September 2003 Archives

I have been working really hard to get my full time schedule worked out for the remainder of the year so that I have no more last minute scrambles to find coverage when my wife is on call or for holidays and the like.

As always this has not been easy. Because our schedules are on a 4 week rotation I always end up having to bother the same few people for swaps. I actually had an easier time getting swaps at holiday time than the rest of the year.

No wonder, I was offering to work Thanksgiving (U.S.) and Christmas Eve and, if I have to New Years Eve. While I like spending time with my family on these days I also don't mind working them all that much. The additional pay makes it worthwhile. Between the holiday premium, night shift premium, plus the 8 hours comp time for working the holiday Christmas eve ends up being paid at almost triple time. Not bad for 12 hours work.

In reality I have been using the fact that I am Jewish to my benefit. The other paramedics, especially those with real young or college age kids want to be able to be home with their kids for the holiday and, as Christmas is just another day for me, it's a good bargaining tool, and in general a pretty nice thing to do. Truth be told even when I was single or divorced I went out of my way to let the guys with kids have the night off if I could.

Anyway, I have gone from having 11 conflicting dates to 2 conflicts and I have put feelers out for swaps on both of those days. I'd love to think that I can be organized enough to continue to work 3 months ahead but I know myself too well. I just don't do things well until the pressure is on.

So last night after so long without being able to sleep I finally did drift off in the middle of a conversation with a friend. It figures. I am having a conversation I want to be having and I cork off almost in mid sentence. Par for the course. On the other hand the sleep was wonderful. If I dreamed I can't remember it (not that that's a bad thing). I slept so soundly and so deeply my wife had to send my children in to attack me so I wouldn't be late getting to work. I just wish I could figure out a way to sleep that soundly all the time.

So here I sit. I have been tired all day. I'm finally done with all my work for the day and I have been tired almost since the beginning and...I can't fall alseep. Figures.

My class went well and I was able to train about 20 firefighters in how to use the Combitube (an airway management device). I love to do teaching like this and wish I could do more of it. Started at 6:00 pm and finished at 10:00 pm with all the paperwork complete, equipment cleaned and repacked, projector returned, and me back home. Tired as I was when I got home I lay down and just couldn't sleep. I guess I really am nocturnal.

Really, I would.

Somedays no matter what you do you are just not going to get enough sleep. The next few days are that way for me. I spent today working at the Apple Store, tonight I'll be at the other job teaching a class for one of the fire departments we work with, tommorow is back to the Apple Store for the day and then I get to reinvent myself as a nocturnal beast so that I can work nights from Weds. through Sunday when Yom Kippor starts and I have to switch back to a day oriented person.

I think I might be OK if I wasn't always switching back and forth from day sleeper to night sleeper. Someday when I make enough money to only have one job I'll have to see if I can arrange that. In the meantime my caffiene consumption is going up and I think I am single handedly supporting the stock price of the Coca-Cola Company. If I ever stop drinking Diet Coke I am convinced that the company will fail.

Sleep when you can. Sleep wherever you can. Sleep is good. Sleep is your friend.

When all is said and done today was only a wash. It has been pouring all day long which put a damper on the morning plans and put daughter #2 into a funk. My 6 year old dances, jazz and tap, and her class was scheduled to perform at a local fair this morning. She was really stoked last night and when we found out it was cancelled she was very dissappointed. I can sympathize but it put her in a pretty vile mood all day.

Daughter #1 (age 9) was going pretty crazy because my wife had to work today. The anxiety that accompanies her Aspergers Syndrome was racheted up several notches and she had a hard time dealing with the day. Normally I would send her outside to play and she would blow off some of her extra energy and it would defuse some of the anxiety. No luck today, she does not like being outside in the rain.

Daughter #3 (age 3) was excercising her ability to annoy her 2 sisters and was doing quite a good job of it. By the time I finally got her down for a nap she was in rare form.

A good friend made some suggestions on how to keep them busy and from killing each other and they were welcome. They worked for long enough to let me clean up the house, get some laundry done, and for me to regroup and regain my composure. Thanks for the help, I needed it pretty bad.

Later in the afternoon, the rain lightened up and I was able to get every dressed in raincoats and boots and we all went outside to splash in some puddles and blow off even more steam. I finally got them tired out enough to think about sleep and had some alone time.

Played my trombone for about 30 minutes tonight. Not very well yet but it is going to take time for me to gain the speed, stamina, and skill that I once had. My jaw hurts like hell right now but it is a good hurt, a hurt that I enjoyed getting and look forward to getting again. So far everything I have been practicing has been basic and fundamental. Scales, long tones, working on increasing my accuracy and endurance. I am not anywhere near ready to start playing any serious jazz pieces or let alone try to improvise anything. It will come and I am seriously looking forward to it. The ability to have that creative outlet back is beyond description.

Hardest thing I have to remember is to keep my practice session short and more frequent. If I keep them to 30 minutes or less and practice more frequently I stand a better chance of making progress. Less pain, more accuracy, less frustration. All will come in good time, I just need to be patient and persistant.

Rosh Hashanah started at sundown last night. I realize that many people are not familiar with the Jewish Holidays so I offer this tiny explaination along with my thoughts.

From the Union of American Hebrew Congregations website:

"Rosh in Hebrew means 'head' and Shanah means 'year'. When it is written as Rosh HaShanah it means 'head of the year,' and is the Hebrew name for the Jewish New Year. Rosh HaShanah is celebrated on the first day of the Hebrew month of Tishrei; in some congregations two days of Rosh HaShanah are celebrated. It is important to remember that Jewish days start with the moon... at night. When the sun goes down a new Jewish day begins. The evenings of our holidays are referred to as 'erev'.

The sages and rabbis who instituted the Jewish calendar tried to count the years from when they thought the world was created. We have stayed with that counting method, even though we know that the world is much older. It is the traditional Jewish way of counting time. This Rosh HaShanah we begin the Jewish year 5764. Another name for Rosh HaShanah is Yom Harat Olam - the Day of the Creation of the World.

Rosh HaShanah is celebrated both at home and in the synagogue. At home, festive meals are prepared and blessings are recited. Shana tovah - Happy New Year cards are sent and received. The synagogue is the focal point for community gathering and prayers. Rosh HaShanah is a time of inward reflection about the past year and a time when one's behavior is judged. This is the basis of another name for Rosh HaShanah - Yom HaDin - the Day of Judgement."

While I am not an incredibly religious person or a significantly observant Jew this is an important time of the year for me because it asks Jews to do something that I believe needs to be done on a regular basis. It asks Jews to examine the good and bad things they have done and not done in the past year and judge their own successes and failures. I believe that such self examination is very important to maintaining one's ability to learn and grow. It also asks Jews to look forward to the new year ahead and the blessings it hopefully contain. For me the is essentially a time to look forward to the new chances that I will have to "do the right thing" for myself and those around me and avoid not "doing the right thing" or knowingly doing the wrong thing.

I admit that there have been times in the past year when I have not done the right thing and even knowingly done the wrong thing. There have been things that I have done that I have not been proud of, things that have been hurtful to others, and times when my actions or inactions were not for the right reasons. At this time of year I have a chance to reflect on these times, learn from my mistakes, and look forward to a new year where, hopefully, I will not make the same mistakes again.

The traditional greeting at this time of year is "L'Shanah Tovah Tikatayvu" or in English "May you be inscribed in the Book of Life for a good year".

Many of my friends and family have not had a good year for the past year, either through their actions or inactions, or through no fault of their own. I wish to take the opportunity to wish them and all of you reading this "Shanah Tovah". May it be a good year for all of us.

A good night, not a very busy night. Two ALS transports in the evening, both serious cases that were challenging not because of the presenting problem but because of their underlying history which made treatment choices more difficult. One patient was admitted at our hospital and one was transfered to a tertiary care facility for cardiac related procedures that are not done at our hospital.

In general it was a pretty positive night with a lot of work getting done and no complications. I'm still uneasy about the highway but so far it has not been an issue.

Total for the night: 5 runs
2 ALS transports
2 BLS downgrades
1 cover assignment

Total mileage for the night: 87 miles

CD of the night: Mirrorball by Sarah McLachlan

Rosh Hashanah is a day that I should be spending home with my family and at the synagogue with my community. Unfortunately I was unable to get the night off so I am here. As a matter of fact both of the jewish paramedics in our department are working tonight. Funny how that worked out.

I was not all that interested in coming to work tonight. After last night I really just wanted to spend some time with my family and try to forget just how badly I felt this morning when I got home. I was so exhausted when I got home that I fell asleep dressed and slept until I had to get up to get the kids off the bus. Surprisingly it was a pretty refreshing sleep and I awoke aware of the funk I had been in but certainly not feeling as unhappy as I did coming home.

When I got to work I found the day medic, once again, out on a call. According to the log he had had a very busy day but had actually transported no patients. I went online in one of our backup vehicles and covered as Medic 5 until the day guy got back. Since he ended up not transporting any patients none of the equipment was out of place from when I turned it over to him. I still did a cursory inspection just so I could say that I had looked at it. It didn't make sure that everything was in place and that the paperwork from the day was all set.

So far the night has not been all that busy with 2 ALS transports and one cover assignment. I'd be happy with just enough calls to keep me awake.

The night is over and it is time to go home. Without a doubt that is a good thing.

To say that last night sucked would be an understatement. I have not been able to get the eyes of those children out of my mind as they watched me treat their father. It was a totally futile effort and to a certain extent I feel like I betrayed them. I gave them hope by continuing to treat their father even after it was clear that he was dead and would not be resuscitated. *Sigh*

Total for the night: 3 runs, all ALS transports

Mileage: 65 miles

CD of the night: nope, none, nada didn't feel like listening to music

It has been a night for eyes tonight. Six pair of eyes have made my night a bad one.

I say that because all three of my patients tonight have had eyes that were remarkable.

I started the night with the "man down" on the sidewalk a few blocks from the hospital. When we got there he had gotten up and was walking his bicycle down the street. When I questioned him as to what happened he couldn't tell me. Not only couldn't he tell me what happened but he also didn't know where he was, what day it was, or even where he lived. What was remarkable were his eyes. He had what I have heard described as the "thousand yard stare". Even when you were talking to him he was staring past you with no response and no emotion in his eyes. It was almost as if we weren't there at all and he was all by himself.

The second patient was an elderly gentleman who had been talking with his family and suddenly stopped talking. When we arrived he had a large right sided facial droop, his whole right side was flacid, and he was completely unable to speak. I have seen this so many times before, patients presenting with major neuorologic deficits that came on them all of the sudden. It happens more frequently that I would want to admit or remember. What was stays with me is the look of total terror in this patients eyes. It was so clear to me that he was terrified of the situation he found himself in. We were there, but there was nothing that we could do to make his fear any less.

The last patient was a 45 year old man who was found in bed by his family and they were unable to rouse him. I was first in on this one and as soon as I entered the room I could see his eyes. They were totally vacant, empty. It was clear to me before I even touched him what was wrong and my touch only confirmed that this patient was clinically dead. No pulse, no respirations, confirmed when I checked the monitor and found flat line, complete cardiac standstill. We started following the protocol. CPR initiated, intubated, IVestablished, medications administered all following a carefully choreographed dance. All to no avail. The situation was made so much worse when I looked up and saw the eyes of this mans children, children old enough to know how serious the situation was but not old enough to understand the futility of what we were doing. The fear in their eyes is beyond description. The sorrow that will be in their eyes later tonight is overwhelming.

They say the eyes are the gateway to the soul and it was because of that the last set of eyes effected me most. Those eyes were mine, looking back at me from the mirror after washing my face off in cold water. I had a hard time reading my own eyes. Fear of my own mortality, the heartache that I felt thinking about the children of a dead man, sympathy for the fear of an old man now trapped inside himself, unable to communicate with the outside world, and the lack of comprehension of the "thousand yard stare".

Sometimes I really hate being able to look in peoples eyes.

It's really unusual that I run ahead of schedule when it comes to getting ready for work. The fact that I feel so ready is one that I am not used to. I don't have to be in until 1900 and I already have most of the tasks that I need to do accomplished. Shirt and pants are pressed, badge polished, shoes shined, showered, shaved, dinner started, kids homework already started, some straightening of the house started, batteries for cell phone, portable radio, pager, and PDA all charged. I have almost 2 hours to go before I have to leave. I am beginning to wonder what is happening to me. But I'm well rested and ready for work.

I'm still feeling pretty uneasy about last weeks dream but I am trying not to let it effect me too much. So far I have not had any highway calls but that can't last forever. Quite illogical for me to be worrying about a dream but for some reason I am.

My wife left to go to a class she is taking and I was left to fend for myself with the kids. Everyone, including me, is getting tired and cranky.

The cranky brigade was being led by my 5 year old. She turns 6 tomorrow and simply can't wait for it to arrive. If we are not going to shower her with presents RIGHT NOW she is going to make sure that everyone around knows she's unhappy. As this is the case I have been hearing various bickering and sniping among the three kids for the past hour or so.

And then it happened. Cleaning up the kitchen from dinner I hear a blood curdling scream from the kids room. All I can assume is that someone has gouged out an eye or lost a limb (well, OK, probably not, but it sure sounded that way) and the thunder of three sets of feet down the hall.

What to my surprise should appear? Instead of three bickering kids I find my almost 6 year old running towards me with her hand tightly closed and outstretched. The other two are clamoring to see what she has. Oh, jeez, now what. She looks up at me, opens her hand and smiles a gap toothed smile and says "Daddy, I lost my first tooth!".

It's been a year, year and a half since our oldest lost her last tooth and I had forgotten just how excited this can make kids. Smiles all around, no bickering anymore, and (I really want to know who replaced my kids with these three) they are cleaning their rooms without being asked.

It must be really wonderful to have a view of the world that allows everything to be forgotten by doing something a simple as losing a tooth. I wonder if any of us can ever get back to a point where our lives can be that simple ever again? I'm jealous.

A friend of mine has been having a difficult time lately and, as hard as I have tried not to, it had been bringing me down. After a lot of conversations I was beginning to worry that things would never get better. Finally, through the actions of another of her friends, something must have clicked. She finally understood what I and, apparantly, others had been trying to tell her for quite a while.

I cannot express how happy I am for her. I know that the road ahead will be difficult but now she has better than a good chance to heal, learn, and move on to a better life.

Even though I was not the catalyst to the epiphany I am so happy and so relieved that it happened. If I could do back flips without ending up in traction I would.

It amazes me how someone elses pain can bring you down sometimes and just how joyous you can feel when someone else makes an important discovery about themselves.

Since I finished work on Monday morning my sleep has been really minimal and my schedule has been really weird. Monday morning I got home and slept for just a couple of hours before I had to get up and get the kids off the bus. Then it was get everyone ready to go out again so thta I could meet my wife at day care and hand off the older two kids and go to work at the Apple Store. Work there for the evening, slow and uneventful and return home.

Of course I was still on a night schedule so I wasn't able to sleep well and ended up helping a friend add RAM to her iBook via webcam from 3000+ miles away. She didn't really need all that much help but it was nice conversation.

Another couple of hours of sleep and it was up, get the kids and wife off to school and work and speed back to the Apple Store for the day shift.

The day shift was mostly uneventful except for one very obnoxious and argumentative customer who kept trying to battle me down on the price of the PowerBook he was buying. It needs to be understood that dickering price is just not how this is done anymore and even if it was I don't have the authority to "make deals". Finally in exasperation it told the guy this. "Sir, you need to understand a couple things. First, I am not a career salesman. I'm just a guy who likes Macintosh computers who is working a second job trying to earn some extra money. Second, I don't get any commission on what I sell and don't have the ability to 'take something off the price' or 'throw something extra in'. I'm not trying to sell you something you don't need. I'm only trying to do my best to sell you a computer that will meet your needs and stay within the price guidelines that you gave me. If you honestly believe that I am trying to sell you something that you don't need I will be more than happy to find someone else to help you and bring the manager here so you can file a complaint."

Very long pregnant pause. I fully expected him to call the manager and to find myself walking out of the store as an ex-employee. I don't lose my temper very much and if I hadn't been so tired I probably would not have this time. I was very surprised to hear the customer say "OK, I'll take it.". Not only that, he was very polite for the remainder of the transaction.

After the transaction was over and the customer had left one of the other guys came up to me, shook my hand, and said that he had wanted to say something like that for years and just never had the guts to. I told him that it wasn't a matter of having the guts to, it was a matter of being so tired that I just couldn't put up with the browbeating anymore.

I don't know if I have heard the last of this incident but I was very happy when 3:00 came and I could go home.

By the time the kids were off the bus, picked up, and delivered to their various after school activities and home again I was so exhausted that I couldn't even tell how tired I was. After making a couple of abortive attempts to actually get work done I fell asleep and slept soundly to the morning. If I dreamed I don't remember it and all I can say is that I really needed the sleep.

Today is going to be a very busy day trying to tun all the errands I have been unable to get to for the past several days because I have been working so much. To top it off, now that my body is acclimated to being awake during the day I need to stay up most of the night to prep for a string of night shifts at work.

I knew it was going to be a bad morning when the pager went off at 0642. "Medic 2, Ambulance 8, Rescue 8, respond (address deleted) for 83 female with chest pain, time out 0642.". I can't grouse too much. The call was in my district, albeit at the extreme edge of my district. No matter which side of the district boundry it was on either I or Medic 1 was going to get out late. No matter how you slice it an 83 year old with chest pain warrants a paramedic response. So I went.

It wouldn't have been so bad if after all was said and done and I was returning to station for shift change the pager hadn't gone off again. "Medic 2, Ambulance 4, Rescue 4, respond (address deleted) female with seizures, time out 0747." This time the call was deep into my district so I went to this one as well. Knowing full well that my relief was back at the station drinking coffee and reading the paper.

So, when everything was said and done I finally got to go home around 0900. After what was a pretty good night even with the 2 late calls. I had a chance to get quite a bit of reading done and a good talk with a friend.

At the end of 14 hours the total for the night was: 5 runs

3 ALS transports
1 BLS downgrade
1 cover assignment

Total milage: 87

CD of the night: Diana Krall, Live in Paris

For the longest time I had rarely had dreams that I could remember but lately this has been changing. I mean, aside from my one recurrent nightmare, I have not really been a big dreamer. I'm sure I dreamed but nothing ever really stuck with me except for that one nightmare.

Yesterday I had had a new nightmare and woke up soaked in sweat and with my heart in my throat. I have never had premonitions before but this seemed very real, and very possible, and has truly scared the hell out of me.

It's a cool fall night and I have responded to a wreck on the interstate. I have arrived to find 2 critical patients. Everything is progressing well, everyone is getting the care they need and I'm waiting for the helicopter to touch down so that I can airlift the most critical of the 2 patients out before transporting the other by ground. As I am preparing to intubate one of the patients I hear the screeching of tires followed by the metallic bang of one vehicle colliding with another. In a split second I look up and see my paramedic unit spinning straight at me being pushed by another vehicle, I am frozen in place and cannot move at all and then everything goes white and I wake up.

For the past 24 hours I have had a very uneasy feeling that has only been magnified since I got to work. The logical side of me knows that this is so unlikely. The logical side of me knows that there would have to be so many failures to follow the guidelines and protocols that are in place and have been followed for years. The emotional side of me still is very uneasy and uncertain about what this all means. I have never been a big believer in premonitions but this is makes me uncomfortable none the less.

In a little before 1900 and the day shift was still out. I couldn't go on line as Medic 4 since the vehicle was out of service. The day medic was fairly busy with 6 runs and a couple of cover assignments. I am unsure if I want to be busy tonight or not.

As soon as he got back I was out on the first cover assignment of the night but nothing since. We'll see what happens.

Today could have been a great day if I had gotten more sleep. But it just didn't happen. I got home and pretty much collapsed into bed quite thoroughly exhausted. Our company was due at 12:30 and my wife woke me up at noon to hop in the shower and be dressed before people started to arrive. Of course almost everyone was early so I got to greet some people in my bathrobe. Even after my shower I wasn't really ready to play host and on a few occasions I found myself nodding off while standing or sitting.

It was a pleasant party anyway with both of my older daughters enjoying being the center of attention and getting gifts that they liked. Fortunately both sets of grandparents were pretty well under control and, for the most part, the gifts were practical and needed.

It was a little difficult for me to stay the gracious host since my in-laws had brought my new trombone with them when they came in from Ney York and I was anxious to take it out of the case and fondle it (yes, I chose that word on purpose) and make some tentative attempts to play it. However excited I was about finally getting to play trombone again I was not ready to play in front of an audience and had to refrain. OK, it was really difficult and I admit I did sneak a couple of quick peaks inside the case, feel the lacquered brass, and remember just how sensual the feel of cool brass against my skin felt.

By the time the party was winding down I had succumbed to my exhaustion and had fallen asleep in an overstuffed chair. After a while my wife chased me down the hall and put me to bed and I slept soundly for a few hours and awoke close to 8:00 pm upset that I missed my chance to play my new axe. It was time to get the kids down for the night and make sure that our houseguests all had comfortable places to sleep.

By the time that was done it was almost 11:00 and I was VERY sure that I would not even be able to look at my horn since we had people sleeping on every sofa and in every room. How frustrating!

So here I sit, it's 1:00 am, and I need to stay up for a couple more hours so that I can sleep the day and be ready for a night shift at Medic 2 tonight. I am sitting at the dining room table, in the dark, listening to my iPod and typing in my blog.

Even though I know my first few weeks of trombone practice will be exquisitly painful both physically and aurally I am anxious to get started and am really teasing myself sitting here looking at the closed case. Sleep, both mine and everybody else's, can be such a major inconvenience sometimes!

Fair night, not all that much challenge but busy.

The night is over and I'm kind of glad. While I had 11 dispatches most did not result in transports. It makes the night seem slower.

I'm off tonight. My two oldest girls are having birthday parties today and I will have to play host after only a few hours of sleep. My oldest will be 9 in 2 weeks and my middle daughter will be 6 next week. Most of the family has been invited for today and we expect to have a large crowd.

Total runs for the night: 11

Cancelled enroute: 4
ALS Transports: 1
BLS Downgrades: 2
Cover Assignments: 5

Total milage: 125

CD of the night: Diana Krall - All For You, a tribute to Nat King Cole

The day medic had the day from hell. It looks like he did about 14 calls throughout the day. As he put it he wishes he was paid by the mile today.

My night has been busy as well. Not as busy as days yet but looking like it may be close. So far 4 runs, but only 1 ALS transport.

In 3 hours I did manage to tick off one of my coworkers pretty bad. I made the best decision I could with the information I had available. I had been dispatched to a sick person at a skilled nursing facility (SNF) in one town over from my station. As I responded I heard the ambulance arrive on scene. I came upon a Motor Vehicle Collision (MVC) at the same time the dispatcher called me and told me to look for it. The bystanders were flagging me down to care for a young man who had put his head through the windshield. Dispatch would not give me a clear answer if they wanted to send another medic to this accident or if they wanted me to proceed to the other call. At that point there were no other medical personnel on scene and I didn't feel that I could leave this patient until other medical help had arrived and I advised dispatch of that fact. Medic 3 had already been dispatched in that direction to handle one of the calls.

Medic 3 intercepted the ambulance from the SNF enroute to the hospital and dealth with a serious cardiac case while I transported with the ambulance that eventually arrived on the scene I was at.

Medic 3 felt that my decision was wrong and that I should have proceeded to the original call and not stopped. I can see his point and it was a decision that had no right answer. I was looking at it from the standpoint of there already being medical personnel on scene at the SNF and my being the only medical person on scene at the crash. My original intent had been to wait at this scene until other medical personnel arrived that could take over for me and then proceed to the SNF. It did not work out that way with Medic 3 intercepting the other ambulance before I could leave the crash scene.

I feel bad when I disagree with my coworkers on issues like this. Mostly because no matter how you slice it there is no correct answer. Do I leave an injured person with no medical care to go to the call I was originally sent to or do I stay and delay the arrival of a paramedic at the original call. I felt that since there was already medical personnel on scene at the SNF I had an obligation to provide care at the crash scene until I was adequately relieved and able to proceed to the original call.

Unfortunately effective arguments can be made for both points of view and this is a scenario that has been plagueing EMS for a long time. In my opinion there is no good answer and I had to pick from 2 equally bad answers.

Mandatory education session this morning to perform our annual airway management validations.

**WARNING** Descriptions of medical procedures follow.

It took a long time but was probably worth blowing my morning. I mean worth it beside the fact that the validations are mandatory and I can't work without them.

I ended up doing double duty as a validator and validatee. We had two validation stations that needed to be run and I took one and one of the other paramedics took the other both of us overseen by the Coordinator and Medical Director.

I ended up on the "SimMan" station. SimMan is a mannequin that can be used for practicing various emergency procedures. The skills that I had to validate were very specific today. Paramedics coming through my station had to display competence on manual methods of airway management, use of the Bag-Valve Mask, Endotracheal Intubation, and the use of our "rescue airways" the Combitube and the Laryngeal Mask Airway (LMA). The other station was validating us on Needle Cricothyroidotomy and Surgical Cricothyroidotomy.

The SimMan was a very cool device. The manufacturer brought it in for us to evaluate so the EMS Education Coordinator and Medical Director could decide if they wanted to apply for a grant to buy this $26,000 piece of training equipment. SimMan, as it was configured today, allowed us to practice various airway maneuvers and also simulate a number of complications that we could encouter in the field. Very surprising just how realistic the complications could be and it was quite a challenge for all of us. It also gave me the opportunity to "break 'em off" on some of my coworkers and my boss during their trips through the station giving them some of the more difficult complications. Everyone took it as good fun and no one got too pissed off about it. Even so, it took a few hours for everyone to get through the station and complete the paperwork.

After I was done evaluating everyone I needed to be validated myself so the other validator and I validated each other at both stations.

When I got to the Criciothyroidotomy station I was pretty excited. Usually when we practice these two skills we do so on a plastic and rubber training mannequin. This time we had been able to obtain a number of pig tracheas and today our procedures were done on these instead. One of the paramedics had driven to a slaughterhouse in New York yesterday to pick them up. It was incredibly realistic and I got a real feel for the two procedures I hope that I will never have to perform again in my career. Simply put a Cricothyroidotomy is an invasive procedure that is performed when a patients airway cannot be secured by any other means. In the needle cricothyroidotomy we place a large needle through the cricothyroid membrane just below the adams apple and we can use that opening to breath for the patient that way. This procedure is pretty specific for children while the surgical cricothyroidotomy is used almost exclusively on adults. The surgical procedure requires the paramedic to actually make an incision in the neck to visualize the cricothyroid membrane, peirce it with a scalpel and place a breathing tube through it to allow us to breath for the patient. Both are pretty gruesome procedures but when they are the only option left they can save a life.

I have only performed the needle cricothyroidotomy once in my 23 year career and never done a surgical. The case that I had was a child who had a small ball lodged in her throat and we were unable to get it out. The patient was unresponsive by the time I got there and had not been breathing for 3 or 4 minutes. I couldn't get the ball out using any method I tried but I was able to perform a needle cricithyroidotomy and the child was awake byt he time we got to the hospital where the patient went to the operating room and had the ball surgically removed. One of the scariest things I have ever had to do and if I ever have to do it again on a live patient it will be too soon.

There is no comparison between the plastic of the mannequin and the pig tracheas. The realism was very helpful and made the procedure "real". I do not normally believe in animal experimention that results in harm to the animal. In the past these procedures had been performed on live animals that usually had to be destroyed afterward. While I always appreciated the learning opportunity but never approved on the destruction of animals like that. This was a much better way of doing things as these tracheas came from a meat packing plant where the animals were being slaughtered for food production and if we had not taken the tracheas for our use they would have been discarded.

While I still don't care for unnecessary destruction of animals I found this situation much more palatable than using living animals and destroying them afterward and still giving us the valuable and realistic experience we need. I maintain that the wrong time for me to be finding out what doing a procedure is really like is while I am performing it for the first time on a critically ill patient.

All in all a pretty positive morning and while I never want to perform either of the cricithyroidotomy procedures again, I know that I have a much better base of knowledge and confidence if I should ever need to.

I hate it when my technology lets me down.

Tonight was one of those times. After getting a really good days sleep I woke up, showered, dressed, and went to work only to find that I was not working tonight. It seems that my Palm Pilot is dying. I've known this for a while now. It's been knocked around, got wet, and generally abused for too long and has started to become undependable. Things in my calender have had the tendency to move or get lost lately. While I keep my master schedule on my laptop the palm syncs with the master everyday, unfortunately.

I say unfortunately since sometime in the last few days it started overwriting the calender on the laptop instead of the laptop always overwriting the schedule on the Palm. I don't know why it's doing that but when it did it left me with some really weird stuff that I didn't notice until I showed up at work tonight and found that someone else was working. Nuts! All rested up and nowhere to go. Of course I can use the time to figure out what I am going to do with the double booking I have for Friday night and figure out what my schedule really is for the next few weeks.

The night is over ...and aside from a momentary fit of craziness (which was very fun BTW) the night was uneventful. Maybe uneventful is the wrong term, may be I should say the night was dead. No calls, no cover assignments, no telephone calls, no email, no carrier pigeons, you get the idea. If it weren't for some IM's from a friend I might as well have been comatose.

Hopefully I will be comatose for most of the day. I'm in as Medic 1 tonight and am hoping that tonight will be busier than last night was (shouldn't be too hard to do).

Total runs for the night: 0
Milage: 26

CD for the night: Mindi Abair, It Just Happens That Way

I have been trying to decide what trombone to purchase for the last couple of weeks and finally, after reading what seems like everything ever written I have made my decision.

**WARNING**This entry may be WAAAAAAYYYYYY too boring for quite a few people as I will attempt to explain an emotional decision in technical terms and justify a decision that was made without logic really applying all that much. But it does have pretty pictures of trombones. ;-)

The decision was difficult for a number of reasons not the least of which is my own almost 20 years away from playing the trombone. I expect that since I am not going to be playing trombone for a living I will be playing a wide variety musical styles and most definitely cannot afford to own more than one trombone .From jazz to klezmer to classical, I need a single trombone that will play everything.

After looking at all the possibilities I find myself buying the same trombone I sold almost 20 years ago. A Bach Stradivarius 36BO trombone. Large enough for symphonic playing but small enough for quick response when playing jazz. The only difference between what I want to buy and what I had in school is a change from traditional wrap to an open wrap.

The Bach Stradivarius with the traditional wrap looks like:

The Bach Stradivarius with the open wrap looks like this: 

I'm sure that many people are looking at these 2 images and going "yeah, so whats the big difference?"

The difference between the two is all in the F attachment (the part of the trombone between the slide and the bell. OK, I know, that doesn't help much, it's that mess of tubing on the left side of the picture. In a very simplified description the F attachment changes the key of the trombone from the key of Bb to the key of F. Again, for most people it's not a big deal but rest assured that the F attachment allows additional flexibility and speed. Why does the wrap matter? Well, again in a simplified explaination, the less and more gentle the turns the air has to take before exiting the horn the less force the player needs to blow with to get adequate sound out.

So, if anyone is left reading this you may be wondering "what's the big deal?". The big deal is that I am really excited to start playing trombone again and finally have the chance to let what is left of my creative side out and express myself like I have not been able to express myself for years. I have never been very good expressing myself verbally, and only marginally better at expressing myself in writing, but in the past I was able to make people understand how I was feeling and what I was thinking with music.

Oh, and before anyone asks, no, I never had the chance to serenade a woman with my trombone but I'd sure love the chance to try.

It's good to be back to work. When I came in to work tonight the day medic was out transporting to the nearest trauma center (about 40 minutes away). No spare vehicle was hear so I couldn't even come on line as Medic 4. All I could do was wait around for the day medic to return. Or more accurately, the day medics. The new guy is orienting here today so he and his preceptor are together.

So far he's only been here about a week but he seems to be fitting in well enough already. He's done intercept work before so he understands the interpersonal skills required to do the job, he can read a map well, and seems (so far) to be a real team player.

Tonight I have some work to get done, mostly schedule stuff since some of the swaps I have worked out for the next couple of weeks have fallen through leaving me working on Rosh Hashanah night which makes me unhappy. Three nights in October conflict with my wife's call schedule and the rest of the year is taken care of for at this point in time.

The only thing that could really screw this whole thing up is if they reject the swaps that I had made with one of the other guys for some of his night shifts. It seems that when a day shift opened up he decided that he wanted to take it because it would give him more time for his bagpiping. If the schedule guy rescinds his approval of these swaps it's back to almost square one.

I fell asleep earlier than I had planned last night. I missed out on a number of things by falling asleep early. First I missed out on getting a chance to talk to a friend who's opinions and judgement has come to mean a lot to me. Then I missed out on the chance to get some work done. I mean, I have quite a bit of stuff that needs to be done before I go back to work Tuesday night. Shirts and trousers to iron, shoes to shine, papers to put in order, and what seems like hundreds of other things

When I woke up this morning I realized just how much I really needed to get done to day and just how tired I still was. So at the same time I felt like I slept too much and not enough.

It didn't really matter which was right since I had to get the work done anyway. Taxes were due today for the quarter, lots of errands to run, a trip to the Apple Store to get some items that I forgot in my locker, a trip to the bank, and a trip to the post office to send out a couple of packages, one being my digital camera for repair and the other being the parts needed by a friend to clean up after I screwed up and sent the wrong computer equipment to her. Then back home in time to get the kids off the bus and from daycare.

No chance to nap, no chance to really even catch my breath.

Tonight I finally got caught up and sat down to answer some email and get some other personal stuff only to find that my cable connection was down and leaving me to fall back to dialup for a while. I really hate dialup.

Fortunately for me I'm still able to get some of the work done that I need to finish, send my email out, and at least stay only a little behind instead of really behind.

Late night tonight so I can sleep for the day tomorrow. I'm actually looking forward to a good day asleep and getting back to work.

My youngest has been giving us terrible time getting her to bed. After several attempts to get her to sleep in her bed I thought we had done it. My wife went to bed and I sat down on the sofa to answer some email. 20 minutes after the last time she came out I hear the patter of little feet coming out into the living room. Trying to be stern I say "You had better have a good reason for being out of bed again".

The sleepy reply comes "I forgot to cuddle with you before I went to bed." and she snuggles in close and promptly falls asleep on my chest.

I really want to be mad that she was still up after midnight. But how can you be mad when they give you a reason like that? What daddy doesn't love to cuddle his kids? Besides, holding a sleeping child is so relaxing I don't think I could be mad if I tried.

Man, do my kids have me wrapped around their little fingers, or what?

Still adjusting to the whole retail thing. Especially some of the parts that don't make sense to me.

Today I had a parent who was looking at a computer get extremely upset because his child was playing one of the Harry Potter computer games on the computers in the Kids Section. He almost walked out. I understand that some people don't want their children playing certian games and that some games are inappropriate for children. What I don't understand is how this was my problem. I mean, I didn't force the child to select a game that was did not meet the approval of the parents. I'm not the one who apparently did not make their expectations clear to the child and failed to provide any supervision. I'm not the one who even decided which games would be on the demo computers. So how was any of this my fault and why did I have to suffer through the parents rage?

I understand wanting to protect your children from things that you feel are objectionable. I do it myself. But, I also accept responsibility for that protection. I make it clear to my children what I find acceptable and what I do not. If we are somewhere where they may be exposed to things that I don't want them exposed to I make sure to provide some supervision. If they see or do what I do not want them to see or do I have to accept responsibility for that as well.

In this situation it would be too easy for me to say that the parents were being too parochial or conservative but the fact of the matter is that I don't think either is the case. The problem in this situation is putting the blame on others for their own failures. I know that the final responsibility for raising my children lays with my wife and me, no one else. We own all the successes and failures no matter how much it hurts. Just as every parent does.

Yesterday was a long day. I didn't realize how long until I woke up this morning. About 5 seconds after I woke up I knew that things had not gone as I had planned. 0730 already, the tasks I had decided I needed to do were still undone, the friend I was supposed to have helped with a geek problem was unhelped and didn't even get the courtesy of a message. Some days I can disappoint even myself.

After a while of being awake and getting some caffiene into my system I realized that my big problem for yesterday was expecting too much of myself. I am very good at reminding my freinds to take better care of themselves and not so good at following my own advice.

Yeserday I got up after only 4 hours of sleep, worked a 9 hour day at the Apple Store, drove home, entertained guests, their kids, as well as my own kids, cleaned up, did some laundry, and proceeded to fall asleep where I was sitting.

I need to take better care of myself and get more sleep. Maybe I should start putting my sleep time into my calender every day so I don't overextend myself.

I managed to make a last minute location swap with the guy that was supposed to work medic 1 tonight. He lives close to Medic 3's station and I live 30 minutes closer to Medic 1's station and we would have passed each other on the trip to work.

When I got here the day medic was gone, taking an ATV accident to the trauma center. With the spare vehicle out of service I was out of luck and unable to go online so I spent 45 minutes doing various chores and getting ready for a meeting I have with the Clinical Engineering Department in the morning about our monitor/defibrillators.

Once days got back I found out that there were actually 2 of them. A new employee was training to replace the resignation we had a couple of weeks ago. I was kind of surprised that the position was filled so quickly considering the state of flux that our department is in but I'm not going to complain. I hope that we can get this guy oriented reasonably quickly, within a couple of months, so that the rest of us do not get beat up too bad with overtime and coverage.

I wish I could say that I would miss the paramedic that resigned but she was not really a great fit for our department, needing too much hand holding and not feeling comfortable operating without the safety net of close backup and support. She's a nice enough person, but this was not a good position for her to be in. Her discomfort with the job showed and effected those around her. A paramedic in a position like ours has to always appear to be in control and confident to the rest of the people around even if inside he/she is totally scared to death and feels like they are in over their head. If you let your fear and discomfort show through others tend to let their fear and discomfort get the best of them.

Not that this is something that you can know about until you are placed in the position. No one knows how they will react to some of the situations we encounter until you are actually on the spot. Some people sink, some people swim, and others barely tread water.

It would be great to find a way to figure this out beforehand through some kind of screening process but you can't. All that can be done is to send new employees through a rigorous orientation and field precepting process to see how they react when placed under stress. That is exactly what we do. Each new paramedic we hire spends 2-3 months working with a seasoned paramedic who watches them closely, helps them get used to the unique system we work in, and helps them make the adjustment. Some people swim right away, like they were born for this job, thriving on the stress and challenge. Some people can keep their head above water in the beginning and gradually get stronger until they can swim strongly. Some people sink like a stone. The sinkers are given ample opportunity for help to teach them to swim but if they show little hope by after a couple of months they are eased out before their probationary orientation is finished. We just can't afford to put a paramedic in the field by themselves who can't handle any situation they may encounter.

As nights go this was pretty slow. I responded to 2 calls and ended up transporting neither of them. Normally I would have been unhappy to be so slow but I was able to use the time to finish a couple of tasks that I have been putting off for a while. The first was transfering a presentation that I have to give at the end of the month from PowerPoint to Apple's new Keynote software. The other was to do some serious schedule work. I can't afford to have more scheduling conflicts with my wifes call schedule.

Total for the night: 3 runs
1 cancelled upon arrival
1 BLS downgrade
1 cover assignment

Total mileage: 56

CD of the night: C'Mon, C'Mon by Sheryl Crow

Two years have passed since the terrorist attacks of Sept. 11, 2001. I have mourned the loss of friends, colleagues, and classmates on that day but what I mourn most is the loss of innocence that struck American society across the face.

As I sit here this morning I see a multitude of news stories across the net remembering the deceased firefighters and law enforcement officers at the World Trade Center in New York City. The stories focus on the deaths of the firefighters and law enforcement officers almost to the exclusion of the other 2600 or so people who died that day not only in New York, but also in Pennsylvania and Washington, D.C.

Depending on what list you read somewhere in the vicinity of 3000 people dies or are still missing from the attacks yet what we hear most about is the 343 firefighters in New York. The people on the planes, the occupants of the Pentagon and the WTC itself are rarely mentioned.

Don't get me wrong, it is a tragedy to lose a single firefighter or law enforcement officer at anytime and more so to lose that many all at once. But each and every rescuer who died that day went to work knowing that they may not ever come home again. It's a given, it's a risk that we all accept, our lives and our safety are not guaranteed and the possibility that any emergency worker could die on any given day is always there. I am reminded of the unofficial motto of the United States Life Saving Service (USLSS), an organization that preceeded the US Coast Guard. The USLSS maintained life saving stations along the eastern coast of the US crewed by men who, when a sinking or wrecked vessel were sited would venture out in small boats to save the lives of as many sailors as they could, frequently at the cost of their own lives. They used to say that "you have to go out, you don't have to come back" and many of them didn't.

In the modern context every police officer, firefighter, paramedic, and EMT knows going in that the possibility of their own death awaits them everyday. By definition we put ourselves into situations that "normal" people flee from and we have all accepted the possibility that we may not go home to our families at the end of our day.

But the remainder of the world has not accepted that, nor have many even considered it a possibility. I am sure that the window washer who left for work in the early morning hours of Sept. 11, 2001 never thought that he would not be returning home that evening. The same for the waitress, the stock broker, the secretary, the electician, the pilot, the stewardess, or any of the other people with "normal" jobs who died that day. It was the furthest thing from any of their minds. These are the people who had little, if any, time to contemplate their own mortality or the value of their lives, or even to say goodbye to their loved ones. These are the inncocent people that I mourn. I mourn the loss of these innocents and of the innocence that was ours.

I will miss my colleagues, friends, and classmates that were lost that day as I will miss all of the ones that were lost before that day and since that day. But I know that all of them went to work that morning with the understanding that they were there to save the lives of innocent people and knew that, sometimes, that meant dying in the attempt and that they were prepared to do so if that was what was to be. I will however, continue to mourn deeply, the loss of so many people who have never had to confront the possibility of their own deaths every day, who never said goodbye to their families like it could be the last time and who never, ever, thought that their world was such a dangerous place.

2 hours into the night shift and not much has happened. I can't decide if I want this to continue or not.

So far all I have done is 2 cover assignments for Medic 1 & Medic 3 who both got tied up on serious calls soon after coming on shift.

I was almost late for work again because I slept through my alarm clock again. I managed to get in just under the wire punching in at 1900 exactly. I really have to work on that since I do not want to be known as a "minuteman" always coming in at the last minute. On the brighter side my sleep today was wonderful. I slept incredibly soundly and woke up late but feeling refreshed. No dreams that I can remember for a change.

One of the nurses looked ta my head and they think I may be ready for the staples to come out and my eyes are rapidly looking more normal. I'm left with just some dark smudges under both eyes that make me look like I haven't slept in weeks.

A busy morning so far with lots of stuff to get done. Aside from dozing on the sofa for about an hour I have been up since yesterday morning. I spent a lot of time cleaning my office last night and managed to either throw out or move into storage quite a bit of stuff. Still a lot more to go but definite progress has been made. I'm pretty happy about that.

My kids started stirring around 6:30 and around that time I switched from cleaning mode to "get the kids out for school" mode. The big debate this morning? Buy lunch at school versus bringing lunch from home. After a lengthy discussion they decided to buy lunch and bring their morning snack. I actually was on the ball this morning and had the two older kids out to the bus a little early.

Then it was back in to send some packages that I am way overdue on sending out. After struggling through the customs declarations I managed to get everything filled out correctly and ready to ship. I'll drop them off when I go out for my haircut in a little while.

Hopefully after my haircut, 10:30 at the latest, I should be back home to finally go to bed and get some sleep. I'm working Medic 2 tonight so I really need some a good, solid 5 or 6 hours of sleep at least (more if I can) before I have to go in.

So now I'm in trouble. I have lost 45 pounds in the past 5 months. Which is fantastic. I am really happy that I am losing so much weight. The problem is this, now that I have lost the weight I can no longer wear my larger uniform trousers. I have been forced to fall back to some smaller trousers that I had in the attic from a number of years ago. The problem is that these trousers do not have the same number of pockets as the trousers I have been using for the past few years.

I have ordered new trousers but they will not be here for a couple of weeks.

*sigh*

Knowing how much I can be thrown off my stride by things that are not my usual (see: http://www.themacmedic.org/2003/08/pockets.html) I wonder how long it will take me to be back on stride.

Another night to stay awake late and look forward to sleeping throughout the day tomorrow. Since I need to stay up I'm going to try to be productive and clean the disaster that serves as my office. My hope is that after it's been cleaned I can thin out my book collection reorganize what's where and, since I am not running my business from there anymore, turn it into a quite place for the grownups to go and read, talk, get on the internet, whatever. It would give us a computer that could be dedicated to the adults instead of having to share with the kids.

So far I've hauled out 3 bags of trash and probably a ton of computer equipment of various types. I have a feeling that with all this electronic gear unplugged I can cut our power consumption by a fair amount.

Tomorrow will be a haircut in the morning and sleep before heading downcounty to work Medic 2. Busy night or slow night probably won't matter since I still have some projects that need to be cleaned up before the end of the month and after getting ahead of the game on a slow night last week I really liked the feeling of not being under the gun. If I could keep it up I may actually start being able to close out some projects and move on to some new stuff.

The last 24 hours have been kind of busy and I'm looking forward to having a low key night.

Work last night was busier than I would have liked and it was much more difficult for me to sleep than I ever expected.

This morning I came home and helped get my wife and kids out the door for work and school. A quick shower and I was ready to leave for my haircut when they called to change the appointment from 9:15 to 9:45. I had to reschedule since I was due in at The Apple Store at 10:00.

The day at The Apple Store was somewhat interesting as we had new product announcements this morning (iPods and iMacs were updated). The day started out slow but picked up around lunchtime and stayed steady until it was time for me to go home. I got several comments about the nice green and yellow shades my black eyes are taking on. They don't hurt as much as they did yesterday and I know that the colour change means that they are starting to heal. The staples will be another few days before they can come out.

I'm really looking forward to as close to a relaxing night as I can get. It will be the first night I have been home with my wife and family in several days.

I knew this would happen. Not only have I had 2 runs already but the worst part of it is, I CAN"T SLEEP! Man, that ticks me off. I'm tired, I've been up too long, and I can't sleep. I knew I would have trouble with the paid to sleep routine. I just need to try harder.

People constantly amaze me. Everytime I feel like I have seen everything something comes along to let me know that I haven't.

Last night had 2 runs each one reminded me that I haven't seen everything. The first one was a guy complaining about almost passing out a couple of times. When I looked at home he looked to be a very fit man in his early 60's. He gave me a history of some heart problems in the past but no other major medical problems. I didn;t think anything of it until I started to work the math to figure his age. This guy in his early 60's was actually 82 years old. Still bicycled every day, still SCUBA dives, still rock climbs. Wow, I'd be happy to look as good as he does when I am in my 60's, let alone my 80's. Anyway, during the transport we talked and he gave me his insight on why he lived so long and was still enjoying life.

He told me that the secret of life is to get enough sleep, spend some time in the sun every day, stay away from tobacco, touch and be touched regularly, and make sure to kiss a beautiful woman at least once a day

The second run was a little different, a 25 year old who was doing his best to not live to see 30. This guy had been using anebolic steroids and ephedrin for the past several months and decided that today would be a good day to try cocaine for, what he wanted us to believe, the first time. Tonight he had chest pain after snorting the cocaine. When I asked him if he knew that all of this stuff interacts with each other he said he had never heard that this stuff wasn't good for him.

So both patients got admitted to the Coronary Care Unit side by side. One showing me how to live a long and happy life and the other how to go about ending life way too early. I'll never have seen everything but that image will stick with me for a while.

Totals for the night: 2 runs both ALS transports

Total mileage: 7

No CD for the night, the van had no CD player

Shift change was done on the run since the day medic was coming across the parking lot to take the call just as I was walking in.

She had had a slow day, only one run that ended up being a BLS downgrade, and really wanted to get home. I certianly can't blame her I'd feel exactly the same way. I love my job, but it is really nice to go home on time.

Looking back in the log nights have been pretty slow, not that that means a lot. I'm hoping for a slow night. I decided to try something different tonight. Since I am allowed to sleep at this station I am going to try. Big bonus if I can work the night at weekend and night differential and get paid to get a few ours of sleep. Usually I don't sleep because I always have enough work to do but I got far enough ahead last night that I could sleep, do no extra work, and still be ahead of the game.

My grandfather died in February. We had always been very close and he, more than anyone else in my life, is responsible for most of the good things in who I am and what kind of father, husband, and man that I am.

He died suddenly and was a short time away from his 90th birthday and his 70th wedding anniversary. I always knew that I could talk to him about anything and that, even though he may not have always understood the specifics my life, he was always able to make me see the problem from a different perspective and offer advice that was helpful.

My life at home with my parents was not always pleasant and I did everything I could to spend as little time there as I could. Don't get me wrong, I love my parents dearly, but when I was living with them I was almost always at odds with one, the other, or, more frequently, both of them. My grandparents house was my refuge. I knew that I was always welcome there and could talk, or not talk, as much as I wanted. That house is one of the few places in the world where I could let my guard down all the way and allow myself to be totally vulnerable.

When my grandfather died my grandmother moved into an assisted living facility. I'm not sure if she really wanted to, but she felt that she had to so that she would not be a burden on her family. This left their house empty. I was steeling myself for the house to be sold and for it to be only a memory. I was more or less prepared for that. What I was not prepared for was the news that my parents were buying the house and moving in.

I had to think hard about this to decide if I was happy that my refuge was still to be in the family and available for me to go and relish the memories of the past or if I was unhappy because my refuge was going to be occupied by the people who made my childhood so unhappy a lot of the time. Such mixed feelings and so much indecision.

Since I heard that my parents were buying the house I have not been back. I knew it was inevitable that I would have to return but I had done well avoiding the situation.

I am so indebted to my mother for helping watch my children that when she asked for help moving furniture I could not even consider saying anything but yes.

I approached the day with quite a bit of uncertianty and when the time came to go and do the work I was so unsure of how I felt that if I could have begged off I would have. But I couldn't, so I went, I moved everything they asked, and I tried very hard to decide how I was feeling.

I'm home now and thinking about how I feel. I just don't know. I want to believe that my memories will remain intact and that house will continue to be a place of safety for me. But I remember my childhood and how much I wanted to get away from home. Reconciling the past and the present is difficult and I expect that it will be much more painful than I am prepared for. I can only hope that the pain will bring the wisdom I need to accept the situation and recognize that this place can still be my parents home and still hold all the feelings of safety and comfort that it has in the past.

Strange night, but a welcome change. For a Saturday night that was weird, even for me. for 12 hours I listened to the other medics operating at a steady pace, even in the next county east of here Medic 11 & Medic 12 were steady. I'm not complaining, mind you, just saying how weird it was.

I am quite glad that the resident was't there last night as the whole purpose was for her to see how we practice medicine in the out of hospital arena. Watching me type on the computer all night would not be much of a learning experience.

Totals for the shift:

mileage: 2.2 miles

calls: 1 BLS Transport (I was bored and it was close to the ED)

CD of the night: Oh, I spent such a short time in the truck I never got to choose one.

So it's probably a very good thing the resident didn't come tonight. Only one run so far. It was very close to the ED and one didn't really need me but I rode in partially because I was bored and partially because something just didn't feel right. It took me out of service for less than 10 minutes and made me feel much better so it was worth taking the ride. As it ended up the patient did fine but I was right, there was quite a bit that the patient "forgot" to tell us.

It's very interesting to me how you develop a sense of when something just isn't right. Frequently I just can't put my finger on the problem and have to go by that feeling in the gut. Sometimes when I write my reports I want to put down "Just didn't feel right" as the reason that I accompanied the patient to the ED. Call it what you will, but I have learned to listen to that feeling. It's right a lot more times than it's wrong and that's OK by me.

Since I have been so slow tonight I took the opportunity to do some paperwork ahead of time. I managed to complete some of the reports that I have due in the next 2 weeks. It doesn't happen often that I have time to get things finished ahead of schedule. Very nice.

I'm even holding my own when it comes to staying awake which really surprises me. Maybe I am caffinated enough to finish the night without falling asleep.

I was a few minutes late getting into work tonight. I fell back asleep after my alarm went off. I wish I could say it was unexpected but with only about 4 hours sleep to get me through the day and tonight I should have known better and set a second alarm.

When I got in the day medic was still waist deep in paperwork and didn't really care. Like me, he's been doing this for a long time and knows how things go some days. He said that as far as he knew *nod**wink* I was there a little before the beginning of the shift and that he was there late anyway doing paperwork.

I'm pretty sore after last night. I was right, I did develop a black eye. Actually both of them are pretty bruises and the staples that are holding my scalp laceration closed are irritating me. I have been injured many times on the job but not in quite a while and while this is not the most painful injury I have sustained it is one of the most visible.

The resident that was supposed to ride blew me off, which is really OK because I am not really in the mood to do much teaching tonight. We'll make arrangements for her to come in on another night. If it's slow I may even break with my usual and put my head down on my desk and doze.

Good thing I got to sleep yesterday, because today I will nto be sleeping much. After screwing up and not seeing the schedule conflict between my schedule and my wifes schedule until it was too late to fix it I will have to deal with my next shift on very little sleep. My wife is on call and spending at least a good portion of the day at the hospital with a patient in labor. This means that will be spending the day with all three of my kids. My parents are coming in the mid to late afternoon to take over for me so I can go to work but they can't come any earlier.

I don't hold out much hope for much more than cat naps on the sofa while the kids play or watch TV and maybe a couple of hours after my parents get here.

Tonight should be exquisitly awful and I expect that it will serve as forceful reminder to me to look at the schedule very closely.

The night got a little more difficult towards the end. My last 2 calls were both serious cases that needed significant interventions, quite a bit of thought and were demanding.

The first call was for a 40ish male who drove his car into a guardrail at high speed. Drunk, of course, and no seat belt, of course, he made a large impression of his face in the windshield. It took the Fire Dept. about 10 minutes to cut him out and throughout the entire process he alternated between being lethargic and fighting with us. Because it was a quick extrication and we were already on the highway we elected to transport him the 20 minutes to the trauma center by ground instead of waiting for the helicopter. Part way to the trauma center the patient experienced a dramtaic change in his mental status and began to fight with us so much that we needed to pull over and the driver needed to come and help restrain him so we could adminster the sedation and paralyzing medication so that he could be intubated. I suspect he has a significant head injury and really hope he does well in the long term, in the short term it may be a difficult journey for him.

This call was difficult from a physical standpoint because all of us took a few good hits from this guy before we successfully restrained him. I am likely to have quite a shiner by later in the day.

The second call was a 60ish female who stopped showing up for work a few days ago. When she didn't show up for the third day in a row her boss called the police. After the Fire Dept. forced the door open they found her unresponsive on the sofa clearly having been there for quite a while. The stench was horrible. She was breathing shallowly and irregularly and after an difficult time establishing IV access we needed to sedate and paralyze her so that she could be intubated and stabilized. When I left the ED this morning they were still trying to figure out the exact cause of her coma. The prognosis didn't look very good at that time and when I get in tonight I will call and see if anything new came to light during the day.

This one was challenging from an emotional standpoint. It brought back many of the fearful feelings I had when I was newly divorced and adjusting to life on my own. I remember being afraid that something would happen to me and nobody would notice that I was not going about my normal life for a long time. It brought those memories back in full force and I have to admit that a few tears escaped my eyes during the transport as I realized that this women was living through what had been one of my greatest fears at one point in my life.

A challenging night, I wouldn't change anything that happened (except maybe getting beat up by an enraged head injured patient). The resident that will be riding with me tonight will be disappointed that she was not with me for these but there is no way to control what call comes in when.

Lots of paperwork had me getting out half an hour late.

Total milage: 88 (surprisingly few for how busy it was!)

Total calls for the night: 8

2 BLS downgrades
1 ALS turned over to the ALS ambulance
2 ALS transports
3 cover assignments

The CDs for the night were a widely varied bunch:

Del Amitri, The Best of Del Amitri
Spin Doctors, Just Go Ahead Now: A Retrospective
Diana Krall, Live in Paris

What a great days sleep this was. My room was dark and cold, no noise, I unplugged the telephone and it was as close to true silence as I can get.

I woke refreshed and looking forward to my night at work. I even remembered what I dreamed about and found that surprisingly calming and deeply relevant to experiences that I have experienced and that friends are experiencing now.

It's funny because, aside from my recurrent nightmare, I usually do not even remember that I have had any dreams. I don't know what that says about me or what that says about what my subconscious is trying to tell me. But this dream will provide me with food for thought during any downtime I have over the next couple of days.

A good night for me, a bad night for other people. It could have been much worse if I had not been there.

A pretty busy night with some very seriously injured and ill patients and some not so seriously ill and injured patients. In both cases I feel like I was able to make a difference by either intervening in the patients medical condition or through showing some compasion and helping them get the help that they needed. All in all pretty satisfying.

The resident that wanted to "walk on the wild side" got to do just that taking in a motorcycle accident. She got to go all the way to the Trauma Center with me since the air evac wasn't flying due to fog. She was having a great time and it just convinces me more that she is doing the wrong residency. She should do Emergency Medicine instead of Family Practice. She's still not satiated though and will be back riding Medic 2 with me on Saturday night.

Of course I got out late with a call shortly before the end of my shift and the resulting paperwork. I cheated a little bit since I knew I was back at the same station tonight. Some of the final paper shuffling is still at the medic desk for me to finish tonight.

Total milage for the night: 228 miles

Total calls: 9

2 ALS
2 turned over to the ALS ambulance
1 BLS
1 cancelled upon arrival
3 cover assignments

Back to Medic 1 tonight so I hope to spend most of the day asleep.

It's good to be back at work after 6 days off. Sounds like it may be a busy night. The day medic was slow in the morning and busy in the afternoon. Fortunately for him he got out only 30 minutes late. Of course he also left me with an 1/4 tank of gas (we're not supposed to let it go below 1/2). My work is cut out for me for the next hour. Gas, equipment check, weekly diagnostics on our monitors.

One of the residents wants to come and ride if I get busy to try and "walk on the wild side". Pretty funny, I've never considered myself to be on the "wild side".

Yesterday I took my suit back to the store where I bought it to have some alterations done. I bought it in January to go to a colleagues wedding and it fit perfectly then. Now, after about 5 months of denying myself one of my addictions I find that I weigh 40+ pounds less.

The suit hangs off me now. If I don't have suspenders on I need to walk around with one hand holding the waistband of the trousers to keep from having them end up around my ankles. The jacket looks like I am wearing someone elses. It is way too big.

The tailor says that he will have to do some serious work on this suit to make it fit me well again but he will have it ready before I have to leave for my trip. I'm pretty happy. This really makes me feel good about what I have been doing.

As I'm standing there in the mirrors and the tailor is chalking and pinning my suit the store's assistant managaer is filling out the ticket with measurements and chatting with me about the gym she has joined and how she hasn't lost any weight but has added muscle mass. I look at her in the mirror and wonder where she had to lose any weight from in a fleeting thought and then return to the dressing room to take my suit off and put my pants back on. Walking me back to the registers she suggests that maybe I should come and workout with her at her gym and see if that will help my weight loss. I make some ambiguous response, pay the bill and walk out of the store.

Once I am back to the car I get in, fasten my seat belt, and drive across the street to the mall and The Apple Store for my evening shift. Halfway through the night the light dawns. Sometimes I can be slow, did I just have a woman try to pick me up? It sure seems that way. I'm torn as to how to feel, part of me is flattered that a woman would make advances towards me. Part of me is wondering if I did something to encourage it and trying to calculate what my wife's reaction would be and part of me is just reeling in the unfamiliarity of the entire situation. Very weird.

As you may be able to tell, stress is a problem for me. Stress at work, stress at home, stress in life in general all build up in me until I cannot take it any more.

In the past my stress management techniques have been, either ineffective, expensive, generally bad for me, or a combination of all of these.

Example, for as long as I can remember I have been a stress eater. As a result of this I was an overweight child who grew into an overweight adolescent, who grew into an overweight adult. In May of this year I topped 300 pounds (about 140 Kilos) it struck me that I could no longer follow the old script and expect to live to see my children grow up. As a result this realization I knew that something had to change. I had to stop eating as stress relief and when I ate I needed to eat more healthful foods. Since May in have gone from 305 lbs to 264 pounds by being absolutely draconian about my carbohydrate intake. It works, what more can I say? Plenty, by doing this I eliminated my primary method of dealing with stress.

I know I can't and won't go back, and I know that I need to find other outlets for my stress. Deep inside I feel the need to develop stress relief methods that not only satisfy my need to bleed off stress but also to allow me to excercise long dormant and little evolved creative energies.

This blog is one of those methods. While I am not a writer by any stretch of the imagination I need to express my thoughts and emotions. in a forum where I am not stifled by my own fear and ineffectiveness at speaking either one on one or in groups of any kind. I recognize this weakness and needed to find a way around it.

I also realized that I needed to develop more than one method of releiving stress. I have given this a considerable amount of thought and after debating inside myself, arguing with myself, and generally doing my best to NOT make decisions I have decided to do two things.

One of these things is a return to a something I did as a young adult. The other is something to honor my recently deceased Grandfather whose gifts to me were so important in my growing into the husband, father, friend, and overall man I have become. His last tangible gift to me will make these things possible.

First, I will be, or I should say have bought a trombone. Throughout high school and my first year of college I played the trombone as a source of income as well as a release of stress and tension. 18 years ago I was involved in a head on collision with a snowplow which resulted in, among other things, a broken upper jaw, multiple broken teeth, and significant facial fractures. My music stopped right then and there. Recently I was given the go ahead to start playing again and with much fear I have decided to do so. It has been a long time. It will be hard work, probably even harder than I perceive it to be already but I will, eventually, have an outlet for my stress and my desire to share my thoughts and feelings with people in ways that I am unable to right now. What I can't say well in words I can (or could in the past) say well in music. I need to do this again even if I never return to the expertise that I had before.

Second, I need to do something with my hands. Something that will produce something tangible. Some of my earliest memories of my grandfather were of him spending hours with "his"wood and producing wonderful things which resonanted with his love for us and his love of woodworking. As a child I never developed the skill to become a craftsman like he was, in reality I did not try very hard, but with what few projects I did undertake I remember the feeling of accomplishment that I had at the end and the release of guiding the wood into it's final form.

My grandfather's art was furniture and picture frames. I have been looking in other directions and have decided to undertake a small project as my first. Something that I can actually visualize right now and bring me closer to some of the places I love best. I will be building a boat. Nothing grand, a small skiff or a kayak but something that I can make with my own hands. Something that, unlike music, stays in existance even after I am done working on it. Something that I can look at and touch and remember the hours spent watching my grandfather and seeing his joy. I have never done anything like this before but I will do this with the help of my grandfather's memory and many of his tools.

I have chosen to do these things not because they will be easy but because I know they will be hard. Because I know that they will cause me to push the envelope of my experiences and abilities, and they will cause me to grow.

As most of you can see I have upgraded the blog to MovableType. After the first month I realized that client based blog management software was the pits. As of this morning MovableType is installed and almost functioning at 100%. I still have some problems with the search module to work out but hope to have those done within the next week or so.

The MedicCam will also be making a come back at http://www.themacmedic.us/~macmedic/webcam.html.

Still in the planning stages are the roving MedicCam and an audio stream of the MacMedics radio frequencies.

As always comments, and suggestions are always welcome.

So much to do, so little time.

Sometimes things change on their own and sometimes they need help. Last night I had a friend give me the gift of some insight. You can't maintain the status quo and expect to continue growing. The mind needs to keep expanding and encountering new things. People need to not be so predictable all the time. I am trying really hard to not be as predictable as in the past. At least once I day I have to challenge myself, push the envelope, and do things I have never tried before.

A precious gift from a friend to whom I am now deeply indebted.

Thanks for caring enough to shake me up.

It isn't often that someone can throw me off my stride but this morning a friend did. Well off my stride. Off my stride even though my pockets were all the way they were supposed to be. I was just off balance enough for it to be a little exciting and I just wanted to say "Thanks!".

I am getting the hang of some things but others will take some more time. I haven't done any retail work in almost 20 years, I'm very comfortable with the product but not with the selling and that is what I need to work on. Sales seems to take a hugely different mindset than service or consulting. Yet another personal challenge. Am I up to this one? Only time will tell.

Today I drove withe the family down the coast of Cape Cod to Chatham. A nice relaxing drive on a sunny cool day. Along the drive you pass the Chatham Lighthouse. I have always loved lighthouses and that has not faded over the years. Today as I sat on the fence looking at the lighthouse and watched the Coast Guardsmen going about their day to day activities and thinking about why I liked being around lighthouses so much.

As I watched today I thought about the qualities of lighthouses that draw me to them. I've already talked about why lighthouses appeal to me enough to sometimes wish I was born over one hundred years ago. Keeping myself grounded in the here and now I wanted to put distill this down to the present and not just the past.

Lighthouses have many qualities that I have realized are essential in being a good husband, father, and friend. Solid, dependable, and unwavering. I have come to believe that my success or failure in a relationship of any kind depends largely on how well I exemplify these three qualities.

There are many other qualities that are necessary for a successful relationship but when you really distill them down everything comes back to these three.

I hope that I am able to maintain these three qualities throughout all of my relationships, as a husband, a father, and a friend.