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Part-Time

For over twenty-five years I was a full time street medic.  I have been part-time now for only a few months.  I have tried to work at least 20 hours a week, but there have been a couple of weeks when I have only worked once, and one week where I did not work at all.

 

I sit at my desk at the hospital and watch the crews come in and listen to their stories, and i feel like a desk-jockey fan boy wishing i was still out there.  Tell me again about that call…

 

When I was full time I always worked at least three twelve hour shifts in a row so my weeks balanced between being a paramedic and then living a regular life.

 

Now that the regular life is a much larger portion of my time, I am finding two things.  I don't look forward to going to work as much as i did and when I do, I am nervous.

 

This isn't to say that I still don't enjoy the work, and don't for most part, still feel comfortable in the position.  It is just that I feel unbalanced.

 

Not having to get up at 4;30 in the morning is great.  Being always free to take my daughter to her sports practices and games is very special.  Getting more time to exercise is life-saving.

 

But when I am back on the street, I feel like a second string guard being put in to play for a few minutes while the starters get a rest, then I am back on the bench, never having really gotten into the flow.  Maybe I scored a bucket or two or had an assist, but I am not the starter.  I think back to when ten years ago, I worked six days a week, and working as a paramedic was as smooth for me as breathing. It was my world.

 

Now sometimes after a long busy shift, I start to feel back in the groove but then I am punching out, and several days later when I punch back in, I feel like a newbie again.

  

I do good calls and I want to work more.  Schedulers who are always trying to grab people for extra shifts (The COVID slowdown has ended) would do well to post themselves in hospital EMS rooms after big trauma calls or STEMIs.  You want to work an extra shift?  Hell yeah!  Sign me up!

 

Sometimes, even after the end of the busy shift when I have done calls that I felt mattered, I will take a look at the open shifts.  I'm a paramedic.  This is where I belong.  This is what I do.

 

I look at my schedule now and say, yes, I'll take that, no, wait a minute, I have a meeting at the hospital that day or yes, I can, no, wait, my daughter has basketball practice, sorry, not available.

 

I do feel more rounded in my life and healthier, but I don't think I'll ever be fully comfortable as a part-time medic.

 

The firefighters are always asking when am I going to retire.  I tell them I will when my daughter graduates college.  Looking at 2030,  I'll be 71.  I hope I can make it that long.  Not sure I'll be able to.

 

I worry that as hard as going part-time has been, retiring completely will likely be even worse.  I'll sit in my rocking chair and when I hear the sirens in the distance, I will have to turn my hearing aide down to keep the pangs of loss from being too great.  If I am ever in a nursing home (please put a bullet in my head), how will I feel watching the crews wheel past my open door?  Will I wheel myself out into the hall and race after them?  Or will I take a pillow and try to suffocate myself to spare myself any further torture of the sad knowledge that life that has passed me by?  When the paramedics come through the door for me, I hope I am long gone.

 

Followers of the legendary guitarist Jimi Hendrix and Duane Allman leave joints and guitar picks on their graves.  Anyone looking to track my final resting place down, please don't put a toy ambulance on my site.  The joint will probably be okay, because I imagine that later in life after my children have grown and moved away, I will have a medical marijuana card by then to ease my  chronic pain and depression.  Wait!  Actually I do not wish to be buried in the cold cold ground.  Cremate me instead.  Spread my ashes in the places I have loved.  Fenway Park, the Atlantic Ocean, and yes, the city streets of Hartford.

Forced Sedation

Interesting article on NBC news about the use of ketamine for sedating patients in police custody. 

 

Elijah McClain was injected with ketamine while handcuffed.  Some medical experts worry about its use during police calls.

 

The reporter centers the story around the tragic case of Elijah McClain, who was apparently walking down the street, wearing a face mask and listening to headphones when a 911 caller said he was acting strangely.  The police stopped him and ended up taking him down with a chokehold.  He said he couldn't breathe and he vomited.  EMS came.  The officers told them he was on something and was exhibiting inhuman strength.  The medics gave Elijah a large dose of ketamine, and shortly after he was in cardiac arrest.  He was resuscitated, but suffered a brain injury and was unplugged.

 

In light of today's awareness of cases of brutality, this case has aroused considerable attention and controversy.

 

The article seems to take the positions that 1) people should not be injected with a sedative during a police action and 2)  they should not be injected against their will.

 

The reporter talks to two college neuroscientists, a pharmacy professor and two lawyers including  someone from the American Civil Liberties Union.  He doesn't talk to an emergency physician or a paramedic.  An ED doctor or a paramedic would have likely provided insight into the real world conditions where these cases play out.

 

Here is my take on it.  First, I just want to say, this was a tragic case that should never have happened.  Just because someone is acting strangely or may be mentally ill (unless they are bothering someone or are observed committing a crime), they probably shouldn't be physically restrained.  Where I work in Hartford there are a lot of people who act strangely, but once you know them, you learn they are not acting strangely for themselves.  There are just a lot of strange people out there, and not everyone should be held to the normal person standard. 

 

In this blog post, I only want to address why a paramedic would give someone ketamine or a sedative like Versed or ativan (benzodiazepines) against their will.  (Note: I do it quite frequently.)  We don't carry ketamine in my section of Hartford, but as an EMS clinical coordinator that oversees several EMS services, we approve ketamine for use in certain circumstances, including to sedate violent patients. 

 

Our statewide paramedic protocols call for a number of measures to calm someone down and deescalate scenes.  It is not uncommon for us to respond to a violent EDP (emotionally disturbed person).  In many cases, the patient may be on drugs such as PCP and are resisting efforts. They may be naked in the middle of winter walking down the street.  (PCP makes people hot and it is quite common to have them disrobing in public). They may be smashing windows or merely threatening others.  I have had such people jump out of open windows.  They may also be schizophrenic, off their meds and talking about killing themselves or others.  If they are just plain crazy, standing on a street corner talking to themselves, as long as they know where they are, and have no intention of hurting themselves or others, we leave them alone.

 

Patients may only be restrained under the following indications:

 

Any patient who exhibits an altered mental status and may harm himself, herself, or others or interfere with their own care may be restrained to prevent injury to the patient or crew. Restraining must be performed in a humane manner and used only as a last resort.

 

We are authorized to do both physical and chemical restraint.  if someone fights against the physical restraints, I will chemically restrain them.

 

Continued patient struggling against restraints may lead to hyperkalemia, rhabdomyolysis, and/or cardiac arrest, chemical restraint may be necessary to prevent continued forceful struggling by the patient.

 

When I arrive on scene, I try to talk to the person, who the police may be holding down, sometimes in handcuffs, sometimes not.  If the person is alert and oriented and can carry on a normal conversation, I will ask the officers to let them up and take off their handcuffs.  If they are still resisting and are out of their minds, I will sedate them per out protocols.  The sedation works wonders.  It takes a few minutes to work, and I will urge everyone on scene to resist agitating them further, and let the medicine take hold.  I get them on the stretcher, we take the cuffs off and they are often sleeping like babies by the time we arrive at the hospital.

 

Paramedics do not medicate at the request of police.  Paramedics medicate based on their own medical guidelines to protect the patient and others from injury.  If a paramedic medicates a person, they are not transported to the jail, but to the hospital where they receive full emergency evaluation and care.

 

I try to put myself in the situation of responding to this particular case.  If I show up and if police are fighting with a man and they tell me he is on something and is showing extra human strength I am inclined to believe them (provided their description seems to match what is occurring in front of my eyes) and I would be inclined to sedate the patient if it appeared what the police were saying was true.  

 

As far as the excessive dose Elijah McClain received, I will say it is not always easy to properly estimate a patient's weight or age in a chaotic setting.  We can't have them step up on a scale as they might in a doctor's office.  The fact that they estimated his weight at 220 pounds is curious because 220 pounds is 100 kilograms, which makes estimating the dose of ketamine much easier than if a patient weighed less.  At 5 mg per kg, the dose would be 500 mg.  Easy math to do in the head.  If the patient weighs 140 pounds, you would have to do the math  140 divided by 2.2 equals 63.6 kilograms.  Then 5 X 63.6 gives you a dose of 318 milligrams, about 2/3s of what he actually received.  A bit more complicated math, harder to do in your head than with the 220 pound/100 kilogram patient.

 

Maybe EMS should be more cautious of the story they receive when they arrive, but I can say based on experience, when the police say that the patient is violent and has superhuman strength, that is usually the case.  I have seen small women on PCP throw large officers off themselves.  I have seen police officers have the s kicked out of them, all the while employing only defensive tactics against people to avoid hurting them.  I have also seen officers respond back with what I might consider excessive counterattack.  The point is there are many mentally ill patients who are violent and there are a lot of drugged out patients who are also violent.  Sedating them is better than wrestling them or having someone, patient or medical worker, get hurt. 

 

As far as dosing, EMS needs to improve its weight estimating abilities, and should probably err on underestimating, particularly with a drug such as ketamine.

 

A Boy

 

In 1999, I wrote a letter to the editor of the Hartford Courant about a police shooting in the city.   The newspaper reported that an unarmed 14-year old black boy had been shot in the back by a white police officer.  They put the story on the front page under the headline Family, Police Want Answers: No Weapon Yet Found At Scene Where City Officer Fatally Shot 14-Year Old   

 

The New York Times also ran a story on the shooting:  Unarmed Boy Is Fatally Shot By the Police In Hartford

 

What motivated me to write the letter to the Courant was the photo of the victim the Courant put on the front page.  Here's what is looked like a little larger.

 

They used a picture of a ten-year-old boy.  I knew the EMS responders on the call that night and they thought the shooting victim was a man in his early twenties.

 

I knew the officer who had shot the boy.  He was far from one of my favorites.  He was one of those cops who was a cop and let you know it.  Still I felt he was getting a bum deal.  The photo of the child was incredibly biasing against him, and I scolded the paper for it.  It apparently made little impression on them as it was never published.

 

Clearly my mindset back then was different than it is today.  (I had completely forgotten about this incident until the other day when it flashed into my mind). Not that I still don't think it was shoddy journalism to put a picture of the victim as a ten-year-old, but I did truly believe then that the victim was a criminal, a thug and up to no good and that he likely deserved what he got.  I don't know whether the fact that he was black or not figured much into it.  In the north end of Hartford, 95% of the population is black.    If I worked in a city that was 95% white and a cop gunned down a 14-year-old I might have felt the same, but maybe not.  Maybe if he had been white, the cop would have let him keep running or not believed the boy might be reaching for a gun and it would never have been a story.

 

There was much community unrest over the shooting.  An all-star panel investigated the incident and exonerated the police officer.

 

The Hartford police chief during the incident had taken a leave of absence, and was replaced by a respected black officer, Deborah Barrows.  Her standing  in the community is credited with preventing riots when the report was released.

 

 

The report stated the boy was one of four youths who "rented" a white Cadillac from a drug addict for $15 so the addict could buy crack.  While joyriding in the drug addict's ride, they brandished "guns," tried to mug a 41-year old woman, who Salmon hit over the head with his "gun"and then on being chased by police, fled the vehicle.  When the lone officer chasing them through a dark back yard commanded the boy stop, the officer allegedly heard a gunshot, he thought he saw the victim reach into his belt and turn.  That was when he shot him — a shot more through the side than in the back (consistent with turning) it was later determined.  No gun was recovered, but a cigarette lighter that looked just like a gun was found at the scene, and another one was recovered in the car.  The youths had apparently bought several of these gun-lighters earlier in the evening. These were the "guns" they had been brandishing on their joy ride.

 

That incident occurred at 2:30 in the morning on a school night, and the fourteen-year-old victim had a home confinement bracelet around his ankle.  Despite the bracelet he had apparently not been home for two weeks.

 

I wonder now if the same event occurred today, how we (I) would be reacting.  Maybe there would be video footage that would tell a different tale.  Maybe it would show a boy running and an officer taking aim, and the boy turning with hands up to surrender, and the officer still firing.  Maybe it would show exactly what the report concluded.

 

Maybe Hartford would be on fire.

 

Reading the papers from back then makes me incredibly sad about the lack of progress in our country today.

 

Barrows said she hopes Aquan's death has awakened the city to issues it can no longer ignore — namely homeless teenagers in trouble with the law, who have trouble succeeding in an ordinary school setting…."It's time to stop talking. What are we going to do? Aquan Salmon's death should have awakened everyone . . . If the Aquans of this city aren't safe, my kids aren't safe," she said.

-Chief Deborah Barrows

 

I still feel that the picture of the 10-year-old Aquan Salmon was biased against the police officer as it made people think he had gunned down an innocent child rather than a troubled manchild with a model gun that looked real who was indeed up to no good in the late hours of the night.

 

Maybe better training or more experience would have kept the officer from pulling the trigger, but that is just speculation.  Who am I to judge someone who had to make a split second determination that means the difference between life and death between yourself and a stranger, between going home to your family at night or them laying a wreath on your grave?

 

But I have changed my mind about one thing.  The ten-year-old boy in that photo is a victim.  He was a victim, not of a rogue police officer, but of a system and a society that failed him and many others like him. He grew up in a poor, dysfunctional family, many who were in or spent time in jail.  He had no role models, no one to steer him in the right path.  The schools in Hartford are far from the schools of its suburbs.  Here in Connecticut, the quality of your education is determined by the zip code you live in and the wealth or poverty of your neighbors, not a child's needs.

 

The Connecticut I grew up in was far different than the Connecticut Aquan Salmon knew.  The Connecticut many minority children are growing up in is different than the Connecticut many poor children in Hartford grow up in.  We can talk about black versus white, but it is really opportunity versus none.  It is about the disenfranchisement of our inner cities.  Some people say get what is yours and pass it on to your own.  Others say use your time on the earth to make the world a better place for all.

 

It is easy to put a Black Lives Matter sign on your freshly cut suburban lawn, to applaud the end of the Confederate flag or confederate statues being torn down, but what will matter in the end, is our country's support for a deep and committed redistribution of educational opportunity so that each kid growing up in our country has the same chances, the same preparation to make the most of their individual lives and not get lost at so young an age.  If you live in a rich suburb and don't want to give up the quality education your child receives, then don't fight against taxes on the more advantaged to provide the same opportunity for the children of the inner-city or poor rural areas.

 

Aquan Salmon would have been 35 years old this year.  Maybe he might have found the path.  Statistically, he would have been more likely to end up in prison, certainly on the path he was headed.  Maybe he would have gotten out of prison and become a community leader, helping others avoid the mistakes he made, or maybe he would have been arrested for buying cigarettes with a counterfeit $20 bill.  Maybe he would have ended up on the pavement in some city with a policeman's knee on his neck.

 

I hope that 20 years from now when we look back on 2020, that it won't be the same old story.  I hope we will look back with pride on the actions and commitments we made to right the world.

 

I hope that we make a safe, nurturing place for all children to grow up in.

 

I hope this movement in the country is real and lasting.

 

Peace and justice for all.

 

Power to the People.

Kevin Andrews

With all that is going on these days, I thought of Kevin Andrews, one of my first partners in EMS.

 

In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that regard.

 

Kevin Andrews was one of my first partners. This was back in 1989. I was a spanking new EMT — so fresh I didn't even have my certification yet. Due to an EMT shortage I was working on a waiver that let EMT class graduates work pending the outcome of their state exams. I even wore a "whop kit" – one of those pouches that attach to your belt and hold your tools of the trade. Mine was small and conservative by some standards. I had a penlight, trauma shears, bandage scissors, and a window-punch.

 

We worked for Eastern Ambulance, a mom and pop ambulance company in Springfield Mass that had the 911 contracts for three suburban towns in addition to backing up calls in the city and doing transfers. On a good day we only had five ambulances on the road. On most we had three. Some of the ambulances had brown bondo on the sides and in one, you could see the road through a hole in the floorboards. On Fridays, we use to all race down to the bank to try to cash our checks. The last to get there often found theirs would bounce. We didn't have paramedics, just basics and intermediates. We didn't even have defibrillators then. But we were a close-knit group, and there was more to the job than money.

Kevin was an EMT, but he was respected as any of the intermediates. He'd tried to take the EMT-I exam a couple times, but kept just missing it. He was very street smart, but had trouble overthinking the tests. I, on the other hand was book-smart, but had no clue about the street. With the wrong partner, my life at work could have been made miserable. I was always glad to find myself working with Kevin.

 

We were both thirty then, but our backgrounds couldn't have been more different. He grew up in a large family in Springfield in a neighborhood where the drug trade flourished. I was from an upper middle class suburban family and my most recent job was working for a United States Senator until his loss had send me on this personal quest to learn how to help people in person rather than from behind a policy desk.

 

Kevin was a big strong man with a shaved head who a instructor and black belt in karate. Still he was gentle and soft-spoken, with a ready smile. I never saw him raise his voice or become excited on a scene. He had that calm about him that for all the occupations I have worked in, I have only ever really seen in certain EMS responders — an unperturbed always in control manner that seemed to deescalate any panic around him from patients, bystanders or partner. He always knew what to do, and if he didn't, he never let that on.

 

Sometimes we used to stop at his mother's house where she always made sandwiches for us and we would visit with his youngest brothers and sisters before heading back on the road. He was their clear pride. Out on the street, Kevin would point out to me the drug houses and dealers. What I might have thought was an innocent boy of twelve on a bike, was instead a drug-dealer's lookout. It was a new world for me.

 

My clearest recollection of a call with Kevin was on a cold sleety morning in winter when we responded for a woman who had slipped on the ice on the top steps of a church. I could tell right away her arm was broken. I palpated it through her coat and it felt almost as if it were in two separate pieces. I had my trauma shears out in a jiffy, but before I could make my first cut, Kevin had a soft but strong grip on my arm. "This might be the only coat she owns," he said quietly. "Let's see if we can ease her arm out of it." Which is what he did, taking his time not to cause any pain. The woman's winter coat was preserved and her arm was carefully splinted and he talked to her in a reassuring way that caused me to feel only awe at what I was witnessing. It made me see that EMS wasn't really about blood and guts and bad car wrecks and doing CPR. It was about taking care of people.

 

The company went bankrupt a couple years later. By that time I was only working one overnight shift a week. I was back behind the policy desk as the ex-Senator after a year in exile had run for Governor and won. Despite the full-time government job I was not only hooked on EMS and had to get my weekly fix, but I felt like I was a part of a family at Eastern Ambulance and I didn't want to lose that connection. I hated to see Eastern close. Kevin and most of the others we worked with went to work for another ambulance company in Springfield while I joined a volunteer service in Connecticut.

 

I saw Kevin periodically over the years. We had a few Eastern get-togethers. Another time he and his girlfriend brought their kids down for a picnic at the condo in Connecticut I shared with my own girlfriend at the time. I visited him in the hospital when he got a bad infection and had to get IV antibiotics. We'd talk on the phone sometimes and get caught up on how all the people we worked with at Eastern were doing. He told me he was honored when I mentioned him in my first book. I was honored to be able to write about him. Whenever he'd call, even if we hadn't talked to each other for a couple years I'd say "Kevin" recognizing him at the first sound of his voice.

 

The last time I talked to him was three years ago right around the birth of my daughter. He'd mentioned there was going to be a new get together of some of the old people we knew. I wrote his number down, but in the confusion of the time, misplaced it. I have always been somewhat of a recluse. I work all the time and I'm not the best about keeping in touch.

 

A month ago I talked to a woman who'd also worked ambulance up in Springfield, starting shortly after I had left the area. When I mentioned I had worked for Eastern, Kevin's name came up. She said she knew him and that he was helping teach basic EMTs at the college where she also taught. I said to say hello. Later in a New Year's Day phone call, she told me she had talked to him and that he had been excited to hear she had spoken with me. He told her about the good times we'd had as partners. She'd given him my cell phone number and he'd said he was going to call me. She wanted to know if he had ever gotten a hold of me. He hadn't. And now he won't be. The reason for the call was to tell me he had passed away suddenly. She didn't know the details. The rest of the conversation was a fog. I kept thinking. What do you mean? He passed away?

I have always found it hard to believe people I have known are gone. I have to see the obituary in the paper. I found it and there is was in print. Kevin Andrews, 52.

 

I am not one who believes in heaven or an afterlife. I believe when you are dead, you are dead. There is no place where you go to sit with others or wander among the clouds. Your conciousness is no more.

 

But what I do believe in is memory. I can close my eyes and see Kevin sitting right next to me in the ambulance, telling me a story. I can see him standing there in his mother's house smiling watching his brothers and sisters play, and then years later, sitting on the back deck watching his own children play in my yard. I can see the true friendship in his eyes and feel his warm handshake when he says "Keep in touch."

 

And I can still see him taking care of that old woman on the church steps as clear as if I were still there. I watch his hands and I want my hands to be able to soothe someone as his do.

 

***

Kevin shaped me as a caregiver and as a person. He helped make me the paramedic I am today. If I am gentle toward a patient, than Kevin's spirit is in me, Kevin's touch is in my hands. If watching the way those of us who were influenced by Kevin treat their patients, others are now gentler with the sick and injured, then Kevin's hands and heart are also in them. His breadth widens. This is what becomes of him. This is how Kevin is passed on, from one caregiver to the next. Let this be how he is remembered.

 

The great church doors open to the icy weather. Outside on the cold steps, an EMT caring for a patient.

Home

A beautiful spring day.  The sky is robin's egg blue.  The air smells like fresh cut grass.  We cut our sirens on approach, and are driving now through the residential neighborhood.  Kids are out on their bikes.  There are joggers aplenty.  Nearly every house has someone out beautifying their yard.  Neighbors talk and laugh with one another.  Optimism abounds.  In just a matter of days, the state will begin phase one of the opening, but in this neighborhood you can already see a future that looks just like the past.  A return to glorious normalcy.

 

People pause and watch us drive slowly past before returning to their conversations.

 

Several blocks away in this residential neighborhood a man and his wife sit holding hands on the front steps of the home they have lived in for thirty-five years.  Red and yellow tulips line the driveway.  There is a basketball hoop above the garage door and an old swing set in the backyard.  The man, his eyes wet, looks at the woman with concern.  Her hands shake.   A man in a bright yellow hazmat suit wearing a gas mask stands over them, checking the woman's pulse saturation.  It is 84.  The couple tested positive for COVID three days ago, and have been on self-quarantine, but her fever grew worse and she became short of breath so he walked slowly to the phone in the kitchen and dialed 911.

 

"I made a mistake," she will tell me on the way to the hospital, her hands and voice trembling.  They went to a party two weeks before where no one wore their masks.

 

Now as we leave the scene she looks out the ambulance's back window at the house where she has raised her family.  She may be wondering if she will ever see her husband, her family, her home, her neighborhood again.

Not Right

A large man stands handcuffed, surrounded by six police officers by the side of the road.  Nearby two citizens have their iPhones out recording.  The man does not mince his words.  "I'm going to kill all of you.  I hate cops.  I'm going to eat you.  You're gonna be in my belly."

 

It is clear that this man is having a manic episode.  He will not shut up.  On and on, he goes about the horrible things he's going to do to.  "Give me back my guns!  I already took my drugs!  Now let me go!"

 

The guns it seems are two plastic toys with flashlights taped to them with masking tape.  "I'm going to kill every motherfucking last one of you."

 

I walk up to an officer to get the story.  "Have you dealt with him before?" she asks.  "This is not unusual for him."

 

I don't recognize him, but he is not unfamiliar at the same time.

 

I nod and then approach him.

 

"Look at what they doing to me," he says.  "I'm going to kill them and eat them!"

 

"You like drugs?" I say.  "How about  Ativan?  I'm going to give you some benzos.  They'll make you feel a whole better."

 

"I already had my drugs!"

 

"More the merrier," I say.  "I give you a shot in the leg, tiny needle, no pain.  You'll feel better and we can get you out of these cuffs."

 

"Take me to the hospital," he says.  "But my guns are coming to."

 

"We'll put them in your bag."

 

He takes the shot – I give him 10 of Versed in his thigh.  He takes it like a champ.  It takes a little while, with pushing and prodding, to get him on the stretcher, and he keeps jabbering away.  We get his two bags and put them on the back of the stretcher.

 

I ask the cop to take his cuffs off.  "He's agreed to behave, isn't that right?"

 

The cop looks dubious, but I don't want this guy lying on his wrists.  I am counting on the Versed and my own powers of persuasion to keep him distracted, and keep him from wrecking any havoc on me.

 

The cuffs come off and he doesn't take a swing, though he keeps up the verbal barrage about how he hates cops and will come back and kill them all for his dinner.

 

He doesn't stop talking in the ambulance, but at least he is not aggressive towards me.

 

"You know who I am," he says, as he reaches into his bag and pulls out a long wig of purple hair, which he sets on his head.

"You're Rick James!" I say, referencing the 70's funk star, who he has become the spitting image of.  "Super Freak, Super Freak," I sing.

 

"No, man I am death.  D-E-A-T-H.  You know who lives in my wrist?"  He points to a large scar.

 

"Tell me."

 

"Jesus Christ.  He lives in my wrist.  He comes and smokes weed with me in the mirror at night."

 

"Interesting," I say.

 

"You look stressed."

 

"Well, all this COVID stuff has me a bit drained."

 

"You know where COVID came from?"

 

"Wuhan, China?'

 

"No, it came from my right eye ball.  I set it loose on the world cause I'm death.  D-E-A-T-H."

 

"Are you planning to summon it back to your eyeball?"

 

"No, I got a girl staying there right now.  My soul sister.  I'm getting mine." He punches his fist against his hand several time rapidly.  "You follow?"

 

"I think so."

 

"We all got soul sisters in our eyes.  You, too!  Don't tell your wife about her."  He makes that motion with his fist and hand again.  "Get yours."

 

"Maybe you could make some room in the other eyeball and get that corona back in there somehow."

 

"You look stressed," he says, again.  "You should quit this job.  Go buy yourself some weed, smoke it in the mirror and talk to Jesus Christ.  Then go get yourself a good job.  Go work at Stop and Shop.  Take the load off, you're old.

 

He ends up four pointed in the psychiatric wing.

 

When I punch out, my partner says if it works out for me at Stop and Shop, maybe I can get him a job, too.

 

***

 

I am feeling old.  The COVID quarantine with the swimming pool and gyms closed, my workout routines have gone to seed.  I find myself sitting in front of the TV most nights, and when I watch TV I need to be eating.  I have gone from raw vegetables and berries to bags of potato chips and Oreos.  My pants are starting to feel tight.  I do exercise with my daughter.  We film part of a one on one game we play.  I realize she is getting by me not just because as a twelve year old, she is quicker me than me, she is getting by me because I am slow.

 

I am an old man with a bent back and a shuffle to his step it seems.  A friend at the hospital tells me with my lack of a haircut, my thinning hair on top, and my corona mustache, I look like David Crosby.  I don't think he means this in a good way.

 

***

 

I waiver back and forth from I already had COVID-19 (either I had it in the end of January/early February when I was so sick or I got it on the job and didn't have any symptoms other than the general symptoms of being 61 or I had it and was completely asymptomatic—how could I not get it doing the calls I am doing with the PPE I am wearing if this thing is infectious at all) to it is only something people in nursing homes, prisons and group homes with major medical problems need to worry about to being concerned the ache in my bones, the slight sore throat, the cough a little worse than normal, are the beginning of the end for me.  Maybe I will be one of the ones the germ sinks its spikes into as it climbs down into my lungs and makes waste of me.

 

I'm not sleeping so well.  I am trying to eat better and work out more, but like tonight when I came home, I was tired and outside it was cold and windy and damp.  I ended up just taking the trash out.  I had several trips with it because tomorrow the garbage truck comes.  That was my work-out for the day.

 

***

 

I am watching TV now and trying to make sense of what I'm seeing.  Today the President ordered meatpacking plants ridden with the virus to re-open.  The Vice-President visited a hospital and wouldn't wear a mask.  The Dow Jones was up another 532 points.  You would think this thing was over, that it was all going to be sucked back up into D-E-A-T-H's eye.

 

Something doesn't seem right.

 

Battle Royale

He is naked in the nursing home hallway, rolling over and over.  We manage to get a sheet under him and lift him up onto our stretcher.  His room air pulse saturation is 74–severely hypoxic.  The nurse, who told us he was COVID positive, said he walks around the wing and can hold a normal conversation.  He is all gibberish this morning, talking in tongues that don't sound human.  I put a nonrebreather mask on him and then place a surgical mask over it.  He tries to grab the mask, but I am able to keep his hands away.  In the back of the ambulance, he tries again to take the mask and oxygen off.  I keep telling him to cut it out and to stop, but he is too far gone to understand me. I take his arms and put both them at his sides, underneath the middle seat belt.  When I move toward the radio to call the hospital, his arms get loose and  he knocks his mask off again.  When I try to  replace it on his face, he grabs my wrist and starts pulling me towards him.  He is strong.  He has a death grip on my wrist.  He grabs my gown and shirt with his other hand and suddenly we are wrestling.  His mask is off and respiratory droplets are shooting out of his mouth right at me.  Even though I have an N95 mask on and a fogged up face shield over that, I am stressed by this turn of events.  COVID -19 has transformed him into Hellboy and he is spitting respiratory droplets at me like a spitfire plane strafing a beach.  I manage to put my knee on his side and and swing my right arm loose.  He still has me by the wrist.  My yellow gown is torn and pulled off my shoulder.  I am finally able to unpry his fingers off my wrist and then I sit back on the seat out of his reach.  The mask is off his face.  He mutters gibberish in his own world.  In the ER he will be sedated, intubated and shipped to the ICU. 

 

Normally after a call, I try to clear the hospital as quickly as I can, but not after this one.  I wash my hands multiple times, and then sit in an armchair in the empty  EMS room.  I write my run form, but instead of getting right up, I sit there a few minutes more.  And then I put my mask back on and head out to the ambulance.

 

I am finding these constant COVID calls draining.

Nursing Homes

COVID-19 will change many things about America. One may be the care our older Americans get at nursing homes of skilled nursing facilities as they are largely known nowadays.

 

Much of the war against COVID is being waged in these homes. Here in Connecticut, 40% of all deaths have been nursing home patients. Many of the patients coming into our hospital are coming from the same nursing facilities where others have tested positive. The radio patch comes over: "89-year-old female, short of breath, room air sat is 88%, fever of 103.1. Not tested yet, but many in her facility are COVID positive. Respiratory isolation precautions in effect."

 

There is one nursing home in our service area where I work as a paramedic that has a very poor reputation, made worse by their COVID response. We in EMS judge a nursing home on several things, smells, appearance, readiness of the staff to give us a report when we arrive, but most of all on the condition that the patient is found in when we arrive.

 

Some nursing homes the 911 calls are never very interesting. High blood pressure, altered mental status, abnormal lab values; others are always bad-respiratory distress, sepsis, cardiac arrests.  The first group sends their patients out at the first sign of trouble; the latter group sends them when they are in common parlance, "shitting the bed."

The best way to rate nursing homes, if you could do it this way, would be to count what percentage of the time the ambulance leaves for the hospital lights and sirens after picking up the patient versus going with speed of traffic which is how the majority of EMS 911 trips to the hospital go.

 

When you show up at a nursing home and you can't find a staff member and the patient is severely hypotensive or in major respiratory distress and they can't tell you when they were last seen normal, that is an issue. The other response we often get is, "I don't know, I'm just an agency nurse. I've never seen her before."

 

This happens frequently. The worse the nursing home the more it happens. If a home can't keep its staff, you end up temps and agency nurses. That is not good for patient care.

 

Today we pick up a woman found on the floor with a severe gash on her forehead. No one knows how she fell. She can't tell us. The nurse looks at her medical records and tells us the woman has dementia. "How does this compare to her normal?' we ask. "I don't know. I've never seen her before." Any other medical history you can tell us about?" She hands us a mimeographed sheet of paper from several weeks ago that is barely readable both due to penmanship and the number of times it has been copied.

 

Because of the reputation of this facility, as a COVID hot spot, we came in fully gowned with face masks on. The woman's pulse saturation is fine, she is not feverish, but she is talking gibberish and the lac on her head is deep. We take her to the hospital. On the way I read through the stack paperwork the nurse handed me in a red envelope.

 

I can barely make out the words COVID. I have to put my glasses on underneath my goggles to make it out but there it is COVID +.

 

There was no sign on her door, The nurse said nothing about it. I'm glad we had our PPE on.

 

I know many people labor in these facilities for low pay and they are horribly understaffed, so I am not blaming the workers. I blame the system. We all saw how COVID devastated the first nursing home in Kirkland, Washington when the epidemic was first beginning.

 

We had to know it was coming. COVID is burning like gasoline in their homes, and even if we turn the corner on this wave of the epidemic, if we have flattened the curve and the numbers drop, does anyone thing we are prepared for the next wave or the next epidemic.

 

Let's have an economic come in and look at where the money is going in these homes. The nurse's aren't rolling in dough. Many ride the bus to work and have two and three jobs. They leave at first chance for better work. No wonder there are so many pool or agencies nurses in these places or nurse's who say, today is my first day. The money has to be going somewhere. How much do the administrators make? Who are their bosses? Are these homes run by for profit corporations. Or maybe the problem is the state. Maybe these places are truly underfunded for what they do in our society. Maybe we need a different model. This can't happen again.

 

 

COVID targets nursing homes and prisons. Think about that.

 

I remember what my old partner Arthur used to say when we came out into the sun after leaving another patient at a nursing home.

 

"Just put a bullet in my head," he'd say

Tiger

It's 12:59 A.M. I have given up on sleep. Fortunately tomorrow is my one day off (I will still go into the office to make my COVID EMS notifications) but I will go in at whatever time I feel like and will only stay for a couple hours. It's not like I have to get up at 4:30 to dress in the darkness for a 12-hour shift on the ambulance.

 

I am up not because I can't sleep, but because my sleep is restless and tormented, and because of the tiger.

 

When I last reported on my nightmares. I was being terrorized by the corona germ that looked like Spongebob. He and I faced off on a basketball court without hoops and I was considerably larger than him and I had a blanket that I tried to smother him with, and even though he escaped, and continued to come at me, making a strange high pitched shrieking sound, I could easily kick him off before he caused me damage. He had no teeth or nails. He was after all only made of sponge,

Now it is a Corona tiger that comes at me. I am no longer on a hoopless court, but in a small two story house. At first the tiger came in the open front door from the yard. But now he comes out of a large square hole in the floor from his basement lair.  I have a host of weapons against him. Giant pillows I can throw at him. Furniture I can pile high that he will have to jump over and doors that I can escape behind. We have a game. He tries to get me and I try to get away, occasionally whacking him with a pillow or a wood board with nails on it. But each time we play, he gets bigger, and my weapons of defense get flimsier. I start on the second floor now and throw stuff on him from the balcony, and he comes up the stairs after me, and I leap over the furniture I have piled high against him, and I escape into the closet with the flimsy wooden door that does not lock. The last time I felt the heat of his breath as he roared outside the door, and I was saved only because he grew bored and wandered elsewhere in the house, and I awoke, but I don't want to play again. He is full size now. When he stands on his hind legs, he can reach the second floor with his sharp clawed paws. I know the next time he will leave deep scratches on me that will not heal.

 

I don't want to play anymore. But he will not leave my house. I can hear him pacing downstairs.

15 Minutes

 

Confusion and Unease. That's what I would say is going on now out here in EMS land.

 

Listen up:

 

First the government told us we had to wear N95 masks when faced with a potential COVID patient. Then we were told a simple face mask was fine. The CDC then issued more revised guidelines that defined risk, saying as long as you did not have "prolonged contact" with a patient without wearing a mask, you were okay. 

 

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)

 

Now a hospital in our area has defined prolonged contact as 15 minutes. They are saying, if you are without a mask for the first fifteen minutes, it doesn't count as an exposure.

 

Read this for yourself:

 

Once on the scene, and as soon as possible, a patient with suspected infection as per the most current CDC recommendations and guidelines should be provided with an isolation (surgical) type mask to wear. Responders should likewise don an isolation mask. If an isolation mask is worn by EMS providers within 15 minutes of initial contact, they will not be considered as having been exposed even with contact to a patient who has tested positive.

 

Where does that 15 minutes come from? What science is that based on? Are they saying it takes 15 minutes of exposure for someone to get COVID? We can get coughed on and respiratory dropletted upon for up to 15 minutes and we will be okay?  Come on.

 

We have also heard that at several services, even if you are exposed, you should keep working until you are symptomatic, even though it is known you can spread the disease on to others before you yourself show symptoms.

 

Many people are angry about this relaxing of restrictions because the relaxing seems more linked to the supplies and the need to keep a sufficient health force working than true safety.

 

Add that to our understandable paranoid belief that EMS worker safety might not be the top concern with higher ups and throw that against the onslaught of news describing the terrors of COVID, "the perfect killing machine," and people are rattled.

 

Here is what I believe:

 

Most Americans (70-80%) are going to get COVID eventually. (This includes many who have or have had it or will get it and not know.)

 

The effort at social distancing and closings are geared to flatten the curve (spread the sickness out over time) and keep the health care system from being overwhelmed, enabling it to save more COVID patients as well as other sick patients who will need ICU level care.

 

These efforts will fall short, but will be better than no effort at all.

 

We will have a true period where the shit hits the fan. Likely beginning in May.

 

The ever changing guidance to EMS reflects the need to find a balance between safety and not exhausting the supply of PPE and the supply of EMS responders. If you insist on the proper level of safety, too many of us will have to be self-isolated and there will not be enough PPE to make it through.

 

We are given a limited supply of PPE and told to only put it on when we encounter someone with a fever and symptoms of respiratory illness and possible contact with a positive patient. Yet we walk into a hospital and everyone is wearing masks, everyone except EMS. You see pictures in the paper of nurses gowned up in space suits to do COVID testing, wearing full body gear that looks nothing like the paper napkin gowns they give us for the most extreme cases, a gown that in my case doesn't even reach my knees. You can see why people feel uneasy.

 

Many like me are resigned to getting it. I hope that my 15 day January/February illness was COVID, but I fear waking up each morning with a raging fever. I'm 61 and am in good health for the most part. I have read enough to understand most of those dying are old and with comorbidities that I do not have.  I want to work.  I love being a paramedic, and have always been and am still willing to be on the front lines.  Like those I work with, I will take the risk.  Just be honest with us about them.

 

For many more posts on the COVID epidemic, go to:

 

Street Watch: Notes of a Paramedic