Blood, Sweat, and Tears (Part 1 of 2)

I had only been running with the ambulance association for a few months.  In fact, the patches on my uniform sleeves were still very crisp and clean.  To this point, however, I had proven myself to be a reliable asset to whichever crew I was riding with.  As a “third”, I was like a bonus provider… not necessary, but often very valuable.  I was learning the “old school” methodical treatment from the regular Monday night stalwarts, Ron and Glen, and picked up loads of great experience by watching them work.  You could tell right away that they had been partners for quite some time.  Each knew exactly what needed to be done, and there was seldom any unnecessary activity or discussion; just compassionate care delivered with confidence and efficiency.  

During the weekdays, things were different.  There was much less regularity in the crew schedule.  This gave me the opportunity to learn from a host of different providers.  I picked up many great habits from a number of different partners, and the diversity helped me hone my own style of emergency medicine rather quickly.  I learned I could deliver the skills required by protocol in the manner dictated by my own personality.  I had been on a few difficult calls, helped save a few lives, saw some trauma, and of course, dealt with the multitude of “hospitality calls” that required a smiling face, a little bit of TLC, and 2% oxygen via nasal cannula during the trip to the emergency room.  

One particular afternoon sticks in my head.  While some of the specific details have faded over the years, I still remember the roller coaster of emotions that I felt as the event unfolded.  It was the kind of call that you knew right away would be in your memory for a long, long time.  The radio began to squawk about a 10-73 (yes, I pre-date the elimination of the 10-codes) in a town about 15 to 20 miles away.  The severity quickly escalated, and before long we were dispatched to assist.  Because of the location and status of several units in the area, we went from 4^th or 5^th due, to “guess what, we will be 2^nd arriving”.  I had the swagger of a young trauma junkie, but was ill-prepared for what we were about to encounter.

What started as excitement soon eroded into terror as we went screaming up the highway toward the scene.  The radio chatter painted a rather bleak picture of a head-on, two-vehicle crash with conflicting reports of up to 8 patients and heavy entrapment in both vehicles.  I had been running rescue calls as a firefighter for a couple of years, but my company was rich with very talented rescue technicians and a strong tradition of earning your place.  Most of my on scene work included staging, cribbing, tool set-up, and peeking over the shoulders of the more experienced guys.  As an EMT, most of my trauma experiences were visual only, from endless slideshows (with actual 35mm slides) during training.  All of that was about to change.  I could do the math…8 patients, 5 EMTs… It was time to suck it up and prove my worth.  

I sat back, and tried my best to quietly control my adrenaline rush.  I needed to compose myself, but my brain was spinning with all the things I may be called upon to assist with.  I didn’t want to screw up, and I could tell by the tone of the voices of my crew that the normal ass-busting and goofing around that was sometimes an appropriate part of our team-building was not part of this mission.  We were about 2-3 minutes from the scene when I heard quite a bit of “exasperation” from the cab.  I broke from my attempts of calming meditation to spin around and look through the windshield to see the first due ambulance whiz by us, en route to the Reading Hospital with two Class 1 trauma patients.  Through the profanity laced heat -of-the-moment critique being conducted by the other 2/3^rds of my crew, I gained immediate understanding of the need to triage when you are first-due.  We were now, for all intents and purposes, starting fresh, and would be FIRST DUE to an accident involving 6 patients and multiple entrapment.  I felt oddly comforted knowing the two in the front of our rig were as stressed about this call as I was, despite their experience during their years of service.  

We approached the scene, which by now looked like a disaster area!  There were car parts splashed from one side of the road to the other.  A few public servants were on the scene, but the majority of the people swarming the site were civilians… panicking, hollering, pointing, crying civilians.  There were so many cars and people choking up the scene that we still hadn’t laid eyes on the involved vehicles.  We hopped from the rig, and grabbed as much trauma gear as we could, and headed into the core of the disaster. 

Along the guardrail was one young, teenage patient, buckled over from pain and spilling blood on the side of the road, but sitting and conscious.  The two vehicles involved in the wreck sat only 20 feet from each other, after what was an obvious headlight to headlight impact.  The first vehicle had one male, heavily trapped behind the wheel, and gravely injured.  The second still held three young patients, also in poor condition from first glance.  Our medic and the driver were forced to make a quick game plan, as the next due EMS unit was about 20 minutes away.  We would triage and treat the remaining patients (as the first unit should have) and through the process of selective elimination, I was assigned to assess the old man in the first car.  I gulped back the fear of the overwhelming responsibility that was just entrusted to me, grabbed what I thought I may need from the jump bag, and made my way over toward him.  I have to admit that I was mentally prepared, and fully expecting to perform a quick assessment and determine that there was nothing we could do for him.  The minutes that followed would test my skills of emergency medicine and patient care in a manner that would mold my compassion for all future patients that would ever be in my care.  

Watch for my next blog post on “Hittin’ the Hot Spot” for the conclusion of this story…           

Parts is Parts

When I was a teen, very few kids had their own car.  I had to share a Chevy Malibu with my mom and sister.  I can remember logging mileage and pro-rating the gas money based on miles driven per driver.  Oh, how I wish it was based on time behind the wheel, because I am sure I drove faster than both of them.  Despite what they think, speed had nothing to do with the tree that jumped out in front of me and punched “Bu” in the teeth.  It took some low budget garage-time and multi-colored junk yard parts, but Bu eventually made it back on the streets.  After I saved enough for some Crager wheels, a sweet paint job and some air shocks, that little muscle car hung with the big dawgs in the bowling alley parking lot. 

My oldest daughter, Ashley was able to score a decently sporty (despite its age) red Grand Am that helped her be one of the “lucky” kids.  Well, that luck ran out in the dreadful parking lot of the Broadcasting Square Shopping Center.  Anyone familiar with that contraption, who just nodded their head in agreement, understands (unless they are still sitting in traffic trying to escape the lot’s grasp).  Because of the damage (she was T-boned) we had to rely on the professionals at West Lawn Auto Body (you owe me one for the free endorsement, Dennis) to put her car, “Gwen” back together.  I am happy to say that Gwen still prowls the roads today. 

My youngest daughter, Stephanie has her own car now, too.  She caught a hand-me-down from her great-grandmother.  Now, I know what you are thinking… it is a “grandma car”!  Yes, it is an olive green, four-door, four-cylinder, funny-smelling, unimpressive piece of Mr. Iacocca’s former inventory, but it gets her where she wants to go, and she has it all to herself.  Besides, the odor has been masked by the half-dozen strawberry air fresheners that dangle inside, and the kissy lip magnet and a few dollars’ worth of plastic AutoZone bling jazzed it up quite nicely.  “Ivy”, named simply for her color, gives Steph the freedom and independence she has earned. 

Steph complained to me about an annoying squeak Ivy was making.  I took the typical dad stance at first, and told her to “live with it.”  One day, as I watched her leave for work, I heard the awful noise she was telling me about.  This was no squeak, this was a metallic bark.  No wonder she was embarrassed by it!  Later that week, I decided to investigate the cause; I know enough about cars to impress an 18 year-old girl with little to no mechanical skills.  I shimmied (OK, I flopped) under the car to take a peak while she pushed lightly on the fender to recreate the squeal.  Before long, I had the cause identified.  Seventeen years of PennDOT road salt has eaten away the left rear sway bar bushing strap bracket.  Don’t be too impressed, it took me over a week to identify the part’s name with the aid of the track mechanic I work with and a few crafty Pictionary-grade sketches.  For the first few days it was called the “thinga-ma-jig”. 

I started shopping for the new thinga-ma-jig, and planned to make my final internet selection on a weekend, but I was asked to help teach Basic Vehicle Rescue to a rather large class that Sunday.  This last minute schedule change crammed up my Saturday plans, and I never had the chance to order the part.  As it turned out, procrastination paid off for me once again! 

That Sunday, I awoke at an ungodly early hour for the class, and I was still half asleep when the class got started.  I made a mental note to avoid late night lager the night before the alarm clock gets set for o-dark thirty.  I didn’t even realize that the one car we had to work on for the class was the exact year, make, and model car as Ivy.  Halfway through the morning session of stabilizing cars, someone forced a door open, and the squeaking grind it made immediately reminded me of my need for a new thinga-ma-jig for Steph’s car.  Jeeminy Moses, there sat “her” car, right in front of me!

During our snack break, I had the backhoe operator flip the junker on its side, the class helped stabilize it, and I quickly cannibalized BOTH rear sway bar bushing strap brackets!  I have been teaching auto extrication for almost 20 years, and have scored some awesome treasures, but this one was a real treat!  It wasn’t the value of the part that was a big deal, it was the timing circumstance under which I found it that was amazing.  What were the odds?  I figured I would be a hero for finding a FREE part to make my daughter smile.  I was too pooped to fix it that night, but promised to play mechanic the following weekend.  That whole week, I was bragging about my good-fortunes, and was looking forward to my weekend driveway mechanic opportunity; that is, until Friday afternoon…

A parent knows after one sentence when their kid is in trouble.  My first line to my mom when I hit the big maple tree was, “Mom, can you bring me my wallet?”  Ashley’s call to me started with, “Um, can you come give me a ride?”  Steph’s report led off with, “First of all, everyone is OK…”  This show of maturity was likely due to the hour delay in contacting me about the crash.  It was pretty clever of her to think through the call to dad BEFORE actually dialing the digits.  Smart girl, huh?  Anyway, this is not about the inevitable fact that she had her first, and hopefully last, crash.  This is about the repair process.

After making a few calls and pricing out both new and used replacement parts, I decided to take Stephanie with me to a junk yard.  Making her go along was supposed to be a punishment for her distracted driving, but it turned into a great daddy-daughter experience.  I was so proud of the way she was digging through cars looking for lost treasures to repurpose and clues to potential “crimes” that had been committed inside these cars, and having someone along to tote the tool bucket and car parts was a real treat as well.  After a bit of searching, we found three olive green 1996 Chrysler Cirrus sedans that offered all the parts we needed.   

I have been teaching crash rescue for 20 years, and know hundreds of methods that can be used to remove a wrinkled car from around a patient.  Many of those tasks involve very powerful hydraulic tools, that snip and bust their way through the components of a car in seconds.  In rescue, however, we are never concerned about saving parts in an undamaged state.  We use tool to perform the following functions (in decreasing order of awesomeness): Severing – Distortion – Displacement – Disassembly.  I found myself struggling with sockets and wrenches to carefully remove parts that could have been forcibly “disconnected” with the push of a button using a rescue tool.  This was all very foreign to me, but going “old school” with hand tools was a great experience.  Within a couple of hours, we were at the gate, paying for a hood, hinges, grille, license plate holder, upper radiator mount, radiator support arms, and a cowl cover.

 

I spent the afternoon in the driveway, revitalizing Ivy’s front end.  Thankfully, the labor consisted mostly of simple parts replacement, and just a little bit of hammering like a baboon.  By the end of the day, I had her looking almost as good as new.  The junk yard hood is a shade darker than Ivy’s, and there is a tiny sag to the plastic bumper cover that I couldn’t straighten, but for a total cost of $80, she was back to looking decent for a grandma car with 140,000 miles on her.  After I finished her up and started cleaning up my tools, I hopped in to turn her around when I heard the dreaded SQUEAK! 

Oh yeah, I forgot all about THAT little bugger.  No problem.  I was feeling like Mr. Goodwrench, and already had my tools splayed around the driveway.  Even with the setting sun, I was confident that I could swap this last part and finish the job before it got too dark to see.  You know that little saying, “Haste makes waste”?  Well, it sometimes makes blood as well.  The thinga-ma-jig would have to wait for another day. 

 

Roll with the Flow

I will be the first one to admit, I live in the fast lane.  No, not THAT fast lane, I am getting too old for that.  I am referring to the fast lane of the highway.  Occasionally I will slide in to the right lane and go with the flow with the normal folks, but I am usually looking forward to reaching my destination, and the sooner the better.  I like speed, and I like the challenge of beating my Garmin’s estimated time of arrival.  I agree with the late George Carlin, who noted that “anyone that is going slower than you is an idiot, and anyone going faster than you is a maniac”.  While the fuzz on the side of the road with the radar gun may disagree, I believe I set a safe but efficient pace for the fast lane. 

Of course, this only applies when there is room to run.  Once highway traffic is congested to the point where speedy travel becomes impossible, I submit to the situation and “go with the flow”.  This is usually the case during certain parts of my daily commute.  Anyone who has ever had the “pleasure” of traveling 222 between Reading and Allentown understands my plight.  Ten miles of outdated, single lane, overcrowded asphalt, choked by heavy trucks, thousands of commuters, Amish kids on bikes, and way too many cross streets is exacerbated by a few agonizing traffic lights, strategically placed to eliminate any possibility of smooth sailing on all but the luckiest of days.  In this situation, the choices are to “go with the masses”, or challenge yourself with the winding back roads that bypass the masses!  Those “shortcuts” don’t make the commute any shorter or quicker, but it sure seems like it does. 

The real analysis of humanity occurs on extremely congested super-highways.  Those that travel rush hour (an oxymoron if I ever heard one) in a major metropolitan area understand this plight.  I recently made a trip On Philadelphia’s “Blue Route” during the afternoon commuter hour.  I was making my way to the Philadelphia International Airport at 5:30 on a weekday when both the Phillies (always a sellout crowd) and the Sixers (poised to eliminate the Bulls from the playoffs) were playing across the street from each other in South Philly.  I was merely a speck in the river of cars that were crawling along the winding 4-lane strip of striped concrete toward Interstate 95. 

In these scenarios, there is no sense trying to “make good time”.  You simply must tune in a good radio station, pick a lane, and “go with the flow”.  When the speed limit is 65 and you are going 15, it is time to concede to the voice of your navigation device… there will be no checkered flag at the end of this excursion.  What you CAN do, however, is pick out the asshats that still believe they can beat the system.  They dart from lane to lane, trying to make up a car length or two by jumping into the lane that seems to be moving faster than the others.  Since their like-minded friends do the same thing, it is usually a few minutes until that lane becomes the idle lane and you see them again, trying to cut back into your lane, which is now steadily flowing by.  It reminds me of the “Tortoise and the Hare” fable.  I was playing the role of tortoise and stayed in my lane of choice, but in this case, the “hares” include the snotty, Armani suit-wearin’ Mercedes pilot, the punk in the multi-colored subcompact with the mosquito mufflers, the young clueless girl on the cell phone in the beat-up duct-taped sedan, or the blue collar contractor with the ladder rack and the squeaky brakes. 

I narrate the movements of these four targeted strategists, since texting while driving is no longer legal in Pennsylvania.  The entertainment keeps my mind off the clock, and is really quite comical.  They dart left, they dart right, and they occupy any gap they think will give them the positional advantage.  They piss people off by cutting in on a smoothly flowing line of traffic.  Brake lights flash like a disco on No-Doze.  The masses lurch forward, the masses stop, the masses repeat…   We are thousands of individuals with a common goal.  I am certain that if we would all work together, we could all enjoy more consistent movement and efficient travel.

I suppose this is where today’s lesson lies.  There are times when we all need to stay with the pack, and understand that “Together Everyone Accomplishes More” (TEAM).  Teamwork produces success.  Long distance runners know this, bikers in the Tour de France know this, herds of animals in the wild know this, and schools of fish know this.   Even NASCAR drivers, who are trying to be the individual that “gets to the finish line first”, know that if they don’t work with the other drivers, including their foes, they will lose!  Within a team, there will members who may be stronger, faster, smarter, or better than the others in some way.  Those individuals also have some shortcomings that can be compensated for by other teammates with different strengths.  That is the concept of a winning team: sticking together, remaining unselfish, supporting teammates who are struggling, using your strength to boost others forward, and staying focused on the group goal.  Even strangers on a highway can function as a team.

After 35 minutes of automotive crawl, the congestion seemed to magically dissipate, with no obvious reason for the sluggishness.  I was free to accelerate for the final 2 miles of my commute.  Not just me, though.  Me,  the “suit” in the Benz, the exhaust buzzing Technicolor Toyota, the chatterbox in the rattlebox, and Marlboro Man look-alike.  I shot past them, grinning at their futile attempt to break from the pack and selfishly navigate past my team of commuters. 

Woops, there is my exit already!  I Gotta go catch a plane!  Ciao.

Service Engine Soon

She is a faithful girl born in Dearborn, Michigan, who I affectionately call Veronica, and has been with me for over 10 years, despite the abuse I inflict on her.  I wake her up on cold mornings and demand she get moving immediately, I don’t bathe her very often, and I make her carry my crap everywhere we go.  I make her run around in all sorts of weather, leave her in strange places for hours on end, and make her listen to me try to sing along with the music (I change pitch at will, and often make up my own words to songs when I can’t understand the real lyrics).  She complains, but I just turn up the music louder so I can’t hear her whining. I am not a complete monster, though.  I feed her often (she has a voracious appetite), give her plenty of fluids, buy new shoes for her from time to time, and take her for a check-up every year.  Despite her age, she is still in good shape, despite her creaking and groaning, and I love her.

She kept hinting to me that she wasn’t feeling well, and every once in awhile, she blew a fuse.  I placated her, and gave her a new bauble, and that shut her up for awhile, but I knew deep in my heart that something was wrong.  I would always leave some spare change in the cup holder for her, stick on a new tattoo on her rear end and spritz her with some spice scented perfume every now and then, plus there was the occasional snack I would let slip between the seats for her to enjoy.  But I knew our relationship was strained.  The tension was mounting.  She was very bossy every time we went for a ride, always “recalculating”, but never just let me go MY way! 

Recently, she showed me that she was not to be neglected any more.  She broke the news to me as I was trying to turn left in front of a gasoline tanker that was traveling faster than I expected.  Like the cold slap in the face of a “Dear John” letter, she told me it was over!  I had experienced with the dreaded “Check Engine Soon” light before, but never with such drama.  Like the others who were with me before (Bu, Sunshine, Grey, Spookie, and Blackie), our relationship seemed to have reached the end.  I begged with her, and swore at her, and finally at the last moment, she lurched forward, and saved my life.  Maybe she still did love me? 

I took her outburst and immediately headed for some long-overdue therapy.  The “doctor” heard the symptoms, took some tests, and told me what I had known all along.  It was her, not me that had flaws… 10 of them to be exact!  He referred me to a specialist, and naturally, this would not be covered by her insurance.  Fortunately, she only had a few screws loose, and before long, she was back in my arms.

We had a long talk that night, and I promised her I would be more attentive to her needs.  I will try to be more responsive to her minor complaints.  Better yet, I have vowed to be thoughtful enough to know what she needs BEFORE she needs it, and tend to those needs promptly.  She is mine, for better or worse, in good times and bad, till death do us part.    

How do you manage your relationships?  Are you attentive to the little hints and your intuition or do you wait for the buzzers and flashing warning lights?  Take it from me (and Ben Franklin), “a stitch in time, saves nine”.  So listen carefully to your partner, and take preemptive action as necessary.  Work together, communicate often, and treat each other with kindness.  Meanwhile, check back later when I blog about properly maintaining your automobile.