“She says she can’t walk,” one of the firefighters told me.

“That’s because she can’t,” I replied.

I heard the wheezing from the front door. The fire company had arrived first, a call for an eighteen year old with difficulty breathing and a peanut allergy. She was in a bedroom, sitting at the edge of the bed, panicked look in her eyes and truly struggling.

“Brian, get the chair. Somebody put her on ten liters with a non-rebreather.”

Somebody had to be in charge, may as well be me.

“Do you have an epi-pen?”

She shook her head yes, then no. I figured she had one but it wasn’t with her. Her throat was closing up fast, she became even more panicked. I drew up .3 mg of 1/1000 epi from a vial and administered it into her triceps area. The first sign of relief was in her eyes. Then the wheezing subsided a little. We carried her out tho the rescue, I gave her a little more epi and her pulsox went from 83% to 95%. She started to cry. I can’t imagine anything worse than not being able to breathe.

I spent ten years fighting fires in Providence. I’ve been in charge of an ALS Rescue for almost ten. Believe it or not, there are a lot of firefighters who have been around a lot longer than me. It can be intimidating responding with these people, especially the thirty plus year fire eating ems hating firesaurases.

It doesn’t matter if you have been around as long as me, or are brand new; somebody has to be in charge of patient care, and it may as well be you. The firefighters, even the old timers respect competence. They do EMS but don’t love it. Some don’t even like it. They want you to take over, and they appreciate the people who can.

We took the girl to the ER for further observation and an evaluation. The fire guys didn’t show it, but they felt the same satisfaction I did. Not much beats a possible life saving intervention.

It must be easy sitting in the office, reading the report stating the case against sending ALS units to care for intoxicated people, and rubber stamping the same old “change of mental status requires transport to an emergency facility” response on the paperwork. Day after day, week after week and year after year we respond to the same payphones and street corners for the same intoxicated people. One dies, another joins the party. It’s the circle of life on the streets of Providence.

I’m sure tomorrow’s report will stand out, the one that reads about how a guy was struck by an auto in front of the station where twelve minutes ago the rescue was set to a pay phone a mile a way for “a regular,” who claimed he was intoxicated and wanted detox. It was his third such call in the last twenty-four hours, hist fortieth this month and well over his hundredth this year.

It’s a little different sitting in a quiet, safe, warm office reading about delayed responses, and traumatic head injury, and trauma codes than it is to leave an intoxicated patient at the ER, paperwork half done, and fly toward the radio report of a guy your age fighting for his life while the nearest ALS unit is tied up, and that ALS unit is you, then arriving on scene, 1oo yards away from the door you left twenty minutes ago to get the same old drunk and seeing a twenty foot blood trail, and at the end of that a crowd of horrified people standing safely away from a crumpled form with his head smashed, his larynx crushed, his teeth lodged down his throat and his eyeballs popped from their sockets. His respiration’s are down to six, his BP is crashing and he needs to be in the operating room, NOW.

It’s not easy wheeling that guy, now a trauma code past the same old drunk sitting comfortably on a stretcher in his nice warm bed for the night, and knowing he “doesn’t give a fuck”,” because he tells you so every night, and knowing the report you plan on sending to headquarters will look nice and pretty, and end up in the pile of all the others trying to make sense of all of this.

It just wouldn’t be right to use the report I had started in the rescue, the one covered in the victims blood and brain matter, and send that one upstairs. Or would it?

I tore it up and started a new one. It looked nice and clean when I was through.

Dave from Engine 10 carried her up the hill. She and her dad were supposed to go down together, but the little devil couldn’t wait. She pushed, and away she went, speeding down the hill that I used to speed down some forty years ago.

A four year old girl has no idea of the danger that waits around every corner, and at the bottom of every hill. Usually, we skate past those obstacles and never even knew they existed. Not today. Today, she slammed into a tree, and her wild ride abruptly ended.

“If you are not young and wild, you will never be old and wise.”

She was done crying by the time we got her to the rescue. A witness described the collision, said she was stunned for a minute, but cried immediately, and got up and looked around, presumably for her dad who was running down the hill after her. Crying is good. Great actually, especially when the injured child does so right after a traumatic head injury.

When I was a kid, a girl my age took a wild ride down a hill near the Warwick Police Station. A root from an oak tree had somehow gotten dislodged and stuck strait in the air. All day long sledders went past the root, around it, maybe even over it. Not not this girl. She somehow fell on top of it, chest first. Her ride ended there, no crying from her, but decades worth from her family. I lived across the street from them, they never fully recovered.

They closed the hill to future sledders. Nobody wanted to sled there anyway.

I thought of that little girl whose life ended on the barren hill in Warwick while treating Maria. She didn’t speak English, but her seven year old brother did and was able to let her know what was going on. I don’t think he could have ever translated the thoughts that ran through my mind as I put the cervical collar around her neck and secured her to the backboard.

It was quiet the week before Christmas. Too quiet. A gift from the people of Providence, a glimpse into what should be. People were busy with their lives, shopping, preparing the house for guests, anticipating the holiday. There was no time to waste, and they didn’t bother going to the emergency room for minor ailments.

Here at Rescue 1 our calls went from about seventeen a day to ten or eleven. At the ER’s the waits were down, spirit up and the places allowed to operate the way they are supposed to. People were happy, and it wasn’t from Christmas magic, it came from a much more simple place, a place where the EMS and emergency medicine systems were allowed a break, and some sanity.

Policy didn’t make it happen, or some new program. It just happened.

New week, same old system. Seventeen calls yesterday. The ER’s were packed with irate people, waits back up to five and six hours plus. Five of my patients were women in their thirties, lying in bed when we arrived, claiming weakness and inability to walk. Three or four vomiters, a headache or two, some kids with fevers, the storm related fender benders and a real emergency or two.

Those people got the cheese. They should have gotten the best care available, by people eager to help them, rather than tired, cynical parts of a broken system on the brink of collapse dragging them to an emergency room staffed by overworked, unappreciated and overwhelmed employees.

I had a lady , call number fifteen for the shift who called with chest pain at three in the morning. She had a cardiac stent installed two days ago and was released yesterday. She did what she was supposed to, rested, took a nitro then another when pains started and called 911 when there was no relief. I wish I responded with eager anticipation of a job to be done, some help to be given and quality patient care rendered rather than dragging myself through the snow, trudging up three flights of stairs and expecting another helpless citizen. I wish the previous fourteen calls hadn’t broken my spirit.

I hope I’ll still be able to flip the switch from burned out responder and babysitter to a provider of quality medical care when needed. It’s getting more and more difficult as the years progress and the non-emergency responses add up.

In an old tenement house in the inner city at ten till midnight a baby wakes, struggling to breathe. When everything his mother tries isn’t enough and her son continues to struggle she calls 911. Ten blocks away the tone sounds at the Broad Street Fire Station, sending The Bullies into the night for another rescue run. They roll out of the bay thirty seconds later, four veteran firefighters, their turnout gear picked up from the floor and taken along, sitting next to them as they speed through the quiet streets. A mile away Rescue 1 leaves the Allen’s Avenue Fire Station toward the same address.

Engine 10 arrives first, a combined eighty years of firefighting experience among them. I’ve known these guys for eighteen years, have seen them at fires, and have worked alongside them. You will not find a tougher bunch anywhere. They enter the house looking for the patient.

A few minutes later Rescue 1 arrives on scene. I copy the report, a two year old infant in respiratory distress. Inside the home I find The Bullies crowded around the little boy, one of them holding the child on his knee, another holding oxygen close and the other two doing anything they can to help. The mother is nervous; she has a four year old with Cerebral Palsy in the next bedroom. She lives alone, the kids father left her when he realized his son “wasn’t right.”

The Bullies bundle the boy up, make sure he has a warm blanket and take him to the rescue while I make sure the mom is okay and the other boy taken care of. He goes upstairs to the landlords house to stay until his family returns.

Inside the rescue the baby has captured the Bullies. He’s still on the knee of one of the firefighters, smiling, enthralled by all the attention. His breathing has improved, his color returned to normal. We get him secured, seat belt the mom and get ready to go. The firefighters leave as soon as they know the baby “is right.” The baby starts to cry. He doesn’t stop until we get to Hasbro Children’s Hospital.

Sleep tight, Providence. There are Saints in the heart of the city, thinly disguised as Bullies.

http://theprovidencefireman.blogspot.com/2010/12/chicago-mourns.html

Tuesday, December 28, 2010

CHICAGO MOURNS…

Chicago mourns for two fallen brothers
As others have before
These occurrences are all too familiar
And I pray there be no more

But just as it’s certain that fires will come
It’s certain that more will die
‘cause there will always be people in peril
And firefighters will always try

They’ll try to save an innocent life
Even while risking their own
They’ll try to rescue another in danger
Though their condition be unknown

There’s no such thing as a vacant building
When arriving at a fire
They treat each one as if it were occupied
And the odds rise ever higher

As the homeless overfill our shelters
And they have nowhere to go
Turned away to fend for themselves
No plan for the overflow

Vacant buildings become makeshift homes
For those who have no voice
Trash fires for heat on wooden floors
For those who have no choice

These are the people firefighters seek out
When entering for their search
It matters not what they once were
A residence or factory or church

This happens every day for firefighters
They assume there’s someone inside
Be it Worcester, Charleston or another city
Opportunity and risk collide

These two brave firefighters from Chicago
Have paid the ultimate price
So until we can stop it from happening again
Our respect will have to suffice

Lt. Tom Kenney
Providence Fire Department
12/27/10

Thank you, Tom.

She sat on the stretcher, security guards to either side, swaying back and forth, arms crossed in front of her. I barely noticed her, even though she was the only patient there. My patient, a forty year old lady who insisted crabs and spiders were crawling all over the floor and trying to go up her legs was triaged and already on her way to the D-pod, where psych patients go. It was 0630, the end of a long shift.

“I’m beat,” I said to the three folks at the triage desk, who looked equally exhausted.

“Me too, and the kids are on vacation,” said one of the nurses. “No sleep for me.”

“Give them Benadryl,” I offered. “That’s what I did when I came home hungover.”

“Yeah, Benydril,” said another, agreeing with my demented philosophy on child rearing.” “Drug them up, and put them to bed.”

“I tried that but it just speeds them up, they get crazy.”

“More Benadryl. Put it in their cereal, they’ll never know.”

“You people are sick!” said the patient swaying on the stretcher.

Patients. They just don’t get us.

“We’re not serious,” I said to her.

“Now you’ve done it,” said one of the security guards, shaking her head.

The patient started ranting and raving about men, and what idiots we are, and how her daughter, age twenty-four is now an “escort.”

“And guys like you!” she pointed at me, “are the ones who use her. Married old men having sex with my baby!”

“Him?” said the pretty, hot,  Hispanic security guard, herself barely twenty-four.”

“Not him. He’s way too Vanilla.”

Vanilla? What the heck is that supposed to mean?

“I’ll have you know I’m perfectly capable of hiring a twenty-four year old escort.”

Now I’m defending myself by professing my ability to be a creepy old pervert.

“Vanilla isn’t bad, it’s just, well, Vanilla,” said the hot security guard.

Vanilla. I’ve been called a lot of things in my day but this one takes the cake.

The psych patient was already in the nut house.

Sorry to inconvenience everybody, but I prayed for a miracle so the Captains test would be delayed.

Prayers answered. The test is next Tuesday. I have to study this time or cold and snow will be a welcome respite from where I’ll be headed.

A deal is a deal.

Thanks again for all of the support concerning Night and Day. I’ve done everything I could, time to sit back and let it happen. Or not…either way it’s been an incredible ride!

Letter to the Publisher:

Hello Tony,

I’ve accomplished a lot, have generated legitimate excitement about a new book and hope we can move forward. I would very much like to put my mind at rest and concentrate on setting up interviews and reviews on a local and national level, which I will do once I know we have a deal. Please let me know where we stand, and have a great Christmas!

Borders-                                              600
Books on the Square-                     100
Brown University Bookstore       25
Dr. Ken Williams                                12
Dr. Francis Sullivan                          50
Blog Readers                                      200
Local 799                                              25
Providence Firefighters              100 (conservative estimate)
Local Indie bookstores               100  (conservative estimate)
Barnes and Noble                          unknown
Amazon                                             unknown

Total to date                   1212 with three pretty big unknowns. I’ll buy the last 288 if I must, but you had better give me a good discount!

Best,

Michael

“Who, are you!”

“I am the Ghost of Christmas Present. And you are a weird little man!”

He was small, but looked tall, dressed in a flowing robe, standing by the pay phone, a bottle of wine cleverly covered with a brown paper bag in one hand, a box of Chicken McNuggets in the other.

“And why did you call me?” I grumbled.

“Because I am intoxicated, and you are not! Come with me you miserable creature, I have only one hour to spend on this puny little planet!”

“Fine then, be done with it,” I said, and tugged his robe.

We sped through the city streets toward our destination. I sat in the Captains seat, trying to ignore the apparition before me. He watched me, wise eyes shining, and laughed heartily as we bounced along.

“You don’t even see it, do you?”

“What do I not see.”

“Life man! It’s all around you, and it’s passing you by. Look at me! I have nothing but am full of the Milk of Human Kindness!”

“You’re full of something, that much is true.”

“See outside these windows!”

He pointed to the rear of the truck, through the dirty glass. Lights blurred past, white ones, colored ones, some blinking some not.

“Tell me what you see.”

“I see a bunch of morons who can’t afford to put food on their table putting up stupid lights to celebrate something they cannot pay for!”

“You cannot “pay for” happiness you wretched creature! You sit there, on your throne of discontentment and judge these happy souls, these brothers and sisters who want nothing more that the chance to work, and be with their families, and put a goose on their table at Christmastime. And you wallow in self pity, and wish you could do more, and have more, and spend more so that your own family will appreciate you! Good God, man have you learned nothing! Life is passing you by, and you are letting it!

“I’ll have you know, I am a man of utmost character, well respected in the community! And you are a bum!”

“A bum I may be, but my soul is light from the knowledge that my fellow man is good, and generous and kind. I am not weighed down by the chains you have forged these forty years passed. You see no cell phone, no vehicle to pay for, no mortgage to tie me to this existence.”

He passed the paper bag toward me.

“Now drink, man and know how it feels to be free!”

He’s sitting on the toilet in his underwear, and he’s dead.

“When did you last see him?” I ask the lady who greeted us at the door.

“Five minutes ago, he got up to ho to the bathroom.”

He’s old, and frail, his skin so dry it flakes into the toilet when I try to rouse him. There is no pulse, but he’s warm. Small chance, but a chance is a chance.

“Harv!” the lady shouts from outside the door. “Harv! get up!”

It takes a minute to get him off the toilet, onto a board and compressions underway. I decide to work the code in the truck enroute to the hospital.

“Take him to the VA!” his wife shouts as we carry him out, “his doctors are all there.”

A guy about my age shows up as we carry his dad out. I explain the seriousness of the situation to him and tell him we’ll be going to the closest hospital which is far better equipped to handle sudden cardiac arrest.

“Do you have an ID or medical papers handy,” I ask as we pass him. He says he’ll look.

Five minutes into the code, the man’s wife tells us to stop pounding on her husbands chest. We are nearly at the hospital now, two shocks administered along with an amp of epi.

“I have paperwork!”

“Keep going,” I tell the guys who want to stop as much as I do.

“Stop!” says the wife from the front seat.

It’s 0300, the ER is quiet. We wheel our patient in, and directly to the code team. One of the doctors asks, “What’s the story?”

As quickly as I can I give the time table, vital signs and our interventions, then put the folder that was handed to me half way there on the triage desk. Inside is a half finished DNR report, along with a Comfort One bracelet. Also, records indicating the man is a stage 4 lung cancer patient who wanted to die with dignity, at home.

He didn’t.

I really can’t wait for this shift to end.

This time, I’m going to make a difference. Everything is working, the family called 911 five minutes after the symptoms began, Engine Company 11 arrived three minutes after that, oxygen was administered immediately, vital signs and neurological function assessed and a report transmitted to me.

This time, everything is going my way, the family has her medications ready, the stair chair is assembled, the patient lies in bed, unable to speak, eyes fixed to the right, facial droop, nothing on the left side. I’m not waiting, I don’t care about my back. I’m closest, I reach into her bed and pick her up and place her in the chair.

She’s fifty-five. A year younger than my mother was on her last day as a functioning person.

This time, this patient will get to the hospital quickly, and this time the medications that will restore her functions will be effective, and she will regain her mobility, and her ability to communicate, and this time she won’t spend the last nine years of her life in a nursing home, half alive, mind sharp but body unable, days and years of steady decline as the family watches her waste away until eventually the feeding tube goes in, and the light in her eyes goes out, and she dies slowly, a week before Christmas.

Not this time.

This time we are in the trauma room, half an hour passed since the onset of symptoms, and of all the doctors who could have been working, this time it’s the one I like more than all of the others, and she just happens to speak fluent Russian, the same language as the lady having the massive stroke. The doctor is able to communicate with the patient, and calm her a little, and figure out what is going wrong. She calls her mother from her cell phone, and finds the Russian word for “Stroke.” A mother daughter connection in the trauma room. This time everything is going to work out well.

This time I sit and watch, a front row spectator as the fifty five year old lady gets a second chance.She’s a candidate for TPA, which I have seen work miracles.

This time I don’t forget about the patient nearly as soon as the triage nurse signs my report. This time, every time I return to the ER with a different patient I check on her, and watch, and talk with the family, and offer encouragement.

Three times everything was going as well as could be expected, her vital signs were stable, the medications doing their job.

This time she is on a ventilator. Now she’s critical. She had a seizure, and her heart stopped, and they worked a code, and the family is looking at me, and telling me they don’t know what is wrong, and they hope I have some answers.

This time, I don’t have any answers, or encouragement, or much of anything. This time it’s all I can do to get through this shift.

Treatment of Ischemic Stroke

The treatment of ischemic stroke aims to dissolve, remove, or shatter a blood clot that is preventing blood from reaching an area of the brain. The most common treatments forischemic stroke are the following:

Intravenous TPA
This is the first line of treatment against ischemic stroke. Tissue plasminogen activator or TPA is injected into the bloodstream through an intravenous line. TPA travels in the blood until it reaches the clot that is causing the stroke. Once there it begins to break up the clot until blood can flow past it toward the affected areas.

“Miriam.” Miriam is a hospital on the other side of the city. Two other hospitals are closer, one of them less than a mile away.

“Excuse me?” The truck hadn’t even rolled to a complete stop.

“I go to Miriam,” he said, before I even opened my door. He went to the side door of the rescue, pulled the latch and let himself in. I think the kicker was when he put his suitcase on my seat. I hate it when they sit in my seat, even more when they put their luggage there.

“Get out.”

“Excuse me?”

“You heard me, get out.” I reached in and grabbed his suitcase and plopped it on the side of the road.

“This is bullshit!” he said, making no move to “get out.”

The radio on my belt came to life.

“Rescue 5, respond to the corner of Broad and Mitchell for a violent, emotional seventeen year old with a knife.”

Broad and Mitchell is in the heart of my district. Here’s a no-brained if ever there was one.

“On second thought, stay in.” Sorry, Rescue 5,  but duty calls elsewhere.

You have to choose your battles. I threw his suitcase back in and took him to the hospital less than a mile away. Compromise, I told myself. It’s the only way, sometimes.

He wanted detox. Fourth time this week. It was an easy ride.

All this studying is giving me flashbacks…

“I’m sorry , Mam, he’s gone.”

I left my fingers on his ice cold neck, where the carotid pulse should have been to emphasize my findings.

“His heart stopped, probably hours ago.”

“Can’t you do something!” she cried, desperate. “Please!”

Her husband was long gone, at least four hours since his last breath. He was ninety, and from the look of his home and his wife led a good, productive life. My partner was busy hooking up the ECG leads to the patient, I was anxious for him to finish. There is little more definitive that a flat line on an ECG screen.

“I’m very sorry for your loss,” I said, and took my hand off of her husband. I felt as if i were intruding now. The final lead went on, and without looking I turned the machine toward her so she could see for herself. I expected resignation, and acceptance. I got a look of hope instead.

There, in living color was a perfect sinus rhythm, with a barely distinguishable spike after the p-wave.

Whoever invented the pacemaker should have installed an automatic “off” button.

Just when I thought I knew everything, along comes the Captains Test.

It is truly amazing the difference between what we do in the streets and what we are taught. On the street, I act as a social worker, psychotherapist, taxi-driver, peace maker and occasional medic. They don’t teach us how to enter a house full of people speaking different languages, and to figure out how to get the combative intoxicated mother away from her kids and into detox, or the million similar scenarios we walk into nearly every day.

The classroom and all we learn there is a vital part of any EMT’s foundation. Without knowing how the body works, and where things are, and how to fix what breaks we are useless. Without the foundation, the house will fall down.

I’m re-learning a lot of things from those first steps as an EMT. Things I take for granted, such as recognising CHF from the doorway of an elderly patient’s home, or how to treat an “unconscious” person, or the difference between an asthma attack and an anxiety attack didn’t magically appear in my brain one day. It took years and hundreds of real life situations before what I learned in the classroom and how it correlates in real life clicked.

Without experience, I’m useless in the streets. At the same time, without the foundation, I’m just as useless.

And, if I don’t get back to the books, I’ll be a useless old Lieutenant instead of a swanky new Captain!

There are few things I enjoy more during Christmas time than Hotei’s version of John Lennon’s Happy Christmas/War is Over.

I hope you take the time to enjoy it as well.

Merry Christmas!

It’s three-thirty in the morning. A  lady called because she has leg pain from a previous accident. She lives on the third floor. The cynical Lieutenant Morse triages the patient en-route, and decides that she is a drug seeker and will most likely refuse to walk down the stairs. Brian, the ever patient and wise partner stops the truck and goes for the stair chair in the rear compartment.

“We won’t be needing that,” says the wise and experienced Lt. “Watch and learn.”

You would think that after all this time the cynical Lieutenant Morse would know better. Forrest Gump said it best, “Rescue runs are like a box of chocolates…you never know what you’re going to get till you get there.”

We climb the stairs, and there is our patient, sitting on a couch, a cast from her toes to her knee covers her left leg. She looks like she’s about to go crazy. And she’s at least two-hundred pounds.I think she’s been eating a lot of boxes of chocolates during her convalescence.

“What’s wrong?” I ask.

“”My leg! It’s driving me crazy! The itching was too much so I stuck a spatula down the side but the end broke off. Every time I move it digs into my leg!”

She moves to demonstrate, then screams in pain.

“I think it’s bleeding.”

“Brian, get the chair.”

Would a carpenter use his hands to drive a nail into a piece of wood? Or a ditch digger dig a hole without a shovel? Or a painter use his hands to cover a wall?

Of course not! So why do I make life difficult by trying to get away with not using the tools that come with the truck? It’s become a battle of wills, and I’m losing the battle. I’ve wrestled with the same intoxicated people who call us daily while trying to haul them into the truck, my reasoning being that “only sick people deserve the stretcher.”

I’ve spent hours in dingy stairwells “helping” young people who vomited once, and said they were too sick to walk, down the stairs.  Oh, they’ll walk alright, I’ll teach them to call 911 for nothing!

Some people never learn. Others do, but it takes a while.

We put the lady in the chair and carried her out.

She’s a rescue cat. For years I thought she was half squirrel, half cat. Any strange sound and she would suddenly fly around the house then hide somewhere for days. We couldn’t touch her, never mind pick her up. Then I thought her mother and father were sister and brother. She is just weird, we thought. Finally, we decided that she’s  simply special.

Six years later, it’s obvious that she was  abused. And it’s taken all six of those years for her to get better. And she’s getting better every day.

And, she sure makes a purrty centerpiece!

I poured another Stoli for Ozzy, passed it across the table and lifted my glass. Ozzy picked his up and asked what we were drinking to.

“The story I’m going to tell for the rest of my life.”

Ozzy knew. He smiled, and nodded, our glasses clinked, and we drank.

“Cheers.”

We drank for a few more hours, smoked Marlboros and told stories. Not the bat eating, rock and roll madman ones you would expect, rather stories about our families, and life, and being on the road.

It was a warm July evening, 1986, before Ozzy became a household name. Black Sabbath had thrown him out of the band a year or two before, he was on the rebound. I nearly needed a rebound when he walked into the bar I was working at that day. I wasn’t a casual fan, Sabbath had been my soundtrack  through high school and beyond. I felt like I knew the man sitting in front of me, not the rock star everybody else thought they knew.

I was right about one thing, I’ve been telling this story for years.

I spent some time reading some blog posts from years ago, and it occurred to me how quickly I forget the people whose paths I cross. I’m glad I started this, or all of those memories would be buried forever. I’m sure the night I spent with Ozzy is long gone from his mind, probably the next day, but the time we spent together stands out in my mind, and probably always will.

When I am called to an emergency, and do things right, and take care to treat the person who called with dignity and respect, and as a fellow human being rather than a job, there’s a good chance that that person will remember our meeting for years to come, maybe forever, and tell that story time and time again.

There is just as good a chance that if I act like an asshole I’ll be remembered longer still.

this poem i wrote for my father just 3 weeks before he died:

“My Fireman”

Over worked and over tired
You take each call
As if your life depends on it.
Sacrificing time with those you love
To risk your life for the sake of saving others.
You do a great honor to us all,
And instill safety and comfort in our homes.
We put all our trust into you
And have faith that you will prevail and survive.
But sometimes, I’ll admit,
I fear for you;
When you don’t come home,
When you’re out on a call.
Every minute counts,
One small mistake could mean your life.
I lie awake at night and pray,
God keep him out of harms way.
But if you shall fall in the line of duty,
Just remember that you have people here who love you,
And who will honor you as a great Hero.

Brianne Day
May 23, 2006

Yes, Brianne, we do honor you dad’s memory, every day, with or without the pins.

“Rescue 1, Respond to 323 Dudley Street for a fifty year old female with difficulty breathing, visiting nurse on scene.”

323 Dudley Street is across the street from the ER. This is the line in the sand, the moment of truth, the opportunity I’ve been waiting for.

“Let’s go.”

I’m focused enroute. The abuse will stop. Visiting nurses are notorious for turfing their patients  on us, barely giving a report and off to the next one, or home. Not today. I’ve had it. All the way there I prepare my speech. I’m taking this one to the top if need be. The abuse of the 911 system will stop. Today.

We arrive in front of the apartment building. A car is running in front. The Nurse’s.

The truck isn’t fully stopped when I open my door and step out, ready to do battle. I strut into the open door of the apartment, no equipment but plenty of attitude.

On the couch is the patient, just as I expected. The nurse stands nearby, inter-agency report ready and starts speaking. I hold up my hand to stop her.

“The ER is across the street!”

She looks at me, dumbfounded. I look at the patient. Then I see her.

She’s fifty. End stage breast cancer. The cancer has spread to her lungs, liver and brain. Her lungs are full of fluid. She’s struggling. The nurse comes every day and drains the fluid from her lungs, and visits with her, and administers pain meds, and actually cares about her well-being.

The patient is cold, and shivering. Thank god one of us who responded has half a brain, Brian shows up, blankets and the 02 bottle, along with the Blue Bag on top of the stretcher.

We bundle her up, administer some oxygen and take her across the street. One hundred feet or one hundred miles, it made no difference to her, she needed us.

It shouldn’t have made a difference to me. Next time it won’t.

Here are 10 fields (out of 21 major job categories) in which full-time workers are most likely to report an episode of major depression in a given year. But if you want to be a nurse (number four), it doesn’t mean you should pick another profession.

Nursing Home/Child Care Workers
Personal-care providers top the list, with nearly 11 percent of people in this field reporting a bout of major depression. (The rate is 13 percent in the unemployed; 7 percent in the general population.)

A typical day can include feeding, bathing and caring for others who are “often incapable of expressing gratitude or appreciation … because they are too ill or too young or they just aren’t in the habit of it,” says Christopher Willard, clinical psychologist at Tufts University and author of “Child’s Mind.” “It is stressful, seeing people sick and not getting a lot of positive reinforcement.”

Food Service Staff
Ranking just below professional-care workers are the people who are serving the food at your favorite local digs. Waitstaff often get low pay and can have exhausting jobs with numerous people telling them what to do each day.

While 10 percent of workers in general reported an episode of major depression in the past year, almost 15 percent of women in this field did so. “This is often a very thankless job,” Legge says. “People can be really rude and there is a lot of physical exertion. When people are depressed, it is hard to have energy and motivation — when you have to be on, it is difficult.”

Social Workers
It’s probably not a huge surprise to find social workers near the top of this list. Dealing with abused children or families on the brink of every imaginable crisis — combined with bureaucratic red tape — can make for a demanding, stressful job that’s often 24/7.

“There can be a culture that says that to do a good job, you have to work really hard and often make sacrifices,” Willard says. “Because social workers work with people who are so needy, it can be hard to not sacrifice too much to the job. I see that happen a lot with social workers and other caring professions, and they get really burned out pretty quickly.”

Health Care Workers
This includes doctors, nurses, therapists and other professions that attract people who might end up giving a lot without saving a little for themselves. Health care workers can have long, irregular hours and days in which other people’s lives are literally in their hands. In other words, the stress can be off the charts.

“Every day they are seeing sickness, trauma and death and dealing with family members of patients,” Willard says. “It can shade one’s outlook on the whole that the world is a sadder place.”

Artists, Entertainers, Writers
These jobs can bring irregular paychecks, uncertain hours and isolation. Creative people may also have higher rates of mood disorders; about 9 percent reported an episode of major depression in the previous year. In men, it’s the job category most likely to be associated with an episode of major depression (nearly 7 percent in full-time workers). “One thing I see a lot in entertainers and artists is bipolar illness,” says Legge. “There could be undiagnosed or untreated mood disorders in people who are artistic … Depression is not uncommon to those who are drawn to work in the arts, and then the lifestyle contributes to it.”

Teachers
The demands on teachers seem to be constantly growing. Many work after school and then take work home. In a lot of areas, they learn to do a lot with a little. “There are pressures from many different audiences — the kids, their parents and the schools trying to meet standards, all [of which] have different demands,” Willard says. “This can make it difficult for teachers to do their thing and remember the reason they got started in the field.”

Administrative Support Staff
People in this field can suffer from a classic case of high demand, low control. They are on the front line, taking orders from all directions. But they are also at the bottom of the totem pole in terms of control and “everything filters down,” according to Legge. They can have unpredictable days and may not be acknowledged for all of the work that they do to make life easier for everyone else.

Maintenance and Grounds Workers
How would you like to be called on only when something goes wrong? That’s essentially what maintenance people deal with each day. They also have to work odd hours, seasonal or varied schedules, and frequent night shifts. They are often paid little for a tough job that can include cleaning up other people’s messes. “There is also higher turnover. In terms of co-workers, they are often isolated, and it can be dangerous work,” Willard says.

Financial Advisors and Accountants
Stress. Stress. Stress. Most people don’t like dealing with their own retirement savings. So can you imagine handling thousands or millions of dollars for other people? “There is so much responsibility for other people’s finances and no control of the market,” Legge says. “There is guilt involved, and when [clients] are losing money, they probably have people screaming at them with regularity.”

Salespeople
People who work in sales are No. 10 on the list, though there are a whole host of reasons why the job could contribute to depression. Many salespeople work on commission, meaning you never know exactly when your next paycheck is coming. They may travel and have to spend time away from home, family and friends. If they work independently, benefits may also be limited. “This uncertainty of income, tremendous pressure for results and long hours” can make for a high-stress occupation, Legge says.

Do these careers sound familiar? We do seven of the top ten every day. We’re in nursing homes, act as social workers, are directly involved as health care workers, and some of us spend a lot of time writing about what we do.

We teach, and are responsible for a lot af administrative tasks each shift. The station doesn’t take care of itself, we’re responsible for that as well.

Seven out of ten. And people wonder why most of us are nuts.

Get help if you need it. And most of us will eventually, if we haven’t already.