Pearl Jam

I worked another shift at the Local Gigantic Sports Venue this week. This time we were covering a Pearl Jam concert. I was pretty stoked - I've never seen them in concert, and they'd just done a marathon 3 hour set at Bonnaroo that weekend, so I was expecting great things.


What I got was a reminder that I'm old, not very cool, and was never very cool to begin with. Oh, and the knowledge that Eddie Vedder is really short.

We were posted at stage left, right behind the mix. Totally cool. We were surrounded by a weird mix of grown-up grunge kids, hippie kids, and what my friend Laurie used to call the "Thrombus contingent". Picture a drunken frat boy with more muscle than any one person should have and you've got it. Not so cool.

The thing that struck me right off is that I didn't know any of the songs in the first half of the show. None of them. Not one. Okay, maybe one, but I couldn't tell you what it was called, and in fact I didn't even know it was a Pearl Jam song. So the take-home lesson from that is that I stopped listening to Pearl Jam in approximately 1994. In the end they played four songs I knew, and knew well enough to be singing along whilst wrestling a drunken asshole in an attempt to check his blood sugar. I think it bears mentioning that all four songs were from Ten, which was released in 1991. Sigh. Refer to earlier "old" and "uncool" comments.


The best part of working at these shows is that you're close enough to the band to notice things you might not otherwise see. For example, did you know Sam Elliott plays keyboards for Pearl Jam? Well, it's actually a guy named Boom Gaspar (Coolest. Name. Ever.), but he *REALLY* looks like Roadhouse-Era Sam Elliott. Also, Eddie Vedder smoked throughout the entire show, drank what seemed to be an entire 40-ounce beer, and half-finished a bottle of wine which he then tossed (corked) into the crowd. Nice.

I was impressed with the fact that the band did two encores, and that Eddie Vedder was so interactive with the fans. He didn't run into the crowd or anything, but he tossed a lot of stuff (guitar picks, bottle of wine, etc.), and just generally played to all sides, including all the hippies in the behind-the-stage nosebleed section.

I was unimpressed that the Thrombus Contingent felt the need to climb around on the folded-up bleachers (while monumentally drunk), then fight with security when they pointed out what a dork move that was. I was unimpressed that the abovementioned drunken asshole with whom I wrestled got in the way of me being able to enjoy one of the four songs I knew.

I had a good time, got a nice contact buzz, and was happy I didn't pay 100$ for a ticket to the show. I think that (along with a complete ignorance of any music past 1994) might be what makes me old. Oh, that and the fact that I didn't find the bleacher-monkeying funny. God forbid anyone make me work while I'm at a free concert.


Sadly, I never found out what was packed in this box. I'm assuming it wasn't actually full of giant rats, but you never know.

Unfortunately I couldn't get close enough to catch any actual sweat/beer/beersweat spatter.

DNR Followup

Just to recap, earlier this year I had a patient in a lethal heart rhythm who had a DNR. He was completely aware of himself and his surroundings, and verbally reaffirmed what his paperwork said - that he wanted to be allowed to die peacefully. I ran into one of the nurses from that day, and asked her if she remembered him. I was curious to know what became of him. The hospital opted not to honor his DNR, and had begun aggressive treatment by the time I left the ER to go on my next call.

Turns out the ER docs continued to treat him as if he were a full code, until they finally got in touch with his personal physician. His doctor assumed care, and discontinued treatment with the exception of (gasp!) palliative care, as the man had wished (and documented in his DNR/advanced directives). He was admitted to the hospital with a heart rate in the 20s, said goodbye to his family, and died a few hours later.

The nurse told me this story with a tone I can only describe as "pitying". As in "What a shame he died". I wonder what happened to "What a joy he isn't suffering any more"?

I don't really have a clever comment to add. I'm just sad the hospital didn't honor his wishes.

The Thing About DNRs

Saturday, March 29, 2008

DNR means Do Not Resuscitate. It's a term people in healthcare are very familiar with, as are those of us with terminally ill family members or friends.

I had my mind blown (again) a couple of days ago at work when the difference between hospital and prehospital once again became staggeringly obvious.

Imagine you have a patient in a truly terrible heart rhythm that while not immediately fatal, isn't sustainable (those of you who are medical - we're talking third degree block, rate of 20). The patient is alert, oriented, and has a DNR. You explain to him that you aren't supposed to give him drugs or electricity, that your mandate extends simply to palliative care. Imagine that he's at peace with that.

Have I lost you? Here's what the state of South Carolina has to say about it:

"...(EMS personnel) Upon finding an unaltered EMS DNR Form, will withhold or withdraw resuscitative measures such as CPR, endotracheal intubation or other advanced airway management, artificial ventilation, defibrillation, cardiac resuscitation medication and related procedures.

Will provide palliative and supportive treatment such as suctioning the
airway, administration of oxygen, control bleeding, provision of pain and non-cardiac medications, provide comfort care and provide emotional support for the patient and the patient’s family...."

We understand the part about no cardiac meds and no resuscitative measures, right? And yes, that includes transcutaneous pacing. Your treatment is pretty much limited to high flow oxygen, Trendelenburg (lie them flat on their back with their feet propped up - helps bring up a low blood pressure), and fluids.

Now imagine you get to the hospital, and are welcomed with comments like "Well, didn't you give atropine?" and "I don't know why people with DNRs want to come to the hospital, because then we have to treat them." Then the patient is quickly administered the same meds that I withheld (in accordance with DNR laws and his personal wishes) while his pleas that he needs to pee are ignored (another aside for the medical people - no, atropine *still* doesn't work on high degree heart blocks).

This being EMS, I don't know how the story really ends. I do know that his family got there in time to explain his wishes in a louder voice than he was capable of, and I also know that in addition to a DNR he also had a living will/advance directives.

I understand that Do Not Resuscitate does not equal Do Not Treat. It means do what you can, and keep them comfortable until you can get them to a higher standard of care. I don't understand why often ER staff can't take a moment to read some paperwork, listen to their patient (and their patient's medic), and respect someone's wishes. That's why people pay lawyers lots of money to write things like living wills. You don't *have* to treat them. You *should* put yourself in their shoes and ask "Would they really want this?"

Experiences like this make me very nervous, and hopeful that the staff at the hospitals in Ottawa are a little better about reading DNRs than they are here. After all, my mother lives in a nursing home in Ottawa, and she can't speak for herself - her DNR has to speak for her.

All I'm hoping for is a little *thought* from the medical people.

Patients Are Liars

Tuesday, February 20, 2007

Someone on a great and now defunct blog (http://trenchdoc.com/trench/) asked a brilliant question recently. "My question is one no one seems to be asking, how do you prevent 'patients are liars' from becoming a kneejerk bias within healthcare and ensure it doesn't penalize patients inappropriately?"

I don't think you can. The really good medics, doctors and nurses (in emergency medicine) are the ones who realize that everything is bullshit until proven otherwise. The skill is in being able to tell the difference, generally at a glance and within seconds of meeting the patient. The crap doctors, nurses and medics are the ones who think everything really, truly IS bullshit, treat as such, and miss things. Either that or they assume everyone is legit and overtreat everyone (which can be just as dangerous as the first category).

The simple fact is that 85% of emergency patients aren't emergencies, they're just too lazy to go to a family physician, trying to get out of going to jail, or don't feel like going to work/school. Witness the 19 year old female complaining of heartburn, 2 episodes of emesis and swollen feet (for 4 years). She wants to go to the hospital across the street in plain view from her front door. She's willing to get a 500$ ambulance bill and 1000$ ER bill for what could have been a 10$ copay at a doctor's office. She's unemployed (but able bodied) and gets medicaid benefits.

And we wonder why healthcare is collapsing???

Motley Crue

Saturday, February 18, 2006

I think I had the coolest shift at work ever last Sunday. Every now and then we work special events at the local gigantic sports venue. Usually it's boring crap like college basketball or giant religious shows or whatever. This time it was a Motley Crue concert. It was so completely badass. Nikki Sixx was spitting all over the crowd, and when struck by some of the splashback I wasn't sure if I should be thrilled or grossed out. I've settled somewhere in between.

Some jackass decided partway through Livewire to throw a beer bottle onstage, and managed to bean Vince Neil with it. Vince got pissed, pitched his mic into the crowd and stomped off in a huff (wouldn't you?). So jackass gets his ass kicked by the people around him in the crowd, then gets dragged backstage where the band and some cops have a go at him. By the time they get us in there to take a look at him he's cuffed, on the floor, and whining that he just wants to talk to Nikki.

"Why can't Nikki come talk to me? I just want him to tell me he's sorry!"



Sorry that you're a giant dork? Sorry that you're going to jail? So loser goes to jail, the band goes back onstage and a riot is narrowly avoided. Awesome.

I got some killer pics from where I was posted at the front of the stage. This next one is clearly not one of them.






Mick Mars rules, yo.

Christmas craziness... er... Joy?

Thursday, December 22, 2005

So with Christmas being this weekend, it occurs to me that I'm once again about to log more personal time with extremely crazy people in a single day than I normally would all year.
Christmas is a weird day in EMS. We're not as busy with the usual onslaught of "My stomach hurts", "My weave got snatched out", "I think I threw up a little", "Someone rearended me and I want to get PAID". Instead all the psychs come out of the woodwork. I don't so much mind it - in fact I rather enjoy it. Mostly. I like hearing people tell me why Listerine is a better hobby than reading, why Jesus told them to wear twist ties and pop tabs, or why they should spend all their money on PCP and Tab soda.
I once met a fabulous older gentleman who told me all about his personal mission to convert people away from "That bullshit organized religion garbage - you can worship in a dumpster and god wouldn't give a fuck", and his personal relationship with Chuck Norris. Fantastic. Wouldn't you know he whipped out a picture of he & Chuck, both sporting their black belts. Super, super, uber-fantastic.
Where are these people the rest of the year? Christmas has turned into an excuse for people to drive like assholes, treat others like total shite and buy meaningless crap for their friends and family because they feel obligated, not because it has meaning or they really want to. I say long live the crazies. At least they're having fun. Oh, and I really think those that are into that whole organized religion thing should look into my elderly friend's dumpster idea. He might be onto something.

Thwarted Blog Attempts

I've tried and failed about three times in the past to be a blogger. I'm clearly not meant for it, but why let that stop me? In the spirit of try-it-again-ism, I'm going to repost what few blog entries I managed before I gave up and wandered off to do something else.

I don't really have a theme in mind, and there's no specific purpose to this. I have funny (or otherwise) stories from work, and I've recently been accepted to medical school, so that's pretty much what you'll see here.