EMSToday, Here I come!

I’ve just booked my flight from the Middle-East to the sprawling, yet surprisingly efficient, Washington Dulles Airport. I’ll be attending EMSToday again. I always get so excited to come out and visit with my EMS family from the USA. As soon at the flight it booked, It becomes REAL!

So, who else is gonna be there this year?



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“…I Miss the Way the Lights Bounce Off the Buildings…”

I work in EMS but I came to it late in life. As such, I have a cadre of friends and a spouse who are, emphatically, NOT in EMS. This usually means I don’t talk about my day at work around the dinner table and, more commonly, I never answer truthfully when someone asks me, "What’s the worst call you’ve ever had?"

The other part about coming to this line of work later in my life is that I really know that this is what I want to do. This is what I LOVE to do. Day to day, my job is the best job for me. I’ve come to assume that I will always be a paramedic. I take it for granted that I will always be the "go-to guy" for anyone with an emergency.

My friend, Ambulance Junkie, shows me what a fool I am. He loves this job as much (if not more) than I do but, due to the fickle assault of fate, he’s been sidelined for almost a year. I met him in person at a conference and, even though he was waylaid by his physical limitation, he was (and still is) all fired up about what we do. He’s made me realize how much I’ve taken for granted the ubiquity of my work. A single colony of bacteria, careless driver, poorly designed house or, even, a meteor strike, could take away my physical ability to pursue one of the four cornerstones of my personal happiness: (Sail boats, Play Music, Good Lovin’, Be a Paramedic).

My favorite junkie is so very eloquent, though:

I know it may seem strange for anyone who isn’t head over heals[sic] about the career they are in. It might even be on the edge of clinically psychotic the excitement I feel about being back on the road one day. It is all the small things that most providers may take for granted which I am looking forward to the most. The patch report to the ER with my signature twang identifier or how my shyness vanishes and I can talk to a stranger asking the most private of questions when in uniform.

Yes, Junkie. We DO take it for granted. Some of the most poignant moments of my professional existence occur when I’m reminded of that. What I deal with as ordinary in my line of work is often the most extraordinary thing that each of my patients have experienced. We also have lovely moments in the mundane parts of our job:

I miss the way the lights bounce off the buildings and catching a glimpse of your flashing rig in the storefronts glass as you pass while driving through downtown. The absence of being involved with a patient is what aches the most for me.

We who do what we do, we paramedics, cops, firefighters, social workers, teachers; all of us who "get involved" would feel so very keenly that absence, were it taken from us.

My current employer is not doing a very good job of making me feel valued but, regardless of who pays me, the job is still the job. And I do love the work. This may be shine left over from Thanksgiving but I am grateful. I do something that makes me feel good, valued and worthy. I’m grateful for the chance to do it.


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No offense

Saggy has left me. He’s been transferred to another region and while I’m still, technically, the senior paramedic in my section, I’ve got a crop of local boys who went to school in the USA but have had less than 10 patient contacts as paramedics since then. I’m now the smartest guy in the room. (It’s become a really dumb room.) My supervisor has apologetically asked me to be a preceptor. 

On this particular day, due to schedule flops and such, I’m working with a guy who used to be a supervisor but now, due to his religion, family name or place of birth (Who knows over here?), he’s now just a regular paramedic. It may look like he’s been demoted but he seems to like how much easier it is to just be a paramedic.  He loves to travel and the first thing he’ll say about anywhere he’s ever been is the best place to eat. I’ll call him "Foodie."

It’s mid-day, mid-work-week and Foodie and I go to an office building for a person who "collapsed." Due to the various languages spoken here and the lack of an organized call-taking system, that can mean anything from having an argument to a full-on cardiac arrest. We, along with our cot (laden with all our kit) are met at the elevator on the 4th floor by someone telling us his colleague had a "Diabetic Stroke."

He’s talking to Foodie so, when I ask, "What’s a ‘Diabetic Stroke?’" he looks at me funny and keeps talking to Foodie. Sarcasm doesn’t cross language barriers as well as I would hope.

Foodie and I find a Western male at his desk who orients to our arrival and answers all our questions appropriately. Foodie seems to be in charge. He was my supervisor in the days of yore but we’ve never worked together before. I stay back and let him take the lead. He does alright. I line up the bags & equipment, take vital signs, set up the glucometer (a computer we use to test how much sugar is in your blood) and otherwise try to be the EMT-B I always prayed for when I was a USA paramedic.

Our patient is a little slow on the uptake but it seems his brain is all there. Foodie is asking a lot of rapid-fire questions but our patient keeps up. He even parses the simultaneous questions that Foodie and I ask him. It’s an old trick I learned from doing "drunk boating" checks in the Coast Guard. Ask someone two questions at the same time or one right after the other. If she/he is impaired (due to alcohol, low blood sugar, concussion or other reasons) then he/she can only focus on one thing.

Our patient is tracking all questions and answering them in order and correctly.

Yes, he’s a diabetic.
Yes, he’s taken his insulin.
Yes, he’s a bit late on his lunch.
Yes, this has happened before.
No, he doesn’t want to go to the hospital.
Yes, he will eat a proper lunch (he’s eating an apple when we arrive).
Yes, he will make an appointment to adjust his regimen.

I look him in the eye. "You know what’s going to happen if you don’t manage your sugar and insulin better, right?" He nods.

"Yep. I’m going to stick a big, huge needle into your arm and jack you up with so much sugar you’re going to feel jittery and hyper for a while." He makes a half-smile that tells me this has happened before.

"You seem like nice fellas." He says to Foodie and I, "But, no offense, I hope I never meet you again. Professionally, that is."

No offense taken.


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Day:Night. Night:Day.

I frequently live in the nebulous, uncertain time between day and night shift. None of my friends know when I’m sleeping.

They also don’t know whether I’m the guy who’s up to "antics" all night.

We often make plans and then discover our confederates have gone to bed. They’re mostly friends of "Herself (Mrs. ‘maddog) and they ain’t EVER been on a night-shift.

At the end of parties, there are some of us (awake) who look around and say, "We’re too alive and awake to go to sleep."

After a bit, we realize we’ve got too many stories to tell before we go to the collective bed.

We make a new confederacy.


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This is just one of the many miserable sunsets I’ve had to suffer while hanging out in Siquijor, Phlippines.



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New Girlfriend.

I found a new girlfriend in the Philippines. Ain’t she pretty?


Get ready for some sweet photos!


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“…it is the one instrument you can’t play and not laugh.”

You ever get a song stuck in your head?

I used to all the time but lately it’s been much more persistent. You see, back in October, I did a foolish thing while I was in Amsterdam. (Not that kind of foolish thing!) I bought a ukulele. Mrs. Maddog and I had met a few friends from the USA in the Netherlands as it was a halfway point between the Middle East and North America. Our friend, Steve, is an accomplished musician. Our wanderings through Amsterdam took us right by The Uke Boutique and we walked right in. After about an hour of messing about with ukuleles, I walked out with a beautiful sunburst blue Makala Dolphin soprano ukulele and a postcard with how to play the basic chords and I never looked back.

Now, I’ve been playing the bodhran (traditional Irish drum) in a music group over here on a regular basis. One of the Irish pubs in a nearby country sponsors a “trad session” where we sit and play music for a few hours in the pub and they feed us free beer. Not a bad gig. I also regularly get together with other expats and have what my Newfoundland friend calls, “kitchen parties” were we get together at someone’s house and play all night (usually drinking our homemade booze and sounding better with each drink!).

With a bodhran, when I’m not accompanying other musicians, it’s not usual to sit around and just play music for my own entertainment. I sometimes do but there’s only so many times you can practice the “Mother of all Jig Rhythms.” Nor do I often find myself picking out a tune that I heard on the radio that I liked.

Well, owning a ukulele changed all that. I can’t put the dang thing down! I found it MUCH easier to learn and play than the guitar and much more portable. I’d hear a song and decide I wanted to play it. One of the first things I decided was I would learn an extensive repertoire of Tom Waits songs on my ukulele because it seemed the most ridiculous to do so (and, I think, Mr. Waits would approve).

So, now I’m playing the ukulele almost all the time. Mrs. Maddog doesn’t even mind when I play in the house. I guess I must be getting good! Or, at least, not so horrible anymore. On my last trip to the USA, I picked up a Kala brand mahogany concert cutaway ukulele with equalizer and pickup (so I can plug into an amplifier and ROCK!!). Again, I’ve not been able to put it down. It’s just too much fun to play and, more so, too much fun to be able to play and sing a song for myself.

The other night, we had some folks over to my place for another “kitchen party” and the usual suspects showed up: RockstarSteve on the mandolin, Julie-U on the accordion, KiwiDoc brought his guitar and amazing bean dip, YoungThomas brought his twelve-string guitar and even by old friend Bruno came by to drink my homemade beer and listen. I’ll elaborate on these “characters” in a later post if I write about them again.

I had a couple songs in my head that I wanted to learn and play for them. They had all heard my ukulele renditions of “Chocolate Jesus” by Tom Waits and “Tell it to Me” By the Old Crow Medicine Show as well as my country-music-styled “Friday I’m in Love” by the Cure. (I only do that one to annoy Mrs Maddog.)

A few days before the kitchen party, I heard “Gravity’s Gone” by the Drive By Truckers come up on my playlist while I was going to work. It stuck in my head. I picked out the chords and played it up. Now I can’t get that song out of my head. It’s not the only song in my head. I’m also a HUGE fan of Michael Franti and Spearhead. His song, “Sound of Sunshine” is pretty much one of the most fun to play on the ukulele. There’s something about strumming away on my ukulele and singing lyrics like:

I wanna go where the summer never ends
With my guitar (ukulele) on the beach, yeah with all my friends
The sun’s so hot, the waves in motion
And everything smells like suntan lotion
The ocean, and the girls so sweet
So kick of your shoes and relax your feet
They say that miracles are never ceasin’
And every single soul needs a little releasin’
The stereo thumpin’ ’till the sun goes down
And I only wanna hear that sound!

Yeah. It’s much fun.

“Maddog! This has nothing to do with EMS. Why are you posting this to your blog?”

Well, it’s something going on with me right now and I find it important. I’m remembering some advice I got when I first started writing this thing from a blogging (at the time) FF/Medic named Clarke Oliver:

Just write about you- all of you, not just the fire dept you.

So that’s what I’m doing. There will be more EMS-related stuff coming up, I’m sure. I’ve been away at training and holiday so I haven’t run that many calls. In the meantime, go out and get a ukulele. As George Harrison said:

Everybody should have and play a uke, it’s so simple to carry with you and it is one instrument you can’t play and not laugh.


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I’m currently taking the 2-week CCEMTP course in the USA. That stands for Critical Care Emergency Medical Transport Program. It’s a big title for a big jump in knowledge and skill. In these 90 or so hours of training, I’ll be absorbing about 30 credits worth of nursing and medical school classes. It’s pretty intense and, at times, overwhelming. Other schools in the USA offer this course as a twice-a-week series over a few months. Since I’ve been flown in from the Middle East and can’t take 3 months for training, I’m in on the “super-intense-you’re-going-to-fail-and-your-brain-is-going-to-explode” version of CCEMTP. It’s made up of 10-hour classroom days followed by 4-5 hours of studying at night, 6 days per week.

Suffice it to say, I’m a little tense right now. I’m remembering some of the stress-induced dreams I had when I was in paramedic school. I might be having more of them as I go along. I told someone today that I’m convinced that I know nothing and, when I go back to work, every patient I touch will die instantly.

We were told that to maximize our chances of passing, we should form study groups. I’ve made one with a few folks I’d like to introduce. Again, I’ll stick to my convention of naming them with pseudonyms. They read my blog so I apologize if I offend.

First up is “Cap’n D.” He’s a certified airline pilot, experienced paramedic, law school student, emergency room technician and one of the nicest, most engaging people you could ever meet. He has the gift of telling good story and he’s ten times smarter than I could ever hope to be. I gain a +3 IQ bonus whenever I’m within 10 feet of him. When he enters a room, everyone notices. He’s charismatic and handsome and looks everyone in the eye. He has a way of making you feel comfortable and, while he’s one of the most interesting people ever, he engages with everyone he meets as if they are the most fascinating person in the world.

When you first see “JJ” with her blond hair, nice tan and deep brown eyes, you might think she’s the party girl you’d have died to meet when you were in college. I think that’s why most people she meets underestimate her from the get-go. JJ has been riding fire trucks and ambulances as a volunteer since she was in high school. She got a job as a Firefighter/Paramedic immediately after she graduated. She’s tough, experienced and has an intuitive, automatic understanding of all thing paramedical. She’s also rides fire trucks like a boss. She keeps us from getting too full of ourselves. Whenever we have a tough time getting our heads around some particularly tricky concept, she seems to find a simple, clear and insightful way to describe it. She claims she doesn’t know much and she’s never afraid to ask questions. Her questions often teach us more than anything we’ve read in a textbook.

The “Evil Mastermind” (“EM” for short) is the least outgoing of our group. He doesn’t speak up much and has a bit of social awkwardness that can be off-putting or charming, depending on how well you know him. When he does speak up, he’s spot-on. His quiet demeanor belies an agile and undeniable intelligence and a vast wealth of knowledge. He’s comfortable to be quiet, I suspect, because he doesn’t feel a need to prove he’s the smartest guy in the room (Which he is). He got his RN (Registered Nurse) but still works as a paramedic. As I get to know him, I suspect he did that for the academic exercise. I call him the “Evil Mastermind” because (and I told him this) he’s so goddamn smart that if he ever decided to go bad, he’s totally be a super-villain.

We’ve studied together, challenged each other’s knowledge, relied on each other’s experience and are becoming friends. Last night at dinner, we set aside our notes and took turns telling the “how me met” stories about our spouses or partners. That was the most fun I’ve had in a long time.

This is the cadre of misfits I’ve assembled as my study group. We won’t be together long but we’ll pack months of experience into these two weeks. As we go along, we are discovering that we genuinely like each other. I’m still pretty stressed out about this test and how little I really know about medicine but, because of my misfit friends, I think I can see the light.


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I usually don’t complain (out loud). It really doesn’t serve to do so as an expatriate, living away from all that you grew to know as familiar. When I do voice complaints, it typically concerns something difficult about living abroad and delivered for the sake of humor.

This time, my gripe is with my home country (and the texbook-publishing mega-business).

You see, I’ve gotten my company to agree to send me back to the US for CCEMT-P course. I’m delighted to have the chance to do some more learning. I’m also a bit nervous about the degree of difficulty and amount of material I have to absorb in such a short time. I’m not going to walk into the class unprepared.

At least I’m trying not to.

You see, there are some great textbooks and an extensive suggested reading list for the course. Were I living in the USA, I’d poke around and find new and used copies of the books and get to it. In fact, I would have done that back in April. However, I live abroad. Shipping here is ridiculously expensive. I can pay $150.00 for a textbook and then pay an additional $200.00 to have it shipped and it’ll take about a month or more. Also, religious-based restrictions on book sales prevent this book from being readily available in this part of the world.

"Gee, maddog, you’re such a prodigious reader. How do you get all those other books you read?"

Well, I have a lovely e-book reader and I download them from the interwebz. It’s all very convenient and easy!

"Gee, maddog, why don’t you download the book you’re looking for?"

I’d love to but it’s not available in e-book form. I’d pay full textbook price for the thing in e-book form, just to save on shipping but the publisher seems too afraid of electronic piracy to put it out. Sigh! Think of the printing costs they’d save. I’m sure it would more than make up for any loss of revenue due to copying and illegal distribution. Get with the times!

"Gee, maddog, why such a tizzy? Aren’t you smart enough to pass the course based on the lectures and material delivered by the excellent instructors?"

No. Simply put, I’m not. The CCEMT-P course is way more difficult than anything I’ve studied to date. Furthermore, there is a financial incentive. You see, my employer is spending a lot of money to fly me thousands of miles, put me up in a hotel, pay for my food, car rental, the course etc. etc.. Basically, the are paying for everything (except book shipping, FFS). Pretty nice, no?

That’s if I pass the course and exam.

If I fail to gain my CCEMT-P certification, I have to pay it all back. All of it, the course fee, airfare, lodging, everything. 

That’s incentive!


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