Three Lives

 The heroin epidemic continues unabated in Hartford. I called the time on two fatal overdoses in a recent week. Both men were in their 40's. One was in a low-rate motel. He sat by the window in his breeze-less room, the curtains pulled just enough so he could see the cars rolling past on the highway. His head had rolled back, his mouth open when he died. He was riggored in his chair, surrounded by half unpacked moving cartons that held his tattered belongings. The room was dirty. The TV showed footage of the Dallas shootings. The ashtrays overflowed with butts. There were scattered glassine envelopes with a monkey stamped on them. The other man was in the guest bedroom of a small apartment where he was staying with his sister and her four year old son. He lay back on the neatly made bed, his feet on the floor, his eyes staring at the ceiling, his skin cold and grayish blue. On the bureau was his prescription for Buprenorphine. His sister said he had been clean for three months. She and her son had spent the night at her mother's and returned in the morning to find him there.

The next day, I did a third overdose. A man spotted down an embankment in the bushes of a city park, across the street from a shopping area where I have treated multiple overdoses in the past. The fire department carried him up through the thickets to the sidewalk path, where we worked on him. He was apneic, but still had a pulse. 2 mgs up Narcan up the nares. While we waited for him to begin breathing on his own again, I bagged him. As I held a tight seal, and steadily squeezed the bag, I looked down on the park and could see the public swimming pool. It is one of the rare fifty yard pools in the country. It was in the 90's that day and the blue water was very inviting. Sometimes in the summer, I take my lunch break from my coordinator job and go to that same pool and swim laps. The water is cold and clear as I glide through it. When I am done, I lie for a few minutes on a towel and feel the sun on my skin and gaze up at the robin egg blue sky. Sometimes a community group comes and they splash and play under the eyes of the councilors and the city lifeguards. When I was a child I lived at the pool in the summer. Most of the mothers of my friends were stay home moms like mine, their job to ferry the kids around. My childhood was idyllic. While I have had my share of sorrow and heartbreaks in life, I have never had a feeling that no cared about me. The three lives I mentioned, one white, one black, one Hispanic could have come from any background. I don't know if they were rich or poor, from broken childhood home or not. All I know if that at some point they lost their way. Whether they got into the drug by getting hooked on prescription opiates following an injury, or through recreational use or to escape sadness, it does not matter. A highway motel. A guest bedroom. A city park. I do not believe that no one loved them, that there was not the possibility of renewal ahead for them. The one survivor denied that he used heroin when he finally came around. A firefighter told him to be honest with us. He had been near death and had his life saved. Had someone not seen him, and the firefighters not gone down into the thickets on ground with scattered human feces, and carried him up where we gave him narcan and breathed for him until he could breathe again on his own, he would have died. The man bowed his head and said nothing. I saw him staring at his swollen and pocked AC in the crook of left elbow. Most of his veins were pristine. He was new to the struggle.

Cat Burglar

One of my greatest joys on the job is the opportunity to play cat burglar. By this I do not mean the opportunity to break into homes to steal jewelry and works of art. I am talking about the chance to break into homes to rescue people (with police permission).

The person has fallen and can’t get up or, perhaps, it is a medical alarm, and no one knows if there is a person in distress or merely a false activation. We arrive on scene. All the doors are locked and there is no key under the flowerpot (almost as good as doing a second story entry is being the guy who finds the key under the flowerpot. Brilliant!).

I have broken into dozens of homes over the years. I consider myself a top tier cat burglar second story man. My three advantages are: 1) my height(and thinness), 2) my ability to lift myself up with my arms, and 3) my quickness to volunteer. After a boost from my partner or a police officer, I usually go in head first, my legs high in the air, providing a chuckle for the earth bound. I hit with arms extended to soften the landing, do a wheelbarrow crawl until my legs are in, then stand and commence the search. As Mighty Mouse used to sing: Here I Come to Save the Day!!!!

Many times no one is home. Often the person is on the ground by the bed. Occasionally, they are dead. Once I thought a man was dead. He was in a chair, his back to me as he watched TV, completely motionlessness and heedless of my call and all the banging and knocking that had preceded the window entry. Turns out he was just hard of hearing.

I have landed near a Scottish terrier and a dachshund. Fortunately, I have never landed in the same room as a rottweiler -- one of the hazards of being a second story man. I was on scene once where a police officer insisted he go in first. He landed on a sleeping cat, who awoke with a screech. Better him than me. It also turned out we were at the wrong house. The correct address was across the street. Whoops.

Ten years ago in a blog post,The Juice, I wrote:

My cold is still lingering, although I might say I am feeling a little better. Still after three back to back calls yesterday, I was getting tired of lugging my gear and lifting people. Everything seems heavier than it should be when you aren’t feeling 100%. I hate standing at the top of the stairs feeling my heart pound, my breathing quicker.

On our last call, when we got there the cops were still trying to get into the house. I saw that a window screen was just barely open, so I climbed out on a ledge and jimmied it open, then I passed the flower pots that were on the window sill to a police officer and had called for my partner to boost me just a touch so I could get my arms into the window enough to pull myself up and in up. I love being a second story cat burglar man, but even as I was preparing to do it, I was thinking I was crazy. Maybe when I was feeling better, I could try it. Here I was with two fit police officers in the late twenties, and me a forty-seven year old man, getting ready to go head first through a high window. I think I was trying to prove something to myself. Fortunately, someone finally came to the door, just as I was getting boosted up. The patient had soiled herself during a syncopal episode, so her daughter was cleaning her up in the shower and hadn't heard the knocks on the door.

I have been reading this book about Barry Bonds and steroids called Game of Shadows. It is a pretty amazing book about more than just Bonds. It meticulously details the drugs Bonds and other athletes, not just baseball players, but world class track and field athletes –were taking. They’d be over the hill, their careers on a downward slide, and then they’d get on this drug regime and start setting world records. They were taking up to 50 pills a day, but the main ones were undetectable steroids and human growth hormone. They’d also take insulin, clomid, a female fertility drug, and some stuff to make lean muscle in cattle.

I’m reading this book and thinking, you know I’ve been feeling run down and over the hill, maybe I could use this stuff. Let’s look at the public good here. Barry Bonds takes steroids to hit home runs, Marion Jones takes steroids to run fast, I would be taking steroids to help people. And I could go for a world record, too. Instead of hitting 73 home runs, I could carry 73 millions pounds of patients and equipment in a year. And steroids would prolong my career. Of course, I wouldn’t want to swallow all the pills, rub all the creme on, and stick myself with all the syringes Bonds used. Forget about the female fertility and the cow stuff, just give me the Clear and the Cream and HGB, along with the legal supplement ZMA — zinc and magnesium.

Worry about getting caught? No, the state doesn’t test medics for steroids. Not yet anyway. But, you know, I might be a standup guy anyway. What bugs me the most about these athletes is not that they took steroids, but that they lie about it. They deny what anyone with eyes can see. I wouldn’t be like that. If someone asks me how I lifted that 400-pounder all by myself, I’ll say, “It’s the juice! man. It’s the juice!”

Anyway, tomorrow I start taking my daily vitamins again.

***
Today I am fifty seven and not nearly as spry as I was at 47. Three years ago, I was quite fit. I ran in a Rugged Maniac, Warrior Dash, Spartan Race, Down and Dirty, Fitathlon, and the penultimate, a Tough Mudder. It was all the result of a year of purposeful training. I ran hills and trails and went to the playground with my daughter and climbed everything on the playscape. The one skill you have to master for those races is the ability to run and jump up a wall, getting your hands on the top, pull yourself up, and then swing your leg over. You do that all the time in these races. I was pretty decent at it. Unfortunately, the last Spartan race I have witnessed this year was on TV, while I sat with poor posture on my couch eating from a bag of Utz Sour Cream and Onion Ridged Potato Chips.

After my adventure race year, I developed plantar fasciitis, which made even walking quite painful so I abandoned mud runs and half marathons and have since been a dedicated swimmer, swimming in meets and open water swims. I swim very fast for my age, but my fitness beyond swimming has deteriorated significantly. The last two years I feel I have been in physical decline. My hearing is shot, I need glasses not just for 24s IVs, but for 20’s, intubations and to read the label on the Alleve package. I take thyroid medication every morning now, and once or twice a year I am afflicted with the gout (the sadness of the gout is I get it after only 1-2 beers on top of a couple days of red meat and bacon eating. I used to love beer drinking. But during my last gout attack (which comes on rapidly and at night, causing excruciating pain even at the feel of the wind on my big toe) I called out for Heroin. I called for it even knowing that if I tried it just once, I would likely begin a life spiral that would lead to the loss of my job, family, home and any vestige of self-regard. I would die alone and be buried in a potter’s field. That’s how bad the pain of gout is. It is tiny shards of glass in your swollen joint. Fortunately, no one heard my call and after a couple zillion years of agony, aided by the exhaustion of my tears, and a Benadryl, I was able to finally sleep for a few hours till the alarm awoke me, calling me back to the work. I picked up my shovel and using it as a crutch, I limped to my 2002 Honda and drove to the EMS mine. Another day older -- and no beer to look forward to at the end of the shift. Normally six to eight times a day, I am asked “How tall are you?” When I get the gout, instead I am asked, “Why are you walking so slow? Is your foot okay?” My answer instead of “six eight and a half -- I used to be six nine and a half, but my partner Jerry has beaten me down,” I say, “I’ve got the gout.”

My partner, Jerry, who has more silver in his hair than I do (mainly because he has more hair) enjoys putting a "Fall Risk" bracelet on my wrist every opportunity he gets while we wait at triage for our number to be called. He gets as big a kick out of it the eighth and ninth times as he did it as he did the first time. Oh, well, I did promise his mother I would look after him.

Which brings us all to today and my impetus for this post. No, I did not break into home to rescue a person -- it has been awhile since I have done that. We responded to an apartment building in the north end for a woman who couldn't walk. Her daughter met us at the door, and held it open so we could go up the stairs and into the apartment building. There a woman with a swollen knee for a month was requesting transportation to the hospital. While my partner and my preceptee put the patient in the stair chair, I carried the gear back out to the ambulance. When I returned, the outside door was locked. This apartment building had balconies that were about five feet off the ground. I raised my eyebrows, measuring just what I would have to do. I tried to reach my foot up to the balcony floor, and it was a tight stretch, and I just made it, then grabbing two of the the balcony railings I pulled myself up. Then I tried to swing my leg up to get over the top railing, but my leg wouldn’t stretch that far. I rested a moment, then tried again, swinging my leg against my stiff joints. Success. I swung my other leg up and over. There I was up on the balcony lickedy-split. I entered the room through the billowing curtains. “Walla,” I said. My partner, my preceptee, our patient and her daughter all looked up at me oddly like what was I doing there and what was I talking about, and then they resumed their conversation. I wanted to say “Walla” again to call the deserved attention to my Batman act, but instead, i just celebrated silently, realizing my feat had more meaning to me than to them.

This afternoon, I had my partner drive me to the playground off Oakwood Street, where I practiced some climbing.

I am not ready to retire the self-title of cat burglar second story man extraordinaire. 

Sinners and Saints

 As each of us will ultimately find ourselves before our god, many will find themselves before their paramedic. But unlike their god, their paramedic does not sit in judgement. We treat all of our patients the same. That is the creed. The man in the Mercedes Benz gets the same care as the man pushing the shopping cart full of cans. The model gets the same priority as the toothless crack whore, the All-American the same careful assessment as the bed sore ridden amputee, the police officer the same professionalism as the thief.

Most of my patients are anonymous. But sometimes they are not. I have cared for famous politicians, athletes, entertainers, scholars, businessmen and criminals. Sometimes I like to talk to my patients. I ask them about their lives, how they ended up here on my stretcher, what lessons or regrets do they have from their journeys. When my patient’s public history is known to me, and I suspect my letting on that I know who they are will make them uncomfortable, I try not to let on that I know. I am just the paramedic and they are just the patient. I don’t ask the real questions I am thinking.

Some of these patients are old and jaundiced, their heart and organs are failing, their lungs filling up with water, their minds moving toward dementia. They are likely not the same people they were in their primes. There are pressing questions I would like to, but do not ask -- questions I am interested in their reflections about. What was it like to change your position on an issue that had meant so much to you, just so you could advance your political career. Did your “move to the center” feel like you had sold your soul and everything that had gotten you into helping people in the first place just for that short burst of fame. How did it feel to buy that historic company, then close down the local factory and layoff all those people while you made millions? Was that miracle season where you seemed to strike batters out at will your greatest memory, or was it the time you spent with your family before the drugs found purchase in your soul? Did you really sleep with your young secretary while your wife lay in bed at home cancer-ridden? What was in your heart that late night when you raised your rifle and squeezed the trigger? Did you lament the bloodied lives you left on that killing floor?

I wonder up in heaven, if God has people who help prepare the new arrivals for their meeting with him -- the meeting that determines whether they get a seat in the clouds or the trapdoor opens beneath them. If there are, I bet those assistants are much like us, professional and kind, treating sinner and saint the same, leaving the judging to the higher ups.

Conrad Casonguay

 Conrad Castonguay died this week at 81. In 1992-93, he helped teach my paramedic class. Pharmacology was his specialty. He wasn’t a paramedic, but he knew what he was talking about and we paid him mind. He was a challenging instructor, and took his work seriously. It became an honor for paramedics to say they were his students.

Conrad Castonguay

That was 24 years ago when he was 57. The last time I saw him was in 2003 at a funeral for Dr. Philip Stent who was the medical director of my paramedic class. Dr. Stent was also the state OEMS Medical Director, and I had worked with him when I was the Executive Assistant at the State Health Department from 1991-1995, just before I started full time as a paramedic. He was instrumental in creating our state trauma system and in moving paramedicine into the modern era.

Dr. Philip Stent

There are many paramedics still out on the street today who remember both men, and are grateful for having known them. We, as paramedics, are a collection of all the knowledge and insight we have been shown along our paths. As we have been taught, so we teach others. I was thinking the other day of all the paramedics I have precepted and all the paramedic students I have had ride with me over the last two plus decades. Sure there were days when I am tired and cranky, but for the most part I have always tried to pass on what I know, what I have been taught, and that includes what Conrad Castonguay and Phillip Stent taught me. Professionalism, knowing your trade, caring about being good at what you do.

Our time is limited, both in the field, and on this earth. But our lessons are passed on, as we pass on the lessons we have been taught.

Conrad Castonguay and Philip Stent ride the streets with us still.

EMS Sports Pages

 When I started in EMS, the term "EMS Sports Pages" referred to the Obituaries. It was where we turned to see how our critical patients did. Get pulses back on a cardiac arrest or bring in an unresponsive patient with multiple trauma from an MVA or a seizing patient with left sided paralysis, you checked the obit section each day. It might be day three or day five or sometimes, day 13, but in most cases, you’d recognize the name,and you’d feel a little down. Never see the name and you’d wonder if maybe it appeared on a day you didn’t check. Followup at many of the hospitals was hard to get.

This was around the time Rescue 911 was on TV. In that show heroic rescues were reenacted, and afterwards the victims came by the EMS station for a celebratory picnic with their rescuers. We didn’t have a station. We went from street corner posting to street corner posting. And we never got a picnic.

Once I got called for a stroke. I found a man sitting on a neighbor’s garbage can, where he had been talking to them after driving up in his car, when he suddenly slumped over. We went lights and sirens to the hospital following the stroke protocol. I dug his ID out of his wallet and was shocked by the name. It was the same name as a man I had treated in cardiac arrest a year before. He had collapsed outside at his landscaping job. We got there quickly and shocked him out of v-fib. I’d gotten pulses back, but never thought anything more of it. I just assumed he had died or was a vegetable in some nursing home. To make it an even better story, his massive stroke turned out to be a TIA and he was talking to me before we even reached the hospital. He was in fact the same guy. At the hospital I met his family and they said they had tried to get in contact with me. They had gone to the fire station with a fruit basket. They said they had left it there with a message for me. I never got the message or the fruit. At least that day in the ER we had our little reunion. We all shook hands and hugged, and smiled a lot.

Some of the local fire departments have been a bit of sore point for some of my coworkers. My co-workers would save a patient or deliver a baby only to see the fire department first responders on TV or in the newspapers being honored for the very call with no mention of the primary care-givers. To the firefighter's credit, their departments had good PR programs. You let the community know what you do and the money will be there at budget time.

I’ve been a part-time EMS coordinator at a local hospital now for almost eight years in addition to being a full time medic. A couple years into the job, I started putting out a monthly newsletter. It has been my goal to highlight cardiac arrest saves, and more recently STEMIs and good stroke care. Every now and then I add an anaphylaxis or overdose or baby delivery. Sometimes I ask the crews to take a picture in front of their vehicle. I asked one older medic once for a picture, but he declined. He said it was his job and he shouldn’t be honored for doing something he was paid to to do and that he was expected to do well . I had to respect that. Still, I am glad others have been willing to share their photos. Some of the stories in the newsletter have led to TV spots and community honors. With patient reunions Recently I went from a two page to a four page newsletter, which I hope I can keep up. The pages are not just not highlighting great calls, they have educational matter, announcements of protocol changes and upcoming events, but I am going to try to increase the number of stories and expand the type of calls I put in my new EMS sports pages.

EMS is like sports. Some days you are phenomenal, other days you are average, and sometimes you strike out. Yet few of us need the cheering crowds. Most of us get our daily rewards in the give and take with patients, the thanks you get from them when you get them safely to their destination, doing better than when you found them.

I think good work deserves recognition, and if EMS is shy about it, it still needs to be celebrated because it raises the public’s esteem for what we do, and that will lead to a better system for all.