Clueless in Nashville

   The other day I was enjoying one of my wife's superb, stent-defying breakfasts—scrambled eggs with diced ham and bacon and sausage; hash browns smothered with cheese; biscuits, gravy and coffee—when I foolishly entered engineer mode and suggested we save money by applying basic inventory management techniques to milk, butter, eggs and other life-sustaining staples that are essential ingredients in so many of Helen's enticing recipes. I'm not sure why I intervened in culinary affairs without an invitation. Our Tennessee kitchen has been my wife's turf ever since I cooked a tuna casserole for four that might have served 40 if we'd invited that many accommodating guests with diminished gag reflexes.

   Helen's reaction to my intrusion was tastefully unambiguous. "Why don't you go write something?" she suggested. It might have been a little more urgent than that. So I took her advice and composed this list of other lessons I still haven't learned:

   Buckling up in back. I've been in four ambulance accidents. I remember three of them. I'm told I was supine on the cab's center pedestal after the fourth. I know I didn't start there, and wouldn't have ended up there if I'd done a better job of securing myself in back. I had a patient, though, and must have been kneeling near his or her head. Was I performing an emergent procedure that justified risking my life? Probably not.

   Wearing glasses when seeing is advantageous. I've been nearsighted almost as long as I've been allowed to buy adult beverages. I keep glasses in the car for driving, movies, sports and anything else where I might have to distinguish one blur from another. Sometimes I get lazy.

   Many years ago, after responding with EMS to an autumn house fire, I thought I spotted the volunteer fire chief surveying the scene. He seemed to be wearing a combination of turnout gear and pajamas—not as unusual as you might think, given the late hour and casual dress code accompanying early-morning alarms. I called out, "Hey, looks like you got dressed in the dark," or something similarly inane that was intended only to promote bonding between two guys providing essential services.

   "Well, I didn't have much time," the displaced homeowner answered in a shrill voice, as her "turnout gear" morphed into a bathrobe. I was terminally embarrassed. In my sleep-deprived state, "Sorry" was the best I could manage.

   Gloving up before things get messy. I became an EMT just before PPE became SOP due to HIV and HBV. Consequently gloves, goggles and gowns sometimes occur to me only after I've been slimed. Vaccinations, technique and luck have kept me disease-free—I think.

   I used to carry gloves. I stopped because I rationalized that one pair per call was mostly for show, and wouldn't prevent me from depositing germs on doors, equipment and steering wheels. True, but that's like abandoning exercise when one workout per month doesn't produce six-pack abs.

   I need to wear—and change—gloves more often.

   Waiting to press the Send button. Sometimes I think the E in EMS stands for e-mail. Like many of you, I start the day with 50–100 of them. Volume plus technology minus body language and inflection makes it easy to offend, mislead, overreact and generally screw up at the speed of light. I've tried self-imposing a 24-hour delay before transmitting opinionated text, but usually I can't wait longer than it takes me to eat lunch. I think the solution is to identify provocative drafts, then read them to someone close who's not afraid to tell me I'm "stirring the pot" when I use phrases like "stirring the pot."

   Putting the stethoscope in my ears before I intubate. In medic school we shared a single stethoscope during advanced airway practice. As a matter of expediency, or possibly hygiene, our instructors allowed us to verbalize "listening for lung sounds." That was the way we drilled and the way we tested. My presence of mind about stethoscopes was further diminished when preceptors verified breath sounds for us during practice on real patients. To this day I almost always forget about the steth until I'm prone and holding the distal end of the tube against the patient's lips. I have yet to find a graceful way to don a stethoscope one-handed. I imagine it's easier if your ears are closer together.

   Taking a sick day when I'm sick. When I was in management, most of my employers offered "unlimited" sick time, meaning our salaries would be unaffected by extended illness. Well, sort of. The unofficial, undocumented policy at some companies was that absence is acceptable only when it doesn't inconvenience anyone higher on the corporate food chain. In other words, never. So we worked sick. A lot.

   I know many EMS people besides me who bring illness to work because last-minute replacements are unavailable, or per-diem positions offer no sick time, or we're just stubborn. Whatever the justification, the nature of our work gives us unique opportunities to spread disease. I read somewhere we're supposed to do the opposite.

   Seeking bathroom facilities according to opportunity instead of need. This wouldn't be an issue if we could forecast standbys, problematic refusals and other time-consuming calls—not likely in my lifetime. Guess I'd better work on my situational awareness.

   The list goes on, but the prognosis is clear: If I don't get my act together, I'm risking embarrassment, trauma and disease.

   Hunger, too, says Helen.

   Mike Rubin, BS, NREMT-P, is a paramedic at Opryland in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.