We can all do better

This might be a long post, but there’s a lot of things I want to cover.

The crux of it revolves around our latest experience with the healthcare system: my wife and I had a baby yesterday. But we weren’t supposed to.

A few days ago, my wife noticed some dark red blood, and spoke to her obstetrician. After consult over the phone, she went to the doctor’s office, had an ultrasound performed, and was sent to our hospital for some longer monitoring. It was determined that everything was okay, and that the contractions she was experiencing were nothing abnormal, and she was sent home, and given instructions for some bed rest.

Nothing is wrong with any of this. This is what we expected, and we are grateful for the office and hospital staff. We were relieved there were no problems, and expected to wait another six weeks to meet our new daughter.

Until my wife woke me up.

It started at midnight. “This pain is different,” she told me. “And now the blood is bright red.” With her past pregnancies, there was a dramatic shift in the quality of her contractions, and this is what she was experiencing. My wife labored for four hours with our first child, and only two with our second one, and here she was telling me that she was in labor.

Six weeks early.

I’ve always prided myself on my ability to remain calm, and to reassure my patients, and their family members. Except in this case, my patient was my wife and unborn baby, and my patient’s family was myself and two small children. My wife is also a former paramedic, and hasn’t practiced in several years, but she was concerned as well.

After performing my own exam (probably against all recommendations, please don’t tell our obstetrician) her cervix was only minimally dilated, at one, but she was becoming effaced. And there was a lot of bright red blood. Her contractions were coming every five minutes, and lasted about 30 seconds. We both felt that delivery was imminent, unless we could stop it.

So we headed to the hospital, and called the obstetrician on the way. Luckily, the office had a physician in the hospital, and we were assured the doctor would come see us right away after we arrived.

But we got a midwife.

Now, listen. I have nothing against a midwife. Nothing at all. I fully understand how vital a role midwives play, and I am sure they are more than competent. But there were two exceptions in my case. First, this was a woman who was nowhere near full term, and second, we made it perfectly clear that we expected a physician in the room, as opposed to any midwives.

Let’s be realistic: when the shit hits the fan, the midwife is going to call a physician. So let’s just cut the crap, and have the physician in the room in case the shit hits the fan. Meanwhile, we have a woman in labor, with bright red bleeding, who is only 34 weeks along, with a documented history of short labors.

That fan was spinning pretty fast.

Of course, the midwife was upset when I specifically requested a physician. “I’m more than capable of delivering babies” she said.

“And so am I. I delivered a baby just last week in the camping section of a Wal-Mart. But we want a physician, specifically a perinatologist, and some terbutaline might be in order if we have any chance of stopping this preterm labor.”

I try really hard not to walk into situations with a chip on my shoulder, and I don’t volunteer that I am a paramedic unless it is called for. In this case, I felt it was called for. The midwife left the room, probably to soothe her hurt feelings, and we were moved to a delivery room quickly.

But I don’t care about her feelings. We had a situation which she could not handle, and it is my belief she should have called a physician on her own, instead of having to be prodded.

Our perinatologist was a fantastic doctor. Just all-around great. She was very reassuring, and explained everything that was going to happen. She ordered and administered the terbutaline, which gave my wife a lot of comfort, except the contractions didn’t stop. Their intensity decreased, but their frequency did not.

This perinatologist explained after a quick exam that my wife was 4 centimeters dilated, and 60 percent effaced. It didn’t look like we were going to be able to stop this labor. When I mentioned that I was concerned about a possible abruption, she assured us that delivery was the best option after all.

We didn’t see any abruption on the ultrasounds, but that didn’t mean there wasn’t one. The presentation was certainly indicative of placental abruption, instead of a bloody show, which is what the midwife called it.

My wife requested an epidural, and the anesthesiologist was called, and he came into the room only several minutes later. We were pleased with the alacrity the hospital staff was showing to our situation. In the meantime, a nurse and respiratory therapist from the NICU came to talk to us, and answered a few of our questions.

It was explained that everything looked just fine with the baby, and they weren’t expecting any complications, but that the baby might have to spend a little bit of time in the NICU if she was having any trouble. The NICU staff was very professional and reassuring, and they assured us they would be in the room for the delivery, as opposed to regular L&D nurses.

Once the anesthesiologist came in, we became somewhat concerned. Our nurse, who was very helpful and friendly, seemed a little too friendly with the doctor, and it seemed as if they were flirting, for lack of a better term, while he was performing the epidural.

As I was standing in front of my wife, with the anesthesiologist behind her performing the puncture, my wife looked at me and said “my head hurts and my toes feel warm.”

Of course, this caused the doctor pause, and after a few more questions, he removed the catheter, and applied a dressing to her back, then we laid my wife back on the bed. Only mere moments after the injection, my wife mentioned that she couldn’t feel her legs, which indicated to the anesthesiologist that he went too far, and administered a spinal block instead of an epidural.

This damned doctor was so busy flirting with our nurse that he went too far with his needle.

Right about now, I notice my wife looks terrible. She looks pale, complained of dizziness and nausea, and was beginning to sweat.

Her blood pressure was 70/30, and her heart rate was 160.

And I was noticing some late deceleration on the fetal monitor.

Our nurse quickly called the perinatologist, the NICU staff, and another anesthesiologist.

Our second anesthesiologist came into the room, and instead of talking to us, conversed with the nurses in the room, and talked about giving “neo.” Our nurse had already given my wife some ephedrine, with no change in the blood pressure.

The anesthesiologist looked at us and said “there’s nothing to worry about here, all this is normal, and we do this every day.”

Y’all, I about lost it. Just about.

“Don’t tell us there’s nothing to worry about. I’m the son of a physician, and I’ve been a paramedic for 17 years. My wife, your patient, is also a paramedic, and we generally act a little more concerned when we have a diaphoretic, hypotensive, tachycardic patient. And if that patient happened to be in preterm labor, and was having bright red bleeding, and we saw late deceleration on the monitor, we wouldn’t be all nonchalant.”

Of course, I hurt this anesthesiologist’s feelings. So now I’ve possibly made two people cry.

But we weren’t playing. This was a serious situation, and it seemed like there were three people who appreciated the seriousness of it: the perinatologist, the patient, and myself.

In the end, the anesthesiologist left, and the perinatologist and I (yes, she let me deliver) delivered a very, very tiny baby girl. She weighed 4 pounds, 3 ounces. Her apgar scores were 8 and 9, which were impressive and reassuring. The NICU staff determined our new baby girl could stay with us instead of going with them.

So we now have a premature, yet very healthy, baby girl. And we couldn’t be happier. Her mommy, daddy, big brother and big sister are very much in love with her, and we can’t wait to bring her home.

But we all need to do better.

Things should have been explained better to us. Granted, we aren’t typical patients, but we still should have things explained to us.

When you have a chest pain patient, do you tell them “I’m going to give you some aspirin, and I need you to chew them up, instead of swallowing them.”? That’s good, because you should. But you should also tell them “aspirin is going to work by making your blood clot slower. That way, in case you’re having a heart attack, the clot won’t be as big, and it will be easier to fix.”

Do you just administer a breathing treatment to an asthmatic, or do you tell them “this medicine might make more spit in your mouth, and might make you feel a little jittery, but that’s how the medicine works; it works by relaxing your lungs, making it easier for you to breathe, and it makes your heart beat a little faster, too.”

Do we do a good enough job explaining these things? When our patients are really sick, do we get in an ‘automatic mode’ and just do a lot of things quickly? Or do we take the time to explain to our STEMI patients that “you’re having a heart attack, and we are going to do a lot of things very quickly.” Do we tell them that they “are very sick, but I am going to take very good care of you, and not let anything bad happen to you.”

I think we owe that to our patients.

Most of us are very competent, capable providers. But that doesn’t reassure patients.

Touch your patients. Skin-to-skin if you can. I like to put my hand on their shoulder, just at the base of the neck. Look them in the eyes. Don’t tell them “everything is going to be okay” because that isn’t always the case. Tell them what is happening to them. Tell them what you are going to do for them, and tell them why.

Tell them you are going to take good care of them.

And mean it.

“Daddy always comes back”

My son is at the age where he gets very upset when either myself or his mommy leaves. “Mommy always comes back” I tell him, and try to comfort him. “Daddy always comes back” is what I tell him when I am leaving for work. He sees me in my uniform, and knows he probably won’t see me until he wakes up the next day.

My son sort of knows what I do. He knows that I work on an ambulance and help people feel better. He knows what my company’s ambulances look like, and he can point one out a mile away.

He doesn’t know that parts of my job are dangerous, and I don’t know that he should.

My job isn’t nearly as dangerous as a police officer, or a firefighter, but he knows we work together. He knows that we are the good guys.

He also knows that sometimes, good guys don’t come home.

On overtime

Being somewhat low in the blog inspiration department, I saw this post from another blogger on EMSBlogs, Flobach.

Flobach asks about overtime in his latest post. “How much overtime/additional shifts do you do monthly, and why? For the money, for the fun, nothing better to do?”

I don’t work overtime, period. Well, sort of. Let me explain.

I used to work overtime. I used to work a lot of overtime.

At another service a few years ago, I worked 12 hour day shifts, on a rotating schedule. I think they are called California 12s or something like that. So I would work Monday, Tuesday, Friday, Saturday, Sunday, Wednesday, then Thursday, and that would repeat every pay period. It was an interesting shift, to say the least. It wasn’t uncommon for me to simply stay on the ambulance at the time.

I would go into work at 6 in the morning on a Monday, and would literally stay on the ambulance until 6 in the morning Wednesday. I would routinely work 36 and 48 hour shifts.

I got burnt out, and quickly.

When I left to join Local Ambulance, I began working 24s, and I would routinely stay after my shift for another 12, and sometimes 24 hours.

The money was fantastic. But it took a toll on me.

It all culminated a few years ago when I lost control of my emotions on a scene. I spoke to a patient’s family member in an incredibly condescending manner. Without going into details, suffice it to say that I was incredibly rude, terse, and inappropriate. I received a well-deserved complaint, the first of my career.

Instead of being fired, which my boss had every right to do, I was given an unpaid suspension for three shifts. That hurt my bottom line, and it took about a month to recover financially. But my boss gave me a gift at the same time: some time off.

During that time off, I learned that the buckets of money weren’t worth it. The big checks aren’t worth coming home tired, cranky, and burned out. That was almost three years ago, and I haven’t worked an extra shift on an ambulance since.

I will occasionally work an extra shift on a standby event or something, but that is only about twice a year.

While being a paramedic is part of my life, it is only a small part. I am not a paramedic when I come home at the end of my shift, I am daddy.

Now, I get to spend my off time playing with my children. I take my son to Kindergarten in the mornings, and I pick him up in the afternoon. About once a week, I take him to get ice cream on the way home, and I get to spend very important time with him. At night, I rock my little princess to sleep while singing to her, and in the morning, I pick her up out of her crib. Then I get to make breakfast for my family, and we get to eat together. My son helps me cook dinner on the grill, and we all eat at the table as a family. I play trains and superheroes with my son, and have tea parties with my daughter. We play “get daddy” when we are all home, and someone usually laughs so hard they pee a little bit.

Now that I work 12 hour shifts again, I get to be home roughly half of every month. I get to spend my time at work with a man I consider to be part of my family, Slimm. Then I come home to my home family.

That time at home is worth an immeasurable amount more than any overtime shift I could ever, ever work. I would rather stretch money a little further in order to spend my time with my family.

There is no amount of money anyone could pay me to give up that time with my family.

Mother’s Day

So I’m a day late. My bad.

Lots of people will tell you their mother is the best, for this reason or that. But I have the best mothers ever.

Yes, plural. I was adopted.

I had the incredible fortune of being chosen by my parents to complete their family. They took me into their home, and made me their son. But, I was even more fortunate for my other mother.

She was a teenager when she and her boyfriend became pregnant with me. At some point, she made what must have been the most difficult decision of anyone’s life. Having children of my own, I can only imagine the heartache that would come from making the incredibly selfless decision to give up a child for adoption. It is difficult to even fathom.

THAT is a mother’s love.

That is the love that only a mother can have for a child.

Only a mother can love a child so much that she would give that child, that newborn baby boy, the chance at a life she couldn’t provide.

Only a mother’s love could accept the responsibility of raising a child as their own, and making that newborn baby boy her son.

I am even more fortunate that I found both of my biological parents, and that we have a relationship. I only wish I could see more of them. It amazes me how much I have grown to be the spitting image of not one, but two sets of parents.

As I get older, my heart grows for both of these women. I am forever grateful to both of them, and I love them both dearly.

Happy Mother’s Day.

Play the ball as it lies

When I was but a little boy, my father began taking me to the driving range, and eventually to the golf course with him. Soon, at around 8 or 9, I graduated to playing rounds of golf with him and his friends. Golf, and especially my father, have taught me many important life lessons.

Golf has taught me how to be gracious both in victory and defeat. When playing a contested match or tournament, I learned to shake my opponent’s hand with the same enthusiasm, regardless of the lower score at the end of the round.

I learned to leave the course better than I found it, so that others may enjoy the course as I have. We do this by replacing divots, fixing ball marks, and raking bunkers.

My father always stressed several fundamentals: grip, head, focus, and rules.

He would periodically inspect my glove and grips and tell me what I was doing wrong. He would take me to the range, grab a handful of my hair, and have me hit long irons. He would call out math problems or historical facts while I was in the middle of my backswing. My father was making me a better golfer. It worked, and I was able to beat my father, a 5 handicapper, on a regular basis before I was a teenager.

The most important lesson he enforced was the rule book. Especially rule 13. “The ball must be played as it lies.”

He used this as a metaphor for life. Just as in the course of a golf round we aren’t allowed to move our ball to a spot that affords us a better shot, we aren’t allowed to cheat in life. We take what the golf course of life gives us, and we make our best attempt on the next shot. Some times we hit the ball fat, some times it slices into the woods, and some times we hit the ball flush, and it stops on the green, inches from the cup.

Sometimes the lie of our ball is perfect: in the middle of the fairway, a perfect distance for a 7-iron approach, flat, with no breeze. Most of the time, something is wrong with the ball’s lie. It could be above or below our feet, in the rough, underneath some branches, or blocked by a tree.

Sometimes we can pull off a 40 yard snap hook to win The Masters like Bubba Watson did from the woods on 10. Sometimes we are coasting to a win at the same tournament a year earlier with 9 holes left to go, and wind up having a colossal meltdown, taking a triple bogey on the very same 10th hole. Just ask Rory McIlroy.

Right now, I have a shitty lie in life. The ball is below my feet, in deep, wet rough, embedded in a divot 240 yards from the green with a 50 foot pine tree between me and the green. And it’s raining with a stiff breeze in my face. Laying up isn’t an option.

I’ve never hit a shot like this, and don’t really know how to approach it. All I can remember is my grip, keeping my head down, and maintaining focus. I’ve taken enough time thinking about how to hit this next shot in life, and now it’s time to swing the club. My focus is aided by several quotes that have been circulating in my head. I believe they are applicable to both the game of golf, and the game of life.

“The most important shot in golf is the next one.” – Ben Hogan

“I never learned anything from a match that I won.” – Bobby Jones

“Play the ball as it lies, son. Play it as it lies.” – Dad