backseatsiren

[backseatsiren]

Never Enough

It's been busy out there, as the omicron surge has taken NYC like wildfire. The ERs are insane right now, with beds in the aisles - it took something like 45 minutes just to get a patient checked in the other day, thanks to an overstuffed, understaffed ER. 

By the way: If you (yes, you!) reading this need medical attention for anything right now: please be patient, because medical staff are unbelievably overworked right now. I want to give everyone in every ER across NYC a gift card for a massage and a bottle of whatever they like best right now. That's a fund I would support, if anyone can get that going...

But, speaking of the pandemic... I actually had COVID right before Christmas, and was luckily not too sick and able to visit family on my tenth day of quarantine (which was Christmas Day itself), but not everyone is so lucky.

Lately

I've gone out twice in the last week: a combination of feeling a personal responsibility to go out, a break from my MMA gym while numbers are so high (you can bet I'm basically vibrating with the need to go back), and a whole bunch of vacation days after a ten day quarantine that left me very, very primed to go out and do something. But, as the title here might clue you in... it's really not enough.

Last Tuesday, I was on the community ambulance. We've been activated in the 911 system constantly since the holidays (briefly: as volunteers, we typically "buff" jobs, listening on the radio for calls, arriving, and either assisting the dispatched crew with the call or taking that call off their hands). The community bus does the usual, buffing jobs, while our second ambulance was in the activation. In an activation, our ambulance is directly dispatched in the 911 system, and sent to calls like any other 911 crew — and many of these are all over the city, not necessarily in our usual service area. We had a couple of calls: a car accident and an interesting syncope job where we had paramedics for most of the call.

There was a difficult element here: our patient didn't speak much english, and his daughter was translating for him throughout the call. But no family was allowed in the ER (again, it was crazy: beds in the aisles, lines to register patients and transfer care), and she had to explain to him that she had to go. Obviously, this is a situation where the policy is understandable and necessary: and also... sucks.

On New Year's Day, I did one of my first activation tours (I'd done one before, but on an uncharacteristically slow day). Honestly, I prefer it, even though we might be all over the place and not in our regular service area, and the call variety was interesting.

After a couple of more routine jobs, we actually had a fairly critical patient that day. A severe pediatric asthma attack (which is a call type that I had a very rough experience on once, years before, where I literally fumbled a medication. Everything was fine, everyone was fine, but I felt like a royal dumbass). We arrived to a "difficulty breathing" call to find a mother walking her daughter out, and she was in obvious distress. Accessory muscle use and you could hear wheezing without a stethoscope.

Sufficiently critical asthma attacks and anaphylaxis calls are TERRIFYING. There are plenty of other, much more gruesome calls that are less straight-up scary, mainly because when a person can't get enough air, they (very understandably) often panic, and honestly, that's fucking terrifying. They can also be wonderful calls to go on because we can often really help someone in that situation: obviously, that depends on many factors. But we have albuterol and epinephrine and they work pretty well. Scary, critical calls where we can really help a patient = a happy EMT. At least, for me.

(For the record, and because this is the internet, I need to say this: I don't want anyone to be hurt or sick. I don't sit there in the ambulance saying "Man, I sure hope someone has a horrible, near-death situation today, for my benefit!" No. I'm just saying — and I think this is a logical, relatable thing — that it feels good to be able to help someone in distress.)

It felt good to treat and reassure and help this kid and her family. On so many calls, there is vanishingly little we can do for a person. Sometimes, all we can do is that bit of "psychological first aid" and try to be there for a person while we bring them to a place that can actually offer care (though, often enough, with issues like substance abuse or any other chronic problem, it's not like they'll go and be cured immediately, so that's more like helping with a potential first step.) I'm pretty sure this is why many people become EMTs, to help people and see a tangible result of that help: the satisfaction of seeing your effort turned to results. That's a lot of why I do it, anyway.

Which leads me to what I'm struggling with now: the feeling that I still don't go out enough. I've gone on two tours in the last week, and I'm thinking about a third. But that's not enough either. While the city is in crisis (I saw a figure around 6k calls in the 911 EMS system last night, which is close to the peak number of above 7k during the worst and deadliest part of the early pandemic in March/April 2020) there is no number of tours that will feel like enough.

Yes, this is a me problem, and an "I have OCD and need to do something" problem, but I'm also not the only one who feels this way. I have a work partner who works full time in another field and he's been on the ambulance practically every day since the activation over the holidays. He's expressed a desire to keep going and keep going while things are this bad, and I am right there with him in heart (even though I really can't be there every day).

Work (at my main, full time job, that is) is starting up again tomorrow, but it's hard to think about much else besides getting back on the truck. On top of feeling like I need to help, there is a more selfish dimension to this: it feels good to help. It feels great to be there and be active and feel, in any possible way, that you are doing something about this horrible fucking thing that's been ruining everyone's life (and taking many, many lives) since March 2020. And it feels good to learn and learn more about our processes in an activation, as opposed to our usual way of doing EMS.

So, no, it's never enough. It never will be enough. I can just do my best and make some attempt to accept that. Maybe someday I will.

[backseatsiren]

So, What Can I Add?

Had another call recently that has stuck with me, and yup, that means I'm going to write a little entry about it here.

We got a call for either an unknown or a sick (I just don't remember specifically), and we arrived alongside the FDNY crew. We waited for a second at the door, and a woman came to the door, walked out, and asked to talk in the ambulance because she didn't want the neighbors to hear. 

I conversed with the FDNY crew, let them know we were happy to take the patient and that was that. (This is standard for volunteer EMS in the city, btw.)

Immediately, she seemed to like me enough, but definitely did NOT like anyone else. My driver asked if she wanted to go to one particular hospital, and she had a pretty rude response. She was worried about neighbors being nosy, and she really wanted to get underway.

But I sat her down inside the ambulance, asked her what was up, and she really, really opened up to me. She was drinking something, and tearfully admitted that she had an alcohol problem and wanted to do something about it. It was clear that she had been thinking about calling, and she said something to the effect of “enough is enough."

She told me she wanted help. 

We went on our way to the hospital. She confided in me about her life. She told me she was trans, and that the pressure to pass and always look her best were getting to her. She told me she was embarrassed by her drinking and her behavior. I kept telling her she was doing the right thing by getting help, and she kept thanking me. She said I was understanding. She seemed to genuinely respond to me. But she was agitated.

At one point she got angry at my partner (who is a new EMT, but was very quiet and respectful), but she was just lashing out, I think? It was hard to tell why she was upset with various people. When she got upset with him, I gently said "you can talk to me." 

We had a whole conversation about high functioning addiction in the back of that ambulance, and about gender, and age, and expectations and about how it can be even harder to seek help when you ARE high functioning, because of the way people treat you.

I got her tissues while she cried. She held my hand walking into the hospital.

There was a genuine shitshow that day in the triage area (due to something completely unrelated: a huge backup thanks to another patient coming in and refusing to be separated from their very large dog to go into the ER, so there were bosses of every kind trying to figure out the situation, security running around, etc.) and she became upset a few more times, but she seemed to trust me when I told her she was doing the right thing and that she would be getting help.

It was actually a pretty long call. I didn't do anything medically for this patient, besides just asking her the usual patient interview questions about her medical history, etc. and some basic vitals. I just sat with her and talked with her. It might be because I told her my partner (not in EMS, in my life, I should make that clear) was trans, It might be because I just have that kind of face that people trust. It might be because she was sick and scared and I wasn’t going to make fun of her or glance sideways at her. I don’t know.

As always, I feel... complicated about it. Right after the call, I felt elated. She kept telling me I really heard her and made her feel listened to (which makes me feel amazing). I want to help, I want to listen, I want to be the shoulder to lean on and the hand to hold and the steady EMT who brings someone to the next level of care. I've written before about how that's where I feel most useful: because most EMTs are so horribly underpaid and overworked and -understandably- might not be in the best place because of that. 

Enter Jolly Volley Danielle, who wants to listen to everyone's problems, because this is a service that I enjoy providing. It's not my every day job.

But also... what did I really do? I brought her to an ER, I was nice to her and listened, and that's something, but that's... it. As ever, who knows if she got the help she truly needed. Who knows if she will ever get the help she needs, in a fucked up medical system that has plenty of cracks to fall in. I wish there was some way of knowing, and some way to help in a much larger capacity.

My ability to really help this person was so limited, and I always want to do more. I know what my role is here, and I won't overstep, nor will I pretend to be something I'm not. I'm not a therapist or addiction counselor or a doctor. And even if I was all of those things, my role in this capacity is to be an EMT, who assesses life threats, treats them, and provides appropriate care as I bring someone to a place where far, far more qualified people work.

To that end, there were two other calls that day for more complex medical patients, with several medications... a few threads are running concurrently here, but this was part of me finally starting to research pharmacology on a more intense basis.

I ordered a couple of pharmacology reference books (paramedic and nursing, primarily, nothing too wild), and I started taking a basic chemistry course online. None of this is necessarily in service of seeking a further certification (maybe, someday, if media completely boots my ass out the door). But I am curious.

I've gotten pretty tired of feeling like a dunce with my PCR (patient care report) on my tablet, writing down medications that I have no earthly idea about. It happens often enough, with any patient who isn't in full command of their entire medical history/medication list at a moment's notice, while something potentially painful and terrifying is happening to them. I don't blame them.

We always ask our patients everything they take, and what their conditions are. If we have the bottles or patches, etc. handy, I can look things up on my phone. But on a busy 911 scene, with an emergency in progress and my patient vomiting or screaming or passing out, it's just not practical. Having a solid working knowledge of at least the major classifications of meds, what they are for, how they are dosed, and a decent command of the most common prescriptions will go a long way. It'll just help me be that much quicker on the draw in a difficult situation.

It's for personal enrichment, yeah. But I also genuinely want to be a great EMT. And I want to teach new EMTs how to do this well, and give something to them when it's my responsibility to help teach them in the field, on calls and in between.

[backseatsiren]

A Dramatic Day

It’s been awhile since I’ve written here! There are a couple of reasons: first, my life has reached brave new heights of busy - I was promoted to Editor in Chief at work a bit over a year ago, and my responsibilities there obviously take a lot of time. I’m also teaching more courses than usual at Berklee (right now, one section of Film and TV and two of Game Design Principles), and, as usual, I’m training grappling on top of it all. Plus, naturally, the ambulance. I’m hitting my tour hours, and proud to do it, and as pumped as ever to be an EMT in this neighborhood.

I’m also... very, very, VERY slowly *actually writing a book* about all of this. I’ve begun interviewing a few fellow EMTs, mainly volunteers, about what it is we do. Because of how insane my schedule is, it’ll be a very long term project, and I can’t put any pressure to finish soon. But, especially through the pandemic, I’ve felt a desire to document and interview and report on the idea of volunteer emergency medical services in New York City, here in Brooklyn and Queens, and I think other folks might be interested in reading a bit about it.

But I’d like to get back into the practice of writing about calls and concepts and experiences. As always, I’ll respect patients and patient privacy, and will never reveal identifying information or anything inappropriate.

Today was a fairly busy day, but it started with a bit of a dramatic call. We were called to an unknown, and flagged down by a bystander. A man called us over and told us that he saw a man lying on the train tracks (a less-used track, not the subway or commuter rail or anything). He said he regularly feeds a colony of feral cats there, and noticed the gentleman lying down the way.

We thanked him and high tailed it over, yelling out to him (the usual “sir are you ok?”). My more experienced (many, many years in EMS, including at a much higher level of certification) partner took a look at him and said “he might be dead” and began looking forward a pulse. He went for more help (another ambulance was arriving and they needed to be directed over, the physical layout of the space was weird), and he instructed me to look for a pulse. I did, and found nothing. My other partner (a newer EMT, just cleared for CC status, who I also love working with), said “he’s cold to the touch.”

It was raining lightly. The tracks were a little slick, and there was some litter. It’s early may, and the grass had that beautiful sheen on it, that it gets in the rain. Weird things, visual and sense memory things, are coming back as I write about it.

He was lying down on his face on the tracks. I checked for a carotid pulse again and felt nothing. I checked his hands - they were closed and held tight. Rigor Mortis. I checked his arms, his coat, his clothing, careful not to mess with anything, but looking for lividity. He was bleeding from his face, and, on inspection, his face was very clearly badly injured, bruised, and bloated. I was wearing an N95, but even so, you could smell that he was deceased.

I told my more experienced partner that when he arrived with the other crew. We inspected the scene - noting a shovel and some other tools. There was a little encampment nearby - possibly where this man lived. Beer and food in a little shelter.

It certainly looked like foul play was possible. I learned a few minutes later (on my next call) that the cops did start an investigation there.

As one of the other EMTs from the other crew noted, it was “like a movie scene.” Something about the rain and the light, the way the blood pooled, the way the ants crawled around in it... was surreal. It may have been my less experienced partner’s first DOA when they were first on the scene (it wasn’t mine, but it was certainly the first *outdoor* DOA where I’ve been first and had to help establish that). It was my first suspected murder scene.

And yes, it was deeply sad. There’s some initial adrenaline, for me, in every call. There would be more on my other calls today. There is a voice in my head that repeats a lot of the basic instructions and goes through scenarios: “ABCs” (a note to always prioritize airway, breathing, and circulation). I think about what happened in any given situation and what I should do for my patient. I look for threats to everyone’s safety. And when I can breathe and get a clearer picture of what’s going on, that’s when I can start to process things a bit.

We covered him with a clean sheet from the ambulance and did all the things we needed to do. We talked about it a little, after the call. But I always need to think about things for a few hours after, which is what I’m doing here, by writing about it a bit.

I’m a deeply, empathetic person. I feel for my patients. The call I’m about to talk about - the very next call - required that of me in a different way. But in this scenario, I want to first do everything right for the person and situation, and next, be as respectful as humanly possible. This poor man died - was very probably killed - and was left outside in the rain. I don’t know much about his life, and very little about his death. The whole scenario is very sad, and very surreal.

Every time I’ve had a dead patient, it’s stuck with me. I don’t think I’ll ever forget my first, a woman who very probably died of a heart attack or in her sleep, and her son found her. He was mourning. He was on top of the body, hugging her, crying “I’m sorry, mommy,” and there’s... I guess there’s nothing on earth like that. Nothing like that kind of pain. People, as a rule, do not expect to see their loved ones deceased, and when we do, we usually have a ceremony for it.

I’m just a bystander to that. I can do nothing to help the deceased person, and very little for a mourning loved one, besides being a respectful, empathetic human presence. For my deceased patient today, all we could do was establish that he was dead and do the proper things to ensure his remains would be taken care of (and his death investigated).

My next call was very different, but it was heavy in a different way. We got a call for, basically, a suicidal young woman. We arrived, with PD, to her door. The officers assessed things to an extent, but she revealed that she had been traumatized by police in the recent past, and didn’t want any police in her home. I talked with her calmly, and was able to relieve the cops and take this one, with my partner.

We listened to her. She had obviously been through some extreme trauma and needed mental health resources. I won’t reveal any details here, but I had to keep assuring her that I had no handcuffs and wasn’t interested in taking her against her will. She was terrified of being taken somewhere she didn’t want to go, and I basically sat calmly with her and talked to her about her options. Just talking. Just listening.

This is a case, like a patient a couple of years ago, where I’m very happy to take my time. I’m a volunteer, man. I’m not grinding through a shift for miserable pay, as most EMTs are - I’m here because I frankly want to be useful in this manner.

And I’m happy to sit with a person going through emotional hell, because this is what I can help with. I’m five years into being an EMT with RVAC. I do this 2-3 shifts per month, so I’ll never be the fastest, best, EMT in NYC. But I can be the most patient EMT, and I can give plenty of extra time to a person.

I’m not a therapist, and I don’t pretend to be. That’s what I told her - first, that I’m not a cop, I don’t have cuffs, I have no interest in taking her if she’s of sound mind and doesn’t want to go. Then, second, that I’m no doctor, and no therapist, and that I want her to have resources if she needs them.

We talked more, and did more vitals, and she decided she wanted to come to a mental health facility. We explained every step of the process to her, and what she could expect, and what to bring.

Do I wish I was an actual therapist who could help this girl right away? Yeah. Do I wish I had the ability to make mental health policy that provides good, effective, supportive therapy to all human beings who need it? Yeah. Do I wish I could do better for her than an ER with psych specialists? Where she could easily get lost in the cracks or simply never connect with what she truly needs? Yeah.

I can only take her to a place where people are at least trained to assess her and offer her further resources. I can only hope they actually can help, and do so.

I had another call where we did a bit of *psychological first aid* not long after that. A dramatic scene! A young woman fainted at work at a store, and several people were surrounding her and holding her at the scene! Folks were holding her hands and crying.

It looked wild at first glance, but our patient was completely ok - we got her out, had medics assess her completely, and brought her to the ER while assuring her parents that things looked ok. Her mother was extremely upset, and we had a bit of a language barrier, but we were able to assure her and let her know things looked ok, that her child had very promising vitals and EKG readings, and we just needed the ER visit to make sure.

The medics helping us out were INCREDIBLE. They offered a full walkthrough for us of what was going on physiologically with her and gave a very helpful tip on scenes like that - give bystanders little jobs (just simple stuff, like holding the door, or looking for something like a towel) to do! It helps (caring, kind, just want to help) folks feel helpful when they get scared, especially in dramatic-looking situations.

A lot of drama today. A lot of learning. I felt really good about taking charge with my psych patient and helping her to feel safe and able to make her own decision. Im glad we were able to help our young fainting patient. And as much as it’s heavy, I’m glad I was at least on scene today for our first call. I know I can do nothing but confirm obvious death, but, I take some heart in the kind bystander who called for him (the gentleman who feeds cats nearby).

At least someone cared enough to try.

I’m forever grateful for my partners, for the folks who have taken the time to teach me (back when I was VERY green and still, to this day, as I am learning every single shift), and for the patients who trust me to do my best for them. 

I noticed today, this month marks five years of doing this, with my volunteer corps. I can only hope I learn more and become a more effective EMT as I go.

[backseatsiren]

My First Shift in the New Normal of the Pandemic

Last night, I did a full shift on my ambulance for the first time since the pandemic was in full effect. The last time I went out was early March, when things had just started to get pretty scary - I had a patient then with a bad cough - and we were relieved when we got to the ER and we confirmed she had no fever. We had no special PPE, but also, life was still borderline “normal.” People were still going to restaurants and gyms. I was still training grappling with my teammates. 

Things obviously changed pretty rapidly.

For the last month, I’d been terrified, but also itching to get out there. It’s probably dominated a few therapy sessions (therapy is great, friends, I highly recommend it): my own terror of this virus, and the stories we’re hearing of people - even, occasionally, young and healthy folks - dying. Drowning. It’s an ugly, ugly death, and I was scared. I’m still scared, honestly, but my need to get the fuck back out there was quite a bit stronger.

You see, I do this for selfish as well as selfless reasons. I genuinely want to help people and serve in my community. I want that, and I love that. It means the world to me to have the opportunity to give back a little. But it’s also a vital need that I have personally - I need to work with my hands and do tangible things. 

I love my job. I’m the luckiest chick in the universe as far as I’m concerned - and hell, I just got promoted. I’m an Editor in Chief now, doing what I love!

But I do feel a disconnect on some level, in my very online job. Again, this is not a complaint - I love what I do and actually really love working from home, being here with my pets. I like making my own schedule, especially because, in normal life, I get to train in the evenings.

But I am such a little... woman of action, I guess. I love grappling and competing and getting my hands dirty, getting my body fully and completely activated and immersed in activity. I simply do not feel right, or feel like myself, without... action. Some Adrenalin. I’m not an adrenalin junkie, per se (idk, I’ve never jumped out of a plane or anything like that?), but it’s an important part of my life. It might make me a slight jock or meathead, and I don’t care. I love it and I need it.

Speaking of Need...

Frankly, the EMTs around me, in my city, in my community, have been utterly swamped in this crisis. Have been working their asses off. NYC had over 7,000 911 calls in a single day this month (the usual busy day is in the 5K range I believe). And here I am, sitting on my ass, doing my nice comfortable job. I felt like a massive, massive asshole and basically... a fraud.

I’m not a fucking EMT cosplayer. I don’t put on a uniform to take selfies, I want to go out there and help.

For a bit, it was hard to get a crew together. At first, we didn’t have enough PPE, so we didn’t send crews out. Then we got equipment, but it was hard to pin sown scheduling. This is understandable - we’re an all-volunteer organization, some ppl are underwater in all this, others have medical conditions that would mean exposure could very possibly kill them or put them in extreme risk. Tons of folks were helping in crucial ways - doing training or coordinating, seeking donations of PPE, etc. And some folks were able to go out on a special 911 service. I’m incredibly proud to be a part of this organization, where people are valued for many different types of service.

I, myself, had spent the last couple of weekends doing driver training with a really rad volunteer who couldn’t go out, but she still wanted to do her part to help. Hey, I drove on the Jackie Robinson in an ambulance for the first time last weekend! It was exciting! But eventually things aligned and I had a crew for Tuesday night. I practiced with my N95 mask and reviewed all our new PPE rules. We had a little demo of the new equipment before going out. And here’s the best part: last night, I got to guide my two other crew members through their first-ever 911 call.

That’s right, I had two (excellent), brand new crew members. That means I had to run all aspects of the call, and give instructions in a pretty wild situation. I’m thrilled and proud to say it went really well.

We turned up to a “fever, cough, difficulty breathing” - almost certainly COVID - for an elderly patient. The family were outside, and I told them we’d be right up, we just needed to suit up. So, on went our special tyvek suits, respirators, face shields and gloves. We went up, accompanied by the FDNY crew chief, who stayed outside the room, and had a very sleepy, confused, and sick patient. I let FDNY know we could take this one - and he was super thankful about it (he even said “God bless,” and i know some people don’t like that, but I think it’s very sincere and kind). We got info and prepped our patient. Based on everything going on (which I won’t go into detail on), I made the decision she should be seen by a doctor (one thing I will say - she found a family member dead, from COVID, in her house a few days before. So this family had already been through hell). She was an incredibly sweet person, and I made sure to keep telling her she was doing a really good job as we got her ready and down to the bus. She was a little scared as we carried her down the stairs, but very, very sweet and compliant as we took care of her. I may have sweated my body weight in that suit. But I will say that in a hazmat suit and shield, I felt safe and confident enough to do my job properly. That, honestly, was a godsend, and something I was pretty scared about before going out. This is a hands-on job. We lift and carry our patients, we have to touch people to care for them. This patient went to the bathroom in front of me and was confused and sleepy and feverish, and it was necessary to keep waking her (gently), and reassure her. We got her to the ER and spent a solid twenty minutes on very careful doffing (taking off the gear) and sanitation. I was deliberately slow and careful with this, since doffing is actually the part that supposedly poses the biggest exposure risk if done improperly. We bleached the crap out of our suits and shields and all surfaces, then used our UV light at base to kill everything else on the truck. I did my paperwork. It was a slow night after that. And yeah, we took our time on that call, ensuring everything was done properly and deliberately. One thing I’m really proud of on the call is my patient communication. My driver told me a couple of times that I had really good bedside manner - and I’ve heard that before. I care very deeply for my patients (yes, even the ones that could be considered annoying or troublesome, though this circumstance was far from that). It’s partially because, as a volunteer, I have plenty of time to work and give reassurance and comfort. I’m not on the clock, and I’m not an overworked, underpaid EMT (this job is brutal, EMTs should be paid frankly double what they are).

A medical emergency is terrifying for people - it’s a bad day when they call us. I like to build rapport and trust with my patients (obviously, in a case where we aren’t rushing, and really, even then I do my absolute best to be comforting and reassuring while moving fast). I think we made this person feel cared for, and she and her family seemed very grateful for the extra attention.

On that note, I am proud of myself. And I’m proud that I felt confident directing my brand new crew members. It was a relatively big job for a first call (with new, extensive PPE, lifting and moving our patient downstairs, transport, vitals and assessment in a pretty intense situation), so I feel good about that. My driver and attendant did an amazing job, stayed cool under pressure, and had a great attitude throughout.

Thank you

One thing that was positively wild was the gratitude, not just from the patient’s family, but... the people across the street from our base waving and clapping for us. The people at the grocery store/deli, thanking us and then letting us cut in line (I was so embarrassed and I probably made it worse by thanking them twenty times). People treated me differently in that uniform where... in the past, it’s more like “oh, an EMT” - and I have complex feelings on that.  I don’t want to steal a single ounce of valor here - I’m not out in the shit every day, I do this a few times a month because I love it. Does it feel super, super fucking nice to be thanked for volunteer service? It sure does! But I also don’t want to take away from folks who live in this shit - so I just want to be clear on that. 

I love that I get to do this, and yes, I love being thanked when I do a good job. I’ll admit that right now. But I also want to be aboveboard about it, and not take attention away from folks who are in this constantly. 

Wrapping up, and dealing with fear

I had a few decontamination procedures to do at home once I got back too. Uniform off at the door, into a tied-off bag. Shower right away, lukewarm water before hot water to avoid opening my pores too much at first. Wiping down a few items, even if I didn’t use them in service, just because they were on the bus. Simple stuff.

But I felt great, mainly that I was able to get out there and help, that I was able to manage the situation well with two rookies, and able to feel confident in the PPE and decontamination procedures.

Is it entirely possible that I was still exposed, despite doing everything? Yes, absolutely. I could get sick. I could get sick just from grabbing that snack from the grocery store (of course, I sanitized my hands twice before eating, but still!) But I tried to go into this with my eyes open, both extremely careful with PPE and fully knowing the risks. And knowing how I’d feel if I didn’t go out, given that I’ve been an EMT in this city for close to four years. Knowing that my skills and experience were valuable and needed at this time. That I can actually help, even if it’s just a little. I’d like to go out again soon. I’m actually volunteering with citymeals this week as well, so hopefully I can be a bit helpful there too. Carefully, of course, so as not to risk any exposure either way! (Gloves and masks and six foot rule in place for safety). But I feel proud, I feel good, and fuck, I just feel more like myself. And I can’t wait to go out again soon.

[backseatsiren]

This was a tough one

Here’s something I’ve been wanting to talk about for a little bit, but I needed some time to work it out a little in my head. I had my first major trauma a couple of weeks ago where the patient was really, fully MY patient. Which is to say, I’ve been on trauma calls - someone hit by the subway in my first month or two of EMS, a few car accidents, plenty of broken bones, etc. but often on those other calls, I was with other crews. Often, on a bigger job, there might be two ambulances, maybe a fire truck, and all those crews working together to help. On this one, another crew did help us a bit with lifting and moving, but this was my case, more or less. So, I think, for the first time, I felt the real weight of responsibility for saving someone’s life.

Here’s what happened.

We arrived at an apartment to find an elderly woman nearly naked on a floor positively strewn with trash. Almost drowning in it. She had a towel but she was cold and shaking. And she was in pain - her leg was twisted at a painful angle. I had to kick trash away to really get to her. Immediately, I was talking to her to establish her airway and level of consciousness - she was fully alert and oriented throughout the call. We got her on a stretcher and down the stairs, and into our ambulance. We had trouble getting a good blood pressure on her (she had several medical issues that she disclosed that gave us some difficulties here), we splinted her leg and gave her oxygen and made haste. I was sweating, and directing my partner —a new EMT on his first big trauma call—while also checking in with my driver (an experienced EMT) privately to ensure we were checking every box for this patient’s treatments. And my patient - I kept talking to her, checking in with her on her pain levels, apologizing for bumps in the road. Telling her she was doing a good job. At the hospital, we brought her in and the beautiful, gorgeous organized chaos that descends in the trauma room began. A half dozen doctors and nurses started moving in, taking various measurements and giving orders.

It really does look like a team sport. 

Aftermath

As usual, we stick around and give details about the patient’s condition and environment, etc. and help with anything we can. But after the call is mostly over, that’s where I can start to breathe a bit. Wonder about the underlying conditions and put some pieces together for events (that is, in this case, who called who, and who is supposedly caring for this woman who very clearly needs more help). And this is when I start to... feel things other than just adrenaline again. At this point, the spike is still in me but I’m starting to calm down a bit. I finished my paperwork (my first big call in our brand new software, so I took my sweet time getting every bit right), and we were ready to go. I did a bit of a debrief with my experienced partner. She gave me great feedback that I do extremely well with “psychological first aid” - talking to a patient/family, calming them, communicating everything we need to and generally being a warm, caring, professional - but noted that I could move faster in terms of getting vitals. And that I could do more when directing my other partner, since this was a new experience for him. This is the part that scares me more the longer I do this. I am a thoughtful and competent EMT, but I know that I’m not as fast as someone who does this every day. I volunteer a few days a month. It’s been three years of doing so, and I’ve learned A LOT. I feel more confident now in my skills (both my technical proficiency and in making a patient feel cared for). But I may not get the vitals as fast. And that’s something I really want to work on as I go forward. Making the transitions more frictionless. Making the movements smoother.

Lingering doubts

I’m scared, deeply, that when I was a much newer EMT, other people didn’t want to ride with me. That they felt like I was basically an idiot. I have never put anyone in danger or fucked up on a call - but yeah, I was slower. I’m faster now. I’ll get faster still. That fear, of course, returned in this call because it was kind of a milestone for me. This was probably most challenging situation I’ve ever handled, since there were tons of complicating factors and I was leading with a less experienced person. Manager Danielle of course came into play. I told him he was doing well and offered appropriate feedback, and I think he learned a lot as well. But the most challenging bit: feeling like this woman’s life was in my hands there for awhile. This woman who needed help, and needs much more help, given her living conditions. She was a kind, attentive, nice person. She didn’t want to complain too much. Yet we found her lying in a pile of garbage on her floor, shaking and almost nude, cold as can be, and it took awhile for someone to call us to help her. I can’t fully put into words how deeply sad that is. How much I personally fear what that image evokes. I’ve talked before about horror is the only genre that seems equipped to deal with our inner fear of decay and death. That its the only kind of media that’s honest about just how existentially terrifying it is to live in our weird little meat cages that 100% absolutely will fall apart one day. This kindly woman experienced that in such an awful, traumatic way. I feel proud and positive that we were able to help. That she got good care with us, and was swiftly brought to one of the best trauma centers in the region. But that image of her - of an older woman, cold, in pain, shaking on the floor, surrounded by old food and wrappers and garbage of every description - will be with me forever. No one gets away from it completely. Mortality is a nasty, nasty thing. And I’m sure that plenty of people who don’t have my particular obsessions (or my diagnoses), may prefer not to think about this shit every day. But I like having the images to put with the feelings. 

Because at least this way I can try to mitigate suffering.

I don’t know if this means much, but all I can hope for was a good result for her, and for all my patients. That all of this lights a fire under my ass to study and train and practice and simply become a better EMT. I’m proud of my compassion, but I want to be proud of my compassion AND be proud of how quickly I can make transitions. 

[backseatsiren]

Some Serious Reflection Indeed

I’ve been doing far too much lately. Working fulltime at VICE. Teaching two courses at Berklee. Training and competing in grappling. Tons of cardio and lifting to support that. And hey, a busy social life (a ton has changed, Patricia and I broke up in June). Oh, hey, and volunteering a minimum shift every other week on the ambulance. Something has to give.

I was worried, for awhile, that it will be my 911 service. I need to re-certify soon, and hey, things can be weird at a volunteer org. People have their misunderstandings, etc. And I was worried about feeling kind of useless. I was struggling with that when I wrote a bunch of this from the back of the ambulance between calls last month:

--

“I’m writing the first part of this on my ambulance, between calls. I’ve been feeling good about my progress, in becoming a bit more confident and also better at knowing where I’m NOT confident. And I’ve been more confident in my cross EMT and MMA/positional/awareness, on a recent call a patient got violent and I was able to immediately help immobilize him and alleviate the threat, without fear or hesitation. And obviously without the violent person being hurt - he immediately fell back asleep after being about to punch another (peaceful) patient’s lights out. I was doing a little soul searching, so, forgive me for being pretty sentimental here. I do wrestle, sometimes, with feeling complicated about what we do here. Buffing 911 calls, basically acting as support for the FDNY crews that are paid (poorly!!!) And private hospital crews who do this professionally in the area. Sometimes I feel a little useless. I’m here to help! But sometimes, I wonder what value that help is. Fundamentally, I believe in volunteer work, I believe, as a guiding principle, in good, evidence-based medical care, in serving in my community. We don’t bill ppl who dont have insurance. And we never send collections to ppl who can’t pay. This is a free service for folks who can’t afford it otherwise. And I believe in that. I think I’d love to volunteer at a homeless services org, or some other free services organization. I believe in service... I’m writing this sitting in the back of the bus, and I’m cranky about how political and weird it can be at a volunteer org sometimes (of course, I know, I know). And I do feel very weary about the American medical system and how it’s structured. How so many ppl get shafted. An earlier draft here had me hand wringing a bit more on this. I can only affect things at all on this level by doing what I do, by volunteering and putting myself out there and doing anything I can. It’s not Pollyanna bullshit. It has to do with something Austin mentioned on a podcast recently, the idea of things being fundamentally broken and wrong, but finding meaning in resisting or acting despite the efficacy of those actions. It may not do a goddamned thing. But I do honestly hope that I can do some minuscule bit of good or help someone meaningfully at least *some* of the time out here. And I have felt great at times, fundamental to an effort to help a person in need. I know I need to hold on to that, and understand that it ain’t all glory lol. I actually love “boring” calls that aren’t a massive emergency, but if I got a sense that I helped to reassure or calm someone, or provide some kind of actual assistance. And I need to hold on to that as well. I just went on a call, and feeling a bit better. A young man, feeling very sick. A big guy, but I felt ok lifting. And he thanked us. I felt for him, he was sick and extremely anxious. It felt good to be a presence and at least hopefully a calming and competent one in getting him some care.

-- 

The next shift, I had one call, but it was over two hours. Extreme psych episode, police were involved because this person was making threats. She was disturbed and traumatized, and being taken in an ambulance was specifically traumatizing for her, because she had been restrained before, being literally dragged out of her house kicking and screaming.

I was the crew chief, and I talked to her calmly. Listened patiently. She was screaming and crying at first, and did many times throughout the call, but I told her I believed her when she said she was traumatized by her experiences with hospital staff and other EMTs and cops. There were cops present, but the main cop here was (he was a POC, it should be noted, I’ve tended to have much, MUCH better experiences w. cops of color) gentle and patient with her. It actually felt like teamwork, the de-escalation process. 

Legally, she needed to go for a psych evaluation, because she posed a danger to the people she was making threats against. But it is always, obviously much better if you can get a person to come happily of their own free will, to understand that I actually really do care and want to help, and get them the best care. She came down willingly, we evaluated her again on the bus, and I talked with her calmly for another half an hour, letting her know that I care about her well-being, but I’m not a psychiatrist, and that they could offer her better help. She chilled out and came with.

There was a friend with her as well, and he was an absolute doll. Thanking us, helping us talk to her calmly. He was impressed that we were volunteers, and with no insurance info, we weren’t going to charge.

And that call cemented in me the ways I can be helpful. A burned out (by no fault of their own, again, EMTS are underpaid and overworked) EMT may not have had the patience I did on that call. To put the time in to build a rapport with a person who was legitimately traumatized by her previous dealings with emergency services, to talk calmly and affirm her feelings. I’m here because I want to be, because I like doing this. I’m not working 24 hour shifts on the bus, I’m on for six every other week. I come in fresh and happy and excited. I can offer that.

I can offer a lot of patience precisely *because* I’m a volunteer here. And no, I’m probably not half the EMT as someone who does this 60 hours a week. It’s taken me a lot longer to be as competent in the field, and there are still some major areas of improvement for me. I try to work on those every time. In every call. 

But it certainly made me feel better, to be able to offer something of real value to a patient, and yes, to an imperfect, shitty system. So much of my life, I just want to be EFFECTIVE, and helpful, and valuable to whatever it is I’m doing. That day, it became clear to me how that can be possible, and it made me happy.

[backseatsiren]

In the Surgical Waiting Room

So, this is my EMS blog, where I write about being an EMT. Well, today, I’m in the hospital, but it’s not for a patient. Ok, it’s for a patient, but that patient is my dad.

It’s medical, it counts!

The last few months have been, to put it mildly, hell on earth. There have been a few things: the world is falling apart under the rule of an insane orange clown, and that affects everyone. In my own personal life, I’ve had a pretty terrible medical scare of my own involving my own brain, I re-injured my wrist, so I'm out of grappling for awhile (a bummer and a loss of my best source of stress relief), there have been some more deaths in the family (including my 39-year-old cousin, who dropped dead one morning of a massive heart attack) oh, and here's the fucking biggie: my dad has a brain tumor.

I'm in the waiting room right now at one of the best hospitals in the world, hoping it gets removed without any major complications.

In October, after my cousin's death, I decided "fuck it, I'm sick of only going home when somebody dies, I'm going to make time for happy time with family," and I scheduled a trip to Disney and Universal (for Halloween horror nights!) with my mom and dad.

The morning I was set to go, and after a major issue with my bank (because, why not), I got a call. My dad had an "episode" sitting by the pool. They thought it was a stroke.

My dad, to this point in life, has been very healthy. Some minor issues, and a cancer scare aside. He still works full time at 66 (as a lawyer), he's a runner, still runs races with my sister and I. He's active, ridiculously smart, and one of the most bouyant people I've ever known. He makes puns by the second. He's sharp as a whip. Something wrong with my dad's brain, that just doesn't compute.

I already had my plane ticket. So I headed down. Yep, of course the flight was delayed. But I got there, comforted my mom, and went to see him in the hospital the next day. He was in good spirits, but of course, scared. Turns out, it was a seizure, caused by this tumor.

When he had the episode, he forgot everyone's names and started talking in gibberish. My mom thankfully had the presence of mind to get him help fast. (Apparently, he was telling the EMTs who helped him that his daughter is an EMT in Brooklyn and Queens, so, that made me happy! He remembered who I was by that point.).

The last couple of months have been filled with tests and uncertainty, but thankfully, he was able to see a very, very good neurosurgery team quickly.

So here we are. He is currently having his skull glued back together. I am hoping and praying there are no major complications, that he can talk and walk and be the same person after this that he has always been.

I'm very close with my dad, as with my whole family. He is maybe the most talkative, sharp, intelligent person around. I'm fucking terrified. He's worried about going to court with a big scar on his skull. Nobody slept last night, in our ultra-hip hotel next to the hospital.

It's been interesting and weird, if I can detach myself for a second, to see other hospitals, other departments from the busy-to-insane ERs that I work in as an EMT. The ones that always smell a little like pee.

It's been weird, too, to be a patient lately, with all the neuro tests I'm going through. I had an MRI with and without contrast two days ago, and that was a fucking bizarre experience.

Anyway, that's where I am right now. Sitting in this waiting room, typing up these fears and experiences. This is why things have been horrible lately.

I'm hoping, really, straining with hope, that things look up from here.

[backseatsiren]

Over a Year

I meant to do this in March, on my one year EMS anniversary, but... well, it’s almost June. That’s actually almost more appropriate, because I think I started in earnest at RVAC in June 2016, so that means I’ve actually been actively *working* in EMS in NYC for a year.

Holy hell. I love it. I still feel like I have a ton to learn, but I do, at the very least, feel a bit more confident going out on calls and even making (gasp!) medical decisions.

Here are a few particularly memorable experiences from the last few months, and some overall thoughts:

-- I had my very first cardiac arrest about a month (maybe 2, ha, life is insane right now) ago, and it was powerful stuff. By the time we had arrived on scene, Medics were there, and had intubated. They were doing CPR and got a pulse, and I got to bag the pt. for a bit while they got him ready to transport.

It was... powerful. It was a crazy scene, but somber. Inside an apartment stairwell. It was an opioid overdose, but too late for narcan (they gave him a bunch, but he was gone, obvi). All the neighbors were lined up on the stairs, watching silently. Several medics and EMTs already there. It was my first call of the night, so when I got on the ambulance, my crew was like “how’s your CPR?” as we rushed over.

So, it was a surreal and powerful feeling to bag a live patient. Literally breathing for someone. I know those who have been to a million arrests will probably roll their eyes a bit, but it was... it was extremely powerful and weirdly quiet. Everyone was just working, just professional, just getting it done.

The patient lived, by the way—we saw him in the hospital later. I have no idea what his overall outcome was, but... well, I hope he got the help he needed.

-- Often, for tours, I’ll do events and training stuff, and i’ve even been training a brand-new EMT. One memorable event had us showing community members how to do hands-only (no AED) CPR, so we taught a ton of kids (and plenty of adults) the basic skill. It actually felt really cool and helpful? I mean, I hope they remember it in a time of need, but it seemed... useful.

-- Sometimes, I do worry about the value of what we do on a volley ambulance, buffing calls. What that means: we don’t often get “assigned” to calls, we just go when we hear one, and either assist the FDNY crew or take it off their hands. I like to think it is helpful—Bushwick is a super heavy call area, and we really do help with a lot of the less exciting calls, hopefully giving crews a good break.

FDNY crews often thank us for taking stuff off their hands, or just helping out - moving patients and equipment, etc. The other night, we assisted with a very violent pt. (a tiny woman, my size!) and the crews were super appreciative.

And I also like to think we are providing a real service to the community, helping wherever we are needed, not trying to charge people with no insurance, etc.

So, I do feel good about what we do. And holy shit, do I love it.

But I’m always going to question if I’m doing enough. Am I really helping, am I doing this for me—putting myself out there so I can feel good about it, etc.—more than I am providing a real service.

And honestly, I’m glad that I question it? Like, I should very fucking well question whether I’m doing all I can.

-- There are times, often enough, when I think about whether I could swing a career in medicine (maybe as an NP?) and I don’t know! I love doing this as a volunteer, not having to get caught up in what is a completely fucked up system (in the US, for sure), I love doing patient care, I like being out there and seeing how the world works in certain ways. 

Things to think about, going into this second year of service, and to always be aware of.

[backseatsiren]

Crew Chief

I’m going to keep this one brief, because it’s late! I did a tour at the end of December that went well -- I had a number of new scenarios, and this was my first time really being the crew chief in terms of giving the reports at the receiving hospital.

Our first patient was the most interesting, medically. She came over the radio as a “difficulty breathing” but really, this was a cardiac call. She had bad chest pain. Aside from not knowing where the switch for the back lights are on the ambulance (slap me), I apparently did well (according to the much, muuuuch more experienced person I was riding with), immediately asking the the right questions and heading for the aspirin.

We had medics ride in with us, and yeah, the EKG was a bit funky. It might have been a heart attach, or “just” ischemia. They gave nitro.

The woman was incredibly nice, and grateful. The best thing about this call was that she appreciably felt better thanks to our interventions: she was at 8/10 for pain when we first saw her, and she improved down to a 6, then 4, then 2. 

Not that we don’t help all patients and provide care for everyone, but there’s simply not a whole hell of a lot you can do for many problems. It’s all about keeping them stable and getting them to the hospital - so it feels amazing to actually be able to treat someone and see a positive result, within our scope of practice.

I also had my first fire scene! A minor fire, but we were the first EMS unit. We checked out a couple of adorable kids for smoke inhalation (they were ok!), and I had my first encounter with staging, etc.

Sunday, I’ll be the CC again. I’ve been officially cleared to be a CC, and holy shit, that’s both exciting and a bit scary. I’ll definitely be riding with another, more experienced EMT again. I can’t thank the folks I ride with enough, for showing me the ropes and guiding me towards, well, being a competent, effective EMT.

[backseatsiren]

A Crew Chief, Perhaps?

I had a good tour last night.

Rode with my Captain and one of the 1st Lts, a dude who I get along with great and has been showing me the ropes since June.

It was actually my first shift in a few weeks, since I started a new job! Fall was positively bananas (in a very good way, mostly) for me. I started on as the Managing Editor at Waypoint - Vice’s new gaming site. It was just before launch, so my first week was something like a 60-hour work week followed by a 72-hour nonstop live broadcast.

I am LOVING my new job. But since all the misery and dread and poison of the election, I’ve been itching to go out and volunteer more.

Yes, I know it’s not directly correlated. But I want to get to the point where I’m a good EMT, a competent clinician, even at my limited scope, and I can actually go help out at events like rallies at protests. I want to be there, I want to show support, and I want to help people in a tangible way.

Last night felt great. We responded to five calls and ended up with three jobs. One was a family who flagged us down in the road - their little baby hit her head, and they were super upset. The baby was ok! But it felt good to reassure them and take care of them, sort of as a family, by ensuring that the little one was ok.

After that call, my partners told me that my hands-on skills were good! That I was good at taking initiative and communicating. That felt nice to hear, since I’m sometimes worried I’m not doing enough on a call, or making myself useful enough.

We had another call that was... pretty amusing. It came over as a cardiac call, and we took it seriously, but really... we had a lady that was high AF. She was in her 30s and VERY SALTY about a 75 she got in english class in high school. A very sweet person, we transported and made sure she got checked out, but yeah. Sometimes the best part of the job is just meeting characters and giving someone peace of mind.

We also had a call that made me sad. Not in the moment, but later, upon reflection. We had an intoxicated guy, found him rolling around on the ground near a subway stop.

He was a homeless veteran. A Marine. And he was actually a very sweet, funny dude. Cracked jokes and was a little rambunctious, but very compliant - any time I went to him, for a pressure or to check his pupils- he would straighten up, say “yes, ma’am” and be fully compliant. A reflex, maybe?

He was the only homeless guy who has hit on me that was actually really sweet about it - he told my partner to make sure to remind me every day how pretty I am. I know that sounds weird and sleazy, but, weirdly, in the context of this dude, drunk, barely moving, and looking like he was fighting back tears, it was actually kind of moving.

When he first told us he was a marine, we sort of thanked him for his service, and he laughed, loud “fuck your service!” - I know that a lot of current veterans have an ambivalence about the ‘thank you for your service’ attitude. That civilians are so far removed, and so rarely give a shit about anything the folks in the armed services go through, that it rings hollow.

I certainly don’t blame him for feeling that way.

I just hope he can get the help he really needs, not just a night sobering up in the ER.

I could go on and on about how our government so inadequately cares for veterans, how our healthcare system sucks in so many ways. You’ve heard it and you probably know it. But I can’t help but want better for that dude and every other vet who needs - and deserves - something better.

And here’s where I put the disclaimer about not, in any way, into war, particularly American warmongering of this century. I am big into “support our troops, bring them home.” There’s a whole lot of complex class stuff inside the folks who comprise our armed forces as well, and I think that’s also worth thinking about when we consider this stuff.

I was evaluated at the end of the night, and it looks like I’ll be cleared as a crew chief soon. Not as a training officer, mind, but CC means I’ll be able to ride more shifts and have more flexibility in who I ride with, and have some more autonomy on patient care decisions.

It basically means I’ll be in charge of calls, though I’ve had some experience with that so far. We’ll see!

I love EMS. I love volunteering in it, especially, because I get to do this to help people, not to try to make a living (wages for EMTS are CRIMINALLY LOW. I could not pay my loans and my rent with what an EMT makes, even with side jobs). 

I just want to do my part to help in my community, to hopefully help some folks who need it. 

[backseatsiren]

First REAL trauma

I rode again today, with the same folks I rode with on Sunday. Later in the month, I have some changes coming up, so I’m getting all my tours done early on.

Anyway! I had my very first pediatric patient today, then a relatively common injury, then, the big one. 

A call came on as we were waiting in between jobs -- both of my partners yelled FUCK, strapped in, and we hauled ass to a fairly major MVA (car accident). We were the first ambulance on scene, fire and PD were there. The other car was ok, but our patient required pretty heavy extrication -- Fire cracked the beam between doors and removed the doors. There was like 6 inches of intrusion into the car. The poor guy was pinned in.

Airbags deployed. Our patient was fully responsive, but in a lot of pain. I took a pulse and talked to him as he was being extricated. He was alert the whole time, but obviously fighting tears. A very sweet guy, and I seriously felt bad for him -- he was almost home when the accident happened, and some asshole t-boned him.

We got him in the ambulance and got to work. It was sort of a whirlwind, but my partner in the back was awesome and while she was DEFINITELY in charge of this call, she allowed me to be helpful, do vitals, give oxygen, splint his arm, etc.

We got him to the trauma room, and holy shit, that was where the adrenaline actually sort of spiked, even though *my* job was almost over. Just giving information about the patient, keeping him calm, etc.

I’ve been in a trauma room a few times before, but, of course, this was my first one as part of the team bringing it in. 

It definitely ignited some of those old feelings about wanting to be an ER doc, no question.

I’m glad that our pt. was A+O the whole time, and he was able to move all of his extremities. But I did feel a lot of sympathy for him. I chatted with him for a moment before leaving.

I asked him about his pain, and he told me he was trying to meditate a little. I told him they would give him pain meds soon. He thanked me. I said “I’m sorry you’re having such a bad day, my friend.” And he looked off and said “They say everything happens for a reason, what’s the reason here?”

We all wished him well when we left. I hope he gets the treatment he needs and gets back on his feet soon.

Earlier, when he was on our stretcher, he seemed a little bewildered, but alert. He said “Thank god for airbags.”

Wear your seatbelt, my friends. This fellow did, and I (and I’m pretty sure he and his family) are pretty glad he did.

I really, really do love this whole EMS stuff. It felt good to be helpful, again, just as part of a team, but there was a very concrete sense of “this guy got help.”

The scene itself was really intense, looking back. Fire trucks, PD. The jaws of life! Onlookers taking pictures. But, thankfully, I was able to focus on my task at hand. It was only after the fact that I sort of had that “holy shit.” moment.

Anyway. That was baby’s first MVA pin. Really, my first major trauma (aside from generally assisting at that subway pin a few months ago, but he was FDNY’s patient, not ours). 

It will always fascinate me and make me very proud -- after the fact, in the moment it’s too tunnel vision-y -- these scenes are so dramatic, so fast-moving, so very weighty. With so many people. Cops. Fire. EMS.

But everyone moves with purpose and efficiency. All anyone cares about is getting that person help and making it safe for everyone to do that job. There’s a purity there that is really wonderful to behold. If you ever watch a trauma scene (from a safe, respectful distance, always), look for that. it’s kind of incredible.

[backseatsiren]

It was slow, until it wasn’t

I had another good night in the ambulance. My first real shift in a few weeks, so I went in feeling a little nervous about being rusty, but thankfully, I had an easy introduction to the night.

It was DEAD for the first couple of hours, with a couple of false alarms. So I had plenty of time to get comfy again in the patient compartment, re-familiarize myself with everything, and take a breath before our first job.

I also got to sing and bullshit with my partners, who are both great, patient, and fun to work with.

https://twitter.com/Danielleri/status/785298213427351552

We had a patient who had fainted -- we went into her apartment, talked to the family, etc. along with FDNY. I was proactive about taking vitals, etc. and generally feeling much more comfortable interacting with folks in their home.

(That’s never been a big issue or anything, just, I was less used to homes as an environment for EMS, thanks to a summer of, well, a lot of intox dudes lying on sidewalks!) That was an RMA. But our big job -- the biggest of the night and by FAR the most serious medical emergency I’ve attended so far -- came next. This was a legit hypertensive emergency, with a gentleman sporting sky-high blood pressure.

I was happy to be with experienced EMTs for the whole thing, and also happy that I was able to stay calm and quickly do everything they asked of me, without flailing around like a crazed muppet.

I’m feeling proud of that, and glad I was able to help out and help reassure the patient and his family in the middle of a pretty terrifying situation.

I was only a small part of a team that helped this guy, so believe me, I’m not trying to get cookies! Just glad to be there.

Slowly but surely, I’m feeling a little more confident about my EMS work. I wish I could go on tours near-daily, but, of course, that’s not feasible with my work schedule. Only 24 hours in the day and so on.

But I LOVE this. I love working with people to help someone who needs it, and I even love going on the smaller jobs, no matter how unglamorous. It feels good to do this sort of job, and better to do it as part of a commitment to community.

[backseatsiren]

A good night

I had a really good night on the ambulance tonight. Which is fantastic, because I haven’t had a real shift in over a month (I’ve done community outreach stuff for my mandatory hours and such). I’ve been traveling, and getting my wrist checked out, and getting shifts was becoming a dicey situation.

But the stars aligned tonight. Or, er, the gods of EMS?

It started out with a meeting wherein I was voted in as a full, active member (I had been a probational newbie til today), then, I got trained on the new epinephrine protocol (since epi-pens are now insanely expensive, yuck), which was, really, my first time learning to deal with drawing medicine with needles.

Then, to the tour! My first on our brand-new, still SMELLS NEW ambulance.

We had a good variety of patients -- first, a psychiatric patient that required a bit of PD interaction, but he was ok. Then, an assault -- the poor guy was punched at his workplace. That was the first time I’ve ever seen actual surveillance footage, standing with the cops watching this poor dude get punched.

Finally, a pair of twin assaults that had me doing my first splint on a live patient. It’s not super pretty. But hey, it immobilized the leg. 

(There is no identifying info here, so it should be ok to post.)

I feel like I learned a ton tonight - my crew chief let me do reporting to the charge nurse, the full patient history on the last job, and, yeah, some of the skills beyond taking vitals and giving ice packs, which is much of what I’d previously done.

Am I still totally new and green and I’m sure it shows? Oh, fuck, definitely. But I’m really, really enjoying the learning process. 

[backseatsiren]

Medical aspirations

Here’s a thing I don’t talk about often... but it’s been on my mind a lot lately. It even keeps me up at night sometimes. It did last night.

The thought of medical school. Or, nursing school. Or even paramedic school.

Growing up, I always had an interest in the medical field. But I had an interest in like, every field. I mostly wanted to be an astronaut, but I was also totally into the idea of being an engineer, a scientist (especially a physicist), an actress/comedian, a professional athlete, a film director, a psychologist... really, a whole bunch of things.

I did so poorly in high school - and failed physics - that anything remotely in the sciences was pretty much null and void. So I thought.

When I first became an EMT in 2007, I started getting very, very interested in the (very remote) future possibility of medical school. I was 23, and in grad school for filmmaking. I would’ve already been a nontraditional student. But I did extremely well in college, including in my bio classes, and that spark had begun.

Then, from the ages of 25-29, I dated a doctor. My ex was a genius - a real, actual bona-fide genius who went to college at 12, started med school at 16, and was a full MD at 20, before she could legally drink. I was there every step of the way from her 4th year of med school throughout her entire residency. I was there through match day, her hardest exams, the pain and drudgery of being a new doctor in intern year, her increasing responsibilities as a senior resident, the whole shebang.

And... I loved it. On some level, I was jealous. She got to heal people every day. Yeah, I know the reality of it - she was a resident, not in charge most of the time with critical patients, and on most days, there was nothing so dramatic. She was a pediatrics resident, and there were a lot of dead kids on that path (through no fault of her own or her team’s - these were mostly kids with incurable cancers, the most that could be done for them was palliative care).

And still, I wanted to do this shit.

I grapple with that. I’m a person who really loves doing very different things every day -- on a typical day, I’ll play a game, write a piece and edit a video for it, record a lecture for my students and grade their projects, train boxing or go for a run, record a podcast, maybe go out on the ambulance and do a few calls. Things that have nothing to do with one another. Variety.

If I were ever to do medicine full time, I would devote 7 (possibly more) years to doing entirely, 100% that. And that’s just for school/training, if I decided to sub specialize, it’d be longer. I could probably still run and exercise (often *while* studying or while on call), maybe write every now and then, but that’s really it.

This is also disregarding a few serious issues. I have worries about my basic academic capacity. I always did very well in my basic college bio and A&P classes, but I didn’t even touch organic chemistry (I didn’t have to, as a psychology/philosophy double major - *giant fart noise for that*). I haven’t had a real chemistry class since HIGH SCHOOL. For these reasons, I am legitimately more afraid of the first two years of med school than the second 2, when you actually start to do practical skills and rotations.

And the money. 200 grand, easy. 250, maybe. I racked up about 180k on my shitty visual media arts master’s degree. I’m paying THAT out the ass, and have been, well above the rate any sane person should pay, since 2009.

If this didn’t work out, and I dropped out, that crushing debt would be... really bad.

Weirdly, I think I’d do ok on rotations and such. I really enjoy talking to patients and doing procedures now, as an EMT. Some young doctors really suck at that at first (the whole ‘book smarts vs. people skills’ thing), and I know I already have good bedside manner and the ability to communicate well with someone under my care, and under pressure. 

So, that makes me think about nursing school. There are 15-month accelerated programs if you already have a bachelor’s, and beyond that, I could become a Nurse Practitioner and have the same authority as, basically, a medical resident (so, an early-stage doctor). From everyone I’ve talked to, that’s actually a really great path. It’s also nowhere near as expensive, and I’d be able to do primary care at the level that I would as say, a family medicine resident.

I think about this very seriously. I think I would enjoy a career in nursing, particularly at the NP level. I also think very seriously about wanting to do medical missions - working with an organization like MSF, or the IMF (my sister works with the latter), going to an area of the world that really needs help, and really, actually fucking helping. Making a difference for people, if only on that single person level.

Paramedic school is also an option. I won’t lie - I think about paramedic school every day. Maybe it sounds weird, but I would really, really LOVE to move to another country for some time - the UK, or Australia or NZ - and be a medic there.

Some part of me wonders about this. Is it just some weird fantasy? Just me dreaming about a different life? Or is this a really serious desire to do this as a career? All I can say for certain is that I have thought about it, very seriously, since 2007. 

I think it’s for real.

But what I need to determine is this: will my time here in volunteer EMS be “enough” to satisfy my desire for a medical career, or will I need to go for further training and the major, massive life change that will come with a full time career in medicine?

I guess time (and way, way more experience) will tell.

[backseatsiren]

First major trauma

I need to preface this with a note that this wasn’t my patient. But it was my first time on a major trauma scene, and hey, we helped out a little bit.

So, I got back in the saddle immediately after... fainting on a patient’s stairwell... and took a Friday evening tour. I was riding with two EMTs I’ve come to admire, respect, and generally, just really like. 

We had a lot of near misses. I was a moron and forgot the AED, so we had to go back to base instead of buffing a potential cardiac call. There was another potential assault that we showed up to the scene and... it was apparently nothing. And a trouble breathing call that we arrived to too late. A whole lot of almost-calls. 

But the most interesting, by far, was this scene. A guy was hit by the subway - right near where I live, on an L stop - and pulled under to the tracks.

https://twitter.com/Danielleri/status/756664465022681097 (vine from just outside the scene)

We ran out, with the tech bag and scoop stretcher and long backboard. We go down the subway stairs to the scene. Sweating like a mother (but, after the other day, chugging electrolyte water like it was my job). All of the bystanders looked at us - including me - with something resembling... hope? People looked a little freaked out. Here I am, in uniform, with an official-looking bag, rushing in with other people, presumably here to help someone in trouble.

It was kind of surreal.

I was breathing hard, sort of mentally preparing myself. “Ok. This is it.” I’ve seen *some* funky traumas. When I was training to be an EMT years ago in Boston, I saw a nice, gnarly compound femur fracture on a teen in a motorcycle accident. He also had a little baggie of drugs in his ass. Interesting patient.

And I’ve seen *some* gross things, mostly a lot of poop and blood and lots of barf. But I knew this would be a lot worse.

There were dozens of firefighters on the scene. A woman cop was running the scene, coordinating. The firefighters were all working to extricate the patient, so all the EMTs around were waiting, on like this state of high alert.

An EMT from a nearby hospital was there. “He’s verbal.” she told us (she’s friends with the folks I was riding with). That means the guy was responding to verbal commands, possibly talking himself. A good sign - he’s at least somewhat responsive.

We provided a few things - gauze, some dressings, a C-spine collar - but this was mostly an FDNY job, we were just around to help. My crew chief helped to strap the guy onto the backboard when he came up.

He looked... bloody, and kind of messed up, but nowhere NEAR the grotesquery I was picturing for a dude run over by the subway. A nasty laceration, a bunch of blood, but well, his parts were all in place. His eyes were open. He was somewhat responsive.

I heard bits and pieces of the story as I walked up the stairs behind them with the patient. He got whacked with some part of the subway (hence that lac), and somehow pulled down. I think maybe the car was slowing down when he was hit, hence his injuries not being far worse.

Don’t get me wrong, dude was hurt. Just...

Ok, look. Once upon a time, I dated a doctor for 4 years. Throughout her last year of medical school and her entire residency (pediatrics, if you’re curious). Once, on her way to the pediatric ER for a shift, she was on a bus that ran over a cyclist. She tried to help out, but the guys was like, bisected. She was a doctor, used to dealing with nasty trauma - but even she was very shaken after that. (Something here about how doctors have their traumas packaged, they aren’t often on the scene, etc.)

I was expecting something like THAT. Parts in different places. 

I’m glad he was all in one piece. And certainly, I have no idea how bad his injuries were - he wasn’t my patient. I hope the guy is ok, and that he can laugh this off with his buddies one day.

But I was very... warmed... by the scene. All of these people working together to try and help this guy. Fire, police, EMS. Everybody wanted to help.

We got a little shoutout over the radio from the policewoman running the scene - she thanked us for our help publicly. That was a really nice thing to do - my crew chief told me that cop is well known for being a rad lady.

It wasn’t my patient. Wasn’t my scene. But it was one of those “oh, shit!” calls that I was glad to be on, if only to get a tiny taste of that teamwork and genuine, honest-to-god heroism of people in the helping professions.

I want to do this. I want to become proficient at this and help people who need it.

[backseatsiren]

I need to staple this to the inside of my skull.

Just a quick reminder:

Selfishness is putting the wants of yourself over the needs of others.

Self respect is putting the needs of yourself over the wants of others.

One is disregarding others, one is taking care of yourself.

The difference between the two is the difference between being a friend and a doormat.

Taking care of yourself does not make you a bad person.

I repeat:

Taking care of yourself does not make you a bad person.

[backseatsiren]

Yup. Yupppp. YUPPPPPPPP.