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A Simple Dream

Twenty-seven years ago, in a retaliatory shooting, a man in Hartford's north end opened fire with an automatic weapon, killing his target.  He was sentenced to fifty years in prison.  He left at home a baby daughter.

 

***

 

I get called for the unconscious.  I arrive first and climb windy wooden stairs to the third floor apartment, where a terrified young woman, holding a toddler, kneels in the hallway by the open bathroom door.   "He collapsed and he won't wake up!"

 

An older man with a grey beard lays on his back, eyes rolled into his head, gurgling.  His arms are stiff.  His carotid pounds.

 

"What kind of medical history does he have?" I ask.

 

"I don't know,'' she says.  "He...he takes pills."

 

"Is he diabetic?  Has he ever had a stroke?  Or seizures?"

 

"I don't know!"

 

I have an ambu bag out and with the help of the arriving fire department we pull the man out into the middle of the living room floor, where we start breathing for him.

 

"Does he do drugs or drink?"

 

"No, no."

 

"What's your relation to him?"

 

"He's my father."

 

"Does he live here?"

 

 "Is he going to be alright?"

 

His pressure is 170/100.  I can't get a good look at his pupils.  I am leaning stroke, but his respirations are slow (6-8 a minute) so I gave him two of narcan in the nose just in case.

 

With bagging, his oxygen saturation is 100% and his end tidal is 59.  The ambulance crew arrives and I tell them I am not certain what is going on.

  

The other medic asks if I want to give him more narcan, but I say hold off.  He is breathing well enough that we don't need to bag him.  If it's an OD we'll know soon enough.  As they get the stair chair ready,  his respiratory drive picks up.

 

The man opens his eyes.

 

"Well, that answers that," I say.  "What did you take?" I ask him.

 

"Huh?" He says.  He has that uh-o surprised look to the left look to the right look that so many overdose patients have when they suddenly wake up and find the room filled with people in uniforms standing over them.

 

"Nothing," he says.  "I'm fine."

 

"Fine?  You weren't breathing, you were unresponsive."

 

"I got high blood pressure," he says.

 

"No, you used heroin," one of the firefighters says.

 

"He used drugs?" the daughter says.

 

She turns on him.  "You're gone twenty-seven years and you come back now and you're going to leave me again like that, after you promised to never leave me again.  Are you going to bring this into our house?  With me and my son?"

 

The man says nothing.  I feel bad for him.  And for his daughter and grandchild. 

 

"He just got out of jail," she says to me.  "One week he's been here.  One week and he goes and does this."

 

Twenty-seven years ago, I imagine a man could sniff a bag of heroin and it was nothing but a nice peaceful easy feeling.  Not today.

 

I tell the daughter about fentanyl, which she knows about. She lives and is raising her son in this neighborhood where drug trafficking and use as well as violence are daily facts of life. I tell her to be patient with her father, that he no doubt loves her, but this transition must be hard for him and he is going to need her.  He is going to need both of them.  She wipes tears from her eyes and hugs her son.  I tell her how she should have narcan in the house and where she can get it.  Even if he promises to never use again, opioids are a powerful force, and if he does slip up again, she can help keep him alive, until more help comes as it did today.  I give her a wrist band with the harm reduction center number on it. You're not in this alone.

 

The daughter, holding her toddler and I follow her father and the crew down the stairs.  Outside, they load him into the back of the ambulance.  Daughter and father eye each other, saying nothing as the door closes.

 

"He should be back in a couple hours," I say. "Don't be too hard on him."

 

She watches the ambulance drive slowly down the street, its red lights no longer swirling, and then she and her boy go back into the house.

 

I get into my response vehicle where I write my patient care form.  Then I Google the man and learn what happened twenty-seven years before, not five blocks from the apartment where he, his daughter and his grandchild will try to become a family, and live the simplest of all our dreams.

 

***

 

A study in the New England Journal of Medicine found that prisoners in Washington State were twelve times more likely to die in their first two weeks after release than were members of the general population (matched for age, sex, and race), and tellingly the ex-cons were 129 times more likely to die of an overdose.

 

Ingrid A. Binswanger, Marc F. Stern, Richard A. Deyo, Patrick J. Heagerty, Allen Cheadle, Joann G. Elmore, and Thomas D. Koepsell, "Release from Prison—a High Risk of Death for Former Inmates," New England Journal of Medicine 356, no. 2 (2007): 157–65.

Mate

Welfare check.  The superintendent lets us in.  The apartment is a poor man's hoarderville, open boxes and dirty clothes stacked as high as the unwashed dishes in the sink.  The man is sitting at a table with his head in his hands; a chess board in front of him.  For a moment, I fear he is not breathing, but when I nudge him he moves.  He turns slowly and stares blankly at me.  I ask if he is okay, but he doesn't answer.  I nudge him again but he is out of it.  I try to get him to squeeze my hands, but he doesn't follow any commands. Still, he has a decent pulse and his breathing while a bit slow is even.

 

His medications are on the table alongside the chessboard.  I read the labels.  Metoprolol and HCTZ for hypertension, furosemide for congestive heart failure, simvastatin for high cholesterol, coumadin for atrial fibrillation and blood clots, allopurinol for gout, metformin for diabetes, oxycodone for pain, colace to soften his stool. As I reach for each bottle, I can't help but admire the antique chessboard; the pieces are large and carved from wood.  No idle purchase.

 

I always wonder about my patients' lives.  On the wall there is a picture of a strong man in military uniform and another with the same man with a large family around him.  There are many pictures of younger children.  The pictures are old and faded.  

We pick him up, me with my hands under his arms, and a firefighter grabbing his legs.  It is then I see the torn heroin bag on the floor below the chair. I check his eyes once we have him strapped in on the stretcher.  His pupils are pinpoint, but he is breathing well enough that I don't need to give him any naloxone.  This is a dose, not an overdose.  All he needs is a little shake  to keep his breathing up when he nods off.

  

I wonder how many years has he been using and where did he get the heroin from?  By the door there is a walker, the kind with tennis balls on the ends to make for smoother rolling.  Did he push his walker all the way down to Park Street to get his $4 bag or does his dealer knock on the door with a regular delivery?

 

Was he once one of those who played chess in the park for a dollar a game? When was the last time he played a fellow human, relegated now to playing against himself in this dim apartment?  I wonder if he replays lost games from his past, like many chess masters do, studying them to see where he went wrong.  Maybe the heroin helps him play better, relaxing him and letting his mind see patterns that reveal to him the proper move.

  

I pick up my gear as we prepare to head down to the ambulance.  I take a last look at the chessboard.  I am new to the game, but it looks like if he is playing black, he is in a losing position.  White's pawns are advancing on his king and his two rooks are about to be forked by the opposing knight.  Soon his pieces will join those already taken, standing helpless now on the sidelines, among his battalion of prescription pill bottles.  The battle will come to an end.  As it will one day for us all.

 

Sunday Morning Coming Down

On the Sunday morning sidewalk
Wishing, Lord, that I was stoned
'Cause there's something in a Sunday
Makes a body feel alone.
"Sunday Morning Coming Down" - Kris Kristofferson

 

Twenty-six people in Connecticut died of overdoses on the four Sundays of this past April. Twenty-one males.  Five females.  One was aged 15-24, eight were 25-34, six 35-44, four 45-54, five 55-64, one 65-74.  I don't know their names, what kind of lives they lived, or who they loved.   Twenty-six deaths was the most fatal overdoses on any day of the week in a month so far this year.*  

 

I don't believe people overdose deliberately.  But I believe some overdose deaths are unintentional suicides of despair.  The person using the drugs knows that the amount of drug they are doing at the time may lead to their death, but they are so sick and forlorn and tired, and often so deeply alone, that they throw an extra bag or two in the cooker in hopes the pain will go away and that they will escape into a bliss they have not known for a long time.

 

On March 21, 2020, Connecticut shut down the state due to COVID.  That move undoubtedly saved countless lives as Connecticut was able to eventually get some semblance of control (at least in the first wave) of the rapidly escalating pandemic.  Unfortunately, some of these twenty-six may have been collateral damage.

 

In a blog post, Fatal Overdoses, written last April, I discussed the possible reasons we might see increased overdose deaths.

 

Established drug supply lines experience disruptions that force users to buy from unfamiliar sources, increasing their chances of overdosing.

 

Training and substance outreach programs are either closed or have limited hours.  Some have moved on-line, which is okay if you have a home and a computer. Not so much if you are displaced.

 

People may not have access to the help they need as well as reduced access to naloxone and clean needles.

 

Isolating people with existing mental health issues may lead former users (with now lowered tolerance) to return to substance use.

 

The increased release of prisoners with a history of drug use puts them at risk for overdose due to their lack of tolerance.

 

Patients with undiagnosed COVID-19 may be less resilient if they do overdose due to reduced respiratory capacity.

 

And people without work, with increased economic and social pressures, may seek escape.

 

I wrote about talking with Mark Jenkins, the head of the Greater Hartford Harm Reduction Coalition, about a homeless woman who I found dead on a mattress in a vacant apartment that she had found a way into.  She had been a regular at his drop-in center, and they were all mourning her passing.  Mark told me that day how worried he was. Now in this time of COVID we are telling people to isolate, he said, to distance themselves, which is opposed to everything we have told the substance use community in the past. Come together, look out for each other, there is safety in groups.

 

In total, April in Connecticut saw 133 overdose deaths, 56% more than the previous April, and as many as would die later in July 2020, a month that is historically one of the highest (unlike April) for overdose deaths. 

 

Connecticut is on pace in 2020 for 1400 people to die of overdoses-- an increase of 200 deaths (17%) over 2019. 

 

I hope that as the chaos clears from the election as it seems to be with an emerging Biden presidency and a continuing Republican Senate, that Democrat and Republican can come together and put vitriol and power struggles aside and start working for the people again, start looking out for our most vulnerable.

 

Address this crisis.  Recognize Addiction is a Disease and Treat it Medically.  End the Stigma.  Embrace Harm Reduction.

 

Bring our brothers and sisters in from the cold.  No one should be alone in this great country of ours.  We take care of our own.  We are our brother's keepers.

 

 

***

 

*Not counting July, a month  known for higher overdose deaths, when there were 27 deaths over five Fridays.

 

Data from Connecticut Department of Public Health

 

Drug Overdose Deaths in Connecticut 2015-2020

(Accessed November 5, 2020)

 

Drug Overdoses Monthly Report, January 2019-September 2020

Narcania

There is a cartoon hero named Narcania created by the same guy who wrote Lil'Dope Fiend Overdose Prevention Guide."  In the mini comix, Narcania rescues people who have overdosed and gives them new life.  As one character who has been resuscitated remarks, "I don't know if there is anything worth living for, but at least now, I'll get to find out!"

 

In San Francisco there is a Narcania mural, Narcania vs. Death proudly painted in an alley.

 

In 2017 I wrote about Narcan Man, the mysterious person or force who seemed to always arrive and be gone before us, leaving only an empty vial of narcan and sometimes a confused, or vomiting person at the spot where we were dispatched for the overdose.  I imagined a man with bandoliers of Narcan and a gold tooth who roamed the metropolis, keeping people safe, and then disappearing into the mist.  Who was that man?!

 

I believe I have finally met the real life Narcania, the female Narcan Man.

 

Her name is Carrie.  She is a smallish woman in her late twenties, whose face shows both the promise of her youth and years of hard living.  Her voice is gravelly from cigarettes, and her eyes are hardened blue grey.  I've seen her walking Park Street and I've seen her helping out at the work harm reduction van.  And most recently I've seen her at a number of overdose scenes, where she stands to the side and disappears once we arrive.  I know her well enough now to call her by name and to chat a little.  One of these days I want to talk with her at length and learn her true story rather than one I might imagine.

 

This time  she was walking through the park ravine when she came across a man half hidden by a pile of logs.  He was unresponsive and cyanotic with agonal breathing.   She hit him with 2 mg of Narcan in the leg with her autoinjector and gave him some good hard shakes until he came around.  When she saw it was me getting out of the paramedic vehicle, after I'd driven down a dirt road and across a field to get to the OD site, she stayed.  The man didn't want to go to the hospital, but she was able to convince him to go.  I let her do the talking because I knew he'd be more apt to listen to her than me.  While I walked him to the arriving ambulance, she gathered the belongings he had left and brought them to him.

 

Once he was loaded in the back of the ambulance, I turned around to say goodbye to Carrie, but she was already walking across the field.

 

"If she hadn't found him, he would have been dead," I said aloud.

 

I waved to her, and she gave me a little salute in return as if she were a cowboy and was tipping her hat to the townspeople as she rode off into the sunset.

 

"Who's that girl?" One of the firemen asked me.

 

"That," I said.  "That there little woman is Narcania!"

 

"Huh," he said.

 

"I read about her in the comix!"

Help is Always Right

The Hartford Courant this week noticed what most everyone else around here has-- panhandlers are on nearly every corner of big intersections these days. Many carry the standard signs drawn on ripped cardboard "Homeless and Hungry." Some wear masks, others don't. Some make eye contact, others look down at their feet. They almost universally say "God Bless," when you roll down your window and give them a dollar. I suspect that is more panhandler etiquette than religious belief.

 

How many of them have lost their jobs, and their homes due to COVID and the economic downturn? And how many of them are substance users? What are they doing with the money? Buying bread to feed their families or buying liquor or drugs and/or alcohol to fight off withdrawal sickness?

 

The article reports that several towns are asking people not to give panhandlers money for fear it will encourage them and increase the problem. Instead, they advocate donating money to local homeless shelters and other charities that service the homeless population.

 

I am one of those who gives panhandlers money. I donate to a local harm reduction charity too, but I know how much a smile, a look in the eye and a dollar or two goes for someone down on their luck or even someone in need of four dollars to get their next fix to hold the sickness at bay. A couple of dollars means nothing to me. Even though I have a daughter in college and another headed there, I work two jobs and make enough money that I can sleep at night. Between the floor of my car, the ashtray and the center console, I always have a few bills and a ton of change that I am not doing anything with. And if I have a single wrapped protein bar or an unopened bottle of water, I may hand them one of these, too.

 

I do have certain rules about which panhandlers I donate too. I admit I freely donate to people I know to be heroin users. These people I either know by sight as people I have seen on Park Street or who I judge by their gauntness. You give them a buck or two and they are gone, headed to Park Street to get their medicine. The ones I tend to avoid are the ones who are there everyday, who stay in one post and never seem to leave. You give them food and they say thank you and then they put the food into their backpack or shopping bag. I have given apples to heroin users and they have cored them before the light has changed. For heroin users with no teeth, I give them oranges and they have peeled and munched down on them before they have even remembered to say God bless. The ones who put the food in the shopping bag and don't eat it right away I am skeptical of.

 

There is an old man with a white beard and a can who is a frequent panhandler at one of the major intersections. I stopped giving money once I realized I never saw him on the rainy days, that he kept regular hours and that he never seemed to eat the food people gave him. I began to suspect he was a professor conducting research on panhandling. I'm probably wrong about that and he may in fact have a chilling life story. Another woman I stopped giving to, is on the same corner from morning to night, and every time I drive by she is putting the food someone has given her into a shopping bag. I don't know if she is putting the food away to save for her family or to hide from people's view who may be less inclined to give if they see her haul. Maybe she has kids at home, but I don't think so. I wish I did know her story, and writing about her now makes me feel like a bad person for judging her. If I had to make up a story for her, I would say she has an abusive boyfriend/pimp who puts her on the street not for sex, but to collect change which she has to give to him at night in place of a mattress to sleep on. No easy life that. When I do give to her, I don't see relief or happiness on her face, just pain. One day I ought to get out and give her ten dollars in return for hearing her story of how she came to be on that corner every day.

 

Sometimes I give heroin users five dollars and ask them to tell me about their lives. I consider it fair value as what I learn is more than I might learn from renting a movie. I think I favor giving my change to heroin users because I know how happy or relieved the money makes them feel, knowing that they can stop worrying if even for a few moments about how they are going to get their next fix. They remind me of the myth of Sisyphus, where Sisyphus is condemned to forever push a rock up a hill and when he gets to the top, it rolls back down and he has to roll it back up the hill. I feel if I give them a dollar or two, it's like I am offering them a chair to sit in and a glass of lemonade to sip for a moment before they resume their relentless struggle.

 

I know some say I am enabling them. I don't think that my dollar is the difference between their decision to quit using or continue. Addiction doesn't work like that. I think my human interaction is more important. I'd like to think that it tells them that the world is not all against them, people do not look down on them, but view them as fellow journeyers on this planet, and that kindness still exists in a world that has treated them roughly.

 

Some of my fellow EMS workers will give to panhandlers, but only food. Food is appreciated, surely. But I bought a large pizza once for a group of users once and bought turkey dinner another time to others. While the gestures were appreciated, the food did not fare well for their stomachs that were not conditioned to that type of greasy food in such quantities.

I always remember the time I asked one user who was standing in front of the Spanish Market if she wanted two dollars or for me to buy her anything she wanted for lunch. "Two dollars," she said without hesitation. I gave her the two dollars, then went inside and in addition to my order of roast pork, yucca, rice and tostones, I asked for an alcapurria  (a fritter made of plantain) and a champagne cola for my friend.

 

Two dollars has more value in a homeless heroin user's world than food. The two dollars ends the body aching, the nausea, the stomach upset. It brings peace, forgetting, even if only temporary of their painful trail and current place.

 

And I have to tell you. If I can bring them a little bit of happiness, it makes me feel good too. So there is some selfishness there. I feel like Bill Gates. Let's give some money away. I drive around the city and in twenty minutes I am ten dollars lighter, but I have made five people happy and I feel good myself. Everyone may have their vices. Giving spare change to others is better than me spending it at the bar myself. I go home at night to my warm house, kiss my kids, fill my belly with food and sleep soundly next to my wife.

 

Here's what the Pope has to say about giving money to panhandlers:

 

Interviewer: Many people wonder if it is right to give alms to people who ask for help on the street; what would you reply?

 

Pope Francis: "There are many arguments to justify oneself when you do not give alms. 'But what, I give money and then he spends it on a glass of wine?' If a glass of wine is the only happiness he has in life, that is fine. …Help is always right. Certainly, it is not a good thing just to throw a few coins at the poor. The gesture is important, helping those who ask, looking them in the eyes and touching their hands."

 

Help is always right.

 

And it turns out it is good for me too.

 

Proverbs 11:24-25 "A generous person will prosper; whoever refreshes others will be refreshed."

 

The Psalms (112.5), "Good will come to those who are generous and lend freely, who conduct their affairs with justice." 

 

I feel the same about politics and government. I may be one of the few, but I am always willing to pay higher taxes if the money is going to help others. I don't like it when government cuts taxes for the right and the programs for the poor are slashed, jobs cut and average American thrown out on the street, while the rich get richer.  I feel happier when I sense the world has less suffering in it.

 

The term panhandling comes from people holding out tin pans asking for money.  Alternatively, they are asking for money to buy bread, which is also known as pan. Breaking bread with someone else is a Christian term, meaning to have a meal together, to share common humanity.

 

Help is always right.

 

God Bless.

Tap Tap Tap

Years ago, I did all of my writing at a desk in a lonely room. I would write on yellow legal pads and then when I had something, I would type it out on my portable smith corona. When my daughter was little, I showed her my old typewriter and she was fascinated with it. She had never seen anything like it. I told her about white out, which for those of you who don't know was like white paint you put over your mistakes so you could retype over the error without having to retype the whole page. I hitchhiked across the country carrying a backpack, a sleeping bag and my portable typewriter. I went everywhere with it, but when I used it, I only used it at a desk.

 

Over forty years later, I do most of my writing on a $125 Google chromebook that sits on my lap -- whether I am in the front seat of an ambulance or now, sitting in a gym (mask on) watching my daughter's AAU basketball tryouts. Her coach called the other night and was talking with me about her playing up another level with older girls, and we discussed the pros and cons -- whether she plays with her own age girls where she can be the star or with other girls where she may struggle. I talked with my daughter about it on the ride over here tonight and she said, Dad, it doesn't matter which team I play for, I get to play basketball!

 

With COVID numbers creeping steadily up, we don't know if there will even be a basketball season, but it sure would be great to be able to keep watching her and other girls out on the court running and shooting The ball swishing through the net. Seeing them all smiling. It's basketball!

 

The town opened the pool up so I have been swimming four times a week. I am not in the shape I was pre-COVID, but I am slowly getting back in shape. Today I did several 50 yard freestyle sprints. I got plenty of rest in between efforts drinking Gatorade while I caught my breath. It felt great to push myself again, head down, arms reaching fast and long, kicking tight and strong, driving for the wall. Swimming! Racing!

 

When I work the ambulance, the shift is long, but I try to clear the hospital quickly when it is busy. I am in the rapid response fly car. When the fire radio goes off, I hit my lights and sirens on and notify dispatch where I'm headed. (In our system Fire gets the call first, then they notify the ambulance.) The fire radio gives me a jump on the calls, and I often am the first to arrive on scene. Up the stairs, through the door, down the hall into the bedroom, where a person lies unconscious on the floor, everyone else in the room now looking at me. When I punch out at the end of ten hours, I am tired but fulfilled. I earned my pay and felt my work was valued.

 

My days are full between work at the hospital and on the ambulance, with taking my daughter to her sports, doing chores around the house (not enough chores as my house is always in a state of disrepair), trying to keep up with the events of the world and trying to make sense of it all with the words I write.

 

Sitting here pounding away at the keyboard, I feel that life is good. I am making use of time. Every night when I go to bed, I am sad that I have to go to sleep and say goodbye to another day on earth.

 

I don't sleep as well as I wish I did. Too much on my mind. COVID-19, Race Relations, Opioid overdoses, the presidential campaign, division and violence in the world. And on a more personal level: Am I being a good father to my daughters? A good husband to my wife? Was I a good person to others? When will I see my father who lives in Florida again? How is my health? (My shoulder hurts, I have a nodule on my thyroid, I cough chronically, I am due for a colonoscopy, but don't want to go). What repairs do I need to do to my house? (One gutter is falling down. I will soon be in need of a new roof, the back steps are starting to rot, all the rooms need repainting). Have I saved enough to retire when my body can no longer carry me through my working day?

 

I am still tired when I get up in the darkness of morning as my world spins farther from the sun on its annual trek. But I don't linger in bed. I don't tarry. So much to do. So much life to live. I may slip up, and I have no white-out to fix my mistakes, but I keep on typing. Keep on keeping on.

 

Now I look up and see the ball swish through the net. Joy on my daughter's face, and then determination and she hustles to get back on defense. No rest on the court. Playing basketball!

 

Stay safe all. Keep on keeping on!

 

Tap Tap Tap.

Empathy, Kindness, Compassion

My old boss, former United States Senator and later Governor of Connecticut, Lowell Weicker used to say, the mark of a great country is not how it treats its richest citizens, but how it treats its most vulnerable.  Yesterday, we witnessed President Donald Trump emerge from Walter Reed Hospital, chopper on Marine One back to the White House, stride across the lawn, mount some stairs, stand on a balcony like an emperor and then rip off his face mask and smile (smirk depending on your view).  The same man earlier tweeted "Don't Be afraid of COVID.  Don't let it dominate your life."  He later declared that COVID was less of a threat to people than the simple flu. (COVID has already killed more Americans than the last five flu seasons combined.)

 

In a matter of days, he had gone from a man with a high fever, needing oxygen to again assume the throne of the most powerful man in the world.  While in the hospital, he had received world class care, including two drugs typically reserved for the sickest COVID patents and an experimental monoclonal antibody "cocktail" not yet approved by the FDA and unavailable to nearly everyone else.

   

Some have speculated he never had COVID and this was a political stunt.  I don't believe that, given the ridicule he has faced oer being infected as well as the high number of people who were apparently infected at the rose garden "superspreader event."  Others are not so sure he is recovered.  We know  from experience that it is in the later stages 7-14 days post infection often after the person has started to feel better that COVID sinks its teeth in and hauls down its prey.

 

Let's hope that's not the case here.

 

I write this because a nation is not its leader, it is its people.  Hear the drumming.  210,000 dead and counting.  Nationwide we mourn those we have lost.  Millions more still sick with long roads ahead and for some no recovery from permanent damage.  But don't let it dominate your life.  Today Anthony Faucci warns we could lose another 200,000 this winter if we are not careful.

 

As we in EMS have learned over the years to look through the eyes of our patients, so should we as a nation look through the eyes of our citizens.

  

Empathy, Compassion, Kindness, these are the traits of which we, as a nation, should strive for and be most proud.

 

Stay safe out there.

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

 

 

A Ravine in Winter

There is a picture in the Hartford Courant of Mark Jenkins talking with police officers looking as forlorn as I have ever seen him. They stand next to yellow tape sectioning off an area of woods just off Park Terrace where down a small ravine a man has been found dead. The paper describes the crime scene as a homeless encampment but it is little more than a small clearing with a dirty mattress, a blanket over some branches as a tarpaulin and a hollowed out log. Mark is the leader of the Hartford Harm Reduction Coalition. A former user, who went to rehab himself seventeen times, with the help of friends he found his way, and now has dedicated his life to harm reduction, which he describes as set of principles that recognizes the humanity of users and works to get them help or keep them safe until they are at a place in their lives where they are ready to stop using.

 

A couple months back, I got dispatched to this same place for an overdose. Mark and two members of his organization, Jose and Bryan, were already there. They had been on their way to work on the construction of their new walk-in center when they were flagged down. They found a man cold and not breathing on the broken winter branches and mat of old heroin bags. They gave him naloxone and by my arrival, the man was breathing again. He was just starting to rouse and was combative in his haze. They helped us carry him up to our stretcher. He was lucky someone has seen him and that Mark and his crew were driving by. In the hospital the man's core temperature was 90 degrees.

 

Some days when I am working, I stop by the site. A few weeks ago, after we'd pulled to the side of the road, I looked down the small ravine and saw a solitary man there. From my vantage, I saw he had his arm outstretched and was injecting himself. In the summertime the clearing is completely hidden by greenery, but in winter, it is all grey and naked trees. The man in jeans and a black shirt nevertheless blended in, as if in this same season, he were stripped himself of much of what he once was. I told my partner to drive on.

 

I don't know if the dead man is the same man I took to the hospital or the man I saw injecting himself in the cold grayness or someone else. I do know that he is not the first to die in those woods.

 

123 Americans died of overdoses in Hartford in 2019. 17 have already died in 2020.

 

In Mark's face you can see the burden of this war he is fighting against stigma, against convention and bureaucracy, against death, against time.

 

***

 

Connecticut drug deaths spiked in 2019, reaching record highs. Those on the front lines of the opioid crisis say they aren’t surprised

 

Harm Reduction

25 Years

I hit my twenty-fifth anniversary at work last month. Twenty-five years full time as a paramedic. I am sixty-one years old now and feeling the wear and tear, particularly in these last two years. I don't sleep well at night. My hearing is shot. I need a stronger prescription for my reading glasses (which I also use for intubating and IVs). Last summer I suffered my first worker's injury to my back that has left me with a lingering weakness in my legs.  Fortunately  it is not bad enough that I can't work, but it is bothersome nonetheless. I still carry all my gear up five flights of stairs. I don't get to the top as quick as I used to and I am sure to use the railing on my way back down. I was sick for over a month this winter. I had the really bad cough that everyone seems to have. I worked through the first three weeks because that's what we do in EMS, coughing up green phlegm and downing decongestants. My energy level just wasn't there. I finally said, enough is enough. I'm not coming back until I am well. I laid in bed for two days, and then when I went back to work after a week out, I had a splitting headache and was getting short of breath toward the end of my shift, and so I took some more time off. Good thing, I had plenty of PTO.

 

On Friday when I came in to work I saw the boss (a young man I precepted) and told him I wanted to change my status to part-time. I managed to get some more hours added to my hospital EMS coordinator job so going part-time at my medic job was going to be necessary anyway eventually, but finally saying it out loud, it felt momentous. I'm not going to work Sundays anymore (unless I want to) and other than a few remaining shifts I am already scheduled for, no more getting up at four in the morning. I will still work twenty hours a week, but will just call in when they have shifts available (they always do) and work the hours I can that don't conflict with my work, family, and trying to get healthy again life-style.

 

The boss said he was glad for me, and then gave me my twenty-five year plaque and pin, which had been sitting in the supervisor's office. I took it and shook his hand. The plaque is in the back seat of my car now. Eventually I will just put it in a box in the garage along with my 10, 15, and 20 year plaques. Not that I don't appreciate it, I just don't display things like that.  I also get to choose a 25-year gift from a special catalog). I got a kitchen knife set for my 10th and 20th anniversaries, which I still have (9 knives for the 10th and 13 for the 20th). For the 15th I got a GPS that my wife lost. I am thinking about whether to get the 17 piece knife set, a digital smoker, or a snowblower. The snowblower would be great for snowy mornings, but if I am no longer getting up at 4, the need isn't as pressing, plus with global warming, I shovel less and less each winter anyway.

 

When I went to punch in Friday, after I'd gotten my plaque and told the boss I was going part-time, I saw a flyer over the clock and a picture of a guy I'd gone to paramedic class with. I was 34 and he was 24 back then. Like me he worked 25 years for the same company but in another division. The paper said he had a medical emergency and passed away unexpectedly. He was just 52. Nice young man with a family. A good paramedic. Since we were in different divisions, I saw him infrequently, always at the hospital pushing a stretcher. We'd say hello by name, and then go on our ways.

 

On Friday I worked with Jerry, an old partner of mine, who's been with the company almost as long as I have. We have a great time together, laughing most of the day. Riding with Jerry, it's like we're not even working, just two friends hanging out. During a downtime between calls, we ran through the list of all the people we'd worked with who had died over the years. It was a long one. Some of the people we struggled to remember their names.

 

I still love being a paramedic. I just know its time to take care of myself and my family first. Today, instead of sitting in the ambulance writing this, I am in the stands watching my twelve year old daughter warm up with her team on the basketball court. I am putting the computer down as the game is about to start.

 

 

1200

1200 Dead.

 

In 2018 Connecticut overdose deaths dropped after six years of steady rises. Was it a plateau? Or just a pause in a grim climb? The first six months of 2019 hinted that the deaths might be be on the upward move again, but none of us were prepared for yesterday's news from the Connecticut Medical Examiner's Office.

 

1200.  An eighteen percent increase over 2018.

 

94% of the deaths involved opioids.

 

The dead ranged from 17 to 74.

 

The culprit:

 

Fentanyl was present in 979 of the deaths (82%), its most ever, continuing its unremitting rise since 2012 when it was detected in only 12 deaths.

 

What's the answer?

 

End the stigma. Treat drug users like we treat victims of heart disease, lung disease, diabetes. With compassion, love and evidenced based medical care.

 

Recognize addiction for what it is — a chronic brain disease, not a character flaw.

 

Make rehab available to those who want it and make medication assisted therapy (MAT) methadone and buprenorphine available to all who want it.

 

For those who aren't ready for rehab or MAT, bring them in from the cold, open drug overdose prevention sites where users can be in the presence of trained providers instead of forcing them to shoot up behind dumpsters, in park thicket and in locked public restrooms where we find them dead.

 

Make naloxone as widely available as possible and drill in the message, never use opioids alone.

 

Sue the pharmaceutical companies for their pivotal role in creating the epidemic (lying about the addictive qualities of their products and for producing massive quantities of painkillers even though they knew they were shipping vast amounts to distributors who were then flooding the black market with their products.

 

Use the money to fund a drug war against addiction.

 

Above all, be kind to those afflicted.

 

Missing

She frequented a neighborhood park near the hospital. I'd see her times smoking a cigarette while she sat on the playground swings. Many nights, she slept on cardboard by the fence, sometimes she tied a tarp from the fence down to the grass to provide shelter on rainy nights. She was tall and gawky with red hair and looked a lot older than her thirty odd years because she had lost most of her teeth. Nothing makes a person look older than when their gums recede. I first saw her one morning this summer when the temperature was already up into the 90's and the humidity made it hard to breathe. I asked her if she wanted a bottle of cold water, which she did, smiling in such a way you could see her youth hadn't completely been obliterated from her body from the hard living she had put it through. I also gave her an orange and a couple bucks. She had a tattoo of a blue pony on her neck. It was faded, but the pony looked like a magical kid's pony — the kind that could fly when it wasn't being cuddled by a four-year-old.

 

I never found out too much about her. I knew her name Tammy and knew she was a heroin user. I didn't know her back story of how she came to call the small park her home. She rarely came down toward Pope Park where we post sometimes in the ambulance and where I get to know many of the users walking east up Park Street to buy their drugs. I usually saw her as I drove past in the ambulance headed west.  She walked alone, going in and out of bodegas or standing on the corner lighting cigarettes. Even among the murals and store signs on Park Street, her orange red hair stood out like technicolor in the old movies.

 

Early on a cold fall morning when you could already start to see people's breaths as they stood at the bus stop or hurried down the street to whatever job put subsistence in their pockets, we get called for an overdose on the basketball court in the park. My partner pulls the stretcher and I sling the house bag over my right shoulder, and carry the heart monitor in my other arm. The fire department responders stand in a semi-circle over a body. One of the guys gives the finger across the throat sign to say we won't be needing the stretcher. As I get closer, I see two feet sticking out from under the blanket. I pull the blanket back and stare at the face. When someone dies their soul leaves and their face becomes almost unrecognizable to what they once were. Then I see the tattoo.  I look at her face again. It is white and waxen. She's been dead for hours. Her limbs are cold and stiff. Her mouth is riggored shut. I run my six second strip of asystole.

 

A slow drizzle has started. I pull the blanket back over her face. We head back to the street, past the empty playground. The morning is black, white and grey.

Judge Rules for Safe Injection Site

A federal judge ruled yesterday that a nonprofit group in Philadelphia's effort to open a safe injection site where people can use drugs under medical supervision does not violate the federal crackhouse statutes prohibiting the operation of a space "for the purpose of manufacturing, distributing or using controlled substances."

 

U.S. District Judge Gerald McHugh wrote: "The ultimate goal of Safehouse's proposed operation is to reduce drug use, not facilitate it." 

 

The federal government has not only vowed to appeal, they have threatened to shut down anyone who attempts to open such a site.  Deputy Attorney General Jeffrey Rosen said, "Any attempt to open illicit drug injection sites in other jurisdictions while this case is pending will continue to be met with immediate action by the department."

 

Ten years back I would have thought a safe injection site was a foolish idea, but after witnessing the sorrow, devastation and death caused by the opioid epidemic, I have come to see these spaces as essential.  The evidence from safe injection sites operated legally in countries around the world shows that they work in reducing death and the spread of disease as well as increasing the number of people getting into treatment.  They are a common sense solution to a major problem.  Today users in Hartford shoot up in public spaces, leaving drug paraphernalia (open needles) on the ground, and many of them die behind dumpsters, in public bathrooms and in their battered cars because they are found too late to be revived.

 

As Mark Jenkins of the Greater Hartford Harm Reduction Coalition often says, we have plenty of public drug consumption spaces in this city already today.  The restrooms of McDonald's, Subway, Burger King, the public library,  not to mention sidewalks, alleys, and public parks are all commonly used to as public places to inject drugs.  But these sites are far from safe for the user or the public.

 

A safe consumption space provides a clean environment where users not only get sterile supplies, they get counseling and access to social services.  They are treated by people who care about them and recognize them as fellow human beings who are afflicted with a severe chronic disease.  They are not stigmatized as scumbags and degenerates. 

 

We can't forget that nearly all of these people are trapped in a vicious addiction that often began through an injury or illness and a visit to their doctors.  Their doctors prescribed them dangerously addictive medications that the pharmaceutical companies were making billions off of, while hiding their addictive dangers. Even those who began their drug use through experimentation don't deserve the horror that addiction inflicts.   If you take addicted opioid users and put them in an MRI, the imaging will show the damage done to their brains as surely as it will show the damage done to hearts injured by cardiac disease, or lungs by respiratory disease. 

 

Heroin destroys and rewires the brain's reward pathways.  For many, the damage is so severe, recovery is not possible, all that can be hoped for is periods of remission.  The job of harm reduction is to keep people alive and minimize the ill effects of their drug use.  It is about being our brother's keeper.

 

 

Peace to all.

Two Boys

We are called for an unconscious and find the man out cold on his feet near Pope Park.  He is a tall man in his early thirties with a ghost white complexion, standing there on the side of the road, his head nodded forward, arms hanging down swaying.  Another drug user on the nod in Hartford.  I shake him and he opens his eyes and says he is fine, but then he drifts back out.  My partner wheels the stretcher over and we gently push him down onto it.  He wakes enough to again, say he is fine, but he drops back out.  In the ambulance, I check his ETCO2 and his pulse saturation.  The numbers are 66 and 90.  I can stimulate him and the numbers come up a little, but if I leave him alone, he doesn't breathe well enough on his own.  I put in an IV, which he doesn't feel.  I take a 10 cc syringe, squirt out one cc, then add 1 cc of Naloxone to the syringe.  I slowly give him one cc of the mixture, delivered 0.1 mgs of Naloxone, a tiny dose.  When he doesn't respond, I give him another 0.1 mg dose, and soon he is talking to me.  He doesn't even know I have given Naloxone to him.

 

"I don't need to go to the hospital," he says.  "What time is it?   I have to get back to work or I'm going to lose my job.  I'm on my lunch break."

 

It is three-thirty in the afternoon.  I ask him where he works and he says he is a house painter.  He asks where we picked him up, and after I tell him, he tells me he is painting a house a few blocks from there.

 

I tell him the doctors will look at him at the hospital, and after, watching him for an hour, will let him go.

 

"Dude, I can't wait that long," he says, "I'll lose my job."

 

I feel for him, but we had to take him in.

 

His name is Keith and he lives in an upscale suburb of Hartford.  The street is familiar to me.  I did an overdose there maybe a year before. I remember the mother sobbing at the sight of her son on the bathroom floor, even though we were easily able to revive him.  I sensed she was at her breaking point.  He had already been through rehab four times.

 

"You didn't give me Narcan, did you?" Keith asks.

 

"Yes, I did," I say.  "Just a little, enough to keep you breathing without me having to shake you every minute."

 

"Fuck, I'm going to lose my job."

 

"You have to be careful if you are going to use," I say.

 

"I only did a half a bag.  I just haven't used.  I got out of a program last week."

 

"Your tolerance is down.  If you are going to use no matter what have someone there with you.  Have Narcan around.  Do you have it at home?"

 

He nods.

 

"Who do you live with?"

 

"My Dad took me back in."

 

"Does he know how to use it?"

 

"Yeah."

 

"You have to be careful with the fentanyl around."

 

"I know my friend Marty died a month ago."

 

The name rings a bell with me.  "What was his name?"

 

"Marty Harris."

 

"I took care of him before," I say.  "That was a year ago."  Marty was the young man I remembered.  The news of his death, even though I barely knew him shocks and saddens me.  Marty and Keith were the same age

 

 "He got out of jail after nine months and he oded and died."

 

"I'm sorry."

 

"Man, I'm going to lose my job."

 

Once we get to the hospital, he gets even more anxious, and he ends up pulling his IV out.  I try to get a nurse to come over.  I give the heads up that he wants to leave.  The nurse says he'll get a doctor to look at him.  The doctor comes over and the doctor and Keith end up in a shouting match.  The doctor tells Keith he obviously doesn't care about his own life because he is doing drugs that may kill him.  The young man tells the doctor to fuck off and walks out, swearing that he is going to lose his job and he has to walk all the way back to the job site.

 

That night I google his friend Marty's name and add obituary and the name of the town to the search.  And there he is – a picture of the other young man.  There is nothing in the obituary that mentions drugs.  It just says he died too soon and what a kind heart he had.  He was a high school swimmer, an avid soccer fan and an accomplished cook.  He liked to camp with his family in the Adirondacks.  There is a long list of family members he left behind.  I read the comments.  One poster says how he remembered him so fondly as a little boy playing in the neighborhood.  There are even pictures of him when he had to be about five.  One shows him with another young boy, and I wonder if it is the man who I transported today.

Another poster writes:   "He is no longer in pain."

Austin Eubanks

I attend the Department of Public Health's 2019 Connecticut Opioid & Prescription Drug Overdose Prevention Conference on May 2. The featured speaker is Austin Eubanks, a survivor of the Columbine shooting. He and his best friend were golfing and fishing buddies. He shows us pictures of the two of them smiling, no idea what fates life had in store for them. In the school library, they hear an odd sound from out in the hallway. Another student says it sounds like gun shots. But they are in a school. Guns aren't allowed in schools. (This was of course the first mass school shooting, while today students drill for such occurrence). Then more commotion and a teacher bursts into the room and says "Everyone get under the tables!"

 

Even with that they stand around for a moment, thinking "really?" Then the gunmen, armed with shotguns and automatic weapons, enter the library. His best friend and he hide under a table as the shooters walk through the room systematically executing their fellow students. They are under the last table. His friend is killed instantly, while Austin is shot in the hand and knee.

 

He survives only by playing dead. He tells us how detaches himself from the scene. Later when he is rescued and meets his father, he bursts into tears, the emotion finally ripping through him. But then he is medicated for his injuries. Doctors prescribe him heavy doses of very powerful drugs. He is seventeen years old and has never drunk a beer or smoked marijuana.

 

He tells us that what the opioids he is given do best is not affect his physical pain, but they take away all his emotional pain. They enable him to block all his emotions. While his physical pain subsides in a matter of days, his emotional pain is still off the charts. He keeps taking the medicine –at times more than he is prescribed — because it is working for his emotional pain — blocking the horror of what he has been through and the thought of all his slaughtered friends. The pills provide an escape that quickly leads to addiction. Within a matter of months he is not only drinking alcohol, but as his tolerance for opioids has increased, he is now obtaining pills and illicit drugs on the black market.

 

He uses all these substances for years to manage his emotional pain, which is not addressed by any of his doctors. Because he is able to put a tie on and go to work, he fools people, he tells us, but his life eventually unravels completely. He uses heroin, methamphetamine and other pills to keep his emotional pain at bay and to keep from feeling the sickness of withdrawal. He loses his job, his family — he is married now with a son– breaks apart. After more than a decade of struggle, he finally makes it though multiple recoveries and finds his way home. He reunites with his son and becomes good friends with his ex-wife, remarries and has another son. He becomes a committed advocate and travels the country speaking about the opioid epidemic, offering messages of recovery and hope. He tells us how important his family is to him now, how grateful he is to have found his way home.

 

He tells us about the difference between feeling better and being better. He urges us to pay close attention to people's emotional pain. He brings the message that those addicted are not junkies and scumbags, but our brothers, sisters, parents and friends. He receives a standing ovation from our packed conference crowd of nearly 300, all people dedicated to battling the opioid epidemic.

 

Three weeks later, I open up the newspaper to see the headline Columbine Shooting Survivor Found Dead. His family issues a statement:

 

"(Austin) lost the battle with the very disease he fought so hard to help others face."

 

Was he using when he spoke to us. Were we fooled because he had a tie on and spoke without slurring his words? Or did he relapse after? It doesn't matter. The point is the battle is never over.

 

I wonder what would Austin's life have been like had he not gone to school that day twenty years ago?

 

Thirty-seven-year olds die of opioid overdoses daily in this country. How do people think of them? Are they scumbags and abusers? Are they the unclean? Or are they members of our community? People to be cared for and shown love and mercy?

 

How close we all are to our lives suddenly falling apart. I think of all my patients who look up at me with irrepressible sadness as they say, "I used to normal once."

 

The scenarios are there for misfortune to knock on any of our doors.

 

All

I'm on scene of an overdose. A fifty year old man in an unkempt apartment went unresponsive after sniffing two bags of heroin. His neighbor found him, giving him 4 mgs of Naloxone IN, and then called us. The man is alert and oriented by our arrival and does not wish to go to the hospital. The neighbor says he will watch the man. The neighbor still has another Naloxone in case the man goes out again. He says he gets his Naloxone from the local harm reduction agency.

 

The cop on scene shakes his head and says, "They'll give out Naloxone for free, but kids have to pay $800 for an Epi-pen."

 

This is an argument I hear quite often. "They'll give a drug addict free Naloxone, but my wife, who is a school teacher, has to pay $1000 for her Epi-pen."

 

What is the implication behind the officer's remark. Is drug user's life less worth saving then a kindergartner who mistakenly eats a cookie with nuts in it?

 

Last year over 70,000 Americans died of accidental overdoses. Only about 150 people die a year from fatal food anaphylaxis.  3,000 die from any type of anaphylaxis.* Each of these deaths were preventable. Were the 70,000 who died of overdose all scumbags who willfully chose to become addicts? Were those  Americans who died of anaphylaxis all a higher class of citizen?

 

"Well, the junkies made a choice to use illegal drugs," an EMT says.

 

In EMS we talk all the time about the lack of respect we get as a profession. What makes us professional?

 

Is it the 120 hours of the EMT class we took? Or even the 2,000 hours paramedics get?

 

Is it how spick and span our uniforms are? How shiny our badges?

 

Or is it the way we treat our patients? The compassion in our hearts that recognizes the humanity of all our people no matter their circumstance?

 

Recently a local fire department in its annual CPR lifesaver awards ceremony, chose not to honor its members who had saved overdose victims from cardiac arrest, alongside those who had achieved ROSC in victims of heart attack or other "medical" cause.

 

There is too much hatred in the world. There is no place for it in EMS.

 

We should never pit patients against each other.

 

We should embrace programs like community Naloxone in the same way we should embrace efforts to hold pharmaceutical companies responsible for price-gouging families for the costs of Epi-pens.

 

We should teach people how to properly use Naloxone with the same fervor that we should teach people how to properly use epinephrine.

Goals and Globetrotters

Saturday night saw one of the pinnacle achievements of my life.  Twelve months before, while attending a Harlem Globetrotters game with my daughter, I announced that I was going to learn how to expertly spin a basketball on my finger just like the Globetrotters do.   Ever since then, I have carried a basketball in the ambulance.  In between calls while at posting locations, I have taken the ball out and practiced.  At home I have a basketball in every room of the house.  I even found a heroin addict in Hartford who for $5 a pop would give me spinning lessons. He was an ex-basketball player, who I am pleased to say now has a handyman business and is no longer on the street. (At least that was his plan when a few months ago, he told me I wouldn't be seeing him around anymore, and true to his word, he disappeared no longer to be seen at his regular haunts.  I can only hope he is doing well).  I practiced so much I developed tendinitis in my elbow and had to suspend all spinning for a month. The elbow is much better and I can spin again without pain.

 

When I received notice that the Globetrotters were coming back to Hartford for their annual visit, I purchased Magic Passes for my daughter and I as well as third row seats at mid-court.  As a returning attendee, I took advantage of the 50% deal when the tickets were offered in a special pre-sale.  The Magic Passes entitled us to attend a pre-admission event where we could meet the players on the court, shoot baskets and spin basketballs.

 

Thanks to my daughter, my tryout was recorded for posterity.  

 

 We had a great time, the Globetrotters stormed back from a 9 point deficit in the 4th quarter and beat the hated Washington Generals in a thrilling victory.

 

My daughter met "Swish,"a female Globetrotter.

 

While I was not offered a contract, I did have the opportunity to buy an official game ball for $60 and a Washington Generals t-shirt for $25. 

 

I write all of this because my ability to devote a year to spinning a basketball is one of the great side benefits of being in EMS.  Over the years, EMS has allowed me to pursue a variety or hobbies and interests while at work getting paid simply to be available to respond to emergency calls.  In the 30 years I have been involved, I have read the works of Shakespeare, written five books and countless blog posts, learned to play poker (and when it was legal to play on-line, made a fair amount of extra cash), trained for triathlons and Tough Mudders (when I was assigned to a contract town, I was able to ride my bike on a 0.7 mile loop around the industrial complex where the ambulance base was located -- my longest at-work ride was 26 miles), learned to speak Spanish, failed in an attempt to learn Vietnamese, wrote a food blog on take-out food in Hartford, trained to perform a 100 push-ups in a row (okay, so I only got to 79, and started cheating at 57), amassed one of the nation's premier heroin bag collections, and now have learned to spin a basketball.

 

So what's next?  I think I will work on my balance with a goal of standing on one foot for ten minutes.  My longest time on 10 tries today was 1 minutes and 49 seconds on my left foot and 1 minute and 36 seconds on my right.  I am six foot-nine and sixty years old, so not only is my balance not great, with each advancing year it becomes less so.  I need to improve upon it if I am going to be able to keep at this job I love.

 

Wish me luck.

Calm

When I first became an EMT, a friend asked me why I liked the job so much. When I come through the door, people look at me like I am an angel, I said. What is it like driving lights and sirens? Another friend asked. Awesome — I feel all powerful. I hit wail and the cars part for me like the red sea parting for Moses.

 

If you asked me then if there was anything wrong with what I described, I would have been seriously puzzled by the question. I didn't quite understand the true nature of the work.

 

When I became a paramedic I quickly learned to be a circus ringmaster, barking orders to partners, other first responders and even bystanders. All eyes were on me as I orchestrated getting vitals signs, med lists, moving furniture, putting on oxygen, getting an IV, delivering medicine, extricating the patients, even determining who could ride with us to the hospital. Eventually I brought that same leader of the band approach to running cardiac arrest (compressions, shocks, IV access, drugs, intubation, post-ROSC 12-lead, dopamine to support blood pressure, all seamlessly timed. I felt like a rock star. Driving home, I would go over in my head how well the calls went, how impressed people must be with me. Even if a call wasn't critical, I still strode in like I owned the world. I bantered with the other responders while making my way to the patient. How's the wife and kids? How about that car accident yesterday? Hope the Sox win tonight. I was a big city medic. Living the dream, as they say nowadays.

 

Of course, over time that changed. Work the streets long enough and you can't help but see the job for what it truly is. It isn't a TV show. It is not a play in which you are the star. It is just a system for getting sick and injured people to the hospital in the safest, calmest, kindest way possible.

 

My old teacher Judy Moore used to say the emergency ends when you arrive. It took me awhile to understand what she meant. But I learned. When you come through the doors, you don't bring the cameras in with you. The patient should be the center of attention, not the paramedic. Don't suck up all the energy in the room. Cut the theatrics, the commotion, and the self-importance. Converse with the patient. Reassure them. Be professional. Do what needs to be done without fanfare.

 

I see my old self in a few younger providers, but I don't say anything. They will learn. Even if they came first for the adventure and the lights and sirens as I did, if they stay long enough, they will stay for the human contact.

 

I remember when I was a young EMT at a car accident, doing my best to seize control. An older medic arrived in the second ambulance, and without saying a word, smiled wryly and somehow managed to make sereneness out of my chaos.

 

You don't need a cape to do this job. Drive carefully, speak softly, act calmly, be competent, be kind. Be a paramedic.

PTSD

 

I attended a critical incident stress debriefing (CISD) a few years ago. I thought I had been invited to an informal get-together of folks from another service who I had been on a upsetting call with the day before. Had I known it was a formal CSID debrief, I wouldn't have gone, as I had always avoided them in the past. Not that CSIDs don't help some people, they are just not for me.

 

I have been in EMS for thirty years now, and I have been on traumatic calls. This one ranked up there, but since I wasn't the first medic in, I didn't catch the brunt of it. For me the worst calls are not always those that make the news.  I take it hardest when my patient dies in my care, when I have to witness a sudden deterioration and  feel helpless to stop it or feel like maybe had I done things differently I could have possibly affected the outcome for the better. Other calls where the patient's fate has already been settled before I arrive are less taxing to me than they used to be.  This was such a call.

 

Each of us processes trauma and stress differently. When I was new, it helped to have an experienced person (another medic) guide me through what I was feeling. In time I learned where to put these calls. It's not like you don't think about them  — you wouldn't be human if you didn't — but you soon understand what the job is, and you understand that tragedy and, in some cases evil, are a part of our world.

 

At this debriefing a team member told those assembled, "You gotta let it out, you gotta let it all out or it'll eat you up inside." I didn't want to be disrespectful because I felt I was a guest at someone's house, but I disagreed. If you have a way of dealing with trauma by yourself and it works for you, then that's good. Go with it.  I found hearing what others had seen and felt on the call was more traumatizing to me than actually going through the call myself. Their details (a cell phone, music playing, a family member's response) recalled details from past calls I had done. They triggered an explosion of what I had kept contained. When it was my turn to say what I found most vivid about this particular call, I passed. I didn't want to burden someone else with the images that were in my memory of the call. I found in the next twenty-four hours, that little box where I kept past traumas had been ripped open and all these ghosts from the past swirled around me. I suddenly vividly remembered calls I had long ago forgotten. It took me two sleepless nights to put them back in their proper place.

 

I have friends who have gone through traumatic calls on a scale larger than my own — calls that could shake a priest's faith in God. They struggled with what they experienced. Some talked with peers, others sought professional help, still others went it alone.  Most found their peace.

 

I know peers who have found great consolation with service dogs (I will likely be writing about this topic soon). Others have gotten medical marijuana cards (although I suspect some of them just like to be able to smoke legal weed). Tell the doctor you are an EMT and have nightmares. That and a $100 fee get you a diagnosis of PTSD and a card you can present at the dispensary. While I enjoyed smoking in my youth, and sometimes long for those times, I am a father and a busy person, and just can't see toking my evenings away. I don't even drink beer much anymore, but when I did, I avoided it in troubled times because I always wanted to be clear minded as I sorted through what challenged me.

 

I know there are some members of our profession who will be broken, who will endure as long as they can, and then end up on the wrong end of the bottle or even the wrong end of their own gun.

 

I guess you have to ask yourself how you are dealing with what you have witnessed, and if you feel like you are having a hard time, then find someone you trust to talk to or seek professional help. There are people out there who will help, and there are methods you can be taught to help you deal with what you have been through. If you don't feel like talking about it, don't. If you do, then talk about it. You are not more or less of a person for seeking help.

 

If you see a brother or sister in EMS struggling, let them know you care. Most organizations have confidential employee helplines and have people trained to recognize who may be suffering. Some cases may be obvious, other too subtle to see.

 

Sometimes it not that big call that does it, it is a quiet long accumulation of common sights that leads to despair.  If you sense someone you know is down, if they seem incapable of joy, ask:

 

"Are you okay?"

 

Three simple words with great power. Don't hesitate to use them, even if you know the response:

 

I am, appreciate your asking.

 

Be vigilant.

 

Stay safe out there, and at home.

 

Take care.

 

Tidying Up

 

Twenty years ago when I was looking to buy my first house, my realtor didn't understand why I did not like the home she was showing me that seemed to meet all my specifications: price, location, size. She did not understand that just two months before I had worked a cardiac arrest there. I could still see and smell the man and all his bodily fluids in the cluttered living room where he collapsed. If I bought that house I would have to live with his ghost. Not for me.

 

Home hunting is hard when you are in EMS. You walk in thinking as I always think when I enter a home, how am I going to get the patient out of here? A stretcher will never fit in that bedroom. Spiral staircase, forget it. Even if you didn't do a cardiac arrest in particular houses, you did arrests or memorable calls in houses with the same design. You remember the mother screaming in the bedroom. You see patients wedged between the toilet and the sink. Blood drips down the stairs.  You see all the crap that was in your way that you had to move to get the patient out to the ambulance.

 

I ended up buying a newer house that was empty with freshly laid carpets and big windows that let in the sun.

 

Today when I go into houses, I am depressed by hoarders, not just the ceiling to the floor appear on TV show kind, any kind of clutter. It bums me out seriously.  Dark apartments with dust particles visible in the air and rooms with dirty carpets and boxes of crap and untidy overflowing shelves — it weakens me.  Maybe it is because my own empty house is now more cluttered than I would like. We can only fit one car in our two car garage there is so much stuff in it. Of course I no longer live alone. I share my house with my wife and three daughters, and all their accumulated and still accumulating possessions.

 

The sun bothers them.  Every time I come in the living room I open the shades. Let some light in here. When I am old, I want to live in a spare space with lots of light so when the angels (or the devil) comes for me, I will ready to go. Leave nothing behind but a few heirlooms for the kids and some money in the bank to help them make their own way without me.

 

I am, hopefully, many years away from that day, but I don't want to be caught off guard. I want things tidy.

I went to a hoarder's house once. The neighbor had noticed newspapers piling up at the door and mail overflowing the box. We had to break in. This was a major hoarder. The house had newspapers stacked to the ceiling making rows in what were once big spacious rooms with high ceilings. We went all through the house wandering through the maze until at last I found her. A stack of papers and boxes had collapsed and her legs stuck out from underneath them like the wicked witch's legs stick out from under that tornado blown house that landed on her in the Wizard of Oz.

 

I did another presumption recently where the room was dank and filled with boxes. The man sat dead in his chair by the window, the curtain pulled just enough so he could look out. A neighbor in fact had noticed his face in the window, unmoving, mouth open, not responding to the neighbor's frantic raps on the pane.

 

I need to sort through my stuff. I have boxes of books, and records and VHS tapes in the garage, but I will buy the book, music or movie again digitally with the tap of a button before I will go down to the garage to look for what I know I already own.

 

There is a new show on Netflix called Tidying Up. A young Japanese woman helps people declutter their homes.  Marie Kondo is the author of the book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing that spawned the series. I thought about buying a hard copy of the book, but instead bought it electronically on my Kindle. This weekend, I am ready to put her plan into action.

 

She advises starting with your clothes. You take every item of clothing you own and put it in a pile in one place, and then you go through it. Rather than deciding what to throw away, you decide what to keep. You hold each item and ask yourself if it sparks joy in you. If it does, you keep it. If it doesn't you thank it for its faithful service, and then put it in the throw or giveaway pile. I have uniforms from past EMS services I worked for. I will never wear them again. I don't need them to remind me of the old days.  A ti-dye tee-shirt  made by my daughter with my name on it and a smiling sun stays.  An old torn Bruce Springsteen concert tee-shirt from 1984 goes, after being thanked for years of service.

 

Next you do your papers. She advises you throw them all away except for those that you are required to keep (wills, birth certificates, tax returns etc.) and those that need attending (bills, correspondence). I will keep my recent CME certificates, which I am required to keep for three years, but I will throw out my handouts from classes taken decades ago, as well as all those old ECG strips I kept. Seen one v-fib, see them all. I don't need them to remember what it felt like to shock all those people with sick, and often dying hearts.  For those rare few, I don't need the strip of the resulting sinus rhythm to remember the feel of the pulse beneath my fingers or the warmth with which their family hugged me when we later met.

 

When it comes to books, Marie Kondo says you shouldn't own more than 30. A book lover, I might dispute that, but the over one thousand I own are mainly in boxes, and the ones on shelves, I rarely take down. Better me sort them now than a grandchild have to haul them off to a tag sale. I will keep a select few (The Iliad and The Odyssey, Moby Dick, The Great Gatsby and The Old Man and The Sea) as well as a box of my books (Paramedic and Rescue 471) to give out from time to time because that brings me joy.

 

You work your way through everything you own, finishing with the personal mementos and sentimental objects.  I will keep a wooden carved Don Quixote, a small brass Bengal tiger given me by my father when I was five, and a single baseball card of Tony Conigilaro, my childhood hero. 

 

The principle around all of this is stuff takes up space and energy. If you are going to have possessions you should be surrounded only by what brings you joy. I can have a garage filled with boxes or I can have space where my eleven-year-old daughter and I can dribble basketballs on cold snowy nights, working on our crossovers to see who's is better (hers).

 

I can't wait to get started.

 

When the day comes when the medic calls the time on me, I want him to think what a beautiful clean well-lit room this old gentleman passed away in, the morning sun on his face. And I want him to look at my spare surroundings and see only the things that brought me joy (pictures of my family on the wall), the Grateful Dead's "Ripple" playing on my Amazon Echo, and to think what a life well lived. And as I journey up toward heaven (again, hopefully as I have tried to be kind), I want to look down and feel I have left a good impression and not a cluttered mess.

Balance

 

December 8, 2018: This weekend, I am in Worcester, Massachusetts at the New England Short Course Meters Masters Swimming Championships as a member of the Connecticut (CONN) team. Last year, we shocked many of the other teams by taking first place. Points are awarded based on place finish in individual and relay events. Each swimmer is only allowed to swim a maximum of six events a day or 13 for the entire meet. Friday evening is distance day (800 Free), Saturday and Sunday are for the relays and the main swimming events. Last year I scored 119 points swimming 12 events despite having a pretty severe chest cold. I also swam in three of the four relays. I came in second in the men's 55-59 200 Meter Butterfly and earned 15 points for it. I was second out of 2 swimmers. Last year I finished 25th in the nation in that event in my age group. 25 out of 25. Still I was proud as it is a difficult event, particularly for someone who did not know how to swim the stroke five years ago. I am swimming it again this year, and if all scheduled swimmers swim, I will likely finish 5 out of 5, but maybe some of them will scratch (drop out) as it is the last individual event. Last year I swam the full 200 meters without stopping. This year I may hang on the wall and catch my breath at some point along the way. I have not trained as much this year as last. My best event is the 50 free, but I will not come close to my best time of two years ago. Again, lack of training time and intensity. Plus Father Time sapping some of my strength.

 

Joe Frazier used to say. "If you cheated on that (your roadwork) in the dark of morning, you're going to get found out now, under the bright lights." I have no cold this year, but I am a year older, and not in the shape I used to be. That lack of training is likely to be apparent. Still I am here as part of a thirty person contingent of people who I have come to call my friends over the years. No matter how fast or slow I swim, i always get high fives and good jobs. I doubt we will win this year. Charles River Masters, who we upset last year, showed up loaded with more swimmers. My goal is to score more points for my team than last year, which will be a little easier as I am swimming one additional event and I have moved up in age to the 60-64 division.

 

Here's why I writing all this on my EMS blog.

 

I was talking the other day with a new medic trainee and we were talking about a number of the old career medics who were around when I started, and I told her of how many of them ended up broken. Here's a roll call. Overweight, fired for poor behavior, dead of a heart attack. Fired for violating policy, seen a few years later in a nursing home with jaundice, dead not long after. Retired unceremoniously, dead within months of lung cancer, obit posted on the operation's wall. Fired for undisclosed reasons, shot dead by police in a standoff — suicide by PD. Left for undisclosed reasons, found dead in bed a few years later, obese, uncertain of heart attack or overdose. Not a lot of happy stories. Many say that the job will leave you bitter in the end.

I used to say that I wanted to stay at this until I am 72 when my youngest daughter is targeted to graduate from college. I don't know if I can make it make it that long. I am hoping to at least stay full time until my middle daughter who is a freshman at college graduates. My goal is to get her through without any debt. In addition to my medic job, I also work as an ems coordinator at a local hospital. Between the two I am scheduled for 64 hours a week, but I often work longer. I try to keep Saturdays as a day for my youngest daughter and I to do things together.

 

My youngest is very into sports, and unfortunately, tomorrow, she has her first basketball game of the season, and I will miss it because I am here at the meet. She is playing in two leagues this winter, one with Saturday games and one with Sunday. Other than today, I will be at all her Saturday games, but because I work Sundays, I will only be able to see the Sunday games if I take off work. A part of me wants to go part-time on the ambulance so I can be free to see all her games, but with the middle daughter in college, I can't really afford that yet. I debated not going to this meet, but last year I skipped several meets to see her games. The fewer meets I do it seems the less I train. This is the one big meet of the year, so I expected if I skipped it, my identity as a masters swimmer would pretty much slip away, and I am not yet ready to give that up. I need athletic competition to keep me healthy and maintain my image of myself as an athlete and a man still in prime health.

 

All these conflicts.

 

I used to never miss an ambulance shift. I prided myself on always being on time and always being there if my name was on the books. In twenty-five years I have only had to go home sick twice, and only called out sick about the same number. I have only been late three times, twice due to a time change and once due to my alarm not going off. I take days off fairly freely now. With my seniority, I get a ton of PTO, so I use it. I took off for Zoey's soccer championships and I will certainly take off for her basketball championships if she makes those. My next swim meet is Superbowl Sunday and I am planning to take off for that, but only if it doesn't conflict with one of her games. I'll take that game over the local meet. Hopefully, I'll be able to do both.

 

I enjoy my swimming friends, as I enjoy my EMS friends. And of course, I enjoy my family most of all. Between the three I hope to be able to maintain a balance that I have not always had. I don't need to be on the ambulance everyday or at every swim meet or at every single one of my daughter's games. I just have to do my best to be there whenever I can, and ensure that I am healthy, and happy. I want to be there for the long run.

 

Postscript:

 

We came in 3rd in the meet. I had the eighth most points of any male in the competition, points mainly accumulated because I was one of a few who swam 13 individual events. I finished the 200 Butterfly only a few seconds slower than last year, and captured 3rd place. Out of 4.

 

My daughter won her game and scored 8 of her team's 14 points. Hearing her recap of the game wasn't as good as being there, but it was still great. Nothing much of interest happened on the ambulance that day, according to the guy who filled in for me, nothing unusual. I didn't miss out on anything exciting.

 

The meet renewed my enthusiasm for swimming, so I have been hitting the pool hard this week. I saw my daughter's game yesterday and it was great. They won and she played well, scoring 10 or 12 points in the win, including making both her free throws. Not bad for 10 years old.

 

I am at work now, posted on a street corner in the December rain, drinking hot tea with honey.  I am hoping the next call will be an interesting one.  I hope that I get out on time so I can swim at the pool.  I hope that when I get home, I will sit in my armchair and have a cold glass of water, while my wife sits on the couch and laughs at Will Ferrell in the Wedding Crashers in a way that brings warmth to my heart.  I hope that my daughter will be dribbling her basketball back and forth between her legs.  I hope that she looks up at me and says "Dad-Catch!"