Thursday, November 28, 2013

Happy Thanksgiving

Happy thanksgiving all. 

Some had a belly food of food, and maybe even one too many cocktails, but I can’t help think of the souls in this country who are going to bed, again, hungry. They have nothing and no one who cares about them.

Writing this blog, I wrestled exactly how to structure it. Should I start from the beginning and try to rattle the brain cells so the sequence of events is chronological or, easier for me, is to just tell stories over the course of the past 30 or so years. I’ll be honest, for me to attempt to put these rantings in chronological order would be practically the same as setting myself, and ultimately you for inaccuracy and failure. So please accept my choice to be a story teller rather than a chronological historian. Deal?
One thanksgiving I was working in New Haven for New Haven Ambulance with my EMT (now Medic) partner Gene Stabile.  Thanksgivings were never fun to work. People ate too much, drank too much and there were more deaths on this day than any other. You got up in the morning, showered and headed off to working with the knowledge is your heart that amongst the stuffed bird, sweet potatoes, and other sundry dishes, one or more family would end the day with a house in disarray and one less family member who would be absent at next year’s celebration.  The thanksgiving prayer in the coming years would include some phrase like “…and please dad, know we love you, miss you and this holiday will never be the same without you”. Families would raise a glass, and having a year pass to heal the wound, would carry on as usual. Very strange.
Back to Gene & I. We got a call in Hamden, CT for a man “not breathing”. What a shock we said out loud. It took us about 5 or 6 minutes to get to the house, and there were fire units and police units who had arrived ahead of us. As an aside, this is called a multi tiered system.  Three agencies are dispatched at the same time, none being equidistant from the address or incident, to begin to deliver care as quickly and as accurately as possible. The funny thing is all people die in the same way. We have a fixed period of time, a very short window where if care is begun, the likelihood of survival increases dramatically.  We use 4 to 6 minutes as the time allotted before the brain starts looking and acting like the turnips on the dining room table. You get the idea. We can resuscitate someone if care is started later, but the outcome is very poor. Hearts are pretty tough muscles and if you do everything correctly they will start beating again. Perhaps not for more than a day or so, but long enough for families to digest (no pun intended) the thought of harvesting organs for other dying souls. Brains however are markedly less forgiving, much more demanding, very high maintenance and not real happy about being oxygen starved. Hearts, Kidneys, Skin, Eyes, Livers, and most other organs are more forgiving.
We walked into a Steven King Movie. There was an old lady trying to hold back Cujo, other, younger members of the family were yelling and swearing and threatening us, telling us (the PD, FD & us) that we were moving too slowly, didn’t know what we were doing, and if dad died, they would see us in court. The Police universally are wonderful. Firstly they exude authority and secondly, they have handcuffs and mace. Never fear about working in a multi-teared system where there are cops. They get it. They understand not only our stress, but the stress being exhibited by distraught families.  We could never ever do our job without us carrying semi-automatic weapons or, more appropriately, having the police on scene. I love those guys.
CPR was in progress by the Hamden fire department, the scene was safe and by having them work really hard on chest compressions, breathing for the man and suctioning out of his mouth and throat what seemed like gallons of thanksgiving over indulgence, we could concentrate on our job of providing advanced life support. (Read: http://www.sca-aware.org/survivor-stories/a-nightmare-for-thanksgiving)
We evaluated his cardiac rhythm, which wasn’t great. After 3 shocks from our defibrillator, we started an IV in his neck, giving him fluid, medication, and interposing re-evaluations of his cardiac rhythm and treating them according to our guidelines, or “protocols”.  Scene time is usually 20 to 30 minutes when all is said and done. This poor man would not respond to all of our efforts. We were all drenched in sweat, the aroma in the room was putrid (not uncommon and something that comes with the territory) and the family was a total, understandable, decompensating mass of sadness.
Once he was “packaged” and our efforts never ceased, he was moved to the ambulance, where we continued our efforts.
Prior to leaving and just before the second rear door was shut, family friend arrived, who was well known in the community because he was the Monsignor at the local Catholic Church. Quite politely and quite self assured, he asked if he might say a prayer and anoint the body with the last rights (talk about a tear jerker). We had 3 people in a van ambulance, plus gear and the patient who we were still working on, so the only body part Father could reach was the patient’s big toe and his left foot. We were anxious to get moving but nevertheless respectful of God’s plan.
Father took out his holy oil, said a prayer, made the sign of the cross on the patients foot and at that precise moment, our patient’s heart started beating on its own again.  Can you say goose bumps? We took him to Yale, no CPR was being done because he was sustaining his own blood pressure and breathing on his own. Not one word was spoken in the back of that ambulance until we had delivered the patient and begun our chores of cleaning up and restocking the material we used. Tears were shed by several members of the team, myself included and at least for myself, I will admit I had an epiphany.
Our Thanksgiving Day patient died two days later, but his family gave life to five people by donating his organs to others.
I have from time to time, wrestled with my religion wondering if God wants someone home, what right do I have to try and change that plan.



Monday, November 18, 2013

Ground rules

Please understand that over many years and many successes and failures, the grey matter gets a bit soft.  The medulla is responsible for the basic vegetative functions of life. Breathing and so forth. Often these days, I think my higher level of thinking is based in my medulla and not in the cerebral cortex. And no, I haven’t started wetting myself….yet

Let me say, I’m not a writer. I’ve never been schooled in the demonstrative syntax that draws folks in, yet I hope my story and the stories of the folks who helped me along the way find a place in your heart.
Before I move forward, I would be remiss if I didn’t thank my old and dear friend Laurie Larson Stone for giving me the inspiration to blog this crazy journey. I haven’t been the greatest friend, but that doesn't diminish the love and respect I have for her & Randy.

So here is the point where I need some help. When I share & document the going’s on, should I use the real names of the folks I worked with. I would never violate the privacy and sanctity of offering a patients name, purely out of the respect they deserve as well as the respect their families deserve. Trust me when I tell you that there are some patients, and many of you would know them, whose names, addresses, and so forth I’d love to give out if for no other reason than retribution. Sanity dictates that I don’t do that.
If you would rather not have your name used in this crazy tirade, drop me a note and I’ll come up with an alias.

Next post: Really? We are ambulance drivers? 

Sunday, November 17, 2013

My initial thoughts

In 1976, My brother Brian and I were working for Gene & Mary Halliwell at a Mobil Gas Station they owned on Main Street, in Westport, CT.

Westport is one of those New England towns which were home to the likes of Paul Newman, Joanne Woodward, Jack Klugman, Linda Blair, and perhaps most infamous, Marylin Chambers. 30,000 folks lived among movie stars and porno stars. Just the way it was and there wasn't an extra eyelash batted.

I met a wonderful man named David Warburg who used to come into "our" station for his daily fill of gasoline in a big 'ol station wagon with NY Ambulance plates, which always gave me pause, because this behemoth was no more an ambulance than a Harley. David however was fascinating. Fact is, he still is. Truth be told, I was out of high school, headed in no particular direction when I met David. His stories of life and death, the training he had and others in Emergency Medical Services (EMS) had drew me in like the proverbial moth to a flame.

"Tell you what" he said,  "I'll sponsor you through an EMT class being held at Norwalk Community College. You pass and get certified, and you can come to work for me" My thoughts vasilated between caregiver, life saver and failure.

Needless to say, I did well. 30 years later, after David's kindest gesture,  and after many years of seeing the worst life could possible dish up  and yet seeing the most beautiful things God and life had to offer, I regret nothing.

In the following days, weeks & months, I will share my experiences, the folks i met, loved and lost along the way and attempt to offer an insight into what life is really like in an ambulance, after those two large tomb-like doors close.