Paramedichron #8

P.M.T. Washout

PMT is the TLA (three letter acronym) for Paramedic Training at HMC)
(Sung to the tune of "Beauty School Dropout" from the musical Grease)

If you forgot the tune

Your story hard to hear,
We still can smell your fear.
Don't know how to feel since they took away your smock!
Your future's so unclear now,
What's left of your career now?
Can't even make a payment on your truck!

MAs and Nurses: (La lalala lalala lalala...)

P.M.T. Washout,
No intubation count for you.
P.M.T. Washout,
Killed the manikin with your tube!
Well at least you could have taken time, to disinfect your hands,
After having your department spend more than a hundred grand!

Brother start packing (brother start packing)
Why are you sitting on you ass?
You took a whacking (you took a whacking)
You know you're not the first half-fast!

If you drove on out to Central, you could spend your own money.
Hand in your name tag and your iPad, E M T

P.M.T. Washout (P.M.T. Washout)
Hanging around the classroom door.
P.M.T. Washout (P.M.T. Washout)
You don't have the code any more!

Well they handed you an eighteen gauge,
Didn't know when to stop trying,
And your patients couldn't answer you - when they were busy dying!

Just say "Whatever" (Whatever)
You are probably better off
Never say "Never" (say Never)
That scratchy Nomex, you can doff.

Now your feet are sore, there's the door, and engines four or three...
Hand in your name tag and your iPad, E M T

Buddy, don't blow it,
You've got nobody else to blame.
Buddy, you know it,
Even Dan Savage 'd say the same!

But I kid you not, you had your shot, how bout a cup of Joe?
Gonna be snoozin', in some station, where it's slow!

P.M.T. Washout (P.M.T. Washout)

Still an E M T
P.M.T. Washout (P.M.T. Washout)   (fading...)
Still an E M T

P.M.T. Washout (P.M.T. Washout)

Still an E M T
P.M.T. Washout (P.M.T. Washout)
Still an E M T

Paramedichron #7

Bleary eyed and a little nervous, we arrived early and milled around outside the Paramedic Training classroom. We were uniformly dolled up in our freshly-pressed blues and the trademark white labcoat officially known as a smock. Even though we had spent the last two months studying Anatomy and Physiology together, meeting nine Tuesdays in this very classroom, donning the schmock changes everything. This endeavor has suddenly become very real, and the next ten months are invisible in a fog of ignorance, like an unknown wilderness.

Our morning was filled with portentous introductions and tradition dimly recognized. We eighteen have tromped in polished duty boots into a hallowed institution, with a history and culture we may not fully understand. There are labyrinthine rules for situations unimagined and undesired. We were told, in no uncertain terms, to not fuck up so as to damage the Medic One organization, nor to have "relations" with the nursing staff, but I repeat myself. Our immunization records were examined and a TB titer test bubbled under our epidermis with a hair-thin needle by a cheerful Harborview nurse.

After a brief lunch, we were inducted into the realm of high-performance CPR and required to perform two minutes of flawless compressions. For some, this took a single effort, but there is always room for improvement and the profficient were told they could improve. Soon we were all dripping sweat inside our schmocks, and the stink of fear and damp synthetic fabrics funked the room. It didn't take too long to get everyone through their requisite flawless demonstration, and we were rewarded with (we were told) a rare attaboy.

The remainder of our inaugural day consisted of a primer on the iPad tablet, which forms a cornerstone to our curriculum. Some setup, some basic hands-on, and the clever little widget is ours to command. It has its limitations, and compared to my Linux netbook, it is a pretty toy, lacking in horsepower and memory. At twice the price. But in deference to Steve Jobs, (who passed away today), I tip my hat to the genius of the robust hardware, the simple interface, and the ruthless marketing that has made an over-priced hardware monopoly into a hipster fashion trend. In concession to the device, I am composing this Short Report on the cursed gadget with insignificant difficulty and complaint.

The apartment (a modest flat we call the Valle de Cula) is only a block away, and it is a luxury to have a bed, bath, and kitchen so close to where we will spend the better part of the next ten months. Two classmates share the space with the Driver and me: A young man from Port Ludlow, and another from Port Townsend. We walk together after class, each quietly processing the events and information from our confusing and overwhelming day.

A couple beers, a call to the wife, and it's about time to hit the rack. Friday night I will be on the medic unit (doing I don't know what) until 0730 Saturday morning and all day Sunday. I have nothing to read, and the more rest I can bank, the easier the long shifts will be.

I have worked for this for years, and it is amazing to finally be here.

Paramedichron #6

I don't know what civilisation consists of, but I know it when I see it.  - Sir Kenneth Clark

In the fifteenth century, in Florence, Italy, a prosperous family took to investing heavily in the arts.  The House of Medici not only acquired masterpieces with their vast wealth, they also patronized artists whose names you now know as the Ninja Turtles: Raphael, Donatello, Michelangelo, Leonardo.  Galileo Galilei was also on the payroll as a tutor to the Medici kids, until the Inquisition made it unfashionable to contradict Catholic orthodoxy.  Even so, the Medici family loyally protected him for years after.

Among the beautiful architecture funded by the Medici family is the Uffizi, a palace originally meant to house the offices of Florence (Uffizi = Offices).  It now enshrines the Uffizi Gallery, one of the oldest and most famous art museums of the Western World.

How I found myself in Florence is a tale of luck and warped priorities, best left for another time.  Suffice it to say, that, after several amazing weeks, divided between Provence and Tuscany, in my last 36 hours, I could not marshal the energy to ride a train 175 miles roundtrip to see the marvels of Roma. I had arrived in Florence (concerned primarily with my departure from the local airport), checked into the Hotel Arno Bellariv, drained the mini-bar, perused a local attractions leaflet and was seized with the possibility of visiting some big-damn-deal museum in the last hours of a Saturday night. The next day I would fly away.

Imagine a warm and muggy August night, in the ancient and hallowed hometown of the Renaissance.   Imagine also that the sky is pregnant with the promise of precipitation, and the flagstones are still damp in places from earlier showers.  You best enter the Uffizi from the river side, via the arches beside the road fronting the Arno River, the Lugnarno Diaz.  A long narrow courtyard, flanked by arched alcoves housing marble and bronze masterworks of sculpture, funnels you to the entrance.  In the high season, the Uffizi is typically a several-hour wait for the unprepared and unconnected tourist.  At five in the afternoon, so close to closing time, the line was a mere thirty minutes.  I gawked, agape, at the public art of the courtyard, some ancient, others modern, a perfect appetizer for the indulgence ahead.  A soul-stirring violin quavered from some shadowed and echoing hiding spot.  Several times, I felt my breath catch in my throat in stifled sobs of ecstatic joy.

I paid a discounted fee for my late and necessarily abbreviated visit, and when I finally stepped through the doors, I had just barely more than an hour until the museum closed.  I adopted a strategy of trotting between galleries and scanning the walls for any famous paintings or sculptures to which I had been exposed in my sheltered middle-class suburban upbringing.  Either my education was better than I give it credit, or the Uffizi just has so many important works of art, but I found something I knew in practically every nook of that beautiful museum.  Even the ceiling is papered with amazing renaissance artworks.  I’d try to lay my eyes on everything in an area and then I would have to move on. 

It was heart-breaking and exhilarating and frustrating and mind boggling.  With so much history, and so many important artworks in that museum, I still feel like I disrespected the original Medici bequest and short-changed myself in the process – insult heaped upon injury.  Ask me now what I saw and learned on that brief, magical evening in Firenze and all I can do is point to the familiar images in the souvenir guidebook I hastily grabbed in the gift shop.  But I try not to forget. 

And THAT is exactly what it’s like to take Anatomy and Physiology in eight weeks.

Paramedichron #5

We're coming into the fifth week of the summer Anatomy and Physiology class, and the subject is the integration of somatic and autonomous neural activity in the nervous system. 

I know.

In simple terms, what you want to do (or don't consciously know that your body wants to do) travels down the spinal cord from the brain or associated structure (descending neural fibers), and information from receptors travel up the spinal column, to the brain stem or your consciousness (ascending neural fibers).  Sometimes, in the case of  a stimulus interpreted as threatening to life or limb (such as grabbing the hot handle of a pot of bubbling spaghetti sauce), before you are even aware that you did something superlatively silly, an interneuron in your spinal cord fires a quick signal to a muscle to contract and, hopefully, pulls your hand to safety.  Then your conscious awareness gets the signal, and you spout some profanity and/or obscenity, while you run your arm under cold water. 

It's truly amazing, but if you've ever done it, odds are split that you might inadvertently slop some boiling tomato concoction on your tender forearm. Which isn't all bad, in that other mechanisms in your central nervous system etch that experience in the neurochemistry of your brain, and maybe next time you'll use a hotpad.  

Paramedichron #4

Any sufficiently advanced technology is indistinguishable from magic.
- Arthur C. Clarke, "Profiles of The Future", 1961 (Clarke's third law)

I feel like I am attending Hogwarts School of Witchcraft and Wizardry, the boarding school attended by Harry Potter and his friends.  Or, more accurately, I am satisfying the prerequisites necessary just to pass through the huge carved wooden doors.  Either way, the concepts and mechanisms revealed in this abbreviated summer course of Anatomy and Physiology are fantastical and amazing.

Every week, we have a reading assignment and a quiz.  The readings started with a linear march through sequential chapters, but by week three, we are hopping around the thick book, at the fiat of our instructors.  The book is heavily cross-referenced, which serves to make the daunting information slightly less unintelligible.  Getting this information to stick in the network of synapses and neurons between my ears demands a full scale assault on the facts and concepts, with hand drawn diagrams, copious highlighting, and repeated visits to an equally fact-dense website.

We eighteen "anointed" (in the wry words of the venerable Dr. C.) come from a variety of Washington state agencies, with a few lucky extra-state candidates who tested into the South King County Medic One program.   Most us are also on duty in our departments while taking this "online" course.  In round numbers, in addition to the standard forty-hour work schedule, our studies require another forty.  This has caused no small amount of strife between unions, administrations, and Dumbledore.  There is a weekly study session, described by the Paramedic program as optional, consisting of test review and lecture.  That no one voluntarily misses this opportunity for face-to-face contact and clarification from the instructors speaks to the notion of option. 

The Driver, in addition to studying and working, spent the first two weeks in the throes of moving.  He rented out his house for the next year or more, to live in the apartment provided by our Department.  I plan to bivouac in the flat as necessary, making strategic raids on the house in Ballard for domestic and marital reinforcement.  Two other paramedic students will co-habitate with us.

The assignment for week three included obtuse chapters on muscular physiology and the endocrine system. After investing two days in sarcomeres, I found the endocrine material particularly baffling. I was not alone.  During this difficult academic week, the Driver informed me that he had been squandering his days off solving a septic drain field problem at his rental.  In typical fashion, he shrugged it off with a resigned and ambivalent, "Whatever." 

I characterize the endocrine system as similar to the nervous system, but with carrier pigeons, spam email, propaganda, and pixie dust. Run by Kim Jong Il and host of crazy minions.  Of course, I attended the classroom session, but I needed to revisit the taped lecture more than once, annotating my notes in different colors each time.  I took the test Friday, confident that I had most of the arcana and minutia under, at least temporary, control.  Twenty-three questions, and almost nothing on the bulk of my concentrated efforts. 

We are entering a cave, perhaps a long and winding tunnel.  We eighteen are only a few steps into the cavern, and the air is warm, the floor and walls dry.  Ahead, in the murk, I hear dripping water, sloshing sounds, and the occasional scream echoing off the rough stone.  For the next year, it is going to consume our every waking hour, just to get to the end of the tunnel.  Behind me, I can hear birdsong.  The heady fragrances of blossoms and mown grass still swirl in the air, and the bright summer sunlight filters into the gloom.  The backwards pull of security and ease is still palpable.

I have worked towards this once-in-a-lifetime opportunity for years.  I expect to see, learn, and do amazing things.  I have heard tales of suffering and humiliation.  I am excited, but I worry about the unknown.  I have seventeen comrades in this adventure, and A & P is only the first challenge.

Paramedichron #3

Consider the noble astronaut.

In the NASA space program, astronauts are selected from the ranks of extremely capable, intelligent, and disciplined professionals. In the early days of space pioneering, the hiring pool was primarily military, primarily pilots, primarily the best of the best. John Glenn, for instance, a decorated Marine pilot, was the first American to orbit the Earth, and returned to space at age 77 on the space shuttle, Discovery. In between his bookend space voyages, he managed to fill his time as an Ohio senator from 1974 - 1999. Neil Armstrong, the first human to walk on the Moon, was a test pilot, who flew the X-15 rocket plane to the very edge of the atmosphere, at an amazing Mach 5.74 (3,989 MPH). The X-15 proved to be a farm league for aspiring spacefarers. These men were undeniably the best of the best. Of. The. Best.

Today, in an age of almost-routine space flights, and after thirty years of shuttle missions, the pedigree of astronauts has blossomed to include geologists, climatologists, meteorologists (pick your favorite Ologist), teachers, researchers, and, as mentioned, a retired astronaut-senator. The shift from get-it-done, proof-of-concept space flight to nuts-and-bolts space science demanded a wide variety of educational credentials, in addition to the ability to function in a dangerous environment, under stressful conditions, and the ability to improvise and make critical decisions. Make no mistake - contemporary astronauts are still highly-trained primates in a rocket, but now they need to do more than just push the right button, at the right time, and not freak out. They have extra-primate gifts, talents, and training that benefit the goals of NASA, and, ultimately, all of the other primates down here on this globe, plus the other animals and plants that share this cosmic oasis.

While there is considerable status in being an astronaut, everyone understands that the mission is the priority.  Decisions about safety, weather, or equipment trump the personal aspirations of individuals in the program, and it's expected that if something goes awry, the launch may be delayed or scrubbed.  For someone who has devoted a considerable amount of their life to the barest chance of space travel, I can only imagine that such an occurrence is a crushing disappointment.  But the mission dwarfs the tiny (yet highly-qualified) monkeys that strap themselves into the seats of an immense and exquisitely exotic vehicle that roars skyward on a plume of fire, only to glide home when the work is done. 

The Driver and I have heard that there is a storm coming. There is no doubt that it will pass very close to the our launch pad, but we continue preparing ourselves, hoping that our launch will not be aborted.  We chat about the consequences of a delay in our launch window, hopeful that this is wasted conversation.  The storm will certainly impact our command base, but it is unknown whether the mission will continue, or if it will necessarily be affected.  We do not know.

We're buckled in, ready, skeptical, hopeful.  The countdown continues.

Paramedichron #2

If your talk to a dietitian for any length of time about the American Diet, eventually the subject of nutrient density will come up.  The idea is that certain foods are nutrient-poor and that certain other foods are packed with vitamins and minerals.  Your goal, as a health-conscious American human, should be to maximize the nutrition of the foods you eat.  Sounds obvious.

Unfortunately, many of the toothsome items that we expect to be part of our day-to-day diet are packed with nothing but calories.  Evidently, you can apply the "yummy test" to any foodstuff, and if you really, really like it, it should probably be hidden on the top shelf, out of reach, out of view, or - better yet - left on the shelf at the grocery store.

Take, for instance, a cookie...  A delightful little nugget, consisting of sugar, simple carbohydrates, and fat, it offers little in the way of nutrition - even if packed with oatmeal, raisins, and nuts. It's a calorie bomb, specifically designed to tickle discreet receptors in our mouth and brain that respond to easy energy, a remnant of our hunter-gatherer origins. 

Once upon a time, buying groceries was extremely hard work.  Someone, probably the womenfolk, would have to traipse across the savanna, poking at the landscape, scratching in the soil, rattling the bushes, to fill the larder.  The menfolk, meanwhile, took part in ritual hunts that occasionally resulted in meat over a fire, but provided ample grist for tales of the One-That-Got-Away. 

Survival was hard, but evolution was kind, in time, to the early peoples who developed a taste for the sparse sugar or fat-laden "cookies" of the day.  Perhaps fruits, avocados, or rich fatty meats constituted the fortuitous treats to be had.  Regardless, our bodies evolved a mechanism that rewards calorie-dense consumption with a tiny chemical neurologic prize. Eat something sweet or rich, and you feel inexplicably good, even happy

I bring all this dubious anthropology up because I am suddenly immersed in studying Anatomy and Physiology.  The foundation of pending weeks of scholarship will be my understanding of basic biochemistry and microbiology.  I studied geology and chemistry in college, but I only have a sixth-grade biology education, which I dredge up from decades-old synaptic memories.  I am amazed that I remember anything, and, more amazing, is that what I remember is still relevant. 

The text I am reading, highlighting, and transcribing as notes, is nutrient-dense.  The information packed in its pages is the culmination of hundreds of years of scientific inquiry, and absolutely up-to-date. It is broccoli printed, bound, and delivered to my hands, and ultimately my brain. There is so much information on any given page that I frequently read it several times, before selecting the key facts that I will endeavor to commit to memory. I duplicate important diagrams and images, in the hope that recreating it will burn it into the fabric of my cerebellum. 

I am chewing, chewing, chewing, digesting the information with my note-taking hand, but the information is so mind-boggling, so arresting in its awesomeness, that I can't help but feel a tiny little tickle in my cortex, an electrochemical reward for understanding even a thin slice of our biological mechanics.  If I were a religious person, I would classify the feeling I get as reverent. As it is, the more I understand about the minutia of cellular biochemistry, the more dumbfounded I am. 

Life is amazing; learning is hard.

Paramedichron: #1

The Anatomy and Physiology course starts on July 26th. We have text books in hand, if not an actual syllabus.  We have met with the Honorable Doc, and he has drawn his private conclusions from the meeting - filed away, no doubt, only to be produced during our Most Heinous Moments Ever.  We know (approximately) Where to be, When to be there, and little more.  At least for Day One.

During the course of the pre-amble to this adventure, The Driver and I have been told many things, most of which have evaporated in a swirling cloud of vapor when exposed to department chiefs, critical examination, or the light of day.  As we approach the zero-hour of immersion in the first chapter of this endeavor, the tales that we have heard have crystallized into wishful thinking, best intentions, and tooth fairies.  These misunderstandings fall at our feet, singing like tiny shards of broken pane. 

The Driver and I discuss such matters; we share a jaundiced disappointment in the Bureaucracy, and a small disgust at the petty skirmishes that stand between us and our year of scholarship.  We look at each other, exchange silent nods, and turn our tired bodies back-to-back.

Our swords may be corroded, long un-used, dragging in their sheathes, but we simultaneously draw them forth.  Even so, they flash wickedly in the glare of this mid-July afternoon, his low, mine high.  At some unspoken cue, they align, extended and opposite to one another.  A biting reckoning awaits. 

We are ready.  We are in hostile territory. We are EFD.