Since I closed down my daily blog I have been trying to increase the number of posts to Street Watch, which I have always thought of as my weekly blog. I am hoping to post at least three or four times a week. Since I will not always be able to write the type of extended life of a paramedic story I like best, I am going to also try to do posts a variety of post types, including research, news story type updates, and a general miscellaneous type post which I will try to do tonight. I am going to try to respond to comments more.
**
I rode today with another paramedic and her preceptee. I had called in looking for a shift, and hers was open. They didn’t tell me she had a preceptee with her. That was all right. I just drove, and let them do the calls. The preceptee is a bright articulate young man, who I think will be an excellent medic. We had no real challenging calls, but I could see he had a good head and common sense. We were in one of the newer ambulance, where the emergency lights are in the ceiling above you head. Supposedly, you just reach up and hit emergency master and they all light up. We got a call to intercept with a basic car that needed a medic, so I looked up, hit the emergency master and off we went. I drove a little faster than normal because I wanted to be able to hit the intercept point before the other ambulance, which was already enroute passed it. We made it fine. Later, the driver of the other ambulance mentioned I had had my siren on, but no lights. I guess, whoever was in the car before me had turned the individual emergency lights off, so you had to not only hit the emergency master, you had to then hit each of the lights. D’ooh! Oh, well.
**
Consider the following merely an idea brewing in my head, a troublesome unformed idea:
The other day I had an interesting talk with an EMT, who used to work in the dispatch center, which is located in another city from us. He works the road, but still keeps his feet in various dispatch centers. While like many road people, I find dispatchers annoying and easy to blame, they do have their side to tell. While I may suspect them of sending me on a priority one for something I don't think should be lights and sirens only because they want to clear their screens( by getting us to the call quicker to get us to the hospital sooner, and clear for the next call sooner) there may in fact be more to it.
We used to have dispatch right in our same building, and we all knew and saw each other everyday, and the dispatchers often knew the streets better than we did, so for the most part we got along. For the most part, they were good to us, we were good to them. It was also in the days before EMD, when dispatchers could use their common sense in selecting how to send us to the call. Now, we hire non-medically trained people to EMD the calls, which I understand is what the EMD company prefers so that the call takers won’t deviate from the algorithm. The ambulance company I guess gets a better insurance rate as long as they stick to the algorithm – the EMD company will defend them in court. The problem is, the dispatchers, whose hands I guess are tired by the call-takers work (And the call-takers side may simply be we're just doing our jobs as we have been trained), end up sending us priority one all the time for difficulty breathings simply because the patient is not breathing normally, but there is no context. Maybe they are COPDers and this is their baseline, and their problem today is a skin tear. Maybe they have had pneumonia for a few days and the doctor has finally decided to send them in for hydration and antibiotics. An glaring example the other day we were sent priority one for difficulty breathing only to find the call was for a psych who was breathing rapidly because she was agitated because the nurse wouldn’t let her watch the show she wanted on the common TV. We found her with a cigarette in her mouth. I could go on. The calls are all appropriate per EMD, but inappropriate for a lights and sirens response per common sense.
I am a big fan of Bryan Bledsoe, an EMS physciaian and writer, who has made a name for himself, among other things exploding EMS myths. I believe I heard him once and another time read him making a reference to their being no science behind EMD – nothing that provided that it in fact made a difference in a measurable way. I eagerly wait for him or someone else to truly tackle the topic. In the meantime a few days ago I was browsing around on a site called Pub Med where you can look up research articles and I found some very recent ones, which I will write about soon in more detail, which showed how poorly many of the calls correlate to the EMD protocols they are assigned by the dispatcher. For instance, something like only 26% of calls given the chest pain protocol, are actually cardiac related, and I read another that I believe said only 1 out of 18 cardiac-related calls is a true MI. I seem to remember reading something that in many cases random chance did a better job of picking the appropriate response than EMD (I hope this isn’t so). Now, keep in mind these numbers are just out of my memory now, and I promise a deeper look into them. The bottom line tonight for me is that while we may all think of EMD as motherhood and apple pie, and may it protect us from liability, it may also not be doing the patients much good and may be putting us in harm’s way.
I’m going to look into this further, and promise to post my findings here, as well as the relevant research. I may in fact be wrong, but I also may be right.
Earlier today we were sent on a priority one by a town police department for a psych and arrived to find the man in handcuffs with about seven cops surrounding him, and the man was quite calm. While this call was not EMDed it came as a request from an officer, I would argue that our going lights and sirens did not contribute to saving anyone’s life and may in fact have endangered someone’s – ours and the public’s.
So here is the deal, I want to put all these things in a pot:
EMS
Evidence-based medicine
Research
Ambulance personnel
Ambulance Companies
Ambulance crashes
Unions
OSHA
Dispatchers
Police and fire requests for ambulance to their scenes
The public in their cars
The public who is sick
EMD
Lights and sirens policies
Safety equipment
First responders
Whatever else I think of
Mix it all up and see if I can come up with a statement about responding lights and sirens that is true.
Here's an abstract from one of the studies that just came out:
1: Acad Emerg Med. 2006 Sep;13(9):954-60. Epub 2006 Aug 7. Links
Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score.Feldman MJ, Verbeek PR, Lyons DG, Chad SJ, Craig AM, Schwartz B.
Sunnybrook-Osler Center for Prehospital Care, 10 Carlson Court, Suite 640, Toronto, Ontario, Canada. mfeldman@socpc.ca
BACKGROUND: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. OBJECTIVES: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. METHODS: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. RESULTS: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. CONCLUSIONS: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements.
**
Speaking of lights and sirens and ambulance crashes, I was disappointed with the final episode of SAVED. In the end, the medic takes the ambulance lights and sirens to see his girl hoping to catch her before she can leave town with the man she doesn’t love. He is distracted to find his partner in the back who has possibly ODed due to domestic unhappiness. He runs the red light and they are t-boned by a semi-truck.
Now despite all the inaccuracies and quibbles here and there seen though a medic’s eyes, I still really enjoyed the season, and hope it gets renewed. In the end, I think it does raise our profile in the public eye, conveys some of the feeling of what it is like to be a medic, and portrays us as carrying, and at times, heroic people. For TV, that’s doing well. And frankly we need all the help we can, so I send them out a nod of appreciation.
**
Here's a story about an interesting study that shows there is no correlation between pain and vital signs.
Correlating Self-Reported Pain and Vital Signs
Here are his concluding remarks:
I have also heard health-care providers say, "Well, he can't be in much pain because he isn't even tachycardic." This study is a milestone in my book to the fact that every patient's pain is theirs and theirs alone. We have created so many myths and personal biases regarding pain that it gets in the way of caring for our patients. Our traditional teaching has been so ingrained in us with these myths that when we don't see the expected changes in vital signs, we assume the patient is simply not in as much pain as they profess.
It may be true that if your patient is tachycardic, tachypneic or hypertensive that it could be a reflection of his or her degree of pain. This is useful when you have the stoic patient who refuses to confess how much it hurts. However, the converse is not true, as it was eloquently demonstrated in this study.
Remember: Our job is not to keep the patients from becoming junkies. It's to provide compassionate care and relieve pain and suffering. Leave the prejudice to someone less enlightened than you.
Thursday, September 07, 2006
Tuesday, September 05, 2006
Patience
Preceptees come in all types, ranging from those who are so smart you have to reread your books at night just to keep up with them to those who think the excuse “well, we didn’t go over that in class” covers them from any need to improve further. I’ve had preceptees for whom, on arriving at a scene, I had to open the back of the ambulance, and say, “Are you planning on getting out anytime soon?” to those who were already in the house with the patient intubated, a IV in their necks, and were whirling the defib paddles like numb-chucks before I could even make it in the door.
Some preceptees are dark clouds – I had one who got a tube on her first call, and who it seemed we went to so many multiple shootings, I actually considered buying a bullet-proof vest. And I had others who were white clouds, people who towns wanted to hire out because when they were on duty trauma and disease took the hours off.
When I first started as a preceptor I think I was much more accepting of a new medic’s ignorance because I was so close to my own precepting period where I frankly didn’t know much and felt it a miracle that I passed. Now I am less understanding of gaps in learning. But also back then I was not as forgiving if they missed an IV or their first shot at a tube. I’d push them right out of the way. I’m much more laid back now. I’ll be right at their side, schooling them in how to tube, manipulating the neck for them, coaching them through it or letting them go for the IV on the third try, if I think they will get it this time.
My new preceptee is a man just a few years younger than myself. I believe he will be the kind of paramedic the company needs. He is kind to the patients, intelligent, and not at all rash. Unfortunately, as far as his precepting goes, he is a white cloud. We have only been together a couple weeks, but we aren’t getting much. The one morning there was a code, it came in just before our shift, and hearing it on the radio, I responded right to the scene and met the night medic there, and we worked it together. My preceptee was waiting at the barn when we got back. “Fifteen minutes later and you would have had the call,” I said.
“Oh, well,” he said.
I consider patience one of my better qualities. My preceptee is patient too. The knock on him has been that he might be too slow on scene. I’m supposed to evaluate him on that. We haven’t really had a bad call yet to test how quick he can move when he has too. It's true he moves a little on the slow side on the calls we’ve been on, but not in a bad way. He reminds me somewhat of Columbo, the TV detective. He has a slow manner, but he is bright, and he ends up with the patient’s full attention. They feel he cares about them, that he listens.
Several of the calls we have had have tried my patience. I guess I am anxious because I want to get good calls for my preceptee. Here’s some of the ones we’ve had this week. The 80 year old man, fully dressed, who called because his home BP cuff gave him a reading of 106/72 and his pressure is usually 120/80, and he is concerned and believes he should go to the hospital because he felt slightly lightheaded when he stood up. The man is upset we brought the stretcher in, he can walk, he says, and no he hasn’t called his doctor. The woman who has a knot in her back and instead of driving to the hospital, drove back to her retirement community because they always call an ambulance for her and she could park her car, and then have the retirement community send their courtesy van when she is done seeing the doctor in the ER. The nursing home patient discharged a few days ago with pneumonia who is requesting to go to the hospital because he is worried his pneumonia is acting up, not because the staff has thought he should go.
And then there is Hazel. Hazel is a skinny old woman with a wig, who looks like a scrawny bird. She lives alone, and always wears a yellow bathroom that is faded and stained. Her house stinks of cigarette smoke. She has early dementia and calls us several times a week for nonspecific complaints. She’s constipated, she wants her blood pressure checked, and she didn’t sleep a wink all night. Sometimes her neighbor is there when we get there – her neighbor said Hazel once called her twenty-two times in one day. Lately, my approach to Hazel has been, you want to go to the hospital, get your coat, let’s go. I can’t take the smell in her apartment. It’s like she has smoked three packs a day for fifty years and has never once opened a window. When I first started getting called there, I tried to get social services involved believing she needed to be in a nursing home because of her increasing dementia. One day I gave her a HIPPA form. She started reading it, and then got bored and put it down. Then she discovered it again and started reading it again, and then got bored and put it down, only to discover it in her hand, and start reading again. I saw her in the hallway five hours later and she was still reading the HIPPA form like it was a racy novel.
The hospital has stopped working her up, and now she just goes to the waiting room. She isn’t demented enough I guess for a nursing home. Still she keeps calling. My preceptee has been with me to her house three times already. He’s very patient with her. I end up standing outside, breathing the fresh air, while he helps her lock up her house and get her things.
Yesterday was a slow day. We sat around a long time until we finally got a call. It was at an elderly apartment complex that just opened in a renovated building that used to be a nursing home. The call was for a medic alarm. A red light was flashing on the alarm board by the front door. The neighbors, seeing the flashing light, called 911. The night medic had warned me about the new place. The night before he’d talked to a commercial crew who had responded there, and taken the patient in. No one answered the apartment door, but before the policeman tried to kick the door in, I had him call dispatch and check and see if it was the same apartment as the one the crew went to the night before. It was, and dispatch now told us they had transported the resident. It seems no one had reset the button. So we cleared. One call, no patients.
We were so bored by then, I suggested we stop at Hazel’s house, walk in and say, “What’s wrong today? You called for an ambulance?” just to see what she would do. Whether she would be upset that she didn’t remember she had called for an ambulance or whether she would think that she had.
I know that wouldn’t have been very nice, but hey we were just cracking jokes, trying to pass the time. We spent much of the day watching the news coverage of the death of the crocodile hunter. What a bummer that was. At least he died doing something he loved. We joked that we were surprised it wasn’t a crocodile that had gotten him. Instead, it was a sting ray. Maybe it was an out-of-town job, we guessed. The crocks got together and called in a hired tail to do the job. Stingy. Made it look like a freak accident. But it was a hit. The word would get around the outback. Teach anyone else to mess with the crocks.
I know it’s not politically correct to make fun of an old lady with dementia or someone so recently tragically killed. Poor taste. But that’s how it is sometimes, particularly when you are bored. Paramedics with time on their hands.
Nothing for the rest of the day. At least it was a holiday. Double time and a half pay. Still I felt like a bad host. Instead of being out there being big bad paramedics – doing codes and MIs and rollovers and pushing all kinds of drugs, showing my preceptee the street life, we were sitting in the base living room, bored, reading the newspaper over and over, watching the same clips on TV. I was feeling restless. My preceptee sat in the arm chair, mouth open, snoring.
This morning, while we were talking about how today would be the day we’d get the good calls he needs before getting cut loose, the tones on the radio went off.
“Unit One!” the dispatcher called.
“Note the urgent quality to the dispatcher’s voice,” I said to my preceptee. “This is going to be good.”
“Unit One,” I answered.
“Female. Constipation.” He gave the familiar address. My preceptee started laughing.
“Hazel,” he said.
My preceptee does his usual stellar job with Hazel. She is all agitated. “I didn’t sleep a lick last night. I’m constipated. I feel horrible all over. I’m a wreck. I didn’t sleep at all. Close the door, you're letting the cold air in.”
"I need to hold the door open," I say, "Because there is no air in here. I can't breathe."
"Close the door. My, what a draft. I feel terrible. I hardly slept a lick," she says.
"Fine," I say. "I'm waiting outside."
"Don't mind him," my preceptee says, "He has a respiratory problem."
They come out of the house fifteen minutes later. She’s wearing her yellow stained bathrobe and tennis shoes and carrying her little purse, her wig slightly off kilter on her head.
The ED is not too busy today and the triage nurse assigns Hazel a bed in the non-urgent wing.
My preceptee gives the room nurse a report. I hand Hazel her HIPPA form.
Some preceptees are dark clouds – I had one who got a tube on her first call, and who it seemed we went to so many multiple shootings, I actually considered buying a bullet-proof vest. And I had others who were white clouds, people who towns wanted to hire out because when they were on duty trauma and disease took the hours off.
When I first started as a preceptor I think I was much more accepting of a new medic’s ignorance because I was so close to my own precepting period where I frankly didn’t know much and felt it a miracle that I passed. Now I am less understanding of gaps in learning. But also back then I was not as forgiving if they missed an IV or their first shot at a tube. I’d push them right out of the way. I’m much more laid back now. I’ll be right at their side, schooling them in how to tube, manipulating the neck for them, coaching them through it or letting them go for the IV on the third try, if I think they will get it this time.
My new preceptee is a man just a few years younger than myself. I believe he will be the kind of paramedic the company needs. He is kind to the patients, intelligent, and not at all rash. Unfortunately, as far as his precepting goes, he is a white cloud. We have only been together a couple weeks, but we aren’t getting much. The one morning there was a code, it came in just before our shift, and hearing it on the radio, I responded right to the scene and met the night medic there, and we worked it together. My preceptee was waiting at the barn when we got back. “Fifteen minutes later and you would have had the call,” I said.
“Oh, well,” he said.
I consider patience one of my better qualities. My preceptee is patient too. The knock on him has been that he might be too slow on scene. I’m supposed to evaluate him on that. We haven’t really had a bad call yet to test how quick he can move when he has too. It's true he moves a little on the slow side on the calls we’ve been on, but not in a bad way. He reminds me somewhat of Columbo, the TV detective. He has a slow manner, but he is bright, and he ends up with the patient’s full attention. They feel he cares about them, that he listens.
Several of the calls we have had have tried my patience. I guess I am anxious because I want to get good calls for my preceptee. Here’s some of the ones we’ve had this week. The 80 year old man, fully dressed, who called because his home BP cuff gave him a reading of 106/72 and his pressure is usually 120/80, and he is concerned and believes he should go to the hospital because he felt slightly lightheaded when he stood up. The man is upset we brought the stretcher in, he can walk, he says, and no he hasn’t called his doctor. The woman who has a knot in her back and instead of driving to the hospital, drove back to her retirement community because they always call an ambulance for her and she could park her car, and then have the retirement community send their courtesy van when she is done seeing the doctor in the ER. The nursing home patient discharged a few days ago with pneumonia who is requesting to go to the hospital because he is worried his pneumonia is acting up, not because the staff has thought he should go.
And then there is Hazel. Hazel is a skinny old woman with a wig, who looks like a scrawny bird. She lives alone, and always wears a yellow bathroom that is faded and stained. Her house stinks of cigarette smoke. She has early dementia and calls us several times a week for nonspecific complaints. She’s constipated, she wants her blood pressure checked, and she didn’t sleep a wink all night. Sometimes her neighbor is there when we get there – her neighbor said Hazel once called her twenty-two times in one day. Lately, my approach to Hazel has been, you want to go to the hospital, get your coat, let’s go. I can’t take the smell in her apartment. It’s like she has smoked three packs a day for fifty years and has never once opened a window. When I first started getting called there, I tried to get social services involved believing she needed to be in a nursing home because of her increasing dementia. One day I gave her a HIPPA form. She started reading it, and then got bored and put it down. Then she discovered it again and started reading it again, and then got bored and put it down, only to discover it in her hand, and start reading again. I saw her in the hallway five hours later and she was still reading the HIPPA form like it was a racy novel.
The hospital has stopped working her up, and now she just goes to the waiting room. She isn’t demented enough I guess for a nursing home. Still she keeps calling. My preceptee has been with me to her house three times already. He’s very patient with her. I end up standing outside, breathing the fresh air, while he helps her lock up her house and get her things.
Yesterday was a slow day. We sat around a long time until we finally got a call. It was at an elderly apartment complex that just opened in a renovated building that used to be a nursing home. The call was for a medic alarm. A red light was flashing on the alarm board by the front door. The neighbors, seeing the flashing light, called 911. The night medic had warned me about the new place. The night before he’d talked to a commercial crew who had responded there, and taken the patient in. No one answered the apartment door, but before the policeman tried to kick the door in, I had him call dispatch and check and see if it was the same apartment as the one the crew went to the night before. It was, and dispatch now told us they had transported the resident. It seems no one had reset the button. So we cleared. One call, no patients.
We were so bored by then, I suggested we stop at Hazel’s house, walk in and say, “What’s wrong today? You called for an ambulance?” just to see what she would do. Whether she would be upset that she didn’t remember she had called for an ambulance or whether she would think that she had.
I know that wouldn’t have been very nice, but hey we were just cracking jokes, trying to pass the time. We spent much of the day watching the news coverage of the death of the crocodile hunter. What a bummer that was. At least he died doing something he loved. We joked that we were surprised it wasn’t a crocodile that had gotten him. Instead, it was a sting ray. Maybe it was an out-of-town job, we guessed. The crocks got together and called in a hired tail to do the job. Stingy. Made it look like a freak accident. But it was a hit. The word would get around the outback. Teach anyone else to mess with the crocks.
I know it’s not politically correct to make fun of an old lady with dementia or someone so recently tragically killed. Poor taste. But that’s how it is sometimes, particularly when you are bored. Paramedics with time on their hands.
Nothing for the rest of the day. At least it was a holiday. Double time and a half pay. Still I felt like a bad host. Instead of being out there being big bad paramedics – doing codes and MIs and rollovers and pushing all kinds of drugs, showing my preceptee the street life, we were sitting in the base living room, bored, reading the newspaper over and over, watching the same clips on TV. I was feeling restless. My preceptee sat in the arm chair, mouth open, snoring.
This morning, while we were talking about how today would be the day we’d get the good calls he needs before getting cut loose, the tones on the radio went off.
“Unit One!” the dispatcher called.
“Note the urgent quality to the dispatcher’s voice,” I said to my preceptee. “This is going to be good.”
“Unit One,” I answered.
“Female. Constipation.” He gave the familiar address. My preceptee started laughing.
“Hazel,” he said.
My preceptee does his usual stellar job with Hazel. She is all agitated. “I didn’t sleep a lick last night. I’m constipated. I feel horrible all over. I’m a wreck. I didn’t sleep at all. Close the door, you're letting the cold air in.”
"I need to hold the door open," I say, "Because there is no air in here. I can't breathe."
"Close the door. My, what a draft. I feel terrible. I hardly slept a lick," she says.
"Fine," I say. "I'm waiting outside."
"Don't mind him," my preceptee says, "He has a respiratory problem."
They come out of the house fifteen minutes later. She’s wearing her yellow stained bathrobe and tennis shoes and carrying her little purse, her wig slightly off kilter on her head.
The ED is not too busy today and the triage nurse assigns Hazel a bed in the non-urgent wing.
My preceptee gives the room nurse a report. I hand Hazel her HIPPA form.
Sunday, September 03, 2006
Note to Fellow Bloggers
I have added a blogroll. If you have an EMS related blog and want it to be listed in the column on the bottom right(or delisted if I have already added you), post a comment here listing the http of your blog or send me an email at: peter@petercanning.org
Thanks.
Thanks.
Saturday, September 02, 2006
Waiting
I go back to work tomorrow morning at six. I last worked the Wednesday overnight in the suburbs, which really wasn’t like working because I slept all night in a bed, and only did one call at five-thirty in the morning, and I didn’t even have to tech that one. I was planning to work on Friday and Saturday, but there were no shifts open. Lately all I’ve had to do was call in to get a shift, but I guess they’ve hired more people or maybe it’s the college students wanting to score a last pay-day before hitting the books. At any rate, I found myself with some unplanned free time.
Thursday I sat on the couch all day and watched the entire 12 episodes of The Wire: The Complete Season Three. If you have never watched it, it is the best show on cable TV. I don’t have HBO, but I liked to buy or rent the series when they come out on DVD. The wire is about cops, drug dealers and politicians in Baltimore. Each episode involves a “wire” where the special police unit listens in on the drug dealers. What is great about the series is the quality of writing and acting. Phenomenal dialogue. The stories are very realistic, and the personalities are complex. Lots of shades of gray. The cops and politicians and drug dealers are all very similar in their approaches. One of the main protagonists is a cop, who is all about the case. He’ll disobey superiors to do what is necessary to solve the case. He is “good police” but being “good police” is always getting him in trouble with his superiors. Plus his personal life is screwed up. He’s divorced, he’s broke, he drinks too much.
He gets in an argument with his buddy about how all that matters is getting the case solved, and his buddy asks him what he’s going to do with his life if he ever does get the case solved, if he will feel fulfilled or will he be just as empty the next morning after the night’s celebratory drinking, as he is now, and when will it end. He tells him life is what is happening to him while he's too busy with the case to notice.
There is another character who is a police major who grew up on the streets and decides to try an innovative strategy to solve the horrible crime rate -— he pushes the drug trade in his district into an abandoned section where he tells the dealers he will leave them alone as long as they stay in the special zones. It works great for awhile, the street corners are safe for people to walk on again, crime is way down, they are even sending health people in to do needle exchange, health and intervention programs, but he knows it won’t last, that when it is discovered that he has basically legalized drugs, there will be a shitstorm, and he’ll be on the wrong end of it, and then the streets will go back to what they were and he’ll have lost his command, but he does it anyway. He's glad he's at least doing something.
And there are two drug dealers who have come up together from the streets, and while one is in prison the other sets up these elaborate private and legitimate businesses – basically insulating them from the street, which they still control but are removed from the violence and the reach of police. They have more money than they could ever spend. But when the guy gets out of prison, he can’t deal with the fact that someone else is on his corners or that his rep suffers because the higher interests of business say don’t retaliate to a small slight, keep the streets quiet, the business going, the profits coming in. His friend asks him “Is it about the money or your rep?”
I was doing a lot of thinking that day. Good story-telling will do that to you.
I thought about the great Karl Wallenda, the guy who walked on the high wire. He said he was only alive when he was on the wire, everything else was waiting. He of course plunged to his death when a gust of wind swept him into the void.
Who are we? How do we see ourselves? What matters most about our time on earth? I can toss out the stock answers: family, God for some, the community, peace on earth. I don’t know. Everyone has their own inner fire, their inner drives, their lonesome valleys – their walks to make.
So, Friday I go to the gym. Pump the iron. I’m starting to get back into some shape after slacking off for awhile. I need the gym today. I’m a little out of sorts. My friend who has cancer emailed me that after her treatment her physical exam that day showed no signs of her tumor. There was some transmission problem with the CAT SCAN, so she didn’t have those results, but it all sounded like great news. I emailed back a Whoo-Hoo! but then I was bothered by the Cat Scan line. I had a growing bad feeling and when I called her that night, it was confirmed – there was a lesion in a new area. They have to do more tests, but still, it just sounded like the weight of the world was back on her, the big shadow approaching again. I didn't know what to say to her. I felt helpless.
I did some errands, went out to Best Buy and bought a CD for the first time in a long time. The new Bob Dylan - Modern Times. I listened to it while I drank beer and played on-line poker. When it comes to poker, I’m a grinder not a gambler. I only play limits I can beat. I’m patient; I sit and wait, bet when the odds are in my favor, fold if there is any doubt. I’m a steady winner, but you won’t see me on TV, I’ll have no big cashes. Just slow and steady. I don’t win every session – I am as subject to fate and the standard deviation as the next man, but I’m better than most at the tables I play. I don’t sit down with the sharks. I just wait. Discipline is key. I like to drink beer when I play so there is another battle going on – the battle between the beer and the sense, but lately it doesn’t matter. I can sit down with a cooler full and I don’t loose my control. Fold, fold, over and over, waiting my moment to raise, my moment to go all-in. Every month I tabulate my modest earnings. Not anything to retire on -- no new car this year. Still every little bit helps.
I’m not always like that in real life – not always in control. Maybe that’s why I try so hard to master it at the poker table. They say poker reveals your true character. It may be so, but life is where your character counts.
Dylan’s album is the third in a trilogy. It’s really good. The last album had a song called "Mississippi" about a guy whose ship has been " splint to splinters" that has another great line in it that goes “The only thing I did wrong, I stayed in Mississippi a day too long.” I remember playing it for my friend. It was a good drinking song. It’s the kind of song you sing with a beer in your hand(and empties on the table)-- and you sing it aloud and give a joyous finger to the fates all waiting for you again outside the barroom.
The new album has a song about a guy who says, “They burnt my barn and stole my horse.” But he’s still strong enough to sing about it.
I guess that’s the important thing – to be strong enough to recognize that everything is little shit compared to the important shit and the important shit is the ability to sing your songs -- to try to be good police or a good paramedic – to solve the case, to do what you feel you need to even if its going to come back and burn you, to care in your heart about something -- family, god, the job --whatever, as long as you give a damn.
I slept till I got up this morning. It was a cold day, raining off and on and I used that as an excuse not to mow my overgrown lawn. I worked some on my novel, and then took my girlfriend’s eleven-year-old to a big agricultural fair. It was a long drive to get there most of it on empty wooded country roads. Over an hour trip. For awhile there I thought I was lost, thought I had taken a wrong turn, cursing myself for leaving the directions at home, trying to rely on my memory. But then there ahead was the Ferris wheel.
My young traveling friend wasn’t feeling too well so we just walked around for awhile. It was cold and windy and the rain was threatening again. She wasn’t up to going on any rides and the barker’s come-ons didn’t interest her. She didn't like the smell of the animals in the barns. I bought her some cotton candy and fried dough with powdered sugar on it. We had an artist draw a portrait of her that came out okay. We only stayed an hour. She thanked me when I dropped her off back at home and asked if I was working tomorrow. I said I was. She said okay, and asked if I could take her swimming at the indoor pool the next time I had a day off. I said I would.
Now I’m listening to Dylan again, playing poker -- I'm up $27 -- and hoping to get to bed at a reasonable hour. No beer tonight. I’ve already got my uniform laid out for tomorrow, my backpack in the car.
I’ll punch in about ten minutes before six, although they won’t start paying me until six. I’ll check my gear out, check the rig, and then I’ll wait.
Wait to see what the day, what the job brings, what life has out there waiting me.
Thursday I sat on the couch all day and watched the entire 12 episodes of The Wire: The Complete Season Three. If you have never watched it, it is the best show on cable TV. I don’t have HBO, but I liked to buy or rent the series when they come out on DVD. The wire is about cops, drug dealers and politicians in Baltimore. Each episode involves a “wire” where the special police unit listens in on the drug dealers. What is great about the series is the quality of writing and acting. Phenomenal dialogue. The stories are very realistic, and the personalities are complex. Lots of shades of gray. The cops and politicians and drug dealers are all very similar in their approaches. One of the main protagonists is a cop, who is all about the case. He’ll disobey superiors to do what is necessary to solve the case. He is “good police” but being “good police” is always getting him in trouble with his superiors. Plus his personal life is screwed up. He’s divorced, he’s broke, he drinks too much.
He gets in an argument with his buddy about how all that matters is getting the case solved, and his buddy asks him what he’s going to do with his life if he ever does get the case solved, if he will feel fulfilled or will he be just as empty the next morning after the night’s celebratory drinking, as he is now, and when will it end. He tells him life is what is happening to him while he's too busy with the case to notice.
There is another character who is a police major who grew up on the streets and decides to try an innovative strategy to solve the horrible crime rate -— he pushes the drug trade in his district into an abandoned section where he tells the dealers he will leave them alone as long as they stay in the special zones. It works great for awhile, the street corners are safe for people to walk on again, crime is way down, they are even sending health people in to do needle exchange, health and intervention programs, but he knows it won’t last, that when it is discovered that he has basically legalized drugs, there will be a shitstorm, and he’ll be on the wrong end of it, and then the streets will go back to what they were and he’ll have lost his command, but he does it anyway. He's glad he's at least doing something.
And there are two drug dealers who have come up together from the streets, and while one is in prison the other sets up these elaborate private and legitimate businesses – basically insulating them from the street, which they still control but are removed from the violence and the reach of police. They have more money than they could ever spend. But when the guy gets out of prison, he can’t deal with the fact that someone else is on his corners or that his rep suffers because the higher interests of business say don’t retaliate to a small slight, keep the streets quiet, the business going, the profits coming in. His friend asks him “Is it about the money or your rep?”
I was doing a lot of thinking that day. Good story-telling will do that to you.
I thought about the great Karl Wallenda, the guy who walked on the high wire. He said he was only alive when he was on the wire, everything else was waiting. He of course plunged to his death when a gust of wind swept him into the void.
Who are we? How do we see ourselves? What matters most about our time on earth? I can toss out the stock answers: family, God for some, the community, peace on earth. I don’t know. Everyone has their own inner fire, their inner drives, their lonesome valleys – their walks to make.
So, Friday I go to the gym. Pump the iron. I’m starting to get back into some shape after slacking off for awhile. I need the gym today. I’m a little out of sorts. My friend who has cancer emailed me that after her treatment her physical exam that day showed no signs of her tumor. There was some transmission problem with the CAT SCAN, so she didn’t have those results, but it all sounded like great news. I emailed back a Whoo-Hoo! but then I was bothered by the Cat Scan line. I had a growing bad feeling and when I called her that night, it was confirmed – there was a lesion in a new area. They have to do more tests, but still, it just sounded like the weight of the world was back on her, the big shadow approaching again. I didn't know what to say to her. I felt helpless.
I did some errands, went out to Best Buy and bought a CD for the first time in a long time. The new Bob Dylan - Modern Times. I listened to it while I drank beer and played on-line poker. When it comes to poker, I’m a grinder not a gambler. I only play limits I can beat. I’m patient; I sit and wait, bet when the odds are in my favor, fold if there is any doubt. I’m a steady winner, but you won’t see me on TV, I’ll have no big cashes. Just slow and steady. I don’t win every session – I am as subject to fate and the standard deviation as the next man, but I’m better than most at the tables I play. I don’t sit down with the sharks. I just wait. Discipline is key. I like to drink beer when I play so there is another battle going on – the battle between the beer and the sense, but lately it doesn’t matter. I can sit down with a cooler full and I don’t loose my control. Fold, fold, over and over, waiting my moment to raise, my moment to go all-in. Every month I tabulate my modest earnings. Not anything to retire on -- no new car this year. Still every little bit helps.
I’m not always like that in real life – not always in control. Maybe that’s why I try so hard to master it at the poker table. They say poker reveals your true character. It may be so, but life is where your character counts.
Dylan’s album is the third in a trilogy. It’s really good. The last album had a song called "Mississippi" about a guy whose ship has been " splint to splinters" that has another great line in it that goes “The only thing I did wrong, I stayed in Mississippi a day too long.” I remember playing it for my friend. It was a good drinking song. It’s the kind of song you sing with a beer in your hand(and empties on the table)-- and you sing it aloud and give a joyous finger to the fates all waiting for you again outside the barroom.
The new album has a song about a guy who says, “They burnt my barn and stole my horse.” But he’s still strong enough to sing about it.
I guess that’s the important thing – to be strong enough to recognize that everything is little shit compared to the important shit and the important shit is the ability to sing your songs -- to try to be good police or a good paramedic – to solve the case, to do what you feel you need to even if its going to come back and burn you, to care in your heart about something -- family, god, the job --whatever, as long as you give a damn.
I slept till I got up this morning. It was a cold day, raining off and on and I used that as an excuse not to mow my overgrown lawn. I worked some on my novel, and then took my girlfriend’s eleven-year-old to a big agricultural fair. It was a long drive to get there most of it on empty wooded country roads. Over an hour trip. For awhile there I thought I was lost, thought I had taken a wrong turn, cursing myself for leaving the directions at home, trying to rely on my memory. But then there ahead was the Ferris wheel.
My young traveling friend wasn’t feeling too well so we just walked around for awhile. It was cold and windy and the rain was threatening again. She wasn’t up to going on any rides and the barker’s come-ons didn’t interest her. She didn't like the smell of the animals in the barns. I bought her some cotton candy and fried dough with powdered sugar on it. We had an artist draw a portrait of her that came out okay. We only stayed an hour. She thanked me when I dropped her off back at home and asked if I was working tomorrow. I said I was. She said okay, and asked if I could take her swimming at the indoor pool the next time I had a day off. I said I would.
Now I’m listening to Dylan again, playing poker -- I'm up $27 -- and hoping to get to bed at a reasonable hour. No beer tonight. I’ve already got my uniform laid out for tomorrow, my backpack in the car.
I’ll punch in about ten minutes before six, although they won’t start paying me until six. I’ll check my gear out, check the rig, and then I’ll wait.
Wait to see what the day, what the job brings, what life has out there waiting me.
Friday, September 01, 2006
Blood Sweat and Tea
I've been reading (and enjoying) Blood Sweat and Tea by U.K. blogger Tom Reynolds. The book contains excerpts from his blog Random Acts of Reality. He has been blogging since 2003 about his life and work as an EMT in inner city London. He writes five times a week, and from his posts EMS in London isn't much different than here in the United States.
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