Tuesday, June 28, 2016

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.

Saturday, June 18, 2016

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.

Monday, June 06, 2016

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.