Charmed Life

I am a man of science. Which is to say, I understand and believe in the scientific method. In college, I studied geology, majoring in paleontology, with supporting roles played by math, chemistry, physics- the foundation of a scientific education. I got married in college and dropped out in my 5th year, to put the Ex through school. Someone had to work; someone had to graduate.

I am a sceptic, and I require evidence. Fundamental religious literalism doesn't work for me. Just because it's written down in a several-times translated book? Nope. I have no patience for matters of faith dressed up as science. I accept that the universe is vastly big, and complex, and amazing. It came from somewhere, but I can't assume the arrogance necessary to tell you that I possess that secret.

When I get emails with believe-it-or-not photographs or amazing stories, I do not. I am at snopes.com so fast, checking the data, that the keyboard virtually smokes. But show me a compelling body of supporting evidence, and I can change my mind. However, I feel somewhat conflicted that I, this man of logic, this 21st century Vulcan, has a firm belief in luck. I always have and I've always considered myself lucky. Clearly, Luck exists. In fact, I once guessed exactly which of the pictured Flintstones toys was free inside my box of Fruity Pebbles. The lottery winner, the guy in the horrible rollover accident who walks away, the cop saved from a bullet by a badge. Good luck. Hit by a falling tree while hiking, freak accident, random act of violence? Bad luck.

Lucky guess. Beginner's luck. Lucked out. Luck of the Irish. Lady Luck. Hard luck. Luckless. We are surrounded by luck, like Eskimos with snow, and we have a myriad of ways to describe the phenomenon. Is good luck merely the manifestation of multiple possibilities, some few of which are fantastically favorable? Or are the cards stacked in our favor, by billions of years of stellar, and then millions more of biological evolution? How many stars? How many planets? How precious few with life? What tiny fraction of those host thinking beings, capable of pondering such deep matters? For good or bad, shit happens, and, in the cosmic scheme of things, every last one of us is pretty lucky to be here. It doesn't feel that way when you get a parking ticket, but consider the lifeless, airless ball called Mercury, whizzing so close to our sun that your illegally parked car would melt in a puddle. No luck for you there.

But can you culture luck? Does my heartfelt belief that I am lucky generate more good luck? What about luck charms? What about them? Every culture on Earth claims tokens or symbols that generate luck, for good or ill. Does the mere acceptance of a charm's power to alter my luck actually work? Maybe acknowledging that you have some measure of control over your fate fosters "lucky behaviors". Either way, can you prove or disprove the power of a lucky charm?

We got new bunker gear today. Sexy black stuff, ninja-cool, and state-of-the-art. I moved the miscellaneous tools and gear from old yellow-gold set to the new. In addition to trauma shears, door chocks, my (lucky) leatherman tool, flashlights, pens, hose straps, I have several items that can only be considered talismans. Charms. At some point I imbued them with some lucky quality. I suffer their minuscule weight, flyshit in the pepper given the heavy load I carry upstairs and into a fire, weighing their protective value against the added grams in and on my gear. I have a small spring, pilfered from an engine at the WA State Fire Academy. There is a crenellated binding washer thingy that holds a helmet's face shield in place, normally in conjunction with a locknut. A D-ring from the back of the same helmet. These tiny charms dangle from my bunker pants and tinkle bell-like when I shuffle in my personal protective equipment. They've been with me in every fire, every car wreck, and I'd miss them in their absence. I discovered the inherent power in these trinkets at some point in my fire career, the details of which escape me now, and I still keep my eyes peeled for the watershed event and associated token of my continued good luck. Hanging from my bunker pants I also have gloves and carabiners, but they keep me safe in specific manufacturer-recommended fashion. It's not just my turnouts, either. Around my neck, on a silver chain, swings a Saint Florian medal. I really don't believe in saints, I couldn't care if he is the patron saint of Poland; Linz, Austria; and chimney sweeps. All of which, the industrious Florian is, in addition to his duty watching over firefighters. This medal was given to me by my friend J upon my graduation from Fire Academy, and has dangled beneath my collar ever since (barring the two occasions where he apparently wriggled free while I fidgeted in my sleep). From my rear-view mirror hangs a red rabbit's foot. I know, not so lucky for the rabbit, but sometimes luck, I reckon, requires a sacrifice. I picked it up at Lincoln's 10,000 Silver Dollar Bar, in the deceptively named Haugen City, Montana, on the return from a fateful trip to see my Grandma, during which my truck broke down and I needed to find and buy a newer one. In Hawaii, with the lovely LMB, I spent days agonizing over miniature Tiki idols, in tacky junk shops, reading and re-reading the tags describing each particular voodoo, hefting the resin, looking for obvious defects that betrayed a mass-produced pedigree.

I've never found a four leaf clover, so maybe this is the summer I lie in the grass and pluck at weeds. A four leaf clover looks an awful lot like the Maltese Cross used in the fire service, and adopted from either the Knights of Malta, the firefighters of the Crusades, or St. Florian, depending upon whom you ask. When I find one I'll probably seal it in plastic and attach it to my helmet. Can't hurt.

I try to do lucky things too. Or, at least, avoid implicitly unlucky actions. My department is busy, and gloating over a day with few calls is just asking for a night of ass-kicking. I always announce that the first cup of coffee I drink each morning is the best cup I ever had. It's become a joke, but why tempt fate by changing what works. I used to wear a tiny diamond in my earlobe, removing it for drills or duty when I was a volunteer firefighter. I was actively seeking employment, but also attached to the idea of expressing some aspect of my individuality via my pierced ear. At one point, I removed the stud and promptly misplaced it. For several days I was earring-less and suddenly the phone rang off the hook with requests for interviews, ultimately culminating in an offer from my current department, my first choice all along. You could argue that my hiring experience was the crescendo of much preparation and testing, but I don't wear an earring anymore. I am, after all, a man of science.

Up every morning, before daaaay!

Most of the toes on my right foot went numb during the third or fourth week. I can only attribute this to the pernicious weight of the bunker gear, helmet, and air pack that I wore on my person most days during fire academy. Perhaps I kinked a nerve, hose bundle shouldered, irons in hand, spine bending sideways. Rarely, we'd spend a part of the morning sitting in the classroom, absorbing wisdom and theory, but the bulk of the day was filled with drilling. Every activity we did was bracketed, like bookends, with marching.

Every morning, at 0600, we'd crawl out of our bunks, assemble in the lunch room, grab a drink of water, line up and march to the HazMat building for morning PT. Our morning regimen consisted of stretching and push ups, and then we'd break up into group, with some running down the hill and back, others involved in strength training, with a third group pulling hoses, taking hydrants, and throwing air packs for time. Later, we'd line up in our companies again, standing at attention in front of the flagpole, waiting for our student officer to march us down the road, around the pond, and to the apparatus building where our gear hung on hooks, organized alphabetically.

Honestly, most of the time our marching was pretty lame. The weather when we started the academy was full-on alpine winter, and the ground was often frosted with a rime of compacted snow. If it wasn't snowing, it was usually raining. Mustering energy, at oh-dark-hundred, for a disciplined display of military marching was difficult the gloom. We grumbled under our breath about the time of day, the temperature, the breakfast the that awaited us after PT.

But we sang. Depressed by this lack of enthusiasm, and hoping to drive home some bullet points, I penned a cadence about our study material for the week. Encouraged by the captains chaperoning us, I assumed the task of cadence master and filled a small notebook with simple rhymes. I soon realized that I wielded an awesome power, and my class would willingly sing anything offered to them.

We're the class of Oh Six One

Adapt, improvise, and overcome...

In the dark, on the path to early morning exercise, I'd call out the cadence, my voice cracking in the morning air, vocal cords tight and cold. The response was variously anemic, goofy, or robust. Knowing that the chief was listening was motivating, and our return trip from PT was invariably louder and more energetic than before. Occasionally, other fire departments from across the state would use the facilities for live fire training, and we'd sing the pride in our hearts across the valley to echo off the mountain and burn tower.

Oh Six One, we are the class

Fightin fire kicks yer ass!

My golden achievement as cadence master occurred one sunny warm day, after lunch. Our drilling had run late and we'd opted to forgo changing out of our bunks, in order to secure our slot in the lunchroom. After a frantic meal, we reassembled in our ranks and headed back to the drill tower. We hadn't yet earned the privilege of using The Path, a gravel shortcut between the our quarters and the drill facilities. Honor and tradition demanded that we take the road, a route that increased the distance fourfold. We were late, and I envisioned our instructors tapping their feet, eyes on wristwatches. As we marched, I quietly consulted Joe, an airforce firefighter veteran, our authority on military drill and precision. The command to step up the pace and run was "Double Time!". I issued the command and we began trotting in time to a faster song, our bunker boots slapping the pavement, an authoritative jangle rising from our bunker gear. Our voices rose over the flam pad, above the burn tower, to the top of Mailbox Hill.

We weren't sprinting, but arrived at our assignment in a loud and organized manner. We shaved valuable minutes off of our transit time and we looked good. We looked great. We felt great. We were professionals.

Oh Six One, we take no slack!

Hot or cold, we gotcher back!

Those toes are still a little dead, sensation diminished. When I notice it, I can't help but smile. I learned so much at the Washington State Fire Academy, but I earned my numb toes.

Earn Money Sleeping

During the year I devoted to getting hired by a fire department, I worked for a private ambulance company. I already had my EMT certification through volunteering, and I had the luxury of a temporary post-divorce lifestyle that could sustain a $10.60 hourly wage. When I finally pulled the trigger, and made the trek down to the local American Medical Response headquarters, I was informed, after acing the preemployment test, that there were no spots in the orientation class for several months. There's a high turnover in the private ambulance business, but an equally high interest in the work.

Prior to my brief career as a professional EMT, my patient contacts were limited by the frequency of my volunteer firefighting shifts, and the relative health of the population we served. Every six days, I would tag in and take my place on the engine or aid car, and hope for disaster. Typically, we'd see one sick person per shift, which works out to be about 5 a month. Pretty hard to become the seasoned seen-it-all EMT I hoped to be at that rate. And I'll profess to a small amount of terror every time I'd walk in the door, confronted with a medical emergency. I'm a quick study with the book learnin', but nothing makes you a better EMT like seeing a lot of patients.

Two months after I applied for the ambulance gig, I got the call to come in for an interview. I detailed my experience and career goals, I asked smart questions about benefits and and the interviewers' experiences, and I shook some hands. I tried to play a little hardball and make them want me, but I'm sure they could smell my eagerness in the panelled meeting room.

Almost every month AMR starts a new-hire class that lasts two weeks. There were about 25 people in my group, ranging from 18 years old to Old Man Schlem, at 40. Some of the training was practical, how to drive the ambulances, how to fill out paperwork, how to protect your self from violent patients. Much of the material, however, consisted of CYA page-by-page reading of policy and procedure. One gal (not being sexist), a Russian imigrant (not being racial) did horribly on driving drills. She was clearly intimidated by the big boxy vans, outfitted as ambulances. We discovered that she had gotten her driver's license two weeks prior to being hired, and had never driven before. She didn't even own a car. She didn't last long.

I precepted for three weeks, working with three different crews, on three different shifts. As an EMT, your work week might assume several shapes. You could be assigned days, either four 9 hours shifts, or three 14 hour shifts, or work at night. With enough seniority, you could elect to simply cherrypick available openings, working around the rest of your life. The first week, I worked with a crew that worked 14 hour shifts during the day. The second week, I worked a "fire car" 5 PM until 7 AM. Moving from a normal diurnal schedule to that nocturnal shift for 3 days, and back again to the real world just about killed me. The two guys precepting me were a little crazy, I think, from the normal weekends and inverted weekday shifts they worked. To make matters worse, they doggedly stayed awake all night, listening to country-western music or reading historical fiction.

It's a tired joke to say that EMS stands for "Earn Money Sleeping", one of the reasons many EMTs are attracted to night shifts. I decided this was not going to work for me. I wanted to be able to see my kids on the weekend, and I had my volunteer firefighting shifts to think about. At the end of my precepting weeks, I lucked into a unique five day 9 hour schedule, with five hours of built-in overtime, with the lovely and charming Greta.

All through the orientation and hiring process I was assured that this was a fun occupation, provided you had a good partner. Greta was the perfect partner for me. She wasn't hard boiled or cynical, she was cheery and flexible. She didn't lord her experience or knowledge over me (like a couple of my preceptors had). We had a lot of fun. Barely twenty years old, slight of build, a freckled redhead, Greta put other EMTs to shame. We carried fat people out of their homes, and back up the stairs when we brought them home again from the hospital. She wasn't a big woman, but she was strong. The kind of strength that comes from knowing what you can do, and recognizing what needs to be done. She was funny, and popular with other EMTs. I basked in her glow and I know my reputation at AMR was enhanced by my association with her.

The time we hit the road in the morning coincided with the opening of Harborview psychiatric court. Harborview Medical Center is the level 1 trauma center for Washington, Alaska, Montana, and Idaho (WAMI), and provides every emergency medical service possible, round the clock. In addition to their in-house psychiatric patient care, they have a King County courtroom for the purposes of commitment and related hearings. Our first call of the day was typically at West Seattle Psych, a mental health facility, tucked into a quiet neighborhood in west Seattle.

I met a lot of psych patients during my stint at AMR, some merely troubled, others profoundly disturbed, crazy. We'd get an aide to key our elevator, sending us up to the appropriate floor, the bigger the floor number, the greater the psychiatric needs of the patient. The patients wore slippers or shuffled around in shoes from which the laces had been removed. Before I became acquainted with the facility, often the only way I could differentiate the staff from the guests was by inspecting their footwear. Most of the time, our patient was cooperative, maybe withdrawn from the medications, other times non-communicative or even openly hostile. Greta and I usually alternated patient care, but I always offered to tend to the higher-risk transports.

"I'm not in the mood for any shit this morning," I'd say, relying on my bulk to imply a world of hurt if things didn't go smoothly. The patient's response to this statement usually determined whether or not they'd be restrained on the stretcher. You can always untie someone who is cooperative, but restraining a combative patient, in the back of an ambulance, is a huge pain in the ass. It means pulling over, the driver coming to the aid of the tech, and maybe an assist from a (hopefully) nearby unit, or rarely, the police.

I came to enjoy working with psych patients. Of course, depression, suicide attempts, and self mutilation aren't funny, but the ones that talk will talk about anything. Want to know if they hear voices? Do they feel like hurting themself? Have they ever received psychiatric care before? Ask. They'll tell you. I learned to recognize patterns of behavior that now might make me suspect psych patient, even though we were dispatched for something entirely else. It's a useful skill, and I try to use it when my patients are behaving strangely.


After Greta left me to work in "the cage", the office which disbursed and collected the kits and radios each shift, I worked with John. John looked like a cool dude, trendy eyeglasses, a little high-tech dumpy maybe, but clear-eyed and well groomed. I quickly learned that John obsessed over Ethipian restaurants, of which their are several on Pill Hill, by Harborview. He'd never had Ethopian cuisine before, but it was his goal in life to have lunch at Kokeb or Meskel when I met him. One day we stopped at McDonald's for a quick and cheap lunch. After he went in the store a third time for a third quarter-pounder, I knew he wasn't roly-poly from days spent at a computer. And when I realized that he was, apparently, incapable of eating with his mouth closed, I knew I couldn't work with him. Listening to him smack and salivate almost made me vomit.

One of the greatest perks of the job was our autonomy, the freedom to use our time, waiting for a call, as we pleased. John, however, lived in terror of losing his $10.60 an hour job, and was absolutely against any, even the slightest, breach of rules. No window shopping, no bookstore browsing, no napping in the grass. I had been spoiled by easy-going Greta, and karma had compensated by delivering John. One morning I showed up and my partner was Jessica, John having accepted another shift, with, presumably, someone less inclined to threaten his employment with enjoyment.

This Excellent Adventure

"Be excellent to one another." Bill and Ted said it best. This is the Golden Rule, and every religion on Earth espouses this basic tenet. Robert Fulgham fleshed out this concept in his famous "All I Ever Really Needed to Know I Learned in Kindergarten" essay. It's a non-denominational postulate for the calculus of life. Imagine the heartache avoided by considering your fellow human. There's always somebody downstream, and it scales to every decision one could make.

Here's a few BAD examples seen on the job: Run a red light into another car, angrily kick your pregnant girlfriend in the stomach, drink and drive, neglect to change your smoke alarm's battery. Self interest + disregard = bad stuff.

Savor your awesome existence Everything you see is a miracle. The universe is so impossibly huge and empty, and our world so insignifi- cant in that humongous void - how can you not be awestruck? I don't care how you think we got here, it's still mind-bendingly crazy-weird.

Consider: A 0230 man-down (probably a sleeping drunk) call beneath the glow of the milky way. Babies born in aid cars. The physiology of digestion and metabolism (look it up). Good Samaritans and passersby. Seek the beauty.

Take care of you and yours. Your family, friends and self are all you get in this life. You get one shot. Why would you choose to screw it up? Yet people make bad choices every day about their loved ones or their health.

Eschew: Drug and alcohol abuse. Materialism. Elder neglect. Child abuse. Overeating. Anorexia. Smoking. Hoarding. Gambling. Foster health.

Play nice, love life, take care.

Today's Theme

Today is Diabetic Emergency day. Three calls so far, and each one has required glucometry to assess and treat low blood sugar. I expect a fourth.

It's funny how some days you get calls that are similar. Cosmic coincidence, lining up of the planets, just dumb luck? Still, you have to tackle each call as if it were a genuine emergency. You must presume that the information you have is incomplete and flawed. Even if you've seen the same patient already, a week ago or an hour ago, something may have changed.

One day, on engine 37, we went to several MVC's (motor vehicle collision) involving different young women named Tiffany. Sometimes she was the collider, sometimes the collidee. They were all substantively different calls, but had enough coincidence to warrant mention. I hadn't had a patient named Tiffany before and haven't had one since.

I enjoy the detective work of interviewing patients. Each patient is a nut to crack, with a unique complaint, history, and presentation. Often, they call because they know enough about what's going on to know they need a ride to the hospital. If they have an obvious injury, there's usually an equally obvious course of action. Other times, they think something's wrong and just want an evaluation. We're not doctors (as we're quick to point out), but we need to formulate a plan for this patient, which boils down to either: A) Stay at home, or B) Go to the ER.

So today's diabetic emergency day, and I just remembered that my aid kit is out of glucometry test strips.

For Openers

The business of firefighting is one of specialized knowledge and tools. The fresh recruit's days are filled with protocol, history, terminology, and drilling - daily drilling. Power tools, ladders, SCBA (self contained breathing apparatus), bunker wear, rope skills, on and on and on. Nozzles, hoses, spanners, appliances, pumps, and monitors. You drill to hone skills, forging muscle memory. Fine-tuning technique to save time, your back, and preserve your equipment. For a hundred different tools, there is, for each, a compartment, bracket, or cubbyhole to be memorized.

Woe betide the probie who drops a ladder during a raise, for instance. Even if it doesn't injure someone, it must be pulled out of service, pending an inspection for damage and replacement - time and money wasted. More lasting, though, is damage to the clumsy firefighter's reputation. A good story will be shared during lunch and retold over dinner and then served with morning coffee. It's like a snowball rolling down a cartoon hill. Embellishments flesh out unknown details and invented conflict lends added flavor. Eventually, everyone in the department gets a taste - until someone else screws up.

The reality is that people make mistakes, and things break. It's preferable for that to happen while drilling, when safety can be maximized. It's expected that there will be a material cost to doing business. Everything has a service life, and when it wears out it is replaced. If a tool repeatedly fails, it might not be the right tool for the job. That can apply to probational firefighters, too. So, be careful when you're a probie.

My department consistently damages and replaces one particular piece of equipment. It is arguably the most expensive item we repair or replace, yet, ironically, new firefighters get precious little training on the device. Operation is seemingly simple, consisting of a single button interface. Like good comedy, it is all about timing, and that might just be something you can't teach people.

The garage door opener is an awesome responsibility to wield. When the tones go off, the driver usually opens the door, everyone piles in, and then the pipeman has to close the door behind the vehicle. If it's nighttime, or the station is empty, security is paramount. This can be vital for stations in neighborhoods where the neighbors might rob you blind. Keeping out the weather and animals is important too.

Many of the garage door openers we use are lame. The pipeman has to roll down the window, and thrust a hand holding the remote outside to make them work. In an engine, you can't see rearwards, and the driver has to give you a "clear" signal, lest you bring the door down on the rig. Most, but not all, of our doors finally have a sensor that reverses the door if a beam of light across the opening is broken. Without exception, the remote has a secret sweet spot that you must find to make the operate the door.

I bought and installed a Sears Craftsman garage door opener for my home, and it outperforms just about every unit in the department. I can open/close the door a block away, and my hand stays inside my truck. It boggles my mind that our fire department garage door openers are so primitive.

I busted my station door on a clear July morning during my probation. The tones went off around 0300 for a residential fire in another station's response area. We weren't dispatched, but procedure required us to "move up" for coverage, taking calls in the affected area. Groggily, I climbed in the rig, and grabbed the remote in preparation for closing the door. Rolling down the window, my deep subconscious mind tried to make me aware of something. In a fog, I listened to a distant faint voice in my head mention something about a garage door, as the engine rolled forward.

BOOM... CRUNCH, CRACK

The engine stopped. We climbed out. Looking up, the door had hung on the ladder rack and bowed outward, and popped off the tracks. Ruined. Devastated. Destroyed. The engine appeared fine, though.

Awww, shit. So..." My captain, WJ, looked at me. " ...what happened, Schlem?"

"I dunno..." (Damn it. Damn it. Damn it!) " I guess I hit the button too soon..."

I volunteered to wait for the door company repairman to arrive for the next hour, keeping watch on the open apparatus bay. When he arrived, he told me that he fixed about 10 doors a year for us. He estimated the damage between three and four thousand dollars. Yikes.

We are currently waiting for a double-sized door at a different station to be repaired. And engine rolled into the door while it was closed. The estimate came in over $20,000. The City requires work above ten thousand bucks to go to bid. It's been broken for 6 months, now.

I wrote up an explanation of the events and the usual protocol for closing that particular door. I spelled out what I thought happened and what might have prevented it. I gave my statement to my captain, and he included it in the accident paperwork. There was no disciplinary action taken.

My next shift, I transferred to a different station, as a normal course of probation, and no one there knew I had killed a door. I cleaned the toilets and kept my mouth shut. A few guys from the old station gave me some grief when I saw them, but luckily someone else drove a ladder truck through a door the next week and my mistake was quickly forgotten.

They say it happens to everyone. Hopefully, it will end. There are now optical sensors on the door I busted.

Gag Order

"Engine 42, Aid call, red: 58 year old male, choking, unable to speak." We dropped what we were doing and sprinted to the engine. We arrived on scene in less than a minute.

It's difficult to predict what will make you uncomfortable. Everyone has their own triggers. Hurt or abused kids are an obvious source of discomfort. Thermal injuries (burns), too. I know a guy who hates to see hangings. Suicides, in general don't bother him, not even self-inflicted gunshot wounds, but "swingers" creep him out.

Personally, I almost lost it on that aid call that evening. The patient lived with his family just around the corner from the fire station. We'd never been there before, but the whole family suffered from a hereditary disorder of the nervous system. No one there was younger than 50 and as they aged, the disease slowly robbed them of coordination and dignity. Our patient was progressing in his illness to the point where he had great difficulty swallowing. We were informed that he had been eating a pork chop and a piece was apparently lodged in his airway.

Preparing dinner is a sport in the firehouse. In my department, we take turns cooking, and we have some very accomplished chefs. We buy all our own food, and someone working overtime contributes more to the fund. Several OT's might contribute more than $100. We eat pretty well. Because disaster could strike at any time, we eat pretty fast, too.

He was still breathing, and stood in the center of the room swaying. Long strings of saliva dangled and spun from his lip. He was gagging and heaving with every breath. He considered us through watering eyes. Wretched sounds came from throat. I took a set of vitals: BP, pulse, respirations, level of consciousness, all unremarkable.

There are two primary requirements for our firehouse cooking: Lots and cheap. If it tastes good, that's alright too. But if you make a stinker dinner, you will hear about it forever. I'll briefly mention "hot dog spaghetti", as an example. If I remember, it wasn't cheap either. You know who you are; sorry, pal.

When a person is choking on something, the basic protocol is wait for things to get either better or worse. The patient clears their airway, or they pass out from oxygen deprivation. If they pass out, they're at risk of cardiac failure, and that means CPR. The chest compressions during CPR might dislodge the blockage, and things get better quickly. But if they can still breathe, it becomes a waiting game.

We have one large station that houses 12 firefighters: four crews and our battalion chief. The meals prepared there can be epic. Find a good price on meat at Safeway, for instance, and the combined buying power of the large station can make for an elaborate meal. It also helps to have a lot of manpower in the kitchen when we're drilling and running calls all day.

Three firefighters, captain, driver, pipeman, stood in the room. Our patient continued to sway back and forth. Rain pissed sideways against the windows, but the house was a stronghold of sauna-like heat against the winter murk. Did I mentions the gagging sounds? The copious drool?

My captain, NJ, disappeared into an adjoining room. Our driver turned to look away from the patient. I was alone with a gagging, wretching man and my overstuffed stomach. I tried to forget about all the salad, bread, steak, potatoes, and ice cream that was churning in my gullet. Perspiration beaded on my scalp, running into my eye.
Ever experience a sympathy puke? Like when you see someone hurl and suddenly you join the party? Six times my pharyngoesophageal sphincter, the flapper at the top of my stomach, spasmed. Six times I fought the rising gorge, acid burning my throat, the taste of vomit in my mouth. Torture. I looked for an exit, weighing liability issues of patient abandonment in my head.
With one last agonizing heave my patient hurked up the chunk of pork chop. It landed on the carpet with a wet plop. "Sorry," he said. "Sorry about that."
"Don't be sorry," I said. "I'm glad it's finally out. I'm really glad you're better."

"Anyone in the mood for popcorn?"

Hungry Hungry HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is legislation that protects the privacy of an individual's health information. This law was enacted in the wake of efforts to minimize health care administration costs, primarily through electronic storage and transmission of medical and insurance information.

Specifically protected are individually identifiable health information, from which an individual's identity could be deduced or extrapolated (e.g., name, address, birth date, Social Security Number).

Every doctor, hospital, clinic, dentist office, and, yes, fire department must have a system in place to protect collected health information. Databases must be secure, filing cabinets must be locked. Patient's charts must be reasonably secured from prying eyes. Initially, this complicated operations for everyone, but has been largely accepted, adopted, and adapted to.

Another requirement is that covered entities educate their patients about this law when health care is provided. That means the nurse or EMT will hand you a form with a lot of words to sign. They might even explain it to you. Most people have seen this form, and the explanations have become pretty terse by now.

I bring this subject to light because one of my goals for this blog is the sharing of interesting, humorous, or touching patient contacts. I plan to do this the same way I'd pass information to a doctor in the semi-public, non-private environment of an ER. This is essentially the same as sharing an interesting x-ray on the Internet. There's important information to convey, but the individual's identity remains top secret. It's like a black bar across the eyes in a photograph.

For instance:
26 year old male, abdominal pain, conscious alert breathing normally, vibrator lost in rectum, seeking transport.
(true story)

or perhaps:
84 year old male, priaprism for 5 hrs, took Viagra, history hypertension, hip replacement, former Republican Majority Leader.
(fabricated)

In the first instance, I have provided age, gender, and medical complaint - not enough data to individually identify the poor fellow who accidentally sat on a sex toy. In the second.... whoops, there's a bit of information might lead the curious or knowledgeable to surmise that Bob Dole called 911 and sought medical help for the condition of priaprism (the definition of which I leave as an exercise for the reader).

Yesterday, I tried to recall some of the noteworthy EMS calls I have seen in my short career. I see a lot of patients, but the details evaporate quickly unless there is something significant that stands out in my mind. I would like to remember and share these vignettes, and this blog is my medium. I want to entertain you, and not get sued.


For more information see the following links:

http://www.hhs.gov/ocr/privacysummary.pdf

http://www.hipaadvisory.com/regs/hipaahistorybyzon.htm

"I get to work tomorrow."

I can't say that with a straight face. I always grin when it comes out. Unlike jobs I have had in the past, I genuinely look forward to going to work. I never know what the day will bring, what might happen. I have zero seniority, so I work all over The City, with all the different crews. I'm the one who loads up his truck with all his stuff, and moves on out to fill the hole.

Every station has its own culture and cast of characters. Each serves a specific response area ("still area"), with its own unique vibe. The Ciy boasts stately homes in manicured neighborhoods, and admits to citizens living on the edge of ruin, in ratbag apartments. Suburbs, waterfront, industry, railroads, lakes, rivers, forests. Every assignment has its upside and downside.

Nursing homes call us in the middle of the night to heft patients back into their bed, we get sick (and not so sick) people to the hospital. If you have a fender bender, we'll probably roll up on the scene, with flashing lights and reflective vests, ready to extinguish your car and check you out. The homeless find the last remaining pay phones and invent symptoms when the weather is crappy. And sometimes stuff catches on fire.

Most of what we do is not firefighting. The Fire Department is The City's insurance policy against Bad Stuff. That policy has been expanded to include (a lot of) pre-hospital emergency medical care. Even if you can't pay for a doctor, you can afford the 911 call, and we will come. We'll make sure you get to the emergency room, and let the insurance and hospital sharks sort it out later.

Occasionally, we arrive too late. A person might lay on the bed or floor, cooling, blood pooling in the body's lowest points. CPR won't save this patient. But if there's a ghost of a chance, paramedics will scoop up the patient and scoot to the ED. They'll deliver what medications they can to preserve and improve this patient's grip on life.

But, like I said, sometimes shit burns. If there's been a fire while you were off duty, you know it as soon as you stride into the apparatus bay in the morning. The smell of smoke clings to equipment like frosting on a cake. It's unmistakable, and it jogs a hundred memories of fires, both real and staged for training. Wet hoses dripping in the tower have a different aroma, and I'm comforted to know that The City's investment paid off for someone.

Some guys crave a good fire. A fire means that someone is having a very bad day. I don't wish that on anyone. They're dangerous, messy, and expensive. But if a different shift gets a fire, I feel some envy. I don't want anyone's property to burn, but if it's gonna happen, let it happen on my watch.

Accidents, fires, earthquake, sickness, and death are all possibilities. What will be, will be. Hopefully, we are prepared with training, tools, and intelligence to make things better.

I get to work tomorrow.

Broken Bones

When I attended my Chief's interview, the assistant chief chided me for being slightly reckless. "Stay off the snowboard. When you're on probation, you won't have sick leave and you can't afford to miss any shifts if you get injured." At the time, I lived 25 minutes from a ski area and had just purchased another season pass. I was able to hit the slopes 3 or 4 times a week. His words haunted me and I haven't been snowboarding since that interview.

I continued to mountain bike, however, usually on a singlespeed. I had always been an avid cyclist, and had never experienced any injury worse than road rash. I considered cycling safe and myself a skilled expert.

One fine day, a couple of months after fire academy, I took the hardtail and drove out to one of my favorite trails and climbed 3000'. I was in fine shape from the running and stairs and heavy lifting, and the hills felt great. The weather was perfect and the view from the top was lyrical. I was coming down the hill, dodging and jumping, working very hard. I'll spare you the details, but I wound up falling at slow speed, my closed fist beneath my ribcage.

"OOOOOoooooooooof" The wind went out of me and wouldn't come back. I rolled onto my back, my bike still clipped to my left shoe. Ouch, I thought. Ouch ouch OUCH. I'm hurt, and who's gonna find me? My diaphragm finally worked again, and that first gulp of air hurt in a strange way. "Owww" Every breath hurt. I disentangled myself from my bike and did a quick self-assessment for other injuries: just a scraped knee. I slowly rode down the hill to my truck.

Some Internet diagnosing revealed broken ribs, a costochondral fracture in the junction of my ribs and the cartilaginous costal arch. Also learned was the lack of specific remediation available for busted ribs. True, I hadn't actually fractured a bone, but at least two joints were flopping around when I breathed, it clicked and popped in a most disconcerting way. There was no way to affect or predict when the free end of a rib might grind loose, so no way to avoid it short of breathing. That was not an option.

When you are hired by a fire department, you enter a probation lasting from six to 18 months. It can be a scary, stressful time. You move around a lot, you meet a lot of new people, and if they know anything abou you, it's probably not something you're proud of. When you are a probationary firefighter, your career is literally in the hands of your brothers and sisters. In many departments, you are treated like a slave and the slightest misdeed might jeopardize your continued employment. If there are dishes to wash, or toilets to clean, the probie better do it, and with a song in his heart. If there's a drill, and someone needs to crawl into a muddy, shitty pipe, it's the probie who volunteers. And probies, in my department, don't have sick leave.

The first week of broken ribs is bad. The second week is horrible. It takes at least six weeks for a costochondral fracture to mend. I didn't tell a soul. Every shift, I'd show up early, scrub and polish, wash and wax, endure the minor humiliations, and smile. And I'd pray there'd be no fire that day, because the exertion was torture.

Nothing happened to expose my injury. I chalked it up as a lesson learned and vowed to a bit more careful in my old age. I got back on the bike as soon as I could tolerate the discomfort of heaving respiration.

Less than a month later, I was goofing around post-ride, in a paved parking lot. I was trying to knock some of the mud off the tires and the asphalt was slightly damp, and I went down. Hard.

I only broke one rib that day.

Overtime Half Shift

Today I worked a 10 hour OT shift, providing coverage so that on-duty companies could attend a hose lay drill. I worked on a reserve (extra, spare) fire engine, but we had also had a reserve aid car in service. We covered the north end of The City in the morning and the south end, in the afternoon. Having half of The City's companies out of service would guarantee us a busier-than-average day, but home for dinner.

Half way through the morning, we were dispatched to a bark fire on the side of the freeway. The address was somewhat vague, essentially a long stretch between two exits. En route, we discussed the locations where we thought The State had used beauty bark in its post-improvement landscaping. Before we even got on the freeway, our driver, KT, pointed out smoke on the side of the road, 300 feet north of the on-ramp.

Bark fires are one of my secret pleasures. When summer rolls around, everything dries out and all the beauty bark in The City becomes like so much charcoal, waiting for a spark or cigarette butt to start a surprize barbecue. It might occur next to a bus stop, where a citizen could easily stomp it out, but they always call 911. It might happen down some quiet cul-de-sac, in a yard next to a house, where it could invisibly smoke for hours, growing to many feet across and surprisingly deep. I don't care much to wait around the station for something to happen, and bark fires keep us just a little busier in the summer months. I might get to pull a hoseline, but usually a portable extinguisher or "brush bag" and a shovel suffices. I am confident that I am entirely alone in my enjoyment of bark fires.

We pulled over, parking on the sidewalk, facing traffic. I jumped out, grabbed a (pressurized water) extinguisher, and soaked the smoldering bark behind a chain-link fence, fearing the wind could lift an ember and ignite more bark or (worse) dried vegetation. While I unloaded the PW, KT hooked up a short hoseline and a nozzle to the pump. He pressurized the hoseline, and I churned up the smoking bark, driving the foamy water into the mulch.

Satisfied that we had solved the problem, we started to clean up, but KT noticed a smoking guardrail post, 30 feet above us, on the side of the freeway. Crap. I tried to reach the post with the firestream, but it wasn't hitting the hot side effectively. We extended the hoseline with a section of 2 1/2 (inch diam hose) and addressed the problem of access.

We considered using a ladder to scale the fence, but our ladders were all too long, and getting hurt for such a silly fire would be stupid. KT pulled out the bolt cutters and we soon had a narrow door through the fence.

I followed my captain, PD, who scampered up the slope. Slogging up the hill, over the wet loose bark, dragging a charged hose was difficult. The guardrail post had burned more than half way through, including all of the block that spaced the rail from the post. It would have been easier to wrestle the hose over the rail and hit it from the shoulder of the freeway, but, again, getting hit by a car while extinguishing a burning post would be a very stupid way to die.

We got an axe from the rig and I trimmed the char from the post as well as possible and then soaked the hot surface with a light fog of foam. Done with the post, I worked water into the bark below the shoulder, hoping to drown any embers hiding in the chips. A highway dept. vehicle rolled up and the crew theorized that the smoldering fire had been started by hot asphalt the night before. I came down and hit the dryer areas with the foam, for good measure.

The "fire" out, we cleaned up our tools and hoses, stowing everything in its proper place. After we washed the hoses once again, but better, on the apron at the station, it was time for lunch.

Short Report

Okay, I already did it. I used a term that warrants some explanation. A "Short Report" is a concise summation of a situation, passed to another entity. The term "Short Report" applies to both EMS and fire calls, which I think makes for a great title for my blog. Additionally, dispatch will provide a short report when you go en route to a call, based on the information received by the reporting party. A short report invariably is skewed by the perceptions of the reporter. Sometimes, it just turns out to be bullshit. Again, apropriate to this endeavor.

In the case of an EMS incident, when you "transfer care", you communicate your patient's condition and history, such that the doctor, paramedics, or other EMTs have a clear picture of what's going on.

A fabricated example:
"48 year old male, complaining of lower abdominal pain, right lower quadrant. Pain 9 out of 10, onset 2 hours ago while doing yard work. Patient denies nausea / vomiting. Stool unremarkable. History of bypass 2 years ago, hypertension, gall bladder. Medications: aspirin, Lipitor. No changes during transport."

It will contain significant vital signs (i.e. a high blood pressure), and important third party info ("Sister says the Patient was drinking cough syrup all morning"). You might include procedures performed or medications delivered. Everything you think is important.

There's also a shorthand for writing a report (there's always paperwork):
48 YOM c/o lower abd Px, RLQ. Px 9/10 x 2h. onset yard work. Pt denies N/V. Stool-Ø obv. Hx bypass 2y ago, HTN, gall bladder. Rx ASA, Lipitor. Ø Δ's during Tx.

Another fictional example:
"Engine 21 arrived, two story wood-frame residence. Light smoke showing from second floor window. Neighbor confirms occupants not at home. Initiating "Main Street Command". Pulling a preconnect to the front door."

Short reports are the verbal highlights of vital information, but you always take the time and consideration to detail everything in the written report, which constitutes the legal record of the incident. I'll touch on lawyers later...

Introduction

Hi. Thanks for reading my blog. Before I get down to it, I feel I should clarify my motivations and intentions.

I have an interesting job. I work with, and meet, interesting people every day. I love my work; it can be great fun, but it can also be weird. I hope to relate this to you in a general way, without exposing my patients, brothers, or the city for which I work (henceforth known as "The City"), and its citizens. I typically get along with everyone, and would like it to stay that way. I have no agenda, no beefs, no axes (pick-head) to grind. I just like to write.

The opinions you will read here are mine. I don't claim to represent my union local, my department, nor its administration. I won't promise to stay away from politics, religion, or controversy.

My life outside of work is pretty interesting too. You're gonna hear, generically, about that too.
To whit: I am engaged to LMB, and survived divorce. I have three excellent, amazing, and beautiful kids, #'s 1, 2, and 3. They live in a different state (which is interesting, no?). More to come on that, for sure.

There is a technical jargon to much I do. Some of this if specific to firefighting, EMS, or simply part of the culture in my department. I will endeavor to explain obscure terminology, but hopefully context (or a quick Google search) will enlighten you if I lapse into incomprehensibility.

If you read my words, send me an email. I'd love to hear from you.
Schlem - nullman@earthlink.net