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Wednesday, July 27, 2011

Never lose control!

by Steven P. Velasquez
July 25, 2011

An instructor should maintain control of their class at all times! 

Photo by S. Velasquez
So read the pages of many instructor's texts.  They offer an instructor ways to identify when a student is being disruptive (jokes, war-stories, generalized digression and argument), when the others are being annoyed/cheated by it, and ways to constructively and politely re-direct a student's focus/attention to the lesson at hand.  The texts even explain the utter importance of classroom control with how it affects time and budget management (i.e.  In a class of 20 students, if 20% of the class is disruptive for only 15 minutes each, you've either tacked an hour onto the tail end of the day or you have to cut valuable information out of the program to stay on time/budget and accommodate the disruption).  The long and short of it being -- an instructor should maintain control of their class at all times!

An instructor loses control

A few months ago, yours truly was teaching a PALS (Pediatric Advanced Life Support) class and had a student that was being rather disruptive.  He was by far the oldest person in the room and according to my manager, was a physician of some sort.  Sometimes this can present a problem when there is a power struggle between an instructor and either an uber-educated or experienced provider in the room.  We try to show respect (sometimes deference) and are often undermined or worse - risk losing control of the class.  The ones who lose most are the students that are strangers to the information being taught.

I'm sure the old man didn't mean to be disruptive.  He often appeared to just be ruminating aloud.  During a break, I discovered he was a retired pediatrician.  The next logical question to me was; "then why are you taking PALS now if you're retired already?"  As it turned out, the old man was moving out of state and had landed a very part-time position with a community hospital performing cover work for when other pediatricians needed time off; you know for important things - like golfing.

He appeared excited and perhaps a bit intimidated with some of the advances in assessment techniques, emergent procedures and inventions like the "Braslow Tape." He peered at it and smiled; "Someone made a lot of money on this idea didn't they?"  He offered some insight on some of the techniques that carried him through his career which were interesting but again threatened to derail the class and prove me a failure as its leader.

During lunch we sat and talked for a while and I discovered he was educated at one of NYC's finest medical schools yet practiced in the rural mountains of Kentucky.  We only talk about diseases like polio, measles and others as historical references as they have been eradicated from at least the first world nations.  This man knew exactly what these illnesses presented like, he had something we didn't - experience.  He was fascinating indeed!  As our micro-group returned with their lunches and gathered around our table, we talked about the difficulty working with pediatric patients, particularly the emotional aspect.  Some of us were parents.  Some worked in pediatric ICU or other children's specialties and one was in her third tri-mester of pregnancy.

He told us how he marveled at the progress we've made with vaccinations and treatment of deadly illnesses like cancer.  He said; "Back in the 60's, when a kid got diagnosed with a cancer, he got a death sentence."  At that point, he became flushed in the face and tears began streaming from his eyes.  I thought; "now I'm fucked."  This didn't appear like it was going to end well, and I was ready to get one of the other instructors to help me lasso the group and reel them back in.  The women in the group hugged him and asked why he was crying.  I let it continue because it looked like whatever he had within him was consuming him and needed to come out. (Perhaps I should try my luck at being a therapist?)

He composed himself and began to tell a story of a child he was taking care of in a cancer ward.  She was 3 or 4 and in her final days of life.  Her mother, in the last term of her 2nd pregnancy, stood vigil at her bedside.  He worried about the health of the mother and fetus as she was so overwhelmingly distraught at the certain fate of her first born.  He explained that he was the type of mountain doctor that made house calls, sat at bedsides and would join in such parental vigils.

On this particular day, the patient asked for mommy's ear.  The mother leaned over the struggling tot.  She said a few words and the mother covered her face, began sobbing and ran from the room.  He never did hear what was said.

A few hours later, she drew her last breath and departed with the angels.

Several months later, the doctor recalled seeing the mother in the cancer wing of that same hospital and almost collapsed thinking that the newborn must have it too.  He joined her at her side and she put him at ease.  The baby was healthy and well.  What escaped him was the fact that these parents often develop relationships with each other since they're all in the same place for the same reason.  She was there to console another mother that was about to experience the same fate.

She took the doctor aside and asked if he recalled her daughter's final moments.  He began to well up with tears and said; "like it was yesterday."  She asked if he remembered how she ran out of the room that day. Again, he nodded while trying to appear strong.  She asked him if he had heard what was said to her?  He said no.  She got choked up and said; "Mommy, please don't love the baby more than you love me."

Ok, let me know when you're finished.  I'm not done yet. (Wiping tears from my eyes.)

So now my entire group is a freakin' mess!   The other two groups are looking over at us like "what the hell are they going over?"

I suppose I failed that day; perhaps not as good an educator as I thought.  But here's the catch, that group left there properly educated.  They scored well and tested well in the hands-on stations too.  We all left there with much more than a certification card for them and a paycheck for me.  I honestly feel like I learn more than I teach in these classes.

Monday, July 25, 2011

So What Do You Guys Have?

By Steven P. Velasquez
July 17 2011

A paramedic unit is dispatched to an address where a volunteer ambulance is on scene with a person who is allegedly showing signs and symptoms of a stroke. On arrival, they approach a dark, remote driveway that has an ambulance and a police car in it. There are dozens of parked cars along the roadway and lots of ambient music and noise indicating there may be a party going on.

They're greeted by a woman in civilian clothes who is hastily managing the stretcher. The paramedics gather their equipment and as they head up the driveway ask; "What do you guys have?" Breathlessly, as she wrestles the stretcher out of the ambulance, she replies; "42 year-old male, was doing the chicken dance when he suddenly passed out. Could be a stroke." The medics contained their laughter, stared at the ground and continued in thinking maybe she's just a helpful civilian since she's in what looked like a party outfit.

As they approached the house, one of the squad members (easily identified by his 53" leather radio strap draped across his co-ed naked EMT t-shirt ) emerges from the basement. Again they ask; "What do you guys have?" He replies; "42 year-old, possible CVA (fancy name for a stroke), was doing the 'Chicken Dance' when he suddenly became weak and now has weakness on his right side."

The two medics glance at each other passing non-verbal communication questioning; "Have we possibly landed on another friggin' planet or something? What's with these people's fascination that a 'Chicken Dance' was involved?" After some other quick questions, they all agree that the medics will take their equipment to the ambulance and setup there while the EMT's take the gravely ill chicken dancer out of the house.

Now I know some will read this and immediately get their feathers ruffled that this is volunteer bashing, BLS bashing, generalized misanthropy but I have to tell you nothing could be further the truth. These are the kind of unfocused thoughts and jumbled reports we have to weed through to eventually get to the truth on a nightly basis. It would be one thing if it were only one person behaving this way, but as you'll read now, it was systemic.

The patient arrives in the back of the ambulance and is now being evaluated by the paramedics. Anxious family and friends clutter the doorways as we try to isolate the patient from the panicked. A third, fourth and fifth EMT are now in the back of the ambulance that we hadn't spoken to yet. The oldest, and probably most experienced of them, sits in the captain's chair with a firm grip on the most valuable of life-saving tools -- the clip board. She now announces her findings. "The patient was at a party doing 'The Chicken Dance' when..." At this point, nothing else she could have said was of any worth. The fact that I've had three or four people decorate me with that useless piece of information at the top of their findings report demonstrates that their thoughts are unfocused, they are poorly educated and can't possibly help me or more importantly, the patient during his time of need.

Another EMT opens up the side door and pops her head in. She looks up at me and says; "I don't know if they told you what happened, but he was..." Yes, I know you know what was said next. I'm now thinking to myself; "If I hear one more fucking reference to the God-damned 'Chicken Dance,' I'm leaving my keys and truck here and quitting!! What's wrong with you people!!!!!??

Capital One Viking child
As I was contemplating either homicide or hari-kari, the side door opens again and a topless, bearded, burly, barefoot man clad only in cut-0ff jean shorts leaps into the ambulance and lands with a loud slap of his bare feet on the floor! He grunts; "I'm here! What's going on?" When we challenged him; "Are you a family member?" He barked; "Well, no, I'm a friend but I'm going with him!"

I started to wonder if there were camera's on me and I was being punk'd. But, Ashton Kutcher never appeared. So far, the naked burly guy, who happened to look like the cast of the Capital One Vikings on TV, was the only person on this scene who didn't furnish me with the much valued tidbit of our patients' poultry polka that seems to have led up to whatever may have happened that, by the way, in no way seemed to even remotely resemble the signs and symptoms of a stroke!

On the way to the hospital, we called our telemetry physician for a consult about this patient. When he asked: "When did the patient's symptoms begin?" My partner and I replied in stereo; "After 'The Chicken Dance' sir." Silence.