Wednesday, November 23

Thank You For Your Service?

This Thanksgiving it is important to reflect on what we are thankful for and what we take for granted.

"Thank you for your service." We hear this term a lot in recent years as we see more and more soldiers coming home from serving abroad.  It carries with it a sense of honor that someone would volunteer to stand where I choose not to.

Some use it as a quick excuse to get out of an awkward situation.  You see someone in full fatigues at the airport or grocery store and you respect them, then they head your way.  What can you do?  "Thank you for your service."

I haven't used the phrase myself, finding it as useless as the "Thanks for taking my call" that starts most radio caller diatribes.  It has almost become required without being required, if you catch my drift.

When I see a Soldier, Marine, Airman or other armed service member traveling through my airport I always stop and offer assistance, either with directions, a call to the USO center or even a cup of coffee.  I address them by name if I can see it and refer to them by rank if I can.  When I am nearby and someone casually says, "Thank you for your service" then continue on I can see the awkwardness in the service member's face and body language.  What do we expect?

"You're welcome?"


Recently I had an HVAC guy come out to the house to give the furnace a once over before winter rolls in.  As he approached the house he saw my car in the driveway and the Firefighter license plate.

"You a fireman?" He asked putting down his tools.

"Yup" I answered and took a sip of coffee.

This fellow in his mid 20s squared his shoulders, looked me in the eye and offered a handshake adding, "Thank you for your service."

I was frozen.  I had no idea how to react.  Not only did I not like that statement, it doesn't apply to me.  Sure I work for a service, provide a service and volunteered to do something few others do, but I'm not a soldier.  Why would he say that?  So I asked.

He told me that he admired firefighters but could never imagine himself going into a burning building or dealing with sick or dying people.  He saw firefighters as an integral part of the community and made a point of saying thank you to each one he saw.

It was that moment, standing in my garage sipping coffee that it occurred to me:  I don't get a say in what he wants to say.

Much like the imagined "War on Christmas" where anyone who says "Happy Holidays" is labeled an enemy of America, it shouldn't matter what was said, but that anything was said at all.  I shouldn't be upset that this person put me in a category I imagined, I should simply say "Thank you" and move on.


When I return to work I don't think my reaction to soldiers I see will change but I will certainly see folks passing by in a different light.  After all, they could have just kept walking, not saying anything at all.


It should only matter that they chose to say something, not necessarily how perfect their words may be.

Something to consider this Holiday Season.

Sunday, November 13

A Complete Secondary Assessment

That's what our policies require and it makes perfect sense.  A complete secondary assessment to rule out all known causes of illness or injury to allow providers to make a good faith report of condition to the patient to inform their decision.  We have tools and education to perform this task and it really isn't hard to put it all together.


Or so I thought.


On a call for the syncopal.  This is our bread and butter.  We find the patient pale, a bit moist with his shirt clearly previously soaked through (symptoms for 25 minutes now) but he is alert and oriented and refusing all care.  Being caring human beings we impressed upon him the need for an assessment.  After all, "what if we find something we can treat?  Wouldn't it feel nice for that dizziness to go away and your head to stop sweating?"

Strong radial, irregular, wife says he's got a history.  No chief complaint verbalized but his body is clearly telling me otherwise.  Meds and history paint the picture of an old a-fib but the ECG is showing PACs in II about 7:1.  Clearly something has changed.  The beats that should be irregular are regular...except that one little bugger.  He is calm and normotensive as we begin the chat that will convince him he should be seen by a physician sooner rather than later.  This conversation usually ends with them telling me they are going to hospital and there is nothing I can do to stop them.  Iceboxes to Eskimos.

The transport crew arrives and I ask them to set up the cot while we run a 12 lead and give a brief report.

"But he isn't having chest pain.  We don't need to run a 12 lead."

I was told later that the glare I shot him was visible from the space station.

"We need to get a better picture of what's going on as we have sudden onset syncope with an abrupt change in baseline ECG.  He is clearly no longer able to maintain homeostasis and we owe it to him to look for anything and everything we can to paint a clearer picture for his continuing care."

I didn't say that to the medic, I said it to the patient's wife who was standing nearby.  She seemed suddenly concerned and I was able to put her at ease.


Later, down at the ambulance I had a chance to speak to the transport medic.

"We don't run 12 leads on non chest pain patients, it isn't in the protocol.  Besides, he said before we got there he didn't even want to go."


I followed them to the hospital and assisted with the hand over, then helped the EMT reload the cot.  As the medic came out we discussed the importance of a complete secondary assessment when we can't reliably determine the cause of the chief complaint.

"He didn't have a chief complaint."

"His body sure as hell did.  Quit trying to pretend you're just here to push Epi and instead use your tools and education to find the cause of your patient's illnesses.  Assess, diagnose, intervene and reassess.  Just keep that wheel turning.  OK?"

"We don't diagnose."

Lost cause.

Friday, November 11

the Crossover Episode 81 - Let's Talk Politics!

crossover logoIn this week's episode, HM and MC talk politics! You know, that thing no one's supposed to talk about. (Stay tuned...because next week they're gonna talk religion!) #Sarcasm

Although, listen to the show and find out why that would not be as totally shocking as you hope it would be!

The guys discuss the outcome of the Presidential election and the amusing aftermath. SPOILER ALERT: Neither HM nor MC voted for Trump...or even the same candidate...and they're still friends!

The guys also touch on some of the most ridiculous propositions on the California ballot and MC goes on one of his epic rants about Prop. 57 and how it's a completely epic shit storm of stupidity.



On a related note, we talk at the beginning of the show about "the third rail" and how the idea of the phrase is to not touch the electrified rail or you will be electrocuted.  Fair enough, but if we don't touch it together (You just read that in Ryan Reynold's voice as Deadpool didn't you) we can't get anywhere.  Unless the train touches the third rail it just sits still.

The start to a civilized, open discussion is to know where the other person is coming from and to respect their beliefs and viewpoints.  I don't mean accept it when your partner tells you they think the new McGuyver is the best TV ever, understand that you likely won't sway their opinion, but at least you know not to bash mullets.


Talk to your coworkers in a civil manner and everything will be fine.  MC and I differ on so many big topics, we talked about it early on, agreed to disagree and wouldn't you know it, everything went fine.


I'll leave you by paraphrasing our closing remarks and the Bible:

"Whatever, dude.  Just don't be a dick about it."