I went down to Baltimore, Maryland to attend the annual JEMS EMS Today Conference. This is the second time I have been, and I was very glad I went. The speakers are always absolutely first rate. It is good to surround yourself with people who are on the leading edge of EMS. I always like finding out what the latest is, both in research and technology.
This years’s conference was dominated by the new AHA guidelines. The message was Compressions, compressions, compressions. Allow full chest recoil when doing CPR and NO hyperventilation. Ventilate your codes at 8-10 times a minute.
Here are some of my notes:
Studies show half the time in CPR compressions don't get done.
When you stop compressions, all blood flow ceases.
Studies show paramedics, doctors and nurses all ventilate at rates from 30-40 a minutes.
High ventilation rates screw up the intrarthoracic pressure preventing effective blood flow.
Normal people breathe through negative pressure. We ventilate people with positive pressure. Too much positive pressure inhibits blood return.
Our ventilations should be fewer and less both in terms of volume and duration.
Studies showed uninterrupted compressions increased survival by 300%.
Anything that interrupts compressions is bad.
You can delay intubation for patients in vfib. They should have a good supply of oxygenated blood in their body that will last for five minutes or so. You could monitor their status by using a nasal end tidal CO2 cannula while using a bag mask.
When you do intubate try to keep compressions going while you pass the tube. If you need to stop compressions, stop only for a brief moment
In a study when pigs were put into arrest, 6 of 7 pigs survived when they were ventilated 6 times a minute, only 1 of 7 survived when they were ventilated at 30 times a minute.
Keep tidal volume to 400 on ventilations.
There are two ways to hyperventilate: Too many respirations and too much volume in a single respiration.
Most pulses that emerge after a shock don't show up for 60 seconds. So keep doing compressions.
One speaker joked “Keep doing compressions until the patient wakes up, grabs you hand and insists you stop.”
There are fewer v-fib codes today than several years ago because of the better cardiac care people receive from their doctors. Most codes are sicker people.
Epi has a IIb rating because they cannot do a study where epi is used against a placebo. No ethics board would allow it. Without such a study, there can be no Level I rating. Its one of the quirks of the evidence rating system.
One of the reasons, cardiac arrest discharge from hospital rates are so low is because the post resuscitation care at the hospital is so poor -- it often consists only of trying to make a person a DNR.
Other notes:
On cardioversion -- if the patient can remember what you look like after you have cardioverted them, don't cardiovert because they probably don't need it.
I asked the Dr. responsible for the tachycardia algorithm about the new phrase “Seek Expert Consultation,” and he said, it means if you don't have to give a patient drugs, don't, wait for the hospital.
On Intubation, a doctor said the FDA would not approve intubation today based on existing studies that show how badly it is being done and its negative effect on patients. A group of doctors said for people to keep intubating, their program needs a solid QI program and people need to go to the ER if they are not getting enough tubes. One doctor said, "a misplaced tube is a travesty. It means, your patient would have done better in a Yellow Cab."
They said never intubate a child unless you absolutely have too.
The adult IO is great for cardiac arrest, it may not have a place in trauma.
Studies have shown that morphine actually helps the surgeon do an abdominal evaluation. We should be giving morphine to patients with abdominal pain.
In trauma, we should practice permissive hypotension – the BP can be kept around 70 for trauma patients and fluid should only be administered if the pressure gets below 40.
Gunshot wounds to the head without neuro deficits, do not need cspine.
Magnesium is great for severe asthma -- 2 grams in 100cc over 1-10 minutes.
Instead of doing one breathing treatment followed by another, do a continuous treatment, which is basically dumping two treatments in the neb to begin with.
CPAP for CHF is outstanding.
Be very cautious with lasix. Never start with Lasix and never give it unless you are also giving nitro because lasix's initial action is as a vasoconstrictor.
For anaphylaxis, give epi IM in the thigh
Everyone intubated should have end tidal Co2 monitoring.
***
And here are my awards for the two best products from the EXPO:
Vida Care Easy IO
RESQPOD
***
The conference will be held again in Baltimore next year. Since EMS is now relying on evidence-based medicine, each new study will shape our direction. As one doctor said, what you are learning today, will be different tomorrow.
Monday, March 27, 2006
Sunday, March 19, 2006
EMS Books - Print on Demand
Every six months I get a report with the sales figures from my two books. In the last few years I have noticed a small but growing uptrend in sales. If the next report continues this trend I will be discuss with my agent the possibility of doing a third book. I actually already have some of the book written, but what I need is her advice to go ahead and make a formal proposal to the publisher. Book publishing, as I have learned, is largely about the dollar. Will they make money off the book? It has little to do with the quality of the writing or the story(beyond the fact that everything else being equal, a better written book is better than a poorly written book.) They are a business and they need to show a return on the dollar. That’s probably how it should be. I wouldn’t run a business any other way.
In recent years the book publishing industry has undergone numerous changes. The big publishers are publishing fewer books. Their efforts are largely aimed toward the blockbuster – the million dollar seller Oprah book. They have been neglecting the mid-list book – the book that sells a small but steady amount. In addition, when it comes to paperback books, the distribution system has fallen apart. In the old days every drug store and supermarket had racks of paperback books of great variety. Nowadays, it’s all bestsellers.
While I have a contract with my publisher that gives them the right of first refusal of my next book, I don’t want to send them a proposal if my agent thinks they won’t accept it. If the sales figures go up, they may be interested. Hopefully, they may see the possibility of a small profit. They have two of my books already. Do they really need a third? And will a third just take shelf space away from the first two? Who really knows? Is the timing right? Maybe the increased interest in paramedics and emergency medicine in recent years will convince them there is an opportunity for profit. I hope so.
While the bad news for writers has been that the major publishers have been publishing fewer books, the good news is the new phenomena of (POD)Print on Demand publishing has filled the void for small books. Now a person can publish their own professional looking book quite reasonably, and it can be sold on the internet through Amazon and other outlets.
Publishers include iuniverse, xlibris, authorhouse, booksurge and LULU. They are many others. Prices range from free to $500 or more dollars depending on the services provided.
I have recently read two self-published EMS books that I enjoyed.
In the Arms of Stranger by Dale Bingham and Paramedic: Buff to Burnt by George Steffenson. While both volumes are slim, I was entertained and at times moved by their stories. Everybody who has worked any length of time in this field has stories to tell, and just getting them down on paper, reasonable edited, and then put in a form that you can share them with others is an admirable feat. I hope that more EMS people will avail themselves of the opportunities offered by POD and make their contribution to the growing literature of EMS.
**
I have taken my latest draft of my novel Diamond in the Rough down from the web site and am just leaving the first nine chapters up while I rewrite the book. I recently had it printed up double sided and spiral bound so I could read it like it was it book. Whenever I do this, I am very depressed after reading it because I see everything that is wrong with it. My depression then passes as I start to recognize what is good about it, and how to fix it to make it better. I have been vicious with my cutting, and hope the book will soon be leaner, tighter, and better. I believe the chance of getting this novel published by a major publisher is pretty slim, so that when I feel I am done with it, I may well go the POD route. It gives you more hope when writing, knowing that your work won’t end up in a dusty drawer.
The following link has many excellent links that provide interesting information about POD publishing:
More info on POD: Pros and Cons
In recent years the book publishing industry has undergone numerous changes. The big publishers are publishing fewer books. Their efforts are largely aimed toward the blockbuster – the million dollar seller Oprah book. They have been neglecting the mid-list book – the book that sells a small but steady amount. In addition, when it comes to paperback books, the distribution system has fallen apart. In the old days every drug store and supermarket had racks of paperback books of great variety. Nowadays, it’s all bestsellers.
While I have a contract with my publisher that gives them the right of first refusal of my next book, I don’t want to send them a proposal if my agent thinks they won’t accept it. If the sales figures go up, they may be interested. Hopefully, they may see the possibility of a small profit. They have two of my books already. Do they really need a third? And will a third just take shelf space away from the first two? Who really knows? Is the timing right? Maybe the increased interest in paramedics and emergency medicine in recent years will convince them there is an opportunity for profit. I hope so.
While the bad news for writers has been that the major publishers have been publishing fewer books, the good news is the new phenomena of (POD)Print on Demand publishing has filled the void for small books. Now a person can publish their own professional looking book quite reasonably, and it can be sold on the internet through Amazon and other outlets.
Publishers include iuniverse, xlibris, authorhouse, booksurge and LULU. They are many others. Prices range from free to $500 or more dollars depending on the services provided.
I have recently read two self-published EMS books that I enjoyed.
In the Arms of Stranger by Dale Bingham and Paramedic: Buff to Burnt by George Steffenson. While both volumes are slim, I was entertained and at times moved by their stories. Everybody who has worked any length of time in this field has stories to tell, and just getting them down on paper, reasonable edited, and then put in a form that you can share them with others is an admirable feat. I hope that more EMS people will avail themselves of the opportunities offered by POD and make their contribution to the growing literature of EMS.
**
I have taken my latest draft of my novel Diamond in the Rough down from the web site and am just leaving the first nine chapters up while I rewrite the book. I recently had it printed up double sided and spiral bound so I could read it like it was it book. Whenever I do this, I am very depressed after reading it because I see everything that is wrong with it. My depression then passes as I start to recognize what is good about it, and how to fix it to make it better. I have been vicious with my cutting, and hope the book will soon be leaner, tighter, and better. I believe the chance of getting this novel published by a major publisher is pretty slim, so that when I feel I am done with it, I may well go the POD route. It gives you more hope when writing, knowing that your work won’t end up in a dusty drawer.
The following link has many excellent links that provide interesting information about POD publishing:
More info on POD: Pros and Cons
Monday, March 13, 2006
My Job
The Maytag Repairman Syndrome is common in EMS. You are a paramedic to save lives, but you cannot save lives if no one’s life is in jeopardy. As an EMS writer, I need interesting calls to write about, because I cannot write stories if my day is boring. One of the reasons I write about my day is to help look and find what is interesting in the day that I might not have otherwise seen if I wasn’t looking carefully. A newspaper reporter assigned to an ambulance for a day can usually write pretty good copy even if the calls are not interesting because they are seeing the work with a fresh eye. A person who rides only one day on an ambulance will remember all the calls vividly while a veteran EMT may not remember what they did that morning.
Each person, each patient is a story waiting to be told, yet for the last many days when I have sat down to write in my daily blog, I have found little to inspire me. Maybe it is time for a vacation. I have already, for various reasons, canceled three planned adventures for this year – days taken off where I ended up working anyway. My trip to Jamaica has been delayed until June, My Atlantic City poker excursion I opted out of, my trip to Florida to see the World Baseball Classic I also opted out of, as I will opt out of going to San Diego to see the finals of the Classic. I am thinking about going to Baltimore for the EMS Conference, but haven’t decided yet. My Hollywood Adventure also didn’t pan out, not really for reasons in my control.
I have just been working. The calls are just turning into a blur. I am hesitant to say nothing interesting has happened or to use the Q word for fear of tempting the gods who will throw a shit storm my way, and as much as I like challenging calls, I do not wish the collateral damage on the patients. I’ve been doing a lot of old people, a lot of nursing home calls, a lot of pneumonias. Basically I’ve been doing the bread and butter of EMS – the routine. Sometimes for better or for worse it is what the work is about.
I think of what I would be doing if I had gone to California. Sitting around a table with a bunch of TV writers sketching out scenes, multiple car MVAs, shootings, stabbings, babies being born, cardiac arrest saves, daring rescues... Throw in some sex and other high-jinks on the job. Add a great soundtrack: Guns and Roses doing Dylan’s “Knocking on Heaven’s Door.” And Billy Joel’s “In the Middle of the Night” which was on the radio years ago when I was doing my first ride time in a big city at night.
Instead I’m sitting here waiting for the nursing home to call to say Mr. Henry fell and has a skin tear or the visiting nurse to say Mrs. Roosevelt’s feet are swollen or the Doctor’s office to call and say Mrs. Brown has a touch of pneumonia or the PD to call to say there is a minor MVA with a driver complaining of neck pain.
And then I off. I will try to be professional, try to do my job well, try to make a difference in someone’s day. To quote a great country song by the late Conway Twitty “That’s My Job, That’s What I do.”
Each person, each patient is a story waiting to be told, yet for the last many days when I have sat down to write in my daily blog, I have found little to inspire me. Maybe it is time for a vacation. I have already, for various reasons, canceled three planned adventures for this year – days taken off where I ended up working anyway. My trip to Jamaica has been delayed until June, My Atlantic City poker excursion I opted out of, my trip to Florida to see the World Baseball Classic I also opted out of, as I will opt out of going to San Diego to see the finals of the Classic. I am thinking about going to Baltimore for the EMS Conference, but haven’t decided yet. My Hollywood Adventure also didn’t pan out, not really for reasons in my control.
I have just been working. The calls are just turning into a blur. I am hesitant to say nothing interesting has happened or to use the Q word for fear of tempting the gods who will throw a shit storm my way, and as much as I like challenging calls, I do not wish the collateral damage on the patients. I’ve been doing a lot of old people, a lot of nursing home calls, a lot of pneumonias. Basically I’ve been doing the bread and butter of EMS – the routine. Sometimes for better or for worse it is what the work is about.
I think of what I would be doing if I had gone to California. Sitting around a table with a bunch of TV writers sketching out scenes, multiple car MVAs, shootings, stabbings, babies being born, cardiac arrest saves, daring rescues... Throw in some sex and other high-jinks on the job. Add a great soundtrack: Guns and Roses doing Dylan’s “Knocking on Heaven’s Door.” And Billy Joel’s “In the Middle of the Night” which was on the radio years ago when I was doing my first ride time in a big city at night.
Instead I’m sitting here waiting for the nursing home to call to say Mr. Henry fell and has a skin tear or the visiting nurse to say Mrs. Roosevelt’s feet are swollen or the Doctor’s office to call and say Mrs. Brown has a touch of pneumonia or the PD to call to say there is a minor MVA with a driver complaining of neck pain.
And then I off. I will try to be professional, try to do my job well, try to make a difference in someone’s day. To quote a great country song by the late Conway Twitty “That’s My Job, That’s What I do.”
Wednesday, March 08, 2006
Transfers
When I started in EMS paramedics rarely did transfers. Out of twenty cars, maye six were medic. Sometimes only two. One of my first partners used to get very upset if we were even dispatched to an ETOH. We were to be kept back for the bad ones.
Who you work with, particuarly when you start out, can be very influential on your own outlook. If your partner is pissed and frustrated, then you may tend to be the same way. If your partner is easy going, then your day goes a little easier. At least I feel my partners moods tend to rub off on me.
Over the years as we have added more medics, transfers have become a regular part of the job, so much so that I tend to not even mind them too much. I guess sometimes I get mad if I'm sent on a transfer as a medic while a BLS truck is kept on-line and they end up having to do a code without a medic available. That clearly isn't right.
Half the week I work in the suburbs as the paid contracted medic on a volunteer ambulance. Our call volume has soared in recent years, mainly due to "emergifers" -- nursing home calls that used to go to the commercial ambulance, but are now kicked to us because the patient is going to the ED for evaluation. We get a lot of fevers, swollen legs, skin tears. It's all part of the job. Our call volume is also up because the town has a high elderly population and so many of them live at home and are cared for by visiting nurses, who call us whenever the patient has a fever or a cough or any kind of dsypnea on exertion. We do a lot of these calls.
A number of years ago -- I don't know what was going on that particualar day or why I was in the mood I was in, but we got sent to a private home for respiratory distress. We went lights and sirens and came charging into the house only to find a man laying in bed, seeming in not much distress at all. He could speak in clear sentences and he said he had a bad cough and wanted to go down to the ER. He was very pleasant, almost cheerful. When I asked, he said his doctor wanted him to go down to the ER. On the radio another call was going out -- for a chest pain -- and I made some out of line comment about how maybe he should have called a taxi instead of us.
"But I have no legs," he said.
Sure enough, I pulled back the sheet and the man just had two stumps.
I felt a little foolish.
***
The other day I did three calls -- all regulars, including the man with the stumps, who I have picked up quiet a few times -- always for fever and respiratory infection. We know each other by name and always make small talk on the way to the hospital. I know all about his family and he knows some about mine. I don't do much for him, but put him on a cannula. He has an IV port. It is not the biggest emergency, but taking him to the hospital is part of my job.
***
Yesterday I worked the HP - high performance car -- for the first time. The deal with the HP car is you do nothing but transfers. As soon as you have done eight, you can go home and still get paid for your 9-5 eight hours. If it is slow or you have to wait too long for a transfer to be ready, you still get credit for a call. I took the shift because an old partner of mine was working it. He recently came back to work for the company after being away for four years, working a variety of other jobs -- group home, security, research lab, er tech. He likes the HP shift. "I did all those calls with you, the shootings, stabbings, digging babies out of toilets, I don't need to do that anymore. I come in, I do my job, and most days I get out early."
We had a good time, catching up on news and rehashing old times. We did our eight calls and were out an hour and a half early.
I can't say as I really enjoyed humping all those transfers -- we didn't have a break -- but I was impressed with my friend's work ethic and bedside manner and impressed with the idea of the HP car. The first four calls were all dialysis patients. He does the same patients every Tuesday and Thursday. One of the calls involved helping an amputee down some narrow stairs, using two of those stair escalators, and then an outside elevator. You could tell the patient was comfortable with him and he joked easily with her and her daughter. I knew the patients liked having the same guy come for them every time rather than an endless procession of new faces. At one diaylsis center, he helped dress an old woman the way she liked, putting her hood up and wrapping a scarf around her. On our next to last call, we took a woman home from the hospital to her daughter's house. We showed the daughter how to put a cannula on the mother, how her 02 machine worked, how a foley bag needed to be kept low so it would drain, and pointed out a sore on the woman's ankle. We gave her the company's number and told her to call us if she needed scheduled transportation and to call 911 if any emergencies developed. She thanked us as she let us out the front door.
Who you work with, particuarly when you start out, can be very influential on your own outlook. If your partner is pissed and frustrated, then you may tend to be the same way. If your partner is easy going, then your day goes a little easier. At least I feel my partners moods tend to rub off on me.
Over the years as we have added more medics, transfers have become a regular part of the job, so much so that I tend to not even mind them too much. I guess sometimes I get mad if I'm sent on a transfer as a medic while a BLS truck is kept on-line and they end up having to do a code without a medic available. That clearly isn't right.
Half the week I work in the suburbs as the paid contracted medic on a volunteer ambulance. Our call volume has soared in recent years, mainly due to "emergifers" -- nursing home calls that used to go to the commercial ambulance, but are now kicked to us because the patient is going to the ED for evaluation. We get a lot of fevers, swollen legs, skin tears. It's all part of the job. Our call volume is also up because the town has a high elderly population and so many of them live at home and are cared for by visiting nurses, who call us whenever the patient has a fever or a cough or any kind of dsypnea on exertion. We do a lot of these calls.
A number of years ago -- I don't know what was going on that particualar day or why I was in the mood I was in, but we got sent to a private home for respiratory distress. We went lights and sirens and came charging into the house only to find a man laying in bed, seeming in not much distress at all. He could speak in clear sentences and he said he had a bad cough and wanted to go down to the ER. He was very pleasant, almost cheerful. When I asked, he said his doctor wanted him to go down to the ER. On the radio another call was going out -- for a chest pain -- and I made some out of line comment about how maybe he should have called a taxi instead of us.
"But I have no legs," he said.
Sure enough, I pulled back the sheet and the man just had two stumps.
I felt a little foolish.
***
The other day I did three calls -- all regulars, including the man with the stumps, who I have picked up quiet a few times -- always for fever and respiratory infection. We know each other by name and always make small talk on the way to the hospital. I know all about his family and he knows some about mine. I don't do much for him, but put him on a cannula. He has an IV port. It is not the biggest emergency, but taking him to the hospital is part of my job.
***
Yesterday I worked the HP - high performance car -- for the first time. The deal with the HP car is you do nothing but transfers. As soon as you have done eight, you can go home and still get paid for your 9-5 eight hours. If it is slow or you have to wait too long for a transfer to be ready, you still get credit for a call. I took the shift because an old partner of mine was working it. He recently came back to work for the company after being away for four years, working a variety of other jobs -- group home, security, research lab, er tech. He likes the HP shift. "I did all those calls with you, the shootings, stabbings, digging babies out of toilets, I don't need to do that anymore. I come in, I do my job, and most days I get out early."
We had a good time, catching up on news and rehashing old times. We did our eight calls and were out an hour and a half early.
I can't say as I really enjoyed humping all those transfers -- we didn't have a break -- but I was impressed with my friend's work ethic and bedside manner and impressed with the idea of the HP car. The first four calls were all dialysis patients. He does the same patients every Tuesday and Thursday. One of the calls involved helping an amputee down some narrow stairs, using two of those stair escalators, and then an outside elevator. You could tell the patient was comfortable with him and he joked easily with her and her daughter. I knew the patients liked having the same guy come for them every time rather than an endless procession of new faces. At one diaylsis center, he helped dress an old woman the way she liked, putting her hood up and wrapping a scarf around her. On our next to last call, we took a woman home from the hospital to her daughter's house. We showed the daughter how to put a cannula on the mother, how her 02 machine worked, how a foley bag needed to be kept low so it would drain, and pointed out a sore on the woman's ankle. We gave her the company's number and told her to call us if she needed scheduled transportation and to call 911 if any emergencies developed. She thanked us as she let us out the front door.
Saturday, March 04, 2006
My Hollywood Adventure
About a month ago I come home one night and see the message light blinking on my answering machine. I hit the play button. It is a message from an assistant at a television production company in Southern California, telling me that the Executive Producer of a new TV series about paramedics has read my books and is interested in talking to me.
***
Background:
Many years ago when I was on an author tour following the publication of my first book I appeared on a show called "Home Team with Terry Bradshaw" a very short-lived talk show (much like Oprah, except with Terry Bradshaw and some lady, whose name I don't remember, as hosts). It was filmed on a studio lot in Hollywood. In my segment I was already sitting in a chair next to Terry Bradshaw when the cameras came on. How I had wanted to be introduced and with music playing, walk out on stage doing a little funky semi-pimp walk, pointing fingers at my boys in the crowd. I guess since I was taller than Bradshaw they didn't want me to stand next to him. Anyway, it was a fun experience. I had a dressing room with a paper sign with my name on it posted on the door. I swiped it when I left. I remember Bradshaw being very nice, but constantly having to wipe the sweat off his brow. He flubbed his lines and they had to reshoot my segment. They were holding big cue cards while he interviewed me. Anyway, the producer who had pre-interviewed me in preparation for the segment told me she liked my book and asked if any Hollywood producers had called yet. No, I said. She assured me they would.
Eight years later, the call has finally come.
***
I stand there in the silence after hearing the message, and am both thrilled that my long awaited moment had arrived, but also a little disturbed that my life that I have so carefully put together (a house, a job I love (great work assignment, seniority, 401K), exciting writing projects, a regular poker game that I am beating, a girlfriend with two children I am quite fond of and who are fond of me) is now at threat. I will admit that a part of me wishes the message isn't there. But Hollywood...Hollywood is the American dream. How do you say no to Hollywood?
***
More background:
When I was in college I took a year off. I hitchhiked out to California where I was going write the Great American novel. I ended up in Hollywood, living a few blocks off Hollywood Boulevard in a seedy apartment building at Wilcox and Yucca where my neighbors where drug dealers, transvestites, and illegal immigrants. A few weeks before I moved in, there was a fatal shooting in the lobby. The manager, who I ended up drinking beer and smoking pot with when I showed up to see the room advertised in the paper, told me he hadn't cleaned up all the blood yet as a warning to people to keep it clean in his building. "You can do anything you want in the street," he said, sucking on a giant reefer, "but don't fuck with me in my building. You fuck with me you better kill me dead, because otherwise I'm putting my combat boots on and I'm going to hunt your sorry ass down." Just then a girl, probably a runaway, who was dancing by herself to Edgar Winter's Free Ride, danced over to him, and he started making out with her in a very physical way. His assistant, a fourteen year old Mexican kid, who never smiled, glared at me and said, "He's serious dude. Don't fuck with him." His glare seemed to add the words, "or me."
Wanting to be as far away from them as possible, I took a job out in Santa Monica as a telephone solicitor. I'd take a two hour bus ride out there early every morning, work the morning shift, spend the afternoon on the beach by the pier, work the night shift, then come back to Hollywood and sneak into the building. At night, the police helicopter would shine its spotlight into my room as it searched for wanted men. I could hear the cops on the loud speaker telling the desperados to give up and come out. It seemed to happen every night. I lasted in that building a month. The runaway smiled at me on the stairs one day when she was walking by with the Mexican kid, and I caught the glare in his eye, and after that I was convinced the Mexican kid was going to get high one night, and carve me up with his knife just for fun.
As soon as my first month rent was used up, I left town and went to San Francisco, which was another story altogether.
***
I get on the internet and research the producer and find a news clip about the show. The production company is located in Santa Monica. I believe in the circular nature of life. I never got into Harvard, and then years later I returned in my own triumphant way. The Governor of Connecticut was the featured speaker at the Harvard JFK School for government. As his speechwriter, I sat in the back row and listened to the power of his voice as he gave song to my words. The standing ovation...I was redeemed. (Now how pathetic am I? Harvard does not want speech writers; Harvard wants the person who gives the speech. Still, I felt a measure of I told you so.) Now it is time to return to Hollywood/Santa Monica. It seems predestined.
***
I talk to the producer the next day and he says he read my books to prepare the pilot episode and now that it has been green lighted by the network (TNT) for thirteen episodes he would love to have me come out and serve as a technical consultant and story developer, and maybe eventually working with another writer, try my hand a doing a script for the series. He needs someone who can combine story-telling with the technical know how to make certain they get it right. And they need me right away. I tell him I am interested, but am not certain I can get off work to come out. We leave it that I will look into getting a leave of absence, and he will look into finding a way to work me into the budget. In the meantime he will send me a copy of the pilot and the first script.
***
The operations head is excited for me and agrees to let me take a leave of absence. The head of the suburban volunteer service where I am based as a contract medic agrees to let me return to my post provided the company can find a regular replacement for me while I am gone. I like my suburban post so much that if I were to lose the post, I would not go.
While I wait for news I take my girl friend's kids swimming. The five-year old jumps into the water and swims to me. We gradually go deeper and deeper until she is jumping in over her head. She jumps in and pops up and dog paddles to me with a big smile of success. She wraps her arms around my neck. When we leave the pool, her ten-year old sister says, "This was the best day ever!" I feel pangs about leaving them.
I hear nothing for two days, and then get an email from the producer telling me they have not forgotten me, but are working through the bureaucracy. I check the mail -- no script or pilot. I get another email from another producer saying they are hoping to work something out and I should call if I have any questions. I talk to him, and he apologizes for the delay in making an offer. I ask again for the pilot. Nothing comes.
I am beginning to think they are blowing me off. I think I should have just said no, up front. My life here is more important than any stupid Hollywood red carpet dream.
I am out in the street playing football with the girls and their two cousins. We huddle up. I tell the five-year old boy to do a buttonhook and then go deep. I tell the ten-year old girl to go straight, and then cut sharply to the mailbox.
"Car! Car!" the defenders shout.
I look down the street and see a big yellow DHX truck. This is it, I think. This is my future coming to snatch me away from my life. The pilot. They haven't forgotten about me. I feel a bittersweet pain. The truck slows, but slows a little late. It passes us, and stops at the next house down. I know it will back up, but it doesn't. The driver gets out and delivers a big thin envelope to my neighbor. We go back to our game. I hit the ten-year with a perfect spiral, which she catches with outstretched arms right by the mail box. As the defenders converge on her, she tosses the ball back to me, and then I lob it to the five-year old who catches it, does a Neon Sanders end zone dance and spikes the ball. We slap high fives all around. The five-year old girl asks if we can go in and have brownies now. F- Hollywood, I think.
***
"They blew me off," I tell people.
***
Then on Saturday, I hear a knock on the door.
Federal Express: The pilot and the script.
***
The show is called SAVED. I read the script first. I admit it is riveting. Some of it strikes a sense of deja veu in me. I can see they did read my books. More than that, the paramedic is a poker player, who dropped out of medical school to the disappointment of his father for not pursing the more traditional work. In the opening scene, he is dealt a pair of 3s, and goes all-in on a bluff. He wins the pot. I have a long-standing poker blog. It's called A Pair of 3s: That's All I Got." Except in the title story, I go all-in on a bluff and lose all my chips. I guess that's the difference between real life and Hollywood.
I watch the pilot. It’s hard not to like a show where paramedics race across town to a soundtrack of Jimi Hendrix "Crosstown Traffic." I watch with great interest. There is some good writing, snappy dialogue, and some very familiar scenes: The street person who thinks he is a Biblical figure, the heroin OD waking up with narcan to yank his IV and blame the caller for seeking help, the pit bull, the worry about the big national company buying up the small company they work for, some lines of dialogue...
The show seems to me a cross between MASH and ER, but not as good as either(although not a bad show). It is not Emergency. There are some medical errors that make me cringe. At least one paramedic should have her license yanked if her medical director is watching, in addition to being fired for treating her fellow employees like crap (maybe not unrealistic). There are the requisite wrinkled uninflated nonrebreathers every time you look, plenty of negative comments about doctors, and one very major medical error in the big scene at the end. (In a life and death situation, the hero debates what to do between a neccessary action and a ridiculous action, while getting some very earnest, but ignorant advice from his fellow medics.) If I am hired as a technical consultant and they do not reshoot the scene, I work on my explanation to my fellow medics. "That was before they hired me, honest, I swear."
Still, I like the show. I am willing to suspend my disbelief at certain things. It is after all, just TV. And as I said, Great soundtrack!
My mind is racing with ideas on what to do with the characters. I already have the episode I will write sketched out (What the heck -- Field Caesarian!) I am psyched!
***
The next week they make an offer to my agent. She calls me and tells me not to take it. They want me for two months (the length of time it will take them to do the scripts for the 13 episodes) and are offering me $2 less a week than I make as a paramedic working 40 hours a week, plus I have to pay my way out there. I need to work overtime just to make ends meet now, plus I'd have all the expenses of finding a place to live and a way to get around, while still having to maintain my home here. We make a counter offer. They come back with their original offer.
That won't work for me.
As much as I would love to go to Hollywood, and as much as I recognize there is a certain non-monetary value in the experience, I don't like being taken advantage of. I will not pay to go to the prom with a pretty girl.
My agent sends them an email telling them they do not have permission to use any material from my books or journals.
***
And so the dream is dead.
I drive to work in the morning through the darkness, thinking I should be in Hollywood, cruising the Boulevard in one of those bouncy Cadillacs with "Dr. Dre's "Let Me Ride" blaring from the radio, a backseat full of MTV dancers.
The show should be on the air in May.
I don't know when the Emmys are on, but I imagine watching seeing myself not on there, Cameron Diaz not on my arm, as others wave their Emmys and thank America. I'll be at home, my girlfriend and two girls nestled up with me on the couch, eating buttered popcorn, my work clothes laid out on the table for me to slip into early the next morning when I rise in the darkness for another working day.
***
Background:
Many years ago when I was on an author tour following the publication of my first book I appeared on a show called "Home Team with Terry Bradshaw" a very short-lived talk show (much like Oprah, except with Terry Bradshaw and some lady, whose name I don't remember, as hosts). It was filmed on a studio lot in Hollywood. In my segment I was already sitting in a chair next to Terry Bradshaw when the cameras came on. How I had wanted to be introduced and with music playing, walk out on stage doing a little funky semi-pimp walk, pointing fingers at my boys in the crowd. I guess since I was taller than Bradshaw they didn't want me to stand next to him. Anyway, it was a fun experience. I had a dressing room with a paper sign with my name on it posted on the door. I swiped it when I left. I remember Bradshaw being very nice, but constantly having to wipe the sweat off his brow. He flubbed his lines and they had to reshoot my segment. They were holding big cue cards while he interviewed me. Anyway, the producer who had pre-interviewed me in preparation for the segment told me she liked my book and asked if any Hollywood producers had called yet. No, I said. She assured me they would.
Eight years later, the call has finally come.
***
I stand there in the silence after hearing the message, and am both thrilled that my long awaited moment had arrived, but also a little disturbed that my life that I have so carefully put together (a house, a job I love (great work assignment, seniority, 401K), exciting writing projects, a regular poker game that I am beating, a girlfriend with two children I am quite fond of and who are fond of me) is now at threat. I will admit that a part of me wishes the message isn't there. But Hollywood...Hollywood is the American dream. How do you say no to Hollywood?
***
More background:
When I was in college I took a year off. I hitchhiked out to California where I was going write the Great American novel. I ended up in Hollywood, living a few blocks off Hollywood Boulevard in a seedy apartment building at Wilcox and Yucca where my neighbors where drug dealers, transvestites, and illegal immigrants. A few weeks before I moved in, there was a fatal shooting in the lobby. The manager, who I ended up drinking beer and smoking pot with when I showed up to see the room advertised in the paper, told me he hadn't cleaned up all the blood yet as a warning to people to keep it clean in his building. "You can do anything you want in the street," he said, sucking on a giant reefer, "but don't fuck with me in my building. You fuck with me you better kill me dead, because otherwise I'm putting my combat boots on and I'm going to hunt your sorry ass down." Just then a girl, probably a runaway, who was dancing by herself to Edgar Winter's Free Ride, danced over to him, and he started making out with her in a very physical way. His assistant, a fourteen year old Mexican kid, who never smiled, glared at me and said, "He's serious dude. Don't fuck with him." His glare seemed to add the words, "or me."
Wanting to be as far away from them as possible, I took a job out in Santa Monica as a telephone solicitor. I'd take a two hour bus ride out there early every morning, work the morning shift, spend the afternoon on the beach by the pier, work the night shift, then come back to Hollywood and sneak into the building. At night, the police helicopter would shine its spotlight into my room as it searched for wanted men. I could hear the cops on the loud speaker telling the desperados to give up and come out. It seemed to happen every night. I lasted in that building a month. The runaway smiled at me on the stairs one day when she was walking by with the Mexican kid, and I caught the glare in his eye, and after that I was convinced the Mexican kid was going to get high one night, and carve me up with his knife just for fun.
As soon as my first month rent was used up, I left town and went to San Francisco, which was another story altogether.
***
I get on the internet and research the producer and find a news clip about the show. The production company is located in Santa Monica. I believe in the circular nature of life. I never got into Harvard, and then years later I returned in my own triumphant way. The Governor of Connecticut was the featured speaker at the Harvard JFK School for government. As his speechwriter, I sat in the back row and listened to the power of his voice as he gave song to my words. The standing ovation...I was redeemed. (Now how pathetic am I? Harvard does not want speech writers; Harvard wants the person who gives the speech. Still, I felt a measure of I told you so.) Now it is time to return to Hollywood/Santa Monica. It seems predestined.
***
I talk to the producer the next day and he says he read my books to prepare the pilot episode and now that it has been green lighted by the network (TNT) for thirteen episodes he would love to have me come out and serve as a technical consultant and story developer, and maybe eventually working with another writer, try my hand a doing a script for the series. He needs someone who can combine story-telling with the technical know how to make certain they get it right. And they need me right away. I tell him I am interested, but am not certain I can get off work to come out. We leave it that I will look into getting a leave of absence, and he will look into finding a way to work me into the budget. In the meantime he will send me a copy of the pilot and the first script.
***
The operations head is excited for me and agrees to let me take a leave of absence. The head of the suburban volunteer service where I am based as a contract medic agrees to let me return to my post provided the company can find a regular replacement for me while I am gone. I like my suburban post so much that if I were to lose the post, I would not go.
While I wait for news I take my girl friend's kids swimming. The five-year old jumps into the water and swims to me. We gradually go deeper and deeper until she is jumping in over her head. She jumps in and pops up and dog paddles to me with a big smile of success. She wraps her arms around my neck. When we leave the pool, her ten-year old sister says, "This was the best day ever!" I feel pangs about leaving them.
I hear nothing for two days, and then get an email from the producer telling me they have not forgotten me, but are working through the bureaucracy. I check the mail -- no script or pilot. I get another email from another producer saying they are hoping to work something out and I should call if I have any questions. I talk to him, and he apologizes for the delay in making an offer. I ask again for the pilot. Nothing comes.
I am beginning to think they are blowing me off. I think I should have just said no, up front. My life here is more important than any stupid Hollywood red carpet dream.
I am out in the street playing football with the girls and their two cousins. We huddle up. I tell the five-year old boy to do a buttonhook and then go deep. I tell the ten-year old girl to go straight, and then cut sharply to the mailbox.
"Car! Car!" the defenders shout.
I look down the street and see a big yellow DHX truck. This is it, I think. This is my future coming to snatch me away from my life. The pilot. They haven't forgotten about me. I feel a bittersweet pain. The truck slows, but slows a little late. It passes us, and stops at the next house down. I know it will back up, but it doesn't. The driver gets out and delivers a big thin envelope to my neighbor. We go back to our game. I hit the ten-year with a perfect spiral, which she catches with outstretched arms right by the mail box. As the defenders converge on her, she tosses the ball back to me, and then I lob it to the five-year old who catches it, does a Neon Sanders end zone dance and spikes the ball. We slap high fives all around. The five-year old girl asks if we can go in and have brownies now. F- Hollywood, I think.
***
"They blew me off," I tell people.
***
Then on Saturday, I hear a knock on the door.
Federal Express: The pilot and the script.
***
The show is called SAVED. I read the script first. I admit it is riveting. Some of it strikes a sense of deja veu in me. I can see they did read my books. More than that, the paramedic is a poker player, who dropped out of medical school to the disappointment of his father for not pursing the more traditional work. In the opening scene, he is dealt a pair of 3s, and goes all-in on a bluff. He wins the pot. I have a long-standing poker blog. It's called A Pair of 3s: That's All I Got." Except in the title story, I go all-in on a bluff and lose all my chips. I guess that's the difference between real life and Hollywood.
I watch the pilot. It’s hard not to like a show where paramedics race across town to a soundtrack of Jimi Hendrix "Crosstown Traffic." I watch with great interest. There is some good writing, snappy dialogue, and some very familiar scenes: The street person who thinks he is a Biblical figure, the heroin OD waking up with narcan to yank his IV and blame the caller for seeking help, the pit bull, the worry about the big national company buying up the small company they work for, some lines of dialogue...
The show seems to me a cross between MASH and ER, but not as good as either(although not a bad show). It is not Emergency. There are some medical errors that make me cringe. At least one paramedic should have her license yanked if her medical director is watching, in addition to being fired for treating her fellow employees like crap (maybe not unrealistic). There are the requisite wrinkled uninflated nonrebreathers every time you look, plenty of negative comments about doctors, and one very major medical error in the big scene at the end. (In a life and death situation, the hero debates what to do between a neccessary action and a ridiculous action, while getting some very earnest, but ignorant advice from his fellow medics.) If I am hired as a technical consultant and they do not reshoot the scene, I work on my explanation to my fellow medics. "That was before they hired me, honest, I swear."
Still, I like the show. I am willing to suspend my disbelief at certain things. It is after all, just TV. And as I said, Great soundtrack!
My mind is racing with ideas on what to do with the characters. I already have the episode I will write sketched out (What the heck -- Field Caesarian!) I am psyched!
***
The next week they make an offer to my agent. She calls me and tells me not to take it. They want me for two months (the length of time it will take them to do the scripts for the 13 episodes) and are offering me $2 less a week than I make as a paramedic working 40 hours a week, plus I have to pay my way out there. I need to work overtime just to make ends meet now, plus I'd have all the expenses of finding a place to live and a way to get around, while still having to maintain my home here. We make a counter offer. They come back with their original offer.
That won't work for me.
As much as I would love to go to Hollywood, and as much as I recognize there is a certain non-monetary value in the experience, I don't like being taken advantage of. I will not pay to go to the prom with a pretty girl.
My agent sends them an email telling them they do not have permission to use any material from my books or journals.
***
And so the dream is dead.
I drive to work in the morning through the darkness, thinking I should be in Hollywood, cruising the Boulevard in one of those bouncy Cadillacs with "Dr. Dre's "Let Me Ride" blaring from the radio, a backseat full of MTV dancers.
The show should be on the air in May.
I don't know when the Emmys are on, but I imagine watching seeing myself not on there, Cameron Diaz not on my arm, as others wave their Emmys and thank America. I'll be at home, my girlfriend and two girls nestled up with me on the couch, eating buttered popcorn, my work clothes laid out on the table for me to slip into early the next morning when I rise in the darkness for another working day.
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