The student and the hurt feelings

I hurt that poor paramedic student’s feelings today. Poor guy. I’m always cordial with students, and nice as I can be. But I was apparently very mean today.

First, I hurt his feelings when I suggested he get some real-world experience as an EMT before even thinking about taking the National Registry exam for paramedic. I know the commercials on late-night TV make this job look easy, and they tell you that you won’t get judged for not working on an ambulance until you have “P” on your patch, but that’s not true.

Then I hurt his feelings when I wrote in his evaluation something along the lines of “there is a lot that happens in the back of the ambulance, but this student wouldn’t know, since he spent the entire 12 hours napping, playing on Facebook, or staring out the back of the ambulance with his hands in his pockets. I guess my suggestion that he spend his time asking questions or reading his book didn’t go over too well.

I hurt his feelings once more when I suggested that he could start an IV if he wanted to, but he had to actually want to try and that it would be his responsibility if (God help us, when) he becomes a paramedic.

And lastly, I hurt his feelings when I suggested his bedside manor was more in line with someone who made a living selling used clothes on eBay.

This ain’t no Sadie Hawkins dance. I’m not going to grab your hand and tell you what to do.

Poor guy. I guess his complaint was warranted, after all.

Stop the charade

Look, I don’t want to be at work either. I come to this place at least twice a week, most frequently on Mondays, and it is always the same thing: a female feeling faint, or with chest pain, or with difficulty breathing.

I understand your boss is a really, really big meany-head, and doesn’t like it when you call out to work because you were hung over the whole weekend, I really do. I get it. I promise.

But every time you call for something like “feeling faint” or “chest pain” or with “difficulty breathing,” we send a fire truck, an rescue truck, and an ambulance to this place.

Ten people, eight EMTs and two paramedics, in 3 vehicles, for one person who just doesn’t want to be at work.

And when you call with one of those complaints, we have to send all those people to this place because it might actually be an ALS call. Then we have to start lines, do 12-leads, give aspirin and nitro, and the hospital has to waste their time doing the same thing.

And I know there isn’t anything wrong with any of you. I’ve been coming here weekly for years. Literally, years. I could drive here in my sleep. It’s like a giant room full of women crying wolf.

So I propose a deal: I will continue being the jovial paramedic who is genuinely concerned for your well-being, and you stop complaining of these things. How about “back pain from a kidney stone” or “nausea” or “pregnancy problem” or something that is BLS, but sick enough for your boss to believe your story.

I will still bring the stretcher to you, because we all know you can’t walk. I’ll still take you to the hospital, and they will still give you a work excuse, and your friend can also get off of work to come pick you up from the hospital, and you can both be back at your house in time to catch Judge Judy.

Stop the charade.

Physician vs. Patient vs. Paramedic

Chest pain at an urgent-care facility. A female in her 40s, according to the dispatch notes. For all we know, this could be a 93 year old male with a bunion. Silly call takers.

This time, they got it right.

“She is 43,” the physician on staff informs us. “Her chest has been hurting since 11 o’clock last night, and she needs to go to the emergency room. Her EKG is abnormal” he goes on, as he hands me a 12-lead.

It’s a sinus rhythm in the 70s with not a thing wrong. I couldn’t draw one better with a ruler and 6 hours of practice. But it says “Abnormal EKG” at the top.

I guess ‘reading EKGs’ is the same as ‘reading the words at the top of the EKG’ to some people.

“Hi, I’m C from the ambulance, how are you doing today?” I ask the very matronly, middle-eastern appearing woman in the room. I notice she is fully clothed, and wonder how an accurate EKG was obtained through a sweater, long sleeve shirt, and bra.

I suppose she could have gotten dressed after disrobing, but I doubt it.

“I’m fine, I guess. What are you guys doing here?” She looks genuinely puzzled.

“Well, the doctor called us and thinks you should go to the emergency room because your chest hurts.”

“I threw up 5 times last night and it made my throat burn. Where did he get chest pain? I don’t want to go to the hospital.”

The doctor walks in the room; “Yes ma’am, these nice ambulance people are going to take you to the hospital to make sure everything is alright.”

“But I don’t want to go to the hospital!” she retorts.

“I really think it is in your best interest” the doctor replies as he walks out of the room.

She acquiesces to the suggestion, but seems hesitant. I’m not too concerned just yet.

“Let’s move you into the ambulance, and get a few things done, and just go from there.”

After loading her in the ambulance, and several uncomfortable moments while she undresses from the waist up, with her modesty maintained, of course, her EKG still looks better than mine. Try and try, I can’t find anything wrong with it. Her vital signs are more than fantastic. Excellent, actually.

We determine that she vomited several times during the night after eating sushi and having drinks with her friends. Her throat and nostrils were burning, but her pain was gone now. Drinking milk or cold liquids seemed to help the situation. Then she says the magic words:
“I don’t want to go to the hospital.”

We do the whole rigmarole with the refusal paperwork, and she signs the form, saying she will go to the hospital if she ever needs to, but will never come back to this place.

I don’t blame her.

She gets dressed again, and steps out of the ambulance, walks to her car, then drives off. After we rearrange the ambulance and put the equipment back, I step out of the side door, to be met by the same doctor from inside with a very disapproving look on his face.

“Just what do you think you are doing?”

“Getting in the ambulance, and going in service” I reply. “The patient didn’t want to go to the hospital.”

“She has to go, I’m the doctor, and that’s why I called the ambulance.”

“Maybe if you had explained to her that you wanted to go to the hospital by ambulance, she could have told you she didn’t want to go, and you wouldn’t have wasted her time.”

Paramedics-1 Urgent Care-0

So I wrote a letter

Three things about me:

  1. I live in this city, and pay taxes in this city. Not just sales taxes, I am a homeowner here, so I get to actually use the “I pay your salary” line for city workers.
  2. I am an emergency worker, and I know how to use due regard.
  3. I know what I am supposed to do when approached by an emergency vehicle while I am driving my personal vehicle. I also know how not to be an ass when I am driving an emergency vehicle.

I imagine all of my EMS readers would fit in that above description.

What happened:

I was running an errand to pick up a toilet paper roll, a corkscrew, and some tinfoil, when I had to make a left-hand turn. I deftly activated my signaling device and gently moved into the center turn lane to await clearance in the oncoming traffic.

While I was waiting for a clearing to turn, I heard the firetruck. I looked in my rearview mirror, while keeping my hands expertly on the wheel at the nine- and three o’clock position. The fire truck was approaching from behind me in the left-hand travel lane.

The cars in the oncoming lane stopped. The fire truck moved into the center turn lane and stopped behind me.

And blared it’s horn.

I did what I thought should have been done. I heard the truck and I held my position. If I had been driving straight, I would have pulled as far to the right as possible, and stopped completely until the truck passed. The other cars did what they should have done: they stopped as well.

After several seconds, and realizing the fire truck was not going to do the easy thing, and simply go around me, I made my turn, swinging my car onto the right-hand shoulder of the road. I turned my head slightly to watch the crew drive by, wondering which station they were from, and if I knew anyone in the truck. As I did, the front seat passenger showed me something.

Both of his middle fingers.

I was taken aback. I didn’t know what to do.

So I wrote a letter. Several letters, actually.

To the Chief of the Fire Department, the mayor, each member of the city council, and two newspapers.

False competence

Double-ALS-night-shift-overtime. Half good, half bad. I don’t know why I agreed to work a night shift.

It’s going easy enough until around 3 in the morning. Diabetic call at the local premortuary sepsis factory decubitus plant nursing home. Easy enough, right? Throw some dextrose up in there and be done with it, right?

Wrong.

The staff says he must go to the hospital to be evaluated because the doctor says so. To complicate matters, we can’t get a line on this guy, who I swear, must have served in the first World War, and he has a long history of dementia, so who is to say what his normal mental status is, anyway?

Fine. No biggie. Stab him with a bit of Glucagon, move him to the stretcher, and drive him to the hospital. No big deal, right?

Wrong.

It’s my turn to drive. It’s going just fine. I’m listening to George Noory talk about aliens over the Pacific Northwest. It’s an easy drive over two lane roads dappled with houses. When all of a sudden…

“Hey, C, light it up, okay?”

“Dowhatnow?”

“Turn on the lights and sirens.”

“Huh?”

“Let’s go emergency!”

“Why?”

“His mental status isn’t improving.”

Taking a glance at my watch and doing some quick calculations, I realize ten minutes isn’t necessarily enough for Glucagon to work, and this guy has dementia anyway.

“Umm, you want me to get back there and ride this call?” I ask.

“No, I’ve got it. We should just get there faster.”

“I have faith in you. And the next three traffic lights won’t hold us up too much.”

—–

I’ll stop the story here, because the conversation became fraught with animosity. Suffice it to say, I don’t believe in traveling emergency to the hospital, except in extreme circumstances. I won’t judge someone who chooses to use the lights and sirens during some calls, but during a hypoglycemic episode, when there hasn’t been enough time to allow the drug to work, and the vitals are better than mine? No way does that warrant lights and sirens.

Especially not at three in the morning.

Let’s not trick ourselves into thinking we are heroes by running people off the road to get to the hospital.

Maybe services could review the calls in which the medic decided to utilize lights and sirens during transport. I bet there is some interesting information out there.

Not a cop

I don’t take people to jail. That is kind of the opposite of what I do. Although I will admit that my uniform can certainly make me look like a police officer to the uninitiated or inebriated.

“What’s this guy here for?” asks the nurse with the voice and demeanor of someone who could only be described as ‘bitchy.’

“He had a little too much to drink last night, and was taking a nap at the bus stop. He was trying to catch a bus down to the Catholic Church for the free breakfast, but he missed it.”

“Why isn’t he in jail, like he should be?”

“Because he is hungry, cold, and tired. Your hospital has food, warm blankets, and soft beds. He needs a nap and a snack, then I’m sure he will be out of your hair pretty quickly.”

“Well, he should have gone to jail.

 

It’s not against the law to be drunk. It’s not against the law to take a nap at a bus stop. It’s not against the law to be homeless, hungry, cold, and tired. No cop I have ever met around here is going to take a guy to jail for sleeping off a drinking binge at a bus stop.

It is also not against the law to be a bitch. But being a bitch doesn’t get you anywhere.

Sometimes I wonder if particular nurses have a crappy attitude because they always get the stinky drunk patients, or if those nurses always get the stinky drunk patients because they have a bad attitude.

About apathy

Just for those of you who asked, I will post my thoughts on the state of apathy. I might even use a big word. Just bear with me.

 

Everybody just wants to complain. Whine, moan, bitch, and complain. But they don’t want to do a thing about it.

We want more drugs, more procedures, more leeway to determine who does and does not need to go to a hospital. But we don’t accept the responsibility that comes with it. We don’t go to lectures at the teaching hospitals offered to the medical staff. We don’t read. We don’t write. We don’t further our profession.

No. We come to work for our checks and we bitch all the way to the bank.

And I’m tired of it.

I know other paramedics don’t go to medical staff lectures. I know this because I do, and invariably, I am the only paramedic in the room. Hell, I’m the only guy in the room that doesn’t have MD or DO behind his name.

I know this because I have been going regularly. Some of the doctors at Big Teaching Hospital know me by name. Because I am involved. I take notes. I ask questions. Good questions, too. Questions that other medics should be asking, but they can’t because they are too busy planning their next vacation or playing the newest video game or planning their next drinking binge with their buddies.

Call me self-righteous all you want. But don’t call me lazy. And you sure as hell better not call me apathetic.

Why wouldn’t we go to the same continuing education programs that physicians do? For crying out loud, the word Paramedic means a person who is trained to work in an auxiliary capacity to a physician.  

I know other medics don’t read. I know this because of the looks I get when I reference medical research. “There was an article in the BMJ a few months ago that…” “What the hell is the BMJ?” is the response I get. “Why would I read a medical journal?”

We don’t further our profession because we don’t care about our profession. Perform your own experiment at your service: ask your coworkers what their plans are for EMS 2.0. Let’s see what the response is.

But nobody cares. NOBODY CARES.

Sure, there are those of you who are regular readers of EMS bloggers. You care. Those with the blogs care. But the rest of EMS doesn’t. I can wade through my almost 1,000 comments posted to my blog since I started roughly 14 months ago and bet that there are fewer than 50 contributors The same people are commenting over and over again.

I’m no prolific blogger by any stretch of the imagination. But when I review my stats, the two posts that have the most views are posts entitled I don’t like people and A letter to a stethoscope thiefThat’s what interests the vast majority of blog readers: sophomoric musings on why people generally suck and an asshole that stole my stethoscope. (Well, mine at least.)

But when I try to get people involved, to actually take ownership of EMS, and to play a more proactive role, I am met with a lugubrious apathy that irritates me to my very core.

I was met with this during our protocol-writing meetings. “It’s not fair that some paramedics would be able to use drugs that other paramedics can’t” was the paraphrased response I heard when we were discussing carrying some antihypertensives. “Life ain’t fair, buddy. You want to use the fancy stuff, go to the fancy classes.” was my response.

Andrew Grove, who rose to be CEO of Intel, wrote a book called Only the Paranoid Survive in which he gives leadership advice to people that work in any industry. Andrew Grove knows how to be successful. He says that there are:

“…moments in any business in which massive change occurs, when all the rules of business shift fast, furiously and forever. He calls these moments “strategic inflection points (SIP)” and he has lived through several. They are not always easy to spot – but you can’t hide from them.”

These strategic inflection points can make or break a business. I believe we are in the midst of what Mr. Grove would refer to as an SIP. Community Paramedicine, Critical Care Transport, expanded scope, changing educational requirements. Those that aren’t prepared to change and adapt are doomed to suffer terrible losses, the same that Intel suffered for three years before realizing they had to change their business model to compete with the Japanese.

Those in our profession who are not willing to change, who are okay with the prevailing apathy, are about to get, run over by a train. And when they get knocked out and wake up to a bright light, it’s not a paramedic checking their pupils; it’s that train coming right back for them.

So, if you aren’t ready to change, if you aren’t ready to make this the true profession that it should be, if you aren’t ready to learn, to take responsibility, to take ownership, to be proactive, then leave.

Go get a job doing something else. Do everyone a favor.

And if you are a manager, and you are the resistant force to this change, step aside and let a true leader take over. Managers manage, and anyone can do that. It’s not hard to babysit employees and to slap their wrists when they do something wrong. It is a whole different story when it comes to being a leader. Leaders have vision, and they know how to accomplish their vision.

Rudy Giuliani was by most accounts, a great mayor. Mayor Giuliani recognized that he did not know how to solve problems, but he had a vision for the way things should be. He used his vision to select people who shared his vision to fill his positions of leadership. And he accomplished his goals as a Republican in an overwhelming Democratic city. I am not from New York, and if you want to disagree with me on Mayor Giuliani’s politics, do it somewhere else, not here.

This is my career. This is what I want to do. It is not a ‘stepping stone’ nor am I in a ‘holding pattern until something better comes along.’ This is what I do.

And frankly, I am tired of the same old lazy, apathetic losers standing in the way of our progress.

Change, get out of the way, or get out. Period.

A grand quote from the aforementioned Mr. Grove:

“Your career is your business, and you are its CEO”

Would you fire yourself? A lot of EMTs and Paramedics should.

A political nutjob

 

Sorry if I bore you with a non-EMS, political post. I’m really not doing much of anything on the ambulance these days.

So I spent a shift with a political clown today. One of those “fringe” guys that seem to be so prevalent these days.

“Obama isn’t even a legitimate president because he isn’t a natural born citizen.1

“Oh, so you don’t think he was born in Hawaii?”

“Dude, it doesn’t matter, his father was born in Kenya, so that means he isn’t a ‘natural-born citizen.’”

Wow.

I was dumbfounded. I really can’t believe there are people out there who have such a difficult time grasping simple definitions. I am certainly not much a fan of our current president, but I would never argue that he was an illegitimate president.

Who did Obama run against in the 2008 primaries? The Clintons2. Well, there was also the rest of the field: Gov. Richardson, Rep. Kucinich, Senators Gravel, Dodd, Edwards, and Biden, but most importantly, Senator Clinton, and the “Clinton Machine.”

Seriously, if Obama isn’t a natural-born citizen, or if he was ineligible for the presidency, does a rational person really believe Bill Clinton would have allowed him to run against, much less defeat his wife?

Not that lunatics are rational.

Not to mention the utter chaos that would be created if Obama was not eligible to be president, but became president anyhow. How many laws, appointments, nominations, etc… would be completely nullified?

You should see the smoke coming from their ears when they hear that Governor Romney isn’t a natural-born citizen under their definition, either. Yeah, Mitt Romney’s father was born in Mexico, so he would fail a similar smell test.

I am very ready for this to be over with.3

 

1. Since I wanted to be a lawyer, I will use the Black’s Law Dictionary definition of “Natural Born Citizen” which is ‘A person born within the jursidiction of a natural government.’

2.Yes, I am aware that the “birther” conspiracy actually began with the democrats when Clinton supporter Phillip Berg filed a lawsuit in 2008. See: Berg v. Obama

3. I could go on and on an on and on about how out of touch these fringe people are, but really, what’s the point? Is it November 7th yet?

Is “Pinktober” over yet?

Look, I appreciate boobs as much as the next guy, and hate cancer just as much as anyone else, but this pink craze in the NFL has just gone too far.

I think it’s cute when MLB players will use a pink bat for Mother’s day. That is pretty neat. But seeing virtually every player in every NFL game in the entire month of October is just too much.

And now the NFL says they are going to use pink penalty flags for the Jets/Dolphins game this week, because of the suggestion of a 5 year old.

Hey, Commissioner Goodell, I have a toddler who would like to see the penalty flags be replaced by chicken nuggets.

Are we supposed to believe that the NFL cares that much about women and breast cancer research? When their poster boys are the likes of Brett Favre, Ben Roethlisberger, and Lawrence Taylor.

Why does it just have to be breast cancer? Why can’t it be just plain old cancer. Money raised from the pink brouhaha goes to “breast cancer research.” I would be interested in knowing how much goes to any research, and how much is for “administrative fees” and such.

Someone is going to have to sew those pink flags, after all.

What about other cancers? Digestive system cancers kill more people per year than breast cancer, as does Respiratory system cancer.

Prostate cancer is estimated to kill 28,170 men this year. But I don’t see guys playing football in kilts.

There’s an idea for you. We should get the KTKC guys on that next year.

Kilts on the football field.

I can see Peyton Manning lifting up the kilt of his center.

Whoa.

Stupid armchair quarterbacks

It’s always easy to criticize an EMT or paramedic when they screw up, perceived or actual, in a situation.

It’s not too easy, but still plausible, to criticize someone when your buddy tells you how dumb the EMT or paramedic screwed up on a call.

But when you weren’t on the call, and your buddies weren’t on the call, and you only heard about the call because it was on the news, and you happened to go to the same hospital several hours later, where you heard fourth-party stories of the situation, you should keep your mouth shut.

There is a time and a place to to discuss calls. That time is usually scheduled, and the place is usually in a conference room. That time is certainly not the choosing of a person who wasn’t even aware of the situation until they turned on their car, and that place certainly isn’t the water cooler.