I'm locked in the second stall from the left. Send help.

We buried my mother in July. Not such an unusual thing, since that's what most North Americans do with dead people, but it was a little odd seeing as how she died in April. The burial required a trip from South Cackalacky to Ottawa, as well as some convincing myself it's okay to look forward to a trip home, even if it's for a burial. If you're still trying to figure out why we waited so long, Ontario is cold as hell in April. Most cemetaries won't bury anyone until the frost melts, and we couldn't schedule it until July. It's definitely weird to have a funeral 3 months after the fact.

My erstwhile friend and work partner Martha (not her real name, although that's what I called her for the entire shift the first time I worked with her) came with me. She'd never been to Canada, and I had built it up to epic proportions in the 4 or 5 years that we've been friends.

The trip started poorly with us missing our flight out of Charlotte. I can't say JetBlue is entirely to blame, but they should shoulder at least 75% of it. We tried to check in 30 minutes before our flight, which has always been what I've done for domestic flights (we didn't fly directly to Canada, as that costs almost as much as my first semester of med school). I guess I forgot what a complete cluster Charlotte-Douglas airport is, because the guy at the check in counter all but laughed out loud at us when he told us there was no way we'd make the flight.

"It's boarding right now. You'll never make it."

"But the gate is right on the other side of security!"

"Have you seen the line at security?"

Riiiight. Charlotte has a lineup to clear security that normally stretches the entire length of the terminal. That day was no exception, and for once they had security checkpoints at both ends of the terminal open. I asked him if there was no possible way that we could get on the flight. No. I even busted out the whole "I don't want to miss my mother's funeral" deal. No. I'm just beginning to think this guy must not have had a mother when he narrowly redeemed himself by finding us seats on a later flight that would still get us there that same day.

Insert an entire day of crap flights, long layovers, and horrible disappointment. We finally got to Syracuse at about 1am, WAY too late to drive to Ottawa (not to mention the car rental counter closed at 11). We ended up staying at a hotel on the airport grounds that was shockingly not terrible. The next morning we were up early, picked up our Crapmobile rental at the terminal, and headed out. On the drive we slowly came to realize that our twelve dollar a day Crapmobile rental had a terrible dead body stench coming from the trunk. It was bad enough to pull over and check out the spare tire compartment. It was also bad enough to contemplate going back and asking for another car. There was no dead body and we were already down a full day due to travel bullshit, so we decided to get stinky food to combat the stench instead. Martha tried spilling half a Dunkin Donuts latte on her seat and herself, but it didn't help the smell so much as hurt her credibility as a contributing member of society.

When the day of the burial showed up, I stuck with tradition and opted not to wear the skirt I brought. I think my mother would have been proud (or at the very least not surprised). We got her into the ground with a minimum of freakouts, and proceeded to have lunch at an atrocious and stupidly expensive "Irish Pub". It was about as Irish as Swiss Chalet. She would have been horrified, and probably wouldn't have ordered anything. I considered a similar protest, but was overwhelmed by the availability of poutine. My personal mission to eat as much of it as possible while in Ontario won that battle.

The rest of the trip rocked. We spent time with my friends Cubicle Warrior and his wife The Amazing M, had dinner with my high school buddy No-Man, spent money at amazing Canadian stores (Roots, MEC), and packed so much food to bring back that Martha ended up buying another suitcase. We also got a fantastic tour of the Ontario Newborn Screening Program lab at CHEO (Children's Hospital of Eastern Ontario) thanks to my university buddy Tall Rye. We also went to Tim Horton's a rediculous amount of times.

I suppose I should have known that such a great trip would have to end badly. Once again the airlines got us. We were almost to the Canada/US border when JetBlue called to tell us our flight was cancelled because of bad weather in Utah. No, not really, but it may as well have been. Apparently there was a tropical storm somewhere completely random (and nowhere near our flight), which resulted in JetBlue completely freaking out and canceling everything. We avoided tears, screaming, and freakouts of our own by stopping at the T.J. Maxx in Watertown and buying completely terrible sunglasses. And by terrible, I mean AWESOME. We stayed at our airport hotel again, and got up stupidly early the next day for our new flight.

The flight from Syracuse to JFK was uneventful. Short flight, cold drinks, no whining babies (or adults), and seat-back TVs on which I caught up on old Episodes of Rob & Big. I finally got to see the horse show episode. Fantastic.

JFK sucked. Bad. We sat there forever, then got on the plane and sat some more. I even managed to run an ems call and piss off a nurse, which I try to confine to doing on days I'm actually working. Made an exception this time. The flight attendant got on the PA and asked if there were any doctors or nurses on the plane for a little girl with chest pain. Nobody got up (and I was bored), so I went up and told him I was a paramedic. I sat and talked with the little girl for a while, and determined that she was bored, hot, and a big fan of panic attacks. I got her some free headphones and we watched SpongeBob for a while. About 10 minutes into it, some random woman came up and suddenly wanted to help.

"What's wrong with her?"

"I'm sorry, you are???"

"I'm a nurse."

"I'm a paramedic. She's fine, and I've got this. Thanks."

"Is she having chest pain?"

"She was, and now she's not. I've got this."

"Well, is it cardiac?"

"I don't happen to have my 25,000$ cardiac monitor with me just now, but seeing as how she's got a history of panic problems and this was resolved with talking and SpongeBob, I'd say likely not. I've got this. Thanks."

The flight attendant could barely contain himself, and the older guy next to the little girl didn't bother to, and giggled throughout the conversation. Nice. I love how suddenly she wanted to help once someone else stepped up. Note to everyone: Appearances are deceiving. Yes, I had on a punk t-shirt, studded belt and shoes with skulls on them. I've also been a medic for 8 years and now I'm a med student. I swear I'll stop dressing like that once I'm a doctor. Maybe.

We finally got off the ground, and eventually made it to Charlotte. We retrieved the Fish Car and hoofed it back to Columbia.

I love going home, but just once I'd love to take a trip that an airline didn't totally screw up. I'm really starting to think that it's impossible. It's worth it for a chance to go home, though.

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.