Anti Black racism Course Thoughts

 

I had some trepidation about taking an Anti-Black Racism course (which was offered free to employees at our hospital, and all students, faculty and staff affiliated with the University of Connecticut) but I was enthused to engage and learn so I could better understand what is going in America and how I could can better help change this country into the country that I love.  Trump had a slogan Make America Great Again, but after hearing a Bruce Springsteen sound tracked campaign ad encouraging people to vote in Pennsylvania, I reimagined that slogan into Make America Recognizable again.  This comes from the song “Streets of Philadelphia” about a person with AIDs who because of the way he is treated/shunned, loses nearly everything, and is now "bruised and battered, unrecognizable to myself."  I have felt that America has been unrecognizable to my vision of it – a land that is a world leader and is an example for others of democracy, rule of law, truth, human rights and compassion for its less fortunate.  We don’t separate kids from their parents, refuse to disavow white supremists or call those who served and died in our military "suckers."  And above all, we are truthful about the difficulties we face (COVID as prime example) and are willing to sacrifice for the greater good. That vision of America has too often been a dream rather than a reality.

What I came to understand in the class is there are two Americas -- the real-life America and the the vision of America.  I studied history from kindergarten where I learned about George Washington never telling a lie to the University of Virginia where I took a course about slavery, that featured a book “Roll, Jordan Roll,” that talked about how slaves and slaveowners learned to get along and survive by humanizing each other.  I did not understand at the time how people could criticize Thomas Jefferson for owning slaves because to me, he was just a prisoner of his time, and that he deserved credit for treating them humanely.  I do not believe now that he is above reproach. 

I have always been an advocate for civil rights and affirmative action, and have spent much of my life as a paramedic working in a predominately black inner city, and care deeply about the city and its people.  I have also taken affront to the term "white privilege" and for criticisms of white people who advocate for black rights, but somehow "don't get it."  I preferred, and still prefer the term, “black disadvantage” because I think the “privileges” whites have are not privileges at all, but basic human rights that should belong to everyone.  It may be semantics, but I think the term white privilege is alienating, and counterproductive to the cause of a better society in the same way I believe “Defund the Police” is an awful term that sets back the cause of improving our police force and addressing the conditions that allow and sometimes condone police brutality.  Rest in Peace George Floyd and so many others.

So what did I learn in this class?  One, the history I was taught in school was stilted and missing key chapters and viewpoints.  I know black people have always had a hard go, but I had no idea how bad it really was and how bad for many it continues to be, how rigged the system is against black people and many minorities.  Even in health care, I always thought black people were more prone to cardiovascular disease due to their genetics (their genetics are virtually the same as white people).  I had not considered how deeply economic and societal disadvantage can affect health and other key aspects of everyday existence.  It is not so easy to take an aerobics class, eat organic food or go for a run in the neighborhood when most of your time is spent just trying to survive from week to week with food on the table, a roof over your head, electricity on, and the kids getting to school.

I was surprised that the course was "so black."  By that I mean all the teachers were black and the point of view all came from the black perspective.  In the end, I didn't mind.  I feel like I had the "privilege" (there we go with that word again) of being sat down in someone else's home and being told the story of their lives, and in the end coming as close as I could to seeing through their eyes what they had been through and continue to go through.  Like any decision someone makes, it always helps to hear from the people who will be affected, and to hear both sides.  This class presented a side (compelling) that  I needed to hear.

What are my takeaways?  The real life America is not as great what it typically made been made out to be.  The real life America has never been perfect (though it has had great moments).  I remember in high school (I went to a prep school in New Hampshire), I was sitting with a group of friends, many of whom were "John Wayne" Americans, and they were very upset when a professor was making this same argument to them.  There was a song on the radio at the time that was a tribute to America and how we always helped the world in need.  It was very patriotic.  The professor pointed out instances where America acted not humanely but in its own political self-interest, chapters that we tended to either gloss over or not be aware of, where we had supported oppressive dictators who willfully violated human rights, and we supported them because they were anti-communist so we ignored their atrocities.  This was back in the 1970's.

Now before anyone accuses me of not liking our country or being unAmerican, I need to say this.  America is not and never has been perfect.  Nor have Republicans or Democrats been shinning examples of what America should be about. In many cases, not even close.  But I believe not in the real life America (and certainly not the America of the last four years), but I believe in the dream of America and in its promise.  I believe it can be a country where we all have equal opportunity, where we find common ground, and where we always strive to do better.  I really liked Spike Lee's documentary “Two Fists Up” about University of Missouri students protesting the racial indifference of the school leaders, protests that led to the administrators resignations after the football team joined in the protest, refusing to play until there was change in the school’s treatment and support of its black students.  I am moved by the Black Lives Matter protests, and hope that the momentum continues.  I agree with what the course posited in the end that the goal is not to make black lives better because they have been getting screwed, the goal is to live in a world where all lives matter, and the hard fact is right now black lives have not mattered so we need to fight to change that so that we can say we all live in a just world, and a just world is a better world for all of us, black and white and all the colors of the rainbow.

I have always told me daughters that when they go to the cafeteria at lunch time and one person is sitting alone because they have no friends or are different, that they are to go and ask them if it is okay they sit down with them, not because they feel sorry for them, but because they should never be a part of a world that shuns those who are different.  And I taught them to stand tall against the bully even when the bully has the crowd.  I taught them to play for the long run, to set an example for others.  A bloody nose is better than slinking away a coward.  Speak up. 

Anyway, sorry for the pontificating.  It was a great course, I learned a lot. I hope it will make me a better person and a better paramedic as I work the streets of Hartford.

Power to the people.  Be kind.  Be just.    

Dark Red

 

I follow COVID ACTNOW daily for a look at how the epidemic is progressing or retreating.  It looks now like it is advancing so severely that they have had to add a new color/category risk level to their map.  Previously red was the worse you could do and it signaled critical - "Active or Imminent Outbreak."  Things have gotten so bad, they have had to add dark red, signifying SEVERE outbreak.  I only pray we don't reach the next likely level -- black, meaning - DEAD, APOCALYPTIC, BEYOND HOPE, DEFEATED, WASTELAND.

God Bless America and wear your damn masks!

Black Friday/EMS Books

It's Black Friday.  When thinking of Christmas gifts, consider supporting EMS authors.

My new book, Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic,   is coming out on April 6, 2021, but if you order two books (or spend $50 now, you can get them for 40% off under a special promotion.  Good through 12/6.  Use code HHSA when checking out at the Johns Hopkins University Press Bookstore.

My first two books, Paramedic: on the Front Lines of Medicine and Rescue 471: A Paramedics's Stories are still available both in print and as ebooks.

 

I have two works of fiction available as ebooks.

Diamond in the Rough tells the story of a young EMT's wayward journey through EMS. It takes place in Hartford in the similar setting to my first novel, Mortal Men: Paramedics on the Streets of Hartford.  The book has caused some controversy because the EMT narrator is a thief, who steals from his patients.  He, of course, eventually pays the price for his actions, but he does, despite his crimes, manage to find some redemption and a path toward grace.  After writing two nonfiction books about EMS in Hartford, I have turned to fiction because it offered a freer reign to explore the world of EMS and tell atypical stories.  

You can read sample chapters of Diamond in the Rough here:

Anthropophagi

Temptation to Steal

 

Mortal Men is a more traditional story.  Paramedic Troy Johnson battles trauma and sickness on the streets of Hartford, Connecticut. When a fellow medic is shot to death responding to a 911 call, a grief-stricken Troy vows to avenge the death, while struggling to come to grips with his own mortality.

i appreciate your buying and reading my books and blog!

***

Here are some of my favorites from other EMS authors you should consider:

 

Lights and Sirens: The Education of a Paramedic by Kevin Grange published by Berkley. This a great account of a young man going through paramedic school. I reviewed it in more detail in this post:

Lights and Sirens

***

Michael Morse first two excellent books Rescuing Providence and Rescue 1 Responding are combined into one book and published by Post Hill Press and distributed by Simon and Shuster.  I reviewed Rescue 1 Responding in this post:

Responding

***

A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back by Kevin Hazzard published by Scribner. This is also a tremendously well written book covering the EMS career of an Atlanta, Georgia paramedic from eager EMT to eventual burn out and fade away nearly a decade later.

***

Kelly Grayson's En Route is a great read by the author of the Ambulance Driver Files.

Grayson is an EMS Mark Twain -- a gifted humorist who packs a serious punch. He does a great job of describing what it is like to be in EMS -- the good and the bad, the high points and the lows.  

***

Turning to EMS Fiction, a little known, but excellent book is Black Flies by Shannon Burke, which retells Joseph Conrad's Heart of Darkness with EMS as the background.

I reviewed this book many years ago on this blog:

Black Flies Review 

Thanksgiving

 I wrote this post on Thanksgiving 2005.  

***

It’s Thanksgiving morning. I awake at 5:10, shower and dress, then open up the garage door to see a couple inches of snow on the ground. It’s beautiful, but I hate winter, hate the cold weather, hate driving in snow.

When I get to the base, I can see from the tracks in the snow by the ambulance doors. The night crew is out on a call. Ten minutes later I hear them clear with a presumption. I sit in the office and drink a diet coke while I read the morning paper.

This week a thirty-year-old female cop in one of the suburban towns was murdered by her ex-boyfriend, a state cop. We had two cars on standby while they looked for the shooter. They found him a couple hours later, also dead. The paper said he parked his car at a park, and then walked over to her house so she wouldn’t see him. He lay in wait for her and when she returned from work, he ambushed her, shooting her three times, twice in the chest and once in the head. He was supposed to turn himself into court today on a police charge, but instead he called his lawyer and said there was a change in plans. The lawyer got the message a couple hours later and alerted police. Her new boyfriend — another cop — came home and found her.

I knew her by face, not by name. I’d been on calls with her a few times over the six years. I remember when she first started working. She was gorgeous. It was hard to believe someone that good-looking would chose to be a cop. Lately I noticed she’d started to wear a bit more makeup around her eyes, her face seemed a little heavier. She never had much to say to us, at least on the calls I went on. She was all business. If she pulled you over, I don’t think you’d want to sweet talk her. I’m sure she had a warm side she showed to those who knew her.

The paper in the news rack the next day had a headline “A Cop’s Fury.” It had pictures of the two dead on the front. It made me think, you are here one day, and the next people are walking by the news rack with your picture on it, only you aren’t one of the people walking by to see it.

**

We did a call in her town this morning, and said our condolences to the two cops who were there. They had black bands over their badges. The call was for an old woman who said she had taken a handful of painkillers. She said she did it because she was stupid. She said her ex-husband and her doctor would be mad. I got the feeling from the cops they were at this house all the time for similar vague complaints of taking too many pills. “I don’t need this today,” one cop said to me.

**

All week I have found myself in idle moments thinking about the dead policewoman. I guess she probably never figured her death was coming that day. She comes home from work, sits down with computer and then suddenly there is the angry man in her house, gun drawn coming at it. Did she know she was going to die?

When do heart attack victims get that sense that right now what is happening — this sudden pain in their chest — might be their end? And car crash victims – they start to loose control and see the tree or the truck careening toward them?

Last New Year’s Eve another cop in the same department was gunned down at a domestic. I knew him too, but also just in passing. We’d been on calls together. A nice, big friendly man. He walked down the basement stairs and then shooter pulled the trigger on a machine gun. Did he have time to realize his end had come?

This summer a paramedic student who rode with me was on a jet ski with his girl friend in Florida when they were blindsided by a boat. I heard about it when I saw his obituary posted at the office. Did he hear the roar of the engine? Did he turn to see it bearing down on him? What did he think in those moments?

Last Saturday they held a memorial for a flight nurse who died in a helicopter crash 13 years ago. I was working in the health department at the time and remember the late night call I got telling me about the crash. I’d seen her around the ER a few times when I brought in patients as a volunteer EMT. And I had ridden in the helicopter as a third rider only a month before. The accident happened when the copter clipped a wire while trying to land near a highway rest stop, a rest stop that now bears her name. When the copter started spinning, did she know?

I don’t mean to be morbid.

The saddest thing about all these deaths is not just the fear they must have felt when they saw what was happening to them, but that fact that everything that would have happened in their lives and all the people they would have affected is just gone. The children they might have had, the things those children would have gone on to do, the memories – all of it vanished. That’s the tragedy.

Death happens everyday and we see it in this job, but it doesn’t impact as much unless it is one of us. You can grow immune to it until it comes close like it has again this week.

But I don’t worry as much about dying as I used to. I’ve lived awhile now and feel lucky to have made it as long as I have. If the deal was when I was born, I agreed to come out of the womb, but in return I would only have these 47 years, I’d take that deal anytime.

I have many, many years ahead I hope. But if I were to die today, if the door were to open and death were to be there, I would be terrified, but I can’t say that I would have been cheated. Life, with its share of sadness and disappointments, has been largely good to me. And today I am as excited about life and its possibilities as I ever have been, excited not in the wild way I was as a youth, but in the more realistic sense that I can enjoy the moments now and not just the thought of the goal.

I want to live fully and feel, for the most part, I have been. I work a lot, but I like my job and the money I make will help me keep doing what I love – being a paramedic, writing, going to foreign countries to help the poor, getting good seats to a Red Sox game every year, living in my house which I feel comfortable in, being able to eat a good steak, and drink a cold beer when I want without having to count nickels on the liquor store counter.

I have much to be thankful for today.

I hope I continue to live a full life and that the door doesn’t open for me any time soon.

Please not any time soon.

I don’t want my picture on the news rack, my obit posted on some bulletin board, people thinking, yeah, I knew that guy. We did a few calls together. I used to see him around.

***

Postscript: Thanksgiving 2020.  Well, I made it fifteen years, though not all those I have shared the front cab of an ambulance with did.  I think about them.  Joe Chipman.  Ransford Smith, Dave Fackleman.  Chris Schmeck.  Wayne Cabral.  Jeff Huffmire.  Susy Ribero Rynaski.  Donavan Alden.  John Michael St. George.  Turk Atkinson.  Kim Butler.  Anita Russo.  Ed Grant.  Ross Chagnon.  Zellie Block.

Of the bunch only Anita and Zellie had what you would call full live spans. You could make a good case that EMS killed (or at least contributed to the deaths) of a number of these fine people.   I remember working with each of them like it was yesterday.  

I hope everyone has a safe Thanksgiving.  Give thanks for what you have.  Stay safe, enjoy your closest family and friends and be careful of the COVID.  

 

Special Glasses

This week I received in the mail special glasses I ordered from the back of an old comic book.  They enable me to see COVID.  He is a tiny little green monster with a coat of suction cups.  He is not just one fellow, but an army of millions of little green monsters.

I sit in the ambulance and watch COVID soldiers pour out of my patient's nose, which keeps sticking out from his sagging mask.  Other hordes of green mercenaries slip out from the bottom and sides of the mask, even a few blow right through the mask.  Some of them float about in the air like spacemen in zero gravity. Many bounce off my face shield but others find purchase with their suction cups.  They stick to my gown and my hair and my pant legs which are too long for the gown that does not fit me. I try not to breathe too much as I do a 12-lead ECG, and put in an IV giving him fluid to try to rehydrate him. The green men begin to accumulate on the floor and pile up upon each other and the green man level rises like a flood, above my boots, and up my pant legs, till I was sitting half-buried in the soft green little buggers.

When we arrive at the hospital, the gowned EMT opens the back door, and the little green men tumble out like millions of tiny ping pong balls.  Some float up into the air and I can see their shapes against the lights of the hospital room, many stories high, and I can even see their reflections against the moon.  

We wait with our patient in triage along with other stretchers of gowned crews and masked patients coughing,  Patients on stretchers coughing and patients in chairs coughing.  Green clouds emerge like dragon’s breath. Clouds of COVID civilizations float in the air like blow bubbles from a child   Some bubbles bounce off the walls while others burst on contact with patients and staff alike.  When it strikes them in just the right spot, there is a puff of green and the person turns entirely green just like my patient.  The COVID civilization bubbles move slowly away from those who are now green so they won’t waste their time targeting someone who is already colonized.

I doff my equipment and then head to the EMS room where none of three people already in the room wear masks, not even the one who is already green himselves.  I sit in an armchair with my mask on while the big screen shows a green man riding a motorcycle.

I look in the mirror in the restroom and while I am covered in green dust, my eyes are still brown, my teeth dull white. 

At night, I throw all my green clothes in the washer and then wearing only my underwear walk up to the bedroom where I shower until the water at my feet no longer has even a hint of green.

I have a restless night.  I dream of little green men inside me battling with my body's natural battalions.  In the morning I stand in front of the mirror with the glasses by the sink.  I am afraid to put them on.

Passengers

Friday night in the city on a dead end street.  Light beams out of the ambulance’s open back doors.  Inside the EMT spreads a clean white sheet on the black stretcher mattress.  He hits the exhaust button on the wall, and then exits from the side doors. My masked patient steps up into the back where he lays down on the stretcher.  I stand in full PPE gear, and take in a last breath of the fresh night air and then enter the compartment.  I sit on the bench seat.  The EMT closes the door and it is just me, the patient and COVID, under the bright fluorescent lights.

A Simple Dream

Twenty-seven years ago, in a retaliatory shooting, a man in Hartford’s north end opened fire with an automatic weapon, killing his target.  He was sentenced to fifty years in prison.  He left at home a baby daughter,

***

I get called for the unconscious.  I arrive first and climb windy wooden stairs to the third floor apartment, where a terrified young woman, holding a toddler, kneels in the hallway by the open bathroom door.   “He collapsed and he won’t wake up!”.

An older man with a grey beard lays on his back, eyes rolled into his head, gurgling.  His arms are stiff.  His carotid pounds..

“What kind of medical history does he have?” I ask.

“I don’t know,'' she says.  “He, he takes pills.”

“Is he diabetic?  Has he ever had a stroke?  Or seizures?”

“I don’t know!”

I have an ambu bag out and with the help of the arriving fire department we pull the man out into the middle of the living room floor, where we start breathing for him.

“Does he do drugs or drink?”

“No, no.”

“What's your relation to him?”

“He’s my father.”

“Does he live here?”

 “Is he going to be alright?”

His pressure is 170/100.  I can’t get a good look at his pupils.  I am leaning stroke, but his respirations are slow (6-8 a minute) so I gave him two of narcan in the nose just in case.

With bagging. his oxygen saturation is 100% and his end tidal is 59.  The ambulance crew arrives and I tell them I am not certain what is going on.  

The other medic asks if I want to give him more narcan, but I say hold off.  He is breathing well enough that we don’t need to bag him.  If it's an OD we’ll know soon enough.  As they get the stair chair ready,  his respiratory drive picks up

The man opens his eyes.

“Well, that answers that,” I say.  “What did you take?” I ask.him.

“Huh?” He says.  He has that uh-ho surprised look to the left look to the right look that so many overdose patients have when they suddenly wake up and find the room filled with people in uniforms standing over them

“Nothing,” he says.  “I’m fine.”

“Fine?  You weren’t breathing, you were unresponsive.”

“I got high blood pressure,” he says.

“No, you used heroin,” one of the firefighters says.

“He used drugs?” the daughter says.

She turns on him.  “You’re gone twenty-seven years and you come back now and you're going to leave me again like that, after you promised to never leave me again.  Are you going to bring this into our house?  With me and my son?”

The man says nothing.  I feel bad for him.  And for his daughter and grandchild. 

“He just got out of jail,” she says to me.  “One week he’s been here.  One week and he goes and does this.”

Twenty-seven years ago, I imagine a man could sniff a bag of heroin and it was nothing but a nice peaceful easy feeling.  Not today.

I tell the daughter about fentanyl, which she knows about. She lives and is raising her son in this neighborhood where drug trafficking and use as well as violence are daily facts of life. I tell her to be patient with her father, that he no doubt loves her, but this transition must be hard for him and he is going to need her.  He is going to need both of them.  She wipes tears from her eyes and hugs her son.  I tell her how she should have narcan in the house and where she can get it.  Even if he promises to never use again, opioids are a powerful force, and if he does slip up again, she can help keep him alive, until more help comes as it did today..  I give her a wrist band with the harm reduction center number on it. You're not in this alone.

The daughter, holding her toddler and I follow her father and the crew down the stairs.  Outside, they load him into the back of the ambulance.  Daughter and father eye each other, saying nothing as the door closes.

“He should be back in a couple hours,” I say. “Don’t be too hard on him.”

She watches the ambulance drive slowly down the street, its red lights no longer swirling, and then she and her boy go back into the house.

I get into my response vehicle where I write my patient care form.  Then I Google the man and learn what happened twenty-seven years before, not five blocks from the apartment where he, his daughter and his grandchild will try to become a family, and live the simplest of all our dreams.

***

A study in the New England Journal of Medicine found that prisoners in Washington State were twelve times more likely to die in their first two weeks after release than were members of the general population (matched for age, sex, and race), and tellingly the ex-cons were 129 times more likely to die of an overdose.

Ingrid A. Binswanger, Marc F. Stern, Richard A. Deyo, Patrick J. Heagerty, Allen Cheadle, Joann G. Elmore, and Thomas D. Koepsell, “Release from Prison—a High Risk of Death for Former Inmates,” New England Journal of Medicine 356, no. 2 (2007): 157–65.

Gun Violence 2020

 

Every morning when I report to work, I check my gear,  my heart monitor, my medic bag, and the blood cooler.  Our service has been carrying whole blood stored in a paramedic response vehicle for a couple months now, and none too soon.  

In the midst of two serious epidemics -- COVID-19 and the opioid crisis, a third forgotten epidemic has risen up again amidst the chaos.  Gun violence is racking Hartford as it is in many cities in the United States.  In Hartford shootings are up 60% in 2020 and are already at a six year high with many days left in the years.  

Brazen shootings frustrate Hartford police as surge in gun violence continues despite crackdown

No one knows why the violence is up.  An article in the Hartford Courant offers two theories.  Decreased probation and violence prevention services during the pandemic and the effects of new police accountability rules that may encourage criminals to be bolder.  From a paramedic’s perspective all I know is the bullets are flying again just like in the days when the Latin Kings and Los Solidos battled over the drug trade back in the mid 1990’s when I first started as a paramedic in the city.

I haven’t used the blood yet, but it has already been credited with saving at least one life.  The medics were able to start infusing blood on the scene and doctors later told them the infusion likely prevented the patient from arresting and provided valuable time to get him to the OR.  Credit to Saint Francis Hospital and Medical Center in partnership with American Medical Response for instituting the program.

I thought I was going to use the blood recently when I responded to a shooting in the north end, with the police urgently hailing me as I arrived on scene.  The patient, who was ambushed in his backyard, was still alert, and  his vitals weren’t within the parameters to start blood (BP less than 90 or pulse above 120).  The man was surprisingly calm for being shot, and being in considerable pain despite my giving him 100 mcgs of fentanyl.  As many shooting victims seem to do, he chatted on his cell phone on the way to the hospital, telling a friend that he had been shot, and in phrases no doubt understandable to the person on the other end, conveyed who he felt was behind it.  After he hung up, he looked me in the eyes and said,  “My days of preaching nonviolence have come to an end.”

There were five more shootings in the city in the next three days.  The paper said it wasn’t clear if any of them were related.

ZIMHI

 

Adamis pharmaceuticals is seeking FDA approval for ZIMHI™(naloxone) Injection, a 5 (FIVE) milligram intramuscular (IM) dose of naloxone for use in suspected opioid overdose.

https://www.adamispharmaceuticals.com/zimhi-naloxone/

In EMS, we try to titrate naloxone to the smallest possible amount to reduce respiratory depression.  We have that luxury because we carry bag valve masks, which enable us to breathe for apneic or agonal patients until they are able to ventilate on their own. 

A few years ago ADAPT pharmaceuticals came out with a 4 mg intranasal product, NARCAN.  Our local fire and police departments started carrying it, and we started showing up on scene just in time for the victims to sit bolt upright and projectile vomit on us.

4 mg intranasal is roughly equivalent to 2 mg IM based on bioavailability.

The only time I have ever given 2 mg IM in one shot is when I have a patient who is not only apneic, but cyanotic and I am having difficulty finding a pulse.  Other than that, I use a lessor amount.  My preferred dose in those patient I can gain IV access on, is 0.1 mg IV Q 1 minute until respirations pick up.

5 mg IM is going to cause some serious opioid withdrawal syndrome in overdosed people with history of opioid use.  I believe it would be criminal to allow EMS to carry and administer such doses.  We should never condone torture.  I have a different view when it comes to layperson administration.

I help administer Connecticut’s SWORD program, where EMS calls in to the Connecticut Poison Control Center after each opioid overdose they respond to and provide answers to a number of questions, including how much naloxone the patient received, who gave it, and whether or not there were any side effects.  I have read over 8,000 of these reports.  It is not uncommon for overdose victims to receive 8, 12, 16 and even 24 mgs of naloxone from laypeople.  Because naloxone does not immediately resuscitate people, when a layperson is standing next to someone who is blue and not breathing or barely breathing, I think there is a tendency of laypeople to just unload everything they have into the overdosed person because they don’t know what else to do.

It is hard to argue that putting someone into withdrawal is worse than not restoring their breathing if you lack ability to breathe for the person while waiting for the naloxone to kick in.

You can give the high doses to lay people.  Just keep the supercharged doses out of EMS drug boxes.

CT COVID-19 Contact Tracing App

 

When I woke up Friday morning and checked my phone, there was a notification asking me to join Connecticut’s new COVID-19 contact tracking app.  I installed it right away. 

The app tracks my proximity to other people using the app.  If I test positive, a contact tracer will ask if I will share my close contacts.  They will give me a code to enter in my phone and anyone who is also using the app who has been within six feet of me for more than fifteen minutes in a day will receive a notification of a positive exposure.  They aren’t told who they were exposed to and where they were exposed.  No private information is shared.  Likewise, if someone else using the app tests positive and shares their contacts, I will get a notification of a possible exposure.

The app is designed to supplement, not replace traditional contact tracing.

I am curious if I will get notified if any of my patients test positive and are also using the app.

It was super easy to activate.  I just hit a couple prompts and I was registered.  I am guessing anyone with a cell phone in Connecticut had the same message this morning.  I hope many signed up.

Here’s more information on it.

COVID Alert CT: How does the app work? What you need to know about Connecticut’s new contact tracing tool

Connecticut needs all the help it can get because like most of the nation, cases are skyrocketing here.  There are still plenty of hospital beds available, but hospitalizations and then deaths usually lag case increases, so the next month is expected to be trying.  Below graph is from COVID ACT NOW.

Mate

 

Welfare check.  The superintendent lets us in.  The apartment is a poor man’s hoarderville, open boxes and dirty clothes stacked as high as the unwashed dishes in the sink.  The man is sitting at a table with his head in his hands; a chess board in front of him.  For a moment, I fear he is not breathing, but when I nudge him he moves.  He turns slowly and stares blankly at me.  I ask if he is okay, but he doesn’t answer.  I nudge him again but he is out of it.  I try to get him to squeeze my hands, but he doesn’t follow any commands. Still, he has a decent pulse and his breathing while a bit slow is even.

His medications are on the table alongside the chessboard.  I read the labels.  Metoprolol and HCTZ for hypertension, furosemide for congestive heart failure, simvastatin for high cholesterol, coumadin for atrial fibrillation and blood clots, allopurinol for gout, metformin for diabetes, oxycodone for pain, colace to soften his stool. As I reach for each bottle, I can’t help but admire the antique chessboard; the pieces are large and carved from wood.  No idle purchase.

I always wonder about my patients' lives.  On the wall there is a picture of a strong man in military uniform and another with the same man with a large family around him.  There are many pictures of younger children.  The pictures are old and faded.  

We pick him up, me with my hands under his arms, and a firefighter grabbing his legs.  It is then I see the torn heroin bag on the floor below the chair. I check his eyes once we have him strapped in on the stretcher.  His pupils are pinpoint, but he is breathing well enough that I don’t need to give him any naloxone.  This is a dose, not an overdose.  All he needs is a little shake  to keep his breathing up when he nods off.  

I wonder how many years has he been using and where did he get the heroin from?  By the door there is a walker, the kind with tennis balls on the ends to make for smoother rolling.  Did he push his walker all the way down to Park Street to get his $4 bag or does his dealer knock on the door with a regular delivery?

Was he once one of those who played chess in the park for a dollar a game? When was the last time he played a fellow human, relegated now to playing against himself in this dim apartment?  I wonder if he replays lost games from his past, like many chess masters do, studying them to see where he went wrong.  Maybe the heroin helps him play better, relaxing him and letting his mind see patterns that reveal to him the proper move.  

I pick up my gear as we prepare to head down to the ambulance.  I take a last look at the chessboard.  I am new to the game, but it looks like if he is playing black, he is in a losing position.  White’s pawns are advancing on his king and his two rooks are about to be forked by the opposing knight.  Soon his pieces will join those already taken, standing helpless now on the sidelines, among his battalion of prescription pill bottles.  The battle will come to an end.  As it will one day for us all.

Masks and Vanilla Ice Cream

 

I arrive for the unconscious patient.  That means I carry my in house bag over my shoulder, the heart monitor in one hand, and an O2 tank and my isolation equipment bag in the other.  I run up four flights of stairs.  I am wearing a surgical mask and a face shield.  By the time I am come out on the landing, I can neither see through the face shield, nor breathe through the mask.  I set the 02 tank down, lift up the visor on my face shield, unloop one side of my mask, and lean against a wall while taking in a few precious gulps of air.  I nod to the old man in the hallway who eyes me silently, flip down the visor on the face shield, reloop my mask, pick up the 02 tank, and continue down the hall to the apartment.

We interrupt this post for a news flash:

The Governor just issued guidance saying all youth basketball players must wear masks while playing.  "Are you kidding?"  Youth basketball is often nonstop fast breaks.  My daughter who played four games this weekend, often stands during timeouts with hand on hips, slightly bent over using accessory muscles to breath.  How can they expect her or any of the girls on the court to run with a mask on?  What about someone who has asthma?  If I was Bobby Knight, I might throw at chair in anger at the idiocy.

Timeout.

Connecticut has gone red on every COVID map I have seen.  Our cases are going parabolic.  While I have been encountering more COVID this fall than last summer, it is not yet as bad as it was last Spring when it first struck us, when people were sucking for air just sitting in a chair trying not to move.  Deaths and hospitalizations are up, but the hammer may still be a few weeks away.

I read the news today.

In North Dakota they are so strapped for nurses they are allowing asymptomatic COVID positive nurses to continue to work.

With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work

Utah has declared a two week state of emergency due to the devastation.  Orders including canceling all sports, mandating all wear masks and limiting gatherings to family members only.

Gov. Gary Herbert declares state of emergency for hospital overcrowding, case surge

Nationwide we have surpassed 10 million cases with over 100,000 new cases a day. 

“What America has to understand is that we are about to enter Covid hell,” Dr. Michael Osterholm, director of Minnesota’s Center of Infectious Disease Research and Policy and the author of Deadliest Enemy: Our War Against Killer Germs, said yesterday.

So…

Back to basketball.

New article in the paper about it.

Benefits of mask wearing for winter sports athletes outweigh discomfort, performance setbacks, experts say

The doctors interviewed concede that wearing masks can and likely will inhibit both performance and communication during the game.

Yeah.  No doubt.

But Dr. Christine Won, from the Yale Medical School, says tellingly, “we have to take the value into what we’re really talking about here.”

And what we are talking about here is a deadly disease that has killed a quarter million Americans and will likely kill many more before it has run its course.

While COVID may not affect the health of any of the children, they can clearly spread it to more vulnerable relatives as easily as they can throw Hail Mary passes to each other on fast breaks.

I was recently reading the hospital chart of an elderly COVID patient with double pneumonia, who EMS had brought in.  "Patient to be admitted.  Her wishes have always been not to be intubated.  Comfort measures only.  Son says patient's sister and daughter are on their way to hospital, driving from 12 hours away.  Son requests vanilla ice cream for mother if possible."

So if my daughter complains, my answer will be, “I'm sorry, honey, I know it's going to be hard.  If you want to play, wear a mask.  The other team will be wearing them too.  And you’re young, you have your health and you are still being allowed to play basketball.  How great is that!”

 

Peace (Two Fingers)

 Recently I was driving down a Hartford Street in my white red and blue  paramedic response vehicle when I saw a single black man walking on the side of the road  with a bicycle.  He raised his middle finger emphatically and stared at me without smiling as I went past.

I was perturbed.  I thought for a moment that I should pull a U-turn and confront him, asking why he gave me the finger.  Me, of all people.  I ran through a silly dialogue in my head where I gave my pro-black credentials (2 black wives (one current, one ex), 3 black kids (1 black, 2 biracial), a life-size standup poster of Obama with a Bob Marley tee-shirt on (“Hit Me with Music”) that has been in my kitchen since before Obama’s first inauguration.  Plus I am currently enrolled in an anti-black racism class where I am learning a shit load I did not know about our history and what it means to be black in the US of A.  Also, for twenty-five years I have served and cared for people in the predominantly black north end of Hartford.  I have never worn a MAGA hat or buddied up to white supremists.  I am friend, not foe.

I did not, of course, turn around and confront him. I did not because at 62 years old, I know enough to know that he likely wasn’t giving me the finger.  He was more probably giving the finger to the Man, to the experience of being black in America that likely included personal experience of being treated badly due to the color of his skin rather than the nature of his character.  I am speculating of course.  Maybe I treated a family member of his who had a bad outcome or I cut him off in traffic as I raced lights and sirens to a call.  

As a father I have, on occasion, experienced watching my daughters be treated differently based on the color of their skin.  I gave my eldest daughter, who is the darkest, my credit card to pick up a computer at the Apple Store for her schoolwork.  Not only did she not come back with the computer the store cancelled my credit card and called me up to see if it had been stolen.  It took me all evening to get my card reactivated, and even then the store wouldn’t sell me the computer unless I came down and picked it up in person.  A year later, my middle daughter who can pass for white, went through the same experiment at the same store.  This time there was no problem.  No credit card cancelation and she came back with a shiny new computer. I can only imagine what it might be like for a parent to be told their child was yanked from a vehicle and cuffed for doing nothing wrong other than being black.  I think of all the times in my youth I had experiences with police, and never once was roughed up or treated unprofessionally.  I have had it easy.

Listen to CNN's Van Jones talk about what the election meant to him and not feel emotion.

https://www.youtube.com/watch?v=9eMoCW1Pq54

***

My wife came home last night with as big a smile as I have seen on her in recent years.  “I feel like a burden has lifted,” she said.  “It’s like we can breathe again.”

She added, “And the woman is vice-president.  Imagine that.  Think of the girls now.  What futures they can have.”

My wife was born in Jamaica.  For many years she was a single mother, who worked her way through school first as a nurse’s aide, then a R.N.   I attended her citizenship ceremony.  The tiny American flag she held that stood stood for a dream and great promise, not for hatred or intolerance for those who are different.

With all the focus on Trump - Biden, a great story is Kamala Harris as a black woman, daughter of a single mother rising to the second highest office in the land.  No small accomplishment.

Click for video:

https://www.nytimes.com/video/us/100000007442387/kamala-vice-president.html

Everyone in my household went to the polls on election day.  My youngest daughter, who is 12, accompanied me and stood at my side as I filled in my ballot.

I want a greater America for her and for her two sisters.

Peace to all. (Two Fingers).

But I hope they are never afraid to Fight the Power.

https://youtu.be/nNUl8bAKdi4

 

Sunday Morning Coming Down

 

On the Sunday morning sidewalk
Wishing, Lord, that I was stoned
'Cause there's something in a Sunday
Makes a body feel alone.
"Sunday Morning Coming Down" - Kris Kristofferson

Twenty-six people in Connecticut died of overdoses on the four Sundays of this past April. Twenty-one males.  Five females.  One was aged 15-24, eight were 25-34, six 35-44, four 45-54, five 55-64, one 65-74.  I don’t know their names, what kind of lives they lived, or who they loved.   Twenty-six deaths was the most fatal overdoses on any day of the week in a month so far this year.*  

I don’t believe people overdose deliberately.  But I believe some overdose deaths are unintentional suicides of despair.  The person using the drugs knows that the amount of drug they are doing at the time may lead to their death, but they are so sick and forlorn and tired, and often so deeply alone, that they throw an extra bag or two in the cooker in hopes the pain will go away and that they will escape into a bliss they have not known for a long time.

On March 21, 2020, Connecticut shut down the state due to COVID.  That move undoubtedly saved countless lives as Connecticut was able to eventually get some semblance of control (at least in the first wave) of the rapidly escalating pandemic.  Unfortunately, some of these twenty-six may have been collateral damage.

In a blog post, Fatal Overdoses written last April, I discussed the possible reasons we might see increased overdose deaths.

Established drug supply lines experience disruptions that force users to buy from unfamiliar sources, increasing their chances of overdosing.

Training and substance outreach programs are either closed or have limited hours.  Some have moved on-line, which is okay if you have a home and a computer. Not so much if you are displaced.

People may not have access to the help they need as well as reduced access to naloxone and clean needles.

Isolating people with existing mental health issues may lead former users (with now lowered tolerance) to return to substance use.

The increased release of prisoners with a history of drug use puts them at risk for overdose due to their lack of tolerance.

Patients with undiagnosed COVID-19 may be less resilient if they do overdose due to reduced respiratory capacity.

And people without work, with increased economic and social pressures, may seek escape.

I wrote about talking with Mark Jenkins, the head of the Greater Hartford Harm Reduction Coalition, about a homeless woman who I found dead on a mattress in a vacant apartment that she had found a way into.  She had been a regular at his drop-in center, and they were all mourning her passing.  Mark told me that day how worried he was. Now in this time of COVID we are telling people to isolate, he said, to distance themselves, which is opposed to everything we have told the substance use community in the past. Come together, look out for each other, there is safety in groups.

In total, April in Connecticut saw 133 overdose deaths, 56% more than the previous April, and as many as would die later in July 2020, a month that is historically one of the highest (unlike April) for overdose deaths.  

Connecticut is on pace in 2020 for 1400 people to die of overdoses-- an increase of 200 deaths (17%) over 2019.  

I hope that as the chaos clears from the election as it seems to be with an emerging Biden presidency and a continuing Republican Senate, that Democrat and Republican can come together and put vitriol and power struggles aside and start working for the people again, start looking out for our most vulnerable.

Address this crisis.  Recognize Addiction is a Disease and Treat it Medically.  End the Stigma.  Embrace Harm Reduction.

Bring our brothers and sisters in from the cold.  No one should be alone in this great country of ours.  We take care of our own.  We are our brother’s keepers.

 

***

*Not counting July, a month  known for higher overdose deaths, when there were 27 deaths over five Fridays.

Data from Connecticut Department of Public Health

Drug Overdose Deaths in Connecticut 2015-2020

(Accessed November 5, 2020)

Drug Overdoses Monthly Report, January 2019-September 2020

 

Chess

 

Rainy Sunday in Connecticut.  I am doing laundry, lifting weights, cleaning the house, playing chess, listening to a chess instructional video, doing homework from my anti-racism course, and cooking dinner all at the same time.  Too busy to write a blog post.

I admit to being nervous about the election on Tuesday, and have been having difficulty concentrating, bouncing around from preoccupation to the next.

I got my haircut this week, the first one in over a year.  I was on my way to the barbershop back in March when  they locked the doors for the shutdown.  I was a minute late.  They wouldn’t open the door.  So I grew my Corona do and secret stache, too (hidden underneath my mask).  While I enjoyed feeling like I was in my teens again back in the 70’s, the hair got a little unmanageable.  I’d throw my medic pack over my shoulder and the strap would catch on my hair.  Annoying. Plus with winter coming, we had our first snow when I worked on Friday, if you have long hair and wear a hat, it results for me in hat head, so I went with the near bald look.  No longer a hippie, I am hoping, the new look will kick me into gear, improve my workouts, make me eat better, and in general, improve my outlook on life.  If I hadn't been so anxious and trying to find ways to keep myself occupied, I might have let it grow a little longer, but going to the barber was another thing to do so I did it.

My team the Patriots lost today with their quarterback fumbling as the team drove to a possible game-winning touchdown or certainly and easy game tying field goal.  I turned the TV off right away and put in the instructional chess video.  I watched a great show on Netflix last week, a seven episode series called Queen’s Gambit about a young orphan who learns to play chess and goes on to battle the Russians in a big chess showdown.  I won’t give it away, but the ending was magnificent, well worth the time invested.  The movie was about many things: coming of age, battling substance use, finding your way in the world, but in the ending moments, it was about the world’s love for chess.  I stood up and cheered at the end.  It restored faith for me in mankind in these most uncertain of times.

When Bobby Fischer beat Boris Spassky back in 1972, I was 14 years old and was waving the American flag with patriotic pride along with the rest of the country when he won.  I like many took up chess for a while because of Fischer, but I was never very good at it.  I am playing again now against a computer because my daughter won’t play with me, and while I handily wiped out the beginner and some of the intermediate computer players, I have been getting crushed by an intermediate avatar named Nelson, who looks like a grinning Lebron James.  He is aggressive with his queen, and while I have beaten him a time or too, they have been with “hints” from the computer.  For the most part, I loose concentration and make a blunder, which the computer immediately flags for me in red, and I fight back my anger and frustration.  I know I will never be a great chess player, but I think it might be something I can work on as I get older.  I have heard chess helps build brain cells and fights off dementia.    Chess for the mind and weights for the body.  My gym sweatpants are dry now.  They got wet because I swam this morning.  With the COVID rules the locker rooms are closed so I have to put my suit on at home and wear it home wet under my sweats.  I have been swimming four and five days a week, but my efforts have been lackluster.  I am allotted 50 minutes to swim in my lane, but find myself leaving after 30 without even having pushed myself hard in my time in the water.  Too much on my mind.

I’m going to do some dumbbell circuits now and some step-ups on a new box I bought and made.  The rectangular box has heights depending on which way you set it -- at 12 inches, 14 inches and 16 inches.  I use the 16 inches for the step-ups, but can only box jump 12 inches and then I only attempt it after I have put the box against the wall to brace myself in case I don’t get up high enough or trip.  If I will survive without breaking my hip, then I will stand on a bosu ball for balance work.  At 62 and my six eight balance not being Wallenda like, and, particularly heading into winter with icy roads and sideways, I am increasingly worried about slip and falls.  Me slipping and falling.

And then of course there is COVID out there, and I find myself glancing often at my chest in anticipation of seeing his red laser light on my heart.  Stressful times.

So you see I am just trying to keep busy, trying to keep myself occupied, trying not to think about what could happen to America on Tuesday.  I just sure hope all Americans vote and that everyone’s vote is counted, and that the election is fair, without voter intimidation or court ordered repression of votes. I hope no one stirs up any trouble or violence.

Good wishes to all (except for Nelson).  But if Nelson checkmates me again, I’ll shake his hand virtually.  He will be the winner in a fair fight.  I will not throw a tantrum.  I will not claim his victory is false. I will not spread lies and conspiracy theories.  I will not dishonor chess.