Romeo y Juliet

went to see my first ballet and what a perfect show and perfect venue to pop my cherry. my lovely fiance used to dance as a little girl and for her birthday i got us tickets to see the American Ballet Theatre (ABT) on their winter tour at the Kennedy Center in DC. we checked into the Renaissance M St. Hotel (a beautiful place, i used Priceline and bid $75 on a 4-star and they took it, next time i'll try a touch lower) and got dressed up just in time for our friends in DC to show up for an early dinner. we went to the Blue Duck Tavern on 24th St. and got lucky getting a table. the wait staff and host were incredible and very funny. great place to eat if you go to DC. we then said our goodbyes and jumped into a cab and got dropped off at the front of the Kennedy Center. the performance was in the Opera House, we were seated in box 4 and had a perfect view. a father and his daughter had the front row on the rail and we talked to them after the first act. they left half way through and gave us their seats for the rest of the show. ABT did Romeo and Juliet (it was nice for my first ballet to know the play). Juliet was played by Julie Kent (see above photo and video below) she was very tiny and graceful and did a great job, she had me laughing at parts and holding my breath at others. Romeo was played by Marcelo Gomes (see video below) he was unbelievable. he is a very muscular Brazilian who made a smooth dancer by himself and such a strong base for Miss Kent, she was like a feather in is arms. he was on his knees at one time, Act III, Scene 1, and had her in the air above him and was sitting back on his legs and then kneeling up again. he did this 3 times and it was flawless. the Kennedy Center is a wonderful place and the Opera House is one of the most beautiful places i've ever stepped into. a wonderful experience, but it was DC and that is what always happens in DC. great food, great friends, great show, great people, great cabbies, great city.
Julie Kent

M. Gomes

New York state...

the new Jay-Z song about NYC (Empire State of Mind) has really grown on me. smooth raps by Z and that hook by Miss Keys just flow to make a really great song about the best city in the world. to sit and wonder what it must be like to have the city in the palm of my hands like Jay...damn. so i started to think about some of the other NYC songs that i have liked and i can only think of a couple. maybe if some day traffic to this site increases (why it would, i have no idea) then if you have a personal fav throw it into the comments and i'll put it front and center in some "updates". here's the Jay-Z video:

the next song i love about NYC was on Big Pun's album "Yeeeah Baby". track #5 New York Giants. i have just an ok stock Honda system in my car but this song sounds unbelieveable in it, i can only guess how mind blowing it must sound in a major system. on top of it the song is a great team song (unlike the lame ass Vikings fight song by Prince. love the Prince, but sometimes i'm not on the same page. oh, and lets not even talk about The Super Bowl Suffle). give it a try and buy it and pump it in the car, a must.

the last, but not least, is the Beastie Boys on their album "To the 5 Boroughs". it is track #12 An Open Letter to NYC. New York City, the Beasie Boys....that's all you need to know.

so there you go. no damn "new york state of mind" Sinatra bullshit. NYC and hip hop. East coast.

lesson in common sense #36...

we are going through some changes over the last year and a half in our system. our new boss, appearing at first to be a big talker, has has come through with some very needed changes. but occasionally there are a few knee-jerk reactions to ANY type of "bad press", no matter how poorly sourced and one-sided the editor of the Cheers and Jeers section happens to be. the inability to attack weak local journalism is a shame for such a politically oriented boss.
today i wish to examine a lack of common sense by the Yes-Men he has surrounded himself with. according to our new state protocols we need a blind insertion device (BIAD) for adults AND pediatric pts. a quick explanation of the use of a BIAD:

in case we are unable to perform an intubation via laryngoscope, after 2 attempts we have the choice to throw in a Combitube and go from there. easy to do and has worked perfectly everytime i have used one. it is so easy to use i can show some 18 year old country hick first responder just once, and he can do it right everytime. the majority of times i have seen failed airways is on TALL, heavy black guys who naturally have large tongues (see: Mallampati airway classification)and no necks.

as for a pediatric BIAD, no big deal there. King Airways makes a wonderful product (see above photo) easy enough, just purchase a size #3 and done. keep our tried and true Combitube and add the King #3. but Sadly, No. our system (and now all the city fire stations) go and throw out the Combitube and buy King #3 and #4. the #3 is for persons 4-5 feet tall and the #4 (our NEW adult BIAD) is for persons 5-6 feet tall. notice anything? of, course you did as did every fire fighter i have talked to....what about a person over 6 feet tall?!?! as medics this is sorta a moot point, we now have numerous other choices in case of a failed or difficult airway (Bougie, AirTrack, surgical, etc.) but the first responders now have to bag (using an OPA/NPA, of course) and try and keep a person oxygenated while they wait for us to get to the scene to intubate. a lack of common sense can result in death in a busy system like we run. and it is funny how the people who make a lot of the major decisions in our system are the people farthest from running on an actual truck. not that i think the regular paramedics have the time to sit in all these meetings, but at least try and get their opinion occasionally about product use and need. oh, and to just show how easy it is to place a Combitube in an adult i'll let this crazy German doctor show you....

old dogs and new tricks...

hey, i guess i have to give props to GW. you can teach an old dog new tricks. bush and clinton have joined forces to help the people of haiti. if you haven't given just google them and donate (even if you are just reading this many many moons later i'm sure the people of haiti still need your help). the above image was taken on Jan. 16th, four days after the first earthquake hit the island. now lets see how GW reacted with Katrina....

the hurricane made landfall at 7am on monday Aug. 29. this photo was taken at 11 am. GW was with the man he destroyed in the 2000 race by sending out mailers to the people of South Carolina. the mailers said that McCain had fathered an illegitimate "black baby" when the truth was that McCain and his wife adopted a child. i love how the idea of The Blacks can turn SC into crazy town (yet another reason to NEVER visit SC).

this photo was taken at 2 pm tuesday Aug. 30. GW plays guitar with some douche bag named mark willis. the levees had already failed over 24 hours prior to this photo op. GW then flys back to the fake ranch/staged prop of Crawford to finish his vacation (if you google bush's vacation days you will see he set a record, as of March 11, 2008 GW had spent 879 days in Crawford)

this photo is from wednesday Aug. 31st. GW does a 35 minute fly-by. FEMA's response is still floundering but the 24 hour news keeps the nation informed (one of the only bright spots by the MSM during GW's days in office). later this night Condi would go to a Broadway show, remember by this time she is Sec. of State (Hillary's job now) and gets booed, she went to see "Spamalot".....i can go on for days (what with Condi shoe shopping, "Heckava job Brownie", GW claiming that no one could have predicted the levees would break, GW's mom talking about the refugees in Houston, etc, etc, etc.) but just go to this link to see the national shame that was Katrina.
so i gotta give props to GW today for linking up with The Clenis to be the faces of the US aid effort. but i'll never forget this picture and everything that happened after...NEVER EVER FORGET.

1/2 a baby...

i have delivered one and a half babies in the field (so far). this is the story of my 1/2 baby. i think i was with JH at the time and we got sent to a 24D, baby on the way. we pull up on scene at like 3 am and walk into a back bedroom and there is a lady with a newborn baby on her belly, umbilical cord still attached. we missed it by seconds. the lady's 18 year old sister delivered it and tied off the cord with shoelace per EMD (EMD are the people you talk to on the phone if you call 911). the baby was great, a little tiny naked little baby. mom was fine and sister did a great job. the baby had its first crap and my partner was helping mom clean up some of that oily messy stuff while i clamped the cord closer to the belly button. i noticed him at first but now i had the time to take it in. the mom's 5 year old son was on the bed with her and by the shock-and-awed look on his face he was there for EVERY THING. he had these wide eyes and was just silent and taking every thing in. i finished clamping off the cord and took out the scalpel and looked up at the boy and said "come around here". he jumped down and ran around to me and i put the scalpel in his little hands with the blade up and told him to hold tight. i slid the cord in a sawing motion across the blade and he got to cut his little sibling's cord. as i got the last of it over the scalpel a burst of blood spurted onto his hand and he looked at it, looked at me and threw down the scalpel and ran into the bathroom and i could here him washing his hands. he came back out and we cleaned up mom and the baby, mom hadn't passed the placenta yet, and we loaded them both onto the stretcher and into the ambulance and off to the hospital we went. the lady had gone to L and D earlier in the night with labor pains but they sent her home at midnight with some percocets...oops. the mom was joking with us in the ambulance and was in a good mood right up until we walked into L and D and she got the greatest pissed-off-black-lady face i ever saw. the nurse saw her and said "did we just see..." she trailed off as she looked down at the baby. that was a funny site.

baby octopus and the surgical site...

im with CC lately, he's "bluedotting" with me, and we get a call, 26A, a lady is having problems with her surgery site. i had just ate way too much food. i went to a Chinese food buffet place that is one of the best in town and got a to-go box. i put a lot of baby octopus in it and some fried sweet plantains. my stomach was full. we walk in to her house and she was easily 400 lbs, sitting on the couch. she had a bowel obstruction on 12/12/09 (she went to the ED that day vomiting feces) and over the last month she has been in the ED 4 times having "electrolyte problems". about 30 minutes prior to calling 911 her surgical site on her belly, which was cleared a couple days prior by the surgeon, burst open at one end and massive amounts of puss flowed out. i noticed her pants were wet in her crotch area and just assumed she pissed herself. CC said "let me look at it" so he began to pull her pants down to look and i could see right away from how tight her pants were, she was presenting with a distended abdomen. her belly was very tight and rigid. as CC pulled her pants down to expose her scar/site there was a towel there. he pulled the towel down and immediately a sound like "blub, blub" occurred and bubbling puss flowed up and over the top of the towel. i'm not kidding, a crap load of puss came out, that was what had wetted her pants in the front. i spun around and stepped right outside. luckily the puss didn't smell but i was way to full to even attempt to stay in that room. i stood out in the carport and called for Engine 12 to come and give us some "lifting assistance". as we were waiting for them i just stood outside and talked through the door asking her name, history, meds, allergies, family doctor, etc. and then i just walked out to the truck and typed in all the stuff until E12 showed up. CC stayed with her in the house and got a set of vitals, he could tell i was fighting to keep my food down. i'm usually very good with smells and sights but i was just too full at that specific time. the only thing that makes me dry heave at work is smelly vagina, the kind that is so rotten the smell is seeping through the persons jeans. i have never puked on scene or in front of a patient....yet. we loaded her onto the stretcher and took her to the ambulance and took her to the hospital. i told the doc what was going on and we both agreed we may have found the source of her "electrolyte problems". CC was all gung-ho about seeing the puss again so when the doc looked at it he helped her but i stood outside the room, behind the glass door and watched. it didn't come out like it did at the house and her belly looked less distended. i would have loved to see what her CT-scan would have looked like had anyone in her previous visits done one. lesson learned for when i become and PA in an ED, if someone comes in with a recent surgery and they have electrolyte problems maybe i should take a peek under the scar.

Grand Ol' Party

the modern GOP (1980-present) can be best understood by first fully understanding this recent quote i saw by the General...

...for nearly two hundred years until the Reagan Revolution triumphantly destroyed the Middle Class in the War of Wage Suppression, a war that so far has lasted just over three decades.

the fact that middle class wages have not grown since the 1970's (read the article "Is Our Tax System Helping Us Create Wealth?" by David Cay Johnston) but prices continue to go up. the drum beat of consumerism keeps steady and credit debt climbs per family. the disparity between "haves" and the "have nots" is as great as it was in the 20's and 30's. the modern GOP can still get dirt poor folks to not only vote Republican, but do it with a smile. they can get poor elderly folks to not only fight against health care reform, but scream about social security "privatisation". these people who live and breath by every word Rush/Beck/Hannity sputter into a mic. these people who vote for anything these multi-millionaire talking heads trick them into supporting. and why do they do it? simple. they all have delusions of grandeur, each one thinks "one day i will/can/could be rich too" and that is all they need. is that the key to eternal bliss? a daydream and a powerball ticket. some days i wish i could just shut off and float in the ignorance with them.

clarity in policy...

some of the times i have directly affected policy in our system.
.....1)no fire personel, even the ones who work part-time for us, cannot drive an ambulance in when on the clock at the fire dept. this was 'cleared up' in the summer of '07 when DC and i were riding together. we had just came out of paramedic school in Dec. and they had faith in us to ride together (this was so awesome because we didn't have to be embarassed as we 'worked things out' with pt's and could correct each other). we got called to a respiratory distress, 6D, and arrived on scene without first responders, we later learned they were accidently not dispatched. the pt was sitting in a chair, outside in the dark. as we approached him his wife stated he has congestive heart failure and we could hear the fluid in his lungs as we walked up to him. we quickly got him to the ambulance and his SPO2 was above 90% with a NRB at 15 liters so we weren't sweating it and i placed him on the monitor while DC looked for IV access. but once on the monitor things got a bit different, V-tach with a pulse, confirmed with a 12-Lead. by this time first responders were re-dispatched and coming to us. i worked the v-tach/cardiac issue and DC started running down the pulmonary edema protocol, they actually start out very similar. the pt was not able to talk in complete sentences but he was very calm and was actualy joking with us and we all were smiling as the fire dept arrived. both DC and i were dealing with v-tach with a pulse for the first time and when one of the firemen opened the door and said 'what's up' i didn't hesitate when i saw who it was. i said 'drive' and he jumped up in the front and took us in emergency traffic. the fireman was DM and he works part-time for us so i just assumed it was no big deal to have him take us in. it was very helpful for DC and i and the pt got great care (just an aside, the amiodorone didn't convert him and since he had a semi-good b/p and was c/a/o x4 i called med control. they advised to cardiovert him and after some sedation and electrical therapy he, needless to say, did not want to joke around with us anymore). but within a couple days a new, clear, written policy arrived to let us know that firemen who are responding with the city or a county fire dept. cannot drive us in anymore, and if needed we could call a QRV to drive.
.....2)this year i was driving with JM and we got a call to a child, like a month or 2 old who was very feverish. we got there and the child had something like a 102 fever axillary so we took him and mom out to the truck and slowly started some passive cooling and i thought 'how about some motrin'. so i looked it up quickly because of his age and it said nothing in our little policy/protocol book. JM's wife is a pharamacist and they have some kids, i don't have any. he said they have given their kids motrin at this approximate age, so i thought, no problem. but when we got to the peds ed the PA there said 'don't give kids under 6 months motrin'. ok. as per the norm in our pediatric ed she was snotty towards me, but hey, nothing new. listen, they deal with babies ok? ok!?!? so within a couple days an IM appeared to not give kids under 6 months motrin and a new 'fever' protocol form took the place of the old one.
.....3)this is a bit different but one day i came in and was told to go out a take 103. this is a lead medics area and it is a QRV. working alone, jumping only the serious calls, getting there first on scene, intercepting intermediate crews when they need an ALS intercept, etc....it's all gravy on a QRV. so i go out and in the morning the other shift comes in and i get a sour look when they see me out at 103. by the next night crap is hitting the fan because (in a whining little voice) 'he's not QRV qualified' whatever the fuck that means. i guess back in the day, good medics were rewarded by getting to go out on QRVs sometimes but only after becoming 'QRV qualified'. my supervisor has complete trust in me and is laid back anyway, so i got to go. i even got to be 102 for a couple nights and that really had the other shifts heads spinning. the sad thing was a lot of my fellow FTOs on the other shifts were talking shit, but it was just jealousy. so now CH, DC, LC and i go out to the QRVs whenever there is an opening and other FTOs have come to our shift to work QRVs (if we are all blue-dotting new employees) and no one says anything anymore. the lead medics in our system are a strange lot and i don't have the next 10 hours free to write about all that bullshit.

got my hair did....

looking back at '09 and found this: on April 21st was sent to a severe allergic rxn, 2D. walked into the house to find a black girl, a little plump, early 20's sitting on the floor up against the couch with major swelling to her face and neck and hives all over her arms and legs. the firefighter/first responder alerted me to the fact that he just hit her with an epi pen (one of the only 'drugs' a fireman carries so he was amped up that he got to give it). we quickly loaded her on the stretcher and bolted to the ambulance, the pt did not eat anything new today and did not have any new meds. the only thing she did differently was go to a different hair stylist and got a weave about an hour ago. i looked at her head and saw her scalp was bright red, bam...there's the culprit. got her on the monitor and she was the first person i have ever been able to go down the entire length of the anaphylaxis protocol. gave her 50 mg benadryl, solu-medrol, albuterol neb and she was still swelling and her airway was getting restricted. called med control and gave her epi IV...that was the trick, damn did that not work fast. had never given a person with a pulse epi IV before. the entire time i had a fireman with me and all he did was use shears to cut out chunks of her weave. we walked in to the recess room and the staff felt so sorry for her they made us stop and one of the nurses got very tiny scissors and cut the rest out. lets just say up until we got into the ED we weren't too worried if it was half her hair and half weave.

capitalism and the police state

I am a medic on both the city SWAT/ERT and the county SWAT/SRT. Went on a raid late one night with the city to a ‘gambling establishment’. the guys on the team said that they normally would never raid a place like this, but certain situations were forcing them to act. The main one was that some of the local soldiers, that have returned from Iraq and Afghanistan, have been losing big money at this place and some of their wives had followed them to the establishment. Now the wives are demanding the city to stop the gambling. I may not be the biggest supporter of capitalism, some have jokingly called my a ‘commie’, but when you are making a choice to gamble it should be on that person not the person who is providing the service. And let me tell you, this guy had a beautiful ‘service’. I am so glad I did not know about this place because I would have loved to play cards there. We rolled up and after the 2-3 minutes of action I walked into paradise. The dude who was running it was in his late 20’s, tall, skinny white dude and his mother was running the door. The ‘owner’ had his brand new 250Z parked right up next to the door. Of, course the old lady was having an anxiety attack and after checking her I went inside. The location was half of an auto body shop with a garage door and a large main shop/room with an office area in the rear with a storage closet and bathroom. The owner had the place straight decked out. There were 6 professional card tables with a dealer for each, a pool table in the middle for guys who bust out or were waiting to get on a table, 8 flat screens on the walls, a convenience store cooler with beer and soda in it and a place in the back to buy chips and snacks. It was wonderful, a man’s playground. There were about 40 guys and gals in there playing cards at the time of the raid, a lot of them soldiers (I could tell by all the military ids turned in). The cops zip tied them and searched them and they were all given tickets and sent on their way. If they had a small amount of drugs that was taken and they were given another ticket. Now, this took awhile to go through each person and while it was going on this big thick white dude was sweating at one of the tables and told me he was having chest pain. He was a good guy, he wasn’t giving me any crap, he just was refusing all treatment and stated that he was going to be fine, so I just stayed by him. Eventually he let me check his b/p, he had a hx HTN, and as he began to calm down a little his b/p dropped and he stated his chest pain went away. Now, when the cops gave you your ticket and you were going to leave they walked out with you and checked your car before letting you go. It turned out that the big man had coke, weed and pills (a lot of all) in his truck and that was the reason for his worries. Poor dude. This is a service economy and he was just providing a service to the community. Like I said, if your husband is out gambling all the money he got fighting in Iraq (yes, yes, yes…I know, the wife is at home worried and watching the kids, blah, blah, blah) then as a wife you need to stomp them balls. My fiancé would NEVER let me get away with that shit, she would stab me in my sleep. So, to the wives of those soldiers who stopped a wonderful illegal card game…..shame on you (I know, harsh words, but hey medicine tastes bad sometimes).