Congrats Mistah Mayor!

Lost amid all the media hubbub over Joe O'Brien's election as Mayor of Worcester this week is the fact that before he was a rising star in the Massachusetts political firmament, he was (and remains) a gifted and universally liked and respected Paramedic.
I've had the pleasure of knowing Joe since 1994, when I got my first job in local EMS as an EMT at the Worcester division of MedTrans, where Joe was working as a Paramedic.
(As a side note, MedTrans is a now-defunct service that found itself without a chair when the music stopped in its parent company's attempts to buy AMR; it was finally folded into the latter's brand when corporate overseer Laidlaw decided AMR carried more weight nationally).
From the very beginning you knew there was something different about Joe.
While all Paramedics are convinced we have the answers to any problem in society, few of us actually become active participants in things like local politics.
Joe was one of the exceptions, probably THE most exceptional of the exceptions.
He didn't simply have an opinion, he was involved and he knew the issues inside and out, far beyond the surface knowledge the rest of us gleaned from the newspapers.
Joe was the first one I ever heard -- in the media or anywhere -- mention the name Deval Patrick as a legitimate candidate for higher office, telling me over breakfast one morning during a shift together that he thought Patrick stood a real chance at winning the race for Massachusetts governor should he decide to run.
Anyone who's ever met Joe knows what I mean when I say that he received a triple-helping of that quintessentially Irish ability to make everyone he meets feel like a long-lost friend, and is especially well-known in local EMS circles for bestowing nicknames.
Joe probably called a hundred people "Superdude" or "Super Salad Shooter" in the course of a day, but when he called YOU that name you felt like he really only meant it for you.
He's a phenomenal clinician, as good as any medic I've ever seen in a jam. He is on that very short list of medics I would trust without question to care for my children.
As much as I've always liked Joe, my admiration for him increased exponentially when he and his wife bought a house in Main South, back at a time when that really meant taking a gamble with your own personal safety AND despite the fact that he could have lived just about anywhere.
But Joe always loved Worcester, and truly believed in the goodness of its residents no matter the neighborhood.
I'd be lying if I said I always agreed with Joe politically.
But as I get older I realize more and more that we've made a huge mistake as a nation by picking our leaders dogmatically, when what really matters is character.
So maybe I don't agree with Joe on every issue, in the end it matters not.
The thing I know about Joe O'Brien is that he is a man of incredible integrity and character and intelligence, and Worcester residents couldn't have chosen a better person to lead their city.
Congrats Mistah Mayor.

Flying Frequently

I'm sitting in the kitchen of a Frequent Flier and wondering what to say.
My main job is for a suburban service now. We're slower, but the patients tend to be sicker because they take their medicine, visit their doctors, take better care of themselves and thus, when they finally need 911, it tends to be because they are very sick.
This patient is the exception.
There is nothing remotely sick about him, at least not physically.
In my last job at a busy urban 911 system, Frequent Fliers were as common as streetlights.
They were an accepted part of the landscape. Only when they decompensated and became real players -- say, calling once or twice a day, every day, for a month or more at a time -- did they warrant comment.
But when they do get under your skin, well, there's NOTHING worse in EMS.
Some guys can handle taking the same Frequent Fliers shift after shift without a problem.
For others, it's sometimes enough to make them contemplate leaving the field entirely.
I'm usually in the former camp, but often in the latter -- much more so lately.
So now I'm in the kitchen of a guy who's called for nine nights in a row, each time complaining that his uclers are bleeding.
But he always has a twist to his main hemorrhagical complaint -- the ulcers are acting up AND a local gang has caused a rash on his forearm, or the ulcers are acting up AND the federal government has him under surveillance.
He's been rotating among the three nearest hospitals because each has identified him for what he is almost immediately.
Typically he's discharged and on his way home within a couple hours, depending on how much time and personnel the overworked EDs have to devote to a patient who darkens their door daily with a slew of bogus and bizarre complaints.
Tonight he is asking to go to a hospital 20 miles away. On a rainy Friday night. In a town with a single ambulance.
I have to measure my words.
These are not good times for telling it like is in EMS.
It's best if you don't think too much, don't worry about the system or allocation of limited resources or wasting public money on public nuisances.
The best thing for my career is to just forget the abuse this particular patient is heaping on the system, forget the tens of thousands of taxpayer dollars wasted on the meaningless carousel of transports, ED evaluations and ambulance rides back home this patient has created in order to exorcise his personal demons, and ESPECIALLY to not consider for a moment the possible patients we won't get to help while we are performing yet another fruitless transport -- the father of four who suddenly goes into cardiac arrest, or the 72-year-old CHFer woken from sleep by the suffocating presence of lungs filling with fluid.
Thankfully this nightmare scenario hasn't happened. But it's only a matter of time, I think.
But telling him so won't do any good and may in fact cause me significant grief.
So as much as I'd like to tell this patient exactly what I think of what he's doing, instead I smile.
We can't go to that hospital 20-miles away, I say. We are, though, more than happy to bring to the hospital of your choice in The Big City, about 5-miles away.
He is appeased, and within minutes we're on our way to the hospital once again, both of us certain in the knowledge that this won't be the last time this particular patient will make this particular trip in this particular ambulance.

In The Land of the Blind, The One-Eyed Man Is King

Think the health care reform debate is complicated?
Think the people making the policy that will result most likely in a government takeover of about 20 percent of the US economy give a flying fart about EMS?
I understand when laymen have trouble figuring out all the ramifications.
What does it mean when the "experts," people with PhDs who do nothing but ruminate daily on the health care reform debate, admit that they haven't thought even for a moment about health care reform's potential impacts on EMS?
And yet, this is exactly the case.
Last week I read a 10-page supplement to the Columbia Journalism Review written by a think-tank that philosophically stands squarely behind President Obama on health care reform.
The think tank advertises itself as "A private foundation working toward a high-performance health system."
When I read this group's piece I thought maybe I had found that touchstone, a group that made it's argument lucidly, plainly and convincingly.
Maybe, finally, I had found a way into the debate that made sense, could give me a reason to get behind reform.
But one nagging thought remained.
Nowhere in this 10-pager was there mention of EMS.
Nothing about how ambulance services would be re-paid for services rendered to Medicare/Medicaid patients despite the fact that almost every proposal for health care reform calls for Draconian cuts to the costs of Medicare/Medicaid.
How, I wondered, would EMS survive deep cuts to Medicare/Medicaid reimbursements if services to those folks were already burdensome financially at the current level of funding?
So I emailed the director of the think tank that wrote the piece and asked if she had any information on the subject.
She wrote back rapidly with the candid admission that she had no idea.
To her credit, this director spent part of her Friday night tracking down the contact information of people who might be able to answer my question, even though it was clear that I'm not a person of any particular importance and was asking the question mainly out of personal curiosity.
But it also points to the fact that EMS is NOT a part of this debate, and my fear is that when the entire US health system is overhauled and re-done, the EMS system could find itself with more demands and no way to meet them.

My son's G-tube fell out this week.

He was at soccer practice.

I was at work, but my wife said he nonchalantly handed her the "tubie," as we called it, its anchor balloon deflated by a lengthwise tear.

"Here," he said. "This fell out."

One of the other players' grandmother is an ICU RN, and she was kind enough to clean and dress the site.

The whole event wasn't the emergency it might otherwise have been.

The g-tube had outlasted its usefulness, Brendan hadn't had a feeding from the tube in months and we were planning this week to ask for its removal.

Fate took care of things, and after a brief inspection by a doctor revealed no problems, the GI clinic at Children's Hospital in Boston signed off on our request to get on with life and close this particular chapter.

We're happy for practical reasons.

The tubie, as far as I'm concerned, was just another route of infection.

It was a constant source of worry, and caused my son a good amount of pain when hit by soccer balls, baseballs and errant limbs while wrestling with his brother.

But it was more than that.

Now 7, Brendan was starting to feel self-conscious about the device.

Most importantly, though, it's another in a progression of mileposts that puts some distance between the now and the then, not that long ago, when Brendan was fighting for his life against medulloblastoma, a highly malignant brain tumor.

And it was a good week to create some more of that space.

September, after all, is National Childhood Cancer Awareness Month.

You can read more about it here, at the Web site Curesearch.org, a wonderful resource, and here, on the Web site of the Dana-Farber Cancer Institute, home of the Jimmy Fund and the Stop & Shop Pediatric Brain Tumor Clinic, the people who directed the care that saved his life.

The Disaster Is The Planning

I've railed on this site before about the ridiculous amounts of money poured down the drain since 9/11 in the quest for "preparedness."
A whole industry has sprung up over the last 8 years dedicated to something, although what that something is I'm not completely sure.
Across my own little corner of the public safety universe legions of trailers, stacks of portable radios, pallets of tents, spacesuits, PAPRs, AV-2000s, and enough Tyvek material to encircle the Earth stand ready to protect central Massachusetts from the forces of evil who are conspiring to destroy us.
But meanwhile the people who would presumably use that equipment to keep us safe are being laid off due to budget cuts.
As disaster preparedness money has appeared in such abundance that no one really knows what to spend it on anymore, real-world public health experts are being discarded because the cash to pay for THEM has dried up.
But I have to wonder, in the end, what's going to protect me and my family -- a comprehensive vaccination program and a robust public health department to ensure the population is protected, or a bunch of bureaucratic hacks in color-coordinated polo shirts and khaki trousers "working" from grant to grant without producing anything that will actually save a single life?
I did some work briefly for a local Medical Reserve Corps who's biggest concern was purchasing an ID system for its volunteers, and what color duffle bag to hand out to its workers.
We got Polo shirts AND a fleece vest.
I didn't last long.
It's all very worrisome to me, and now it appears that an MIT doctoral student has published a paper that supports my concern.
In it, MIT PhD candidate Peter Doshi suggests that so-called "pandemic flu" planning has actually made us less ready for a real breakout of a flu epidemic like that one in 1918 that killed 50 to 100 million people worldwide, depending on who's estimate you believe.
It's an interesting read.
I think it's time for a little common sense when it comes to preparing for disasters.
You can't just throw money at the problem -- the people who catch the most cash are rarely the ones who can do a darn thing to help us.

Helping a Helper

I really like this.

Michael Morse, author of my favorite blog, Rescuing Providence, linked to this site.

Besides just being a nice thing to do for someone who clearly deserves it (I can't even begin to describe the respect I have for working Moms and Dads who manage to complete something as daunting as Paramedic school), I think the writer is addressing a real need.

With the world's credit markets still frozen like the Siberian Tundra, school loans are becoming harder and harder to come by.

A friend of mine who runs a Paramedic program told me that the company that once financed the considerable cost of an education at his school notified six members of his last class at the last minute that the money they had counted on would not be coming.

Those six are having to instead wait a few more years to attend school.

I love what's being done here, and I hope some Central Mass Medics readers might be able to help out even a little.

To steal a little more from Morse's last post, here's a link that might explain why this is worth it.

Adios, redux...

I've quit EMS in The Big City.
For real this time.
I've left before, once to go to work as a flight paramedic, the other a firefighter.
Both times I remained per diem.
But not this time.
The heart can't serve two masters, or something like that, so this time I made a complete break, and barring unforseen events I will never again wear the brown uniform that has meant so much to most people who've worn it, myself included.
I am very proud to have worked here.
I think I did a good job.
I think I was a good partner, and a good clinician, but ultimately those judgments are left to the people I worked with.
I only hope they enjoyed working with me as much as I enjoyed working with them.
It wasn't an easy decision to leave, but in the end not as hard as I would have thought.
It wasn't the 20-call shifts, or the every other weekend schedule, or the banged up trucks.
Truth be told, while we complain about those things, the reality is that we wear the craptastic nature of some of our equipment like badges of honor.
Miracles have occurred in the back of beasts of burden like 611, or 68, or even in the crop of ambulances that were on their way out when I arrived, the ones with cabs so small that Gomesy drove with his knees pinned behind his ears and roofs so thin that the metal flapped like tinfoil at highway speeds.
And while five new ambulances are planned for shipment soon, there's a grim pride in tapping numbers like "264,500" into the "mileage" field of our newly-installed Mobile Data Terminals at the start of every shift.
It's kind of like when I was in the Marines and you would meet Huey pilots proud of their ships and the way they could get so much from aircraft abandoned so long ago by larger, more pampered services.
Kind of like that.
Though I'll remain forever pissed off that 2667 doesn't have arm rests...
I didn't leave because of the continuous influx of new technology, some of it balky and overly-delicate and maybe released into the wild a little before being ready for prime time.
Nor did I leave because of that new EMD dispatching system -- designed for a completely different model of EMS delivery than the one we use in The Big City -- that sends first responders careening through the city for urinary tract infections because some card tells the dispatchers to make it so, or that sends us and a fire engine and some police officers, Priority 1, EVERY NIGHT, for the same guy who calls at the same time from the same steet corner complaining of "assmar," when all he really wants is a sandwich and some sleep in a comfy hospital bed.
It was none of those things.
Technology improves.
No EMS system is perfect.
Frequent fliers are a bane everywhere.
It wasn't the lousy press we've gotten lately, notably from Tom Caywood at the Telegram, who's more stenographer than reporter, and who has seen fit to ruin the reputations of six medics since April without ever contacting any of the targets of his "investigations," even once, for comment.
Tom, I don't think you can ethically accuse six people of the horrible things you accused them of, name them publically and prominently on Page 1 of the most-read edition of New England's largest metro daily newspaper outside of Boston, and not have the decency to EVEN ATTEMPT to contact ANY of them.
Not once.
Nothing.
Complete...radio...(and telephone)....silence.....
The medics you've maligned didn't deserve any of what you've brought upon them.
The press is becoming something we all need to fear, I think.
I was once a newspaper reporter.
I still have friends in the business, and the business is dying.
One of the consequences is that newspapers are too busy trying to stay afloat to pay much attention to the stories their reporters are turning in.
And if those reporters decide to forgo fully reporting their stories in order to make a quick hit before splitting town for, say, a weekend blues festival, then that flies in today's media, the innocent be damned.
This is a dangerous time for journalism, and I had a front-row seat to just how bad things are.
But bad press had nothing to do with it, either.
No, the main reason I'm leaving is to spend more time with my family.
It's that simple.
But I find that the simplest things in life are the most important.
I wish the best for my now-former colleagues, and I hope if you're reading this you'll take a moment some day in The Big City, when you see those folks in brown working yet another shift on some of the busiest ambulances in America, to let them know they're appreciated.
Almost no one ever does, but I bet it would go a long way.

As for this blog, I intend to get it going again.
I had refrained from posting over the last few months during the furor of which I spoke earlier.
It just seemed best to keep on the sidelines.
Also, though, a colleague of mine who writes one of the most entertaining area blogs -- Wormtown Medic -- had gotten some grief from management for his unabashedly honest analysis of various local EMS issues.
It was the first period in my life where I caved in to what amounts to prior censorship.
I'm not proud of that fact.
It won't happen again.