Peter Canning

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

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 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.

 

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.

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.

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."

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.

 

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.

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.

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.

 

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.

 

 

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.

 

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!"