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Thursday, December 17, 2009

Steven of Nazareth

By Steven P. Velasquez
December 16, 2009

A Holiday story of songs, food and mucho machismo!

As we approach the Christmas holiday, tales of lore are passed from generation to generation maintaining years of tradition and keeping Christianity in the mouths and hearts of the current. This story my friends, will not be one of them.

Last night I attended the "Holiday" (watered down, sterile, non-denominational, non-offensive, sanitized word for CHRISTMAS) concert of my daughter Nicolette (13). She and the combined musical talents of the Nazareth, PA Middle and High School's serenaded us for an hour and a half. They sang songs from different languages, countries and religions. They incorporated musical instruments at different points and belted out some beautiful solo's as well. A proud father I was when in front of the scores of caroling teens was my most beautiful, my first born, my Nicolette singing along -- in sign language.

I had only seen her perform this way once before, within the past few weeks as she stood before a church full of grieving family, at 
the passing of my former father in-law -- her "Pop-pop."

Nicolette signs at Pop Pop's funeral
The tears of joy and pride were wrung from my head like water from a pregnant sponge. I couldn't contain the surge of emotion at the beautiful images of my silently serenading progeny. I told her that day "I have never seen you look so beautiful, not since the moment you were first born."

To the left of me sat my ex-wife Dawn happily hugging and holding my three year-old Brianna (not hers). To the right of me sat my partner and love Michele (Brianna's mother). Further to my right was my oldest daughter Samantha (19). Samantha is not biologically mine but our family has never used the term "step" for anything but to clarify our non-biological relationship. To Sam I am Daddy and to me, she is my oldest baby, as I've raised her since she was four.

If this sounds complex, good! It is. It is complex beyond imagination but that is why I write you. A family is not defined by who carries who's DNA, but by who carries love in their heart of one another. Who is there for each other? Who supports each other in times of trouble? No one in the audience, or anywhere for that matter questions who is "biologically connected." They simply say "what a beautiful family" or "what beautiful children" you have. I've told my daughters in the past, "Our family is not black & white. It's more like -- plaid, a beautiful tapestry of plaid."

The joint mission of my past and present relationships have been to illustrate to my children that divorce exists. Separation and the cessation of living arrangements exist for as many reasons as there are stars in the sky. But more importantly, family exists! Love exists endures and transcends the world's troubles, for as many reasons -- as there are stars in the sky. The presence of a divorce does not mean the absence of civility. It does not dictate that everything in life has to turn into a hostile, hateful engagement every time you're near each other. That example does nothing but fuel more hostility and damage the hearts of the one's we love most -- our children.

Okay, sermon over. Here's the good part.

After the concert, we all visited a local pizzeria for a warm supper together, all of us. We were seated and our drink orders were taken. I got up to visit the rest room when I was greeted by the owner. One glance at me and he immediately (and correctly) assumed I was "one of his own" -- a Latino. He greeted me in Spanish and asked where my heritage was from. I explained that my mother was from Puerto Rico and my father Peru. He shared that he was from Guatemala and we conversed cheerfully for a short while. He asked who was with me and that's where the complexity began. I explained that I was with both mother's and all my children. His eyes widened as he peered over my shoulder at my family. Not an easy task for him as I'm 6 ft. tall and he stood approximately 5'4" or regulation height for Central American's. With furrowed brow he asked "they're American's aren't they?" "One Italian and one Irish" I replied. "Wow" he exclaimed "that explains it." "What?" I asked. "I knew they weren't Latinas, because they'd be killing each other!" We both belly laughed at the situation and he shook his head in bewilderment. He admiringly stared up at me; "How do you do it?" "It's not easy" I replied as the mutual laughter waned.

My family enjoyed their meal and shared laughter, hugs and holiday cheer. The two mother's spoke across the table and compared notes about the children, their similarities and differences. The supper came to an end and it was now about closing time for the restaurant. As I paid the bill and went to leave, there was a small gathering of other Spanish-speaking men (the employees) and coincidentally all of regulation height gathering at the end of the counter. The owner said to them as I was leaving "this guy is here, eating dinner, with TWO women that have his children!" They gasped out loud as they queried "que cosa" (WTF?), "y como lo haces?" (and how do you do it?) "y no se estan matando?" (and they're not killing each other?). Again I laughed as I addressed my new fan club, "it's not easy." They continued to admire me as I glided by looking down (physically only) at their bewildered faces.

In the parking lot, I shared the story with the two mothers and we all laughed heartily. And there you have the story of "Steven of Nazareth."

Tell your friends.

Monday, August 31, 2009

Hitting Close To Home

By Steven P. Velasquez
August 31, 2009

There are many ways that our jobs in emergency services hit "close to home." Most often, a patient may look, sound, or somehow remind us of someone close to us. Children are a big source of identification too. Most of us have a soft spot for the young, usually because of their innocence and the belief that they are, or should be, somehow excused from life's tragedies. Fatherhood has been the single greatest catalyst for change in my personal views on the world and the field I love so much. This time however, I would like to discuss something else that hits close to home -- our hobbies, passions and pass times -- the objects or activities we devote ourselves to when not out "saving the world."

A year ago I turned 40, and with the fast approaching pages of my mid-life about to be authored (crises yet to be determined) came the decision to purchase a Harley Davidson motorcycle.

A passion of mine since I was a teen, tearing up the Meadowlands of New Jersey on my dirt-bikes, I always dreamed of someday owning a cruiser. For years, life circumstances and finances obstructed the realization of this dream, but last year I finally brought her home and have loved and adored her ever since. Together, we've traveled over ten thousand miles, have joined a club, embraced a sunrise, parked on high peaks, hugged the shoreline and inhaled the salty ocean air together. We've coasted through historic towns and smelled the fragrances of the changing seasons. We've been stuck in the rain, battled the cold and raised money for charities together. We've even encountered a distracted driver or two and shamelessly interrupted their phone calls!

One thing I noticed with the purchase of a motorcycle is the sudden interest everyone has in telling me of any motorcycle tragedy within the continental U.S. I've never received so many pictures, videos and web links! People approach me to admire my bike's beauty, the shiny chrome, the glistening pipes, and are awed by the thundering exhaust -- then quickly switch gears and tell me about the beloved uncle they lost, the unfortunate friend who's a quad, or the great video they recently saw where the cops chased a land-rocket that got smashed by a tractor trailer on some reality show! Enough! I know it happens but have no desire to know about every single time it happens anywhere in the country. They seem to forget that I'm a paramedic for a living. I get it! I see it.

And that's where this story gains meaning for me; the part about seeing it. I've been in emergency services for more than half my life. I've seen a good bit of motorcycle trauma, not too much, but I know what it looks like. Recently at one of my jobs, other units responded to a motorcycle MVA that was dispatched as a possible DOA. The dispatcher added that the patient was eviscerated with his abdominal contents in the roadway. The BLS and ALS unit assigned to the job handled it, and the patient became pulseless enroute to the trauma center. When they arrived, I assisted getting him out of the ambulance. The ambulance looked like a twister had gone through it. I saw the patients' blood-soaked helmet laying on the floor and believing it may have some forensic value, I picked it up to take it inside. That's when a switch in my head had flipped. The helmet was the exact make, model and color as the one I use. One of my co-workers just purchased her first motorcycle a few weeks ago and she too, has that exact helmet. This job was now officially "close to home" as I no longer had the objective view of this patient but now saw him, strangely, as my possible future outcome. I felt like Scrooge with a front-row seat to one of his possible futures.

I went inside the trauma bays and watched the team work feverishly to resuscitate the patient. Like a hive of provident bees, they swarmed around their work and performed at a yeoman's pace. He was more fractured than he was intact. They hung fluids and blood, gave catecholamines and other life-saving medications. Finally, he had regained pulses. The physicians consulted about his horribly fractured leg. One said that as soon as the patient begins perfusing, he's going to bleed out from that site; and suggested they amputate the limb. I thought they meant upstairs, when the patient reached the surgical suite! No sooner did the words escape the Dr.'s mouth than another doctor whipped out a scalpel and began cutting along the circumference of the limb. Within seconds, they sliced, then gently applied pressure and pulled the patient's leg away from his body; no bone saw, nothing intricate. They cut with the same grace and ease as the guy at your local supermarket deli; and in a few seconds it was done. The patient's leg lay still on the floor, still wearing the sock and sneaker that he began this tragic night with. The patient was mortally wounded and hanging on by a thread, but "miracles do happen" I thought!

My thoughts followed a strange path to what kind of future this patient would expect to have if he did somehow live. Morbidity, mortality, length of stay, cost of treatment, rehabilitation, pain and suffering, medications, support from family/friends, future income and a long list of other thoughts began to race through my tired mind; thoughts alien to the newer "get the tube, get the line, let the surgeons figure out the rest" paramedics. Thoughts that probably appeared because it was now me laying on that table and not some random, unfortunate person.

After this patient was whisked off to the surgical suite, my motorcycle riding partner and I went back in service. An unnatural quiet joined us. Ironically, both of us rode our motorcycles (together) into work this evening. We even had a long discussion about serious motorcycle trauma with our Chief at shift change. Our now eerie silence began to unnerve me. I knew she too had been affected by what we had just witnessed. I also thought she'll talk to me if and when she's ready to. The night had given way to the day. Our shift had come to an end. The patient had also given way to his injuries and had passed on. I knew that in a few short days, somewhere in the city a sidewalk memorial with candles, flowers, balloons and a youthful, smiling picture would occupy some street corner briefly reminding passersby that someone was very loved, and had passed away there.

My partner and I rode home together after the shift. The unnatural silence came for the ride too. She and I rode off into the sunrise -- silent, without expression. We took it easy, rode the slow lane and let the hurried others pass. Both of us probably digesting how "close to home" this job just hit.

Monday, August 10, 2009

A Father's Revenge

by Steven P. Velasquez
August 10, 2009

Two days from today, we'll be taking our daughters (18, 13 and 2) to Disney World in Florida. The excitement is reaching a fever pitch and the anxiety is palpable. I've promised my daughters since they were babies that we would someday go see "The Mouse." For one reason or another, the finances or time or some other factor always got in the way of what other people make look so simple; a family vacation.

During all that time (14 years now but who's counting?), there have been trials and tribulations, problems, crisis, poor report cards, incomplete homework, not coming home at the time they were supposed to, arguments, and rooms not cleaned! You know, the rigors of parenting! We're no different than any of you.

Alas, the day has come. The day two parents are to keep their promise to their younglings. This year we thought would be special because, Samantha (my oldest) has graduated high school and will be attending college the day after we return. Nicolette has become a teenager and has just returned from a "Missions Trip" to Nicaragua with her church, where their group helped provide clean, running water to a village about 6 miles away from the Capitol City of Managua. And last but not least, Brianna. The precocious two and a half year-old that loves all things Disney. She'll have no permanent recollection of this trip, but WHO CARES? It's going to be so special to see her face light up when she sees all her favorite TV and movie stars alive before her. We really can't wait!

Ah, and now the revenge part! Remember I told you about all those little nuisances that are native to parenting? Now it's my turn, particularly against the older two as they are now in their "cool years" and they're conscious of their appearance and just a little boy crazy.

My parents were naturally "un-cool" because of a few reasons. 1. There was a bigger age difference between they and I. 2. There was also a cultural divide between us as Mom was from Puerto Rico and Dad, from Peru. They tried their best but wow, did I feel like I was from another planet! I could go on and on about the endless embarrassment of my teen years but will spare you the gory details. Night after night of "hey Dad, can you drop me off over here?" (about 6 blocks away from where the party or event was to avoid being embarrassed again). My children don't have those divides but are convinced 40 is ancient. My time has arrived. My time to capitalize on my little angels! I've been preparing this for years!!

I'm planning to show up at Disney wearing the most repulsive Bermuda shorts, pulled up over my rotund belly and cinched up just below the bottom of my rib-cage. I'm purchasing a hideous set of Mariachi sandals of course to be contrasted against a set of black socks that come up to my knee line. All this under a silk button down shirt of some sort with an embroidered naked lady on the back. My shirt, mostly unbuttoned, will expose the three chest hairs I've managed to grow since puberty and perhaps a large gold medallion of some sort ('cause I think that's kinda hot!). I'm not going to shave so I get that rough Don Johnson of "Miami Vice" look (God I miss the 80's)! I'll probably light up a cigar just to annoy everyone around me and bark at them when they confront me about the smell. A big set of Blues Brother's dark beach cruiser sunglasses will certainly punctuate my coolness and this entire ensemble will be topped off with one of those captain's hats with the gold scrambled eggs on the visor. I will exude cool!

I'll deliberately stare and ogle at the "chicks" as they pass by while telling the girls stories about how I used to have several chicks, much prettier than that, at my disposal. If said chick should catch me staring and curse at, pour a drink on me, throw something at me or assault me with her mouse ears, I'll explain to the girls that she just doesn't know what a real man looks like!

I figure if the roller coasters don't make the girls hurl -- Daddy surely can.

Monday, July 20, 2009

Nikki's Shoes

By Nikki's Dad
July 20, 2009

Dear Nikki,

Tonight is an important night for all of us. Your mother and I find ourselves in an awkward position as we've spent the past thirteen years trying to guide and raise you and to always be a good example for you. Tonight you've reversed the playing field as we believe you - have become a good example for us.

Tonight our little girl is no longer little as you've made a conscious, adult decision to travel to a foreign land, without the security of your parents, without our influence either, for this you've come upon - "all by yourself (your famous line for every one of your accomplishments as a baby)."

My mind goes back to when you were your little sister's age (2), how hurried you were to shed your youth. You wore Mommy's shoes, Daddy's helmet and anything else that you thought made you "a big girl."

Here you are at 13 (just barely) and you're so filled with love and compassion for humanity that instead of spending warm summer afternoons like we did, playing sports, riding bikes or catching fireflies, you chose to travel to the equator, to an impoverished land, plagued with poverty, hunger, and an unstable government. You not only chose to do it, but you do it without fear, eyes and mind wide open, screaming Geronimo the entire way!

Tonight you'll board a flight and climb into the heavens bound for your adventure. We're sure you're vibrating with excitement and so you should, for your life is about to be changed from this day forward - for the rest of your days. Your mother and I are nervous, fearful even. It's what we parents do when outside forces pull our young away and replace their presence with uncertainty. What helps us balance out all those fears is the absolutely enormous pride we have for our "little" girl. You - are - a big girl now.

Like I said earlier, you've reversed the playing field. Mommy and I now find ourselves awkwardly clumping around - in Nikki's shoes.

"Geronimo my love. Geronimo!"

Come home soon and tell us all about it.

Nicolette in Nicaragua - 2009

Saturday, June 13, 2009

A Check Up From the Neck Up For EMS' Future Leaders

By Steven P. Velasquez
June 13, 2009

Radio talk show host, attorney and activist Ron Kuby introduced me to a phrase some time ago, regarding young hot shots with a head full of new information. He said
 "you cannot preach, as truth, today, what you only learned yesterday."
I wish this concept would have been imparted on me as a young paramedic in my 20's. It certainly would have saved me some personal embarrassment and I really think it needs to be taught to today's new generation of paramedics as they appear to be coming out of school much younger, far less experienced and increasingly arrogant. 

At the risk of sounding like an old man shooing a bunch of youngsters off his front lawn, please allow me to explain myself. When I became a paramedic at the age of 22, I immediately came home and wanted to master my craft and to improve my resume. I inquired about teaching ACLS & PALS with a very special lady, and nurse, named Linda Sylvester (may she rest in peace). She gently explained to me that her strong suggestion was that I first
 "go out and see ACLS work, before attempting to teach it to others." I was fit to be tied! This arrogant, self-appointed deity in a skirt was going to tell me what's up with ACLS? I've worked over five years in Union City, Passaic and Jersey City. I've seen more ACLS than some people see in a career; or so I thought. I could run through those algorithms better than most people I knew! "Shock, shock, shock, everybody shock, little shock..." Remember? My God, I was incensed! This woman obviously doesn't know anything about what she's talking about and less about me.

What Linda had shared with me was that I cannot preach, as truth, today, what I only learned yesterday. But, like a petulant child, that wasn't the truth I wanted to hear. Fast forward 17 years, a bunch of life experience, and a pair of careers and no truer words could be spoken. It took a lot of time and exposure, not to memorize the order of a list of directions but to answer the why's and how's of the process down to the cellular level. We often hear that one can teach a monkey to perform certain tasks we perform to illustrate the difference between rote memorization and actual conscious thought (not to mention having an opposable thumb). Yet, our newest and youngest are jumping out of the box with not much more than enough information to qualify -- to go out and really begin learning the truths of the field. That is NOT to say that they are unintelligent or that they could not explain the nuances of J-Points in 12-lead EKG's which were not part of my primary paramedic education, it just means that all those concepts, terms, algorithm's etc... need time and exposure, like developing film for a camera (device used to capture images on paper using chemicals and brief exposure to light prior to the digital age. Avg. size was 24 exposures vs. 4 GB). We have yet to enter the age of Neo in the movie
 "The Matrix" where we can plug wires in the back of our skull, download a couple of Judo lessons and come out as masters of the art. 

Today’s newest paramedics hit the streets, answer their first couple of calls and are immediately convinced:
· That EMT’s (the cert they held only yesterday and only for a few years) are a lesser form of the species or misguided hobbyists.
· Anyone who is not on the brink of death is not a candidate for ALS
· And my personal favorite flawed philosophy “my patient’s have to prove to me that they are candidates for ALS.”
Who in the world is teaching these people? When did we become deity’s, sitting in thrones, having subjects brought before us to evaluate if they qualify for or merit our services? Those uninformed EMT’s only a few weeks ago were your partners, co-workers, BFF’s, your best man, or Godfather to your children. Suddenly, they’re there only to lift your patients or to serve as the subject of your sarcasm? 

Read your Hippocratic Oath folks! The information you are now (temporarily) in possession of, has been distilled over the ages and over the bodies of the millions of dead and diseased. It is yours to add to, subtract from, modify or refine based on evidence -- gained from your experience. The information is not yours! It's only yours for now, to improve upon and then pass it on.

Go out and discover, research, prove and disprove the fields' truths. There will be plenty of time to preach later.

Friday, May 29, 2009

Anyone Can Do My Job

by Steven P. Velasquez
May 29, 2009

So what does it take to do my job? Well to begin with, watch a few episodes of "ER", "Third Watch" and "House." Then read a couple of tabloid stories in the local news rag and lastly, take a few completely unrelated classes in a community college and bring some strong opinions with you too! 

Jesus Christ! I sometimes live a personal nightmare with my, all too often, misunderstood profession. Oh no, please don't think it's because of the recurrent dreams I have of the screams and the cries of the injured, the ill and the maimed. Oh no, this nightmare takes place when I'm conscious, when I'm completely alert and when I'm performing the thing I do most next to breathing these days -- my job! 

I received a double-whammy a few weeks ago while assigned to the medic unit that covers Newark Liberty International Airport in Newark, NJ. My partner and I were dispatched to one of the terminals for a baby with a head injury. Allegedly, the two (or so) year-old tyke fell from a standing position, out of her stroller face first against the carpeted floor. Her injury pattern consisted of a about a 1 inch long red bruise along her cheek, or what we professionally refer to as a boo boo. She also was reportedly stunned after the fall but had since become -- (deep breath) her normal, playful self (gasp!). 

The family had abandoned their overseas flight so as not to face the possibility of a trans-Atlantic medical catastrophe with their little one. So far, my partner and I are ok with their decision. Who wants to gamble with the little one's right? A little over-cautious for my taste, but I'm not there to be anyone's judge. We offered transportation to the nearest ED for an examination (for their peace of mind more than anything). 

Our first problem was the police officer who greeted us at the scene. The very concerned officer came to us with a look of consternation and emphatically exclaimed "she absolutely needs to go get checked out." We didn't disagree, but we also hadn't seen the patient yet. After all of our findings pointed to an unremarkable exam, I thought "hey brudda, I promise I won't catch any burglars or bad guys if you promise not to try to play Paramedic ok?" Jeez!! 

The hysterical mother of the "seriously injured" child then speed dials her father who's what?? The medical muckety muck director of some hospital in South Jersey. Crying and hyperventilating, she exclaims: "She's had a terrible fall and..." Holy misrepresentation of facts Batman!! 

Her dad told her that more than likely, it's nothing but you can never be too cautious. She was then about to dial the home of her surely sleeping pediatrician to awake him and seek his input! Somebody stop this lady before she speed dials the situation room at the White House and I have B.O. on the scene asking me to put this child on a "breathalyzer!" Good Lord!! 

My partner and I look at each other like we've crossed a time-space continuum into some alternate universe where wrong is right, down is up and I'm sure you can figure out the rest. The entire time, we are continuing to offer our assessment findings, a list of the signs and symptoms of concussion, head injury etc... And most of all, transportation to a very good hospital just a few minutes away! 

"Will they give her a CAT Scan immediately?" she breathlessly asked. Both of us explained that while that may be a possibility, the probability is low in the absence of those things, oh what are they called? Ummm? Oh yeah SYMPTOMS!!! 

We skillfully and eloquently began to diffuse the parental anxiety and began to introduce some semblance of sanity to the situation when all of a sudden we were confronted by yet another medical "expert," the "Ticket Chick!" That's right folks, from checking your ticket, to pointing you to first class or coach, to diagnosing Traumatic Brain Injury, this one-stop airline has it all! The Ticket Chick pokes her head into our huddle, looks at my partner and I and while pointing her finger at us states "this baby could have a brain injury or cerebral bleed and needs a CAT Scan right now!" "Perhaps you haven't heard about what recently happened to Natasha Richardson!" 

AAAAHHHHH!!! That's it!! I've had it! No offense to Natasha or her family but I knew this crap was going to happen! I called it on the day we all heard of her passing. More so, the way in which her injury progressed. I knew we would have a public knee-jerk response and have everyone with a cranial boo boo being "rushed to the hospital by ambulance" to get a CAT Scan so they don't suffer the same outcome. 

When we politely asked what Ticket Chick's credentials (if any) are, she replies "I'm in nursing school." My partner and I were about to crack, but I'm new at this employer and am taking it as coolly as possible. Between the two of us, there's more than 30 years of ALS (advanced life support) experience and we're being schooled by civil servants, hysterical parents, their endless list of life-line's and The Ticket Chick who's studying the very basics of patient care. Oh and of course, the family is at the peak of hysteria again because Ticket Chick referenced her professional medical opinion with a paragraph she probably glanced over in the 
"National Enquirer!" 

In closing, the cops went back to preventing crime in one of the nation's largest international airports. The family signed a refusal of medical attention from us and had a "faith based" EMS service respond (approx. 70 miles) from Ocean County to the airport to transport the child back to where daddy's influence could fire up a CAT Scan for peace of mind. Ticket Chick apologized for interjecting and told us of some of the things learning in LPN school! And the two of us returned to serve the rest of society. 

Believe me, Anyone Can Do My Job.