I once worked a night shift with a paramedic who, when referencing the mapbook to navigate our ambulance to an emergency, began striking himself in the head with the book when he became overcome with the stress of having to tell me how to get to our call.

These are heavy, THICK notebooks with pages and pages of maps representing every corner of the county inside.

Over and over, he kept striking himself in the forehead with the book, chastising himself with, "Think, damnit! Think!"

I knew all along how to get to the call, I just thought it was so funny to watch him beat himself up.

Navigation can be just as stressful as medical care for some medics.

Another partner I had, while enroute to a fatal car accident, examined the mapbook for directions, turned the map every which way - up, down, and sideways - then in disgust slammed the mapbook shut, stuffed it back under her seat and said, "I can't do it."

Cranky Paramedic Chick Response: "We are manning an ambulance. There is no choice but to get to the call. It's not like we can just pull over, call dispatch and say, 'We can't read the map'. Get the book back out and tell me how to get to the damn call."

Again, I knew all along where we were going (it was a major county intersection that SHE should have known without looking up too) but she was new and I was teaching her how to be a paramedic instead of a girl in uniform looking for guys in uniform. She never could read the map and tell me how to get to the call. She ended up quitting EMS and becoming a dispatcher but not before we ran a fatal shooting in which she was reciting, aloud, the words, "Oh shit... oh shit... oh shit" all the way up to the point of making contact with our patient.

Stressful occupations are not for the easily stressed.

Oy.

Another in a series of true and amazing recounts from "My Thirteen Year Career as a Paramedic".

I'm going to let you in on a little secret. It's a secret only paramedics and police officers are ever privy to, but Cranky Chick is feeling generous today so here it is ...

... there are no drunk drivers. I know. It's shocking but it's true. You have been led astray.

Drivers involved in alcohol related accidents never have more than "two beers". Ever. When asked how much they've had to drink, they'll invariably plead, "Two beers." Not "one", never "three". Always, always, "two beers". And it's never wine. It's never Vodka. It's never a "couple of shots of Tequila". It's always... repeat after me... "two beers".

You have learned something here today. From your favorite, former, "Two beers my ass, get your drunk butt on the cot, shut up, don't breathe on me and don't even THINK of puking in my ambulance cause I'll make you wear it before I'll see it on my floor" paramedic...

Do you know how disconcerting it is to be assisting an elderly woman on the toilet, have her ask you to tear off some toilet paper and then suffer her admonishments as to the quantity of toilet paper she was given?

Who is accustomed to tearing off just the right amount of toilet paper for another human being?

* Another in a series of true and amazing recounts from "My Life as a Paramedic".

The most frequently asked questions of a paramedic, and my responses:

1. What happened? - My usual response, regardless of medical or trauma call, was: "Plane crash".

2. Do you have all the streets in the city memorized? - No. Luckily they make visual aid tools called "maps" which we employ when your exact longitude and latitude escape our memories.

3. How long have you been a paramedic? - Long enough to know what I'm doing but just short of the Post Traumatic Stress Disorder.

4. Is it hard to start an IV in the back of a moving vehicle? - Not hard at all once you've practiced on a few hundred drunks.

5. Have you ever thrown up on a call? - No. But I felt like it once when I realized I was wearing the same underwear I'd had on the day before.

6. I could never do what you do. How do you do it? - Apparently, by not being you.

7. Isn't it heart warming to save someone's life? - Only until they wake up and try to beat the shit out of me for ruining their Heroin fix. Narcan, a tool of the devil...

8. Is it cool to drive really fast and run all the stop lights? - I don't know. Ask the drunk driver we're scooping off the pavement.

9. What's the hardest part of being a paramedic? - Resisting the urge to inject an epinephrine bolus into the heart of every surly drunk that's gotten behind the wheel of car, killed someone, and lived to tell about it.

10. What's the worst thing you've ever seen? It's already been covered.

I will be jotting notes about calls I ran at EMS from time to time. They are more for me than you, so if they don't make sense, or you don't understand them, that's ok. You really aren't supposed to.

The fire squad was already there when we pulled up in the ambulance. The fire crew came walking out of the dilapidated old house, slowly, their packs swung over their shoulders.

The Lieutenant said, "He's code yellow" (triage meaning dead & beyond viable).

My partner and I entered the house and saw him sitting up on the couch as if still watching television, dead indeed, ashen, bloated, mottled. An elderly man, in his 70's, I suppose. I guessed he'd been there about 3 or 4 days. The house was trashed... newspapers, grocery bags, letters, years worth, cluttering the floor, chairs, tables. Pizza boxes, clutter of every size and shape.

Cockroaches were swarming in and out of holes they'd eaten in his neck. I remember just marveling at that. They were literally living inside this man's skin. Coming and going with great purpose. I watched them for several seconds and then started to worry about my fascination.

Paramedics often turn to what seems like grim and calloused humor to ease the tension. Just to be funny, I came outside as the firemen were getting back in their squad and with a deadpan face said, "Guys... we've decided to code him just in case." I've never seen such a look of disgust and disbelief on a fireman's face as I did that day. The Lieutenant paused and said, "You've got to be kidding me?"

I said, "Yes... I am." And smiled...

She was 81. She couldn't breathe.... congestive heart failure. Lungs full of fluid, sweating, gasping for breath, panicking but fighting to keep her dignity, fully alert to her situation.

I gave her Oxygen... thinking, "Shit... why can't she pass out or at least get tired enough for me to intubate her?"

I talked to her while I worked furiously in the back of the ambulance. I started the IV. I gave her the maximum amount of Morphine and Lasix we could give. I told her I wanted to put a tube down her throat and into her lungs to help her breathe.

She begged me to let her die. Over and over again...

She wouldn't let me tube her, too restless even after the Morphine, but I got her to the hospital alive.

We wheeled her into the ER room we were assigned and no one came. I could hear the nurses all gathered around the nurses station, laughing, joking, talking. No one came. Not a doctor. No one. I couldn't figure out why they weren't coming. We were the only ones... it wasn't even busy that night.

She was dying and the more we waited, the more pissed I became. I yelled, exasperated, to the nurses station, "Can we get a little HELP here, please?" And as the nurse casually sauntered over, I thought, "You fucking bitch. Could you be more uncaring?" I told her, "I want you to find a doctor, NOW!" and she left for several minutes.

The little lady was fighting to breathe yet ripping the Oxygen mask away from her face, believing it was suffocating her. She was drowning in her own fluid as I stayed beside her, holding her up and forcing the Oxygen into her lungs. But then she reached across the bed railing and gently put her arms around my neck, tired from fighting, and hung on to me as if I were the only thing between life and death. I held her as she was dying, and it was the only time I've ever cried, silent but openly, while still on a call.

I couldn't be silent any longer, but didn't want her to die alone. I peeled myself away and told my partner to stay with her.

I went into the bathroom and sobbed.

And then there were more calls to run.

She had died, hours later, in CCU, I had heard.
I still think of her. Often.

Max asked me, based on my rat poison post, if I was a police negotiator at that time.

Max - I was a paramedic. There was rarely any negotiation; it was, "get in the ambulance, shut up, stop your whining and don't even think of puking on my floor."

A kinder, gentler paramedic. ;)

By popular demand, I've been asked to fill in the blanks on the rat poison story.

He swallowed some, he spit some out. I talked him out of the motel room he was in and coaxed him into the ambulance, whereby we chatted about life, love and how rat poison tastes amazingly similar to chicken.

He lived to love... and lose, again, I'm sure.

I once insisted that a suicidal man either "swallow it, or spit it out" when he was collecting rat poison in his cheeks at an alarming rate, because I could not understand a word he was saying to me.

Me: Why are you eating rat poison?

Him: (with chipmunk cheeks) Beclaush mly wofe lef me floor anover worman ann ah donut wan to flive any larger.

Me: Look. Either swallow it, or spit it out because I can't understand a damn thing you're saying.

No, you don't need to call 911 every time you or someone you know gets sick or injured. You need to realize that there's a time to call 911 and there's a time to suck it in and transport yourself.

Ambulances don't grow on trees. They usually sprout out of government funding, but only after the administrators get their company cars with lightbars that they never take to an emergency. There's a limited supply, and while you may think it's within your right as a tax payer to call whenever you encounter minor illness or injury, what you're doing is taking an ambulance away from somebody that may need it worse than you do.

When to call 911:

1. Chest pain - don't screw around with this one unless you're within 5 minutes from a hospital. It will take the ambulance 5 minutes or longer, in most cases, to get to you, and then they'll f*ck around getting your insurance and billing information when they DO get there, so just pop an Aspirin and have somebody drive your ass. You'll thank me later.

2. Profuse bleeding: - You do NOT want to mess up somebody else's car, or worse, your own, so call 911 if it's arterial or bleeding that can't be stopped with direct pressure. I'm not talking your average nosebleed here, either.

3. Unconscious - Try lugging dead weight out to your car and you'll see why I'm suggesting an ambulance here.

4. Stroke: Symptoms of a stroke include - headache, numbness/tingling, paralysis, slurred speech, drooping of facial muscles, etc. I once had a stroke victim that was able to understand every word I said and yet when communicating back to me, spoke every word backwards, or so it sounded. Call 911 for someone having a stroke. You don't want brain infarct on your conscience.

5. Gunshot/Stab Wounds - If you transport one of these people yourself, you're going to court. You want to stay out of court, especially if the poor bastard dies. In court, their only goal will be to pin the rap on you for your poor driving skills. If only you'd driven faster, taken a different route, etc., etc., etc. Avoid this one. Call 911 and let the professionals go to court.

6. Respiratory Distress: Ineffective breathing often leads to the more serious (though remarkably less anxiety producing) complication of death; not to mention the deleterious effect on one's ability to maintain a pleasant disposition. Call an ambulance for this cranky person, especially if gurgling is involved. Gurgling is bad. Very bad.

6. Dead - This goes without saying. Or... does it?

Disclaimer for the stupid: This list is not comprehensive and does not constitute medical advice. It was also written with serious tongue in cheek, which could be considered a medical emergency in itself, but one that most certainly does NOT require ambulance transport.

This is one case in which a seatbelt more than likely could have saved this young man's life.

He had led the police on a wild car chase... rolled his vehicle... got ejected... and ended up with his vehicle on top of him. His legs are pinned by the passenger side. Choices. It's all about choices.

That's me, back in 1989 (yeah, look at all that hair) about to put a tube in his throat so we could oxygenate his lungs. The medic on the left is Randy, the guy that taught me everything I knew about being a paramedic. He was a god.

The patient's unconscious, barely breathing here, but died sometime after we got him to the hospital from a massive head injury as well as internal injuries. The fire department worked diligently to not only keep the vehicle from teetering over on us, but to get it off of the patient so we could get him to the ambulance.

Moral: If you can stay inside the vehicle, you have a chance. Become ejected and you're as good as dead. Oh, and, crime doesn't pay.

Usually, when telling someone you either are a paramedic, or were, the first thing they want to know is, "What's the worst thing you've ever seen?"

They expect me to talk about the decapitations, the amputations, the guts, the gore. Yes, there was all of that, but usually I respond with:

1. Vaginal Boil - Can you imagine calling 911 for a vaginal boil? Can you imagine being called to a home for a vaginal boil? Neither could I.

When I walked in to the dilapidated, 2 bedroom house in the lower income part of town, there she was - buck naked and spread eagle on the couch right inside the front door, welfare card in hand. There wasn't even time for preparation, or to get psyched up - there it was, staring me in the face, right when I walked in the door.

As she attempted to explain why she had a vaginal boil, I cut her off. I waved my hands together in a gesture that indicated she could close her legs, and then said, "That's really more about you than I need to know."

Professional? No. But then, I knew her game and this really wasn't an ambulance call - this was a free taxi ride to the hospital for free treatment and a free couple of hours away from the kids. All I can say is, that boil was an angry boil...

2. The Lodged Sex Toy - Imagine being summoned to the home of a woman whose boyfriend has called 911 and told the dispatcher nothing more than, "my girlfriend is sick." Upon entering the home, he points us to the bedroom and says, "She's in there."

Entering the bedroom, it's like the vaginal boil call all over again, but not as horrendous. This girl is buck naked, spread eagle on the bed, writhing in pain and pointing to her rectum. She desperately informs me, "It's still in there!"

Not wanting to make rash assumptions, I said, "What is... it?"

She explained that her boyfriend had inserted a sex toy and that it was lodged and causing her a great deal of discomfort. I could see that. She then assumed rectal exam position and proceeded to describe the object to me, as if I might find several things up there and she wanted to be sure I only removed the one that was hurting her.

She said, as she writhed, "It's... about... 3 inches long... and silver."

I told her, "Um... we're not trained to do rectal exams, but we'll take you someplace where they are. What hospital do you want to go to?"

We transported her to the hospital, but I still had the radio report to the hospital to give on the way in to let them know what we were bringing. These are the kind of radio reports that ER staffs never let paramedics live down:

Cranky: Medic 36 traffic Wesley Medical Center...

ER: Go ahead Medic 36.

Cranky: We're transporting a code white, 24 year old female with a .... sex toy... lodged in her rectum. The object is approximately 3 inches in length .... and... we see no sign of it on visual exam. Vital signs are within normal limits, ETA 10 minutes.

ER: [lengthy pause]

ER: [stiffling giggles] 10-4... Medic... 36.... we'll see you in... 10.

I've gotten hundreds of emails asking me why I left my EMS career. Ok, not hundreds... but close... like... three... so, I thought instead of having to write three separate emails, I'd just blog about it here and save all that extra work bandwidth.

Back in 1985 I was truly lost. I was in my second year of college studying Music Composition and miserable. I had no idea what I was going to do with my life but I knew that I wasn't prolific enough to make any money at writing music; the music has a mind of its own - it gets written when it damn well feels like getting written and not before!

I was sad, lonely (all my friends had gone away to school) and trying to figure out what to do with my life.

One day, I was flipping through the college catalog of courses trying to fill up some electives when I saw "EMT Class". I read through the description, saw that I would be able to view a real, live surgery and ride on an ambulance as an observor for a day and I signed up. I had watched the TV show "Emergency!" religiously as a child and had always been drawn to situations where I could "rescue" people, so it just seemed to make sense. I was scared to death, though, on my first day, as the thought of having human life in my hands was petrifying.

I was scared for all of about 22 minutes, then everything in life just fell into place. I had found my niche. Nothing I'd ever done had come so easily and naturally to me. That's how I knew it was absolutely the perfect job for me. Everything I learned, everything we put into practice on mannequins and in labs, absolutely made sense to me. Every bit of it.

I put everything I had into EMT class, got certified, and after doing some volunteer work to make sure I could handle the things I'd see and do, I enrolled in EMICT class, which in Kansas means "Paramedic". It was 15 months of grueling work, but I poured my heart into it and graduated with a 94% average. I passed boards and became a Paramedic in 1988.

Being the demanding, perfectionistic person I am, I expected the best of myself and those around me at all times. There was never one day when I didn't take my job and its responsibilities seriously. It never felt like a burden, or overly "stressful", because I just fit so perfectly in that role.

The only problem I had was that some of the people I had to work with, and even the administrators of EMS, didn't have the same drive for perfection. They didn't have the same high standards and sense of responsibility for others that I had, and I was constantly finding myself in battle with those around me.

I had many a run-in with the administration, who thought me less than diplomatic in expressing my concerns (I was) and overly aggressive in my methods of treating patients. Looking back, I can see now that, because it all came so naturally for me, it was easy to be damn good at it. Others weren't living their "calling" - it was just a job to them - so naturally, their standards and mine collided.

Thanks to the teachings of a few truly great paramedics that influenced not only my career, but my life (Randy, Chris, Dave, Craig, etc.), I never compromised on my standards. Throughout my thirteen year career I held to my belief that paramedics could be more than "ambulance drivers" and they could truly effect the outcome of a person's life, or determine whether they had a life at all, by their action or nonaction.

As I tried to pass this knowledge on to students and new hires, some of it rubbed off on the people I call "sponges" and bounced right off the people I call "rocks". Sponges absorb knowledge and rocks resist it, especially if it means overextending themselves. I'm proud to say that there are paramedics on the street today that have taken a little of what I offered and put it to good use in saving lives. There are others that I booted right out of their internships that probably to this day still hate my guts, but I think the streets are safer without them. Paramedicine isn't something you do for a paycheck - there's just too much at stake. And if my students didn't show even the remotest of natural, innate ability or common sense, they were shown the door rather quickly.

In my career, I watched not only the standard of care of EMS drop unbelievably low, but medicine as a whole. I began to tire of fighting the system, the people around me and not being given the tools I needed to take the very best care of my patients. Our ambulances were getting more maintenance than the paramedics were, and to me, that was unacceptable. Training was a joke, yearly recertification was a farce as the administration hand fed us information we already knew and called it "continuing education", and the students coming out of paramedic classes grew dumber and dumber. It became impossible to flunk them, as the power was stripped from us as preceptors for monetary and political reasons. If the student paid the tab, they'd get the certification whether they were competent or not.

After thirteen years, I decided I couldn't watch it any longer. I knew I was getting older, feeling the strain of the physical demands and long hours more every year, tired of working all night (7 PM - 7 AM) and sleeping my daylight away, and certainly tired of those abusing the 911 system. Third was a shift I chose to work, as it afforded me less time with the brass and more of the "action" calls, which I loved, but it started to wear on me and ontop of everything else, I decided enough was enough.

In 1999, at the age of 35, I finished my college degree in Computer Information Systems and left EMS. I didn't really know WHAT in computers I wanted to do, but I knew I enjoyed troubleshooting and seemed to have an intuitive knack for it, much like I did with paramedicine. I took an entry level job as a PC tech once I graduated and that's where I've been ever since.

Now, I find myself feeling a lot like I did before I found my niche in EMS - lost, miserable and searching for something meaningful to do with my life again. EMS was my identity for so long, that it's been terribly difficult to shake the loss I feel at having let it go. It was the right thing to do, and I know that, but I still miss it every day. There's a light at the end of the tunnel, as B and I have a little sideline multimedia business that, among other things, affords me the opportunity to live my dream of being a filmmaker. I do digital video editing and production in the evenings, which I truly love, and it allows me to get lost in time as I make watchable productions of people's home movies, old photographs and favorite music. I could definitely do this full time, and I hope if our business continues to grow as it is, that we'll be able to quit our jobs and be self employed before too long.

So there you have it - a short story made long, but it was good for me to put it down in writing to save for posterity. So thanks for being curious, or I would never have gotten this out. :)

How to fake your symptoms and really fool EMS
(More true and amazing recounts from an actual paramedic career):

1. When you fake a Grand Mal seizure, don't forget to wet yourself. Seizure patients rarely keep control of their bladder while losing all muscle tone elsewhere. If you can bite half your tongue off before paramedics arrive, all the better.

2. Remember, when you claim you can't feel your legs, it generally bodes poorly for you to giggle like a girl when the paramedic scrapes the bottom of your foot with a pen.

3. If you try to convince the paramedic that the other driver has left you paralyzed, please understand that there is no such thing as paralysis only from the waist up, and that moving your legs while feigning paralysis of your arms makes you look like a complete rube.

4. If you suddenly collapse, unconscious, moments before being arrested, holding your breath to avoid the ammonia capsule won't do any good when the fine paramedic shoves it all the way up your nostril. Best to just do the time like a man.

5. When you jerk away from the pin prick while feigning paralysis, paramedics love to be funny and exclaim, "It's a miracle!" while high-fiving and praising the Lord. Try to be completely immobile, thus, being true to the term "paralyzed".

6. When faking blindness, well, just don't.

7. Asthma? Trust me... real asthma patients only wish they could muster the kind of Oxygen it's taking you to make that Horshack sound you're embarrasing yourself with so just give it a rest.

Some time ago, having been a paramedic for many years, I conceived the idea of a Mobile Sterilization Unit.

This unit, much like an ambulance, would have emergency lights, a siren and a gurney. Equipment would consist of just one item: a scalpel.

The MSU would be dispatched wherever stupid, fertile people existed. It would show no bias, no prejudice in its endeavor. Its utility would be felt from the lowliest of public housing to the wealthiest neighborhoods in town.

Staffing the MSU would be specially trained Mobile Sterilization Technicians (MST's), experts in performing emergency tubal ligations and vasectomies. Tax dollars would support its functions and pay the salaries of the MST's. The community tax payors would think it cheap at whatever the cost.

Callers to 911 would be screened. The dispatcher would have full capacity and authorization to (a) either send an ambulance, or (b) send the MSU. A typical 911 MSU dispatch call might sound something like this - please keep in mind these are ACTUAL 911 calls received in my career:

Dispatcher: 911, what's your emergency?

Caller: I was giving my baby a bath and there was this hair that was floating in the water. It got wrapped around my babies toe and turned it red! I removed it, but I want someone to make sure that the blood supply in her toe wasn't cut off for too long.

Dispatcher: 911, what's your emergency?

Caller: My 10 year old daughter stepped into the shower, and see, the water was really, really hot so she jumped back out, but some of the water splashed on her head. Could you send someone out? I want to make sure she didn't injure her brain.

At this point, the Mobile Sterilization Unit would be activated. Upon arrival, all stupid, fertile residents of child conceiving age would be removed from the home, bound, gagged and sedated. Tubal ligations and vasectomies would ensue and then the subjects would be placed back in their homes, infertile and incapable of reproducing again. The numbers 9 and 1 would also be removed from their phones.

MST's would enjoy full benefits, 21 days of paid time off, the adulation and respect of many and a national holiday in their honor.

Ever since I left my 13 year EMS career back in '99, my life hasn't had the same adrenaline induced excitement it once had. What I was thinking when I went from paramedic to computer geek, I'll never know. Sure, it's much cleaner, neater and nothing gruesome or tragic befalls me each day. But neither does anything wonderous, or incredible or life affirming.

As a PC tech, I don't have the same sense of accomplishment, the same pride in being of service to mankind, the same impact on human life, or the same liberty in using the "F" word as I once did. The PC calls are generally always the same, the users are most definitely the same, and there's relatively little to shake up my day. At least at EMS the drunks were all filthy and disgusting in new and exciting ways.

As a PC tech, I'm dispensible. I'm ordinary. I'm invisible. No one stares at me when I eat anymore and that annoys me. No one vomits on me while I'm working, they generally bleed without involving me and they rarely if ever insult my mother. I am red light and sirenless. My heart rate rarely exceeds 60, and I have never once been spit on.

As a PC tech I've never had to put a user in 4 point restraints, though I suspect many would be more effective in that condition. I've never cursed upon one to their face, threatened them with psych lockup or admonished them for abusing the system and calling the Help Desk too frequently.

As a PC tech, small children don't wave at me with youthful exuberance, nor do they beg for a tour of the PC configuration center. Elderly war veterans do not salute me and big, overweight men with flashlights don't flag me down and point to the scene of the crash.

As a PC tech, I'm never blinded by news camera lights and not one single journalist has ever requested an interview after a save from the blue screen of death. I'm boring. I'm dull. I'm uninteresting and not news-worthy. I suck.

I'm a PC tech. Someone wake me the hell up...

One night at EMS we received a call for a "man hit by a train". I was still just a part-time EMT at the time, and was working with a fairly new paramedic. She was "acting Lieutenant" that night, which meant she was filling in for her partner, the real Lieutenant. She was pretty scared, because the Lieutenant has all the responsibility for what happens on any call.

So we got there and found that this guy had laid across the railroad tracks, apparently in an act of suicide. We looked under the train and his torso was still there underneath, but the top of his head was gone from the nose up, and both of his legs were gone. He had been dragged for awhile, and so there were bits and pieces of flesh around him. We found his legs in the ditch, 25 feet apart from each other.

My partner started flippin' out, because one of the assumptions made when you declare somebody dead is that you had checked their pulse. Here's this guy's torso laying under the train, no head to speak of and my partner looks at me and says, "You're going to have to crawl under there and check his pulse!". I said without a pause, "Trust me. He has no pulse". I followed up with, "As for the paper work, I think when we write that he had no head they'll kind of pick up on the fact that an injury like that is usually incompatible with life".

Back to the station we went, and to this day, I still wonder if, when we left, that guy didn't grab his legs, find his head, hitch a ride with a passerby and call it a night.

The kind of common sense shown by my partner that night isn't uncommon in the medical field. But don't get me started on that...