Chapter 3

We've all seen them, those crusty old paramedics who've been in EMS since it was established in the 70's, cantankerous, grouchy and for the most part highly opinionated on "these young bucks" coming into EMS. Some have made the transition to management, but some for what ever reason, have remained in the trenches, or on the trucks, still pulling calls, and keeping us in our place.

These guys deserve respect no doubt, but sometimes being in close proximity with them is a challenge. They have given their lives to promote the profession of EMS, and have a wealth of experience and knowledge. Unfortunately, some of them are resistant to any and all change, and are quite vocal in their protest; such was the case with a medic I'll only refer to as Dee. This is his story.

"You don't know nuthin bout no cardiac patient ... I ran the furst damn cardiac call ever run in dis county..."

He glared at us over his glasses, mumbling about young pups thinking they knew all about cardiac. We'd been discussing an earlier call, rehashing the treatment given and the overall outcome of the patient. Someone had mentioned how much they loved the 12 lead EKG and this had been the straw that broke the camel's back.

But first, let me introduce you to Dee. He had started in EMS in the early 70's at the age of 20 and had never done anything else. It was his life, his passion, and his profession. He'd gone through paramedic school before I graduated high school, and was the oldest member of our company. Dee was highly thought of throughout the county, and while we all loved him, there were many occasions where we would have cheerfully choked him to death just to shut him up. In fact, it had even been suggested if you looked up "grouchy bastard" in the encyclopedia, it would have his picture, social security number and home address.

His knowledge was immense, but so was his ability to come up with the most off the wall "facts" which he threw out as truths. Often, his facts would leave you wondering whether to laugh or cry, or check him for signs of a stroke. His facts were always preceded by his pet declaration, "You don't know nuttin bout..." After which he would proceed to offer some of the wildest theories, and defend them till you gave up simply from exhaustion.

We were standing out in the ambulance bay having a smoke and talking about the 12 Lead EKGs, mentioning how they were an asset, and how they simplified some of our calls. Someone commented on the fact that they could analyze the more difficult rhythms, which due to their chaotic baseline, were hard to visualize. Suddenly, like the wrath of GOD, came the following declaration.

"You don't know nuttin bout no cardiac patient, you don't need no damn monitor to analyze a damn rhythm. I can tell what rhythm they in by just palpating they pulse!"

There was a stunned moment of silence; we looked around at each other with wary eyes. We'd heard a lot of wild statements, but this one was near the top. We waited, and here it came.

"I can feel your wrist and tell you what rhythm you in" he said, he reached over to me, "Come here Duke, lemme see yo wrist."

He grabbed my wrist and placed his finger on my radial. He looked at his watch for a moment then said, "You in a normal sinus rhythm at bout 82."

One of our EMTs said, "Well no shit, I can do that, but what about A-fib, or V-tach?"

"Or Multifocal atrial tach" asked one of the paramedics, "can you palpate a wandering atrial pacemaker?"

Dee gave us all a glare, "you might have a number, but ya'll all still a bunch of damn rookies. I know what I'm talking bout." He walked over to the rescue truck and leaned against it, still muttering. "Bunch a damn smartass youngins"

I shouldn't have done it, but it was just too tempting, so I grabbed Dee's wrist and palpated his pulse, then stated, "Damn Dee, you're in Sinus Tach," then I switched fingers and said. "But let me verify it in two leads!"

Everyone started laughing as Dee snatched his hand away and stormed back inside, "Shut the Hell up Duke".

On another occasion, one of our paramedic students was prepping for a test by reviewing the drugs in the drug box. He sat looking at each drug as he removed it from the box, telling himself the dosage and the specifics on administration, dangers and such. Dee was sitting on the couch watching the races, occasionally sending a glare towards the student.

Anyone familiar with Lasix, a common diuretic, knows that it can't be administered rapidly because it will cause tinnitus, or ringing of the ears and can permanently damage the auditory nerve. However, this fact or rather part of this fact had escaped the student's memory. He looked at the box, and correctly stated the dosage, but couldn't remember why it was administered slowly.