No Easy Trail

 Police cordon off the abandoned vehicle with yellow tape. It is an 86 Plymouth – an old man’s car.

“Am I going to need all my gear, or just the monitor?” I ask the officer.

“The monitor."

I look across the grass toward the tree line at the eastern end of the cemetery. I don’t want to have to get all the way in there and find out he’s workable. “He’s been there awhile?”

“Long enough. There won’t be an issue.”

I walk in alone. The leaves of late fall rest brittle on the ground. I have to watch my step on the uneven terrain. Bare branches pull at my pants and workshirt. There is no easy trail here. Still the air is fresh and it is good to be out of doors. No stale wheelchair lined hall this trek.

Fifteen minutes later, I reemerge with burrs on my clothes and blood on my hand from a thorn scratch. In my pocket I have a six second strip of asystole, a man’s name and date of birth on the back. 74 years old.

As I walk back across the grass, the late afternoon sun in the west makes me squint. I can hear the traffic from the main road that runs along the northern edge of the cemetery.

Indians lived here 300 years ago. When they grew old they too used to walk into the woods to die.

Ambassador of Love

 In emergency medicine, field and hospital come together when the EMT/paramedic hands over patient care to the nurse. This transfer is almost always professional and courteous. The good feelings demonstrated on the job between paramedic and nurse are not limited to working hours. After we punch out for the shift, we often meet in restaurants, bars and at parties large and small. Paramedics and emergency nurses love to eat, drink and be merry together. Many end up spending their lives with one another.

At one of the trauma centers in our city, a pretty young nurse chatted with four medics as we waited to get room assignments for our patients. We were discussing the routine “wait” of the triage line when the nurse smiled and said, “Well, at least the nurses at (our) hospital are the friendliest.” She was met with silence and bemused grins -- a reaction she clearly hadn’t expected. “We are the friendliest?...Aren’t we?”

While none of us would complain about the friendliness of the nurses at her hospital, the truth was all four of us were either married to or living with nurses at the other hospital in addition to being the fathers of their children.

My point is the much discussed conflict between nurses and paramedics is more often the exception that the rule. At work and at play, we love and respect each other. Still there is no hiding the fact that there can be conflicts. It usually arises when the nurse and EMT/paramedic are unfamiliar with each other. A rude or misunderstood remark takes on a larger significance. Instead of nurse and paramedic, it's Hatfields and McCoy’s.

Sly Hero

Each confrontation is retold and enhanced with the paramedic always being the sly hero and nurse being an archetype moron or villian. I wrote about this a couple years ago in Left Lateral Condoyle, Paramedic as Sly Hero and Stud or Idiot?

Dumb nurse and sly paramedic stories are quite common in EMS rooms or any place where ambulance crews gather to swap the day's tales. I suspect nurses may tell their own version of dumb paramedic and sly nurse stories when they are among their own kind in their own clubhouses.

Threat to Public Health?

Years ago I went before the legislature to testify about a bill enabling paramedics to give controlled substances on standing orders. (Connecticut had an antiquated law that required controlled substances be given only by “simultaneous communication” with an ED physician.) A few months before the state had passed a law changing paramedics from certified to licensed status, which meant instead of paying $35 every two years, medics now owed the state $75 every year. A certain interest group was concerned that giving license status to paramedics would enable them to work as paramedics in doctors' offices, walk-in clinics and nursing homes. So in response, they cajoled the legislature into writing a bill specifying that paramedics could only practice as paramedics within the confines of the emergency medical services system. This legal language change was lumped together with the proposal enabling us to use controlled substances on standing order.

My lowest day as a paramedic came from watching the representatives from the Nurse’s Association and the Emergency Nurses Association testify that it would be unsafe to have paramedics working in doctors' offices because paramedics were not as well trained as nurses and thus would be a danger to the public health, blah, blah, blah. A lone ER doc then got up and said completely without irony that in addition to being untrained, if we let paramedics work in doctor’s offices, there would be no one left to take care of the truly sick people in the field.

While the doctor was allowed to go on for 11 minutes, any paramedic that wished to speak was gaveled into silence after three. The one bright spot of the day was when a hospital clinical coordinator who was also a paramedic made the savvy point of speaking about first aid stations at a large area boat show that were manned by nurses. If a visitor needs an ice pack or a Band-Aid, he said, then the nurse takes care of them, but if they go into cardiac arrest, the nurse’s first action is to call for paramedics.

Mutual Respect

I do not hold the actions of the nursing organizations (that were successful in limiting our area of practice and who slandered our profession) against the ED nurses who take over care of the sick patients we bring in to the hospital or against the sweet ED nurse who gets up in the middle of the night to comfort my crying daughter, while I get up to warm a fresh bottle of milk. We have a mutual respect.

But still there are those rare, but telling moments when an unfamiliar nurse lets me know that SHE is a nurse and her actions imply I don’t know anything. This happened just the other day at one of the local nursing homes. A COPD patient, who I have been caring for for many, many years, was again having an exacerbation. While I questioned “Frank” about how he was feeling this time and assessed his lungs and breathing, the nurse tried to tell me how much oxygen to give and how to position the patient. Frankly, she was in my way.

I attempted to explain to her that I knew Frank well and had learned to trust him to tell me what he needed. Also, I told her we had capnography and could thus monitor his ventilatory status. She clearly didn’t want to listen nor do I think she had any idea what I was talking about. “I know what you can monitor,” she said, “but you can’t give him too much oxygen.”

I told her we had it in hand – a cue for her to leave. I wanted to say, not only have I been a paramedic for almost two decades, I am also a registered nurse, but I couldn’t say it because my nurse status was still listed as pending on the official state license verification site.

Paramedic, R.N.

That’s right.

For the last couple years I have (off and on) pursued a nursing degree, and I recently completed the final step of the process by successfully passing the NCLEX exam. Yesterday morning, I received an official letter from the state addressing me as Peter Canning, R.N. and including a copy of my new license. I am now a dual citizen.

In addition to pledgeing to uphold the fine and honored nurse traditions and standards of caring for my patients, I really want to meet Dixie McCall. I want her to teach me the nurses’s secret handshake and to formally invite me to the Nurses Annual Hotenanny at the local Moose Lodge.

Ambassador of Peace and Love

I will save a future post for a detailed look at how I got my nursing degree – what I think about the educational experience I had and what I plan to do with my nurse education (besides being an ambassador for peace and love among the clans).

I can say definitively, I have no intention of leaving the paramedic streets as long as I am healthy and able-bodied.

As far as credentials, I intend to be listed as Paramedic, R.N.