Vintage Big Med – D Newman | Pandemic Revisited – Sept 2007

Pandemic Revisited – David A H Newman

[Sep 6 07]

The great flu pandemic of 2007 hasn’t happened yet. But don’t go away! The pandemic flu knows no seasons, and isn’t a once-a-year event. Bird flu is spreading – mostly among birds so far, and in many places. What we don’t know about it would fill volumes: we never know enough beforehand. That seems to be a law of nature. Grim scenarios might still happen.

I wrote: “Ethics and Triage – A Nasty Scenario” a few months ago, suggesting that even with the best of pandemic planning, our health care systems might become overwhelmed if one or more of the basic assumptions proves too optimistic. I received feedback suggesting that our propensity to go into ‘feeding’ frenzies when confronted with real or anticipated scarcities of anything – such as popularized toys or almost anything else – makes it inevitable that the ‘nasty’ scenarios, including riots and mayhem, are highly likely. In other words, the breakdown of civilized norms will surely accompany pandemic. My good friend Thomas Hobbes has described life in such circumstances as “nasty, brutish, and short.”

Such frenzies could happen, and might happen here and there. However, the records of what happened in the London Plague of 1664-65 and what has happened since in times of war, pandemic, and disasters both natural and deliberate, including ice-storms, floods, hurricanes, earthquakes and tornados, suggest that we humans are amazingly resilient and will as a rule help each other. The folks who make up the ‘grass-roots’ in our communities, though usually ignored by the planners, are our great strength.

Planning can help. Preparation, including training and education, can help greatly. First Responders are mightily needed. Central governments can play a key role in organizing supplies and logistics, and bringing in emergency legislation such as quarantines. But as we have seen time and again, it’s the folks on the ground where and when ‘it’ happens, who must do the coping.

The professionals can seldom get to the scene (or many scenes simultaneously) immediately. Sometimes it can take hours, days, and even weeks to get through the debris. Too often, the jurisdictional barriers are worse than the physical ones. Until the professionals arrive, people suffer and die without recourse other than helping themselves, and helping those around them. Sometimes, as in a pandemic, too many will suffer and die; regardless of what we do. But we must do what we can while we can.

The more distant the authority, the longer the delay: the more immediate to the disaster, the quicker the response. Centralization has no place in disaster first response. Its main utility is in churning out press releases justifying its existence.

We organize for disasters ass-forward and upside down.

D Newman | The Positive Paramedic Project #93 To be a first responder

A nugget of Big Medicine for your consideration from the late David AH Newman. #93 To be a first responder

My late father, David AH Newman, originally wrote this piece for Big Med in 2007.

It is an interesting take on what makes a first responder and seems particularly apropo while the Newtown school massacre is still much closer than it appears to be in our collective rear-view mirror.

I’ll preface it with his comments:

“You may not receive heartfelt thanks for what you do. Sometimes you will be blamed, because people suffering pain and loss need to blame someone. It goes with the territory and only time can redress the injustice. Learn to accept the hurt with the good things, and don’t be too hard on yourself. 

“If you can give support and show compassion beyond the minimum the situation seems to call for, you and your colleagues will long be remembered with gratitude, and you will build reservoirs of credibility and affection for you and others to draw upon; and you will know that what you are doing is worthy and significant.” To be a First Responder

[November 2007]

Foreword 

This is an exploration into the forces and values which guide First Responders of all kinds everywhere.  

If I had gone at it the usual way, I might have surveyed the populaces First Responders serve. Or I might have analyzed articles on First Response to produce lists of descriptive words and their frequencies. But instead of  being scientific and rational and following an approved research methodology, I decided to follow my intuition.     

Of course, intuitive ventures leave you with an assortment of cryptic phrases and imagery, which then have to be dressed up in words and arranged according to headings – and that is a subjective process,  so my own background has something to do with the result.

Finding a title was challenging, because it raises the question: “What’s this going to be used for?” It might be a  useful article for would-be first responders to read, and ask questions around. Then someone could fill in some of the blanks with stories from her personal experience.

It might also serve as a starting point for those sufficiently interested to take issue with and add to – helping to gradually accumulate a “First Responder Manual or Book of Front-Line Wisdom” – “Aphorisms from the Field.” You will encounter quite a few aphorisms in what follows: an aphorism is a powerful one-liner which rings true across time, distance, and circumstance.

The Nature of the Work

First Responders never know exactly what they will have to deal with next, or when, or where. They have to become expert at dealing with the unexpected. They are always led by the situation, however, they can and do learn to be prepared – to be ready to take on whatever comes. It needs a “Job Shop” mentality, and an assortment of general-purpose skills and tools.

Provide for what is needed to meet the Future — Accumulate Strength through Foresight. That is your best insurance.

Most calls are routine, in the sense that experience and commonsense help to minimize the risks. But exceptions happen, and then precipitate rushing into danger — Heroics without consideration — can endanger and sometimes kill; you and others. Heroism should be a last resort. So Patience becomes a strength.

Whatever situation you are called to is sure to involve danger for someone. So don’t give in to confusion: be firm in finding out  what the situation really is, to the extent you can, and don’t jump in blindly. Seek verification, and document the evidence. Trying to enforce your will on the situation means ignoring the emerging reality – and reality does and will emerge. 

Judgment

Hippocrates said, in his most famous Aphorism — “Judgment is difficult.” Judgment has to be informed by experience and by the facts. Informed judgment equates with Situationally-Relevant Wisdom – and that amounts to Know-how. Judgment can’t be taught, though it can be exercised.

If every situation was clearcut and only needed a yes-no answer, there wouldn’t be any need for judgment. But nearly all real-life situations involve trade-offs, and sometimes there are no good answers – only combinations of more or less good and more or less bad. However you decide, someone will inevitably suffer – and you, if you have any feelings, will also suffer, inevitably. You too are mortal and stress is real. Your colleagues and advisors can help you deal with it: don’t try to stand alone: you are a member of a team and the team is there for you, as you are for the others.    

Deal with multiple demands and competing claims resolutely and intelligently. Use your informed judgment to assign resources and energies — as in Triage situations. Follow the rules, and your values, and don’t be afraid to talk it out with colleagues – but remember that coming to judgment is not the same as taking a poll. Advice and consensus are simply more elements to consider. Facts alone will not give you an absolute answer where there are no absolute answers.

It isn’t enough to rely on your enthusiasm to carry you through. Enthusiasm creates opportunities for both Greatness and Illusion. Judge carefully. 

Don’t judge anyone unless you understand the special circumstances surrounding the individuals and the action. There are always special circumstances. Treat each and every person as someone special – as a unique being caught up in a possibly unique situation.

Confront whatever is causing Suffering

Some may regard suffering as noble – even pious; perhaps its in the human makeup to seek virtue in  the most grim experiences – when we are the ones afflicted. But it is not noble, pious, or virtuous, to ignore and pass by the suffering of others. Suffering is evil and there must be no compromise when facing it.

It is the first responsibility of a First Responder to look out for and attend to sufferers. Service is about easing the path.

‘The way to exorcise suffering is to make energetic progress in the good’. The ‘good’ isn’t always easy to define. But a sure sign, and a useful measurement, is the observation of re-awakened life.  

There is a great mystery underlying the struggle, which, for humankind, is without limit and end. The struggle has its dangers, not least becoming entangled in our own hatreds and passions — passion and reason cannot exist side by side. Know thyself, and be on guard: we are each our own worst enemy. Self-Knowledge (Inner Perception) allows inner concentration on outward events: essential when you have to confront and subdue Outer Danger.

You may not receive heartfelt thanks for what you do. Sometimes you will be blamed, because people suffering pain and loss need to blame someone. It goes with the territory and only time can redress the injustice. Learn to accept the hurt with the good things, and don’t be too hard on yourself. 

If you can give support and show compassion beyond the minimum the situation seems to call for, you and your colleagues will long be remembered with gratitude, and you will build reservoirs of credibility and affection for you and others to draw upon; and you will know that what you are doing is worthy and significant

Desire for Independence and the need for Role

We all want our independence, our freedom to do our thing unhampered by the restrictions of authority and the rules, regulations, and protocols imposed on us, and that we impose on ourselves by our choice of profession, training, and service. At the same time, we need others.

Most important, and most irritating, we have no choice but to fit in with the formal structure of society; otherwise we have no place to fulfill our calling. We are forced by our calling to train, to meet standards, to accept credentials, to follow the rules.

We must fit into the on-going structure of assignments, of peers and supervisors, of mentors and teachers – and of how they choose to judge us. Peer acceptance, in particular, is the biggest hurdle, and, the greatest reward. There is nothing quite like winning acceptance as a member of a team.

While structure, status, and rules do get in the way, they sometimes are a blessing — if you have the courage to think for yourself, and have earned enough authority to follow your hunches.

Hippocrates states that ‘Experiment is Perilous’ – its usually safer for the provider as well as the patient to go with what ‘we’ know works because we’ve seen it work often enough. Be wary of applying untested ‘remedies’: because life and well-being are precious and must not be put at risk unduly. The modern expression is “Evidence-based.” Note that ‘Evidence-based’ is not the same as “Conventional Wisdom,” which is seldom wise and lacks factual support.

But what has worked time and again, and for many, may not work for a particular individual – or the situation has already deteriorated too far. Sometimes you may have to judge whether or not to push the limits. Hippocrates said: “Desperate situations may demand desperate answers.”

It takes rare courage to decide, and if you go ahead with a last resort attempt, it may not work; and then the patient is dead, or worse, and you are in deep trouble because you departed from the accepted norms. This is why many breakthroughs happen on the battlefield and during pandemics and other disasters – because the usual standards do not apply.     

We learn and we try. Life goes on and lives go by, and there’s always more to learn and to try. As Hippocrates said: “Life is short, and the Art long.”

Have the courage of conscience to say “No” to orders which are poorly thought through, unnecessarily hazardous, or cruel and humiliating to the sufferer or to their families, or to your colleagues. Challenge the tradition and the ‘received wisdom’ when it clearly flies in the face of the evidence. Shun the monsters in the system. Report such events and individuals, and errors and omissions, without fear or favor. You owe it to your colleagues and to the people you serve, and ultimately you have to answer to and live with yourself.

Being true to yourself and to your calling has its challenges.

Emotional Growth

First Responders are never alone, though it may sometimes seem to be a lonely existence. However, relationships are the central fact; as exemplified in the team interplays, the provider-patient relationship, and the learning, mentoring, and  teaching.

Relationships depend on a capacity to allow feelings into the open, and then fulfillment, joy, and love – in the best sense – happen. Everything alive has feelings, including feelings for others; though humans can develop blocks against showing it — Blocking is one defense against emotional overload, but it comes at a high cost. Personal Growth, like Caring,  is impossible without Understanding and Compassion.

The best defense is to recognize that the emotional burden can at times become overwhelming: when it seems everything in our life is coming apart. This means accepting that each of us has finite limits, and needs help. We seem to be getting better at doing that: it is no longer shameful to admit to being      human and mortal. Problems sometimes are not of the outer world, and only loom large in your mind. Talking it through can help you regain perspective.

Don’t take it out on yourself, or on your significant others who only want to help you, and for all  the right reasons. And music has its own soothing power.

Fulfillment

Your work can bring you a sense of self-worth which is a wonderful asset when derived from knowing you are on your own special personal path, and that your path is worthy.

Find your on-going process of being as you go through life: your life is your very own significant enterprise. Seek to learn, discover, and understand whatever you think will help make you what you believe you are meant to be — to the extent one can in one lifetime.

Don’t become impatient: learn as you go, and don’t be afraid to change your situation when you think  you should. Everything comes in its own time (Ecclesiastes).

Making It So — Act with Purposeful Consistency

Join in the Stream of Life with a worthy goal or purpose. Then you can act with dedication and devotion, without doubt or fear,  in continuous support of your mission.

Your words should be supportive, positive, consistent, and truthful. It only takes one person of inferior character to frustrate and put down many others. Build teams carefully, and trust peer selection. 

Bring your earned credentials and authority to each situation, tempered always by understanding and compassion. 

Be a center of stability for yourself and others as things happen; be supple, yet solid in what counts.

Time

Time is alive, dynamic, and has many aspects: we live according to Cyclical Time — The Seasons and the Life-Cycle; we all seek The ‘Right’ Time; we try to live in accordance with ‘The Times’; we sometimes desperately want our ‘Set-aside’ Time for contemplation and inner discovery. And on some level, we ‘know’ we are part of ‘All-Encompassing Time’ — the on-going Process of The Cosmos.

We also speak of ‘Moments out of Time’, markers with potential for greatness or doom — when all creation stops for an instant — the birth of a new life, the collapse of a hope — a time to live and a time to die. There are even those rare, sacred, instants when time itself is transcended, allowing us an intimation of Creator. 

All of these aspects and qualities enter into the lives and works of everyone, and of First Responders in particular. First Responders know from first-hand experience that the Cosmos has dimensions beyond what we can measure and understand – they have been ‘touched’ by it, though they may prefer to not talk about it — because its impossible to communicate the experience to someone who hasn’t ‘been there’: other than to acknowledge that ‘It’ does happen.

Values

As you Grow, the Values you live will influence the world around you. Recognize and accept you are an exemplar – let your light shine, illuminating your path, and serving as a beacon for others.

You have the potential to impact many lives – for good or for ill. Live appropriately.

 

Rooker | The Positive Paramedic Project #92 Just what do you say?

The remains of the Our Lady of the Sierras Convent. Photo by Norm Rooker.

A nugget of Big Medicine for your consideration from Norm Rooker. #92 Just what do you say?

Vicki, my bride of 29 years and counting, and I were making good time on Interstate 10 across Alabama on our way to Galveston, Texas.  2012 has been a very active year for me with the majority of it being spent away from home.  Between a three-month contract in Saudi Arabia teaching structural firefighting and this year’s devastating wildfire season, Vicki and I have not had a heck of a lot of quality time together.

We were making up for it with a two-month road trip that literally was taking us from the Atlantic to the Pacific Ocean visiting family, friends and other activities along the way.  As I was saying, we were making good time along I-10 when she made what I have come to call the third certainty.  You know, nothing is certain except death and taxes.  Well the third one for me is that long before I need to, the love of my life will quietly announce that she needs me to find a restroom for her.

We have traveled long enough together and frankly since my bladder cancer, I don’t have the “iron bladder” that I used to, so I don’t argue, sigh or even make comments like “again?” or “marking your route across (fill in the blank)?” or some other equally insensitive expression of mild spousal frustration.  Nope, it was, “Yes dear” and “How immediate is this request?” Vicki, being a retired paramedic herself with 22 years on the job, of course identified her discomfort/need on the 10 scale.  Fortunately it was only a 5 or 6 on the 10 scale of needing to micturate.  So we had a little wiggle room before we finally got off on exit 4 and pulled up to a service station/quick shop.  While Vicki was taking care of her business I went inside to refill my soda cup and that is where things got momentarily awkward.

There was no one behind the counter as I made my way over to the soda dispenser but from somewhere in the back I heard a woman’s voice holler out a muffled “Good Afternoon.”

Since it was only 11:30 and me being me, I responded back by saying “Well technically, it’s still morning so good morning to you.”

A big old friendly gal came out from the back office apologizing stating that she just wasn’t feeling right but that it would be a good afternoon eventually.

Her comment about “not feeling right” immediately activated my medic “Spidey senses” and while still smiling and with no change in the tone of my voice, I switched over to medic mode and started doing an initial assessment.  You know, when you begin your patient assessment with your general impression.

She was smiling, although it looked almost forced, was speaking in full sentences, didn’t appear to be diaphoretic and her skin color was good but something wasn’t quite right.  She just looked off.

“Darlin’, are you alright?” I asked her.  In the meantime my mind is working through rule-outs for a stroke, TIA or possibly some other cardiac event.

The woman, I never did get her name, looked up at me with a weak smile and that is when things actually got a “bit” awkward.

“Well, I don’t know.  I guess I’m fine but my former daughter-in-law was just murdered three nights ago and I just don’t know what or how I am supposed to be feeling.”

A number of conflicting thoughts shot through my head, one after the other and not all of them reflected well on me.

The first was ‘TMI, whoa, too much information!’ Quickly followed by the exact opposite, ‘Great! She’s not having an MI and I don’t have to call 911 for her’ quickly replaced by, well, ‘What exactly is the proper polite response to someone when they suddenly share an awkward bit of sensitive personal information with you?’

“I’m sorry, are you doing OK?” was all I could initially manage, which far from comforting her, actually seemed to make things a bit more uncomfortable.

I didn’t want to leave this woman like this, call it that Pavlovian rescue response, but I knew I had to do better than just brushing her off.  That and at the same time not prying or saying the wrong thing.

“Ma’am, you said it was your former daughter-in-law?”

She looked up at me with a warmth in her eyes that I had not expected.  The store clerk went on to inform me that the murdered girl and her son had gotten divorced, but despite that the girl had stayed in touch with the woman and made sure that she had access to their two children. She had stated that just because she and the woman’s son were unable to stay married didn’t mean that they weren’t both still parents and that the children still had all of their grandparents and now this was all just so unfair and she didn’t know what or how she was supposed to feel.  That nothing in her upbringing, education or even the bible had prepared her for an event like this and she really hoped that she wasn’t going crazy.

WOW!  That’s one heck of a lot to share with a total stranger. Run on sentence notwithstanding.  But at the same time, how near the edge must she be feeling to need to share this much with a stranger?

Talk about awkward with a capitol A.

But actually, it wasn’t.  All of us have been there at some point in our lives or careers.  Not the murder part, at least hopefully not.  But rather the ‘am I nuts for feeling this way?  I should or should not be feeling …”

And then the answer, the right answer, at least the right answer for this woman, came to me.

Set the way back machine for 1983.  I was attending the National Fire Academy in Emmitsburg, Maryland for a pair of back-to-back two-week courses.  Between the first and second classes I had made arrangements to do a ride-along with the Bethesda-Chevy Chase Rescue Squad.  The EMS Chief for Prince Georges County Fire & Rescue, of which BCC was a part of, was Chief Marybeth Michos.

While I was signing the various ride along waivers and permission slips I learned that Chief Michos was the chair of the relatively new EMS section of the International Association of Fire Service Instructors.  She followed that statement up with a query in that unique Chief Michos style,  “and was I the same Norm Rooker who had recently joined her section?”

When I acknowledged that I was I learned that the cost of my ride along would be that I would be attending the FDIC, the Fire Dept. Instructor’s Conference for free the following March but that I would be serving as the facilitator for two of the EMS sessions.

“Yes ma’am, thank you ma’am.”  For those of you who have never had the privilege of working with or interacting with Chief Michos, there really is no other appropriate answer.

So in March of 1984 my brand new bride and sister medic, Vic the Chick, and I made our way to Cincinnati, Ohio, where I had the privilege of facilitating a presentation by Dr. Jeffrey Mitchell where he rolled out his then radically new concept of Critical Incident Stress Debriefing.  It was an excellent talk and Vicki and I both benefited greatly from it.  And it was the core concept from Dr. Mitchell’s talk that I was able to pass along to this woman.

As the clerk gave me change back for my soda I looked her in the eye and told her that she wasn’t going crazy, that she was just an ordinary person having an ordinary reaction to an extraordinary event. That there was no “right” way to feel and that again, I was sorry for her loss.

It must have been what she needed to hear as her smile now beamed.  Me, I ducked my head and slipped most of my change into the donation jar for the murder victim’s family, and with a final encouraging nod to the store clerk, made my way as calmly but as quickly as possible out of the store.

Vicki and I resumed our journey with over 300 miles still to go until we arrived at our destination.  As the miles rolled by the VCR/DVR in my head couldn’t help but replay the encounter. I hope I said and did the right thing.  Regardless of the right or wrong of my response, the one thing I don’t regret, is that the conversation took place.

If we are to acknowledge that life is not all unicorns and fairies, then we must also be ready to deal with the other aspects that make life “real”.  That there is no “fast forward” button on life.  And that includes honestly acknowledging that someone is hurting and that it is alright for them to be in pain and not “perfect”.

Dr. Brené Brown, Ph.D., LMSW is a research professor at the University of Houston Graduate College of Social Work. Dr. Brown has spent over a decade studying vulnerability, courage, worthiness, and shame.

I had just recently listened to her talk entitled Listening to Shame.  Towards the end of this well done presentation Dr. Brown related an interaction with a man in which he stated that as a man, a husband and a father, he was not allowed to lay it out there, to be vulnerable, and that it was not the fault of his father, his coaches or other dominant male figures in his life and upbringing.

That the worst perpetrators of this were his wife and daughters.  That they would rather he die on that white horse than fall off it or admit his vulnerabilities.

Over the course of my almost four decades in emergency response Vicki and I have lost 10 brother and sister emergency responders to suicide.  Folks who were hurting, hurting so bad that the only way they saw to get out of their pain was to end their life.

Would they have taken the same action if they felt, if they knew it was okay to be vulnerable and that they would not be ostracized for doing so?  I don’t know but I strongly suspect that not wanting to appear weak or vulnerable to the extraordinary events or circumstances they were dealing with at the moment was a major contributing factor to their decision to end it all.

But for them to be able to do that, to acknowledge their pain, then we need to be able to deal with our own discomfort over a potentially “awkward encounter”.  Easier said than done but very, very possible. That is if we allow it to be.

By the time Vicki and I arrived at our destination for that day I knew that I had allowed myself to do just that.  This woman, in her pain had actually given me a gift, a chance to be human.  The chance to interact with my emotional armor down and realize that I could, no – make that would, live to tell about it.  No easy feat for me and a lesson I needed.

Take care everyone and best wishes for healthy and happy holidays for you and yours.

Be well. Practice big medicine.

Norm

Newman | The Positive Paramedic Project #91 Christmas Jew

A nugget of Big Medicine for your consideration. #91 Christmas Jew

Long before the Brunelle Family introduced me to the joys of celebrating Christmas in the company of family at the foot of a beautifully decorated tree, I was a Christmas Jew.

For on Christmas eve ‘tis the moment when one becomes truly aware of the real number of Jewish paramedics in any given EMS system as they file into station for what might be one of only a very few shifts they pull in the course of a year.

They are the religious mutual aid team. The part-time paramedics whose certification continuation is always a matter of cost-benefit debate right up until the moment their names appear on the Christmas Eve roster. They volunteer to work on Christmas so their Christian brothers and sisters can spend time with their families. They are entrusted with the keys to the city as they respond to emergency calls and hold hands with the sad, the lonely and the destitute.

As a Christmas Jew, I wandered the snow-wrapped streets in my ambulance looking for the tell-tale signs of Santa’s passage – the lights on at pre-dawn hours and little ones excitedly waving out frosted livingroom windows at our truck.

I’ve rolled on calls to seniors residences expecting heartbreak only to be welcomed as prodigal sons returning. “Before you take Mildred to the hospital, you simply must have a spot of tea and a piece of cake.”

I’ve watched in awe as a senior police commander pulled up alongside our rig and handing over a large box of catered takeout food said, “You’re the Jew Crew right? This is from everyone down at the station. Thanks much for your service tonight.”

And I’ve been flagged down in front of a church by a priest who waved us inside while telling us we wouldn’t need any of our emergency gear. When we got inside, the entire congregation stood and applauded quietly as the priest explained, “These are our Jewish friends from the EMS station up the road. I’ve invited them to break bread with us.” I still smile when I remember calling that one in on the radio.

There is something almost magical about being on the streets as Christmas Eve ends and Christmas Day begins. There’s a voice on the air and it’s Dispatch however the tone is more akin to a Hallmark ad than to yet another emergency run. “Merry Christmas” or “Joyeux Noel” or both without the need to add the time, answered in turn by every rig on the air at that moment.

Back at the station there were always trays of food from the neighbours and cakes, cookies and all manner of sweet things from our colleagues.

The next time our daughters ask me if I celebrated Christmas before I met Mommy, I’ll have to tell them what it was like being a Christmas Jew for EMS.

Be well. Practice big medicine.

Hal

Newman | The Positive Paramedic Project #90 The bet

A nugget of Big Medicine for your consideration. #90 The bet

Michael Smith still owes me a case of beer.

The beer is the debt on a bet made between paramedics rolling the ju-jube dice and hoping for excellent vibes. Michael threw it down as a measure of extra karma against impossible odds. It wasn’t meant to be claimed. It never was.

The unclaimed case of beer is now a counter-intuitive memory sticky note.  That basket of associated thoughts includes mauby, roti and a night on the ambulance when everything was covered in a layer of ice. Michael Smith introduced me to The Curry House in the Cote des Neiges district of Montreal. Back then we were the only white people in the house as we ordered rotis with hot sauce and a tall cup of mauby. I loved the bitterness of mauby as it extinguished the sweet heat of the veggie roti. We became regular irregulars in that Mike and I didn’t work together all that often.

The night the bet was placed we didn’t stop at The Curry House. It was closed.

I think it was a holiday – New Year’s Eve perhaps or maybe Christmas.  We were working the night shift. Just a couple of irregular paramedics covering for the regular denizens of that rig.

I was driving. I don’t remember how we worked out who would take the wheel but I was the one tucked into the left hand seat of the cab.

The freezing rain had coated everything – the streets, the sidewalks, the traffic lights – with a thick layer of low-friction ice. The radio was alive with the sounds of crashing. There were dozens of calls for road traffic crashes. There were several calls from ambos that had crashed en route to crashes.

Michael placed the bet where Edouard-Monpetit meets Legare and starts its long descent to the Decarie Expressway. There were cars parked on each side of the road and a narrowed luge-chute of a pathway between them. Michael said he’d give me a case of beer if we made it through the shift without hitting anything – or anyone.

Those were steep odds.

I remember driving with two wheels on the sidewalk and two wheels on peoples’ lawns as we slowly descended Edouard-Montpetit. The ice-covered grass had more give and provided more traction. I distinctly remember seeing people staring out their first floor duplex kitchen window over top of a long stretch of cedar hedges as an ambulance crawled down the sidewalk between the first steps of walkways and the mirrors of parked cars.

That was the night when Michael Smith invented vocal triage. We already had two C-spine patients aboard from a crash when we came up on another multi-vehicle crash on Autoroute 13.  He stood on the back step of our ambo and yelled out at the sea of crumpled cars and confused occupants.

Does anyone know if anyone is seriously injured?”

A pause followed by sideways glances and some low chatter. And then a spontaneous crash spokesperson yelled back. “No, no one is seriously injured.”

“We’ll send some help.”

And we were off, doing the best we could under the circumstances.That’s probably the best summation I can provide for my years in EMS.

The debt remains unpaid. I believe some beer was never meant to leave a bottle.

Be well. Practice big medicine.

Hal

Newman | The Positive Paramedic Project #89 Tzedakah

Christmakah being celebrated at our old home in Pointe Claire

A nugget of Big Medicine for your consideration. #89 Tzedakah

I wrote this piece a number of Christmakahs ago. I thought about it yesterday when I heard about the heartwarming story of Larry DePrimo, the NYPD cop who bought a homeless man a pair of shoes. We like to hear stories about the good people do – those little acts of kindness that can change someone’s world. This is one such story.

“Last year I made my gift bags for the homeless too late in the season. We drove around downtown in the freezing cold and found only one person who lived on the streets. I put the bag down next to him and he said, “Thanks.”  I watched from our car as he reached in and pulled out the gloves and put them on. It was so sad. I cried and cried. We go through our lives saying, ‘I wish I had, I wish I had,’ and these people have nothing at all. An experience like this changes your perspective forever.” She’s a very spiritual person who shares and openly celebrates her Jewish faith with her family and friends. She speaks with an empassioned wisdom that belies the fact she is only twenty-seven years of age. Choosing to remain anonymous because she doesn’t want her act of kindness to be obscured by a distracted glance at the giver. So focused is her view that what she is doing is an essential act of human kindness that transcends race, religion, language, or any other artificial boundaries.

“I don’t believe in not giving money to someone who asks me directly for it. And so, every year during the holidays I’d be downtown and I’d find myself giving a loony here and a twoony there. I wanted to do something more and so last year I started making Christmas gift bags for homeless people. I made ten bags last year—matched them up with ten polar fleece blankets a friend of mine gave to the cause. I ended up leaving nine of them with Sid Stevens at Sun Youth who promised to give them to people in need.”

They’re not wealthy people but, she reminds me more than once in the course of the interview, they’ve been blessed with a good life. The gift bags are funded by the “Swear To Help” Fund. Her husband is an incorrigible curser although it must be said he has been trying to clean up his verbal act since the birth of their daughter nearly two years ago. Every time he swears or uses inappropriate language in their home, he donates $5 to the Fund. This year must have been a bit more stressful than last; there was enough in the Fund to create an extra gift bag.

And so, tonight they’ll leave their home in the ‘burbs and drive into the center of the city looking to spread some intensely personal holiday cheer of their own. The contents of the gift bags have been carefully planned to be useful to people with little or nothing to call their own. A hat, socks, and gloves; a bottle of orange juice; a can of soup with a pull-tab top, a cup of noodles; a box of rice krispie squares; and a zip lock bag filled with disposable spoons and napkins. It’s the attention to detail that makes me smile as she tells me why she makes sure the soup has a pull-tab top for ease of opening.

“I gave our daughter a Tzedakah bank so she can save money to help others. We give her our loose change. She probably doesn’t know what it means yet but one day she will. I’ve always believed the best form of charity is blind—giving to people you don’t know who don’t know you. And Christmas, well, at Christmas there are people without others who are the most lonely.”

Tzedakah is the Hebrew word for the acts that we call “charity” in English: giving aid, assistance and money to the poor and needy or to other worthy causes.  The word “tzedakah” is derived from the Hebrew root Tzade-Dalet-Qof, meaning righteousness, justice or fairness.

Her husband reflects on last year’s scene in the street: “It was heartwarming and, at the same time, heartbreaking. The guy reached right into the giftwrapped bag and pulled out the gloves. He looked so content just to have a pair of gloves sitting there on the street.”

Be well. Practice big medicine.

Hal

 

Newman | The Positive Paramedic Project #88 The union we deserve

Circa 1980 Montreal Paramedics Save Lives protest march through downtown streets

A nugget of Big Medicine for your consideration. #88 The union we deserve

I’m not a union guy but I once started a wildcat strike.

Mike ‘Elwood’ Crowley and I reported for work about 45 minutes early, as per usual, at the Western Sector garage of Urgences Sante (Montreal EMS). We liked to get in early, ensure that everything was hunky dory on our rig and then hit the streets ready to roll.

Our regular rig was nowhere to be found. Instead, there were these beat-up sub-standard ambulances that had been absorbed into the fleet after the latest private ambulance company gave up the ghost. They were rolling relics that had no place in our garage. We asked for our usual ride. The shift supervisor told us to stop whining and get our gear and our asses onto one of those trucks.

I’m not quite sure what happened in my head at that moment but I turned to Elwood and said, “No way. Let’s invoke our right of refusal.” And we did. Our collective agreement and labour laws in Quebec allow for a worker to invoke his/her right of refusal if he/she believes the situation is unsafe and/or there is an unwarranted risk to life and limb.

We sat down.

The other medics looked at us in disbelief. Elwood and I were probably the two paramedics voted least likely to ever initiate a labour action in Montreal EMS history.

The supervisor demanded that we get up and get on the road. We refused. We stayed glued to our chairs.

The other medics sat down. While many were not friends – we had all been thrown together as the organization took its first chaotic steps – they all understood the importance of the moment. Either we sat tall for ourselves or took to the road in ambulances no longer fit for duty.

Mike and I both knew what it meant to ride with luck as your co-pilot and neither one of us wanted to take a step back to the times when we had watched as our back wheels had detached and rocketed past us as we were braking or tried to combat an electrical fire in an overhead panel while simultaneously driving as your partner performed CPR in the back of the rig.

It got pretty surreal very quickly. A work stoppage doesn’t become a work stoppage until the rigs returning from the last shift are due to be replaced by the next shift. Evening rush hour is not a good time to suddenly run out of EMS crews. The seriousness of the situation became clearer as the usual sounds of shift change were replaced by the quiet scraping of chairs being pulled up and nervous words exchanged in whispered tones.

Our union rep was freaking out. Union organizers were mainly francophone. It seemed impossible, it had to be unprecedented. Two Anglo medics had initiated a wildcat strike and the other medics were following suite. He called his way up the union ladder until he was talking with Mario Cotton. Mario was the fiery leader of the union.

We could hear his side of the conversation through the earpiece of the phone and clear across the garage.

“They’re doing what?! Tabarnak – that’s not possible! Are you sure? Newman and Crowley?! Incredible!”

Our union rep asked for guidance. “Support them, dammit. Support them,” was the reply. “No one rolls until they get their regular rigs.”

I’d have loved to have been in that room when Mario Cotton got off the call and tried to explain what was going on to his union colleagues.

We got our rigs back. We hit the streets. The wildcat strike ended without any collateral damage.

I’m still not a union guy. Probably because as a paramedic I have never felt as if my interests were truly represented by any union leadership. I remain forever hopeful.

Be well. Practice big medicine.

Hal

 

Newman | The Positive Paramedic Project #87 C’est tiguidou

Christian Meloche, paramedic, 1956-2012

A nugget of Big Medicine every day. #87 C’est tiguidou

As a semi-pro breaker of bad news I should have seen the signs. Ambulance Mike calling relatively early on a Sunday morning. No attempt at striking a Monty Pythonesque accent as per the previous hundreds of calls between us. Straight to the point.

“Did you hear that Christian Meloche died this morning?”

It got very quiet inside my head. I could hear the hens clucking outside as if they were off in the distance somewhere.

“I just wrote about Christian and I and the summer of Jesus of Montreal,” I replied, as if a non-sequitur would somehow negate the bad news Mike was trying to break. “He died. This morning. It was cancer. Denis Hebert also died – more cancer. Do you remember Denis? He was a gentle soul.”

Christian Meloche was dead. It wasn’t like we were close or even friendly really. We were partners once. It was still quiet in my head.

“You okay?” asked Mike.

“I need to digest this, get my head around it. Thanks. Bye.”

In my head I was thinking “Christian Meloche died. He had cancer and it killed him this morning.” I felt the need to blurt out “C’est tiguidou” but, of course, it wasn’t ‘tiguidou’ [‘a-okay’].

Christian had taught me the correct usage of the expression ‘C’est tiguidou’ [sounds like ‘cé tsiguidou’] during our time together on the ambulance. We worked nights in Hochelega-Maisonneuve mostly with regular forays downtown and occasional trips out to the West End where we’d marvel at the relative calm while waiting for sunrise and the end of our shift.

We were the oddest of couples – an anglo paramedic fresh out of States and a franco union activist who loved working the streets East of The Main. I was tall and chunky, Christian was tall and lean. He favoured all-night diners where they’d serve up poutine with smoked meat sprinkled on top. I was always hoping for something a little greener. And yet, for reasons best left to alchemists to work out, we clicked as partners.

My partnership with Christian was short as ambo partnerships went. We only worked a few months together before I left the ambulances to go to work with Cote Saint-Luc EMS. The intensity of the calls we rolled on was on the high- to just-shy-of-insane side. We were both experienced medics, loved the job, and challenged one another to stay up on our respective clinical games.

We talked politics, redesigned the EMS system, and consistently disagreed [often loudly] about the role of the union in protecting our jobs. We talked in a mix of english and french that became our own surreal patois shorthand – a ridiculous mix of directly translated words from each other’s mother tongues thrown around casually in the presence of others for effect.

And then we went our separate ways. Christian stayed on the rigs and became much more involved in the union. I went to Cote Saint-Luc EMS. We lost touch for a long while until Facebook afforded us the privilege of occasionally crossing one another’s digital pathways.

We weren’t close friends by any stretch of the imagination. We were partners once – and forever. Rest In Peace, Christian. “C’est tiguidou”

Be well. Practice big medicine.

Hal

 

Newman | The Positive Paramedic Project #86 First person – Bike crash

A nugget of Big Medicine every day. #86 First person – Bike crash

Writing in response to #84 Professional Indifference, my sister Susan said, “When I had that bike accident a couple of years ago, amidst the chaos and confusion one woman sat down next to me and calmly held my hand until the ambulance arrived. There was blood running down my face so I never saw her face, and I never got to thank her. But her calm steadying hand and voice was my island in the midst of all the chaos. Tell your friend she made a world of difference for that woman. I know.

And then I remembered the excellent first-person essay she had written for Big Med. [October 26 2009, by Susan E. Newman]

Like many seasoned bike riders in Montreal, I had a certain arrogance about wearing a helmet. Yes, I would wear it when riding for a long distance, but secretly I thought my bike riding skills would preempt any serious collision. Having survived many a near miss with car doors springing open, and pedestrians leaping off curbs, I was sure that even if I were in an accident I would have the instincts and reflexes to emerge unscathed.

The Friday afternoon I got hit by a car I was returning from a four-hour bike ride, which was the only reason I was wearing my helmet. After hours of carefully navigating through the thick traffic and congested bike paths in the east end of our city, I was in the home stretch, only a couple of blocks from home. The area where I would not normally be wearing a helmet.

I was in that zone where, after riding for hours, your body and bike are like a seamless well-oiled machine. My mind was miles ahead already. As my legs and lungs pumped, in my head I was already picking up corn for dinner and walking the dog. Mentally I had already passed onto the next activity as I flew around the corner, just as the light turned green, at rush hour.

The car that hit me turned left onto the street just as I turned my right. We met in the middle. I never saw it. I was going top speed, when, out of the corner of my eye, I sensed rather than saw a blur of colour. Burgundy? A thought flashed through my head – almost too fast to register. Uh oh. Another thought – to my hands – apply brakes. Then, before my hand could act, the sound of a crash, miles in the distance. So far that it sounded like it was blocks away. As if I had already reached home, and, from my living room, was hearing the sickening metal crunch of a car making impact. The terrible noise of an accident, with the associated dread: I hope no one is hurt.

Then: nothing. I have no recollection of the accident itself. The car had over $2500 in damage. I think now, how could I have had that much impact with metal and not remember it? All I know is that one moment I was on my bike, going full speed, and the next thing I knew I was smashing back onto the ground, full force, onto the back of my head. This is bad, I thought.

Suddenly there was sky, blinding my eyes. Dimly, I sensed a flurry of activity around me. Cars, people, too much commotion. A voice, coming from the side. Frantic, panicked. The driver of the car. Pulling me, lifting me, dragging me the side of the road. Don’t move me, I thought, but I was too dazed to speak.

Then I was on the grass, next to a sidewalk, lying face down. A crowd had gathered around me. Excited voices shrilled all around me. Stay calm, I thought. Stay focused, I thought. Don’t lose consciousness. The light, and reality, was too glaring to observe, so I kept my eyes shut. I begged the crowd to call an ambulance. They all seemed far more panicked than I was. I was amazed at my own calmness, observed it patiently, detached. I asked someone to move my bicycle to the side of the road. A frenzy of disorganized voices buzzed around me.

A young man’s voice next to me suggested that he would try to move me. He explained that he was a lifeguard. What? He sounded like a panicked teenager. The sister of a paramedic, the one thing I knew for sure is that I had taken a bad hit, my head was hurting badly, and I couldn’t move my shoulder. Moving me anywhere would not be a good thing. I said, “Don’t move me” softly, and when the young man attempted to move me anyway, I said, loudly, “Fuck off”. His hands sprang back, and I felt contrite, but remained adamant about not being moved. I insisted that no one touch me until the paramedics arrive.

My head started to bleed. A lot. The panic in the crowd around me ratcheted up to fever pitch. Voices shouted shrilly, “Look at how much her head is bleeding!” I could feel hot blood running down my face, my arm, my chest, I could dimly sense the grass going dark with my blood below me. I observed it all calmly, from a great distance. One person, perhaps the young lifeguard, gasped in panic to another, “Is she still breathing?” The other responded, in equal panic, “I think she’s still alive…she’s still breathing, I think…!” I thought, angrily, I can hear all of you.

I thought, shut up. All of you, go away. Please, just go away. There was just one woman who remained calm, with a soft voice. She kept quietly repeating that an ambulance was on the way, and I was doing fine. I focused on her, listening to her voice, her gentle breathing. I reached out and held her hand. A complete stranger I couldn’t see, and yet, at that moment, her steadying grasp was hugely comforting.

I asked to borrow a cell phone. I was afraid I would lose consciousness, and my mind remained riveted on my dog that needed walking. The man who hit me handed me his cell phone. He was babbling, hysterical, grateful to do anything to assist. Dimly, I felt sorry for him. He seemed like a nice guy. He could have been me, my neighbour, anyone. He was just a normal guy in the wrong place, at the wrong time, heading home to his family on a normal Friday night. I kept telling him not to worry. Shit happens, I mumbled. He wasn’t terribly comforted, however, as blood poured from my head all over his cell phone.

My husband answered his cell, thank goodness. I told him I had been in a car accident with my bike, and that the dog needed walking. I told him I was waiting for an ambulance to come get me. I was so calm he asked me why I didn’t just come home. I told him I needed help. I was tired, I didn’t want to talk. I just said I thought it had been a bad accident, and I was bleeding alot. He said he’d come meet me, and he sent over our nephew to walk our dog. I felt relieved. I lay there, with my hand in a stranger’s hand, and waited for my husband, and the sound of the siren.

The ambulance arrived. The paramedic wanted to take my helmet off. I was afraid. There was so much blood, I was afraid my head had split open. Mostly, I was terrified of the crowd’s reaction. I kept asking the medic to tell the crowd to move away. They seemed reluctant. He asked them to leave once, nicely, and when they didn’t disperse, he said it again harshly, loudly. I heard their rumblings in the background. Disappointed, I thought. Show’s over.

Then silence. It was just the two paramedics and I. I felt better once the crowd was gone. I hated how their scared voices and frightening words kept trying to punch fatal holes in my calm. My husband arrived just as the crowd dispersed. I listened carefully to his voice as well. He was trying to remain calm and cheerful, but I could detect a note of shock and alarm in his voice, his pitch higher than normal. When your eyes are closed, it is amazing how important the sounds around you are. In a moment of crisis, it feels as if your very survival depends upon what you hear.

The medic gingerly removed my helmet, and the two paramedics carefully placed me in a neck brace, and onto a back board. My biggest fear was that I would be paralyzed. Strapped down, my hands were tingling badly. I was rolled into the back of the ambulance, and my husband got into the front. I could hear him speaking loudly, trying to remain cheery, a fear under his words. I was relieved he would be riding with me.

I kept asking the medic if I would be paralyzed. I started to tremble uncontrollably. The fear and shock were catching up to me. I was afraid I would be car sick, because I suffer from motion sickness. The medic told his partner, and they drove slowly and carefully, which was a relief to me. Becoming frantic at that point, I kept imploring the paramedic for his assurance that I would be all right. Finally, tiredly, he promised I would be all right, with an impatient chuckle. His words were comforting to me, and I calmed down a bit.

When we arrived at the hospital I thanked the medic who had rode with me. I couldn’t really see him, or anyone, with my head strapped into place. It was a strange, disorienting feeling. From the moment I was hit, I felt cut off from the rest of the world, floating, by myself. The paramedic, obviously at the end of his shift, said something a bit bitterly like I shouldn’t sound so surprised he had been helpful – paramedics did more than drink coffee, after all. I quickly told him my brother had been a paramedic for years. Instantly, his voice was apologetic, human, personal, and he hastily asked me who my brother was. But we had arrived at the hospital, and I was already being rushed down the halls on a stretcher, my eyes fixed on the white ceiling above, listening to the strangers on either side of me.

I was raced into the trauma room. Instantly, there was a pack of medical personnel around me. I thought, numbly, how different it was from waiting for hours in a hospital waiting room to be seen. Here there were doctors and nurses rapidly firing questions at me, over and over again. What was my name, how old was I, what year was it? They tried to take my top off, but my shoulder was in so much pain I begged them to cut it off, which they did.

They asked me if I could feel my hands and my feet. They were still tingling, which set me into a panic. I told a nurse how scared I was, and she gave me an Ativan, which I appreciated. They rolled me onto my side. The doctor told me a nurse was going to check my butt reflexes to test if I was paralyzed. Strangely, I wasn’t the least bit perturbed by the thought of this. All I wanted was to be told I would be all right. In moments of crisis, dignity and modesty are instantly rendered irrelevant.

My initial test passed successfully, I lay in my stretcher in a hallway and waited for an MRI and CT scan. The shock fading, and facilitated by the Ativan, I started thinking more rationally. I looked to see what time it was, and realized my gold watch was missing. I asked a nurse who passed in the hallway if she could see it anywhere. She discovered it in a little baggie, crumpled on the bottom shelf of my stretcher next to my cut-off clothing. Amazing, I thought, what would normally be perceived as precious was just another useless belonging that had gotten in the way of saving me.

I asked the nurse if she could send in my husband, and she kindly agreed. My husband was ushered into the hallway with me, and there we waited for both tests to be done. The CT scan was a little scary, as I am claustrophobic, but by that time I was used to closing my eyes. I just glued my eyes shut and waited, praying that they wouldn’t find anything.

I was one of the lucky ones. If I hadn’t worn a helmet, I wouldn’t have been. Hours later, when I caught my reflection in a mirror, I looked like an extra in a horror movie. My hair was matted with blood, and dried blood was all over my face, neck, chest, stomach and arms. Despite all the blood, I didn’t need stitches on my head, and it was determined that I had a Stage 3 separation of my shoulder. Outfitted with a sling, I was sent home.

My shoulder hurt badly at first, and six weeks later, it still aches. I also have a Frankenbump on my shoulder that will be there for life. I suffered from bad headaches and a very sore and scabby scalp for the first week, and room spins and vertigo for weeks after. But I lived, and I walked out of the hospital that night. My helmet – a good one, that I paid a fair amount for – had survived the accident bloody, but intact. I left it behind at the hospital anyway. When I am ready to go bike riding again, I will go out and buy another good solid helmet. It may be the most important investment I will ever make.

Sometimes I think about what would have happened if I hadn’t been wearing a helmet. It’s so scary, I try not to think about it too much. The paramedic said that my helmet surely saved me. He said that I had been going full speed when I had the accident, so I probably hit the pavement at over 30 miles an hour. He explained that the helmet absorbed most of the accident first, and then my brain second. If I hadn’t have been wearing it, however….

I shudder to think about it. I can’t help flash to the possibilities, however, when I see the teenage boy next door heading out on his bike – without a helmet. When I stop him, he says he’s only biking a few blocks away. I tell him that I had a major bike accident – just a few blocks away. I tell him my story. His face registers alarm, but he leaves, helmetless, anyway.

I watch him bike away, his confident pace clearly communicating how invincible he feels. I fear for him, and all the bikers who navigate our streets with their hair blowing in the wind, sure it could never happen to them. It can, and it may someday, I think, helplessly, as I watch them.

It’s so simple to put on a helmet, I think. It’s so easy to die without one.

Newman | The Positive Paramedic Project #85 Shoes

A nugget of Big Medicine every day. #85 Shoes

Like the detritus left by high tide after an intense storm, there are usually clues left at the scene of a particularly brutal interface between victim and paramedics.

Little bundles of latex gloves, torn wrappers of trauma dressings, ecg pad backings, and sometimes a dark stain on the pavement. Gloves, hats, purses, backpacks mark the patient’s sudden and unexpected encounter with EMS.

But of all the artifacts left to linger, it is the shoes I find most disturbing. I guess it’s because we tie our shoes on, we zip them up, we purposefully slip our feet inside – there’s a sense our shoes are a part of our lives. There’s a permanence attached to our shoes.

A silk necktie and one very expensive right foot wingtip shoe at the scene of a downtown stabbing.

A bloodied motorcycle boot cut off with paramedic shears and left by the side of the highway. The broken glass and metal swept clean and the boot somehow unseen in the too-high grass and weeds.

A pair of Prada pumps left to ruin indelicately in the rain after a taxi was broadsided by a DUI armed with a SUV. I remember those because my partner remarked those shoes were worth more than the monthly rent on her apartment.

The shoes I remember most were a pair of white high-top Nikes.

They were in the middle of the road at the top of the slope leading down into an underpass on Westminster Avenue in Cote Saint-Luc.

The Nikes belonged to a teen who was wearing them as he darted across the street and was blindsided by a car moving just a little bit faster than the 50 kmh speed limit. The impact was ferocious. The motorist locked up the brakes just inches before the front bumper made contact with the kid. The car came to a stop roughly 40 feet later.

The teen was launched out of his shoes and into the air. He flew upward and forward. Failure to defy the law of gravity can be devastating without a parachute or safety net. Such was the case for the patient. Our medics had declared a major trauma patient and instructed the inbound ambulance to keep rolling hot.

Hours later as police officers reconstructed the scene those Nikes stayed out in the middle of the road.

They were pristine and looked like they had just come out of the box. The laces were still tied. Those Nikes looked like they were ready to be pushed off on for a three-point shot just as the buzzer sounded to end the game.

They were almost perfect.

Be well. Practice big medicine.

Hal