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Monday, December 30, 2013

Those Pesky Volunteers!!

by Steven P. Velasquez
December 30, 2013

Recently, an overnight call in a nursing home provided a much-needed shot in the arm for me. I often write about the issues we face in the pre-hospital world like being underpaid, underrecognized and often undermined (sometimes) by people who perform our type of work for free (volunteers). Sometimes I and other writers highlight the blunders and failed expectations and place an accusatory, blaming beam of light squarely upon them, those pesky volunteers. The irony there is that when one works in EMS in New Jersey, unlike any other career, they most often begin as a volunteer EMT before moving into career departments or becoming paramedics or other allied health professionals. Volunteering is a sort of proving ground, a place to cut one's teeth and learn this trade, before moving into a career position (or continuing a life of dedicated volunteerism). So the discomfort lies in being so frustrated at the very system that produced - YOU.

Now I can go on about the kinks, flaws and perceived failures but that would read like the words of every other angry paramedic in the field.  I had an encounter that reassured me that perhaps the field will survive if I, or others like me, who have roamed these streets for decades, should die.

These pesky volunteers are often young - very young - which sometimes punctuates their errors; and especially from the increasing distance of my aging eyes. They often lack social skills as they interact with the three inch screen of their smart phones more often than fellow human beings. They have no appreciation of history and those who have lived it, whether it's the veteran EMS provider beside them or the WWII veteran on their stretcher. Life, or should I say the world, to these young pesky people, seemingly begins and ends - with them.

The four EMT's on this call perhaps had a combined age of 75 to 80, or about a decade short of our patient, who happened to be a combat veteran of WWII. I remember being in my late teens, early twenties and facing the geriatric patient before me and hating it! They looked weird, smelled funny, didn't move or act like me, had nothing relatable with me and they were just not exciting. I wanted shootings, stabbings and cars on fire like on TV!


 As we drove to the hospital, the young volunteers of the Cranford First Aid Squad allowed me to perform my work on the patient, and as we buckled in for the trip to the hospital, they did the unexpected. They didn't disappear into their smart phones or imaginations, they engaged. They engaged the patient and listened, not to his medical history and medications etc... but to him, about his military service, where he served and who he served under. Then when he stopped talking, they responded and not with "oh, that's interesting," but with their own stories! No, they weren't in WWII silly, do the maff! Stories passed onto them from their grandfathers!



George C. Scott as Patton directing tanks
I was witnessing a meaningful, life changing, exchange of information between these young, pesky volunteers and the nonagenarian before them! One shared a story where if you had ever seen the 1970 movie "Patton" featuring George C. Scott as the general, there was a scene in there where the general was playing traffic cop, directing tank traffic through a village in France. One of the tank operators was the grandfather of that young, pesky volunteer.


Back and forth they went, patient and providers young, transferring their stories, lived or passed on, both breathing life into the pages of history, something I value tremendously and hope you will too!

I'll admit, you would have to hold a gun to my head to make history important when I was their age. I hated it and resented having to learn any of it. Today, I'm a proud history buff. I read the books, watch the movies and documentaries and walk the battlefields of our country's fathers. The little I know was transferred to me by the aging infirmed, in the back of my ambulance, when I too was young, pesky and volunteered.

Thank you Cranford First Aid Squad for renewing my faith in the future of our field. Keep listening and show your young to do the same.







Tuesday, December 24, 2013

Ghosts of Christmases Past


by Steven P. Velasquez
December 31, 2011


Over the past few weeks, the EMS community in NJ has once again, endured the pain of having to bury a brother paramedic.  The details of why, how, ages etc… are irrelevant, for they all can be answered with the adjectives “painful,” “tragic,” “too soon,” “saddening” or “unnecessary.”  The reality is that we now have yet another, empty seat at our table. 

Every calendar year ends with the Holiday Season, a time for celebration, family and joy.  For us in emergency services, the inverse is often true and can often weigh very heavily upon us.  The daily exposure to tragedy and pain can exact a sometimes deadly toll. Thus I encourage all my brother's and sister's – to take steps to actively become “our brother’s keeper” and let none of “our family” suffer in silence.  To borrow a saying from the Department of Homeland Security, “If you see something, say something.”  

Strangely, even when we have the opportunity to not work the holiday’s, we often do.  Sometimes for economic reasons and often to run and hide from other parts of our lives, and sometimes without knowing what we signed up for, we go to face what later become “The Ghosts of Christmases Past.”

I can’t begin to express the sense of agony in our crew-rooms or parking lot conversations where those of us left behind scan our minds and memories to see if there was something we missed or could have done to avert a tragedy among one of our own.  The following article has been simmering in my thoughts for years and now presents with new and saddening emphasis.

The following are some recent memories, memories of "The Ghosts of Christmases Past.”

A few years ago, I reported to work Christmas Eve just before 7 p.m.  The day shift was relieved to see me and informed me there was a call holding for a pronouncement of death (not a high priority dispatch that requires an emergency response).  My partner and I gathered our gear and responded to the address.  Upon arrival, I was pleasantly surprised to have met my ex-wife’s cousin at the door.  He serves as a sergeant with the police department of that town and cautioned us that this wasn’t going to be easy and that we should watch our step.  Apparently there were firearms involved and the mess trailed through the festively-adorned house.  The agonizing cries of a grieving family emitted from the basement as we made entry into the unknown.    His lifeless body lay there in the bedroom.  He had received news the prior night that a close relative had unexpectedly passed away. He became overwhelmed, and could deal with it no more.  His permanent answer to short-term pain was to face the working end of a deer rifle against his youthful head.  He, a boy, was 14.

The combined experience of my partner and I bring decades of experience and plenty of exposure to ballistic injuries.  The horrific sight and devastating pattern of injury left here took our collective breath away.  It was a haunting juxtaposition against a beautiful home prepared for the Christmas holiday.  With each moment we spent on scene, the horrifying images around us seared into our memories.  We made our observations, contacted our medical control doctor and were given a time of death.

After that call, winded, we visited a local diner in hopes of getting some dinner before the world closed up for the holiday.  Our warm coffee was interrupted (as usual) by another call in another town for a “possible DOA.”  “Another one?” we said aloud.  Death is something we encounter daily but usually not back to back.  This was not the beginning of a Christmas merry!

This one was far less emotional.  A person who lived in some form of indigent rooming home, with all of his earthly belongings in a pungent 6X10 bedroom was found on the floor, quite dead, and by the smell of things, for a long time.  Again, we went through our ritual procedure, received a time of death and released him to the local constabulary.  Back to the diner we flew, quite hungry and quite done with all the death in our call area; or so we thought.  The diner people were so good to us, they threw away the first dinner order we placed and completely brought out a freshly cooked order of the same.  When what to our wondering taste buds appeared?  But another dispatch, for yes, another DOA back in the first town we visited earlier.  We looked at each other in disbelief.  “How is this possible?” we thought.  But off we went with empty bellies, dwindling holiday spirit and a death-induced fatigue that really made us not want to be there this Christmas Eve. 
This woman was in her 50’s, found in bed surrounded by her best friends -- ash-trays piled high with cigarette butts and an army of liquor bottles lined on the shelves, the TV, the window sills, the floors even.  She appeared to have been the most peaceful of this evening’s departed, as she was still in bed covered by a warm winter’s blanket.  They say bad things come in three’s right?  “If that diner closes before we get back, I’m going to be pissed!” I exclaimed.

After we cleared from that scene, an unprecedented event, and evidence of a true and living God followed.  One of our supervisors happened to be working in dispatch that night.  He paged us to call him ASAP.  We obliged and he greeted us with an offer of genuine concern (something we are not used to).  He said he had been monitoring the radio traffic and couldn’t believe the cards we had been dealt.  He asked us if we were okay, if we had yet eaten and then offered to take us off the road and send us home!  He said, “You’ve had enough.  If you want to go home, just say so” then extended the offer.  We declined (probably because we didn’t want to be perceived as weak by our peers, but more so, probably for fear of being alone with this rattling about in our heads).  In retrospect, I should have sucked it up and gone home!  The night remained busy with lots of really sick people and the repeating vision of a lifeless boy, in a festively adorned home, and the result of a rifle’s work on a Christmas Eve.

Now this is just the stuff that goes on at work.  Then there’s the home front to deal with too.  After that horrible and exhausting shift, I was to go to my mother’s house for a 2 p.m. Christmas dinner before going back to work Christmas night.  My ex-wife was going to have dinner with us there and I would be able to see 2/3 of my children.  The youngest daughter (Little B) was with her mother and their family in NY.  Two out of three ain’t bad right? 

My renal alarm clock woke me up at 6:45 p.m. that night, or 15 minutes before I was to appear for work.  My phone had about 30 missed calls and 13 voice mails from my parents, my children, my ex-wife, and my youngest daughter’s mother.  They were all looking for me since I was supposed to be at Mom’s about 5 hours earlier.  That year, I had bought a Harley Davidson and everyone thought I might have crashed on the way to Mom’s.  My sister had driven about 40 miles and was about 15 minutes away when I finally reached her.  My daughter’s mother called the neighbors to come knock on the door thinking I may have died at home. 
When I finally became aware of the time and the events in my midst, my face was awash with tears.  I shook and uncontrollably cried as I had missed Christmas with my children.  I wanted nothing else than to see my daughters on this day and especially since I rarely get a chance to see them on any holiday.  I’m usually out fixing the world.  “What a friggin’ loser you are” said my teary reflection.  I couldn’t even get this right.  I failed my daughters – yet again.  I made it to work about 15 to 20 min. late and cursed the fact I had to be there.  My partner knew something was wrong with me but didn’t ask.  He probably figured if I wanted to talk about it, I would.

A year later, and on the eve of Christmas, we were dispatched to a residence for a “possible miscarriage.”  These dispatches are usually non-eventful and don’t require the services of paramedics.  We entered the home and there seemed to be a party going on with many faces.  A few distressed faces in EMT uniforms emerged with a towel in their hand.  They told us about the mother’s condition and said the fetus was in the towel.

Strangely, the mother was unaware of her pregnancy and claimed to know nothing of what was going on.  The many people in the home seemed concerned in the same way slowing traffic does at a collision.  They weren’t interested enough, as if they were actual friends or family.  It was then we realized these people were part of a group of recovering alcohol or drug addicts from Jersey City and knew this victim only by name. 

My partner performed an exam on the mother and I went into another bedroom to examine the fetus.  Unsure of how many weeks along it was, I applied the electrodes of our heart monitor to verify the absence of any activity.  I regret ever having done that as my eyes nearly popped from their sockets when I saw an organized electrical rhythm on the monitor.  Without getting into too much detail, the finding was transient and again, we obtained the time of death.  The EMT’s had already left the scene with the mother.  We were now left with the awkward circumstance where we don’t move a body after pronouncement of death has been made and, in good conscience, we could not leave the lifeless fetus here with this detached group of bystanders.  Not to mention, fetal tissue can often prove beneficial for diagnostics of hidden problems in other family members. So, we decided to transport the towel-wrapped fetus to the hospital as well.

Quietly, we returned to our ambulance and my partner entered the rear compartment with the towel in hand.  I looked up at him and stated, “Bro, it’s already been pronounced.  I don’t think it needs to be transported in the patient compartment.  There is no care to give to it.”  My partner looked like a stunned duck after receiving a shovel’s blow to its head.  “Um yeah, you’re right.”  He jumped out and sat in the front with the towel in his lap. 

The ride seemed to be the longest, slowest ride to a hospital – ever.  All the radio stations had constant loops of Christmas music or ads for erectile dysfunction.  We drove with our eyes forward and conversed about the birth of baby Jesus (my partner was Jewish) that the world celebrated this eve.
The next time you speak to one of us about why we’re working the holidays, please understand that sometimes our schedule demands it, and other times, we go to work purely out of fear of being alone or facing our private lives. Often we wind up facing what turn out to be - the “Ghosts of Christmases Past.”