Old Paramedics

 I have been getting in and out of ambulances for over 20 years now. That means just what it does. Twenty years ago my knees and back and all my bones and joints were twenty years younger than they are today. I’m in good shape, but still, I find now when I get out of the back of the ambulance when we arrive at the hospital my partners tend to offer me their hand to help me down. I ignore their help of course, but I do admit I’m not jumping down as spryly as I used to.

I read this article -- As Doctors Age, Worries About Their Ability Grow in the New York Times this week and it made me think for a moment in the same way I think for a moment when I read the “Will you have enough Money for Retirement?” articles. I think I can put worrying about this off for awhile longer, but I sense that someday these articles will be my front page stories. Just not yet.

The physical deterioration of these years is slow, but undeniable. When I went to nursing school a couple years ago, I found I had to buy a pair of reading glasses so I could see the fine markings on the insulin syringe so I could draw up just the exact amount before handing it to my examiner to verify. On calls now, sometimes I squint to see the tiny vein I am trying to thread a 24 into in. A month or so go when I intubated a patient, I, for a moment saw two sets of vocal chords side by side. During cardiac arrests now I have learned not to relay on my view of the monitor beyond two arms length. What may look like asystole, if examined may actually be a defined rhythm with low voltage. I make it a practice now to print or have the strip printed out and handed to me so I can verify it.

When it comes to hearing, I have always been annoyed with patients who don’t speak up when I ask them questions, but lately I have found myself saying “Huh?" and “What?” more often than before, and finally asking them to please speak up blaming my difficulty hearing on the noise of the engine.

I used to love breaking into locked homes to rescue patients unable to get to their doors to let us in,. I'd divehead first into windows (while getting a boost from my partner) or climb up onto roofs to access second story bedrooms. Now, just as with carrying our heavier equipment, I sometimes defer to stronger more agile partners or responders on scene.

A few times I have seen a tremble in my hand and asked, is this the first hint of a condition that will change my life or am I merely suffering from lack of sleep or caffeine withdrawal? (A reassurance, I just checked both hands, and today as I sit in front of the computer, each hand is as steady as a gunfighter’s, although quite lacking the gunfighter’s speed).

One of my partners is ten years older than I am. Sometimes his slow deliberate way is frustrating to me. His scene clock is slower than mine, but then when I work with younger people, I sense they may feel the same about my pace. I like to think that I move quickly when I have to, but as in a game of softball, I no longer have the reflexes to snare a blazing line drive in the infield.

A few years back I came on the scene of a rollover, a car on its side with a women still in there, although with only minor injuries. While I pondered what to do, considering the best approach, another medic arrived on the scene, and was in the car before I could even say “good day” to him.

I like to think my approach was mature, deliberate and proper, but I do wonder if someday it will tick past the mature deliberate safe response and into the doddering greys of early dementia.

My hearing is not so bad that I can’t at a distance hear the tick tick tick of the finite clock that beats for all of us.

Paramedics and EMTs

 Back in 1995 when I started working fulltime as a paramedic in the city, paramedics got to choose their own partners. This was great for the paramedics and could also be great for the EMT partners. You worked three twelve hour shifts together and you always knew what to expect. You picked someone you were compatible with, liked and could work together without too many issues. Partners rarely called in sick or booked off for fear of leaving their partner with someone they couldn’t stand. On a bad call, your partner was right there. You were going to tube someone. You reached back and your partner laid the right size tube in your hand. You had each other's back. You took care of each other.

While my first partner was assigned to me because I was new and medical control felt I needed a strong partner and an IV tech, once he moved on, I was free to choose my next partner. I remember then I was approached by another medic who offered me his partner. They had worked together a long time and had finally come to a place where they needed a change. The medic wanted his partner taken care of so he sought me out. That was how I originally became partners with Arthur, who I have written about extensively. The other medic and I shook on the deal and I gave him a Snickers bar in ceremonial payment. Years later when I moved on to another shift, I found Arthur his next partner. My payment in return was a mini Snickers bar. Arthur was upset that he had apparently lost value. I took the rap. I'm sorry, I said, I wore you out. Your the worse for the wear and tear. At least he kept a decent shift and a paramedic partner and didn't have to hump transfers all day.

The drawback to having paramedics choose their partners was the issue of seniority for the EMTs. A medic might pick a new hire for their primo shift while a ten-year EMT might be stuck working a lousy shift. As the EMTs gained power in the union and with the service takeover by a new company, things changed. A six month bidding system was put into place. Not only did you have to rebid for your shift every six months, but you were assigned with whatever EMT won the bid for the EMT half of the shift. Needless to say, there were some mismatched pairings.

A couple years after that, I was lucky enough to gain a position in a contract town. While I still worked multiple overtime days in the city, I could pick and choose my overtime shifts to work with partners I liked. Working with someone you like wasn’t like working at all, it was getting paid to hang out. Spending a day with a disliked partner sometimes wasn’t worth the wages you were paid.

Being in the suburbs working with volunteer partners now poses its own challenges. Instead of one partner who knows your routine, you can work with multiple partners in the course of a day, much less a week. I come in at six AM and have one set of partners. At eight I might get a new partner or two, and then again at one. On my sixteen hour days, a new set of partners would also come in at six in the evening.

This can be a problem when I leave the ambulance in one condition after a call, and then on the next call find my new partner has rearranged things. The BP cuff is no longer on the bench where I like it, but zippered up into a BP cuff case and placed in a cabinet out of reach. The worst is the oxygen. I leave the portable oxygen open. A new partner comes in, checks the oxygen and then shuts it off, but doesn't bleed it down. We get a patient, I put them on a cannula, and it is not until we get to the hospital when I disconnect the cannula do I realize the tank had been turned off.

But really, it isn’t so bad. In practice, I often have one partner for ten of the twelve hours, and since I have been out here for over ten years now, I have gotten used to most of my partners and they have gotten used to me. Some of the partners I have out here I have worked on and off with the entire time I have been out here. Thus more often than not, we are in sync.

I think it is more difficult for the EMTs to get used to the four different medics who work with them. All the medics like their stretchers put together differently. We all put electrodes in a different spot. We all have our own ways of working a call. Unless a patient needs immediate treatment, I prefer to get them out to the ambulance and on to the hospital, doing everything on the way. Some medics let their partners jump all over the patient taking vitals, asking history questions. Me, I prefer to be the one who asks the questions. I can’t stand it when a partner walks over me when I am interviewing the patient.

I pretty much insist on doing calls my way. I have been doing this for over twenty years now and have become fairly set in my style. Sometimes I will ask a partner for advice or a better idea on logistical issues, but for the most part I am comfortable with my own solutions.

Working as a single medic, I am always in charge. The calls are mine unless I turn them over to my partner to BLS it. Once I do, they are free to do the call the way they want. That said, I often will do the BLS call myself instead of turning it over depending on the patient’s issue and the partner I am working with. Some of my partners prefer to always drive, so when working with them, I tech all calls all the time, ALS and BLS.

Years ago, I saw a very funny cartoon which showed how people in EMS viewed each other. I don’t remember the whole cartoon, I just remembered how the EMT viewed the paramedic. The paramedic was drawn as Darth Vader.

I like to think I am benevolent. I rarely ever raise my voice or express displeasure. And when it comes to driving, I let my partner handle that. Unless they are driving like a mad person or unless they ask for directions, they control that aspect. I know some medics not only run the calls, but also do all the driving to the calls and from the hospitals back to town. The only time they don’t drive in when they are teching an ALS call.

This all is not to say that medics can’t learn a lot from their partners. A new medic particularly would be wise to listen to a more road experienced partner. The saying "Paramedics save patients, EMTs save paramedics" has a great deal of truth to it. A partner who knows what they are doing and what is expected of them can make or break a call for you. Even today, sometimes a partner will point something out to me I might have missed, and I am grateful for that.

A medic needs to know what their partner is capable of and plan accordingly. If you don’t think you can trust your partner’s blood pressure reading, then don’t trust it. Only assign them do what you know they are capable of. You can have them do anything, but you need to verify anything you are uncertain about. If a call goes bad, the medic has to take the rap. Publicly blaming a partner is not an excuse.

Kevin Andrews

In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that regard.

Kevin Andrews was one of my first partners. This was back in 1989. I was a spanking new EMT -- so fresh I didn’t even have my certification yet. Due to an EMT shortage I was working on a waiver that let EMT class graduates work pending the outcome of their state exams. I even wore a “whop kit” – one of those pouches that attach to your belt and hold your tools of the trade. Mine was small and conservative by some standards. I had a penlight, trauma shears, bandage scissors, and a window-punch.

We worked for Eastern Ambulance, a mom and pop ambulance company in Springfield Mass that had the 911 contracts for three suburban towns in addition to backing up calls in the city and doing transfers. On a good day we only had five ambulances on the road. On most we had three. Some of the ambulances had brown bondo on the sides and in one, you could see the road through a hole in the floorboards. On Fridays, we use to all race down to the bank to try to cash our checks. The last to get there often found theirs would bounce. We didn’t have paramedics, just basics and intermediates. We didn’t even have defibrillators then. But we were a close-knit group, and there was more to the job than money.

Kevin was an EMT, but he was respected as any of the intermediates. He’d tried to take the EMT-I exam a couple times, but kept just missing it. He was very street smart, but had trouble overthinking the tests. I, on the other hand was book-smart, but had no clue about the street. With the wrong partner, my life at work could have been made miserable. I was always glad to find myself working with Kevin.

We were both thirty then, but our backgrounds couldn’t have been more different. He grew up in a large family in Springfield in a neighborhood where the drug trade flourished. I was from an upper middle class suburban family and my most recent job was working for a United States Senator until his loss had send me on this personal quest to learn how to help people in person rather than from behind a policy desk.

Kevin was a big strong man with a shaved head who a instructor and black belt in karate. Still he was gentle and soft-spoken, with a ready smile. I never saw him raise his voice or become excited on a scene. He had that calm about him that for all the occupations I have worked in, I have only ever really seen in certain EMS responders -- an unperturbed always in control manner that seemed to deescalate any panic around him from patients, bystanders or partner. He always knew what to do, and if he didn't, he never let that on.

Sometimes we used to stop at his mother’s house where she always made sandwiches for us and we would visit with his youngest brothers and sisters before heading back on the road. He was their clear pride. Out on the street, Kevin would point out to me the drug houses and dealers. What I might have thought was an innocent boy of twelve on a bike, was instead a drug-dealer’s lookout. It was a new world for me.

My clearest recollection of a call with Kevin was on a cold sleety morning in winter when we responded for a woman who had slipped on the ice on the top steps of a church. I could tell right away her arm was broken. I palpated it through her coat and it felt almost as if it were in two separate pieces. I had my trauma shears out in a jiffy, but before I could make my first cut, Kevin had a soft but strong grip on my arm. “This might be the only coat she owns,” he said quietly. “Let’s see if we can ease her arm out of it.” Which is what he did, taking his time not to cause any pain. The woman’s winter coat was preserved and her arm was carefully splinted and he talked to her in a reassuring way that caused me to feel only awe at what I was witnessing. It made me see that EMS wasn't really about blood and guts and bad car wrecks and doing CPR. It was about taking care of people.

The company went bankrupt a couple years later. By that time I was only working one overnight shift a week. I was back behind the policy desk as the ex-Senator after a year in exile had run for Governor and won. Despite the full-time government job I was not only hooked on EMS and had to get my weekly fix, but I felt like I was a part of a family at Eastern Ambulance and I didn't want to lose that connection. I hated to see Eastern close. Kevin and most of the others we worked with went to work for another ambulance company in Springfield while I joined a volunteer service in Connecticut.

I saw Kevin periodically over the years. We had a few Eastern get-togethers. Another time he and his girlfriend brought their kids down for a picnic at the condo in Connecticut I shared with my own girlfriend at the time. I visited him in the hospital when he got a bad infection and had to get IV antibiotics. We’d talk on the phone sometimes and get caught up on how all the people we worked with at Eastern were doing. He told me he was honored when I mentioned him in my first book. I was honored to be able to write about him. Whenever he’d call, even if we hadn’t talked to each other for a couple years I’d say “Kevin” recognizing him at the first sound of his voice.

The last time I talked to him was three years ago right around the birth of my daughter. He’d mentioned there was going to be a new get together of some of the old people we knew. I wrote his number down, but in the confusion of the time, misplaced it. I have always been somewhat of a recluse. I work all the time and I’m not the best about keeping in touch.

A month ago I talked to a woman who'd also worked ambulance up in Springfield, starting shortly after I had left the area. When I mentioned I had worked for Eastern, Kevin's name came up. She said she knew him and that he was helping teach basic EMTs at the college where she also taught. I said to say hello. Later in a New Year's Day phone call, she told me she had talked to him and that he had been excited to hear she had spoken with me. He told her about the good times we’d had as partners. She’d given him my cell phone number and he’d said he was going to call me. She wanted to know if he had ever gotten a hold of me. He hadn't. And now he won't be. The reason for the call was to tell me he had passed away suddenly. She didn't know the details. The rest of the conversation was a fog. I kept thinking. What do you mean? He passed away?

I have always found it hard to believe people I have known are gone. I have to see the obituary in the paper. I found it and there is was in print. Kevin Andrews, 52.

I am not one who believes in heaven or an afterlife. I believe when you are dead, you are dead. There is no place where you go to sit with others or wander among the clouds. Your conciousness is no more.

But what I do believe in is memory. I can close my eyes and see Kevin sitting right next to me in the ambulance, telling me a story. I can see him standing there in his mother's house smiling watching his brothers and sisters play, and then years later, sitting on the back deck watching his own children play in my yard. I can see the true friendship in his eyes and feel his warm handshake when he says "Keep in touch."

And I can still see him taking care of that old woman on the church steps as clear as if I were still there. I watch his hands and I want my hands to be able to soothe someone as his do.

***

Kevin shaped me as a caregiver and as a person. He helped make me the paramedic I am today. If I am gentle toward a patient, than Kevin's spirit is in me, Kevin’s touch is in my hands. If watching the way those of us who were influenced by Kevin treat their patients, others are now gentler with the sick and injured, then Kevin’s hands and heart are also in them. His breadth widens. This is what becomes of him. This is how Kevin is passed on, from one caregiver to the next. Let this be how he is remembered.

The great church doors open to the icy weather. Outside on the cold steps, an EMT caring for a patient. 

My Hollywood Adventure

 On my previous post about the pilot for the Hartford based police drama, The Second District, mcffp asked, "Didn’t I hear you might have been working on producing an EMS based drama?"

In 2006, I was asked to be a advisor/possible writer on the TNT show SAVED when the show was green-lighted for 13 episodes. Unfortunately, the money they offered me was less than I was making in 40 hours much less the 80 hours I was working. Had I been younger and less attached, I likely would have still jumped at the opportunity. Instead, I had to pass and they turned to someone else. Here then, reposted, is my account at that time of "My Hollywood Adventure."

***

March 4, 2006

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 wi
ll 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.

***
Later I posted my thoughts about the show, which can be found here:

Saved on TNT