Dad On Duty Blog #71

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I’ve done an awful lot of paramedic stuff the past couple weeks. That’s surprising, considering I don’t have a paramedic job, and haven’t for a while.

Sorry, Steve.
{Steve is my medical director, and college roommate, and friend, and business partner. But in this situation he is…my medical director. If I touch a sick person, I do so as his delegate and with his license. So, my sincerest apologies to Steve and his family}

Last week, on a flight back from who-knows-where (since none of my paying work is in this friggin state) I am minding my own business, playing black jack on my iPad (and winning, thanks for asking), when I see a passenger run (that’s never good on an airplane….running) past me to the galley area to get a flight attendant.

The flight attendant runs back with him and then barks to her colleague back up front “code red!”

I figure that’s likely to be something I should go check out. Although another part of my brain is saying “really? ‘Code Red’? That’s some hokey shit. Is the plane on fire? If not, how about ‘hey, somebody is sick…'”

I unbuckle and walk back there. Two flight attendants are nervously fawning over a lady in the window seat.

She appears unresponsive, and grey. I’m pretty interested now. I hear one attendant ask the other “is it a stroke?”

I interrupt. “I’m a paramedic. Can I take a look?”

They part like the Red Sea. It’s amazing how fast people will gladly hand over what appears to be a turd of a situation, if you tell them “I’m a certified turd handler”.

She’s pretty damn sick. No radial (wrist) pulse; fast, weak carotid (neck). Cool, wet skin. Nobody knows anything about her. One flight attendant asks “would you like oxygen?” Yeah, that’s a great idea. He hands me the mask that drops out of the ceiling, hooked to the smallest O2 tank I’ve ever seen. Ok, it’ll hafta do.

At this point, the Captain announces that we are on final descent, and will land shortly.

I lay her seat back as far as it goes, and pull out the tray table, propping her feet up on it to put her in the best shock position I can get in a coach airplane seat. Almost immediately, I can now feel a radial pulse. Her eyes flutter.

The flight attendant says “um, we need you to put her seat and tray table up for landing”. I’m a little cranky. I’ve been traveling, and it’s late. I just turn and glare at him, silently. After a second, he says “ok, you’re good…..”

I tell them to call EMS to meet us on landing.

My patient wakes up. She turns and looks at me. We talk a bit, and I run through my assessment. I hop onto her seat and literally straddle her, so I can see her face and do some stroke assessment stuff.

I remember….for a moment….the intensity and intimacy and…, well, importance…of my old job. This right here. One on one, no one else involved. In the “private room” that we create when we really engage a patient. I miss it.

The flight attendant reappears and tells me “you really need to belt in”. I’m kneeling over the patient, in her seat, checking neuro. I glare at him again. He stammers…”when you get a chance…no problem…”

The patient is doing better after some O2 and OJ. Might have just been a sugar issue. I prepare her for what’s going to happen when we land. She’s thankful and appreciative.

We land and I accompany her off with the FD crew. We meet the medic crew and I give report, help them a bit. I go back on the plane to get my stuff, and the flight attendant stops me to ask my “license number”. I laugh and tell him “that ain’t gonna happen. No idea what my number is, and I stopped carrying my card about 15 years ago”. He replies “I’ll just put ‘n/a’. Thanks for your help”

The next day, I’m working at school. A teacher gets sick and Mary, our school nurse, asks for my help. I help her assess and care for the teacher, who is in tremendous pain. I hand her off to EMS…the second such exchange in less than 24 hours.

A few days later, I’m working off campus at a field trip for our 3rd graders. I do a lot of first aid, mostly bandaids. One girl is brought to me with a diffuse allergic dermatitis. Her dad is with her, says this happens occasionally. She also has environmentally triggered asthma. Similar pathologies. Got it. I check her breathing and vitals, all good. It’s just the dermatitis.

Her dad says “she needs a Benadryl”. Yep. I dig thru the med bag sent by the school and sure enough, there’s Benadryl. I hand it to the dad, who gives it to his kid. I also instruct him to take her to the bathroom and wash her off as much as possible. He does. Thirty minutes later, she bounces up to me and sticks her arms out; no hives or rash. “How do you feel?” “Great!” she replies, and runs off to the obstacle course.

When I return to the school in the afternoon, I relate to the school nurse that I used a Benadryl. She kinda freaks out. “We can’t give medicines!”

And we directly confront the biggest gap between paramedics and nurses. It’s uncomfortable.

First, I was careful to make sure the Dad gave her the medicine; I just supplied it. And, second, actually, yes….I can give medicines. A lot of them. Under broad discretionary authority. State rules and a guy named Steve say so, for me individually. My authorization to treat exists in any situation, anywhere. It is independent of GISD. Whether I stop at a wreck, or help at an event, I am covered. I wrote it that way, and Steve signed it (sorry, again, Steve). But I am cautious, conservative and respectful of my friend and boss’ license, and act accordingly.

On the other hand, nurses generally can’t act nearly as independently in situations like this. Especially ISD nurses. Our school nurse is actually much better trained and more experienced in the everyday stuff we encounter, but is limited in what she can do. I am relatively unlimited in what I can do, but don’t know nearly as much as she does about the pathologies I am seeing among school kids.

It’s a weird situation that could lead to conflict. I tiptoe around it, almost everyday, carefully.

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The boy is sitting, sullen and crumpled, on the edge of the love seat in the hallway. His face dark, fists clenched.

The Boss asks if I will try to engage him, get him to do some stuff. She thinks activity will help break him out of the shell of anger he is in now. She talks with him and tells him he’s going to help me do some chores. He has no interest in it at first; stuck on the incident with another boy that led to this current state. Recounting the verbal exchange, over and over. The Boss skillfully guides him around that emotional rock, and leads him to me. He finally relents, and we head down the hall.

We work on a variety of tasks, and I slowly direct the conversation to the problem at hand; his overwhelming anger.

This boy, like so many others, suffered real trauma and injury throughout his childhood, until very recently. For him, the damage manifests itself as uncontrollable rage. He will most likely never be free of it completely; the physical changes to his brain preclude that. But we talk a lot about things he can do, and the inner dialogue he should have, to help control it. He listens intently and engages me on the topic, much more than I expected. After an hour or so, he returns to the mainstream, seemingly better.

But I’m left wondering; why do some people that are exposed to bad things have so much trouble with societal integration and “good” behaviors, and some don’t? What is the difference between this boy and other people I know, who had similar traumas, who function much better? Do we individually have any control? If so, how do we teach that? Is it luck? Is it choice?

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A few days ago, I attended a planning session for our Field Day.

The entire school is going to a big “ranch” where there are a wide variety of activities and games.

It will be tantamount to invading Normandy; none of us have ever tried to move 600 kids to an offsite location, and keep them safe, hydrated, fed and un-sun-burnt.

The planning committee consists of a teacher from each grade (the team leader), a few additional teachers, and the PE coaches. They have already done a fair amount of work prior to this meeting, and it’s downright impressive. This is a huge operational endeavor, and these are teachers. But they are smart enough and experienced enough in “kid ops” to have put together a pretty darn good plan.

This is a tough spot for me; I am just a volunteer here, and am in no way in charge of anything. But this is my stuff, right in my wheelhouse; large scale event logistics and operations. It’s everything I can do not to jump in and take over; I’m pretty sure if there had been a dry erase board in the room, I would have been completely out of control.

I offered thoughts on a couple of things, but largely listened. I was acutely aware, too, of the differences between how men and women handle planning like this. Other than myself and one of the PE teachers, it’s all women. They talk through the ideas, offering suggestions and ideas, but at the end of the discussion, I’m not entirely clear on what was decided. They obviously are clear, and proceed to write stuff down and go to the next issue. But I’m thinking “so…what did we decide?”

There are a LOT more words exchanged than would have occurred in an all-male Ops planning meeting. A. Lot.

That’s another reason I try to keep my mouth shut as much as I can; I realize it is likely that I will appear downright sexist if I….a volunteer…..suddenly jump up and push the women aside “don’t worry your little heads ladies, me and the boys have this under control”. I imagine that scene in my mind, and it helps me keep my thoughts to myself.

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The grief comes in waves. Sometimes there’s an obvious trigger…thinking about Mother’s Day, or running across items that we brought back from my Mom’s house.

Sometimes there seems to be no trigger at all. For no reason, I feel a swell of sadness. Unpredictable, and uncontrollable.

It must show on my face; almost every time, Amy asks “are you OK?”

Kinda. Not as OK as I thought I was. This is harder than I expected, and harder than I’m willing to accept.

But the grief will find it’s way to you. You can’t will it away.

I remember a key point from prior counseling; grief and sadness is like a sine wave, gradually the waves get smaller and farther apart. Slowly, but surely.

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Third grade took a field trip to a venue with lots of outdoor activities, including a zip line, obstacle course and a high “dive” onto a giant air mattress.

 The venue staff tell us over and over how impressed they are with us; all our kids are in color-coded shirts, we brought our own security (Marc) and our own medic (me). The owner, an ex military guy who spent many years in a dangerous civilian job, tells me “y’all really have your &^*# together”.

I treat a lot of minor boo-boos, but the real challenge is the mud. So much mud. In order to put a bandaid on, I must expend just about an entire bottle of saline wash to uncover the injury.

As we ready for departure, the teachers use their radios to call out their movement toward the busses and their loading status. They have internalized how that shared information makes everyone more situationally aware.
They do it without knowing the terms or theories…they haven’t had that class…but it is now becoming a natural behavior for them. Pretty cool.

On our return, we totally trash the school. A long trail of mud leads from the door, up the stairs to the third grade hallway. It

looks like cattle have come through, after fording a river. The custodians have a much better attitude about it than I woulda.

The kids are tired, but happy. It’s a good day.