The Paramedic Process

Another Haiti photo.  I'm not sure if the scale was discarded of not, but it stood alone in the hospital street, seemingly neglected.

I've done eight straight nights on a 911 ambulance, and have spent a little time reflecting on my paramedic sprint.  I don't remember their faces, and less so their names, but I remember their ailments.  65-year old man, hypoglycemia and profoundly diaphoretic; 56-year old man, severe asthma attack that I fixed in three minutes flat; 67-year old man with new onset a-fib that I diagnosed by feeling his radial pulse; a twenty something man that I knew was lying to me about drug use just by looking at his dilated pupils.  After each run I would review the call in my head looking for mistakes, and there were plenty. I'd see a new medication that I had to look up, a symptom that I didn't catch, a blip on a 12-lead that was significant. Everything got looked up after the fact on my iPhone full of medical applications, mentally filed away for the next time that I see it.  I was intent on each run making me a better medic.  Being a paramedic is a process, I'm, seeing that now.

Seeing

  Also from Haiti.  A woman walks along the street carrying her child closely to her.  The little feet sticking our from the blanket make me sad in a way.

In the very early hours of the morning I sat parked in an ambulance at a truck stop and starred into the window of the late-night restaurant.  I had little else to look at aside from my watch, counting the hours until I got off from work and could go home to my own bed. 

Through the window I watched a very heavy-set African American woman, dressed in the cheap, red uniform, push a broom across the floor. If I were any place else I wouldn't have given it a second thought, but here I was a captive audience and couldn't help reflect on what I was witnessing.  Dozens of questions flashed through my mind as I watched the thirty-something woman go about her manual tasks.  Was this where she envisioned fifteen years ago that her life would end up?  What does she dream of, aspire to, or has she resigned her life to where she is now? I couldn't help myself and tried to recreate her life in my mind, I wanted to project myself into her reality.  What were her disappointments, her victories?  What motivates her?  Where, if at all, would she go back and change her life.  Above all, was she happy? The questions kept coming and coming as I watched her through the grimy window.

I suppose my lesson was that everyone has a story, a life, a past, and a present.  I for one am guilty of going through my days at times oblivious to those around me.  I see people but I truly do not "see' them; the man crossing the street with his young son or the woman pushing the broom late at night.  I suppose in many ways this is why I like 911 so much.  For a brief moment in time it's just me in the back of the ambulance with another person, a chance to get to know someone on a deeper more compassionate level, other than just simply seeing them.     

Not A Good Night For Humanity

 A photo from Haiti. A daughter watches over her father while waiting outside of the hospital "Emergency Room" tent in the heat of the day.

A 911 call came to us last night, respond to a convenience store only a few blocks from where my EMT partner and I were sitting.  Within moments as we arrive to find four squad cars rocketing in and out of the parking lot, one of the officers is eagerly motioning for us to come inside and attend to the patient.  I remember thinking that these guys are amp-ed up, this level of activity is normally reserved for gunshots.

An older Asian woman sits slumped on a stool with an obvious laceration under her eye.  She's in quite a bit emotional and or physical pain.  The story goes that a man came into the store, got himself a large cup of hot coffee and threw it onto the attendant's face.  He then viciously punched her in the eye, grabbed the money out of the open drawer and fled through the front door. 

As my EMT treated the lady I couldn't help but be moved by the degree of violence and inhumanity that had just taken place.  Why would anyone do this and moreover, what was going through their mind?  A question that I've wrestled with lately is, does everyone in the world consider themselves "deep-down a good person", conversely are there people that simply know that they are at-root evil and devoid of humanity and kindness?  How can someone commit such a barbaric act and still view themselves as a "good person"?  Sadly,  I realized my answer last night.

Transitions

IV bottles hang from a tree branch.  Below, an adolescent boy lays dieing on a make-shift cot.  I couldn't bring myself to shoot the the boy.

Coming home from a deployment is often difficult, especially when you wake-up in some desperate third world country and find yourself going to sleep that night in your own bed at home.  The shock of abruptly moving between the two environments is often dramatic and catches many people by surprise. Aside from your dusty luggage you arrive home still emotionally invested in your previous environment.  For me, I find myself being a bit quiet, withdrawn, hyper-sensitive to sights and smells, and with an overwhelming sense of being "off-balance". 

I often counsel people that I work with to spend a night in a place that is in many respects half-way between the two; a place where they can decompress, have a world-class shower, a solid meal, and slowly turn the lights back up.  Only slightly in jest, a good bottle of wine is also a great help.

Triage Notes

Now a common sight on the Haitian streets.

Not all emergencies are created equal.  The triage area of the Haitian hospital I've been working at is a busy and often ugly place.  An elderly lady is vomiting frank blood into a clear plastic bag, a man has large pieces of his face missing and is bleeding badly onto a filthy rag.  Next to them an agitated twenty-something man sits clutching a slightly angulated little finger… I know it was angulated because I looked REALLY closely.  Mr. Hurt Pinky is motioning for me to treat his finger, his eyes beam impatience and frustration that he is not being promptly taken care of.  "Why am I not at the head of the line?" I don't speak Creole so I point to the lady with the bag-o-blood in her feeble fingers and raise my hands in the international "are you serious?" gesture.  He backs down… for a few minutes.  This is "triage"… isn't that a French word, similar to Creole, that means bags of blood and missing faces come before hurt pinkies?

Not The Sole Providence Of The Strong

 A mother holds her child in one of the hospital's pediatric tents

Again, last night I worked in the hospital's emergency room, my task was to suture lacerations as they came in; I was certainly not at a loss for work.  I trolled the triage area looking for anyone with a bloody dressing; a quick examination and I would usher them into my little work area within the tent.

Sitting on the pew-like benches was a tiny girl atop her father's lap.  She held a stained piece of cloth over her forehead with her own hand.  She couldn't have been more than 5-years old.  As I took a gentle look I silently prayed that I would be able to stick a Band-Aid on it and send her happily on her way.  This was not the case, she had a 4 cm "lac" to her forehead that was going to require a few interrupted sutures.  I cringed at the thought of having to cause this innocent little girl further pain in her life. 

I took them both back into the tent and laid her down on a worn cot so that I could get a better look using my headlamp, often the only light source that we have at night.  She was stoic, unafraid, staring at me with a look of curiosity, almost daring me to assault her bravery.  I wanted to sit a bit with her before I had to inject her with a syringe of lidocaine which is often the most painful part of the procedure.  We smiled at one another, she played with my light, and I patted her on the head.  The interpreter explained to her that it was going to sting a bit, but try to remain still.

She closed her eyes as the steel needle sunk into the gaping wound,  not so much as a wince.  Her face remained calm and passive almost as if she were asleep.  Her bravery penetrated me, this 5-year old girl, in the face of something that would make me cringe, laid there determined to be brave. 

It took only a few minutes to place the three sutures, but not even so much as a whimper.  In the end I touched her forehead and told her "finished"; her eyes fluttered open… a smile from me to her. Little fingers reached up to explore the new dressing.  Her father thanked me and he scooped her up in her arms and disappeared down the dark street.  Bravery is not the sole providence of the strong.

Moments For The Soul

A bit of commotion in the ICU tent early in the evening as some of the American staff were scurrying around.  A young boy, maybe ten or eleven, had taken a 10-foot fall onto the ground; upon further investigation it became a 50-foot fall.  In the center of maelstrom were two Americans, an ex-football player now trauma surgeon and an anesthesiologist; both were desperately attempting to obtain needed laboratory results in order to get the boy into emergency surgery.

An ancient hand-litter was found abandoned in the corner;  the surgeon and I hurriedly carried the boy through the obstacle course of patients, beds, tents, and doorways into the operating room. Along side the litter the boy's father struggled to keep up; his calloused hand resting on the tiny chest. A panicked voice in the dark muttered, "son, son, son" over and over again trying desperately to communicate with his little boy.

To describe the operating room would be it's own post, but suffice it to say the only word that I can find is, "medieval"; only a handful of dim florescent lights, stacks of disorganized supplies, and a few pieces of dysfunctional equipment.  The boy was dying. 

A Haitian surgeon appeared while the boy was being intubated and "put to sleep".  The new arrival could plainly see in the American's eyes that he was "assisting" on this one.   With only a single patent IV line an incision was rapidly made in the little boy's abdomen, fluid erupted from his belly in staggering amounts.  I left, there was nothing more I could do, it was in the hands of the surgeon.

Hours later I learned that the boy had died.  The surgeon, standing by himself in the street's shadows, was clearly alone within his thoughts.  What struck me was the emotional investment on the part of the burly American, a man who likely had faced death and dying countless times in his life. My image of the quintessential 'trauma surgeon', the gods on earth that are the definition of stoic, precise executors of their science/art was immediately burst.  A moment that has become a part of my soul for the remainder of my life.

Rules To Live By

A young Haitian girl stands outside one of the hospital pediatric tents.

There's an art to living on top of people, one which I suspect actually gets taught in naval submarine schools and fire academies.  My existence for this trip to Haiti has been highlighted by the return of communal sleeping conditions to my life, something that I've not experienced since my days in Special Forces. I fear that I've grown accustom to 5-star hotel suites with multiple flat screens and ocean views. Those that know me are laughing right now.

The group that I'm with on this trip is camped out in a small, open room with 15-20 thinly mattress-ed metal frames placed within a foot of one another. My personal space extends from my bunk to 6-inches on every direction; I am the master of my kingdom.

The first and really only rule is to be overly considerate.  Here are some things to think about:

• No unnecessary banging around of things during sleep hours.  Even the slightest rustling of stuff can be annoying to those that are trying to sleep.
• iPods can be heard by neighbors, also typing on keyboards.  Take it elsewhere.
• Be mindful of your neighbor's kingdom… no border excursions however unintentional.
• Keep your things packed and neat. You're not setting up house - it's temporary. 
• Flush the toilet.  Even if there's no water in the tank, that's what the big barrel of water and bucket are for sitting right next to it.  The water goes in the bowl, not the tank. Also, in most third world bathrooms- the paper goes in the trash not the bowl.  Get used to it.
• Learn to love cold water bucket showers. Close your eyes an imagine a tropical waterfall.  It lessens the shock.
• Personal hygiene.  It's not a competition to see how nasty we can all be. Wash yourself, especially your hands as often as you can.
• Pick-up communal spaces, and especially don't leave stuff for others to have to deal with.  Leave it cleaner than you found it. Pack it out baby!!
• Pitch in, pitch in, pitch in.  Someone has to take the trash out and sweep the floors. You know it needs to get done.  Don't ignore it.
• Keep valuables secured.  You never know who will come strolling though your living spaces, and  other cultures look differently upon opportune acquisitions than we do in the west.
• Share electrical outlets.

Watching

I've spent the last several nights working in a Haitian emergency room along side some very talented and caring physicians and nurses.  Last night an unconscious man was brought in by car and carefully laid on a stretcher outside our rain-soaked tent. Dressed in mud-soaked jeans and a worn t-shirt he had simply collapsed while crossing the street. His family brought him to us.  There was no neurologic function, his blood pressure was very high, and his heart rate was slow; all indications that he had burst a blood vessel in his head.  There was nothing that we could do for the man.

The family listened intently as the news was passed through a Creole translator.  They asked if there was some machine that we could put him on, some medication that they could procure that might give him a chance to come back to them. "We're sorry, there is really nothing we can do".  The family went away to get some other clothes so that their father/friend/husband didn't have to die in wet jeans and a soiled t-shirt.

He lay there and I watched.  All night, breath after breath… I watched.  I watched as the man took his last breath, nothing more than a small gasp really.  It stopped raining; I left the tent to get some coffee.

Happines Has Many Forms

What makes people angry?  Lately I've encountered more than my monthly quota of angry people, and have had to endure their rants and raves about everyone in their life that has caused them grief. I listen to stories of liars, cheats, idiots, and thieves as the tellers recount their woes, blaming the world for all of the ills that have effected them.  I attempt to offer counsel, but it's evident that the grieved do not want it.  Instead they're happy to wallow in their own mud hole, as if it gives them a raison d'être; their life is defined by their own anger, they don't seek nor even desire peace.

Happiness, it seems, comes in many forms.  Maybe to some, attention seeking through anger is their form of true happiness, giving them the peace of being surrounded by consoling and attentive "friends". They reach out with their anger like a fisherman casts a line hoping that someone will pay attention and offer the attention that they are looking for. I can't do it. I can't find the compassion within me yet to allow myself to strike at the line and be netted into their world of drama. Instead I ignore, telling myself that this is truly what they need, my inattention is therapeutic for them. That, it appears, is the lie that I tell myself.

Restraint

 A drainage cover on a Chicago street.  Not particularly interesting, but I like the colors.

I know an explosion when I hear one, and that was an explosion. Within a few minutes,  a wail of sirens in the distance as the firetrucks and ambulance approach.  My neighbor's car has spontaneously caught fire and clouds of black, greasy smoke rise above the rooftops.

My first thought is to drive around the block and ensure that everyone is alright, both my medical kit and my camera pretty much stay in my Jeep just for this reason.  When I arrive the fire department is already working on the car, and everyone, it turns out, is just fine.  I watch the blaze, instinctively wanting to reach for my camera but 'am halted by the fear of trampling on the sensitivities of my neighbor. I project myself into his place, how would I feel if my car were engulfed in flames and my neighbor was happily shooting photographs of it?  Yes, restraint is called for; I let my camera lie.

How is my neighbor any different than anyone else that I take photos of?  I make my way into their world, often uninvited, and proceed to shoot their moments of great emotion, loss, elation, pain, happiness, etc.  I'm not good at that, I believe that I'm far too sensitive of others feelings to impose myself.  This is why I would make a lousy photojournalist.

Coffeebreak

 I'm in "my office" this morning known to most people as Starbucks Coffee, and while this is my office, Barnes & Noble is "my church".  I come here to read, write, edit photos, and watch people, the last is my most favorite pastime. 

This morning people are lined up three-deep at the counter ordering every sort of caffeinated concoction, feeding the American coffee culture.  This fascination with coffee is not something that we necessarily share in large degree with the rest of the world.

Many years ago I was living in Santiago, Chile doing the bidding of Queen and country, and in Chile, like most LATAM countries at the time, coffee came in tiny cups that looked like they were part of a little girl's tea set. The Chileans just didn't eat much of a breakfast so the idea of morning coffee was a bit foreign to them.  Coffee was something that allowed them to stay up into the wee hours attending dinner parties.

Down the street from my apartment, not far from the U.S. Embassy (a brilliant idea) a Dunkin Donuts prepared to open for business; this would be the country's first, and I can't describe the excitement that streaked through Santiago's ex-pat community.

On the first day that the shop was open I steered clear because the line was outrageous.  Ex-pats wanted a taste of home, and Chileans were morbidly curious as to what the excitement was all about. From all accounts it was an authentic Dunkin Donuts and the Americans, especially those from the northeast, were beside themselves with glee.

The very next day I made sure that I was first in-line when the door opened in the morning.  I strode in all giddy and excited to have my first massive styrofoam cup in well-over a year of American-style joe.  I placed my order, however the Chilean attendant frowned and told me that the coffee wasn't hot yet, pointing to the urn positioned underneath the brand new brewer.  I politely asked him how that was possible, as "The coffee comes out hot", I exclaimed .  He tapped the metal urn and said, "No, todaiva no".  It then hit me, he had left last night's coffee in the urn and had simply turned on the hotplate and was waiting for it to get hot.  Yea, I can see we still have a ways to go.

Past Mosaics

Oriental rugs for sale 

We went on a 911 call last night to a lady that had fallen.  I let my EMT partner run the call as it was well-within his scope of practice, and I was content to drive the ambulance to the hospital.  Sitting next to me during the 10-minute drive was the patient's brother, an older African American man who struck me as being both very pleasant and very supportive of his sister.

A conversation ensued and I discovered that the gentleman had spent over 15-years working for the U.S. Postal Service, however prior to that he had retired from the U.S. Army after twenty years of military service; that was our common link and became the subject of a short conversation.

What struck me was that my new friend didn't wear his military service nor his time spent in Vietnam on his sleeve.  He confessed that it was his goal when he retired to leave that part of his life behind and to look forward to other new adventures and opportunities.  My friend did not want to be one of those retirees that spent the remainder of his life in the VFW reliving his past; identifying and labeling himself as a veteran for all to see.  He believed that if he did so his entire identity as a person would be contingent on something that he had done many, many years ago and not on who he was today. 

I listened to the wisdom of this man seated next to me in the shadows of the ambulance, and it was as if he were speaking for me as well.  Like him, it was my fervent wish when I left the military; no U.S. Army Retiree baseball caps, no veterans license plates.  It was my life then and now it's not.  It's that simple.

This is not to say that people should not be justifiably proud of their accomplishments in life, but don't let them become your sole identity.  We're all so much more than what we did in the past.  A better measure may be what we are doing right now.

Change

I've changed the template and the layout of the blog, it's the first time that I've done so since it's inception three years ago. I have no eye for graphic design so thankfully there are templates to choose from.

I was never a huge fan of change, but over the years I've come to almost ignore it. Everything changes; not for the good or the bad, it just does. It's not the change that's good or bad, but rather the qualitative value that people want to hang around it's neck. If we could stop evaluating, categorizing, naming, or judging things I think we all would certainly find greater happiness.

Karma At Barnes & Noble

As I was walking into Barnes & Noble yesterday afternoon a young African American woman approached the door at the same time from the opposite direction. She was nicely dressed in jeans, a colorful shirt, and knee-high boots. Just as she approached the entrance a voice cried out in a leering tone, "You're awesome! I'm married, but you're just awesome. Come over here for a second and talk to me". A middle-aged African American man was leaning up against the wall, obviously waiting for someone, but the girl just continued on her way and eventually entered the store.

I felt sorry for her and the the fact that she had to endure that sort of treatment from a complete stranger on the street. Why did the man feel it was appropriate or acceptable to speak to anyone that way? I wonder what he would say if someone approached his wife or daughter like that. "Wow", I thought, "your karma sucks." Then I realized that it wasn't just his. He affects how that woman, and probably countless others, view men, of which I'm included. So his karma is now linked to mine. When I realized that, I opened the door for the woman and apologized that she had to endure that sort of treatment. Can we delink our karma from others? I don't think so. What one person does, affects us all. Please smile at the next person you see, because that guy at Barnes & Noble is going to need all of the help he can get.

Random Thoughts From A Himalayan Cave

Door knocker on the door of a Chicago Chinese restaurant

I've spent the last several days pretty much by myself, which is generally a good thing for me. I'm not a very social person, and would do very well in a Himalayan cave meditating for eight years. To that end, here are some random thoughts.

- I don't like zoos. While I understand the purposes; money, research, and display. I think we as humans can do better.

- BRicks (Bike-Run, ick!) workouts are the bane of most triathletes, and I dislike them as much as anybody, but they're a necessary evil for me this year as my bike-to-run transitions suck.

- I need to go to the zendo tomorrow morning and sit… a lot.

- Matt Damon's Green Zone is a good movie, and I enjoyed it very much. I like Matt as an actor.

- Paramedics need to think clinically and have a good medical reason to "collar and board" a patient. Mechanism alone is not enough.

- Chain sushi restaurants tend to be not very authentic and not very good.

- I like Barnes & Noble's electronic book reader, the Nook very much. I'm an Amazon Kindle owner, but am considering trading up.

- I don't understand why funeral processions have the right of way and are allowed to inconvenience hundreds of people along the route. Certainly this wasn't the deceased's last wish? I want to pass the deceased in my car, not drive over him.

- I need to go fly fishing but the Chattahoochee River is too swollen with all of the recent rains. I'm not a good enough fly fisherman to lure a trout out of a fast-flowing, murky river.

- I need to call my parents.

Just Live A Good Life

I had a conversation with a life-long city EMS medic a while back and we were speaking about traveling. He told me that during his fifteen years of EMS that his one great regret was that he had never really ventured very far away from his native city, certainly not overseas. We exchanged stories over coffee and he confided in me that he was actually envious of my life; that I spend it traveling from one distant land to another, having the chance to see so many places and their people.

I've been down this road before and cautioned my friend that everything has it's downside. He looked at me quizzically as I pointed out that he has the luxury of coming home every night to his family, his wife and kids, never missing a single birthday, a ball game, or a school play. In many ways it was I who was envious of his life, doing what he loved and sleeping in his own bed every night.

As the morning coffee ended I think that each of us realized that we were both doing exactly what we wanted to do, however no life is perfect. Everything has it's upsides and its downs, and not everyone's DNA is programed to explore the world and conversely not to remain static. Each has it's own goals and aspirations, neither bad nor good, just to live a good life.

Chicago

Chicago-style houses. What a great city!

I spent a few days in Chicago this past week, a city that I don't have a lot of exposure to. I made it a point to walk around a little bit and explore with my camera. I wanted to shoot in RAW, which is an uncompressed image file direct from the subject right to the data card on my camera. The RAW files are large, but have a lot of detail, and I wanted to see the difference between RAW and JPEG. I also played around with some other settings on the camera, as well as the new version of Apple Aperture to edit. The result was 120 shutter snaps and six shots that I edited and liked, well below my average. Maybe I'm becoming more selective.

I enjoyed Chicago immensely, it reminded me of a much bigger Boston, as city that you really want to walk around and explore. I was impressed with the number of athletes there, the running and biking trails were full of early-morning athletes braving the frigid downpour. I need to come back again.

My Path

I got an email from a wonderful friend of mine the other day asking about Buddhism. I typed my response to his questions, and later thought that it may, in some way, assist others that had similar questions. I'm by no means an expert, so your mileage may vary.

Zen, or more generally, Buddhism is many things to many people. For some it's a religion, for others its a personal philosophy. The great thing about Buddhism is that it doesn't care one way or the other. No one will ever tell you what to believe; this is right and this is wrong, this is good and this is evil; Buddhism lets you make those decisions for yourself.

As far as books, there are a plethora; most of which are very ethereal and difficult to understand for the brand new lay practitioner. Having said that, my favorite book in this whole world is Lama Surya Das', Awakening the Buddha Within. I read this book every year, and while Surya Das is a very practiced Buddhist he only uses Buddhism as a framework to find greater spirituality in one's life. So it's really applicable to everyone that is seeking. Surya Das' book serves as a great primer for Buddhism and how it can fit into and augment your daily life. That's my number one recommendation.

As stupid as you may think it is, Buddhism for Dummies or Idiots is a good book to sort of help you make sense of the larger things that you may see or feel. In other words, what is the difference between Soto Zen, Rinzai Zen and say Tibetan Buddhism? It helps you understand the major muscle movers.

I'm just back from Haiti, now working on the ambulances for a few days before I jet off to Mexico for a few months. Good luck in your search.... I hope that you find nothing (Zen koan).

-eric