It's a rainy weekend here. The sky grows dark and the thunder echoes through my bedroom window as I stagger to the kitchen for a brew of coffee. The rainy coolness has a blue jay busy at the feeder when I go to fire up the trusty java maker. What to do today? I contemplated this as I sipped and stared at the doings of nature playing out in the front yard and in the woods distant. Something different, something my wife and I could do that isn't a chore, or something that needs to get done, that isn't a re-make of every other weekend we happen to have together. A not too frequent occurrence on my schedule. Maybe a show, I thought? The Mississippi gulf coast has become like a mini Las Vegas strip since the early 90's, why not take advantage of it? Pulling up the Beau Rivage, a casino located in Biloxi, not more than a 45 min drive away, and one that I've had the pleasure to see George Carlin live (back in 03'), Stomp, and River Dance in years past. Why not? It's raining, there was some money in the bank, and a live show would be different than mowing the lawn, pulling kudzu vines off everything, washing the boat, watching the bugs eat my crop, cleaning the house, and everything else we usually find necessary to make life livable. I see that there's this show playing by the description posted is similar to Cirque du Solei, perhaps I'm not spelling that right, that I missed back when they was last touring the coast a few years ago. It had a sexy woman with hoola hoops to showcase the spectacle that was showing at 3pm.
That was good enough for me, and my wife seemed happy to go with the plan. Despite what they say about marriage, sometimes there is a consensus.
We got in our car, a quickly aging conveyance closing in on two hundred thousand miles, that my wife calls "little red." It's a hatch back Toyota Matrix with plastic fenders that rattle when the speeds exceed forty miles and hour. It's good on gas, or at least I say that now when gas is still affordable. We arrive at the Beau Rivage early despite the insanity that is interstate driving, a zig-zagging chorus of rudeness and chaos. Defensiveness has become a imperative for survival, or maybe it always has been that way. We park at the highest level of their stacked parking garage that it seems the employee's use too as we notice waiters, cooks, and tellers drone out of their cars in uniform, their personals in shoulder bags, purses, and packs. A cool breeze blows in from the Gulf of Mexico as a wet sky storms near the horizon. I notice none of them even takes the time to see the sky and all its rapture. Their text messaging taking priority. I look at mine drawing it forth from pocket, a now outdated iphone3, its back cracked from being dropped too many times. Is this a chink of the chain that has me too preoccupied for what really matters? I suppose, I suppose what I now write is part of that as well. We walk and get into the elevator which has a camera trained on our heads. My privacy already invaded by obedient choice. Down in the casino lobby it seemed busy, people coming in with their luggage for a weekend stay, the line at the bathrooms which had sharp containers for the diabetics, and women dressed up in finery milling in the overpriced casino stores. I suggested we go to the coffee shop for some mocha and conversations before getting in line at the ticket office. The mocha espresso came in a pleasant textured cup, a woody spoon to stir with, and protective plastic cap to protect more delicate palates. I chose instead to drudge the concoction dipping my facial hair in with the whip cream. The hotness losing its bite through the colder topping made a well temp brew. Our communion fell to the topic of failed dreams, and my many regrets, the chips I carry around like so many bruises. Perhaps appropriate since she chastised me for wearing blue shorts with a black shirt, saying that I looked like a bruise before coming to the casino, all in good jest mind you. My dream was always to be a physician and to be a father. It looks more and more like I will die never having fulfilled any of those personal ambitions. What percentage was my fault, and what percentage did destiny kill? My dark thoughts were too heavy for a preamble to the entertainment that we were seeking to enjoy so I got off the subject. Other couples sat quietly with nothing to say around us. Marriage has it's way of speechlessly communicating.
The theatre had this smoky haze that added suspense as we waited for the show to begin. I had managed to get good seats, near the stage, but not so near to be hit by a snapped cable and a shocked trapezist. People used their phones to preoccupy the inevitable boredom of waiting, and young kids bobbed up and down in their seats with unrestrained energy powered by too much high fructose corn syrup. The thirty minute wait didn't seem too long with all the people watching I was doing, like a trip at the zoo. "Look at the humans!" I thought, as though I was an alien to my own species. The show began with a bang, booming music, and vibrating stages. A short man wearing an inflatable circus suit emerges from the floor, his hair a crazy style not easily described, who sported a selling grin. His spoofs had the crowd, and us, laughing gaudily at his mime style humor introducing the acrobatic show, his own dexterity and skill not lacking. A gorgeous sexy woman comes out wearing a suit that makes her appear naked but decorated in tribal goth symboledge that then grabs long curtains that attach with cables to the ceiling high overhead. Oh man, did she put on a death defying show that had me gripping the seats whenever she'd do this amazing flip that left her free falling down to her ankles only to be caught by her tense feet hooking the curtains. Between the Braveheart style music and the rich wardrobe enticing women it left me more than entertained. One set proceeded to the next with stunts of all sorts that had everyone clapping. Adults and kids both enthralled by the feats that few in the world could ever do. Bodies well disciplined and worked over into immaculate physiques. One particular act featured two muscled men that towered and tilted with each other into handstands and sick positions that seemed impossible. Positions that took amazing feats of strength, the pains of which shown in their strained countenance. Then there was this women you could see every cut and muscled shadow etched in delicate relief as she twisted and torqued around a pole, her legs at one point so flexible and stretched she could surpass the well known split - and then beyond - into a wondrous feat of dexterous physicality. Wow, what specimens! I look at the crowded theatre, at myself, and feel woefully inferior. I think of the descriptions Europeans had of the "savages" and what fine specimens were they, and think of what had been lost.
The show couldn't go on forever. Completely entertained we took ourselves from the theatre and headed back home talking about all that we had seen. I chose to drive the coastal highway along the beach to see the many changes since Katrina. None of the Yacht clubs had returned, their docks and moorings empty with weeds growing through their parking lots. The live oaks looked a struggle, their ancient limbs bearing a still injured canopy, and their trunks bearing scars and rips. I counted the dead ones that some local artist had chainsawed and chiseled into beautiful carvings depicting birds, turtles, and fish.
A dozen by the time we reached Bay st. Louis? I swore to myself to take the bike down next week and give an accounting with digital camera. A little adventure to see the coastal scars, and plus it would be fine exercise. A fine specimen I was not......
Sunday, August 19, 2012
Thursday, August 9, 2012
The truth about cops
This will not be a popular post. Most cops are good people who want to protect the neighborhoods they serve, and enforce the law to the best of their ability. It's there duty, and it's a extremely unpopular one in a country that has too many dominionist laws - like prohibiting marijuana. Cops also represent the State and its arm of enforcement, an institution which is becoming increasingly isolated as people begin to realize they have almost no power to affect their governance, and it places them more often than naught against the citizens they're meant to protect. Cops themselves are just as disillusioned to the corruption that they're obligated and sworn to protect, but the bottom line is "it's there job," a job that's more than protecting the bourgeois class from the proletariat. It's a job that encompasses robberies, rape, assault, motor vehicle accidents, fraud, child abuse, molestation, murder, and so much more, and while they are loathed and held in contempt by many it's the public - not the police - that's the problem. A good, healthy, and civilized society, one that arguably has probably never existed in its idealized form, would never warrant a strong police force, or perhaps none at all. But today's society is not healthy or civilized, and it's not the fault of the cops either, but rather the endemic philosophy that enslaves us. Cops, like us, because they come from the proletariat class, are just as caught up in the corrupt morality that sickens and destroys lives. They, more than any other profession, are more prone to corruption because of the constant restrained action they're encouraged to take when dealing with a collapsing and increasingly deranged public. When they go too far, which is easy to do when you have the power do so, gives them the taste that they can dish out judgement before judgement. They themselves become the court of public opinion, one that is more susceptible to real harm than the judgements on twitter and facebook. They become a reflection of what we feel and think but are unable to do. It's why cops become cops - they want to do something about society. A more noble cause than all the vapant talk the public undertakes gossiping about the latest justice theatre put on by the media.
Cops are respected, but not liked by most. Whether it's the third speeding ticket in so many months, or the power trip expressed at a chance meeting, the innumerable stories of corrupt cops, the countless video's on utube showing abuse, or a drunk overnight stay at the popo, cops are not liked. Especially if the citizen is on the wrong end of the law. If you have any of these feelings towards the cops you can rest assured you're not alone, but I'm here to tell you cops as a job, as a group, are so much more. When they are polite, when they do their jobs well, and truly live up to the claim of protecting citizens they are so seldom reported. Today's gaudy and fustian media would have trouble selling the stories. The public, a mentally and emotionally impaired group, wants blood, wants wickedness so they can chew on it in the court of public opinion. This is why you don't hear much about all the good they do, of which I'm here to tell you is of far greater occurrence than the inevitable wickedness that sometimes plaques all those who weld power. My opinion is not validated by sitting at the laptop and blogging about it after watching Beverley Hills Cop, Lethal Weapon, or the latest version of The Lone Ranger, but rather from twenty one years working with them on countless emergencies. I have personally seen police officers carry a seven year old child actively seizing from a burning car, subdue the most violent people you can imagine before they could hurt anyone else, and retrieve possessions that were once stolen. I have seen them spend hours upon hours patiently talking a man down from certain suicide, or homicide in some cases. I have seen cops turn lives around by listening. I have seen cops prevent preventable accidents that steal away lives everyday. I have seen them save children from abusive parents, and nab the most sick of the sick before they could rape another kid. All while doing it professionally, calmly, and with due diligence.....mostly. But I'm also here to tell you they are human, psychologically frail as any, and more exposed to the raw iniquities of society than anyone else. Some of them eventually reach a point where they are sick to death with criminals, and their professional inhibitions towards judgement are crossed and they evolve into something akin to judge Dred - "I am the law!" I have seen these cops, they are the understandable product of a sick society. It only takes one to make the whole group look bad. The more sick the community they serve, the more prevalent one of these bad cops will show up. Take New Orleans for example, a very sick community, one ill with poverty, drug use, hate, gangs, theft, and rape to greater degree's than much larger cities their size. It's extremely prone to police corruption. 35k a year to handle that public? Lord, it would take someone morally divine to have a career without corruption there. Sometimes, all it takes is for the wrong person to join up, take the oath, and swear the law to be affected by the worst of crimes to fall to temptation. They're human right? All different and capable of potentially different transgresses. Take a look at yourself before you judge them. What are you doing for society? When was the last time you stopped a murder, or prevented a drunk from killing someone. When was the last time you stopped a husband from beating his wife or kid? They're expected to do this without passing judgement on the presumption of innocence. Can we at the armchair of social networks? No, I haven't seen it.
As a paramedic I work with cops all the time. They form the back bone of emergency response, and in my area they are the first to speak with anyone calling 911. They readily respond to any emergency that may endanger our safety or the safety of firefighters. They're also there to enforce the law, the breaking of which is the cause of many emergencies. For instance the drunks that endanger everyone when they get behind the wheel. A virtual guarantee where I work. The public high on drugs as they threaten their neighbor or steal their belongings to buy the next hit. A badge, a gun, and a person willing to put themselves between me and these crazies is much appreciated by myself and the family I come home to. I look out for the cops, and they look out for me, and we include the firefighters in this family of first responders. So when I see people presuming corruption and judging cops in the theatre of public opinion without the assumption of innocence I become perturbed and irritated. They are my uniform brothers and sisters who are out there with me trying to make a difference.
Finally, to my fellow protesters, I offer this video up as evidence to many cops that respect the constitutionally protected right to protest
Cops are respected, but not liked by most. Whether it's the third speeding ticket in so many months, or the power trip expressed at a chance meeting, the innumerable stories of corrupt cops, the countless video's on utube showing abuse, or a drunk overnight stay at the popo, cops are not liked. Especially if the citizen is on the wrong end of the law. If you have any of these feelings towards the cops you can rest assured you're not alone, but I'm here to tell you cops as a job, as a group, are so much more. When they are polite, when they do their jobs well, and truly live up to the claim of protecting citizens they are so seldom reported. Today's gaudy and fustian media would have trouble selling the stories. The public, a mentally and emotionally impaired group, wants blood, wants wickedness so they can chew on it in the court of public opinion. This is why you don't hear much about all the good they do, of which I'm here to tell you is of far greater occurrence than the inevitable wickedness that sometimes plaques all those who weld power. My opinion is not validated by sitting at the laptop and blogging about it after watching Beverley Hills Cop, Lethal Weapon, or the latest version of The Lone Ranger, but rather from twenty one years working with them on countless emergencies. I have personally seen police officers carry a seven year old child actively seizing from a burning car, subdue the most violent people you can imagine before they could hurt anyone else, and retrieve possessions that were once stolen. I have seen them spend hours upon hours patiently talking a man down from certain suicide, or homicide in some cases. I have seen cops turn lives around by listening. I have seen cops prevent preventable accidents that steal away lives everyday. I have seen them save children from abusive parents, and nab the most sick of the sick before they could rape another kid. All while doing it professionally, calmly, and with due diligence.....mostly. But I'm also here to tell you they are human, psychologically frail as any, and more exposed to the raw iniquities of society than anyone else. Some of them eventually reach a point where they are sick to death with criminals, and their professional inhibitions towards judgement are crossed and they evolve into something akin to judge Dred - "I am the law!" I have seen these cops, they are the understandable product of a sick society. It only takes one to make the whole group look bad. The more sick the community they serve, the more prevalent one of these bad cops will show up. Take New Orleans for example, a very sick community, one ill with poverty, drug use, hate, gangs, theft, and rape to greater degree's than much larger cities their size. It's extremely prone to police corruption. 35k a year to handle that public? Lord, it would take someone morally divine to have a career without corruption there. Sometimes, all it takes is for the wrong person to join up, take the oath, and swear the law to be affected by the worst of crimes to fall to temptation. They're human right? All different and capable of potentially different transgresses. Take a look at yourself before you judge them. What are you doing for society? When was the last time you stopped a murder, or prevented a drunk from killing someone. When was the last time you stopped a husband from beating his wife or kid? They're expected to do this without passing judgement on the presumption of innocence. Can we at the armchair of social networks? No, I haven't seen it.
As a paramedic I work with cops all the time. They form the back bone of emergency response, and in my area they are the first to speak with anyone calling 911. They readily respond to any emergency that may endanger our safety or the safety of firefighters. They're also there to enforce the law, the breaking of which is the cause of many emergencies. For instance the drunks that endanger everyone when they get behind the wheel. A virtual guarantee where I work. The public high on drugs as they threaten their neighbor or steal their belongings to buy the next hit. A badge, a gun, and a person willing to put themselves between me and these crazies is much appreciated by myself and the family I come home to. I look out for the cops, and they look out for me, and we include the firefighters in this family of first responders. So when I see people presuming corruption and judging cops in the theatre of public opinion without the assumption of innocence I become perturbed and irritated. They are my uniform brothers and sisters who are out there with me trying to make a difference.
Finally, to my fellow protesters, I offer this video up as evidence to many cops that respect the constitutionally protected right to protest
There are many cops like this one. Just remember to know the regional laws regarding protests and where you can do them legally. The problem isn't with the cops, it's with the laws, and how they are manufactured to destroy liberty. The origin of this corruption comes from the bourgeois. The cops, like us, are their tool and resources. Remember then who to focus your anger against.
Wednesday, August 1, 2012
Small heart beats
Summer, a season for water slides, skinny dipping, snowballs, and flying kites just to name a few. All of which spells fun for kids of all ages, even the kids at heart who now wear bifocals and muse themselves in times long past. One chases her older brother through the spray of a wet willy, the other sheds tears at church in loving memory. The laughter of children echoes through the blades of grass, the crickets orchestrate a symphony, and the sun emblazons the silhouette of a ancient live oak bearded in grey shaded moss. The Southern sky invigorated by a distant storm casting bolts of lightening, a omen, the kiss of a Summer soon to be lost.
Mama comes out with ice cold pops prompting a "all for one" scream and a trouncing stampede of bare feet across the grassy carpet. The hot sea of asphalt made from the black blood of the earth separated them from cold rhapsody of frozen sweetness. Its purpose to tempt, to lead astray, and convey death by way of destruction. "Mommy!" screamed the joyous and giggling three year old making her way across the demonic roadway. Her little legs unable to keep up with her two older brothers who innocently race ahead. Their wet bathing suits dripping prints in the sizzling and falsely quiet roadway. A ways away an Oldsmobile turns for home with a mournful old woman still remembering Summer's of old. A distant thunder gives warning without being heard. The innocent one makes her way across the road defying what seems fated. She's usurped by grandma opening her door to check on the weather from across the street. The pistoned beast picks up speed headed for home seeing that the roadway is now clear but isn't.
Ah, but what was that?! A thump and scraping growl, a hollow pumpkin bounce with a gravel sounding slide. The lady at the wheel, now white knuckled grip and trembling hands, pale as the dead she said goodbye to understands with rapid abandon. Simultaneous screams of utter dread echo between the trailered homes and the meaning of the approaching darkness made apparent. A bare chested and tattooed muscular man bursts forth from the door nearly slipping on the now dropped and forgotten frozen treats, his countenance of furious vengeance raining down on the ghostly driver. "YOU KILLED MY BABY!" was barreled like a small army of charging vikings and one would swear the glass windows vibrated as if enduring a small earthquake and even the distant storm sensed an equal. The heavy man with thundering footsteps closed the distance to his little girl, a tiny body shattered and sheared, her blood a'mix with the blackness of tar and pebble. The stuff of life pumping out like so much spilled milk. A unrequited howl tones a now weakened father. The horror siphoning every bit of him away as quickly as the bloody tributaries traced their way to the ditches. Her small heart beating its way to the land of the dead.
Trembling fingers touched numbers in a glassy face, three numbers in all, 911 they say, but might as well be a twenty digit launch code of infinite complexity to one under the influence of the mighty hormone adrenaline. In a metal clad station half a town away came the familiar tones beckoning us to the life saving chariot. Getting the dreaded news across the radio we made haste while daring those who failed to yield to us to make them a crash test dummy. A small heart was waiting for salvation, and a vigil in spirit dying in lieu. Arriving when surely her spirit rode the final tunnel to undying light, and our promise of hope flickering in red and white strobes, we at her side watching father cradle and rock flesh and blood. A flash of gorgeous blond hair covered in thick rivets of blood was draped down across her back as head and scalp lay unfolded. Her left eye smashed deeply, skull depressed, and spittle's of gasping breath between glossy white baby teeth. A frame too delicate to touch but must. It seemed such a front to open the mouth and insert a steely bladed scope; peering deep inside, sliding tube to trachea. Blood and a deathly brew clouded what I aimed to see. Breath, that enduring necessity of life, once again filled her lungs. Father could look no more and the killing ghost sobbed endlessly behind her locked car doors. Brothers a grim stood disbelievingly, mother to phone trying to speak between the flood of tears, and grandma buried to palm. Deliberate action was trusted to us as we rushed her wrecked body to the unit, her heart still beating under the Summer sun. Inside our little operating room on wheels, a mini ICU, a mobile CCU, we further assessed her injuries under a flood of artificial lights. Oh dreaded be! Air bubbles under chest and flesh! The heavy car having run entirely over head AND chest! The realization already being felt with each squeeze of the ventilation bag, a terrible firmness that increased with each breath. A lung cannot expand when entrapped by air and blood. Mercy! When was the last time I decompressed the chest of a three year old? Never comes the realization, but never would do. A dear friend and coworker brought drill to bone plugging in an intraosseous line near the little girls left knee. Saline infusion filling in through the rich vessels of the tibial bone. I being stuck with task at uncapping a fiercely sharp decompressing needle and welding it above her dying body as though conducting a macob necromantic ceremony. A pensive piercing of flesh as the dagger like needle drove dreadfully deep, its appearance and sound not resting well in nearby thoughts. The gloved catheter sticking grossly out of her chest bobbing with each breath. Its task having faired well despite our doubts, breathing air into her grew easier. Time was short being measured in blood dripping steady like sand through an hourglass.
A fierce race did we wage as her small heart galloped and bleeped on our monitors, her small limp body a angel in repose. Like a relay for life we gave up our baby to a team of flight nurses and medics. The rest of her journey would be up in the clouds with a Summer undone.
To this she took flight with body and soul, gone from us. She died high in the clouds.
Mama comes out with ice cold pops prompting a "all for one" scream and a trouncing stampede of bare feet across the grassy carpet. The hot sea of asphalt made from the black blood of the earth separated them from cold rhapsody of frozen sweetness. Its purpose to tempt, to lead astray, and convey death by way of destruction. "Mommy!" screamed the joyous and giggling three year old making her way across the demonic roadway. Her little legs unable to keep up with her two older brothers who innocently race ahead. Their wet bathing suits dripping prints in the sizzling and falsely quiet roadway. A ways away an Oldsmobile turns for home with a mournful old woman still remembering Summer's of old. A distant thunder gives warning without being heard. The innocent one makes her way across the road defying what seems fated. She's usurped by grandma opening her door to check on the weather from across the street. The pistoned beast picks up speed headed for home seeing that the roadway is now clear but isn't.
Ah, but what was that?! A thump and scraping growl, a hollow pumpkin bounce with a gravel sounding slide. The lady at the wheel, now white knuckled grip and trembling hands, pale as the dead she said goodbye to understands with rapid abandon. Simultaneous screams of utter dread echo between the trailered homes and the meaning of the approaching darkness made apparent. A bare chested and tattooed muscular man bursts forth from the door nearly slipping on the now dropped and forgotten frozen treats, his countenance of furious vengeance raining down on the ghostly driver. "YOU KILLED MY BABY!" was barreled like a small army of charging vikings and one would swear the glass windows vibrated as if enduring a small earthquake and even the distant storm sensed an equal. The heavy man with thundering footsteps closed the distance to his little girl, a tiny body shattered and sheared, her blood a'mix with the blackness of tar and pebble. The stuff of life pumping out like so much spilled milk. A unrequited howl tones a now weakened father. The horror siphoning every bit of him away as quickly as the bloody tributaries traced their way to the ditches. Her small heart beating its way to the land of the dead.
Trembling fingers touched numbers in a glassy face, three numbers in all, 911 they say, but might as well be a twenty digit launch code of infinite complexity to one under the influence of the mighty hormone adrenaline. In a metal clad station half a town away came the familiar tones beckoning us to the life saving chariot. Getting the dreaded news across the radio we made haste while daring those who failed to yield to us to make them a crash test dummy. A small heart was waiting for salvation, and a vigil in spirit dying in lieu. Arriving when surely her spirit rode the final tunnel to undying light, and our promise of hope flickering in red and white strobes, we at her side watching father cradle and rock flesh and blood. A flash of gorgeous blond hair covered in thick rivets of blood was draped down across her back as head and scalp lay unfolded. Her left eye smashed deeply, skull depressed, and spittle's of gasping breath between glossy white baby teeth. A frame too delicate to touch but must. It seemed such a front to open the mouth and insert a steely bladed scope; peering deep inside, sliding tube to trachea. Blood and a deathly brew clouded what I aimed to see. Breath, that enduring necessity of life, once again filled her lungs. Father could look no more and the killing ghost sobbed endlessly behind her locked car doors. Brothers a grim stood disbelievingly, mother to phone trying to speak between the flood of tears, and grandma buried to palm. Deliberate action was trusted to us as we rushed her wrecked body to the unit, her heart still beating under the Summer sun. Inside our little operating room on wheels, a mini ICU, a mobile CCU, we further assessed her injuries under a flood of artificial lights. Oh dreaded be! Air bubbles under chest and flesh! The heavy car having run entirely over head AND chest! The realization already being felt with each squeeze of the ventilation bag, a terrible firmness that increased with each breath. A lung cannot expand when entrapped by air and blood. Mercy! When was the last time I decompressed the chest of a three year old? Never comes the realization, but never would do. A dear friend and coworker brought drill to bone plugging in an intraosseous line near the little girls left knee. Saline infusion filling in through the rich vessels of the tibial bone. I being stuck with task at uncapping a fiercely sharp decompressing needle and welding it above her dying body as though conducting a macob necromantic ceremony. A pensive piercing of flesh as the dagger like needle drove dreadfully deep, its appearance and sound not resting well in nearby thoughts. The gloved catheter sticking grossly out of her chest bobbing with each breath. Its task having faired well despite our doubts, breathing air into her grew easier. Time was short being measured in blood dripping steady like sand through an hourglass.
A fierce race did we wage as her small heart galloped and bleeped on our monitors, her small limp body a angel in repose. Like a relay for life we gave up our baby to a team of flight nurses and medics. The rest of her journey would be up in the clouds with a Summer undone.
To this she took flight with body and soul, gone from us. She died high in the clouds.
Sunday, April 8, 2012
A tragic denial
Holidays, like Easter, are usually very quiet and slow for EMS except for New Years and the 4th of July. Oh, I've had the van full of kids flipped over killing everyone on Christmas Eve night, or Grand paw having a heart attack after Turkey dinner, but as a whole it's regularly slow because everyone is home, off the roads, off work, and generally not in the mood to sit at a hospital. Who would, right? Hospitals aren't the best of places to go at any time, much less when a spread of turkey and gravy is layed out, when there's mistle toe and a sweetie to kiss under, or watching toddlers in their Sunday dresses search in the Azalea bushes for colored eggs. No, that is not the time to go to the hospital. But sometimes it is.
So it was with this woman in her fifties. After spending two hours decorating eggs and smoking a pack of cig's while keeping three kids from pulling their sister's hair out, and a wailing toddler who was trying to put the cat in the dryer she was suddenly hit with a horrible headache, trouble speaking, and the inability to stand up. "Oh my god," said the brother and Uncle before calling 911. It was Easter eve, a full bright moon, and Jupiter and Venus pointing like an arrow over it like a celestial curse. The kids cried like a pack of wolves baying to the moon, instinctively frightened. "Mama, what's wrong?" the older kids asked. "Ammmm dkkk, a dkkk," her speech slurring badly. The volunteer first responders were hit with the call first, their station down the road from the lady's house. My partner and I had just been shifted north to cover the area as the previous unit was transporting a heart attack to the hospital. Running on two hours of sleep in the last 30 hrs, my eyes burned and my caffeine receptors were shot, but I managed to plug in the address into the GPS and my EMT hit the master switch for lights, flashers, and various blinky things before we rolled down the dark roads of rural MS. Looking for a address in which the numeric's are typically black and only 3" tall is much harder than it would seem to be. Unlit country streets don't improve the odds and we pass the address up. Not a infrequent occurrence, and we always hate it when it happens, but GPS isn't always right. It seems accuracy is afforded to battleships and tanks, toys for the ultra rich, but a 50 year old mother....not so much.
The on scene first responders gave us a update on her condition. "Yep, that'll be a stroke....get the helicopter en route." I told my partner. A hospital capable of dealing with a stroke is over a hour away and our victims have to be identified quickly. A prescription for a nursing home and long term disability was practically guaranteed if she was transported by ambulance. Thank goodness the weather allowed. Come thunder, rain, and fog we're forced to treat with diesel and make the best of it. Out here where everyone has a deer head on the wall, there's a lot of time to play before passing the baton to nurses and doctors. I like that in a way, but there's only so much that can be done out on the street. There's no CT scan, x-ray machine, or specimen lab in ambulance tow. Just a wore out old medic with a bag filled with airway stuff, oxygen, IV fluids, a defibrillator/pacer and a bunch medications to treat a wide range of emergency problems. Stuff to keep you alive until we can get you under the operating room lights. With strokes our goal is to get a victim inside a time window of a few hours the necessary thromblytics (clot busting drugs if indicated) or the relief of hemorrhagic intracranial pressure. Course there are all sorts of contraindications that can make every medical effort futile. Just a few reasons why strokes are best described as "life destroying." I hate them. I hate seeing the consequences of them in the misery faced by the multitude that are stricken. Like god mischievously coming down and plucking the puppet strings that allow Pinocchio to move. I know all things have to die, but why so incompletely? Like chopping someones leg off and asking them to hobble a few miles to the chopping block. One cripple step at a time. Either it's a test or downright cruel.
We arrive at a home that looked like a small plantation, tall white columns, two stories, and beautiful brick veneer. Not a particularly wealthy estate, just a miniature facsimile they call the plantation style. Two rain stained miniature lions usher our stretcher into the foyer as we begin asking our questions and seeing what kind of stroke victim we have. The uncle had the kids off at one end of the living room while we conducted a test called the Cincinnati stroke scale/others use the Miami scale, both required to document neurological deficits. "Can you smile for me?" is usually the first question we ask and pt's typically look at us dumbfounded. "Why on earth are you asking me to smile at a time like this?" they're thinking. That thought is written in the face they give me. This lady was no different but she edged out a half cocked smile that would make the Joker on batman envious. We call it right sided facial drooping, and it was very obvious. I then ask her to repeat after me, "you can't teach an old dog new tricks." The phrase is designed to test their neuromechanical
I felt like it was time to get deadly serious with her. I knelt down in front of her, fortified my countenance, and looked her straight in the eyes. Pretty blue eyes too. "You are having a stroke. It is very serious and we must get you to a neuro center to prevent permanent disability or death." I then follow it, and gauging by her shocked expression, with "you must listen to us and allow us to take care of you." It was like a spell had been cast, and all she could do was nod affirmatively. I went on to check her blood pressure, which I expected to be high, was confirmed with a reading of 220/110. Nothing unusual there. Pipes get clogged, pressure goes up. If a pipe bursts and has no where to go....same result. A clogged pipe is preferred to one that is burst, we call those "the kiss of death" (hemorrhage strokes). I was praying for the latter.
Wig-wag, wig-wag, wig-wag, the crystalline flickers of light reflected in the piney canopy as we raced to the landing zone miles north of us. Ah the joy of starting an IV while bouncing down the roads attempting to steady myself from rolling one side to the other and surgically poking a needle into someones arm for venous cannulation. One service I worked for called me "the IV sniper." The woman grimaced from the sting, but her misery was still better than the ghostly silence given by many others. The helicopter's medic came over the radio requesting a report while I perform a practiced acrobatic maneuver to clear the web of wires stretching from the monitor to the pt. The microphone was always too far from the pt's side. "Rescue 9, I have a 58 year old female........." When I was finished she gave me that look that said, "what did all that mean?" Best you not know, I'm thinking, but I offer something reassuring while holding her hand. Given that she was experiencing a severe sharp headache over the left side of her head, and her deficits were on the right, and that her symptoms began acutely I was very suspicious she was having a hemorrhagic stroke. I did my other checks as we grew closer to the landing zone - blood glucose, EKG, oxygen saturation's, etc. Nothing critical so I was hopeful. Arriving at the landing zone the rescue helicopter was waiting with rotors spinning. We call it a "hot load." Dispatch dropped another call on us before we could even get our stroke victim off the stretcher. There were no other available units. With that to look forward to we rolled her to the side door of the helicopter, and she panicked. A particular dangerous thing for pt's to do is grab things while lying on the stretcher. As we were attempting to slide her into the helicopter's cot she gripped the door with one good hand which almost sent her tumbling down onto the skids. The helicopter's rotors were loud and washed out our instructions. I was forced to get close and personal, lips at the ear canal telling her to "let go, keep your hands in, we have you." Between the raging flying machine and the now bug eyed woman my stress levels soared. Certain death whipped a mere foot over my head. I hate that feeling. It leaves my instincts throbbing as I retreat to calmer winds. She was off.........headed towards her fate.
Our attentions were quickly focused on our new mission, a man who had just shot himself in the head. Deputies on scene were saying he was "still breathing," but for how long? We were a considerable ways from the address and there were several bridges out - for construction - between us and the scene. The cops seemed desperate on the radio. "Y'all need to hurry!" garbled through the radio in a deep southern MS drawl. A sea of blue lights made spotting the address easy through a stand of magnolia and live oak. A small crowd of neighbors stood outside gawking, some with their hands to their mouth, others arms crossed and curious, and still others on their cell phones spreading the news far and wide throughout the community. The whole town will know before it ever shows up in the morning paper. We grab our equipment and run in. The victims mother was unaware of what had happened, just that there was something seriously wrong with her son in the other room. The deputies had kept her out and while remaining silent on the matter. The air in the house seemed thick, a bad feeling hung in the hall hiding dark secrets. I turned the corner to greet a deputy who I knew well, "hey Billy, what'cha got?" He pointed to a middle aged man sitting in a recliner, a large caliber hand gun lying on his left shoulder, and a thick pool of blood grossly recessing across his back and shoulders. The odor of traumatic death was strong, like a butcher yard. A single bullet hole was at his left temple with powder burns etched neatly at the point of contact. Bits of brain bulged and protruded through the small hole and oozed down his ghostly white face. Purple swollen eye sockets and a gaping mouth. I took meticulous note of my findings and began documenting them on my computer tablet/electronic pt care report. I instructed my partner to attached ECG leads and run a strip. Asystole (flat line ) in 3 leads from each perspective. Death.....at 12:30am. On scenes like this I always wonder if "they" are still in the room....watching. Was that the heavy presence I felt?
When I was done, I came back out into the living room to tell the mother. She looked at me as if I could still offer hope and a fleetly chance that her son was alive. I had done this before, it's not what I really wanted to say, "I'm so sorry mam, he is dead from his injuries." Her reaction was immediate. Every inch of her cried out as if her flesh could not contain her souls sorrow. I looked around....pictures of him in pretty ornate frames hung on the walls, mementos of the past decorated the shelves, and many other things reminded me of his humanity. Physically, he was no more. To be bagged and pawed over by morticians, and added to the states suicide statistics. I put my hand on the mothers shoulder to show that I wasn't one of those cold robots come to simply pronounce. But then dispatch was calling for us to get clear and take another since we weren't transporting.
Like fast food death, we move on to another. Each of these leaving their mark on my soul. I hear later in the night that our stroke victim was intubated on arrival at the hospital and scanned. Massive brain bleed. If she lives she'll be permanently disabled with tremendous deficits.....if she lives.
"I'm not having a stroke," she said.
So it was with this woman in her fifties. After spending two hours decorating eggs and smoking a pack of cig's while keeping three kids from pulling their sister's hair out, and a wailing toddler who was trying to put the cat in the dryer she was suddenly hit with a horrible headache, trouble speaking, and the inability to stand up. "Oh my god," said the brother and Uncle before calling 911. It was Easter eve, a full bright moon, and Jupiter and Venus pointing like an arrow over it like a celestial curse. The kids cried like a pack of wolves baying to the moon, instinctively frightened. "Mama, what's wrong?" the older kids asked. "Ammmm dkkk, a dkkk," her speech slurring badly. The volunteer first responders were hit with the call first, their station down the road from the lady's house. My partner and I had just been shifted north to cover the area as the previous unit was transporting a heart attack to the hospital. Running on two hours of sleep in the last 30 hrs, my eyes burned and my caffeine receptors were shot, but I managed to plug in the address into the GPS and my EMT hit the master switch for lights, flashers, and various blinky things before we rolled down the dark roads of rural MS. Looking for a address in which the numeric's are typically black and only 3" tall is much harder than it would seem to be. Unlit country streets don't improve the odds and we pass the address up. Not a infrequent occurrence, and we always hate it when it happens, but GPS isn't always right. It seems accuracy is afforded to battleships and tanks, toys for the ultra rich, but a 50 year old mother....not so much.
The on scene first responders gave us a update on her condition. "Yep, that'll be a stroke....get the helicopter en route." I told my partner. A hospital capable of dealing with a stroke is over a hour away and our victims have to be identified quickly. A prescription for a nursing home and long term disability was practically guaranteed if she was transported by ambulance. Thank goodness the weather allowed. Come thunder, rain, and fog we're forced to treat with diesel and make the best of it. Out here where everyone has a deer head on the wall, there's a lot of time to play before passing the baton to nurses and doctors. I like that in a way, but there's only so much that can be done out on the street. There's no CT scan, x-ray machine, or specimen lab in ambulance tow. Just a wore out old medic with a bag filled with airway stuff, oxygen, IV fluids, a defibrillator/pacer and a bunch medications to treat a wide range of emergency problems. Stuff to keep you alive until we can get you under the operating room lights. With strokes our goal is to get a victim inside a time window of a few hours the necessary thromblytics (clot busting drugs if indicated) or the relief of hemorrhagic intracranial pressure. Course there are all sorts of contraindications that can make every medical effort futile. Just a few reasons why strokes are best described as "life destroying." I hate them. I hate seeing the consequences of them in the misery faced by the multitude that are stricken. Like god mischievously coming down and plucking the puppet strings that allow Pinocchio to move. I know all things have to die, but why so incompletely? Like chopping someones leg off and asking them to hobble a few miles to the chopping block. One cripple step at a time. Either it's a test or downright cruel.
We arrive at a home that looked like a small plantation, tall white columns, two stories, and beautiful brick veneer. Not a particularly wealthy estate, just a miniature facsimile they call the plantation style. Two rain stained miniature lions usher our stretcher into the foyer as we begin asking our questions and seeing what kind of stroke victim we have. The uncle had the kids off at one end of the living room while we conducted a test called the Cincinnati stroke scale/others use the Miami scale, both required to document neurological deficits. "Can you smile for me?" is usually the first question we ask and pt's typically look at us dumbfounded. "Why on earth are you asking me to smile at a time like this?" they're thinking. That thought is written in the face they give me. This lady was no different but she edged out a half cocked smile that would make the Joker on batman envious. We call it right sided facial drooping, and it was very obvious. I then ask her to repeat after me, "you can't teach an old dog new tricks." The phrase is designed to test their neuromechanical
I felt like it was time to get deadly serious with her. I knelt down in front of her, fortified my countenance, and looked her straight in the eyes. Pretty blue eyes too. "You are having a stroke. It is very serious and we must get you to a neuro center to prevent permanent disability or death." I then follow it, and gauging by her shocked expression, with "you must listen to us and allow us to take care of you." It was like a spell had been cast, and all she could do was nod affirmatively. I went on to check her blood pressure, which I expected to be high, was confirmed with a reading of 220/110. Nothing unusual there. Pipes get clogged, pressure goes up. If a pipe bursts and has no where to go....same result. A clogged pipe is preferred to one that is burst, we call those "the kiss of death" (hemorrhage strokes). I was praying for the latter.
Wig-wag, wig-wag, wig-wag, the crystalline flickers of light reflected in the piney canopy as we raced to the landing zone miles north of us. Ah the joy of starting an IV while bouncing down the roads attempting to steady myself from rolling one side to the other and surgically poking a needle into someones arm for venous cannulation. One service I worked for called me "the IV sniper." The woman grimaced from the sting, but her misery was still better than the ghostly silence given by many others. The helicopter's medic came over the radio requesting a report while I perform a practiced acrobatic maneuver to clear the web of wires stretching from the monitor to the pt. The microphone was always too far from the pt's side. "Rescue 9, I have a 58 year old female........." When I was finished she gave me that look that said, "what did all that mean?" Best you not know, I'm thinking, but I offer something reassuring while holding her hand. Given that she was experiencing a severe sharp headache over the left side of her head, and her deficits were on the right, and that her symptoms began acutely I was very suspicious she was having a hemorrhagic stroke. I did my other checks as we grew closer to the landing zone - blood glucose, EKG, oxygen saturation's, etc. Nothing critical so I was hopeful. Arriving at the landing zone the rescue helicopter was waiting with rotors spinning. We call it a "hot load." Dispatch dropped another call on us before we could even get our stroke victim off the stretcher. There were no other available units. With that to look forward to we rolled her to the side door of the helicopter, and she panicked. A particular dangerous thing for pt's to do is grab things while lying on the stretcher. As we were attempting to slide her into the helicopter's cot she gripped the door with one good hand which almost sent her tumbling down onto the skids. The helicopter's rotors were loud and washed out our instructions. I was forced to get close and personal, lips at the ear canal telling her to "let go, keep your hands in, we have you." Between the raging flying machine and the now bug eyed woman my stress levels soared. Certain death whipped a mere foot over my head. I hate that feeling. It leaves my instincts throbbing as I retreat to calmer winds. She was off.........headed towards her fate.
Our attentions were quickly focused on our new mission, a man who had just shot himself in the head. Deputies on scene were saying he was "still breathing," but for how long? We were a considerable ways from the address and there were several bridges out - for construction - between us and the scene. The cops seemed desperate on the radio. "Y'all need to hurry!" garbled through the radio in a deep southern MS drawl. A sea of blue lights made spotting the address easy through a stand of magnolia and live oak. A small crowd of neighbors stood outside gawking, some with their hands to their mouth, others arms crossed and curious, and still others on their cell phones spreading the news far and wide throughout the community. The whole town will know before it ever shows up in the morning paper. We grab our equipment and run in. The victims mother was unaware of what had happened, just that there was something seriously wrong with her son in the other room. The deputies had kept her out and while remaining silent on the matter. The air in the house seemed thick, a bad feeling hung in the hall hiding dark secrets. I turned the corner to greet a deputy who I knew well, "hey Billy, what'cha got?" He pointed to a middle aged man sitting in a recliner, a large caliber hand gun lying on his left shoulder, and a thick pool of blood grossly recessing across his back and shoulders. The odor of traumatic death was strong, like a butcher yard. A single bullet hole was at his left temple with powder burns etched neatly at the point of contact. Bits of brain bulged and protruded through the small hole and oozed down his ghostly white face. Purple swollen eye sockets and a gaping mouth. I took meticulous note of my findings and began documenting them on my computer tablet/electronic pt care report. I instructed my partner to attached ECG leads and run a strip. Asystole (flat line ) in 3 leads from each perspective. Death.....at 12:30am. On scenes like this I always wonder if "they" are still in the room....watching. Was that the heavy presence I felt?
When I was done, I came back out into the living room to tell the mother. She looked at me as if I could still offer hope and a fleetly chance that her son was alive. I had done this before, it's not what I really wanted to say, "I'm so sorry mam, he is dead from his injuries." Her reaction was immediate. Every inch of her cried out as if her flesh could not contain her souls sorrow. I looked around....pictures of him in pretty ornate frames hung on the walls, mementos of the past decorated the shelves, and many other things reminded me of his humanity. Physically, he was no more. To be bagged and pawed over by morticians, and added to the states suicide statistics. I put my hand on the mothers shoulder to show that I wasn't one of those cold robots come to simply pronounce. But then dispatch was calling for us to get clear and take another since we weren't transporting.
Like fast food death, we move on to another. Each of these leaving their mark on my soul. I hear later in the night that our stroke victim was intubated on arrival at the hospital and scanned. Massive brain bleed. If she lives she'll be permanently disabled with tremendous deficits.....if she lives.
"I'm not having a stroke," she said.
Monday, April 2, 2012
What do the dead say?
You know how you hear people always say, "it was a miracle I survived" following a tornado or other "act of god" that destroys their town? But what do the dead say? For instance, remember when that awful tornado outbreak hit Indiana this year, and that baby they called the "miracle baby" (Angel Babcock) was flung out of her home and 300 yards through the air was found alive? She didn't. She died a week later. I didn't see the towns, nay, the nations prayers answered then. How about the huddled family's in the attics of the lower 9th ward during hurricane Katrina who drowned? You can bet they were praying and calling on god to save them. Many did not survive, and the dead were not asked their opinion on gods divine providence. Sometimes everyone calls on god to be saved, as in a doomed aircraft with its wings stripped off plunging into a New York crowded neighborhood. All dead, and even the innocent watching TV in their homes died. No prayers were answered then. A firefighter sifting through the wreckage found a man burnt to a crisp clutching his infant child in a protective embrace. No one ever talks about those unanswered prayers. I can recall people "thanking god" that the crash occurred when most were at work and not in their homes. Never mind the ones that were. They must've some how earned their grim ticket to the nether world. The spotlight and the focus of attention is always when someone seemingly escapes death and they call it a miracle. If it is mentioned, it's excused as "gods will." A divine excuse for the invisible man.
It was a pleasant Wednesday afternoon when I beheld another fine example of gods will in action. A elderly couple who had been happily married for 38 years were on their way home when the husband, who was driving, experienced a massive grand mal seizure. Uncontrolled spasms forced his right foot hard onto accelerator and the vehicle raced wildly through a suburban neighborhood. The wife, a frail women in her 70's tried desperately to pull her husbands leg off the accelerator and hit the brake pedal to no avail. The outcome was as anyone could predict, a catastrophic crash that sent the car in "Dukes of Hazard" fashion leaping across a yard and straight into the brick wall of a house. Half the roof composed of 2x6's, shingles, and plywood came down hard on the driver's side, and the veneer of brick tumbled across the hood and windshield. The dash was pushed in and onto the occupants trapping them completely. The horrific scene sent neighbors frantically calling 911, while one went and held the hand of the old woman to reassure her that rescue was on the way. Covered in blood herself, she repeatedly told bystanders to "please help my husband." No one could reach the husband who was buried under roof, brick, and wood. He was still alive though, his moaning could be heard beneath the rubble. The woman's elbow was sticking through the passenger window was split open with forearm long bones sticking out in all directions and the muscle meat hung out in grisly fashion. Only one neighbor had the strength to stomach the scene enough to hold her hand to reassure her. "They're coming," the good Samaritan said.
Firefighters were the first to arrive as their station was just two blocks from the accident. Dispatch activated our unit and gave us the details shortly thereafter. I could hear some of the details from the on scene firefighters as my partner battled the drivers who refused to yield to our sirens. We received the usual slew of indignant looks at inconveniencing their trips to Wally world. The firefighters were unloading and setting up the compressors/hydraulics that would power their extrication equipment and lift bags and letting us know by radio how many victims we had, and a preliminary assessment to how bad they were. Bottom line.....bad. I reached between the seats and snatched a pair of latex gloves to wear, and I pulled from the dash my utility belt and its arsenal of shears, mag lights, and tourniquets. Like Batman, I felt ready to scale a building, or in this case save some people dying. Scaling a building seemed vastly easier in hindsight. When we finally arrived I could see two firefighters running towards a car that was buried by a brick wall and a elderly woman on a back board out on the front lawn. It's never a good indicator to see firefighters "running" around at the scene of accident. It's always deadly serious when you see that sorta behavior from trained professionals. I could see the old woman was awake and able to talk and the most obvious injury being her right elbow which as described earlier was split wide open. The hemorrhage of a open compound fracture had already completed itself and all bleeding appeared arrested. As on scene commander I had to triage these two and see which was the most serious, and a talking victim is a good sign so I moved on to the crushed car to see how far the firefighters had progressed in their extrication. Two firefighters were on top of the roof with jaws and cutters while another was crawled up in the back seat providing c-spine support to the male occupant. "I need to get out of here, get me out of here! I can't breathe!" yelled the old man. "I'm dying," he said. We call these expressions in EMS, "feelings of impending doom," and it's one of the most ominous statements you can hear from your pt's. When a person says "they're dying," they usually are.
The man's scalp was avulsed from the forehead back leaving his entire skull cap exposed and a pool of blood down the top of his shirt. Another pool equally ominous was one that gathered in his groin, and it was near impossible to tell where that one was coming from with him so wedge under the dash. His appearance was pale and clammy, each breath with intense effort, and eyes that demanded merciful exemption from the pain. Divine mercy was inconveniently absent on this day. Being unable to do more than slide an oxygen mask over his face I backed away to allow the firefighters who were wearing thick protective bunker gear their chance at getting in and opening the cockpit with jaws and cutters. A mix of painful screams, the pop of glass, and crunch of metal echoed between the two houses as I hurried to load the old woman out on the grass into the back of our ambulance. I had my partner setup an IV and get a set of preliminary vitals while I radioed a helicopter and a additional unit in for assistance. Naturally the radios weren't working particularly well that day and I struggled to relay what resources were needed to dispatch and the responding unit. In between repeating my radio requests I saw the firefighters pull the man out from the crumbled car and onto a backboard. The man was non to happy with being layed flat on a spine board given that it was making his effort at breathing worse. But it had to be done or risk paralysis. I came over to give the man a good stare and a focused assurance that he would make it to a hospital alive if he would just following our instructions. With great reluctance he submitted to a supine position and we continued our care with great haste. I shredded his clothes from his body trying to find where all these pools of blood were coming from. The man was for all practical purposes "descalped" so I knew where one pool was from. The other was found from where his left femur had snapped and perforated the inside of his thigh, and his pelvis was loose and unstable. His genitalia was pooling with blood from the pelvic cavity. Another critical finding was an easily identifiable flail segment across the right chest wall paradoxically moving in and out with each labored breath. We're taught to stabilize a flail segment with a sandbag or 1000ml bag of saline taped across it, a treatment easier said than done. Electing to go with an bag of IV fluid we attempted to tape it across the flail segment only to fight wet and cold sweaty skin and tape that wouldn't....well, tape. Desperate ingenuity had us taping from one end of the backboard to the other across the whole fluid bag. The old man's breathing failed to improve.
The man was now inside the ambulance fighting to breathe while his wife gripped my leg and implored, "please don't let my husband die." Not feeling particularly assured I offered assurances that "we'll do everything we can for him." I had a bad feeling though. I had my EMT get us en route to the LZ (landing zone) as these two were headed to a trauma center. One of the firefighter's rode with us to assist me since it's not easy managing two critical pt's by myself. I had the firefighter hold the man's arm out at length while I stuck a large bore needle into it searching for a vein that was now flat from lack of blood. Rural bumpy roads, the awkward angle of the units tight confines, and inadequate lighting made the IV attempt a fat chance in hell of happening. Pulling it out I elected to go with a smaller gauge catheter as it just wasn't happening with a 16g. Veins tend to flatten out at the peripheral when in shock so I searched along the man's neck looking for some juicy jugulars. Finding one was the easy part the other was in positioning oneself in the well of the unit's side door while crouching in the shadows of the captains chair and the stretcher to achieve the angle of optimum penetration. By some trickery of skill and luck the IV flowed after achieving a good flash. I began dumping fluids into the man's body while moving on to start an IV on the old woman. Compared to the husband she was relatively easy. IV's are great and all but they're not blood and these two needed blood transfusion in order to survive. We raced to the LZ and the inbound trauma team and watched the golden hour narrow like the closing fist of death. Still, the woman gripped my leg and repeated her demand. "Don't let my husband die."
The man's blood pressure was critically low, his heart racing to keep up with dwindling blood reserves, and his breathing unrelieved with the stabilization of his flail. Something else was terribly wrong. I listened to his breath sounds straining to listen over the motor of the ambulance, the sirens imploring the eye rolling public to move out of the way, and the clacking made by a loose cabinet door. Breath sounds were clearly diminished on the left, and I knew that probably meant he had a pneumothorax/or hemothorax that was progressing to a tension pneumo. I hadn't decompressed anyone in some time and in those instances the outcomes were not at all good. Something had to be done so I reached into our IV kit and pulled out a 14 gauge catheter dreading what would come next. I cut one finger off a latex glove and thread the catheter through this forming a device called a "flutter valve." Since we don't have chest tubes this was the next best thing, that next though was a far departure from a medical tube sutured into the chest wall, its placement confirmed with x-ray, and attached to a 3 chambered vacuum device. "Please don't let my husband die," the woman said again as she grew chill with a morbid clamminess. Her blood pressure becoming dangerously low too. Hating to be a paramedic for a brief second, I stuck the needle between the ribs as we're taught to and felt the latex flutter with air and blood. It was working to the best of its capability to relieve tension in the chest and allow the man to breath, but it was anything but efficient and tolerable. The man was in deep profound shock and was muttering intelligibly. We were still ten minutes from the LZ, and at a moment every paramedic dreads, the moment when you realize your pt is quickly circling-the-drain, paying the final coin to the boatman, and leaving the flesh. His blood pressure could not be maintained. His groin swollen the size of a basket ball and his face turning ghostly white. Pupils dilating and breath shallow. The firefighter attempted to distract the wife with fake assurances while I made ready to intubate the man and begin working a trauma code. A code that has only one type of ending, one final resting place, the morgue. If you die from lack of blood, you're dead. IV fluids don't transport oxygen, and only a surgeon can open you up and repair the internal damage. "Please don't let my husband die," wailed the woman while imploring the god almighty once more. God wasn't listening, or if he was, felt differently about whether this man should live or not. Arriving at the LZ we vainly hurried to pull our dead body out and do compressions to the helicopter. Epinephrine and amiodarone were doing their tricks to the heart, but neither drug would miraculously replace blood that was now pooled in his gut and groin. The man's heart flipped and fluttered like a unprimed heart until it could take no more and simply ceased doing anything at all. Probably somewhere in the skies over South MS. Another helicopter was tied up elsewhere so I was forced to race the wife up to the trauma center by ambulance battling her own blood loss. Divine providence seemed to be with her as she maintained consciousness even at a awfully low pressure of 50/30. Pale and clammy herself, and tilted in trendelenburg she found herself under the surgeon's blade at the end of the "golden hour." Our unit's innards looked like a murder scene and stains on my uniform in places I could not reach.
What do the dead say, I wondered. Certainly no explanation from the almighty.
It was a pleasant Wednesday afternoon when I beheld another fine example of gods will in action. A elderly couple who had been happily married for 38 years were on their way home when the husband, who was driving, experienced a massive grand mal seizure. Uncontrolled spasms forced his right foot hard onto accelerator and the vehicle raced wildly through a suburban neighborhood. The wife, a frail women in her 70's tried desperately to pull her husbands leg off the accelerator and hit the brake pedal to no avail. The outcome was as anyone could predict, a catastrophic crash that sent the car in "Dukes of Hazard" fashion leaping across a yard and straight into the brick wall of a house. Half the roof composed of 2x6's, shingles, and plywood came down hard on the driver's side, and the veneer of brick tumbled across the hood and windshield. The dash was pushed in and onto the occupants trapping them completely. The horrific scene sent neighbors frantically calling 911, while one went and held the hand of the old woman to reassure her that rescue was on the way. Covered in blood herself, she repeatedly told bystanders to "please help my husband." No one could reach the husband who was buried under roof, brick, and wood. He was still alive though, his moaning could be heard beneath the rubble. The woman's elbow was sticking through the passenger window was split open with forearm long bones sticking out in all directions and the muscle meat hung out in grisly fashion. Only one neighbor had the strength to stomach the scene enough to hold her hand to reassure her. "They're coming," the good Samaritan said.
Firefighters were the first to arrive as their station was just two blocks from the accident. Dispatch activated our unit and gave us the details shortly thereafter. I could hear some of the details from the on scene firefighters as my partner battled the drivers who refused to yield to our sirens. We received the usual slew of indignant looks at inconveniencing their trips to Wally world. The firefighters were unloading and setting up the compressors/hydraulics that would power their extrication equipment and lift bags and letting us know by radio how many victims we had, and a preliminary assessment to how bad they were. Bottom line.....bad. I reached between the seats and snatched a pair of latex gloves to wear, and I pulled from the dash my utility belt and its arsenal of shears, mag lights, and tourniquets. Like Batman, I felt ready to scale a building, or in this case save some people dying. Scaling a building seemed vastly easier in hindsight. When we finally arrived I could see two firefighters running towards a car that was buried by a brick wall and a elderly woman on a back board out on the front lawn. It's never a good indicator to see firefighters "running" around at the scene of accident. It's always deadly serious when you see that sorta behavior from trained professionals. I could see the old woman was awake and able to talk and the most obvious injury being her right elbow which as described earlier was split wide open. The hemorrhage of a open compound fracture had already completed itself and all bleeding appeared arrested. As on scene commander I had to triage these two and see which was the most serious, and a talking victim is a good sign so I moved on to the crushed car to see how far the firefighters had progressed in their extrication. Two firefighters were on top of the roof with jaws and cutters while another was crawled up in the back seat providing c-spine support to the male occupant. "I need to get out of here, get me out of here! I can't breathe!" yelled the old man. "I'm dying," he said. We call these expressions in EMS, "feelings of impending doom," and it's one of the most ominous statements you can hear from your pt's. When a person says "they're dying," they usually are.
The man's scalp was avulsed from the forehead back leaving his entire skull cap exposed and a pool of blood down the top of his shirt. Another pool equally ominous was one that gathered in his groin, and it was near impossible to tell where that one was coming from with him so wedge under the dash. His appearance was pale and clammy, each breath with intense effort, and eyes that demanded merciful exemption from the pain. Divine mercy was inconveniently absent on this day. Being unable to do more than slide an oxygen mask over his face I backed away to allow the firefighters who were wearing thick protective bunker gear their chance at getting in and opening the cockpit with jaws and cutters. A mix of painful screams, the pop of glass, and crunch of metal echoed between the two houses as I hurried to load the old woman out on the grass into the back of our ambulance. I had my partner setup an IV and get a set of preliminary vitals while I radioed a helicopter and a additional unit in for assistance. Naturally the radios weren't working particularly well that day and I struggled to relay what resources were needed to dispatch and the responding unit. In between repeating my radio requests I saw the firefighters pull the man out from the crumbled car and onto a backboard. The man was non to happy with being layed flat on a spine board given that it was making his effort at breathing worse. But it had to be done or risk paralysis. I came over to give the man a good stare and a focused assurance that he would make it to a hospital alive if he would just following our instructions. With great reluctance he submitted to a supine position and we continued our care with great haste. I shredded his clothes from his body trying to find where all these pools of blood were coming from. The man was for all practical purposes "descalped" so I knew where one pool was from. The other was found from where his left femur had snapped and perforated the inside of his thigh, and his pelvis was loose and unstable. His genitalia was pooling with blood from the pelvic cavity. Another critical finding was an easily identifiable flail segment across the right chest wall paradoxically moving in and out with each labored breath. We're taught to stabilize a flail segment with a sandbag or 1000ml bag of saline taped across it, a treatment easier said than done. Electing to go with an bag of IV fluid we attempted to tape it across the flail segment only to fight wet and cold sweaty skin and tape that wouldn't....well, tape. Desperate ingenuity had us taping from one end of the backboard to the other across the whole fluid bag. The old man's breathing failed to improve.
The man was now inside the ambulance fighting to breathe while his wife gripped my leg and implored, "please don't let my husband die." Not feeling particularly assured I offered assurances that "we'll do everything we can for him." I had a bad feeling though. I had my EMT get us en route to the LZ (landing zone) as these two were headed to a trauma center. One of the firefighter's rode with us to assist me since it's not easy managing two critical pt's by myself. I had the firefighter hold the man's arm out at length while I stuck a large bore needle into it searching for a vein that was now flat from lack of blood. Rural bumpy roads, the awkward angle of the units tight confines, and inadequate lighting made the IV attempt a fat chance in hell of happening. Pulling it out I elected to go with a smaller gauge catheter as it just wasn't happening with a 16g. Veins tend to flatten out at the peripheral when in shock so I searched along the man's neck looking for some juicy jugulars. Finding one was the easy part the other was in positioning oneself in the well of the unit's side door while crouching in the shadows of the captains chair and the stretcher to achieve the angle of optimum penetration. By some trickery of skill and luck the IV flowed after achieving a good flash. I began dumping fluids into the man's body while moving on to start an IV on the old woman. Compared to the husband she was relatively easy. IV's are great and all but they're not blood and these two needed blood transfusion in order to survive. We raced to the LZ and the inbound trauma team and watched the golden hour narrow like the closing fist of death. Still, the woman gripped my leg and repeated her demand. "Don't let my husband die."
The man's blood pressure was critically low, his heart racing to keep up with dwindling blood reserves, and his breathing unrelieved with the stabilization of his flail. Something else was terribly wrong. I listened to his breath sounds straining to listen over the motor of the ambulance, the sirens imploring the eye rolling public to move out of the way, and the clacking made by a loose cabinet door. Breath sounds were clearly diminished on the left, and I knew that probably meant he had a pneumothorax/or hemothorax that was progressing to a tension pneumo. I hadn't decompressed anyone in some time and in those instances the outcomes were not at all good. Something had to be done so I reached into our IV kit and pulled out a 14 gauge catheter dreading what would come next. I cut one finger off a latex glove and thread the catheter through this forming a device called a "flutter valve." Since we don't have chest tubes this was the next best thing, that next though was a far departure from a medical tube sutured into the chest wall, its placement confirmed with x-ray, and attached to a 3 chambered vacuum device. "Please don't let my husband die," the woman said again as she grew chill with a morbid clamminess. Her blood pressure becoming dangerously low too. Hating to be a paramedic for a brief second, I stuck the needle between the ribs as we're taught to and felt the latex flutter with air and blood. It was working to the best of its capability to relieve tension in the chest and allow the man to breath, but it was anything but efficient and tolerable. The man was in deep profound shock and was muttering intelligibly. We were still ten minutes from the LZ, and at a moment every paramedic dreads, the moment when you realize your pt is quickly circling-the-drain, paying the final coin to the boatman, and leaving the flesh. His blood pressure could not be maintained. His groin swollen the size of a basket ball and his face turning ghostly white. Pupils dilating and breath shallow. The firefighter attempted to distract the wife with fake assurances while I made ready to intubate the man and begin working a trauma code. A code that has only one type of ending, one final resting place, the morgue. If you die from lack of blood, you're dead. IV fluids don't transport oxygen, and only a surgeon can open you up and repair the internal damage. "Please don't let my husband die," wailed the woman while imploring the god almighty once more. God wasn't listening, or if he was, felt differently about whether this man should live or not. Arriving at the LZ we vainly hurried to pull our dead body out and do compressions to the helicopter. Epinephrine and amiodarone were doing their tricks to the heart, but neither drug would miraculously replace blood that was now pooled in his gut and groin. The man's heart flipped and fluttered like a unprimed heart until it could take no more and simply ceased doing anything at all. Probably somewhere in the skies over South MS. Another helicopter was tied up elsewhere so I was forced to race the wife up to the trauma center by ambulance battling her own blood loss. Divine providence seemed to be with her as she maintained consciousness even at a awfully low pressure of 50/30. Pale and clammy herself, and tilted in trendelenburg she found herself under the surgeon's blade at the end of the "golden hour." Our unit's innards looked like a murder scene and stains on my uniform in places I could not reach.
What do the dead say, I wondered. Certainly no explanation from the almighty.
Friday, March 16, 2012
Adaptability
What is adaptability? Adaptability has been described as the ability to cope with unexpected disturbances in the environment, and that is certainly true, but I'd define adaptability in much simpler terms - it is merely the ability to simplify a solution. Ernest Bramah once said about adaptability, "One learns to itch where one can scratch." That's a definition that fits my experience too. The last forty eight hours has been no exception, and a paramedic quickly learns to adapt to challenges or fail completely. When we fail people die.
The radio squawked, "medic 107, respond to dogwood dr for general illness." This type of call is all too common, and not everything is a life and death emergency when 911 is activated. In fact very little of it ever is. You just never know, and one thing you learn as a paramedic is to never assume anything. Assumptions are the mother of all failures. Arriving on scene we find a modest home with a cadillac parked outside. A dog in the distance was barking as we came up to the front door and knocked. Nothing, not footsteps coming to the door, not screams for help, not anything. Silence could be a good thing; as in the victim may have left for the hospital, or a bad thing, as in the victim was dead. We were tired, it was late, and since medics are typically quite morbid we were agreeable with either one. But one thing we can't do is "assume." And since the doors were locked we were faced with a challenge, how do we get inside to eliminate the possibility the victim is still inside and either dead or incapacitated? We can't just bash down the door or bust a window out, although that might be the easiest, it's not particularly acceptable for legal reasons. We're not cops. Request was made to dispatch that we needed a deputy out at the home to make entry. One by one we circled the house to check each window while we waited for a deputy to arrive. Just as he was pulling up we found one by the ac unit in the back bedroom that was open enough to wiggle the frame and provide an entry. The deputy was a good friend of ours and a frequent accomplice to zoo like calls we get on the many nights where the natives are restless, where the drunks run off the road and into the woods, and the teens swallow pill bottles. He sees it all too.
Calling for a victim the deputy pulled himself up through the opening while handing us his utility belt with holstered gun to pull the whole maneuver off. No point in shooting himself in the foot or us as we hoisted him above us. If there was no one inside it would turn into alot of effort for nothing, and god knows we were tired, having spent the last 28 hrs dealing with other emergencies. But then if there was no one inside we could document "no pt found" and return to the station and to our quarters where our lonely beds were. No, we couldn't think like that, we had to know. Searching room to room we called for a victim and there was nothing. The deputy and his mag lite scanned the corners and shadows finding nothing. Minutes went by and it felt surreal to be inside someones house digging around like a bunch thieves looking at pictures of people we didn't know and nick knacks that had zero meaning to us. "Guess no one is here," said the deputy. "Yep......" but then I spot a door that looked like a closet that was outlined and traced in light. Someone had a light on inside. But why would they be in the closet? Maybe it was something else, and there was certainly no where else to check so I slowly open the door; which opened in, and hit something. I can't get door the door open enough to get in, but I look down and see the reason why. An elderly woman was lying face down in a pool of vomit. She looked dead at first glance but then she groaned and snored a breath or two. She was all wet and clammy, her face pale and mottled, and the gruel of death hung tentatively in the air.
Rather than being a closet, our victim was stuck in a half bath and her body was now decisively blocking the door and our ability to get in and help her. Another challenge that needed a simple solution. I don't know if it was one of those light bulb moments in cartoons, or this lady's guardian angel whispering little tricks in my ear, but the thought came to me that I could pull the pins on the door hinges and just take the door off. The solution was so simple. Our old lady was in bad shape and unresponsive. Defecation and vomit was everywhere and our gloves slide across her stretchy old skin trying to find grip. The foul smell of it stressed our efforts as we pulled her out into the living room and then onto our stretcher. Had to be a stroke I was thinking. She was aphasic, that is, unable to speak, but just stares blankly at nothing. I've seen it hundreds of times. Bounding distal pulses and pupils that react little. Out to the unit we had her on low dose oxygen, a modified therapy that once called for hiflo oxygen but was found most recently to be causing harm rather than good. Giving large amounts of oxygen causes the cerebral arteries to dilate and that's the last thing you want to do with a clot wedge in somewhere up in her brain. My EMT fiddled with the nasal cannula while I spiked a bag of normal saline and searched her old veins for one to poke. I had one pretty quick and gained venous access. We weren't looking to hydrate her but to provide a portal to her systemic circulation in case medications were called for. I didn't waste time thinking about where I was going to take her, it had to be a prioritized stroke center, so I got on the state net line and called a helicopter in. We affectionately call it the whirly bird, and the bird was invaluable in these rural parts where anything definitive is at least an hour away. So off we went with our lights flickering among the piney woods. Enroute our lady took a turn for the worse and began to seize on me, but the seizure didn't last much longer than ten seconds or so. Not enough time for me pull the narcotics out of their locked gun case situated among the cabinets, but what followed required more immediate action anyway. She had a breathing pattern we medically define as agonal and insufficient for respiration. After updating the inbound flight team I pulled our giant green bag that normally sits wedged above the cabinet with the suction out from it's cramped quarters. Popping seals along the zipper line I pulled out the intubation roll and selected some endotracheal tubes, stylet, 10 ml syringe, and my personal larygnscopic blade, a number four miller. Our victim was still breathing so visualize her vocal cords would prove difficult as she chumped down periodically while this big metal blade attempted to displace her tongue enough to see what I had to see, and what I had to see was a tiny narrow passage into her trachea - her windpipe. Finding it and timing it just right, I slid the endotracheal tube into its proper position, not too far, and too short or otherwise it wouldn't effectively distribute air into both lungs. A messy affair at best when the ambulance is bumping down the back roads of Mississippi's highways. It's been twenty years since I first started doing this so it wasn't a challenge I couldn't adapt to. Airway in place and effective ventilation restored we pulled up to our landing zone, a point halfway between where we were and where she had to go, to offload and hand over further care to a flight team and off she went.
We were left like wet sweaty dogs that had been in a fight to clean a ambulance now filled with blood, puke, shit, and various medical supply wrappers. Ah, the perks of the job, and still 20 hrs more to go in my 48 hr shift. A cherry lime-aid at the local Sonic for a reward and we were back in station an hour later. Oh, but the challenges were just beginning.
"Medic 107 respond to a medical unknown on the interstate. MHP is out with a person that is acting funny." So what does acting funny look like I thought as we zipped up our boots and headed out to the unit. We pull up to a scene in which a highway patrolman has a 18 wheeler pulled over on the shoulder. One of the local volunteer firefighters was on scene who is known as the "pastor," a elderly firefighter with a heart of gold. "Got a big one." "How big?" I ask. Probably four hundred pounds or more. Just great we say to each other while slipping into our yellow reflective vests that are required up on the interstate. They want us to be safe and all, but sometimes it would be safer to either stay in bed or come prepared with a forklift. I swear, people are getting bigger each day, but what I found high above me in the semi's cab I was unprepared for. This man was no four hundred pounds, he had to be 600 plus. Whoa nelly and riddle me this, "how do you get a 600 pounder down out of semi cab, which if you didn't know is situated eight or more feet above the ground, and onto a stretcher with myself, a female partner, and a couple of elderly compassionate first responders? A victim that was acting confused and disoriented, and unable to even get up from the drivers chair. This man's legs were as big as my whole 280 lb body and every bit of them was wedged under the steering wheel. Our man was struggling to breath and would not tolerate a prolonged fooling around at the scene. I felt stumped and my partner and I looked at each other with that look that says, "this call sucks, why did we choose this profession?" Finally, after looking at the situation for several minutes and realizing there simply was no easy or perfect way it was going to get done, but by god this man was coming out of there one way or the other. Sometimes you just have to plunge right in and see what happens when a solution doesn't present itself. So I grabbed the handles attached to outside of the cab and pulled myself into position while directing my partner to go around and snag the other side of this huge man. I then directed the firefighters and enlisting the begrudging patrolmen into position below me with the stretcher set to receiving said victim or perhaps to break a sudden fall. My biggest fear was the victim would just crumple coming out and we would be too few in strength to slow his fall.
So here this big guy cometh as we pulled and pushed for many agonizing minutes while shouting various instructions to either him or the pushee's. The effort was more out of will than any mechanical advantage, and little by little he made his way to the door and the moment of truth had arrived. Ah, but to make the situation even more delectably interesting, the man had shit diarrhea all down his 600 lb backside which was now evenly and disastrously right in my face. We have a frequent saying in EMS down here, "it is what it is," in other words there was nothing I could do about it. Trying my best not to soil my uniform I pushed with all my might on his butt to keep him from coming down hard on the stretcher below. I can remember thinking what motorist were saying when they past by during all this to see this giant of a human being with his crack showing, and poo dripping, while a few old men scaffolded everything from certain disaster. Surprisingly this victim didn't come down with a sudden crash and take all of us out, but rather came down in doable position on the waiting stretcher, not perfect mind you, but good enough. We certainly weren't going to be doing any repositioning. The guy was so big the handles on the stretcher could not close and his width was spread from one wall to the next. Even with six people now at each point it took 3 tries to load him into the back as we fought to fit round flesh into a square hole. My left bicep throbbed as if I had tried to go for a world record in dead lifting and my partner ended up pulling her neck from all the strain. Sadly, no one wants to go on workman's comp around here for how little it pays. We were no exception, but by god we did it. We managed to get a 600 plus pound man out of a 18 wheeler and to definitive care. After an IV line en route, some blood sugar tests, and ECG monitoring we had him to a hospital that would later go on to diagnose an infection that was making him confused. Sometimes you just have to "getter done," and see what happens. But one must take action to affect anything and Jane Heard once said, "a well adjusted person is one who makes the same mistake twice without getting nervous."
The shift over I come home for some R&R and take care of some home projects I had been meaning to do. Cutting drywall and hanging it. Another chance at being adaptable arose when my utility knife broke into pieces. Keeping it simple and following my philosophy of "gett'er done," I grabbed a pair of vice grips and clamped them to a razor and thereby making a fine what-cha-macall-it and a crude utility knife. Good enough to carry on with my project without any hitches.
The radio squawked, "medic 107, respond to dogwood dr for general illness." This type of call is all too common, and not everything is a life and death emergency when 911 is activated. In fact very little of it ever is. You just never know, and one thing you learn as a paramedic is to never assume anything. Assumptions are the mother of all failures. Arriving on scene we find a modest home with a cadillac parked outside. A dog in the distance was barking as we came up to the front door and knocked. Nothing, not footsteps coming to the door, not screams for help, not anything. Silence could be a good thing; as in the victim may have left for the hospital, or a bad thing, as in the victim was dead. We were tired, it was late, and since medics are typically quite morbid we were agreeable with either one. But one thing we can't do is "assume." And since the doors were locked we were faced with a challenge, how do we get inside to eliminate the possibility the victim is still inside and either dead or incapacitated? We can't just bash down the door or bust a window out, although that might be the easiest, it's not particularly acceptable for legal reasons. We're not cops. Request was made to dispatch that we needed a deputy out at the home to make entry. One by one we circled the house to check each window while we waited for a deputy to arrive. Just as he was pulling up we found one by the ac unit in the back bedroom that was open enough to wiggle the frame and provide an entry. The deputy was a good friend of ours and a frequent accomplice to zoo like calls we get on the many nights where the natives are restless, where the drunks run off the road and into the woods, and the teens swallow pill bottles. He sees it all too.
Calling for a victim the deputy pulled himself up through the opening while handing us his utility belt with holstered gun to pull the whole maneuver off. No point in shooting himself in the foot or us as we hoisted him above us. If there was no one inside it would turn into alot of effort for nothing, and god knows we were tired, having spent the last 28 hrs dealing with other emergencies. But then if there was no one inside we could document "no pt found" and return to the station and to our quarters where our lonely beds were. No, we couldn't think like that, we had to know. Searching room to room we called for a victim and there was nothing. The deputy and his mag lite scanned the corners and shadows finding nothing. Minutes went by and it felt surreal to be inside someones house digging around like a bunch thieves looking at pictures of people we didn't know and nick knacks that had zero meaning to us. "Guess no one is here," said the deputy. "Yep......" but then I spot a door that looked like a closet that was outlined and traced in light. Someone had a light on inside. But why would they be in the closet? Maybe it was something else, and there was certainly no where else to check so I slowly open the door; which opened in, and hit something. I can't get door the door open enough to get in, but I look down and see the reason why. An elderly woman was lying face down in a pool of vomit. She looked dead at first glance but then she groaned and snored a breath or two. She was all wet and clammy, her face pale and mottled, and the gruel of death hung tentatively in the air.
Rather than being a closet, our victim was stuck in a half bath and her body was now decisively blocking the door and our ability to get in and help her. Another challenge that needed a simple solution. I don't know if it was one of those light bulb moments in cartoons, or this lady's guardian angel whispering little tricks in my ear, but the thought came to me that I could pull the pins on the door hinges and just take the door off. The solution was so simple. Our old lady was in bad shape and unresponsive. Defecation and vomit was everywhere and our gloves slide across her stretchy old skin trying to find grip. The foul smell of it stressed our efforts as we pulled her out into the living room and then onto our stretcher. Had to be a stroke I was thinking. She was aphasic, that is, unable to speak, but just stares blankly at nothing. I've seen it hundreds of times. Bounding distal pulses and pupils that react little. Out to the unit we had her on low dose oxygen, a modified therapy that once called for hiflo oxygen but was found most recently to be causing harm rather than good. Giving large amounts of oxygen causes the cerebral arteries to dilate and that's the last thing you want to do with a clot wedge in somewhere up in her brain. My EMT fiddled with the nasal cannula while I spiked a bag of normal saline and searched her old veins for one to poke. I had one pretty quick and gained venous access. We weren't looking to hydrate her but to provide a portal to her systemic circulation in case medications were called for. I didn't waste time thinking about where I was going to take her, it had to be a prioritized stroke center, so I got on the state net line and called a helicopter in. We affectionately call it the whirly bird, and the bird was invaluable in these rural parts where anything definitive is at least an hour away. So off we went with our lights flickering among the piney woods. Enroute our lady took a turn for the worse and began to seize on me, but the seizure didn't last much longer than ten seconds or so. Not enough time for me pull the narcotics out of their locked gun case situated among the cabinets, but what followed required more immediate action anyway. She had a breathing pattern we medically define as agonal and insufficient for respiration. After updating the inbound flight team I pulled our giant green bag that normally sits wedged above the cabinet with the suction out from it's cramped quarters. Popping seals along the zipper line I pulled out the intubation roll and selected some endotracheal tubes, stylet, 10 ml syringe, and my personal larygnscopic blade, a number four miller. Our victim was still breathing so visualize her vocal cords would prove difficult as she chumped down periodically while this big metal blade attempted to displace her tongue enough to see what I had to see, and what I had to see was a tiny narrow passage into her trachea - her windpipe. Finding it and timing it just right, I slid the endotracheal tube into its proper position, not too far, and too short or otherwise it wouldn't effectively distribute air into both lungs. A messy affair at best when the ambulance is bumping down the back roads of Mississippi's highways. It's been twenty years since I first started doing this so it wasn't a challenge I couldn't adapt to. Airway in place and effective ventilation restored we pulled up to our landing zone, a point halfway between where we were and where she had to go, to offload and hand over further care to a flight team and off she went.
We were left like wet sweaty dogs that had been in a fight to clean a ambulance now filled with blood, puke, shit, and various medical supply wrappers. Ah, the perks of the job, and still 20 hrs more to go in my 48 hr shift. A cherry lime-aid at the local Sonic for a reward and we were back in station an hour later. Oh, but the challenges were just beginning.
"Medic 107 respond to a medical unknown on the interstate. MHP is out with a person that is acting funny." So what does acting funny look like I thought as we zipped up our boots and headed out to the unit. We pull up to a scene in which a highway patrolman has a 18 wheeler pulled over on the shoulder. One of the local volunteer firefighters was on scene who is known as the "pastor," a elderly firefighter with a heart of gold. "Got a big one." "How big?" I ask. Probably four hundred pounds or more. Just great we say to each other while slipping into our yellow reflective vests that are required up on the interstate. They want us to be safe and all, but sometimes it would be safer to either stay in bed or come prepared with a forklift. I swear, people are getting bigger each day, but what I found high above me in the semi's cab I was unprepared for. This man was no four hundred pounds, he had to be 600 plus. Whoa nelly and riddle me this, "how do you get a 600 pounder down out of semi cab, which if you didn't know is situated eight or more feet above the ground, and onto a stretcher with myself, a female partner, and a couple of elderly compassionate first responders? A victim that was acting confused and disoriented, and unable to even get up from the drivers chair. This man's legs were as big as my whole 280 lb body and every bit of them was wedged under the steering wheel. Our man was struggling to breath and would not tolerate a prolonged fooling around at the scene. I felt stumped and my partner and I looked at each other with that look that says, "this call sucks, why did we choose this profession?" Finally, after looking at the situation for several minutes and realizing there simply was no easy or perfect way it was going to get done, but by god this man was coming out of there one way or the other. Sometimes you just have to plunge right in and see what happens when a solution doesn't present itself. So I grabbed the handles attached to outside of the cab and pulled myself into position while directing my partner to go around and snag the other side of this huge man. I then directed the firefighters and enlisting the begrudging patrolmen into position below me with the stretcher set to receiving said victim or perhaps to break a sudden fall. My biggest fear was the victim would just crumple coming out and we would be too few in strength to slow his fall.
So here this big guy cometh as we pulled and pushed for many agonizing minutes while shouting various instructions to either him or the pushee's. The effort was more out of will than any mechanical advantage, and little by little he made his way to the door and the moment of truth had arrived. Ah, but to make the situation even more delectably interesting, the man had shit diarrhea all down his 600 lb backside which was now evenly and disastrously right in my face. We have a frequent saying in EMS down here, "it is what it is," in other words there was nothing I could do about it. Trying my best not to soil my uniform I pushed with all my might on his butt to keep him from coming down hard on the stretcher below. I can remember thinking what motorist were saying when they past by during all this to see this giant of a human being with his crack showing, and poo dripping, while a few old men scaffolded everything from certain disaster. Surprisingly this victim didn't come down with a sudden crash and take all of us out, but rather came down in doable position on the waiting stretcher, not perfect mind you, but good enough. We certainly weren't going to be doing any repositioning. The guy was so big the handles on the stretcher could not close and his width was spread from one wall to the next. Even with six people now at each point it took 3 tries to load him into the back as we fought to fit round flesh into a square hole. My left bicep throbbed as if I had tried to go for a world record in dead lifting and my partner ended up pulling her neck from all the strain. Sadly, no one wants to go on workman's comp around here for how little it pays. We were no exception, but by god we did it. We managed to get a 600 plus pound man out of a 18 wheeler and to definitive care. After an IV line en route, some blood sugar tests, and ECG monitoring we had him to a hospital that would later go on to diagnose an infection that was making him confused. Sometimes you just have to "getter done," and see what happens. But one must take action to affect anything and Jane Heard once said, "a well adjusted person is one who makes the same mistake twice without getting nervous."
The shift over I come home for some R&R and take care of some home projects I had been meaning to do. Cutting drywall and hanging it. Another chance at being adaptable arose when my utility knife broke into pieces. Keeping it simple and following my philosophy of "gett'er done," I grabbed a pair of vice grips and clamped them to a razor and thereby making a fine what-cha-macall-it and a crude utility knife. Good enough to carry on with my project without any hitches.
Wednesday, March 14, 2012
WWIII in 2012
Yada, yada, yada, yada, some of us will say. We've all heard the saber rattling rhetoric a thousand times before. Year after year the same dire warning that Iran will be attacked, and then nothing. Indeed, it seems that subject has cried wolf a thousand times that it is now so hoarse that no one can hear it anymore.
It's why IMO it's a "thief in the night" event that sets off WWIII. I don't know if the Mayans foresaw any of this or it's coincidental, but the leading economic mammoths of power have slowly propped up the global crisis for as long as possible and in so doing have probably given themselves great yields in profit and time to prepare. 2012 is coincidentally an election year, and the political machinations the US does during these theatrical plays provides the necessary catalyst for end game triggers. Deficit spending cannot continue to support our current GDP and delusional sense of vigor.
http://market-ticker.org/akcs-www?post=203352
The Depression featured this sort of attempt at "repression" by The Fed and government and it was unsuccessful. It looked successful for a while, - where we are right now -but eventually the math caught up with them and we slumped back into the morass. Our "exit" was war; we blew up all of our industrial competitor's output capacity and by doing so rejiggered demand. That's a rather bleak way of looking at what was "death by all forms" for the common man, but from an economic perspective that's what happened. But "war as a solution" since that time hasn't "worked" (and in fact can't) since small-ball wars run into the broken-window fallacy; you can't "win" by breaking windows as the economic damage from a war exceeds the benefit. For war to be a "winning" strategy you have to literally flatten your economic competitors so that even with the economic damage you wind up with a net benefit.
We have hidden the depression we're in with deficit spending. Many of you think that the fed can keep printing indefinitely with no repercussions. This is absolutely false. It eventually catches up, as it caught up to us after 1930. Obama See's it and all his economic hitman do as well. Hell, a lot of American's realize it too, except they seldom make the connection between GDP and government spending, they just realize the debt and deficit situation as rightfully dire. Most have no idea HOW dire.
I see the exit as WWIII. They'll attempt to reset the global economy with another war. It's just that we're in a new age of capability where we really do have the technology to wipe us off the planet with some key turns and buttons pressed. I don't think the 1%'ers want this, but I'm not sure if they can prevent it either. Resetting through war will be a far greater source of ma-cab debauchery than every previous war known throughout history.
And what if something else, something natural that cuts short our war? We've gone and done the deed as far as climate change is concerned, and the Arctic is melting faster than at any time in geological history. Methane is bubbling up from the melted sea holes as we speak. Seas are rapidly acidifying. And who can argue with this:
Deniers are just stubborn and incapable of seeing the flower blooming 2 months ahead of time for what it is. They are signs that humanity is facing a rapid shift in our way of life, a way of life that is shoving out every other lifeform and plant that made our world beautiful and full of life. Messing with this spherical vestibule of life floating around in space, our only one, is just crazy.
Now then, back to WWIII, and back to the blah-blah about attacking Iran.
http://www.zerohedge.com/news/russia-discloses-iran-ultimatum-cooperate-or-be-invaded-year-end
A million new ones is what is needed to start the great reset. Obama has to act this year or he will be replaced by someone that will. With the weapons at the disposal of super powers, I'm sure everyone involved is more than a little fearful over what will happen if Iran is attacked. A nation tied to two super powers and the heart of Persia. But that fear has to be acted on or the US faces absolute and undeniable economic collapse in 2013 (see bonds and debt), and likely a foreign invasion. Yes, that's right, red dawn and all that jazz. That's what's at stake, and the 1%er's know this.
So friends.....this is the last year to store up what you think will help you stay alive during the great "reset."
Before 2013 arrives you will hear me say, "THIS IS IT."
It's why IMO it's a "thief in the night" event that sets off WWIII. I don't know if the Mayans foresaw any of this or it's coincidental, but the leading economic mammoths of power have slowly propped up the global crisis for as long as possible and in so doing have probably given themselves great yields in profit and time to prepare. 2012 is coincidentally an election year, and the political machinations the US does during these theatrical plays provides the necessary catalyst for end game triggers. Deficit spending cannot continue to support our current GDP and delusional sense of vigor.
http://market-ticker.org/akcs-www?post=203352
Now, however, the fun begins. See, the TNX moved up strongly -- the 10 year yield. This in turn will force The Fed to sit on its bond holdings to maturity, lest they take a market loss (and given their thin capitalization that would bankrupt The Fed instantly!), which in turn ties Bernanke's hands to a large degree.
I know many will argue that The Fed can always "print more", but that's not how it works. This is a negative feedback situation and triggering a run out of the long end of the bond curve isn't so much a problem for The Fed as it is for the Federal Government's financing and deficit numbers. Take a look at the FVX (5yr Treasury Yield) and you see a materially-more-frightening thing. Yields have backed up from 0.7% to 0.97%. Sounds trivial. It's not -- it's a huge move, close to 40% on yield since the end of January!
This matters because the Federal Government's deficit spending in February is what has been driving the "improving" economic numbers, just as it has been for the last three years. This is a pincer move; while yields have to normalize if and when they start to move in this direction that move will also choke off federal deficit spending capacity.
The Depression featured this sort of attempt at "repression" by The Fed and government and it was unsuccessful. It looked successful for a while, - where we are right now -but eventually the math caught up with them and we slumped back into the morass. Our "exit" was war; we blew up all of our industrial competitor's output capacity and by doing so rejiggered demand. That's a rather bleak way of looking at what was "death by all forms" for the common man, but from an economic perspective that's what happened. But "war as a solution" since that time hasn't "worked" (and in fact can't) since small-ball wars run into the broken-window fallacy; you can't "win" by breaking windows as the economic damage from a war exceeds the benefit. For war to be a "winning" strategy you have to literally flatten your economic competitors so that even with the economic damage you wind up with a net benefit.
Such a conflict in the modern era has a high risk of turning nuclear and then everyone loses. In the next few days the market is likely to trade on euphoria from the financial sector, but I don't buy it at all. Repression destroyed net interest margin in gross earnings terms irrespective of the spread and makes earning a profit much more difficult. Most of Europe is in recession now and that's a huge market. The ECB has no room to maneuver and further QE by The Fed will declare that the so-called "recovery" is false.
Bernanke, Obama and Congress have swam into the jaws of the shark and now the trick is to try to get back out before the teeth clamp down on all of us. The problem is that extrication in one area will produce undesirable moves in another. If the Federal Government pulls back on deficit spending then the economy softens materially, unemployment goes back up and with a falling labor participation rate tax receipts collapse, adding to the problem. If The Fed pulls liquidity then interest rates go up, the deficit goes up, Congress finds itself up against the debt ceiling again in short order and a pullback on deficit spending will become inevitable. If The Fed engages in aggressive acts to try to prevent the yield curve from backing up on them then oil will likely skyrocket, gas prices will go through $5 and we all know what comes next. Finally, the corner we've painted ourselves into has occurred into a cyclical profit cycle peak.
We have hidden the depression we're in with deficit spending. Many of you think that the fed can keep printing indefinitely with no repercussions. This is absolutely false. It eventually catches up, as it caught up to us after 1930. Obama See's it and all his economic hitman do as well. Hell, a lot of American's realize it too, except they seldom make the connection between GDP and government spending, they just realize the debt and deficit situation as rightfully dire. Most have no idea HOW dire.
I see the exit as WWIII. They'll attempt to reset the global economy with another war. It's just that we're in a new age of capability where we really do have the technology to wipe us off the planet with some key turns and buttons pressed. I don't think the 1%'ers want this, but I'm not sure if they can prevent it either. Resetting through war will be a far greater source of ma-cab debauchery than every previous war known throughout history.
And what if something else, something natural that cuts short our war? We've gone and done the deed as far as climate change is concerned, and the Arctic is melting faster than at any time in geological history. Methane is bubbling up from the melted sea holes as we speak. Seas are rapidly acidifying. And who can argue with this:
Deniers are just stubborn and incapable of seeing the flower blooming 2 months ahead of time for what it is. They are signs that humanity is facing a rapid shift in our way of life, a way of life that is shoving out every other lifeform and plant that made our world beautiful and full of life. Messing with this spherical vestibule of life floating around in space, our only one, is just crazy.
Now then, back to WWIII, and back to the blah-blah about attacking Iran.
http://www.zerohedge.com/news/russia-discloses-iran-ultimatum-cooperate-or-be-invaded-year-end
In what can only be seen as raising the rhetoric bar on the timing, scale, and seriousness of the Iran 'situation', Kommersant is reporting that "Tehran has one last chance" as US Secretary of State Clinton asks her Russian counterpart Sergei Lavrov to relay the message to Iranian leaders. If this 'last chance' is wasted an attack will happen in months as diplomats noted that the probability of an Israel/US attack on Iran is now a specific 'when' instead of an indefinite 'if'. The sentiment is best summarized by a quote from inside the meeting "The invasion will happen before year’s end. The Israelis are de facto blackmailing Obama. They’ve put him in this interesting position – either he supports the war or loses the support of the Jewish lobby". Russian diplomats, as Russia Today points out, criticized the 'last chance' rhetoric as unprofessional suggesting "those tempted to use military force should restrain themselves - a war will not solve any problems, but create a million new ones."
A million new ones is what is needed to start the great reset. Obama has to act this year or he will be replaced by someone that will. With the weapons at the disposal of super powers, I'm sure everyone involved is more than a little fearful over what will happen if Iran is attacked. A nation tied to two super powers and the heart of Persia. But that fear has to be acted on or the US faces absolute and undeniable economic collapse in 2013 (see bonds and debt), and likely a foreign invasion. Yes, that's right, red dawn and all that jazz. That's what's at stake, and the 1%er's know this.
So friends.....this is the last year to store up what you think will help you stay alive during the great "reset."
Before 2013 arrives you will hear me say, "THIS IS IT."
Sunday, March 11, 2012
The Omen of a dying Racoon
Our winterless winter has now blossomed into an early Spring. My fruit tree's bloom with delicate white petals, the butterfly's and bee's fly from flower to flower, and Azalea bushes everywhere inspire the eager gardener. The local garden shop is full of people busy buying snap dragons, petunia's, and marigolds while my wife and I privately have gone on a mass planting of actual stuff you can eat. The weather has been perfect for it, and unlike last year there's rain a plenty for the stuff that comes out of the earth. I wish I could say it wasn't good for the blood-suckers, but alas, they are in abundance from the dusk induced clouds of gnats, to the mid day attack of deer and horse flies, and never failing to cover all 24 hrs, the nightly mosquito swarms. There never seems to be enough spiders, frogs, and toads to eat enough to make a difference. Most of our poor bullfrogs, once in abundance in these parts, are long gone only to hear the lonely one or two from the culverts that mark the entrance to my drive. Back in the 70's when my mother first bought this house and moved out here, I keenly remember spending the afternoon's with my best friend netting big thumb sized tadpoles from the area ditches to bottle and watch them metamorphasize into foot sized bullfrogs. Those days have past away like the grizzlies and bison the local Indians once hunted.
Back in January I busied myself in constructing a 10'x20' greenhouse using my learned carpentry skills from hurricane Katrina. It's one of those things you can say "what didn't kill you, made you stronger." Took me a month as I put it together by myself on the off days, and I'm none to proud to show it off. First A-frame roof I've ever constructed and a real framed building, and not just a lean to chicken coop. Though, that's the next project, and a large pond to house the ducks and geese.
Back in January I busied myself in constructing a 10'x20' greenhouse using my learned carpentry skills from hurricane Katrina. It's one of those things you can say "what didn't kill you, made you stronger." Took me a month as I put it together by myself on the off days, and I'm none to proud to show it off. First A-frame roof I've ever constructed and a real framed building, and not just a lean to chicken coop. Though, that's the next project, and a large pond to house the ducks and geese.
My wife is delighted and has been seed planting with such zeal that I find it inspiring to our relationship. Sorry about the photo quality as these are just pics from my camera phone, the ones on the good camera I'll upload later when I have a cord to do it with.
It never gets old to be amazed when planting a plain looking seed into the moist dirt to then see a living green seedling emerge and grow. Everything that it is in encapsulated in such a tiny package, and everything it is to become is pulled from the earth using the energy of a ray of sunshine. Honestly, it's like magic. As good as watching a plain o'chicken egg that is kept warm instead of just throwing into a frying pan pop out a living, breathing, new chicken. All that needs to be inputed is the sun and heat, both forms of energy we humans have only begun to tap. Feels like a miracle....it is a miracle. I know of no human technology that shows any such equivalency. We are such primitive animals when such things are compared. Order is brought out of chaos, by annuit coeptis, by providence. Few are even aware that magic still exists. They would rather be enamored with iphones, ipads, and all virtual facsimiles of what nature does with a fraction of the cost in energy. The real world is the grand master in technology, one that is honed and perfected with billions of years. It enslaves nothing in the creation process, it doesn't demand that mountains be blown up, or children to work 15 hr days to the point of throwing themselves off buildings, or dumping waste into pristine watersheds. We humans are but its apprentice, one in which we have grabbed the Mickey hat and run amok. Well the real wizard in this play is about to show up and bring order to chaos, and the apprentice will pay a dear price indeed.
20 dollars a bag!
We'll see, as I'm skeptical having enjoyed prior gardens using the traditional till it up crop of annuals. The soil does feel nice through the fingers as I plant our seedlings, and it smells good too. Yes, I'm a smell er and feeler when it comes to life. Not everything gets tasted as one can imagine. I've also been busy planting perennials as any doomer can testify as being the absolute champions when it comes to low energy inputs vs calorie outputs, and this year I'll be keeping track of calories yielded in harvest vs calories spent producing it all. I've planted grapes and blackberries all up and down the fence line of our acre and choice fruit tree's (Satsuma's, pears, oranges) too. Spring is so exciting!
It's almost time to dig the duck pond as I've marked out the dimensions with orange spray paint used by professional landscapers. Need to measure it though, but I think it's close to 40'x60'? Which the ducks are sure to love. Six feet deep and the koi are sure to thrive and hopefully multiply. I also have plans to raise Talipia with several large holding tanks in a planned aquaculture project this May. Already have the pumps and stuff for it with the hope to pickup some solar panels to power it all. Need some panels for the greenhouse too as we just have an extension cord coming from the house to it now powering a flood light I've wire tied to the ceiling rafter. Then there's ditch-witching to do to run electrical conduit and plumping to the greenhouse and water features. My two guard dogs look on with fascination as I busy myself on ladders, pushing tillers, and nail gunning 2x4's together. Passing Pearlington locals fly by honking their horns as if thanking me in improving the neighborhoods land value. They just better not turn my little food vault and life boat into the local zombie watering hole. My two best friends and I have plans if they do since we're all throwing in together when the shit hits the fan.
Work has been fascinating and full of omens. Paramedics get an inside view of people's lives with each 911 call that's made. We go inside people's homes, we look around when we do, and listen to what's going on. People tell us all sorts of things, and the pulse of humanity is registered with this doomer. Yesterday, a man dying of metastasised lung cancer gripped my hand and pulled me close yelling in my ear with the last hour of his life, "Jesus is coming, the devil is here, and the land weeps. God bless you." I'm not at all religious as anyone that knows me can attest, but I work in a hyper religious rural setting - rural Mississippi, and what this dying man had to say cannot help but resonate with my feelings that a tipping point in human global crisis has been reached, and this "Jesus" or whatever is about to show up. My dying man lived in the perfect doomstead, a gorgeous log cabin, acres and acres of land, a large garden, horses, pigs, a gun rack full of weapons, and all the other acrugements survivalist horde up in their thoughts of what it might be like - the end of the world as we know it. For this man of 52 it has all come for naught, and the family that knows him thinks it's all a bag of malarky that the Winn Dixie won't have the packaged meats, the individually sliced processed cheese, and the piles of fruits and vegetables any day of the week they choose to go and shop, and god forbid the Voice won't come on to delight their frivolous fancy in the evenings while they chug 2-liter cokes.
For many of us, we will come to an ignoble end, like this now dead doomer whose preparations were for naught. Thus, preps should not be a form of anxious storing, but a process of wise living. Like a bear that prepares to hibernate stores up calories ravenously eating during the warm months. We too must live wisely and prepare for lean, cold, hard times. We will not all make it, for the leans months to come can not be predicted, but they suredly will arrive. "Like a thief in the night." So thus live life ravenously, like the bear during the Summer, and may we too sleep soundly when the land of the zombie goes dark and silent.
As we departed from the dying man's doomstead, the ambulance came upon a raccoon that was sitting in the middle of the road. It's hind quarters were crushed and smashed into the roadway, but the rest of it sat up and swayed to and fro in a sort of deathly worship. Something about it was so creepy and filled of portent. The animal was in sheer agony. The ambulance at the command of Megadoom gave it quick relief. Natures master will render what is broken a quick relief too, and thus will man know that there is little that separates it from any other animal that breathes air and has a beating heart.
Friday, March 9, 2012
Fabricating a recovery
Well the latest employment report is in, and as usual the media pundits are chiming in with the producer instructed propaganda of a growing recovery. Here are some stat graphs from this report, and look at the labor participation rate. That's significant and won't be talked about on NPR, FOX, CNN, AP, REUTERS, and so no. Neither will the fact that those who can no longer file unemployment claims because they're past the maximum are no longer counted as "unemployed." We're saturated with purposeful delusion and capitalistic grandiosity to support consumer confidence, like a bunch of shoe buying lemmings. Like Pavlov's dog they'll repeat themselves all day long - "the recovery shows strong job growth" - until like a bell and a treat we feel as though the economy is getting better. Then why are 48 million Americans on food stamps? Why are states all over the country having to make hard and politically costly cuts? Why are home sales flat? Why is homelessness at a all time high? Why is worker productivity, that is, forcing more work out of existing employee's higher than ever? Why is the trade deficit so high? Worst of all, why do we have a deficit that is increasingly made larger past 1 trillion dollars with 15 trillion in the hole? That's no recovery countrymen, that's using a credit card when you're flat broke and deeply in debt to carry on with business as usual. Business as usual is making the rich richer, and the poor poorer.
So basically, I can pump trillions into banks by way of bailouts and operation twists while waiting for people to fall off extended claims, and I to can fabricate a recovery. It's like being caught flat broke at the end of a monopoly game and being given the bank tray to continue playing.
The truth has been beaten up and locked in a dungeon somewhere.
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