August 2003 Archives

Kind of a strange day as far as schedule goes. Technically I am off until Thursday from the medic job. Usually I would have been using yesterday and today to switch to a daytime schedule. Usually yet I was up most of the night. My initial hope had been that I would be working tonight but none of the swaps worked out and it's on to Plan B, finding someone to come and stay with the kids on Saturday while I sleep and my wife works and then while we are both working at night. I'm hoping that this plan will work because there is no Plan C.

So why, once I figured out I was not going to be working tonight was I not sleeping for the remainder of the night? I don't really know. It may have something to do with sleeping most of the day yesterday. It may have had to do with work that I felt I needed to get done. Maybe it had to do with wanting to hear from a friend who had been out of touch for a couple days.

Either way it worked out for the best. I got some work done, I did some reading, I caught up on my email, and I had a long chat with a friend. Even though I was up until almost 5:30 a.m. It was well worth it in so many ways. I wouldn't change it if I could.

I did take a short nap in the afternoon to make sure that I was ready for the 4 hour drive back from my in-laws house. I slept deeply, soundly, and without a hint of dreams. I awoke feeling pretty refreshed and in good spirits.

or how my job works.

I realized that some people may not understand how the EMS system works in my area since it is a bit unusual and makes my job challenging (and fun).

I work for a private, non-profit hospital in a medium sized city of about 50,000 people. We have about 200 beds and 14 bassinets in the hospital with some or all of them available for use depending on nursing staffing. The EMS Department is a separate department in the hospital which provides paramedic coverage for the entire county and several sounding towns. All told we cover about 600 square miles with a population of about 1/4 million people. The bulk of our coverage area is considered rural or suburban with only a few places qualifying as urban areas.

The hospital maintains 3 emergency departments in the area. The first, and largest at the main hospital campus in the largest city in the county. The other two are satellite facilities, basically free standing emergency departments with some outpatient services in outlying towns. These satellites have no inpatient beds so any patients who cannot be treated and released have to be transported to the main hospital campus or another hospital for inpatient admission.

The EMS Department operates 1 paramedic intercept unit at each ED location 24 hours a day, 7 days a week. Each unit is staffed by a single highly trained, well experienced paramedic who responds in a 4 wheel drive SUV to meet the local ambulance service on the scene of an accident or medical emergency. Aside from the city the main hospital is located in no other paramedic units operate in our service area. In the city the local commercial (for profit) ambulance company has some paramedic staffed ambulances and some basic level ambulances. We respond to any calls that meet specific criteria indicating the need or high likelihood of needing paramedic level care.

Our vehicles are configured so that we have radio contact with almost every possible service we could need to contact while responding to an emergency or operating on the scene. Each vehicle carries limited basic equipment in case we arrive on the scene of an accident or emergency first and extensive advanced equipment that is packaged expressly for portability that allows us to take all the equipment we might need with us into whatever ambulance we need to and still carry the minimum number of things.

The standard equipment that is brought with us on every run is a Medtronic Physio-Control Lifepak 12, a backpack type case by a company called Thomas Transport Packs that is specially designed for medical equipment and contains all of our IV solutions, medications, and airway management equipment. In addition to these 2 pieces we also carry a certain amount of narcotics that are kept in a locked container mounted in the vehicle. When we depart the vehicle to see a patient we access this locked box and take a small plastic container with us that contains our narcotics and controlled substances. This container must either be enclosed in the box and secured using 2 independent locks or carried on our person. In addition we also have a smaller pack that contains specialized pediatric equipment for the treatment of small children and newborns. Enough equipment is carried in each vehicle to treat 2 or 3 patients without returning to our base to restock supplies.

When one of our units is dispatched to an emergency the paramedic responds to the scene or meets the ambulance on the way to the hospital to provide advanced care. If the ambulance crew has the personnel or the paramedic unit has a volunteer paramedic assistant the vehicle follows the ambulance to the destination hospital. If the vehicle cannot follow for any reason it is abandon at the location where the paramedic met the ambulance and locked up to await the return of the paramedic from the destination hospital.

If we respond to the same scene as a paramedic staffed ambulance we have the option, provided that the paramedic on the ambulance and the hospital paramedic are comfortable and agreeable on a plan of treatment, to turn the patient over to the ambulance for continued treatment and transport. The idea is that 2 paramedics are not tied up unless the patient is unstable enough to need two paramedics attention.

If we respond and after assessing the patient feel that paramedic services are not warranted we also have the option of downgrading the patient to be transported with the basic ambulance without a paramedic. If an ambulance finds a situation where it is clear that they do not need the responding paramedic they have the option of canceling the responding paramedic freeing that unit up for the next run.

As paramedic units are committed to calls the remaining paramedic resources relocate themselves in our service area to provide better response times and coverage for the area where the paramedic is already occupied. These cover assignments are a necessary evil and while we do not enjoy sitting in our vehicles for long periods of time it is better than responding from extremely long distances and putting ourselves at greater risk.

In addition to these three primary units we also have a contract with one of the towns on the fringe of our coverage area to provide paramedic staff for their ambulance service. Here the ambulance service provides all the equipment, vehicles, supplies, and maintenance and the hospital provides the staffing only. Even though the hospital provides this paramedic to the town it is not able to be drawn into the overall system except in cases of disaster or major incidents. Thus it it not uncommon for the 3 primary units to be extremely busy while the contracted paramedic may do few, if any, runs.

Two odd things about our department are that we are somewhat self-managed and that we have clinical responsibilities inside the hospital while not responding to emergency calls. In a nutshell we provide clinical support to the ED staff. We establish IV's draw blood, perform 12 lead ECG's and generally act as part of the team.

By self managed I mean that each of us has certain administrative responsibilities that we perform that are not directly patient care related that keep our department functioning. Paramedic scheduling, tracking and arranging vehicle maintenance, ordering and stocking of supplies, ordering uniforms, maintenance of equipment and reference materials, the initial stages of our quality improvement program, management of the volunteer paramedic assistants, approval of bills to be paid before they are forwarded to accounts payable, and various types of training and education are all managed by a field paramedic with little, if any, action on the part of our department director. Myself, I am in charge of maintenance of the LifePak 12 units, pharmacy liaison, webmaster, and one of the primary instructors for advanced skills for the basic services. This means that many of us are very busy even when we have no emergencies to respond to.

In order to balance these responsibilities with our clinical duties in the hospital we have developed an "Order of Paramedic Needs". This say in effect all of our responsibilities can be broken down into 4 categories which are prioritized like this:

1. Responding to calls for emergency assistance
2. Assisting ED staff with critical patients in the ED
3. Tasks needed to keep our department running
4. Assisting the ED staff with non-critical patients in the ED

All in all we are kept very busy no matter what is going on. The system has worked well for the past 16 years and we have had an incredible ability to retain experienced paramedics, far better than any other service that I have heard of. When the department started in 1987 9 paramedics were originally hired. Of those nine, seven are still working in the department in some way. Our average experience level is higher than the state average, and unusual for paramedics, most of our staff have college degrees, many Associates Degrees, the majority Bachelors Degrees, a few have Masters Degrees with 4 of us having work completed towards Doctorates in various disciplines.

Currently we have a staff of 14 full time paramedics, 2 full time administrators, and 16 per diem paramedics who combined are able to cover 56 12 hour shifts per week plus many requests for additional coverage for special events, training functions, and public service events. Shifts are 12 hours long running from 7 to 7, a full time work week is 3 12 hour shifts.All our paramedics work either days or nights but do not switch between them in their normal schedule. The specific day of the week we work are laid out in a four week rotation which puts us on every other weekend, and every other major holiday. Since scheduling is done by one of us flexibility in scheduling is allowed and encouraged. Overtime is available to any paramedic who desires it to cover for vacations, sick calls, people out for training and education and the like.

The average paramedic in our department is in his or her mid 30's, married or divorced, many have at least one child and average between 8 and 12 years of field experience. Of all our staff we have very little turnover with full time employees who get promoted or take other jobs frequently staying with the department as per diem paramedics allowing us to retain their experience and knowledge.

All in all we are an unusual bunch with widely varied backgrounds and experiences. We all enjoy the challenge of being a limited resource in a large area and working as the only advanced provider. As a rule we need little supervision and receive little from our director doing what needs to be done to keep the department functioning and keeping him aware of what we did after it has been done. For my part, even though I have a Bachelors Degree in Engineering and could make a significant bigger salary in that industry, I will not be leaving until they take my badge away and tell me to stop showing up to work.

Sleeping is sleeping, no matter where you do it. So plans change sometimes. My wife was so unimpressed with the idea of me staying home that I found myself packed into the car with my pillow, iPod, and sleep mask to go to sleep while she drove us to Cape Cod. I was asleep within 30 minutes and slept the entire trip.

When we arrived my daughter was happy to see us bounding into the car and on top of me. Knee placement on her part was a problem for me and woke me up much faster than I would have liked. Once inside we had lunch and I promptly fell asleep at the table and was ushered to a bed and proceeded to sleep away the whole afternoon.

When I woke up I really had to get down to business on my phone calls. I still needed to try to swap the shift on Saturday so I would end up working on tomorrow instead. After a couple of phone calls I found out that my chances were slim. My only hope was that one guy couldn't work out the swap he needed to go to Pittsburgh PA for an Irish Festival. I've left that ball in the air and started to work on Plan B, finding someone to some and stay with my kids while I sleep away the day and work for the night. This promises to be a tough nut to crack and I am not very hopeful. If I can't arrange this I really don't have a Plan C so it will make things really interesting.

An uninspiring night. The night was unusually slow with only 4 runs and no transports. I spent a good portion of the night on cover assignments for Medic 2 who got absolutely pummeled all night. It's the way things work, sometimes you get all the bad ones and sometimes you don't. Last night was my night to do not much.

Of course it wasn't without excitement as I found a flaw in my scheduling that left me working a Medic 2 shift on Saturday night at the same time my wife is on call. Oops, I need to be home with the kids so I have to either find a swap for my only evening free, Sunday night, or find someone to come and stay with the kids on Saturday night (do I dare tap my mother again?). I'll work the swap angle first. This means that instead of going to Cape Cod to pick up my middle daughter and having a late night trip back on Sunday I either will have to stay home or we will need to leave early on Sunday to get me home by 7 p.m. My wife is not happy about either prospect.

Total runs for the night: 9
2 turned over to the ALS ambulance
2 cancelled enroute
5 cover assignments

Total milage: 156

CD of the night: The Soundtrack from When Harry met Sally by Harry Connick, Jr.

What does tonight hold? I came in before my shift started but not soon enough to take the child not breathing call for the day shift. He rolled in shortly after 700pm with a child with a febrile seizure. While the child probably wasn't breathing when his mother called he was breathing now. Awake, cranky, and breathing on his own. A much better end to the story than it could be.

Tonight I'll have a volunteer with me so I should have fewer problems getting my vehicle back to the hospital. Every once in a while one of our small group of Paramedic Assistants will work with us and help us out with a lot of phases of operations. It's especially helpful in keep our turnaround time short. The PA can restock our pack, help collect information, follow the ambulance with the paramedic truck, and hundreds of other little things that add up to a whole lot.

My assistant tonight is relatively new to EMS and wants to see as much as possible as fast as possible. I'm not sure I want to be THAT busy but we'll see what we can find.

My mom comes through again.

My oldest is still home today and my mom has come through yet again. I need to sleep today so I can work tonight. It looks like a nice day and I'm hoping that my mom and daughter will go shopping again, this time for school supplies. My oldest has been fixated on school supplies so we have given her a budget of $10 to spend on them. I have no idea what she'll come back with but as long as she sticks to the list her teacher sent she should be OK. Tuesday can't come soon enough. The structure of being back to school will be a tremendous help to her and me.

After I get home from work in the morning it's into the car to go to Cape Cod to get my middle daughter at my in-laws. I'll have to sleep in the car on the way up or I will be exhausted and very very cranky. It's not great sleep but any sleep is better than none, so long as I don't get revisited by nightmares.

The domestic stuff pretty much complete it's on to the geek stuff. I have made the conclusion that I need to move to new blog software. Everyone I have talked to has recommended Movable Type so I have made arrangements to have Movable Type installed on my server. We'll see how smooth the transition goes.

I'll keep everyone updated on progress as it is made.

Still learning, and boy is there a lot to learn. Working in retail is such a foreign concept to me. I am slowly adjusting but it will take me a while. Only one more day of training before they send me out on the sales floor by myself.

Today was moderately busy with back to school shoppers but I think I did OK. At least I was able to tell when I was in over my head and needed help.

It's a strange experience.

***WARNING! This entry contains descriptions of physical trauma that some readers may find disturbing.***

I've seen this before...

and I have hated it every time. Tonight I fell asleep on the sofa while reading a magazine. It actually felt really good when I knew I was going to sleep and I was feeling pretty relaxed. Now a few hours later I am drenched in sweat, hands trembling, and heart pounding through my chest. It happened again, the same nightmare that used to terrorize me on a regular basis, the one that had been getting less frequent, the one that I hadn't had in a couple of years, the one that scares the hell out of me every time.

It starts out as a familiar memory. All the facts are dead on with what actually happened right up to the end.

It starts out as an ordinary day almost 13 years ago, springtime, sunny, pleasant. I'm working as a paramedic for an ambulance company in one of the larger cities in the area. I'm younger. I still had hair. My partner and I are bringing a patient to the dialysis unit at the hospital and as we step off the elevator I feel pretty happy even though I know that my first marriage is failing rapidly. We help the patient onto the scale, weigh him, and help him into the chair.

The radio crackles requesting us to respond to a nearby intersection priority 1. The dispatcher said something big was happening but they had conflicting reports and would get back to us. We never hear anything else.

As we pull up to the intersection I can see that it is at the bottom of a large hill. And I have to look again and then again to register what I am seeing. I see a fire engine crashed head on into a large tree. The first in crew appears to be performing CPR on a firefighter about 40 feet from the engine. There are 2 firefighters trying to get the Jaws of Life assembled on the passenger side where I can now see the officer pinned in the cab. More units arrive. As the firefighters start trying to cut their brothers from the wreckage I can see that the officer is moving and talking but the firefighter in the jump seat behind him is not moving at all. The roof is crushed down so that he is only accessible from the waist down. My partner and I split up. He starts working on the officer and I try to find a way into the crushed jump seat area finally crawling in the other side and sliding across the engine compartment on my stomach. I can get to the firefighter, partially, I can get to his chest and right arm. His head is still forced down to his chest and I can't get in to see his face. IV equipment is pushed through the opening that I came through along with an oxygen mask. I reach under the helmet and try to get the mask on his face. I start one IV in the right arm as someone on the outside starts another in the left arm. The efforts to disentangle both the firefighter I was working on and the trapped officer continues. The noise is incredible.

I can talk to my entrapped patient. He is in significant pain. He asks me "I'm going to die aren't I?". I give him the only answer that I can; "Not if I can help it. We're doing everything we can.". The cutting continues, the officer is freed, we still aren't able to free my patient. He asks me again "Am I going to die?". "I don't know." is the only response I have left. He's been getting weaker and harder to keep awake for the past 30 minutes and I really don't know. Then quiet from him. Ten more minutes pass and the crushed roof is lifted off of us and we can finally get at his head but he still is trapped with the side of the vehicle still pinning him at his chest and hips.

Here dream and reality diverge. In reality we take his helmet off and stabilize his neck. I wipe the blood off and get a good look at his injured face. Eyes open, no response, no pulse, no breathing. His helmet is in his lap and I can see, taped on the inside, a picture of a young woman and a child.

In the dream the helmet is removed, neck stabilized and the blood wiped away revealing that the face underneath is not the face I was expecting, it is my face.

Then I wake up. I wake up as I always wake up, always screaming, always drenched in sweat, always trembling.....always terrified.

I don't know why this keeps coming back to me. I have seen more gruesome deaths. I have seen more disturbing deaths. I have encountered deaths of people that I knew better. I have seen deaths of other emergency responders. Why this one? Why still? When will it stop?

It's been almost 3 years since I have had to relive that May morning of 13 years ago. Every time I pray that this time will be the last time. But deep down I know it probably won't be.

Fantasy, delusion or random thought? You decide.

Every once in a while, especially when I am tired and things are on my mind, my thoughts start to wander to other places and other times. This morning I came across some pictures of the Minot's Ledge Light, off the coast of Scituate, Massachusetts. Sometimes when I have a lot on my mind I think about what the life of a lighthouse keeper was like 125 years ago.

The opportunity to spend time alone with my thoughts, something I don't get to do all that often, is very appealing. I know that life for a late 19th century lighthouse keeper was not easy but I also know from my reading that these men and women knew they were performing a valuable job and some of them read and wrote extensively not only about their lives but also about philosophy, religion, ethics, and what they considered the foundations of life and society.

In this day and age few of us have much, if any time, to think deep thoughts. Our lives are too busy, too cluttered, and our thoughts pulled in too many different directions. The ability to think deep thoughts, to luxuriate in them, and evaluate and test them for truthfulness is just something that we do not enjoy. To cleanse your thoughts through hard and honest work and think clearly again would be a priceless gift. Our society is formed around instant gratification, easy answers, and self centered concepts. The ability to stand off shore from society, totally surrounded by the sea, and examine life and nature and understand our relationship to it is very appealing.

Night shift over, day not over.

The high anxiety level that started the shift stayed with me throughout the night. Sometimes no news is not good news. The ambulance crash that started the night resulted in injuries to all parties involved and lots of news was not forthcoming. All we know so far is that the driver of the car involved was airlifted to the Trauma Center, all four crew members were injured to various degrees and, although we know some of the crew were discharged from the Emergency Department others were not. The ambulance itself and the car involved are being kept in a secure location pending the outcome of the police investigation.

I stayed distracted through out the night but found that my distraction didn't have that much effect on my ability to work.

A fairly busy night:

2 ALS transports
1 BLS downgrade
1 Unable to intercept
6 cover assignments

Total milage: 187 miles

CD for the night: Riding with the King by B.B, King and Eric Clapton

It's been a stressful night already with one of the ambulances involved in a serious accident. I don't know the whole story yet, only that one of the ambulances we work with was involved in a serious collision while responding with lights & siren to a medical call. Because it wasn't in my district I was to far away to hear both sides of all the radio traffic. All I could hear was the communications center side of things and that was very discomforting. Additional ambulances, Medic 3, and a helicopter for air evac were all called to the scene in addition to the fire department for extrication and disentanglement.

This is all very stressful. I don't know who was injured, how bad, and what their condition is now. Ambulances perform very badly in crash tests and because of the positioning and frequent lack of adequate restraints crews have been seriously injured in crashes. The driver of the other vehicle involved stands a good chance of serious injury just because of the size and weight of the ambulance. It classic newtonian physics, F=ma. Force equals mass times acceleration is inescapable.

I'm worried but I can't let that effect me or my work. How the hell can you do that? One of the big risks and sources of injury in my profession has reached out and slapped us in the face, how can you not let that effect you?

My mom is a lifesaver!

Yet again my mother came through and saved the day. School doesn't start for another week so I had my oldest home today. My mom dropped everything to come and watch her. I am so grateful. It meant that I got about 5 hours of sleep which will make my shift tonight easier.

My oldest was having a fair day. Lots of head shaking and whistling, signs of her anxiety, but my mom took her to the mall anyway to do some shopping. When I woke up they had just returned after what ended up being a very successful trip. Both of them had a great time and I got some sleep. Who could ask for more?

Just one more night to work and then I am off for three days. I've got to remember to call and see how one of my patients is doing from last night and find out it they were able to identify her yet. That was such a disturbing experience that I blogged it separately last night.

Not a busy night at all. I was so tired this morning that I fell asleep before I could make this entry. Last night was a good night, few runs but I was able to make a significant difference in a patients outcome. That makes the rest all seem worthwhile.

Total calls: 6 
1 BLS downgrade
2 ALS transports
3 cover assignments

Total milage: 125

CD of the night: Karealia Visa by Hedningarna

Medic 1 tonight.

Don't leave home without identification.

While I enjoy challenging patients one of my patients tonight left me with an empty feeling inside.

I responded to a woman who had fallen and struck her head on a rock wall while walking along the beach. Her injuries were bad and requiring that she be helicoptered out to the trauma center. She wasn't breathing well and needed to be intubated and when the flight crew arrived I was able to give them an good report on what had happened. What bothered me is that I was unable to provide them with any information about who she was, where she lived, and who should be notified that she was injured.

My request is a simple one. Please don't leave home without some kind of identification. Nobody wants to think about getting hurt, especially hurt bad enough that you can't tell someone your name, address, and who to contact but it does happen.

She wore a wedding ring so I assume that somebody, somewhere must be looking for this her. I can only imagine the panic they must feel not knowing where she is.

My wish for her is a speedy recovery and that she can be identified quickly so that she can have the support of friends and family during a difficult time.

Busy for the day medic but not for me. Compared with yesterday today is much slower. The day medic had 8 runs but so far I have done only one. Medic 1 & Medic 3 have been much busier but no need for me to provide coverage for them yet.

The hot nighttime weather seems to be gone for a while. Temperatures tonight are already down into the low 60's with low humidity.

I took a drive down by the shore tonight on my way back from my call and opened all the windows in the truck. It was wonderful to get a cool breeze off the water with that great smell of the sea. I stopped and parked for a while and watched our local lighthouse for a while while I finished paperwork. Quite nice and very relaxing.

A long night that started out very busy. The shift started out extremely busy. 9 runs for the night all of them before 2 a.m. This actually worked out as I had enough time to finish the paperwork and do my routine chores before morning. The one conclusion I have come to is that 16 hours at a time is probably too long.

Total 9 runs

3 ALS transports
1 Refusal of care
1 DOA
2 Cancelled enroute
2 cover assignments

Milage: 112

CDs of the night:

The Best of Del Amitri by Del Amitri 
and
Etched in Stone by Off Kilter

The night has slowed down, for now. We've slowed down for the moment. It was a little wild for a while and was kind of fun. I wish I had had a paramedic student or a physician resident riding with me. Lots of interesting stuff for them to experience and learn from.

For a change I am all caught up on paperwork. Usually I am eternally 2 or 3 reports behind and end up having to stay late to finish them. I'm hoping that I can stay caught up since I am sure that I'm going to be pretty tired come morning. I'll need to get a good days sleep and be back at the same station for another night shift. Fortunately my next one will only be the standard 12 hours.

I expect the night to get a little busier at 0300. We go down a medic unit for a few hours because we don't have enough staffing. Medic 3 will go off line at 0300 and both Medic 1 & Medic 2 will have to relocated to more central locations to pick up the slack. My boss is currently covering Medic 3 but he won't work past 0300. We'll just have to make due with what resources we have even though it will make life much more difficult.

What's in your pockets?

A television commercial has been asking "what's in your wallet?" for the past several months and it has started me thinking not about what's in my wallet but what's in my pockets. I've noticed that when I go to work the same things always go in the same pockets. Always. Not that that is all that unusual. I'm told that most men have some type of pocket ritual. What has impressed me is just how much I am thrown off my stride when I forget something or when I have to use trousers with different pocket configurations.

What I carry in my pockets has developed over many years of experience and is unlikely to change much whether I want it to or not. At this point in time I can pull any object out of my pockets and identify why I need to be carrying it on my person as opposed to in a bag/box/container of some type.

The real question is does carrying any or all of this stuff make me any better at my job or is it a security blanket of a type? Is it simply making me feel more comfortable because I know I have what I believe I need or does it truly make a difference in my day to day operations?

Makes me wonder what other little rituals I have developed over the years.

I need to get a good days sleep tomorrow. Because I need to sleep tomorrow I need to I'll be staying up late. I'll spend some time catching up on my email and doing laundry so I can have uniforms for the next 3 nights. I can't wait for the cleaners to be back from vacation so I can go back to having them launder my shirts. I never seem to wake up in time to regularly wash, dry, and iron them myself. Besides, they get enough starch in them and don't scorch the shirts, all for a buck a shirt.

I won't get to sleep as long as I would like, with vacations and sick calls for the weekend I will have to go in 4 hours early. 16 hours is a long shift but the shift needs to be covered and I can always use the overtime.

A long night last night and an equally long day today. Last night was looking like a mediocre night, I have been trying to plan a surprise trip to take my wife on for our 10th anniversary. Lots of great destinations came to mind and in the end I boiled it down to just 3 (in no particular order):

Reykjavik, Iceland
Quebec, Quebec, Canada
Vancouver/Victoria, BC, Canada

Reykjavik and Vancouver were interesting because neither of us has been there before and until I got some good advice with a combination of more travel sense, more common sense, and more romantic sense I was ready to make reservations for either one.

After a late night (for me at least) chat with a wise advisor I came to the conclusion that, although both of these would have been wonderful destinations, I was missing a few glaring considerations. First, on closer exam both of these destinations had reasonable flight times going one way the other way would really eat into our time in either city. Second, as far as Reykjavik is concerned, I neglected to think about increasingly long nights which would really put a cramp into our explorations of the surrounding country.

By morning I had made the final decision that we would go to the Old City in Quebec. After a few hours of sleep and the usual morning routine to get most of the family out the door I had to go about making reservations and arrangements.

It's been a long day as far as that is concerned but I have made good progress making arrangements for my wife has the time off we'll need, hotel reservations, airline tickets, rental car, babysitting for the three kids for four days and three nights, making sure that I have the time off that we will need. Oh yeah, and doing this all in such a way that my wife will not find out.

It's a good thing I was able to get some good advice or this could have been a disaster.

The first day of any new job is usually weird and today was no exception. This was really weird for me since I haven't worked in retail since I worked at a convenience store in college. Today was the usual first day stuff, get a locker, get uniforms (T-shirts), fill out paperwork, read lots of policies and procedures, meet lots of people and promptly forget most of their names, and start the training program.

I'm not sure about this whole retail thing. I mean I'm a geek, not a salesman. I'll give this a try and hope my geekness will make me comfortable with the product that I can concentrate on the rest of it.

My oldest has been with her grandparents on Cape Cod for the past week. Today when she called it was instantly clear that she was not having a good day. Her anxiety level was very high and I could tell she was very impulsive and obsessive. Because of her Asperger's Syndrome she frequently has these episode but her medication used to keep them more or less under control. For the past few months they have been getting much worse and much more frequent. Today, even with medication she was not doing well at all.

To say that these episodes are upsetting is an understatement. It makes me feel awful and makes me wish that there was more that I could do. I would give anything for her to be able to have normal days without the anxiety and obsessive-compulsive factors in her life.

I never used to understand when I heard of parents that would give up their own life and happiness for the well being of their children. Since she was very young I have understood. I understood and stood ready to give anything if I could make her better. The saddest thing in my life is knowing that there is nothing that I can do.

Too bad I fell asleep early. Last thing I remember is listening to Your Mac Life on my laptop with an interesting interview with Matt Deatherage about the 25 most influential people in the Macintosh industry. Next thing I know it's time to wake up and get the kids ready to go. Great sleep, I need more of it.

Today will be an interesting day. I start training at my new part time job at The Apple Store at Westfarms . In a way I can't believe that I would ever work in retail since I am not a salesperson by any stretch of the imagination. Since I closed my consulting business I needed a way to keep up with changes in the Mac industry and this seemed like a good way to do it. I'm going to give it a try for a while and see if I can meet this new challenge. I promised myself that I would give it until after the holiday season and that if it wasn't working I would get out then.

Not bad, but I want to go back to working at night. I was only in for 4 hours today. Overtime is overtime and you take what you can get. The sun was out and it was pretty hot when I got in at 3pm. I felt somewhat like a vampire being out in the sun, I'm not used to working in the sun much. I was right out to the first run shortly after relieving the day medic and ran pretty much non-stop for the entire 4 hours.

Total 4 runs

1 DOA
2 BLS downgrades
1 ALS transport

Total milage 56

CD of the day: "Far Side of the World" by Jimmy Buffett

Busy night all around. The rest of the night stayed pretty busy for all of us. I ended the night with 11 dispatches and a ton of paperwork.

The total for the night:

1 ALS transport
1 ALS turnover to the paramedic ambulance
1 BLS downgrade
4 cancellations
4 cover assignments
(+3 calls that I was unavailable for)

Total milage: 156

CD for the night Live in Paris by Diana Krall

I've got to get a few hours of sleep so I can go in for a short shift (4 hours) that I took as overtime.

It sure feels like sometimes.

Tonight I had one of the most frustrating experiences of my career. I had a critical patient where no matter what I did things did not go as I wanted them to go. I realize that in life there are no guarantees and that things will not go right all the time but it doesn't make me feel any better when nothing goes the way I wanted.

The patient was a severe asthmatic who had been having trouble breathing all day. When I got there she was anxious and agitated and clearly starting to poop out. She was very tired of breathing and was no longer able to breath well enough on her own. She was going to need us to place a tube into her lungs and breath for her since she just couldn't go on much longer. This procedure is call intubation.

We have procedures for this with special medications and equipment that we use. With only one paramedic on scene it is quite a challenge to get everything done but it is possible and we do it with some regularity. Tonight the ambulance had another paramedic on it and I expected this to make the whole process go much more smoothly.

Normally when we intubate a patient the breathing tube is passed through the mouth and into the trachea where we can use mechanical means to force air into the lungs. Sometimes, if the patient is still awake, we need to administer medications to facilitate the intubation process by reducing the gag reflex. This was one of those cases. This patient still had a gag reflex and was very anxious, there was no way we were going to be able to place the breathing tube without giving the patient medication.

In order to do this you need to start and intravenous line so that the medications can be administered directly into the bloodstream. After two tries to place the IV we were not able to establish an IV that we could use. This is a problem.

No IV access means we can't use the medications we normally would to facilitate the placement of the breathing tube. Time to move to plan B.

It is possible to place a breathing tube in a patients lungs by going down through their nose. It's not a pleasant experience for either the patient or the person performing the procedure but we were running out of choices. I try placing the breathing tube through her nose.

Any time a patient is intubated you have two possible results, the end of the tube either ends up in the lungs or the stomach. When we place the tube through the mouth we use equipment which lets us actually look in the patients throat, see what is happening, make adjustments, and place the breathing tube. This is the best way. In this case this method was not an option. When you place the breathing tube through the nose you have the same two choices of end results except since you cannot directly see what you are doing it is a more difficult procedure.

It is important to remember that, in a most simplified explanation, asthma is the closing of the airways in the lungs resulting in reduced airflow and reduced oxygen reaching the bloodstream. One of the ways that we tell if we have successfully placed a breathing tub is to listen to a patients lungs while we mechanically ventilate them. If the tube is in the right place we should here air moving through their lungs. If it is not there will be no air movement. This patients asthma was so bad that I could not hear any air moving at all. Am I in the lungs? Am I in the stomach? I can't tell. This is one of many situations where "I think so" is just not good enough, you have to be sure. I'm not entirely sure so I have to take the tube out.

By now the patient has stopped breathing altogether and we are at the hospital. What a nightmare. I feel awful that I wasn't able to do what the patient needed.

The logical portion of my mind knows that I did my best and that the important thing is that I did the right things at the right time. The emotional part of me laments the fact that even though I tried I wasn't able to what really needed to be done.

I knew going into this career that it was a job where performing successfully 1 out of 4 or 1 out of 3 just wasn't acceptable. I also knew that there is no way that everything would go right with every patient throughout my entire career.

I knew this, but it doesn't make me feel any better this morning.

Very very busy so far, mind you I'm not complaining (I love it). Five runs so far with a few interesting and challenging patients. The most interesting and challenging of them was also very frustrating. I was just one of those runs where nothing goes the way it is supposed to even though everything was in place for it to have been very smooth. These happen every once in a while, fortunately they don't happen too often. But that doesn't make me feel any better about it.

We'll see what the rest of the night brings.

Well 1800 and I have been up, done the grocery shopping, ironed shirts and trousers, showered and am ready to go for another night. My assignment changed for tonight and I will be working Medic 1 instead of Medic 3. I realized that the guy working Medic 1 tonight lived closer to the station for Medic 3. Since I live 15 minutes away from Medic 1's station we would end up passing each other going opposite directions on our way to work. It wasn't a hard sell for him to change assignments with me. I'm looking forward to getting to work tonight.

I got too much sleep last night. I fell asleep on the couch again around 1:00am. I hate it when I do that. I have to work tonight and had hoped to stay awake until 3 or 4 so I could get a good days sleep. Now I'm either going to have to take some Benadryl or struggle to get enough sleep to stay up all night. Is that as weird as it sounds? How many people complain about getting too much sleep?

Any way, my youngest daughter is off to day care with my wife, my oldest is on Cape Cod with her grandparents, and we are waiting for the other grandparents to arrive to take my middle daughter out so I can try to go back to sleep.

When I get up I will have to finish the stuff I didn't get to yesterday (groceries mostly) and see if I can iron my shirts with the right amount of starch without scorching them or burning myself.

Today I'm home with my middle daughter and what sounded like a low intensity day has turned into a really busy day.

After I got home from work I realized that I had one last consulting appointment left. I officially closed the business several weeks ago but told clients that had already scheduled appointments that I would fulfill those obligations. This appointment was pretty much a no brainer since it involved mostly solving the clients AOL problems. Not very difficult but less than convenient. The client lived about half an hour away and I had to bring my daughter, something I have generally avoided because each time I had tried this in the past it had been a disaster. Today was different. We arrived at the clients home, my daughter sat down on the floor to play with her toys and, except for a request for a bathroom, was absolutely quiet and stayed out of the way. A first! In about 45 minutes all the clients problems had been worked out and we were ready to leave.

To reward her for her excellent behavior I told her we would search for a geocache on the way home. This prospect excited her so we stopped at a nearby historical site, The Nathan Hale Schoolhouse, to search for the cache that had been placed there. As we searched we wandered around the grounds and talked about what schools were like 200+ years ago, looking at monuments and gravestones. The cache was an easy find and enjoyable. After an hour there we started heading home.

Of course we never got home, my wife called and told me that my oldest daughter had a prescription that needed to be filled and overnighted to her on Cape Cod at my in laws house. OK, change destination, go to the doctors office, pickup the prescription, drive to the pharmacy and drop it off. Ready in 40 minutes.

OK, off to Wendy's for lunch and then back to the pharmacy to pick up the prescription.

Now we're home and I have to package it up and bring it with us when we go out again to drop in the FedEx box at Staple's. In the meantime laundry, telephone calls, email, and getting ready to go out again.

Still to go, bring my middle daughter to dance practice, drop off a CD of my final business figures at the accountant, drop off the packages in the FedEx box, groceries, and don't forget to pick up my youngest at day care.

So much for getting a nap.

Not a bad night after all. The rain tapered off before 2300 and I only had one call in it. The other call was shortly before midnight on the interstate but was nothing of any consequence.

Since I had returned from Cape Cod today I was quite tired by the end of the second run and actually managed to get a few hours of sleep, something I rarely do.

Total 2 runs, 1 ALS, 1 BLS downgrade.

Milage: 12

Why is it that some people miss the entire point of taking time away from work? I've been on Cape Cod for 2 days and have seen more wildly stressed out people here than I do at home. So many people are on vacation and still talking on their cell phones, sending and receiving huge amounts of email, checking their pagers, and generally still being high stress. Their driving shows it. What's the matter with life in the slow lane for a while?

Yesterday I came across a guy syncing his Palm Pilot to his laptop which was connected to the Internet via a cellular phone WHILE HE WAS AT THE BEACH. Hello!! I though vacations were a time to decrease your stress, not add to it? I left my pager home, I made one cell phone call to see if I could get someone to cover me at work so I could stay longer, and have sent 4 pieces of email, 1 to my sister, 1 to my parents, and 2 to a friend who is helping me make some travel plans for my 10th anniversary so I can surprise my wife. Unless the incoming email was from them it remains unread. I haven't checked my work email, I haven't called, I don't even know where my Palm Pilot is. My goal is to de-stress as much as I can in the short period of time I have available to me. I must have missed the part of the vacation instructions where they said stress had to stay level or increase, either that or I am completely missing the point, but I don't think so.

I fell asleep before I could put this up

What a busy day. After oversleeping I went straight to overdrive it seems. After breakfast I went on a bike ride by myself. I left my in-laws house and got onto the Cape Cod Rail Trail and headed north. My intent was to only travel a mile or two since this would be the first ride I had taken in many months. Of course I was enjoying myself so much I didn't notice I had gone 5 miles until my legs began to feel like rubber. Uh oh, this was going to hurt later.

I stopped to take a short rest and stretch my legs some more and found an excellent place for placing the geocache geocache that my kids and I had been working on. I went back to my bike and got the cache and carefully hid it exactly 100 miles from Boston. I started the ride back home and was surprised when I got back my legs didn't feel any worse than they did at the 5 mile mark.

A quick shower before everyone else got back for lunch, a nap for the kids and then off to the next activity.

We had place a geocache and now the kids wanted to find one. Nickerson State Park is nearby so we went there to find one of the two geocaches in the park. The GPS led us right to the cache without much bushwacking. The kids were for the most party really happy about finding the cache although there was a quick realization in their part that since we had walked in to find it now we had to walk out. The walk out was less pleasant than the walk in with 3 somewhat cranky kids. After working up another good sweat we made it back to the car just in time to get to the fish market to pick up our steamed lobsters.

Normally I am not a big lobster fan, not because their not Kosher (I eat lots of non-Kosher foods), but simply because I have other shellfish and seafood that I think are much more delicious. That being said I do eat lobster and did then because I was very hungry and it was very tasty.

After dinner things start to get a little foggy. I was getting very tired and had a slight headache. The kids were cranky still and difficult to get to bed, and it was still pretty hot and humid.

I fell asleep to the sound of a thunderstorm at some unknown time in the evening.

I overslept this morning. I was trying to make a quick switch from being a nighttime person to being a daytime person and slept much later than I had wanted to. I don't have much time to do the night to day switch and then go back again as I am supposed to work Sunday night. Unless something miraculous happens between now and tomorrow afternoon I will be sleeping for the trip home and trying to make do for the night shift with much less sleep than is optimal.

Still, it was very nice to sleep late and wake up to a gentle breeze scented with a combination of sea air and pine needles. I'm slowly getting better at relaxing when I come up here.

At first I was always in an uptight mode for several days (usually until just before I had to go home) and now I can feel some of the stress bleeding off as soon as I get out of the car. It just ruins a vacation if I can't shed my stress fast enough because I get cranky and introverted and start to resent everyone else wanting to do things that aren't exactly what I want to do. Everything gets on my nerves and I generally have a bad vacation and so does everyone else. It took me quite a while to learn to come out of high stress mode and into a stress shedding mode. I still have not mastered it and it will be quite a while before I can go between the two at a moments notice.

It's a long drive going anywhere with three kids. Three kids, suitcases, 3 bicycles, a bicycle trailer, toys, games, books, snacks left me with little room left in the car for the grown ups. At 7:00 p.m. we were off to go to my in-laws house on Cape Cod. By 7:30 p.m. we needed to make our first of many stops. Gas, different snacks, potty breaks for the kids, potty breaks for the grownups, "she touched me", "I want a different song", "she's singing a song I don't like", "are we there yet?", "where are we?", "can we go swimming when we get there?" until the younger two fell asleep. That left the older one in the back seat whistling (a nervous tic) and talking. She has this ability to talk almost nonstop in a total stream of consciousness. No subconscious filter, think it say it and be done with it. In some ways I envy her because she doesn't worry about sugar coating the truth, hiding her feelings, or playing verbal parry and thrust. To her life is very much black and white and she will tell you so. In some ways it makes me feel so bad for her because it keeps her on the fringe of the socialization circle with other children. Compromise and joint play are difficult and she frequently ends up on her own especially when she is more anxiety ridden than normal or fixated on one specific thing or activity.

I love all my children so much but my oldest often leaves me feeling sad and depressed because I don't know how to help her and I worry about what kind of childhood she is having and what kind of an adult she will grow into. My social skills were nothing to brag about and I had always said that I would do everything in my power to make sure that my children were better at it than I was.

Tonight has been a little weirder than usual. Many areas that we respond to are without power and it is very strange traveling down streets that are normally brightly lit and having them be completely dark. I feel bad for a lot of these folks since it is still pretty warm and humid out. They will have a very uncomfortable night. I expect to see a good amount of breathing problems because of that.

It was seriously crazy when the shift started with both the day and night shifts out on runs at the same time. Lots of calls and relocations for coverage for everyone. I really enjoy being busy. It makes feel like I am accomplishing something and it makes the shift go by faster. The ED is very full, they tried to go on diversion and start sending ambulances elsewhere but when they called other hospitals everyone else is in the same situation. That's good for me because it keeps my turnaround time shorter but not great for the ED staff or the patients due to the sheer volume of work in the ED.

The power company says that the power should be restored in a few hours. I find that quite laughable when you consider the number of people that are without power in the mid and northeast US and southern Canada.

A good night aside from the awful heat and humidity.

2 ALS
2 BLS downgrades
1 Cancelled Enroute

Total milage: 105

Medic 1 tonight so it's off to bed to get a good days sleep.

What to do when approached by an emergency vehicle. OR More Stupid Driver Tricks.

You would think that after 22 years in the business I would know better. I have always believed that when you are approached by an emergency vehicle that there is really only one correct answer; pull to the shoulder and stop. I am always amazed by some of the alternative answers that people come up with.

Take tonight for example, I am responding to a call and traveling on the main street in one of the towns we cover. In the space of 60 seconds I see three new "answers" on what to do when approached by an emergency vehicle.

1. Approaching another vehicle from behind. I'm seen and the driver pulls to the right. Good, right? It would have been except they pulled to the right edge of the road and continued driving at 50 mph. What does this guy do when he sees debris on the shoulder of the road? He pulls left into my path of travel. Not smart. I avoid colliding with him, barely.

2. Approaching a four way intersection, traffic light facing me is green with one car waiting to turn left. I move to the left to go around him on the left side and the other driver decides that he just has to make that left turn before letting me cross through the intersection. Lock up the brakes and manage to swerve to avoid hitting him will he completes his turn.

3. Still trying to recover from two close calls already I approach the driveway of the McDonalds. Line of 2 cars waiting to pull out onto the road. First driver stops moving, looks in my direction. We make eye contact and he nods at me and pulls out in front of me. Did I miss something when I learned to drive? Pull in front of an emergency vehicle? In my mirror I can see the police officer a few cars back pull this guy over. A few hours later I run into that same officer on another call. After we're done and the patient on the way to the hospital he comes over and tells me that the driver told him that he pulled out in front of an emergency vehicle because "I thought he'd stop". He thought what!?!?

60 seconds, three close calls, and more grey hair. Sometimes I get really scared by some of these things. I'm just glad that I was able to avoid the potential accidents.

Hot and humid usually means a busy night. It is 2230 already, the temperature is 80 and the humidity is close to 100%. Busy night so far with a few dispatches but either BLSdowngrades, cancellations enroute or cover assignments. We sure could use another unit on evenings.

Fortunately for me our trucks have excellent air conditioning and my truck is almost as cold as a refrigerator. Perfect on a night like this. The only problem that I find is the condensation of the outside of all the truck windows and the fogging of my glasses when I get out of the truck. I'm still not used to wearing them and this doesn't make me like them any more.

Pleasant surprise. My relief showed up at 0300 instead of 0500. Not being one to look a gift horse in the mouth I took the opportunity and went home.

3 runs: 1 BLS, 1 ALS, and 1 no medical emergency

Total milage: 46 miles

I normally get on quite well with the local and state police but...

but tonight I almost blew up. Medic 6, Ambulance 2 respond to the front lawn of [location deleted] for the unresponsive person. We arrive to find 2 local police officers standing next to a chaise lounge with a man lying in it and a beer can between his legs. Unusual at almost midnight but still could be something. "What's up?" I ask. "This guy is out cold" they tell me. "OK" says me and I shake the patients shoulder. Imagine my surprise when he woke up quickly and asked what we were all doing there. It seems he locked himself out of the house and was waiting for his wife to return from work around 1230. Since he had a couple of hours to kill he borrowed a beer from a neighbor and proceeded to FALL ASLEEP.

No big deal yet, I have seen this before. So the patrolman looks at me and in total seriousness says "So you're going to take him to the hospital, right?"

I was speechless, did he really want me to take a guy to the hospital for falling asleep in his front yard after drinking a can of beer?

I had to just walk away.

Part 2 of my earlier hair comments

Someone was nice enough to forward me a list of other sexy bald men:

Sean Connery
Anthony Hopkins
James Caan
Burt Reynolds
Marlon Brando
Russell Crow
Kevin Spacey
Danny DeVito?!?!
Richard Schiff
John Lithgow
Peter Boyle

Somehow this didn't make me feel much better.

Not the uppercase letters "Why Am I Here?", the lowercase letters "Why am I here?". I got home from work this morning to the usual morning chaos of trying to get 3 kids and a career women out the door on time. OK, wife to work? Check. Older girls to day camp? Check. Youngest to day care? Check. Now I am free to do what I want. Should be sleep, right? So why am I sitting in Border's blogging and surfing the internet?

The only answer I can come up with is "because I can". You know, that answer doesn't even make sense to me. Of course I am still sitting in the Café instead of packing up my stuff and going home. I guess life isn't always supposed to make sense.

I knew it had to end eventually. I was starting to wonder if time was standing still. But it's finally time to go home. Thus endeth my one shift at this station and, after a couple of days off, I will return to the real world. I did manage to get 45 minutes of sleep and a lot of paperwork done.

Grand total...0 calls, .4 miles on the vehicle.

An interesting question with a convoluted answer. Before I was a father I devoured books. At least one or two a week. Then came my children and I went from readying books on assorted topics of interest to me like history, philosophy, religion, science fiction (especially Asimov), and anything by Tom Clancy (his politics are a bit on the conservative side for me but he is a terrific author) and started reading books to my children. I love reading to them but their books don't satisfy my need to stimulate my mind and fantasize. thinking about lots of the situations presented and playing the scenarios over in my mind looking for alternative endings, practical applications to real life, and generally relishing the complexity of the thoughts.

That being said there are very few things better than getting one, two, or all three of my kids under a quilt on a cold winter night and reading book after book to them and answering the deluge of questions that always came. "Why didn't the hungry caterpillar ask it's mom or dad if it was OK to eat so much?", "why didn't Stellaluna look for her mother after she fell off her back?" and the like went on forever and was very satisfying. But I still needed something complex.

Then I found books on tape or rather books on CD and books downloadable over the Internet. What a great idea! I could listen to an actual grown up book even when I was on the move. I miss the feel of the pages and the ease of stopping in mid-sentence to think about what was being said but it is so enjoyable to exercise my mind.

Some of the readers have been incredible. If you ever have the opportunity to listen to something read by David Ogden Stiers do it. The man has such and wonderful voice and the ability to do accents so well he can narrate a book and make it sound like there were a room full of people recording it.

Today was like so many others...

Sleep from 0800-1300 and then up to do laundry, housecleaning, and making sure that the kids are ready for another week at camp. I can never seem to get enough starch in my uniform shirts *frown*. A few more minutes to shine my shoes and the onto the shower. I have to be in at 7pm, a little earlier if I can just to make sure that the day guy doesn't get stuck with a late call.

The answer was no...

So in the final 90 minutes nothing happened. I got a lot of other work done and almost caught up with my email. Time to go home to bed and sleep for a few hours and get ready to come in again. Tonights a sleeping shift so I can't sleep too long.

Sometimes I think I am. So I'm at work standing in line at the convenience store to buy one of what promises to be several bottles of Diet Coke. I am talking to the State Trooper in line in front of me and the topic turned to what kind of night I was going to have. She was surprised when I said I would love a busy night with some really challenging patients and asked me why. I replied that I knew bad things were going to happen to somebody somewhere and that they may as well happen where I was since I know what to do about them and enjoy my work so much. It made sense to me.

The lady in front of us turned around and said "You're totally sick! How could you wish for such a thing?". When I tried to explain that in some areas of the country people suffering major traumatic or medical problems may not get a paramedic to help them and because of that their outcomes are sometimes much more dismal. That argument didn't change her opinion at all.

Now I wonder. Am I as sick as she thought I was or am I just being realistic?

Busy for the day medic. Unsure how the night will be. Nights at Medic 2 can go either way during the summer. You can be busy as hell or you can do next to nothing. In all the years I have been doing this I have yet to figure out the key to predicting what kind of night it will be.

Looks like it's going to be a busy night. The day medic is still out, no calls logged and no paperwork here. That doesn't bode well. Usually that means that days has been too busy to finish paperwork yet. Definitely not a good sign.

Nice day to sleep.

It was a good day to sleep. 80's outside with humidity to match. Cranked the AC to refrigerate the bedroom, put on my sleep mask and fell asleep quickly. To quickly it seems since I forgot to set my alarm clock.

The sleep was great and when the phone woke me up I was feeling pretty refreshed and in a good mood. Right up until I realized I had 2 minutes to be at summer camp to pick up my kids.

Nothing spoils a good sleep better than oversleeping

Just why am I doing this?

There comes a point in time when you realize that you need to talk about what is happening to you or it will drive you out of your mind.

That point arrived for me in April of this year when 20% of my department was laid off. The hospital I work for had some financial difficulties, sorry, revenue shortfalls, that made things look pretty bleak. Among the many ways that they tried to reduce expenses was the layoff of 24 employees. The paramedic department consisting of 18 full time employees lost 4 full time positions. Just ratchet up my stress levels a few more notches.

Don't get me wrong, I love my job. This is without a doubt the best job I ever had. I am in a position that gives me a lot of responsibility, autonomy, and pays me well. Most of the time I find myself looking forward to going to work, enjoying myself while I am there and feeling pretty good when I go home in the morning. Most of the time. There are some patients that I see that frustrate me either because they are so sick or injured that nothing I can do is going to change their outcome or because their call for help is a signal of a deeper psycho-social problem that has not been addressed and I do not have the resources to even propose a solution. I find this stressful and it bothers me to the point that some days I come home in the morning and throw my uniform in the closet hoping that the stress of the night and the memories of bad things happening to good people will stay in the closet with it. It doesn't work, never has, probably never will but it hasn't stopped me from trying on a regular basis.

Of course, like everyone else, I have another set of stressors at home waiting for me. I have a great family. My wife is a doctor and works very hard in her own right. Decreasing medical reimbursement, skyrocketing malpractice insurance costs, and a tortuous schedule are sapping her enjoyment of her career.

I have three wonderful daughters who are the greatest joys I have ever known and sometimes seem to instinctively know how to push my buttons.

My oldest is almost 9 and has been diagnosed with Apsergers Syndrome which is a high functioning form of autism characterized severe and sustained impairment in social interaction, development of restricted and repetitive patterns of behavior, interests, and activities. These characteristics result in clinically significant impairment in social, occupational, or other important areas of functioning. It also causes severe anxiety. Needless to say she needs a lot of attention and effort on our part to make sure she gets the care that she needs and stays in situations that will help her develop as normal as possibly.

My middle daughter is the drama queen of the family. Everything has to be dramatic and she has to be the center of attention no matter what or where. She's developing many of the skills she needs to stay the center of attention throughout her life. She dances well, sings, enjoys acting (and acting out), is a first class flirt, social butterfly and button pusher of the highest order. She's 5 going on 15 or that is the way it seems.

My youngest just turned three and is hell on wheels. If there is something that can be gotten into she will get into it. Her mantra right now seems to be play hard, sleep hard, and snuggle with mom & dad as much as possible. She can't decide if she wants to be a little kid or stretch her wings and grow.

I always worry that I am not the father, husband, person, or paramedic that I should be, could be, or want to be be. There just aren't enough hours in the day.

That leads me right back to the original question, why am I doing this? I'm doing this because I need to put my thoughts down on paper, real or virtual, so I can look at them, mull them over, consider them, and make the best decisions I can. I need to tell the tale of my search for happiness and balance in my life. If others can glean some useful thoughts from my tale I am happy to tell it.