by apologizing for some of my language, colorful though it may have been, it wasn’t exactly what could have been deemed as professional. They in turn apologized as a group for being so unprepared and promised that it would never happen again.

After making a comment about how actions speak louder than words and tell fewer lies, I resumed the lecture. It went off fairly well and they participated gamely and even asked some fairly astute questions.

I’m proud to say that this class went on to become a very successful group and by the time I returned for my regularly scheduled presentations towards the end of their training program, they were all over it and we had quite a bit a fun.

Through the years there have been other paramedic classes and training programs, over a dozen of them, but none of them has quite stood out in my mind like this one. I wish them all well but also have put my own version of the mother’s curse on them. May they all have at least one paramedic intern just like they once were to try and teach and guide into becoming a successful, safe and competent paramedic.

Be safe everyone.

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