Archive for April, 2013

Dancing in Dreamland: The Book

Posted in Confessions of a Mad Philosopher, Dancing in Dreamland, EMS War Stories, Memoires of a Post-Neo Dharma Bum, Metaphysical Action/Adventure, Much Too Good For Children, Possibly Dangerous to Everyone, Zen with tags , , , , , , , , , , , , , , , , , , , , , , , , on April 27, 2013 by dreamlanddancing

Dreamland Dancing COVER ONLY
Dancing in Dreamland
Memoires of a Post-Neo Dharma Bum
Confessions of a Mad Philosopher
Chazz Vincent

Table of Contents
Memoires of a Post-Neo Dharma Bum
One Man’s Meat
About Tonglin
It’s All in the Moment
The Last Raccoon in Central Park
Somewhere Between Nothingness and Eternity
Fun and Games
The Chicken, or the Egg
Nobody calls 911 Just to Say Hello
Why it’s all Fun and Games
Confessions of a Mad Philosopher
Enlightenment is Not the Everlasting Kiss
If you want a Happy Ending
Tigers above, Tigers Below
Clyde and the Tree
Would you die for your Beliefs?
If you should meet The Buddha
Dreamland Dancing
Would You Kill for Your Religion?
(Yet Another Digression)
Would you Live for Your Beliefs?
Form Is Form, Emptiness is Emptiness
The Frog Sings, but Gives no Wool or Milk
Modes of Transport
Special Circumstances
Form is Emptiness, Emptiness is Form
Miguel and Sonja
The Tables are Turned
Neither Matter nor Energy
No Form, No Emptiness
Wheels Down
To Be the Hero of One’s Own Hero
Love and Marriage
Is It Possible to be Afraid of Too Much Truth?
The Mouse eats Cat-Food, but the Cat-Bowl is Broken
A Career in EMS
The Mouse eats Cat-Food, but the Cat-Bowl is Broken
We Judge Others by Their Actions
If All Things Return to the One
Stella Wakes Up
Shark-Filled Waters
Three Hundred Channels…
A Fix-Up Life
If You Are Going to Save the World
War Stories and Fairy Tales
Drug Abuse
Celebrity Quirks and Co-Incidences
High Above the Republic
Real vs. Symbolic Power
Assessment and Report
Perspective as it Influences…
Code Blue on the Ninth Floor
The Tables are Turned
Conservation of Mass and Energy
Meanwhile, Somewhere in Ft. Lauderdale
Love and Marriage
My Eternal Beloved
Real vs. Symbolic
Assessment and Report
Perspective as it Influences your Plan of Action
Code Blue on the Ninth Floor
Life on the Road
A New Wrinkle
The Importance of Re-Assessment
The Cavalry Arrives
Go With the Flow, Don’t Piss Off the Locals
Transportation of the Sick and Injured
Amazing Grace
Comparative Diagnosis
El Hospital
God Gives Us but One Face
World Peace
The Performance
That Which Passes for Philosophy
Good Acting Is Not Bad Medicine
Outside the Box
Memoires of a Post-Neo-Dharma Bum
More Like A Short Conclusion
Would You Die for Your Beliefs?
Casual Criminals
Your Standard of Living
Until You Can Remember
Faces of Death
No Way to Treat a Lady
No Last Kiss
We Own the House of God
Transfer Logistics
Improvise, Adapt, and Overcome.
Logistics, Logistics, Logistics
Or Else
Perpetuate your Illusions
More a Matter of Image Than Principle
Wheels Up
The Point of No Return
Confessions of a Mad Philosopher
Your Entire Life is an Illusion
Who Will Protect Us from Our Protectors?
The Best Justice Money Can Buy
Deconstruction and Displacement
God Gives Us But One Face
Shrimps that Sleep
Something is Happening
Back to Business
Are There Any Beliefs for which You Would Die?
Three Card Monty
You Always Do Everything the Hard Way
The Long Way Home
You’re Not a Real Paramedic…
How Can You Tell?
(More Memoires of a Dharma Bum)
How Many People?
There are Things Much Worse than Death
All Too Often….
The Boulevard of Lost Memories
For Those Who Feel
Your Conscience
Seeking Enlightenment
If You Think Death
One Big Family
Author’s Note
Never Underestimate
The Answer to the Question
The End
The Snake only Sheds its Skin
Is There Enough Heaven?
Is There Life After Zen?
Hellfire and Damnation
Some People Hear Voices
Final Confessions, Rants, Lost Rights, Last Rites and Wrongs


One Man’s meat is another man’s Poison.
One Man’s ceiling is another man’s Floor.
One man’s mate is another man’s Person.
One man’s Princess is another man’s Whore.

Data is not information; information is not is not logic; logic is not truth; truth is not wisdom; wisdom is not beauty; beauty is not love; love is not music; music is not data. (Apologies to Frank Zappa.)

And (inhale)
Five (exhale).
And (inhale)
Four (exhale)
And (inhale)
Three (exhale)
And (inhale)
Two (exhale)
And (inhale)
One (exhale)
And (inhale)
Zero (exhale)
Repeat, prn.
(Zen Breathing Meditation Technique, Tonglin Practice)

About Tonglin

We instinctively cling to joy, and try to avoid sorrow, or anything unpleasant. In the process, we make fearful babies of ourselves. During meditation, while counting down to zero from five as they breathe in and out, many practitioners of Zen Meditation try to breathe out the Sorrow and Pain, and breathe in the Love and the Joy. This is a very good thing, but it is not the only thing. It takes the heart of a true Warrior to breathe in Sadness, Disappointment, Pain, and even Death, and breathe out Love and Joy.

I was introduced to Korean Zen Buddhism sometime during the Nineties by a friend and EMS associate who shared our mutual general interest in Buddhism in general and Zen in particular. One book centered upon the teachings of Tonglin practice. It is called Dropping Ashes on the Buddha. Tibetan Buddhism and Pema Chodron’s The Wisdom of No Escape were also major influences at that time.

In my own experience, first, I meditated about external Sorrow, the Sorrows of the World. Racism, Hatred, Ethnic Cleansing, Fear, Guilt, Shame, Greed, Envy, Jealousy, Intolerance, Malice, Ignorance, and Cruelty swarmed upon me like malevolent disembodied spirits in a haunted house. As I struggled with visions bred by both personal experience as well as news headlines, I felt like I was having my breath sucked out of me, as the really terrifying realization of how overwhelming the personal sorrow and disappointments in my life had become.

I had railed against the Principles and Theoretical Constructs that embodied External Sorrow, perhaps to distract myself from the nature and degree of my own personal suffering. I felt unable to acknowledge any Joy, and as I began to acknowledge the extent of my own self-doubts, it became increasingly difficult to believe or take any comfort in believing that anyone really loved me.

All I could do was try to focus on my love for my children. Fear overtook me again, as I realized that I was far from my own parents, who were not long for this earth. Too many years had slipped through our fingers and a lifetime of regrets and disappointments that could never be set right were coming to an end, and I was powerless to even go visit them, as my own level of impoverishment had reached an all-time record. I thought: “I guess that’s just the way it is. Your children grow up and leave you to die alone.”

Depression and Despair overwhelmed me. I felt empty. I was gripped with fear of having no Love to call upon to breathe out. I did not feel any anger or hatred. I was paralyzed, like some Haitian Voodoo Zombie. I came to realize how completely my marriage was failed, and how immersed in denial I had been about it, but I could not even feel anger concerning my bitter disappointment over losing the Love of My Life. Already the Arrow had Passed Downtown.

I try to think of Reasons to Carry On
I can think of Nothing.
I try to Think of Ways to keep going
I come up with Nothing.
I try to Imagine Someplace Else
I can think of Nowhere.
I haven’t the strength
To even Care.

I had become an empty vessel, if only for a moment. What happened next can only be described by a childhood memory of the terrified fascination with which I had watched the recently released motion pictures that had been taken by the Army during the testing of the Atomic Bomb. I remembered an old clapboard two-story house. The initial shock wave destroyed the house piece by piece and blew it away as if it had never existed in the first place, even blowing away huge amounts of soil, burning everything, and fusing the sand into glass. Then, like a hurricane whose eye has passed over, the tremendous winds reversed direction with at least equal force. Those test sites were referred to by the codename Dreamland, the same name used for radio transmissions from Area 51.

I felt the same sort of fascination and terror as I realized that the Blast that was hitting me was the realization of my Life, as if it was returning to me. More visions and memories than I had ever dreamed possible, let alone remembered, that had been the Gestalt of my existence thus far, and glimmers of recognition of past, as well as yet unidentified experiences, more like Feelings of Empathy for strangely familiar, but previously unknown existences.

Next came the first shocks of realizations of all the Deepest Secret Fears that I had been suppressing for nearly fifty years. I was staring down the Great Realizations I had subconsciously avoided facing, and they were staring back. Imagine suddenly realizing that the feeling of Déjà Vu that I had believed to be a precursor of some great epiphany turned out to be a deep-seated impulse to recoil from facing those Fears.

It must be different for each of us, but for me it started with realizing that everything I did was impermanent, and probably inconsequential in the scheme of things, even within the next hundred years here on earth…I wondered how many worlds there were elsewhere. So many planets and suns, in so many galaxies in our known universe…even if God did not exist, it’s a miracle beyond the probabilities of pedestrian mathematics that we are here, and alive, and yet with infinite time (oxymoron) and nearly infinite opportunities, it is also inevitable that there would be life on other planets. In fact, for the estimated number of planets similar to ours in the known universe, it is quite improbable that there would not be life on other planets just by random chance. What is Life? What does it mean? What is our purpose? What is Time? From where did all that original Matter and Energy come? I questioned every activity in which I had participated in terms of why I did what I did. What was based on Assumption? On Image? Habit? Socialization? All activity of any kind was simply Passing the Time as we tried to delay the inevitable.

Then it came to me: Here I am, preoccupied with Death, and making Death as the World, preoccupied and hypnotized by the unexamined Life, writhes in Suffering, overcome with Desire, seeking only Pleasure…If the string is too taught, it will break…if too loose…it will not sound. Find the Middle Path.

I was overwhelmed. I felt as equally indifferent to the impending Doom of all of our mortal existences as I did exhilarated in anticipation of what lies before the end of the road. My regrets only fueled my determination, having realized the incredible richness of experiences thus far. As much for the sake of my sins, as well as my salvation, I was renewed.

It’s All in the moment.
The Moment is All.
The Ever-Present, Never-Present

Although neither my financial or romantic status at present have improved, and could just as well get worse before they get any better, my enthusiasm has returned. Not to argue, but to understand. Not to fight, but to prevail. Not so much to gain, as to be content with what I have, and how I am. Right here, right now. Face your Demons. Make them your Friends, Pets, and Lovers. Face your Sorrows and find your Solace.

Most of my life has been lived, not so much as an imposter as an actor. Not so much a hobo, as a Nomad. A college-educated Tramp. A Knight of the Road, if not the Realm.

Many of us would try to perfect Logical Rationality, while others would utilize Emotion and Feelings to control and shape their worlds. As systems, they define the behaviors of those who would manipulate them, failing to realize that either approach is simply and most basically a system of rationalizations to do whatever it is you wanted to do in the first place, which is to say, to follow one’s nature.

In the end, we all seek in one way or another to manipulate our environments to our satisfaction. Beyond that, the personae of those subjective environments are as diverse as a cabin in the woods is to a high-rise apartment in the city.
I Feel like the Last Raccoon in Central Park.
My heart and my brain are on honeymoon, dancing to the Music born of Fire by Friction between Love and Logic, Romance and Reason in a place called Dreamland.

Life is a song about a dream. If Art imitates Life, how is it possible that the Creation exceeds the Inspiration? In some ways, it frequently does. A song about being in love allows us to project our feelings using the vehicle of the song to do our own interpretive waveriding. The song only focuses our attention on what the singer wants you to experience, so it is not Love; it is a Song about Love.

Sometimes Love is a song about a Song about Love.

Happiness is a choice.

As humans, we are an enigma of self-awareness and oblivion.

Self-awareness can be unbalanced by self-consciousness.

Step away from yourself and you step closer to God. Step away from God, and eventually the emptiness and stillness that precedes the backrush of everyday life provides a moment of Clarity and Peace. In it, all is stillness and nothingness. An interlude outside of time that is shattered and consumed by the backrush…the return of Nothing Special. As we dance in Dreamland, we are all dancing The Ghost Dance.

Memoires of a Post-Neo Dharma Bum

This is not just a story about the air ambulance industry, because in order to tell this story, seemingly random asides and references to Emergency Medical Services and other background references are necessary to lend perspective.

The central theme revolves around an air transport of a critically injured man out of the Caribbean to more definitive care in Miami. Jeff Fredericks, the Lead Medic for the flight medical crew was also a major contributor for much of the material presented herein, including tall tales, bon mots, and rhetoric. He was my best friend, and our paths crossed many times during our careers as medics. Jeff taught me to trust my instincts and pay attention to my dreams. After a great deal of time, I eventually learned how to accept ideas from sources I had previously overlooked and acceptance of realizations from which I had subconsciously run. Nevertheless, this is more than just a story about one man’s life, or just that one incident. It is also the story of The Journey…The Good Fight and The Great Peace. Within that context, sordid details, flashbacks, rationalizations, and humorous anecdotes are swirled together to provide an inside point of view, which is at least, potentially more sympathetic. In this respect, Art imitates Journalism, although the relationship between the Participants, who were also the Eyewitnesses and the reporter are purposefully blurred beyond recognition. The narration is done (with considerable apologies) within the subtext of Zen Buddhism.

The apologies are offered to the true followers of Zen who have devoted their entire lives to the study and practice of Zen Buddhism, as well as to the readers who have not. Zen is, in my estimation more of a practice than a religion, that embraces the Eternally Questioning Mind, rather than devotional worship. In this respect, both Jeff and I were more practitioners than devotees or True Believers. Also, my opinions and observations are just that…they are my own, and not official Zen doctrine, if indeed such a thing exists. In other words, you may or may not agree…that is axiomatic to Zen, considering that one premise of Zen is that…If you open your mouth to speak, already you are wrong. This is at best, a view of Zen. The apologies to the readers are prompted by the fact that although the numerous references to Zen may seem to be either distracting or unrelated to the story line, they are central to the state of mind of both Jeff and myself in the same way that the references to Jeff’s marriage and personal relationships did. Zen provided me the incentive, courage, and perspective to assimilate the various cultural, emotional, and spiritual shocks that I was encountering throughout that time. Eventually, the eternal questioning not only led to my breakdown, but also my eventual recovery. Zen is not necessarily for everyone, as it does not offer much in the way of external comfort, sense of purpose, salvation, or promises of eternal life in heaven. You may choose to believe or disbelieve in anything, but whatever it is, you will have to find it for yourself.

The Zen quotations are taken almost entirely from the sayings of Seung-Sahn, a Korean Zen Patriarch, or classic statements and Koans many centuries old.

The main character, Jeff inspired me to write this story when he told me about what had happened on that transport. The last phone call I received from him was made right after he had touched down in Miami, before he started the trip back home. He was stuck for several hours at Customs, and was wound up about as tight as a G string on a Stratocaster. I tried to take notes, but couldn’t really keep up with him. His mind was racing about twice as fast as his mouth which was going many times too fast for me to follow his stream of consciousness, which frequently jumped subjects from one incomplete sentence to another. I wrote as fast as I could follow and later added any other details or notes to fill in the gaps as best as I could remember. It took many readings to interpret the context of what he was saying.

Several years beforehand, another associate of ours had told me of plans to write an assemblage of EMS-related stories, using a number of authors to provide their input, based on actual experiences. He had asked me to contribute any story of my choice, as he had often been entertained by more than a few experiences that I had shared with him. Although I fully intended to contribute, we both went our separate ways before we had a chance to collaborate. Later, I realized that in order to make a work like this possible, as well as accessible to non-EMS readers, I would have to provide an inside perspective that would give readers an opportunity to imagine, understand and empathize with the situations that are described here. In most horror stories, you empathize with either the heroes, or victims, but usually not the monster. In this story, the heroes, the victims, and the monsters are one.

For any number of reasons, that we will examine later, it goes without saying that few normal people actually plan on a career in Emergency Services, at least once they attain, say ten years of age or so. Cowboys, police officers, firefighters, and paramedics are traditional childhood heroes…at least until you begin to find out what those careers actually demand of you. Most of us were driven to those choices by any number of forces that made it seem like it was not even a choice in the first place.

Once that first step is taken, everything that happens afterwards changes you forever. Like Uroboros (the snake that swallows its own tail), everything turns back upon itself. All thoughts, all beliefs, and most of all, all words are as equally beautiful as they are ugly, and as perfect as they are innately dangerously insane. The paradox of trying to explain the sublime (or that which transcends words and explanations) has never stopped anyone from trying to describe the indescribable. Life itself is an enigma, a terminal condition for which the only cure is death. Life will literally kill you. Desire is suffering, but unless we learn to participate in it joyously, we will never come to achieve any understanding of either. What’s more, as long as we seek the attainment of understanding, we will never achieve it.

Truth, wisdom, beauty, or love, for instance, are in the eyes, mouths, and hearts of their beholders on a moment-by moment basis, and any idea, carried to it logical conclusion, is nonsense. The question remains: why are we constantly arguing with each other (and ourselves), instead of simply enjoying the moment?

This story is an attempt to capture a series of moments occurring within several other series of moments. They are as connected as they are separate, which is to say that in context, they need to be viewed as one continuous event, as if it were held at armslength, and at the same time up close, intimate, and personal, in the same way that it was for the participants at the time it was happening, or like a film editor, deconstructing and reconstructing events according to his vision so as to tell the story of the telling of the story.

Somewhere Between Nothingness

We love to lust after things, all the while trying to avoid Suffering. In so doing we continue to separate everything into Good and Bad. I desired Enlightenment, so I suffered for it, so I lost my desire….Imagine my surprise to discover…NOTHING….The stillness between the blast and the backrush. Others are doing the Ghost Dance in Dreamland. I am a lone observer:

An endless parade of
Witches to be burned
Virgins to be sacrificed
Communists to be purged
Ethnic cleansings
Crusades to be waged
Holy Wars
Patriot Acts
Cultural Wars

Each scenario precludes listening to the Lone Voice of Reason screaming: “Are you fucking serious?”

No time to listen or think…we’re too busy stacking bodies.

The glut of prosperity of the Fifties led to the social unrest of the Sixties. Those who have are no longer willing to risk it all for the sake of those who have not. Everyone believes that they have too much too loose to rock the boat, so our current economic depression equals compliance. Only in America do you drive to the unemployment office in a six thousand dollar car.

It has been claimed that members of the crew of Christopher Columbus’ three ships were responsible for introducing Syphilis to the native and indigenous peoples of what was soon to be called The New World. It would later be called America. They would soon be called Indians, but contrary to popular myth, not because Columbus thought that he was in India, since at that time, India was referred to as Hindustan. He had, however, referred to them as “Una gente en Dios” (a people of God) because he was impressed by their profoundly spiritual nature.

Also, it should be noted that “Injun” is not a slang term for “Indian” but rather a phonetic corruption of a word used by the Lakota Sioux to mean Human Being. And, it was in fact a New World only to the self-centered peoples of Europe, but I digress….

I mention this because it is not without a certain degree of trepidation that I find myself writing this introduction. There is a high degree of certainty that many people will find themselves highly offended by any number of remarks, statements, or even casual references made within the following story. Some might even consider it Dangerous….

There was a time when we had a much better sense of humor about ourselves, and even giving offense was much better tolerated than it is now. Then again, like the difference between inference and implication, if those of us who find ourselves so easily offended in the first place would take responsibility for their own actions and regard the process as taking offense, then we might more easily shed this mantle of self-righteousness that is causing us to lose our sense of humor, as well as our capacity for tolerance.

While the United States was seriously considering the boycott of Venezuelan Oil, simply because their presidente referred to our president as “El Diablo” I realized that we were in fact in dangerous waters indeed.

At least at the time of this writing, there is no universal rating system for books. At least not yet, but the current state of affairs will undoubtedly get much worse before it gets any better. No one with whom I would seek rational discourse pays much attention to Religious Warnings.

On a certain level, I would be a little disappointed if this book was NOT banned in Boston. Regardless, I would suggest that this introduction be also considered either a warning, or disclaimer, if you will, for the thin-skinned, the narrow-minded, and the weak of heart, (and sadly) of humor.

Regard this writing in the same way that you would one of cable TV’s darkest, most profane, sexually provocative, and dangerously controversial episodes imaginable. This story is only for mature adults with a broad-minded sense of humor. If you believe yourself to be one of these increasingly rare individuals, then you will probably enjoy this story, but it is by no means any guarantee that you won’t still find yourself uncomfortable, offended, abraded, or provoked at one point or another. Fritz Pearls frequently said that there is no growth without pain, and I believe that if you really are a mature, broad-minded adult, then you will have nothing to fear, because it is fear that has so empowered the manipulators of our culture who are the self-proclaimed protectors of the weak. There is no reason that a story cannot be both entertaining and culturally significant at the same time, but if all else fails, just consider it as entertainment.

The first drafts of this book began about seven years ago. Three years into the venture, Jeff, the protagonist, and co-mentor/technical advisor as regards Emergency Medical Services, as well as War Stories in general, underwent a profound life-changing experience that provided the backbone of the narrative, as well as a unique perspective otherwise not possible without his input.

Sometime thereafter I suffered a nervous breakdown, and was forced to “rely upon the Charity of friends” before I could get a grip again. Any pen can write the Poison Thought. All during that period of time, I wrote profusely, but very little of it was coherent enough to be of any use at all. Nonetheless, I do believe that those rantings helped me find my way back out.

Most of the writing (as well as the drowning) took place in real time, insofar as I often had no idea how any individual writing session would begin or end until it was already being written. That is not really as surprising as it may seem.

The story, i.e. The Narrative in terms of physical action is relatively straightforward. The dramatic action has a lot more twists and turns to it, but it is still on that level, largely plot-driven. As reader/viewers, it is very easy to become jaded as to how one might regard the real effects that most of those experiences would have on real people’s minds. I wanted to expose the reader to experiences and states of mind that would more easily explain how a once-normal person makes decisions that lead to choices that a normal person would probably not want to imagine, let alone choose. That has everything to do with state of mind. And because I believe that each of us can empathize with momentary states, or potentials for unhappier sorts of results, than you could have experienced yourself, I also believe that you will be drawn into just such a preposterous series of described events as easily as I was, and but by the grace of God…any of us might go.

I also know that there are many of us still out there, regardless of social privilege or economic station, who still are haunted by those vagabond impulses of humor, and sexuality, like St. Elmo’s Fire, or the Aurora Borealis, just zapping from here to there like aberrant radio waves of Music You Never Heard Before but were instantly So Damn Glad That You Just Did. The Music of the Survivors. The Symphonies of the Post-Neo Dharma Bums.

With a decade and a half of dangerous living culminating in twenty years of EMS experiences, the picture is still incomplete without realizing how it is that of those worlds either can be alternately foreground or background to the even larger picture of One’s Own Life.

In my case, this represents the chronicle of my quest to discover if there really is Life after 911. Although my experiences may have been extreme, they are far from as isolated as they should be. Keep in mind, EMS providers are masters of denial, as well as disguise as regards hiding their symptoms and signs.

This is a story of crisis, of disappointments, of Loss, and Confusion. Huge Critical Stress Incidents overlaid on a backdrop of debilitating, Chronic Stress.

Out of my delirium grew a realization, an elusive and undefined feeling that somehow, I had been given a gift, even if it was only the ability to recognize the third lifeboat, in spite of the fact that I had no idea where the lifeboat would take me, or what was waiting for me there. (Reference to the drowning man who prays for God to save him, all the while turning away three rescuers while awaiting the arrival of the Almighty in Person)

As time passed, and situations deteriorated further, my zeal waned. Answers were replaced by questions without answers, but since all I wanted was to finish the book, I failed to recognize how that which passes for truth usually only answers improper questions that were no use at all in the first place. It had become just another story about something. I thought that the disintegration of my so-called Life had no real bearing on anything but my own misery. I did not realize that in order to find the answers I sought to my questions, I would have to open Pandora’s Box, and in the process face a Cure more debilitating than the Disease. (Anyone who has listened to, or read the potential side effects, Benefits vs. Risks, and general precautions listed for most prescription medications knows this is not as uncommon as it sounds. It just all depends on how you feel about trading halitosis for alopecia, neutropenia and ‘certain’ (unspecified)’…sexual effects’…. Don’t worry, if those effects included hypertrophy, Priapism, or gave you the stamina of a satyr, IT WOULD SAY SO IN VERY LARGE LETTERS, IN NON-LATIN WORDS AND COST MORE MONEY THAN YOU COULD AFFORD, BECAUSE YOUR INSURANCE WOULDN’T COVER IT.)

This is a story about my search for The Cure, as well as how to survive it.

The book was floundering in shoal waters, largely because I had at that time begun to believe that this was indeed, a dangerous book, at least to me. Inadvertently, I had asked myself questions for which I could find no answers. Although I frequently read the more comical sections of those drafts to my children, either to amuse them, or tell EMS War Stories in the great American tradition of the Tall Tale, many sections were never introduced to them at that time. I was very much concerned about the effect of the entire book upon them. I am not sure anyone less than eighteen years of age should read it. Some days I still think of it as a dangerous book.

In truth, there are no real dangers. Lies are dangerous. Denial is dangerous.
Fear is dangerous.

Freedom involves Risks.
Freedom is frequently
And Selfish
(…but there is a down side….)

And Yes Virginia, It is all Fun and Games until somebody puts an eye out….
(Then it’s time to call 911)

Ever since I began working EMS, people have always asked one question. “What is the worst call you ever ran?” That is a tricky question for several reasons. First, there are just so many different types of really bad calls, depending on how you judge or categorize them. Many of my associates would call them good calls, meaning that they were challenging or may have provided excellent opportunities to utilize their best skills. Aside from challenging vs. boring, the worst calls would be categorized into something like:
• The bloodiest, or the most disgusting, in terms of common standards.
• The most heart wrenching or emotionally disturbing.
• The Strange, The Weird, and The Peculiar.
• The most dangerous or challenging rescue operations.
• The Stuff People Put up their Asses.

The bloodiest calls would be anybody vs. a train. The train always wins. Trains literally deconstruct their victims. One or two passengers inside a car hit by a train can provide more than enough gore and goo to completely coat the inside of the vehicle with the insides of the passengers. Same thing goes for anyone who falls more than three stories, especially onto concrete. Not that it matters much, as the decelerating injuries onto any surface, even water, can explode the internal organs. Eviscerated bowels and brain matter are especially disarming, although the most initially disarming thing I ever saw was a prolapsed uterus secondary to a motor vehicle vs. pedestrian accident. Nevertheless, for Bloody/Gory/Disarming all at once, you can’t beat any suicide involving a twelve-gauge shotgun.

The most heart wrenching would have to be pronouncing a fifteen year-old boy dead after he shot himself in the chest with a shotgun. The family discovered him in the bathroom upon return to their home. Our job was to obtain an ECG strip, and write a report on our findings in order to pronounce him officially DOA. In the ten or so minutes I was in the house, his family was in the living room with several detectives. Just remembering hearing their grief makes me choke up even now, twenty years later.
The strangest and weirdest calls usually involved drag queens, although I do not say that in derogation. My previous life experiences involving The Arts, Music, and Theater as well as Education provided me ample opportunities to experience and observe Gay, Lesbian, Transvestite, Transgender, and Cross-Dressing individuals in a much more unguarded and “natural” state, where acceptance and understanding were considered de rigueur. Indeed, in those settings I frequently felt like an intruder into their world, like Jane Goodall among the chimpanzees. If I was going to learn and prosper within the setting of a foreign and often closed culture, I would have to check my prejudices at the door if I intended to be tolerated and accepted as an unobtrusive observer. That having been said, there were still occasions within the framework of rescue operations, when I was unprepared for the sort of surprises that a career in EMS has the opportunity to provide, like…

“Med Three to XXXXXX Hospital Medcom.”

“This is XXXXXX Hospital; go ahead.”

“Show us in route to your facility with an unconscious, unresponsive female in her mid-thirties who was involved in a high-speed, head-on motor vehicle crash with significant front-end deformity to both vehicles and marked intrusion into the passenger compartment. Seat belts were in use and both airbags deployed with mild to moderate contusions and abrasions to the face secondary to the airbag. Patient is negative for obvious deformities, frank hemorrhage, or compound fractures…Uhhh… (long vocalized pause, slightly off mike)…What?… (another long pause)…Update to follow shortly….”

“Correction. We are in route to your facility with a mid-thirties MALE involved in the previously described motor vehicle crash….”

In the course of conducting the secondary exam and survey, which involves removal of clothing to inspect for occult injuries, it was discovered that the patient had a little something extra to present for which the medic was just not prepared. Of course it did not change the treatment or level of care which the patient received, at least not a few miles north of Key West…I wouldn’t care to speculate about Utah or Montana, however.

In the Sixties and early Seventies, when mind-altering drugs like LSD, mescaline, peyote, or psilocybin mushrooms were commonly used, and marijuana use was almost assumed, the more untoward reactions could frequently be managed by counseling in a quiet, non-threatening atmosphere. The occasional violent or overtly psychotic reactions were usually managed by Thorazine administration, but were relatively rare. I remember. I was there in the thick of it. By the Eighties and Nineties, Cocaine, Crack, Ice, PCP (Angel Dust), Heroin, Ketamine, Quaaludes, Rohypnol (Rufies), MDMA (Ecstasy), THC, Valium, Halcion, Amyl Nitrate, and many other legal, illegal, or even designer drugs were readily available everywhere. Their use in the Gay community was pandemic.

Drag in itself involves a great deal of fantasy, imagination, and varying degrees of the Willing Suspension of Disbelief, especially in Gender Dysmorphic individuals who believe that they are a woman trapped in the body of a man, for instance. The Club Kids of the Eighties carried costume to the extreme, even masquerading as aliens or animals. Drag has everything to do with State of Mind. When you stop and think about it, there isn’t that much difference between a Civil War re-enactor and a drag queen. One uses black powder and the other uses face powder. One is primarily concerned with muzzle loaders, while the other employs both muzzle loaders and breech loaders freely. Both involve fantasy, masquerade, and costuming. For the Civil War re-enactor, the drug of choice would invariably be alcohol, (preferably after the performance), but with drag queens, you had to add the possibility of unknown quantities of unknown medications with almost limitless possibilities for synergy and/or cross-reactions, and it could make for some of the most bizarre and unnerving encounters and conversations you can imagine, at least in the Eighties and Nineties.

One particular evening, we were dispatched to a report of a naked woman walking down the median strip on Los Olas Boulevard in Fort Lauderdale. Upon our arrival, police officers transferred custody of a somewhat delirious recently post-operative transgendered individual intent upon showing “her” goodies to anyone who was interested, consequently accusing anyone who even looked remotely in her direction of being either gay or bi-curious…Of course I looked…besides, it was part of my job, right?

Another time, during Spring Break, we were dispatched to a bar on the “Strip” in Fort Lauderdale referenced “unconscious person”. Upon our arrival, we were presented with a heavily mustachioed male in his early thirties lying on the floor dressed in black motorcycle boots and cap, as well as a black leather motorcycle jacket covering a pink ballet tutu. Although it was the first time I had ever encountered such an incongruous mix of clothing styles, no one in the bar seemed to pay any special notice. In fact, they were all standing around him drinking and talking as if it was the most natural thing in the world, at least at that bar. I recall they said he was a regular.

Not all of these categories are clear-cut by any means. One call in particular managed to encompass strange, bizarre, peculiar, disarming, and bloody/gory in an instant.

We were dispatched to the southeast edge of the county just south of a major interchange of three major highways that was still under construction. We were unfamiliar with the new roadways as they now involved circular on and off ramps, elevated sections, and were not especially well-marked as to exactly where you were at any given point, lacking even mile-markers, although the new exchange was just recently opened to the public only days before. The call was referenced simply “signal twenty” (psychiatric), which also became the label we used to refer to the patients we treated. Upon our arrival, we saw both Highway Patrol and County Sherriff’s Deputies standing near a naked man behind a maroon Buick Cutlass with the trunk lid open. The man was obviously distraught and sweating profusely, in spite of the fact that it was about three am in December in South Florida, or that he was unclothed. His hair was disheveled, and his gestures were exaggerated, but the look in his eyes was clearly one of a totally irrational being. When the officers got too close, he would start to become even more agitated, so as a result, one deputy stood about three feet from him as he attempted to reason with the man, as they others stood back, so as not to crowd him. The high intensity sodium vapor lights cast a sort of flamingo-pink hue down upon the scene as our stark white Halogen headlights provided an exaggerated modeling effect upon the group, like Caravaggio on acid. The pulsating red, white, and blue strobes of our combined emergency lights created a disarming final touch to this vision of one man’s personal Hell.

As we arrived, and took our stretcher out, we tried to approach the subject as unobtrusively as possible, given the bizarre scene encountered, as we did not want the patient to feel any more defensive, or become alarmed by our approach and perhaps run out into traffic. The officers involved were clearly nearly as uncomfortable as their suspect, and couldn’t wait to relinquish responsibility of this naked madman to us. Without warning, he suddenly spun around toward the trunk of the car and slammed the lid down violently as he howled a blood-curdling scream. As the cops attempted to subdue him, he spun around again several times, trying to avoid their grasp, revealing that he had indeed slammed the trunk lid down upon his penis and scrotum, inflicting a guillotine amputation which was now spurting blood from severe bilateral arterial bleeders. They reflexively jumped back, but were nonetheless soaked by the blood spray, although they quickly regained what was left of their composure enough to subdue him sufficiently to secure him to our stretcher using twisted, knotted sheets rather than handcuffs, as was our practice in those days, since he was now our patient, rather than their prisoner, and state regulations did not allow us to carry the leather restraints normally used in hospitals, preferred by nurses and medics alike…even at home….

Once restrained, our treatment predominantly involved applying bulky surgical dressings to the affected areas with very firm direct pressure. The patient was in serious danger of exsanguination in a very short time without definitive treatment. Emergency treatment also involved establishing two large-bore intravenous lines running lactated Ringer’s solution at rate sufficient to maintain a viable pulse and blood pressure, and high-flow oxygen administration. Since the intravenous crystalloid fluid administration is a volume replacement only, it does effectively dilute the remaining blood supply, which is why it has to be done judiciously so as to not force out the remaining blood. Add to this the further complication that I was obligated to apply continuous pressure, and that immediate transport could not be delayed by IV administration, or that I needed to maintain the presence of mind to request the officers on scene to unlock the trunk to retrieve the amputated part before we left (which they were none too keen on touching) or the fact that we were all drenched in blood within seconds, and you can easily see why this call still remains on my top-ten list of worst calls, no matter what your criterion. To the best of my recollection, that was at least the first time I was obligated to grab (and hold) the crotch of an insane man. It would not, however be the last time, but that is another story for another time….

The most revolting call involved being dispatched reference “worms”. Upon arrival, a small boy about ten years old came out of the house. We asked if anybody had called 911. The boy nodded. We asked if they called because of worms. The boy nodded again. We asked if it was he. He nodded a third time, and then opened his mouth to reveal pinworms crawling up his esophagus and into his mouth like a handful of angel hair pasta.

Challenging and dangerous rescue operations that stand out in my mind would involve extricating a shooting victim in the middle of a riot, water rescue of a motor vehicle crash victim in shark-infested waters at night, and water rescue of a baby from the back seat of a car in a canal.

The first call was dispatched as a man down secondary to gunshot wounds. On arrival, we discovered that a half-dozen sheriff’s deputies were on scene in a vacant lot trying to disperse a mob of what looked like a hundred or so people, and a man lying face down about twenty feet away. We had no idea what was the relationship between the shooting victim and the crowd, but they were extremely agitated, and would probably have overrun the deputies, were it not for the presence of three or four canines who looked like they couldn’t wait to take a bite of fresh meat, as well as the shotguns the deputies were brandishing in a most menacing manner. We arrived in a squad unit, and our ambulance arrived separately with two EMT’s to assist.

In a situation like this, even the most basic assessment procedures will be done later. For now, the object is to “swoop and scoop” to safely remove the victim from the crime scene. There was no additional information as far as what events had precipitated the shooting, or even if the shooter was still on scene, or somewhere close enough to still represent a threat. Full trauma precautions involve spinal immobilization with a “Philly Collar”, a long spine board, and cross-strapping. In less than a minute, the four of us log-rolled the patient onto the board and carried him into the ambulance, which was parked in the middle of the lot. My partner quickly transferred our ALS gear into the ambulance via the side doors as I prepared to work the patient, assisted by one of the EMT’s who arrived with the transport unit. Everyone was very excited at this point, and unbeknown to the driver, my partner was still standing between the two open side doors. Suddenly, the driver put the unit in gear and floored it. The driver also did not realize that the right side of the unit had been parked much too close to a no parking sign, which he sideswiped, knocking the door shut, and narrowly missing my partner in the process.

The victim was in full cardiopulmonary arrest, although strangely enough, there was little blood on scene, and only two very small-caliber bullet wounds in the middle of both deltoid muscles, almost identically placed. Later X-rays revealed that one of the two wounds was an entrance wound, and the other a very non-characteristic exit wound. The bizarre part of this scenario was that the path of the bullet went from entering at the deltoid muscle, glancing off the scapula, ricocheting off the base of the skull into the first two cervical vertebrae, which it vaporized, only to finally glance downward, off the opposite scapula, and out the other deltoid muscle. This kind of injury is characteristic of the .223 caliber bullet used in the M16 assault rifle. Regardless of where the bullet enters, it can tumble and ricochet all over the body, and exit almost anywhere.

The water rescue was necessary to locate a MVC (Motor Vehicle Crash) victim who had been ejected from an eighties-era Trans-Am through the T-top. We were first on scene; it was after eleven P.M. and I was new to the area. The driver stated that his friend had been ejected into the water. There was blood everywhere on the passenger side of the vehicle. I immediately grabbed a mask, snorkel, fins and a light and went into the water. About thirty yards from the shore, I found the victim floating face down in chest-deep water. He had no skull above the eyebrow line. I brought him to shore about the time the volunteer firemen arrived. They later told me a story about a legendary hammerhead shark, a behemoth over seventeen feet long that was often known to inhabit that particular stretch of water, and had terrorized anglers and local residents alike for years.

The last rescue was referenced car in canal. On arrival, we found a Florida Power and Light employee and several bystanders trying to use one of the poles the employee had on a trailer to try to wedge it under the vehicle to prevent it from falling completely into the water. Along this stretch of road, the canals are dug into bare coral rock, with sheer walls, almost twenty feet deep, and about as wide as the length of the car. The back wheels were still on land as we arrived, but shortly afterward, the car rolled off the pole, and started to go nose-down into the water, Although the mother had jumped clear of the driver’s seat, her baby was strapped into a car seat in the back. My partner immediately jumped into the water and swam into the car as it disappeared from sight, only to surface several moments later, holding the child.

Eventually, the last subject will come up, if there is sufficient time, booze, or weed to provoke such discussion. People frequently ask it a great deal more often than you might suspect. It seems like everyone has heard of rumors about it, but no one seems to claim having personally known anyone to whom it has happened, and NO ONE EVER admits to having had to call 911 because of something they stuck up their ass, although on more than one occasion, I have suspected that it was more than just idle curiosity about an urban legend that prompted the question in the first place. “Does that really happen? Have you ever seen anything like that?” and my own personal favorite “Is that actually possible?” all tend to make me suspect that what they really want to know is “Could that actually happen to me?”

In case you are still wondering, the answer is yes. As regards softer and less dangerous objects, (like dildoes, cucumbers, and those embarrassing looking squash you see in the grocery store) the main principle is What Goes In, Must Come Out, at least eventually. Pain and fear usually provoke panic, which will produce muscle clenching enough to thwart initial removal. ER treatment is usually centered around getting the patient to relax long enough for nature to take its course, but I know of a surgical RN who has a sort of rogues’ gallery of Xerox copies of x-rays of pickle jars, bottles, a thermos, and similarly dangerous objects that did have to be surgically removed. Add the challenge of emergency extrication and what we call disentanglement if the patient has managed to squeeze the faucet from their bathtub up there while it was still attached to the wall… (and yes, that really did happen).

The Chicken or the Egg?

There are numerous references to both Zen Buddhism and Emergency Medical Services throughout this story. They do represent pivotal points of reference, if not an actual horizon line within this account.

Although the author is experienced in both subjects, he does not wish to be considered a spokesperson for either of them, any more than they would want him as a spokesperson. He also does not consider himself to be religious; religion demands too much commitment, due to its essentially political nature. Spirituality, on the other hand, demands only that one should pay attention,

The members of the EMS community seem more prone to regarding their realm as sacred than do the followers of Zen. It is in fact the separation of religiosity from Zen that distinguishes it from the rest of Buddhism. If you don’t try to label and judge anything as either sacred or profane in and of itself, you just might be able to strip away a few of the Illusions, like the Dance of the Seven Veils. At least, that is the author’s contention, although he would himself encourage you to decide that for yourselves.

There is a frequent flaw in logic that is referred to as sic hoc ergo propter hoc, meaning after this, therefore because of this. The author claims not to remember which came first. Regardless, of any speculation over the chicken or the egg, it is the author’s contention that although his involvement with Zen as well as his career in EMS did influence each other significantly, they should be regarded as nothing more than a series of interestingly appropriate coincidences. Although parallel lines never intersect, once you see the connectivity of everything in the universe, Cause and Effect represent one field of view only. Everything else is both connected and separate. Even coincidences are perhaps more accurately regarded as influences.

One of Jeff’s mentors, “Fat Tony”, was an ex-partner in EMS and the godfather of his eldest son. He used to say: “Everybody is a signal 20 (person with psychological problems), one way or another, but there are good signal 20’s and bad signal 20’s. You gotta be crazy to be in this line of work in the first place, but if you’re a good signal twenty you can still do good things, and help some people in the process, including the bad signal 20’s without getting hurt, or hurting anybody else who doesn’t already deserve it. In fact, being a good signal twenty can actually prevent you from becoming a bad signal 20.”

This was about the time that CISD (Critical Incident Stress Debriefing) was just beginning to gain popularity. In the meantime, advice and council such as this was handed down from generation to generation as a way of protecting ourselves from The Madness…a generation back then lasted about five years. By that time, the squeamish and weak of heart were already culled from the herd, and all that would be left were either seasoned veterans or the dangerously insane, with varying mixtures of both. If you worked in a busy system, you soon saw it all. Twenty years’ experience was more like your first years’ experience repeated twenty different ways.

Much like a news cameraman, an EMS provider’s focus becomes riveted on the perverse, the grotesque, the gruesome, and the sorrowful aspects of the human condition.

Nobody calls 911 just to say Hello

Why It’s All Fun and Games until Somebody Pokes out an Eye

Even in the busiest EMS systems in America, there is some down time. The scarcer it is, the more precious it becomes. How you use that time is largely a reflection of the character of the individual, and may even be factored into your yearly re-evaluations during recertification periods.

In the very busiest downtown urban zones, there is a minimum of activity until perhaps as late as 3 PM. If you are smart, you inspect and stock your truck, eat, and go back to station to nap and relax ASAP. Downtown stations often run more than thirty calls in twenty-four hours, and usually run all night. Suburban areas, especially if they have large proportions of retired and elderly people, like Tamarac or Plantation, Florida will also keep you running all night running medical calls. Downtown, the trauma of man’s inhumanity to man predominates. In the Burbs, it is medical. Heart attacks (now called coronary incidents), strokes, diabetic emergencies, and acute abdomens round out even rookie medics’ range of experiences in less than a year. This is why we call Florida God’s Waiting Room. In one part of town, The Knife and Gun Club is offering short, lifetime memberships. Other areas specialize in Better Living through Chemistry. Another area may have a Cardiac Canyon, Lined with high-rise mausoleums.

Because of the long duty hours, most medics try to make the best use of their available time while on shift. Paying bills or making phone calls for their outside businesses is one of the more typical approaches. Some like to read or study. The profession requires around forty hours of continuing education units to be completed every two years to qualify for recertification. Other medics may choose to study toward Registered Nurse and Physician’s Assistant programs, or pursue one the several degree programs in EMS Administration, but virtually no one is satisfied with who they are at that particular point. Most medics still have not figured out what they want to be when they grow up.

Now, many departments do not allow ambulances to go out at large, unless they are being dispatched to an emergency call. Some dispatchers even send out otherwise non-dispatched units to do “zone coverage” at a particular fixed point to await the next available call. You hear a lot of senior medics refer to “back in the day…” as they smile and reminisce. Well, back in the day, you could take an ambulance anywhere in your zone by telling dispatch you were 10-8, doing zone familiarization. Before the advent of GPS systems and onboard computer maps, this was a legitimate concern for medics and EMTs who needed to know the quickest routes to and from anywhere within your zone, and a great excuse for exploring.

This could include side trips to the end of the airstrip at the naval base to watch touch-and go landings and take-offs of fighter jets and other military aircraft whose personnel had flight quotas to fulfill. Ambulances and fire trucks are generally admonished from being seen in the parking lots of bars, and especially strip clubs, but a fire alarm or bomb threat can generate more municipal workers than you even knew could be on the payroll, and you can be sure they will be quick to respond, but slow to clear the scene.

Jeff once worked for a municipal service that covered a motel that featured a performing dolphin. Local legend had it that the trainer was the former male lead for the TV series Flipper that was shot in Miami. Jeff and Mark used to take the ambulance to the lodge every morning at the start of shift to eat breakfast and watch the dolphin show.

Jeff and Mark had been partnered for over six months, and were nearly finished the three-month rotation they were scheduled to serve at this station, which they shared with the sheriff’s department. Jeff was hired approximately six months earlier, and still had not worked a single “code blue” (cardiac arrest) since his arrival. Jeff’s initial hiring had been ballyhooed a bit too much for his liking. He had just left a very busy urban state-of-the-art municipal 911 system, in favor of a more laid-back county system that catered to the interests of their considerable tourist industry. Comprised of a series of small seaside resort communities, it was originally staffed by volunteers. Later, it was run by one of the three hospitals within the county before developing into a countywide 911-dispatched system. Many of their medics had little serious critical care experience, which only fueled resentments and suspicion towards all new arrivals.

Although Jeff badly needed the “vacation” aspect of his new position, doldrums and boredom had begun to set in. Mark, Jeff’s partner, and EMT\Driver was also a commercial fisherman, and no stranger to the pleasures of cannabis sativa. Jeff was no stranger either, but to Jeff, as a medic, work was work and play was play although he had turned his head for the first several months and ignored his partner’s indulgences, Jeff had never smoked dope the same day he worked, and rarely smoked it the night before., but with little to challenge him, next to no supervision, and little chance of discovery, he decided maybe it was time to relax and unwind a bit. He was in the throes of his fifth divorce and suffered regular anxiety attacks. He figured it would be a great way to kick back during one of their typical two-hour breakfasts while they watched the dolphin show.

Mark was completely taken aback when Jeff had requested “a hit”, and cautioned Jeff to “take it easy” and further warned him “look, man, this is some really strong shit, and I don’t know if you can handle this weed. You better take it easy…no more than one toke…really.”

“Fuck you man!” Jeff quipped. “I was smokin’ East Asian dope when you were still in grammar school sneaking cigarettes in the bathroom. Trust me; I can handle anything you got.” With that, Jeff perfunctorily took two very deep drags of the proffered joint, sat back, and blew smoke rings back at his partner.

Of course, thirty seconds later, the alarm tones sounded over the radio summonsing the ambulance to a cardiac arrest. They looked at each other and just laughed. This was a bit of a kick in the nuts, but they had both been around the block enough to fake it for whatever was awaiting them.

Indeed. On arrival, they first discovered that their stretcher would not fit down the hallway where the victim lay, due to bundles of magazines piled floor to ceiling along one wall. There was barely enough room for a single person to walk, due to the bundles of National Geographic, Scientific American, and similar publications. “Great! Just the sort of job to keep the volunteers out of the way while we do our magic.” so while Jeff and Mark went down the hall with their gear, the firemen set out to do enough housecleaning to get the patient out, once she was stabilized and/or ready for transport.

The family stated that they had last seen “grandma” alive about twenty minutes ago (which means forty minutes to an hour). Upon exam, she was pulseless and apnic. When she was connected to the ECG monitor, it revealed what is called an agonal rhythm of less than thirty per minute. This represents the last dying electrical impulses of the heart, and may be either pulsed, or pulseless, but of course, today it would be the latter. CPR was initiated, an IV line was established, and atropine and epinephrine were administered, as the patient was endotracheally intubated. The patient quickly went from sinus tachycardia to ventricular fibrillation in less than two minutes. Now countershock would be administered in a series of three “stacked” shocks of increasing strength with pulse checks in between the shocks. Remarkably, she responded with pulses and a blood pressure, but no spontaneous respirations. In fact, the resuscitation had proceeded so quickly that the volunteer firemen had not yet gotten the hallway cleared. Moments later, the patient went back into v-fib, so lidocaine was bloused and a drip was hung while CPR was initiated again.

This particular system still used “The Thumper”, an oxygen-powered mechanical CPR device that performed chest compressions and ventilated the patient. Because of the long transport times and shortage of qualified personnel, this was a real plus for situations like these.

Once the hallway was cleared and the patient was loaded and ready for transport, they sped away to the hospital, about sixteen miles away. Enroute, the patient regained pulses and lost them several more times, but at each juncture, the crew performed flawlessly, and the patient responded accordingly, for the exception that she never initiated spontaneous respirations or regained consciousness. Mark and Jeff were determined that they would deliver a live patient to the ER. Never before had Jeff run such a perfect code blue, in spite of the patient’s attempts to die on their watch.

Just as they were entering the hospital ER entrance, the patient’s pulses and rhythm returned. As they raced into the ER, the Doctor, who happened to be the patient’s personal physician proclaimed “What the fuck is this? She is a DNR!!!

It is not altogether unusual that the family should have forgotten to mention that the patient was terminal and had already had Do Not Resuscitate orders signed, but once they were called out, the crew had a duty to act in the absence of seeing those orders. As a result, the crew was instructed to place the patient in a side room, remove the oxygen from the patient, stop ventilations, and let her die in peace.

This was by no means a typical “day in the life”, even for those two clowns, but it does point up a couple of issues. First, this does not represent any attempt to rationalize drug experimentation or usage while entrusted with the care, health, and safety of the public. This can only be described at best as “a very bad idea”. The criminal and moral aspects of their actions could have had dire consequences. That they chose to disregard what amounts to a sacred trust with the lives of others only points up what a sad and sorry state of mind that allowed them to indulge themselves like that in the first place. How they managed to rationalize their bad behaviors only points up how warped the judgment of an otherwise good person who has chosen a career devoted to the care and safety of other human beings can get. It does point out another aspect of the persona of many EMS professionals, and that is the fact that many, if not most of them were risk-takers by nature, especially in the early days. Besides, these same men and women who don’t take NO for an answer also don’t take DEAD for an answer or DANGEROUS as a prohibition.

You can’t live every minute of your life coiled like a snake ready to strike. Somewhere you have to assert yourself just to step outside the paramilitary atmosphere long enough to remind yourself that you are still a human being. The trick is in being able to find your escape in a way that precludes detection. I knew of a female paramedic who once told me she only wore the sexiest bras and panties she could find to wear under her uniform while she was on duty, just to help remind her of her feminine nature, no matter how tough she had to be on the outside. That shift was no exception….
EMS does not, as a rule do much to nurture or comfort its own. It takes no small amount of panache to push the envelope and yet not become labeled a “flake” or a “red ass”.

During the eighties, the subject of “burnout” was a regular topic of EMS lectures and many seminars. CISD or Critical Incident Stress Debriefing was the hot new topic of the day. Although it enjoyed a level of support and acceptance by most of the EMS community as far as lip service was concerned, few people ever willingly sought out help until they could no longer hide the signs and symptoms, which meant they screwed up in some way. In the vast majority of cases, being caught or being forced to acknowledge your dysfunction was the only wakeup call you got, and nobody was immune, not even supervisors or CISD facilitators themselves. Divorce, infidelity, violence, financial irresponsibility, substance abuse, and other forms of compulsive and obsessive-compulsive behaviors ran rampant in many systems until there was no pace left for denial. It can make the most conscientious, and caring human being into a monster in a great deal less than five years.

During his first year in EMS, a veteran fire captain once told him: “You gotta be very suspicious of anyone who runs into a building when the rats and the cockroaches are running out!” The author believes that Zen was his personal coping mechanism for the pain of being human. Zen also teaches you to embrace difficult questions, and to leave no stone unturned in terms of your questioning. No one forces you to do it. When you work in EMS, you cannot afford to look away from even the most gruesome spectacles of human depravity or tragedy. Zen can teach you to embrace your fears. Zen can teach you to question everything, although it cannot give you the answers you seek to the questions you ask, it can help you find them for yourself. The risk is that like Pandora’s Box, once it is opened, there is no turning back and there is no respite once the questions are asked.

This is not to say that job stress was the only issue, either, since so much of Jeff’s life had been lived like living in the eye of a tornado. As long as you keep up with the storm, life can be relatively calm. Then again, there was a time when Jeff first realized that, for once, if he encountered an over dose, or even a dead person lying on the floor, the chances were very good that it was not someone Jeff actually knew personally, which caused a certain calm to settle over Jeff that he had not known in years. EMS tends to attract risk-takers in general, and few can live up to the idealized image that is expected of them. Many were non-conformists who gravitated to a field filled with rigid conformity and uniformity.

Confessions of a Mad Philosopher

Understand that you are being warned: This may well be the most dangerous book you will ever read, depending on what it provokes in you, or if you have lived most of your life being force-fed Dogma, by ideologues. If you don’t believe that it is possible to ask yourself questions that are capable of cracking your own reality, then you just haven’t been using your imagination to its fullest potential. True realizations often come as a result of admissions of the potential truth of something we most greatly fear. If not, you may consider yourself a seeker of the truth, even a bit of a risk-taker. I still have serious concerns for the well-being of unbalanced individuals who might read this book, but fuck them anyway. A man should be allowed to choose his own Poison.

If you get stuck, put the book down for awhile and just think about it. Then stop thinking about it for a while. If you are still stuck, start reading it again, but never give up on yourself. You just haven’t gotten it yet. I read a book about Korean Zen, off and on, for about seven years before I even scratched the surface, in terms of understanding anything about anything…I tried so very hard to achieve understanding, that I missed it right under my nose until I blew it, so to speak. The answer was “Nothing”.

There were numerous times that I put down everything, Zen, EMS, Desire, Looking for a way to Finish This Book (…or more accurately, to realize a way to End The Story…). Jeff and I both wrestled like Job with our respective marriages, relationships, and finances, and lost, while I swam in a sea of legal, prescription, psych medications…, and drowned. I watched my latest career choice circle the drain as the time clock seemed to be running out.

I sat, meditated, went to work, came home, ate, drank, shit, bathed and slept. I was full and empty at the same time. A long time ago, I was simply delirious, and intoxicated by my new, unexamined Life. I started asking dangerous questions, and eventually began to look for answers. Back then, I believed I had all the time in the world. It later came to my attention that these were such important questions, that I should seek these answers myself, rather than to entrust the purpose and direction, or more properly the nature of my search, to anybody else, so as to avoid taking serious council from those with an axe to grind, and in the process, a profit to be made.

Sometimes, it’s not so much a matter of answering questions as it is recognizing false answers and improper questions. Your choice of how and what questions you do ask are more important initially than the answers (and motives) of those who want to answer.

Enlightenment is not the EVERLASTING KISS

Most of us think about enlightenment as being eternal bliss, as if, once attained, we would no longer feel anger, or disappointment, envy, or sadness. The Eternal Life in Heaven. The road to hell is not only paved with good intentions, but it is also charted by unrealistic expectations.

The analogy of the everlasting kiss works well because it represents a desire within most of us to prolong a momentary state of bliss into a perpetual one. Although most of us recognize that even everlasting love represents a continual, dynamic state of flux, we still hold onto ideals of an ice cream cone that never melts, much like a child who has never had to bury a beloved pet…or mother.

Imagine being on the best (or worst) roller-coaster ride ever built, and then imagine never being able to get off it. Better yet, imagine the everlasting orgasm…two, maybe three days tops before it turned into unending torture….

It is unlikely that any of us will attain true enlightenment if we attempt to attain it, so in the meantime, we could all be a lot happier if we make friends with ourselves, accept our present temporary state of affairs, and realize that all we will ever need we already have, and everything we will ever need to be, we already are. Everyone and everything that we encounter is here to teach us something, so long as we are willing to learn.

If you want a Happy Ending,
Try an Asian Massage Parlor.
This Book is not for You….

A Zen master is chased to the edge of a cliff by a tiger, and scrambles over the edge, clutching a small bush growing out of the side of the precipice, just beyond the reach of the tiger. He looks below, and sees two more tigers. He then realizes that the bush cannot support his weight for long, as a small mouse gnaws the roots of the bush; beside him, a small bunch of strawberries are also growing out from the same cliff…
Tigers above, Tigers below…The Strawberries were sweet.

Clyde and The Tree
(The Importance of Unrelenting Persistence)

When Jeff was hired by his first municipal 911 EMS system, all new employees were on probationary status for one full year, even if you were already paying union dues, they could not offer any protection against being fired for any reason…even no reason. That first year involved a sort of hazing of all new hires, but the ones with whom they were already familiar got off easily. The rest were considered fresh meat. The unspoken rule was to wash out two of the weakest candidates during training in order to give some opportunities to the candidates with slightly lower test scores, but a proven record within the community.

Jeff had very high test scores, but was relatively unknown in that county, as all his previous BLS experience had been in Miami, and even that had been extremely limited. He was too slow to treat and much too cerebral in his initial approach. His transition was not easy, and his training was not going well. He seriously feared for his job. This tended to make him “choke” under pressure, so his training officers just turned up the heat that much farther. If you are going to “crack up”, they want it to happen now, rather than later.

By the end of three months, Jeff was desperate; his own fears and anxiety were getting the best of his considerable knowledge and skills. He could feel himself start to choke every time the alarm sounded. He already began to dread going to work for what he had considered to be his “dream job”. At thirty-seven years of age, he had made a serious commitment to a goal he had set, and he was not accustomed to failing at anything; he felt like he was going into a flat spiral.

Jeff had started doing Zen meditation about a year earlier, and tried to apply it to his everyday life. He applied the same diligence to his study of Zen as he had to emergency medicine. In retrospect, Jeff was probably too high-strung to work in EMS, and he probably sensed it. He wanted to believe Zen could give him the clarity and inner peace he so desperately needed.

Jeff also had a dog, an eighty-pound pit bull named Clyde, and he used to take Clyde to the edge of a canal that bordered their property. He would put the dog in the back of his pickup truck and drive over the dike that surrounded the development in which he lived. He would sometimes just let the dog loose, so he could chase Jeff’s truck as they raced along the edge of the canal. Other times, he would throw a tennis ball into the canal, so the dog could swim to it and retrieve the ball.

One day, after a particularly heavy thunderstorm, Jeff discovered that a very large tree had washed up on the bank of the canal where he and his dog would run. This was not just a log, but rather an entire tree, maybe forty feet tall, branches, roots, and everything. It was stuck on a small spit of sand along the edge of the bank. The minute that Clyde saw the tree, he ran up to it, grabbed a branch with his jaws, and tried to drag it back into the water, but it was much too big and heavy, and quite firmly stuck in the sand. The utter impossibility of the task did not deter the dog’s efforts to drag the tree as he furiously latched on and pulled with all his might. Every day was a repeat of the day before. The dog never seemed the least bit discouraged as each day, he attacked the tree with seemingly newfound intensity as soon as they returned to the canal. Both the dog’s determination and the futility of his efforts amused Jeff each time they returned.

The pressure at work was becoming worse, and now seemed to occupy Jeff’s every waking thought, which hung like ominous storm clouds over his head.

A month passed with no progress or improvement in his situation as each shift, he feared might be his last. One morning, the water level on the canal was a little higher than usual, due to heavy rains for several days. The rains had been so heavy for so long, that Jeff and Clyde did not bother to go to the canal at all for two days. On this particular morning, as the dog latched on the tree, it actually began to move. The dog barked loudly, as if jubilant over his success. As he continued to pull on the branches of the tree, it began to roll over, and pulled the surprised terrier under the water as it rolled. Clyde eventually freed himself from the branches, and continued to swim with the tree as he now tried to pull it back to shore, with absolutely no success whatsoever.

Jeff began to laugh hysterically as he realized the analogy that the tree seemed to point up about his own life. He let out a huge sigh of relief, and said “All right!”, if only to himself, as the dog began his swim back to the shore. (Clyde finally had to give up, as the tree quickly went nearly one hundred yards downstream in almost no time at all.)

Jeff always believed that this scene had been an omen that was responsible for his breakthrough. From that point on, he was more confident, less easily rattled, and filled with newfound resolve to succeed. Although Clyde had struggled daily against seemingly insurmountable odds, he never gave up. In Fact, in retrospect, the dog seemed to relish the challenge, and was clearly disappointed when his success resulted in the loss of the tree.

So much of what we do in our own lives is not really all that much different. Our character is as much determined by the challenges of our adversaries as we are by our successes and the support of our allies. Never give up. Failure may be just one more effort short of success, but even the victory over an adversity does not come without some loss. We may fail to recognize that the challenges we face in our lives bring out the very best in each of us, and we are in fact mutually interdependent. For Jeff, that meant whatever was meant to be would happen according to its own schedule, so long as he persevered and kept faith in his own best efforts. He had been his own worst enemy all along, and all he needed to do was simply pay attention long enough to recognize the connection and meaning of what he had just witnessed.

Long before it was a television catch phrase for a gambling resort, the unwritten law was “What happens in the ambulance STAYS in the ambulance.” That is not an environment that lends itself well to any sort of written account of this industry other than propaganda, hero-worship, or whitewash, despite the fact that every alarm, every call, has the potential to contain an entire novel’s worth of drama, intrigue, humor, and adventure before you get back to station. Because of the necessity of anonymity, it is the stuff of which Urban Legends are made….

Would You Die for your Beliefs?

It should go without saying that the main character of this story is no hero, but he himself would have been the first to deny that he was a victim either. (That’s why they call it denial…) We are connected to our actions, and their results. It is said that nature abhors a vacuum, and when we lose our illusions, something else will have to take their place. As long as we use words, and thoughts created by our minds to rationalize and justify our actions, we will just as likely replace one illusion with another. Labels are just as dangerous as preconceived notions, blanket judgments, and all other forms of prejudice. Jeff often did bad things for good reasons, and good things for bad reasons. Jeff was not a bad person, but it took him a long time to recognize that simply not being bad doesn’t necessarily make you very good, either.

Even at his very best, Jeff was like a slightly flawed or failed experiment in contradictory dialectic synergism. A degenerate saint, a knight in stolen armor, a mad scientist turned suspect philosopher, a heretic monk, a Boy Scout prankster, a hobo prince performing high-class low-brow, and a rogue gentleman with ulterior motives for acts of selfless kindness. As good as he could be, and as badly as he sometimes behaved, he was as good as he was as bad as he was. It was an addiction that for Jeff, there was no cure because no matter how much he suffered for it, it was as if it was his raison d’etre and compulsive pleasure.

If you should meet the Buddha while Traveling along the Road, you should Kill him, and Feed his Body to a Hungry Dog.
(For ten years, I struggled with the meaning of this Koan. Fellow students, teachers, and mentors alike repeated it, regardless of their level of understanding of its meaning. Its words evoke strong feelings of the necessity of Dharma Action…but How? What? It wasn’t until after I Thought I had Achieved an understanding of it that I simultaneously realized what I was to Do.)

Epiphanies are usually the result of having stripped away the layers of illusion that we create that obscure true understanding. Once these illusions are removed, we have the opportunity to see everything exactly as it is…just like this…the world as it is, before words…before thinking….just this, only this.

Dreamland Dancing

(Black screen. Fade in slowly on extreme close-up of very full lips, heavily covered in fire-engine red lipstick.)

“Happy birthday to you”

(Slowly zoom out to face. Very tight shot of eyes, face to chin and forehead, showing blonde bangs. Very wide-eyed, and expressive face of a Marilyn Monroe impersonator.)

“Happy Birthday to you…”

(Slow zoom out to reveal MM on all fours, on top of a long table, dressed in only a black lace bra and panties. The rest of the room is dark.)

“Happy Birthday Mister President…”

Zoom out to reveal a long, tapered dinner-table candle protruding from the ass of MM. It is lit.)

“Happy Birthday to You!”

(Long shot of room, lights have been turned on. MM impersonator jumps up, revealing that it is a male, gleefully clapping hands together, jumping up and down. Falsies pop out of a bra. A half-dozen men in EMS uniforms clap and generally camp it up. It is as if the entire troupe of the Village People is now in the employ of one of the local private ambulance services.)

Welcome to a private ambulance service in the early Eighties in Miami.

(Cut to close-up of the face of Jeff, a paramedic asleep in the cabin of an air ambulance. His eyes snap open in a startled expression that instantly explodes into laughter.)

All this was a replay of a memory from Jeff’s first ambulance job, about twenty years ago. As bizarre as it may seem, it is not an especially isolated event in his memory bank from this period of time, or for that matter, from any other period of time in his life. It is as if the bizarre has been the connecting thread that had run through most of his life. Then again, it all depends upon your perspective. If you focus on the bizarre, then the picture you reveal as you connect the dots will be a great deal different than if you attempt to ignore, or block out those same experiences. And of course, there is no accounting for just how much of a magnet some people are for the weird.

Take for instance, the episode that immediately prompted Jeff’s journey into the dayroom of that Miami ambulance company. He had been sleeping in the lower bunk in the crew room at their main station. It was a large room with about ten bunks in it. The overhead light was rarely ever turned on, day or night, since there was almost always someone sleeping in it. Twenty-four hour shifts, and lots of overtime, frequently resulting in forty-eight or seventy-two hours of continuous ambulance duty. (At that time, “full-time” employees were forced to work “more than” seventy-two hours per week to either get benefits as “full-time” employees, or even be paid time-and a-half rates.) One-hundred-plus hour workweeks were not uncommon then. Whenever possible, day or night, you slept.

At approximately three am, he was awakened by the steel bunk bed in which he had been sleeping creaking and rocking, accompanied by muffled groans. He eventually realized that his partner, a fellow EMT, was having sex with another (male) EMT. It was like some low-rent grade-B, XXX-rated prison movie that never ended. Now that he was awake, this kind of thing would be hard to just ignore, so he decided to go outside to have a smoke, and went by way of the dayroom so he could take a leak first, resulting in yet another indelible “Kodak Moment” being burned into his memory banks.

If this seems too disturbing, or too offensive an image to be associated with medical professionals upon whom people routinely entrust their very lives, then you really won’t like hearing about the ambulance that used to station itself every Friday afternoon in the parking lot across from the Orange Bowl, dealing cocaine to fellow ambulance personnel, and friends. Sometime before noon, an Ohaus Triple-Beam scale was extracted from a black gym bag, and grams of cocaine would be weighed and placed into tiny zip-lock baggies and sold for fifty dollars each. Just like that. It seemed like everyone knew about it, and yet it went on like it was the most natural thing in the world, either ignored, or tolerated by those in whom it held no appeal. A third of the company personnel openly smoked weed, and made no bones about it. Another third did so, but tried to keep it a secret from the third of those who didn’t.

Imagine it is your first day of work as an EMT. It is a little after 0800 hrs. Suddenly the radio begins to “broadcast” from one of the ambulances, which is to say, the microphone has gone “live” due to having the transmit button being accidentally held in, either by a leg, or some piece of personal gear. Every word being spoken in the rig is now being heard by not only dispatch, but also every other rig that is on the road, and 10-8 with the radio on. (In New York, for instance, an ambulance is called a “car”, e.g.: “six o’clock car”. In Florida, they are more likely to be called a “truck”, or a “rig”. Some locales use the initialization: “ERV” (Emergency Response Vehicle), or similar references.)

“Cummon, nigga! Ya gonna smoke dat whole spliff yo’ self? I toned you on yestiday, ya cheap-ass muthafucka!”

“You’ll get ya share when I is good an’ Goddamn ready…dat shit you braht yestaday was nuthin’ but a bunch a’ Mexican bush-weed. Dis ‘ere is da real ting…sinsemilla. Two tokes gonna put ya on da floor trippin’. So shut ya mout’ an’ wait yo’ turn, bitch!”

“Who is you callin’ bitch, yo’ nappy-headed assho?”

“Speakin’ a nappy-headed bitches, tell yo Mama I lef the money on the dressa, and I’ll see her tamarra night.”

This dialogue continued for more than twenty minutes before the supervisor eventually recognized the voices, and intercepted them at their next scheduled pickup. They were not fired, nor were they even officially identified or the subject of any known disciplinary action, only unsubstantiated rumors about their suspected complicity. Speculation aside, the conversation was real, and heard by everyone who was on duty that day, including Jeff.

Eventually, one of the company’s top collectors was arrested in uniform, with the ambulance parked outside, while trying to enter a Miami crack house while it was being busted. Phone calls were made, but it never became a news item. This was before mandatory pre-employment, or even post-accident urine testing for drugs. (Bonuses were awarded each month for drivers who collected the most money for their transports-COD. The top collector for the year usually received a paid vacation in Hawaii. Some even had credit-card imprinters (just like the most elite Miami prostitutes), and some even were known to take their patients through the drive-through lanes of local banks on the way to their destinations.) They often used two sets of bills, which allowed them to turn in all collections as cash, thereby allowing them to overcharge for call-out fees, mileage rates, and supplies, like oxygen. The speedometers were intentionally set to read higher MPH than the rigs actually ran so that the company already charged for more miles than actual miles to the scene, or hospital, long before standard mileages were assigned first by Medicare, and later by private insurance. This was another time when insurance practices in the private sector copied what was set in the public sector.

Would you Kill for your Religion?

This is the way it was, over twenty years ago, like it or not. In nineteen eighty four, EMT’s were paid a little over three dollars an hour to work for a private ambulance company. Commercial painters were paid over eight dollars an hour starting salary.

It should be made clear, however, that private, non-municipal ambulance companies represent the absolute bottom of the barrel, so to speak, of an industry that, in its infancy was one of those lint-traps for human behavior that required people to work for shitty, low wages to do work no one else wanted to do. (The food service industry and house painting are similar examples; although painting pays better; it seems to be the safe harbor for semi-respectable alcoholics and drug users.) A private-service non-municipal EMT is to the Medical profession what a waitress is to the Food Service Industry. Even prostitutes have been known to say: “At least it beats being a waitress”.

For every hundred students that enroll in EMT classes, only one in three would actually pass the four-month training they received, then go on to pass the state certification exam. Of those, less than a dozen would actually go back to school to successfully complete the next year of training and state certification exams to become Paramedics. Less than a quarter of them were hired as municipal 911 rescue Paramedics. The left-overs worked for private services, “slinging lizards” (transporting geriatric patients) back and forth from the nursing homes to the ER’s, and interfacility transports from one hospital to another. Industrial Paramedics. Like at the nuclear plant, or the local jails and prisons. Like the School Nurse only with Drugs, needles, and a defibrillator/monitor. It is a business with a high attrition rate, and poor longevity. All things considered, your chances of a long and financially successful career, and retirement are about the same as a professional athlete’s. Top salary, if you make Captain, or Chief, might be around a hundred thousand a year at the end of twenty years if you work for one of the top ten departments in your state. The minimum for a rookie professional baseball player is something like one hundred fifty thousand. A rookie Paramedic is very lucky to make forty grand a year, before overtime. The State of Florida spent about eight thousand dollars more per year to incarcerate convicted felons than any department would pay as starting salary for a paramedic.

There is currently a shortage of paramedics, and although the wages are much higher now in total dollars, they do not support the standard of living, due to inflation, and (ironically), healthcare costs. It is predicted that the situation will actually get worse. It is becoming harder every year to recruit personnel. No one wants to pay better wages, so the proposed answer has been to consider lowering the entrance requirements, and test score minimums, rather than attempt to recruit better people by offering better wages.

But even an enviable position in a professional municipal EMS service does not preclude compulsively bad behaviors…

(Yet Another Digression…)

Sometimes, Art imitates Life imitating Art, and Urban Legends spawn swarms of posers attempting performances of acts and situations that had theretofore existed only in mythological states.

Witness the “Mile High Club”: It rarely takes very long for people discovering new territories, avocations, hobbies, industry, or states of mind or body to quickly develop more than just an idle curiosity about what it would be like to fuck (or to be fucked) while experiencing them, much like the marijuana smoker who considers weed to be an enhancement to just about anything. (It is my suspicion that it starts shortly after just doing it right at all no longer demands total concentration, but also well before it becomes routine…). Also, the only way to achieve confirmation of legends is when their perpetrators get killed, or otherwise caught, which potentially represents the Perfect Crime when they don’t. They are the stuff of which Headlines and SoundBites are made.

For instance: You would think that by now, EVERYBODY would have heard that it is an extremely bad idea for ANYONE to stick either their, (or anyone else’s) Penis into either a vacuum cleaner hose OR any of the orifices related to Swimming Pools, Hot Tubs, or similar devices. But No…Every few years, (depending on the strictness of local Standards and Practices of the broadcast media) news stations run stories about some Asshole who tries it again. The traffic on the dispatch channels for local Emergency Services, is overheard by the news media, who quickly swarm and contaminate the Emergency Scene, and turn it into a News Scene, and thereby confirm that it is Still Not a Good Idea to Stick a Penis into Either of those Two Items, and simultaneously transform it from Urban Legend to Confirmed Stupidity. In EMS, it represents the unspoken consolation prize for having seen too much…and that is: Job Security. I was once criticized by a Pollyanna Paramedic for walking into an EMS station wearing a baseball cap that said “I’d hate to be accused of advocating the use of drugs, sex, and violence, but they’ve always worked for me…” (re: Hunter Thompson discussing his sources of inspiration). My reply was “If it wasn’t for sex, drugs, and violence…we’d all be out of work.”
So let’s just leave it to say that we all know about the Mile High Club. In more than two EMS Services, let us also just say that there is also a Code Three Club involving sex with Emergency Services personnel in an Emergency Vehicle while speeding down the road with lights and sirens operating. This is not to be confused with having sex with a patient (especially psych patients) in an ambulance, which is pretty much generally considered abuse no matter where you go, or who you ask.

First of all, you have to find a roadway where no one will see you and an excuse if anybody does. Then you also have to find a willing participant, either a stretcher bunny or a siren slut…or, say a civilian videographer, assigned to ride with you for twenty-four hours to shoot footage for a documentary she is making. (The two charming sexist monikers usually refer to female EMT’s who work for private ambulance services, and non-EMS women who like to hang out in fire stations or near ambulance entrances at hospitals. They are the “groupies” of EMS. God Bless them, wherever they are.)

High Jinks in general help to relieve both the stress and the boredom inherent to professional EMS. Although I have heard variations of this story many times, in many different parts of the country, I was personally familiar with a crew who may have themselves taken this Urban Legend up to the level of confirmed stupidity.

It was a particularly boring stretch of summer, at a station in one of our westernmost areas of the county, which was particularly isolated, and one of the few last “slow” stations left, where Medics were briefly “pastured” for a few weeks of rotation, while they received certification in various areas of training when they had the time.

About twenty-two hundred hours (ten PM), a fireman from another station called, to let the crew know that the Chief had just left their station and was on his way home. It had been a “surprise” inspection, and both crews anticipated their station would be next. The crew decided it would be funny to arrange a semi-circle of chairs in the area of the equipment bay usually occupied by the ambulance. They then turned out the lights in the bay, took off all of their clothing, and waited for the arrival of the Chief dressed in only fire helmets, bunker boots and gloves, pretending to play cards. One member of the crew was a female, not to be outdone in such a notoriously chauvinistic profession; she was as naked as the rest. And so they waited, in the dark, until the chief finally drove into the driveway. Using his garage door opener, he drove right up to the bay, headlights on high beam. The crew had not been told that the Chief would be bringing his wife and children….

Jeff’s career had swung in both directions between the two extremes of great expectations and mind-numbing disappointment. He had worked private non-emergency services with some of the worst. Twice, he had been hired to work for municipal, 911 rescue services. Often he was either Lead Paramedic, Training Officer, or Supervisor for private, municipal, or hospital-based operations. If he had been a little wiser, and a lot less high-strung, he would still be working for one or the other of them.

His knowledge and skills levels were exemplary, and he had managed to acquire a reputation as a top-notch medic with a volatile temper, unpredictable mood swings, and an overbearing personality who was difficult to tolerate for twenty four hours at a time. He was high-strung, and tended to verbalize his frustrations incessantly. He had a foul mouth, and a generally perverse sense of humor that alarmed more than a few of his colleagues in a business in which “ambulance humor” was already notoriously dark. People either loved him, or hated him. Believe it or not, there were more than a few medics who held him in the highest regard. I was one of them.

One of his closest friends had compared him to a pit-bull: fiercely loyal, tenaciously stubborn, and suicidally fearless. He routinely exhibited long-suffering patience and compassion for his patients. If he trusted and respected them, he might show a similar quality for his co-workers. If he did not, he was notoriously short-fused. He seemed to have no time for weakness among his fellow employees, and frequently referred to EMS as “the business that eats its own young”.
He had a penchant for professional self-sabotage that had similar roots in his personal life. He rarely stayed anywhere more than five or six years. Although he generally stayed out of any serious trouble, he seemed inexplicably drawn to controversy, and constantly pushed the envelope. He challenged his supervisors incessantly in a way that alienated him to them, in spite of awards, commendations, and many letters of gratitude from the public he served. He found himself frequently regarded as quite unlikable by people who would have preferred to treat him like the fair-haired boy, had he given them the opportunity. Eventually, he would start to feel stifled by this world of his own creation, and move on.

Would You Live for your Beliefs?

Air ambulance seemed like it would be his Saving Grace. He was assigned to work with a very attractive and intelligent flight nurse who had considerable experience working ICU and Surgical Recovery. They both had an uncanny knack for anticipating each other’s moves, and their capacity for teamwork was quite remarkable from the first day. Because she had no flight experience, when necessary, she would take directions from Jeff more graciously than even Jeff expected.

Although they both were very much concerned with maintaining an absolutely professional relationship, they were also becoming very fond of each other. This created an atmosphere that lent a note of intrigue, and a fascinating tension that neither of them wanted to end by consummation, at least any time soon. They were both married, and had enough problems already. Oddly enough, they both believed that as long as they didn’t start anything, it didn’t have to end, because when you have no claim, you can’t make any criticisms. He came to believe that the very thing that attracts you to a person is the same thing that leads you to do things that bring the mutual validation to an end.

He also had numerous opportunities to speak either French or Spanish, as needed, although his flight nurse was much more fluent in French than he was. Sometimes, the captains or first officers would let him hand-fly the aircraft when there were no patients on board, and he got flying lessons he could have never afforded on aircraft he could never normally fly without certifications he would never be able to get.

This particular service sent their flight crews out for two weeks at a time, with two weeks off. The pay wasn’t great, but it wasn’t bad, and the per diem allowances were better than most. It seemed he had finally found his niche. His crew got along famously, and in spite of his quirks, and temperamental outbursts, he felt not only tolerated, but also genuinely liked and appreciated, and respected, both as a medic and as a human being. He was a genuinely colorful character among people who were to some extent at least, cut from the same cloth.

Not only was this not Jeff’s first job as a paramedic, this was far from his first career, having only started his education and training as a medic at the age of thirty-five. Prior to that, he had been a faculty member at a local community college, a chemist, an electronic equipment installation technician, a TV repairman, a telemarketer, a body guard, private investigator, armed guard, cable TV installer, long-distance truck driver, guitarist, and proprietor of a small music recording studio he had built for producing demos for a record label and talent consultant firm he had set up to promote the musicians he had recorded.

This was definitely not his first rodeo, and more than anything, Jeff desperately hoped it would not be his last. It just wasn’t fun anymore. It was time to move on, and he didn’t know which way to turn. He seemed to be able to do just about anything he set his mind to, just not for very long. He had been a medic for over twenty years now, and the walls seemed to be closing in around him.

Jeff was in his early fifties, and tried to stay in shape, but not very hard. He often referred to himself as a Buddhist, but he was not a very good one. He looked at least ten years younger than his age, but had grown weary in spirit. He had lost his enthusiasm. He was short, but muscular, although he was about twenty pounds overweight, and had what women often call “rugged good looks”. When he was younger, he had a somewhat boyish cute look about him, and all things considered, he had been very fortunate to age so well. Of course, this was no consolation to him.

He had been in the same predicament twenty years ago, after he closed down his recording studio. It was like everything he had done since college had been a prelude to a dead end, and there was no turning back. Then his estranged wife went back to her drugs, and got herself killed in the process.
Eventually, he met a nurse named Inga who advised him to go back to school to become a paramedic. At the time, he was working as an in-house cable TV Installer. He had been assigned to install cable in her house, and she had invited him back that night for “dinner”. He ended up spending the night, and they started dating. Although she seemed to like him, his current occupation was too proletarian for her rather snobbish bourgeois tastes. She kept telling him he was not living up to his potential, and that he should start thinking about his future. Her initial encouragement was at best, a sort of left-handed compliment. She said: “You could be a paramedic if you wanted. In less than two years’ time, you could have a new career that would change your life. You have a good knowledge of science, and a flair for learning, and you are definitely the biggest bull-shit artist I ever met.”

In one sentence, she had fairly well summarized how most nurses regard paramedics in general.

Although Inga was not very tall, she was by no means petite. Her figure was decidedly more on the voluptuous side, or as some might say, Reubanesque. Large, full, pendulous breasts offset a surprisingly small waist, broad hips, and a very generously round bottom. She seemed to ooze sexuality and mischief in every movement she made. Her eyes were quite large, expressive, and deep blue. Blonde hair and a fair complexion complemented her fine Scandinavian features. She seemed inordinately preoccupied with status, money, and appearances for Jeff’s liking, but sexually, she was fun loving, lustful, and imaginative. They both had sex with anyone else they desired, but attempted some degree of discretion, although they were quite frank and honest with each other as regards their peccadilloes.

Her father had been a high-ranking military officer from some place in Mississippi. When he died, they named an airfield after him. She had a penchant for emulating that snobbish, haughty condescension so often typical of self-impressed Southern aristocracy in decay.

From the day they met, she constantly proclaimed that she did not want a relationship, and did not need a boyfriend. Jeff had heartily agreed and often stated, “A woman without a husband is like a fish without a bicycle”. Despite their supposed agreement on the subject, every time Jeff went back to his house, she would eventually show up on his doorstep in tears, professing her undying love, only to toss his shoes amid caustic remarks if he stayed much more than overnight. This was more than simply disconcerting, because Jeff lived more than twenty-five miles away. It was also damn inconvenient.

Theirs had been a love/hate relationship at best, but in some ways, it characterized the professional relationship between medics and nurses. She had promised to help him through school, and said she could coach him and help study for exams. She even lent him the tuition money to enroll in his first semester, an EMT class, and EVOC (emergency vehicle operator’s course) certification, only to break up with him for no real apparent or stated reason during the first week of classes. In the meantime, he met his next future ex-wife. As soon as he got the money to pay Inga back, he called her up.

The minute he got through the door, she threw herself at him. For six months, they had been on this seesaw romance, and he knew he would not be doing this again, and he suspected she felt the same way. They became one mass of tongues, fingers, and bodies as they ripped each other’s clothes off. They were naked before they got to the bedroom door, fucking like animals, finally collapsing, breathless, and in a heap, falling off the bed onto the carpeted floor. As they lay there gasping, she started to giggle which grew into nearly hysterical laughter. Their bodies glistened with sweat, he-goo and Vulvaline 50 weight, that marvelously fragrant industrial lubricant of Humanity. Imagine a humid summer ocean breeze blowing through a salt-water taffy shop “…down at the shore”…sweet and salty, with an intriguing undertone of musk. He leaned over to kiss her face as a large bead of sweat dripped from the tip of his nose onto her face, barely missing her left eye. Still laughing uncontrollably, she pushed him away, proclaiming “Your face smells like pussy!” Not in the least deterred by her remark, he said “Don’t even try to pretend that you don’t like it; It wouldn’t be your first…or is it just because it’s yours?” She giggled impishly and turned her face away. Next, he rolled her over, his still-rigid member glistening and dripping with their co-mingled human stew-broth, parted the generous mounds of her round and sticky buttocks as he pressed his Jade Stick against her still-slippery sphincter which parted easily to swallow the impatient intruder and heartily grasped his cock like a politician shaking hands at a convention. What once was an exit is now an entrance for Kundalini as he seeks the first chakra. She resisted half-heartedly, moaned licentiously and raised her ass upwards to accommodate his thrusts as he plowed and planted deeply into her backyard playground with newfound zeal, increasing the tempo and force of his pelvic thrusts as he felt her clenching spasmodically until he could stand it no more, shuddering and spewing what felt like every last drop of moisture from every cellular fluid from his body. Even his mouth felt dry by the time he had stopped although both their eyes glistened in the semi-darkness of her room. As the last paroxysmal contraction seized her body, she gaped cavernously and spit him out with considerable force, comingled viscous humors, audible vapors, and yet more laughter. Then, for the moment, all was stillness between them, save for the sound of their breathing and the air conditioning. A stillness and calm passed over them as Jeff broke the silence, only to barely breathe the words “Le Petite Mort”, for once not choosing to compulsively explain his reference to “The Little Death”…she may have come from Metairie, Louisiana, but at that moment, he cared little about her comprehension of French. Though they shared this moment, for him, it was his moment. Even years later, in the occasional reverie in which each of us indulges ourselves for no apparent provocation, it always seemed to be a galvanizing experience of empowerment and serenity.

This had nothing to do with domination, humiliation, or any other sort of sexual politics. As bad as she was for him, she had influenced his life more significantly than he was yet to realize, and he had loved her more than was probably good for him, or for her. She helped inspire him to launch a career that would span over twenty years as he saved countless lives, but their moment on his timeline was just that, a moment. He never saw her again after that day. He doubted that his influence on her had been as important as hers had been on him, but then again, she reeked of a loneliness that she clearly despised within herself, as if torn between her need for companionship and her perception of independence. She had been badly hurt by an abusive husband, and avowed to never be so needy ever again. Her lust was her undoing, but if she could have coped with being so well-done, she wouldn’t have been so conflicted. In reality, Jeff was just an animated sex-toy to Inga, and maybe that was all she really needed.
Afterwards, he simply got up, put on his pants, put the borrowed tuition money on the dresser, and walked out the door. The only other contact he ever had with her was about two weeks later, when she left a note on his windshield while his car was parked at school; it said: “Maybe it wasn’t so much because you didn’t even say good-bye, but the way you left the money on the dresser that made me feel so cheap, even though six hundred dollars is a lot more than I get downtown. (ha ha). Give me a call, and I might let you make it up to me.”
He knew better than to respond. He was certain that the only reason she had left the note was to get a chance to get the upper hand again. For once, there had been no harsh judgments or words between them when they parted, and all in all, he felt it had ended on a rather upbeat note. From his perspective, it was better to not look back. She was not his first nurse, and she would not be his last.

Although Calamity seemed to walk on his shadow, he considered himself lucky beyond the telling. Even people who didn’t much care for him either admired or envied him. It was his friends, however, who were the first to realize how shitty his judgment was, or at least, they were the first to share this observation with him. Unfortunately, they had no idea how to explain it to him, and he was none too quick to recognize it himself. Sometimes, he had the weird personae of an idiot savant. At other times, he was completely self-absorbed, to the point of appearing naïve; the next minute he could take on this character of sharp, biting wit, and clever repartee, with a razor-like intensity. Or he could stare through you with the most un-focused thousand-yard stare that would make you feel exactly like he was walking on your grave, right then, somewhere far away.

At other times, it seemed like he would never catch on as to the full extent of his obsessively poor judgment regarding his own Life Choices, which was odd, considering how good not only his medical judgments, but also his instincts were.

Form is Form. Emptiness is Emptiness.

In late June, just around the solstice, Six PM in Miami still feels like afternoon. Eastbound, on 36th Street, headed into Allapata, with the sun coming through the back windows of the Ford van the Coroner’s Office uses to transport the (usually) more or less recently dead, it’s hard to tell Two PM from Six, except for the angle of the sun. It’s still
stinking hot; especially inside this particular van, whose third, horizontal passenger no longer feels even the slightest shame about the sporadic emissions of flatulence that seem to punctuate each jolt, or bump in this jointed concrete road as it approaches Miami Jackson High School. (The process of decomposition starts within minutes, and the gases produced are capable of very strange phenomena, especially after several hours, like the farts of the dead, or full, round, firm breasts on eighty-year-old dead women.) The stench inside the van is so astonishing, that even with the front windows open, and the air conditioning on MAX, the two attendants, long-time veterans, cannot even blunt the acrid vapors with the two Esplendido they have lit.

The Cuban-American community in Miami is as decidedly divided in their opinions about genuine Havana cigars as they are about the now more than forty-year embargo of their homeland itself. Most share the essentially ancestral hatred of Castro, who long ago dubbed them “Los Gusanos Amarillo” (The Yellow Worms), for having fled their homeland. The last three generations have never seen their “homeland” which is still depicted with tearful fondness by their elders. Some of them still belong to Alpha 66, an extremely determined, heavily armed, and well-funded paramilitary group bent upon the overthrow of Fidel Castro, even adopting the image of an angry yellow worm, with gritted teeth clenching a stogie, wearing an army helmet, and brandishing a Thompson machine gun.

It is difficult to grasp how to justify an embargo that progressively has starved parents, siblings, and other family members unable to escape the island, living in abject poverty, on the brink of desperation, but the Cubans of Miami are themselves an enigma on many levels, and unless you have lived and worked with them long enough to really know and love them simply for who they are, as they are, they will seem to be a formidably incomprehensible series of contradictions. Several years ago, after his heart attack, Fidel Castro denounced the same Havana cigar that had been his trademark for so many years previous. And in Miami, many otherwise politically correct Cuban-Americans pay top dollar for smuggled “Cubans”, be they flesh or tobacco….

Artie and Oscar had been partners for over twenty years, and are two of the most unflappable characters you will ever meet. They share a point of view that few people will ever know, except nurses, paramedics, and the very few ER doctors who aren’t too full of themselves as to be above what is called Ambulance Humor. Sometimes you have to laugh to keep from crying, at least in front of your peers.

Hey Oscar!
WWWWWWWWhat, djew wan, AAAAAArtie?
Hey Oscar!
Eeeescuse Me?
Why, did you just fart?
NNNNNNNo, AAAAAArtie, wwwwhy?
Conyo! You mean you always smell this way? Cabron!
I don’t think I’m going to want to fuck you in the ass tonight. You sure you didn’t shit your pants?
NNNNNNNo, Artie, I don’t think so…
I don’t just mean today.
But I took a chower.
What about our “hitchhiker”?
DDDDDjew wan me to axe heem?

They break into paroxysms of gasping laughter as both of them hang their heads out the windows. Completely self-entertained, most of any shift they work together is punctuated by shtick such as this, whether they have an audience or not. Their department chronicled stories of interns so shocked by their antics that they did not return from lunch.

Today, they have a short hiatus to complete before depositing their cargo to the coroner’s office. The traffic this time of day is so bad, that no one will notice the slight delay incurred in stopping at a funeral home just a few blocks off their route to I-95 south.

They pull around to the back of the mortuary, and back into the space normally reserved for the hearses. Everything is done very quickly, and precisely, the same way it has always been done when they make one of these “runs” into this establishment to “unload”.

“A Puerto te! We have to be in and out in less than fifteen minutes!”

Artie is the more assertive, and animated of the pair, and a Cuban-American. Oscar is laconic, bucolic and a relatively phlegmatic, nationalized Colombian-American who usually functions as the straight man for their one-liners and slight gags. Oscar tends to stutter and stammer, which also helps set up the straight lines for Artie. Both verbal and physical humor were their trademarks in a profession where humor is rare, and considered inappropriate at best, and seldom tolerated.

Now they move with the swiftness and precision of true professionals. Although they do not appear to be rushed, not a movement or moment is wasted, and they do nothing to attract attention to themselves. They are focused, and deadly serious in both their intent, and actions. The back doors are opened, the stretcher is unloaded, as the undercarriage drops to the asphalt and they glide effortlessly backwards into the open doors of the establishment. This is, by the way, no mean feat, considering their cargo, plus the stretcher weighs well over five hundred pounds. He is enclosed in a dark-grey-black “body bag”, which only augments his immense size.

“Chingao! What did you do, free Willy?”

The funeral home attendant, a slight, but wiry man in his sixties has a hawkish look about him; his sharp, prominent nose and intense eyes give him the look of a bird of prey, and his thin, heavily oiled hair is combed straight back. Like an eagle, or falcon, with the same quick, precise but slight head and eye movements that focus instantly on his intended subject.

“No, Padron. This whale did not wash up on the beach, but fell from the sky like a giant piñatas!

“Si, yo entiendo. I was told we got over ten kilos of excess baggage to remove. Conyo! This jackass will be the mother-of-all mules! We could never get this much shit down the gullet of a live one and even a dead maricon couldn’t take this much up the ass. We were lucky he had so much recent surgery to cover up the way they stuffed him like a gringo turkey for thanksgiving. Now it is time for us to be swift and very thankful for our good fortune, so let’s slice this guanajo and be on our way.”

Recent sutures, too new to even heal, are quickly snipped and removed. The abdomen and thorax are opened, and many bags of white powder, encased in plastic, are removed from where the spleen and most of the liver had been. The lungs have been displaced upward so as to allow the placement of even more tightly compacted bags. In all, fourteen kilograms of contraband are removed. The funeral attendant, once a surgeon in Havana “opens and closes the case” almost as one would unzip a suitcase, remove a shaving kit, and zip it back up. Long, bony fingers replace the sutures so well that one would not even suspect that they had been removed in the first place. The “patient” had not even been removed from the body bag, but rather simply “unzipped”, and re-sutured in less than ten minutes while the three of them sipped buchitos (small paper cups of oily, black Cuban coffee, with a thin layer of brown foam, heavily sugared, and chased with ice water). A small dab of Vicks Vapo-Rub under the nostrils helps disguise the odor of a morbidly obese, recently deceased man who has just spent the last four and a half hours in the cabin of a small private jet sitting on the tarmac in the sun while quarantined at Customs. The last two hours, it had reached over one hundred thirty degrees inside the plane after it had landed at Miami International Airport.)

Meanwhile, the trio discussed the evening Jai-Alai lineup, and made tentative plans to reunite later for wagering, drinking, and “a couple bumps of perico”. In less than ten minutes they were back out the door and back on 36th street, headed for the morgue at the coroner’s office.

“It’s a good thing Alberto held things up at Customs as long as he did, or else we’d have been back before the suits left. I hate those fucking guys! Always sniffing around, like it’s a federal case…of course it would be if they ever got their noses out of each other’s asses long enough to get a whiff of what’s really going on…always playing politics for pennies like they were somebody important, and all the same, the whole bunch of them don’t make what either one of us do in a year. Fucking pendejos! Those cabrones always looking down their noses at us…two, maybe three years more, and we will be done; retired and living large like country gentlemen, while they keep fighting like dogs over scraps.”

Artie rarely got worked up like that, but it takes a lot to rationalize his “situation”, given his background. The son of a doctor in Cuba, his family had fled the island with nothing, and his father had died suddenly of a heart attack, a broken man, who had never regained either the medical license or social and financial stature that had been his dream when he expatriated his homeland.

Artie was ten years old when his family came to America, and the transition had been hard. He had once been a privileged eldest son, and adjusting to life on Calle Ocho had made him grow up quickly, and harshly. He was not very large in stature, so his wit, humor, and cunning had been his salvation. He was well-liked in high school, but always on the edge of trouble. He was bright, good-looking, and showed much promise. He could talk his way out of just about anything. His ambitions, however, had taken him down a few paths he thought would be only shortcuts to a life he only now saw as a real possibility.

Although he wished he could somehow make his father proud of his recently acquired wealth, he also knew that if his father could look down from heaven to see his son mixed up with drugas, it would break his heart. They say there is a broken heart for every light on Broadway, and Los Angeles has the Boulevard of Broken Dreams. Miami, once dubbed the Shanghai of the Western Hemisphere, is no stranger to broken dreams, hearts, or promises.

Oscar, on the other hand, bore more than a slight resemblance to Manuel Noriega, and stammered almost constantly. He was very good-natured, and possessed the more subtle wit of the two. Although Artie often made Oscar the butt of his jokes, Oscar was more than a little shy and insecure, so allowing Artie to play Oscar as the clown nonetheless gave Oscar the spotlight a great deal of the time. They were a legend on the streets of Miami, especially among the police officers and detectives with whom they rubbed elbows on a daily basis. Ironically, it was their benign comical personae that allowed them the unfettered passage they required to accomplish their hidden agendas without suspicion.

The frog sings, but gives no wool or milk.
(Cuban Proverb)

In the scheme of things great and small, this operation would not be especially noteworthy in and of itself in a city where, as a port of entry to the US, a major smuggling operation can move several hundred kilos of narcotics at a time. It is not even an especially well-kept secret that a number of banks in the Metro Miami-Dade area owed their existence to laundered drug money acquired in the seventies and eighties. Mid-level dealers are the only ones who have a hard time here now, since the place has been dubbed “too hot” due to the increased DEA presence.

Small time street dealers flourish everywhere, but mid-level upwardly mobile nouveau professionals are the fish just big enough to appease the agents who have quotas to fill, and they are fed to the government sharks by the really big fish in order to maintain the status quo. During the seventies, The Black Tuna Gang made sensational headlines because of the Metro Dade Police involvement in cocaine trafficking, home invasions, and murder. It was neither the first, nor the last time such a thing would happen here, but the real professionals got a lot more careful after that. Everything is relative, but everything is also connected.


When Jeff first became involved in EMS, the last of the Cadillac hearses were being phased out of service. In its infancy, ambulances were furnished by local funeral homes. Many acted as removal services for the recently deceased. Nobody seemed inclined to suggest that this arrangement may have represented something of a conflict of interest, and besides oxygen, a stretcher, and some bandages and splints, they may just as well have been hearses anyway. The hearses were too expensive, the patient care/transport area was too low, and they were generally ill suited for actual treatment of viable patients. In many cases, the attendant would not even ride in the back with the patient, but would sit up front with the driver to catch a smoke on the way to the hospital. This is how it was possible for Jimi Hendrix to die aspirating his own vomit while lying on his back on a stretcher in an English ambulance shortly after the Isle of Wight Festival.

The development of the Ford conversion van for ambulance work was a quantum leap for EMS. The ceilings were raised enough to accommodate treatment and movement within the patient compartment. Oxygen, suctioning, and monitoring devices were readily available, as well as electrical power, radios to Medical Control, and access to numerous medications for treatment and stabilization prior to arrival at the hospital Emergency Department.

Another milestone came in the form of battery-powered infusion pumps and portable EKG monitor/defibrillators. Jeff was accustomed to using the IVAC/Seimens Mini-Med, which was a multiple channel intravenous pump that had provision for up to three separate infusion rates and dosages for accurate administration of fluids and medications at a controlled rate that was independent of ambient pressure, or elevation of the IV bag above the patient. His aircraft carried two pumps, for up to a total of six separate lines of medications and fluids, as well as being a redundant back-up in case one pump failed.

Physio-Control introduced the LIFEPAK 1 more than thirty years ago. It was a behemoth, a boat-anchor of gargantuan proportions responsible for many career-ending chronic motion injuries to AC joints and rotator cuffs resulting from having to pull them out of unaccommodating compartments placed too high, causing undue stress as they swung downwards, jerking the arm nearly out of the socket. Jeff first worked with the LIFEPAK 3, which was nicely trimmed and lightened. It was the first readily-available, nearly-universal EKG monitor/defibrillator for municipal EMS services everywhere. It was a three-lead monitor. The LIFEPAK 10 followed shortly afterward, with three battery compartments, and more features, which was slightly larger, followed sometime thereafter by the LIFEPAK 12, which brought portable 12-lead EKG monitoring and defibrillation in one unit to the ambulance. Its major significance being that it was the first 12-lead monitor to also include defibrillation.

Despite their claims or attempts to the contrary, hospitals are NOT models of efficiency, due to their unrealistic Standards of Care, which would normally preclude allowing the person who recorded the EKG to actually administer the appropriate treatment, since they require a doctor to interpret the form, rate, and rhythm so as to make a diagnosis and order the administration of treatment in the sort of timely fashion mandated by the American Heart Association at that time. Emergency Departments and ICU units were the first to challenge that view and position, but the rest of the hospital had been slow to allow or support anything other than protectionist policies as a way of perpetuating job security at the expense of the patients’ well-being, partly due to the efforts of corporate conglomerates’ attempts at cost containment at all costs, which tends to make the hospital personnel grumpy and defensive about anything that threatened their elitist positions.

Jeff’s employer at that time, the air-ambulance company, was using the Zoll defibrillator/monitor, or the Welch-Allen ProPac, another monitor/defibrillator that also included SaO2 and PCO2 monitoring. Both were either battery or AC-powered portable units that represented the latest and best equipment available.

The next major milestone was the development of the portable ventilator. Impact Industries had developed a model that was very nearly comparable to the more bulky and heavy ventilators used in hospitals, that usually required the services of a respiratory tech to operate, and generally unsuitable for any sort of ambulance use. There had been other models marketed by other companies before, but they used much more oxygen, and were not suitable for more sophisticated treatments required by the most difficult patients. Not everyone could use them effectively in all situations, but Jeff never encountered a setting or problem he couldn’t solve. Whether it involved electronics or other forms of technology, he was first and foremost a technician, and all good paramedics have to utilize their best troubleshooting skills on a more or less daily basis. It’s just the nature of the game. Emergency situations often involve series’ of uncontrolled variables that require you to shoot from the hip…Improvise, Adapt and Overcome…Always.

This was yet another reason for the rift between hospitals, doctors and nurses, and Paramedics. Out of the hospital, either on the street or in your home, and most especially in the air, it was Paramedics that saved your life, or kept you alive long enough for the hospital’s doctors and nurses to treat you once you arrived. They had their turf, and we had ours.

Later on, much larger modular ambulances began to replace the Ford conversion vans in many locales, but the vans still remain in service all over the country.

The Korean War saw the advent of the use of helicopters as medevac vehicles. The patient rode outside the bubble cab of the helicopter on a Stokes Basket-style stretcher, so no care could be rendered enroute, but they could rapidly access nearly inaccessible locations and quickly deliver patients to field surgical locations. As this tradition continued, the level of patient care while in flight has improved concurrently. For rapid evacuation from nearly inaccessible locations as well as rapid means for relatively short distances directly to receiving facilities, helicopters remain without equal.

Longer transports require the use of fixed-wing aircraft. By far, the two most preferred aircraft for that purpose were the Beechcraft King-Air 300 and the Lear 25. The King-Air is a turbo-prop, which means it is much slower, but requires less take-off and landing room. It has a much lower altitude ceiling, and stands much higher off the tarmac, making placement of the patient into the aircraft more difficult, but once you get up in the plane, it is substantially roomier. It is also considerably less expensive to own, operate, and maintain.

The Lear 25 series was built during the sixties through the early seventies. By the nineties, the average age of the first officers and captains was between twenty-two and early thirty-something, which means that in most cases, the planes were older than the pilots.

Legend has it that originally Bill Lear bought the aircraft design from a company that had intended to use it to build a sub-sonic fighter aircraft for the Swiss. The wings and airframe were designed to withstand something like eleven G’s, but the plans did not include engines or tail structures. The next several attempts at tail design took the lives of numerous test pilots before a configuration could be found that did not tear loose from the body, thereby causing a crash while attempting the “military maneuvers” for which it would later become legendary, including its alleged ability to take off on one engine only, or to climb at a reputed 88 degree angle on takeoff, commonly referred to as “yanking and banking”. At the time of this writing, the Lear 25 still had the fastest rate of climb of any non-military production aircraft. It was the aircraft that inspired the Byrds to write the song “Eight Miles High”, referring to the forty-five thousand foot ceiling of which the aircraft was capable of attaining. From that height, you can see the effects of the curvature of the earth. You can watch the literal edge of night as it crawls upon cities to your east that are already below the horizon line of the sun as it appears to them.

For many aircraft owners, air ambulance charters represent a way of making jet ownership possible. Even sitting still in a hangar, a jet aircraft bleeds money in silence. Maintenance intervals, insurance premiums, licensing, and even storage fees are fixed requirements that can be calculated down to cost per hour, including amortization. The more time it spends in the air, the more it costs to keep it up there, but it only makes money while it’s in the air. The options include private/corporate charter, freight, and air ambulance.

To fly an air ambulance, the aircraft must be inspected, and licensed by the state in which it is officially hangared. It must have provisions for oxygen administration and an inverter capable of providing sufficient 120-volt alternating current to operate all the monitoring devices, infusion pumps, ventilator, and respiratory equipment. It also has to have some sort of provisions for supporting and securing the stretcher upon which the patient is on and off-loaded. Many air ambulance flights are brokered by agencies that provide the equipment and personnel, as well as the clients, and who charter the aircraft for a specific mission.

This has both advantages as well as drawbacks for both parties. On the one hand, the owner/operator of the aircraft is responsible for all the logistical support and general operations of his aircraft. This is good for the owner, who doesn’t have to be overloaded with medical details beyond the transportation of the patient. This is good for the air ambulance service because they don’t have to be plagued by aviation issues beyond chartering the flight. These flights are commonly called “out and backs”, a round trip that also includes returning home at the end of the mission. Occasionally, a “back flight” is booked, if there is a client in need of transportation. Everyone considers these to be extremely fortuitous, as extra money is made by everyone without incurring any significant additional fuel costs, and without having to arrange a completely new charter. For this reason, “back flights” are frequently sold for much less than a primary flight would cost.

The disadvantages include missing opportunities for all the additional flights that could be chartered like pearls on a string, thereby eliminating a great deal of replicated return flights, (commonly called “dead heading”), as the crew members are not usually available for more than one to two days at a time. Most Flight crew members have “real jobs” working for hospital or EMS systems. Medics characteristically work 24 hours on, with 48 hours time off, while hospital personnel usually work four tens or three twelve’s for shifts that are usually arranged a month in advance. Both timeframes allow for enough idle time to either spend money, or make more money, and most choose the latter over the former, at least eventually. This tends to cause conflicts for all parties concerned if the aircraft is grounded by weather or mechanical problems because the medical crewmembers’ time is usually spoken for beyond the specified charter. Unless the crewmembers have a good reliable back-up person who will cover their shifts when they get held over, most personnel leave the business after a few years, or as soon as it starts to jeopardize their “real” jobs. Working on-call for an air ambulance service rarely pays enough to be sufficient by itself.

Very few air ambulance companies actually own their own aircraft, (most broker their flights to private owners) but for those that do, it allows the company to have unlimited access to an aircraft as well as a flight medical crew on practically a moment’s notice. Eventually, Jeff ended up working for one of these services.

This means that the aircraft is configured for ambulance use 24/7, eliminating the hour-plus set-up time required on chartered planes. It also means you have two full crews of flight and medical personnel. Sometimes, it may be cheaper to fly your relief in to a local commercial airport, rather than bring the plane back to headquarters, but at least it means that the aircraft will remain stocked and configured for ambulance use at all times. It also means that four people are destined to live half of their lives away from their regular homes and families. You actually spend more waking, interactive time with your “alternate family” than you do with your spouses and children. This lends itself to some very unusual dynamics on all fronts.

Special Circumstances

There are any number of situations peculiar to air ambulance that involve using special techniques or special allowances for the unique set of dynamics peculiar to hyperbarics, acceleration/deceleration, ascending and descending altitudes, etc. Most of them are covered in depth in the training manual. This one is not, for reasons that will be apparent very shortly.

There is a medication called isoproterenol, or Isuprel. It is a synthetic form of norepinephrine, a form of adrenaline. It is a very powerful alpha and beta-adrenergic catecholamine used to increase blood pressure, and well as increasing the force and contractility of the heart muscle. Powerful enough to make an old leather boot jump up and do a tap-dance. In the past, it was used as a last-ditch measure to produce a heartbeat, pulse, and blood pressure in patients who were in low-output cardiac failure, especially when refractory to long-term dopamine administration. A number of years ago, The American Heart Association re-classified Isuprel (or Levophed) administration from a recommended, possibly helpful action to a non-recommended, potentially harmful action, due largely to the fact that frequently its resulting inotropic and chronotropic cardiac effects were generated at the expense of mesenteric and peripheral perfusion, which is to say that sometime within about four days of administration, end-organ failure may result. This means that I can give you Levophed to produce a pulse in a blood pressure today by giving your gastrointestinal tract, your liver, and your kidneys a ninety-six hour stay of execution by way of necrosis.

One may well be tempted to ask why a modern, state-of-the-art air ambulance service would even consider adding it to their rather considerable armamentarium of life-saving medications known to have proven positive effects on patient mortality and morbidity. The answer is this: if a family pays a fifty per cent non-refundable deposit on a ten to twenty thousand dollar air ambulance transport to bring grandpa from Missouri to Los Angeles so the family can say their goodbyes before he dies, everyone involved will be VERY DISAPPOINTED if grandpa arrives DOA.

If grandpa is already dying, an extra four days’ time for the family to say goodbye is a good thing, and no one will be disappointed. For patients with life expectancies of more than ninety-six hours, it would not be considered a wise decision by anyone. Hence the adage: “Levophed or leave ‘em dead”.

The service for which Jeff worked carried Isuprel for cases where the former, rather than the latter circumstances prevailed.

Another set of special circumstances would involve the addition of family members, pets, and luggage into the logistics of how it all gets done. Especially on return flights to foreign countries, the family will sometimes attempt to overload the aircraft with microwave ovens, TV. sets, and other consumer goods, presumably to avoid tariffs and taxes that would otherwise have to be paid. The pets were either caged and/or muzzled. Similarly, provisions were also made for the administration of sedatives to particularly unruly, high-strung, or uncooperative family members (or pets), “…as needed to maintain flight safety”.

Other circumstances may involve details like arriving at a foreign hospital after hours to find out that copies have not been made of the charts and records. The Business Office and Medical Records Departments may have the only copiers available in the entire hospital.

Bed sheets and pillowcases are a sort of barter commodity in this business when you are out of country. It is not uncommon to have a nurse standing in your way demanding trade of clean sheets for every sheet with which the patient leaves. More than once, flights have been delayed at the airport while a customs agent checks a special list to see if the patient owes money to anyone important enough to prevent their exodus.

Form is Emptiness. Emptiness is form.

Miguel and Sonja

From the first moment that Miguel saw Sonja, he knew that they shared a common destiny. In their world, abstractions like Love, (or for that matter) Destiny were unknown. They shared a world we would consider to be filled with only the harsh realities defined by the Real and the Finite. And yet, as mean and minimalist as their worlds had been, they both felt a heretofore unknown attraction stirring within themselves that left them both mesmerized and spellbound. Being relatively young, they shared the reckless impulse of youth. Unaccustomed to the sort of culturally-determined cautions with which most of us have been poisoned, it was with a new found frenzy that they embraced and copulated in reckless abandon.

This was not, however, a product of either their tropical, or their Catholic Caribbean/Hispanic-influenced environment. Although they had only known each other for less than five minutes, nether knew that they would both be dead within the year. They were young and impetuous and had no concept of impregnation, let alone contraception. This was not unusual in their world. For Blattodea Periplaneta (cockroaches), it was a way of life.

Not far away, more sinister activities would prove to be the harbinger of Death.

The Tables are Turned

A man kneels; his eyes covered with a dirty blindfold half-soaked with blood. His face is swollen almost beyond recognition. His hands are tied behind his back. In North America, he could have been a model for some “Big and Tall” mall outlets for men’s clothing. Doubtless, there must have been some point when hope of pleading for his life had left, or even a point where he still felt fearful, but that was now long gone. It seemed a lifetime ago, and in fact, almost was. Sixty or so years now seemed, in retrospect, to have passed incredibly quickly, with the exception of the last four terrifying and excruciating hours. Resignation had settled until all that was left was the waiting, and an occasional sigh.

“Cabron! You don’t look so proud or arrogant now, do you?” Although he can no longer see any of his captors, the voice is familiar. A half-dozen men stand around him. They are all sweating, and none of them have escaped being stained from the gore, like picadors at a bullfight. The largest of them, a menacing young man, perhaps in his late twenties, leans next to the ear of his hostage. A giant of a man, perhaps six and a half feet tall; his intimidating demeanor is further augmented by his sheer muscularity. His bulk, as well as his lantern-jawed facial features would suggest he is no stranger to injectable anabolic steroids. He speaks in a stage whisper, as his victim flinches by the mere sound of his tormentor’s voice.

“Where are all your friends in high places now, puto” He spits into the face of the captive man to punctuate his contempt. “Now that you are no more use to them, you’ve become a liability that even they don’t want to have to deny. You strutted around here like some kind of rooster for a very long time, but roosters don’t fly so good. I wonder how well you can fly.”

They are standing on a second-story veranda that overlooks the front of the villa. A car is approaching the estate by way of the long, tree-shaded drive. Oblivious to the witnesses within the vehicle, the large young man grabs his hostage by the belt and the back of his shirt and tosses him over the railing. He lands face down into a flower bed with a dull thud, motionless.

“Conyo! Mamma is going to be muy encojonado if you messed up her flowers!

Carlos, the smaller, older man is visibly shaken by the recent actions, but they all burst into nervous laughter at the incongruity of the slight man’s concern over the flowerbed. As he looks over the edge of the railing, a well-dressed man in his sixties exits the back seat of the limousine that has just now pulled around the circular drive in front of the villa. For a man as large and as old as he, he leaps from the vehicle like a panther. He removes the dark esplendido stogy from his clenched teeth as he looks first at the man lying prone and motionless in the flower bed, and then back up at the men on the veranda. He repeats these motions several times, in disbelief. His face glows a florid purple as he shouts.

“Chingao! Rueben, have you lost your mind? What do you think you are doing?”

Ola, Poppy! The man on the balcony responds nonchalantly. “Nada mui importante, really. Just throwing out the trash. Old stuff we don’t need anymore… solamente uno poco basura”

“Come down here, right now”, the old man shouts. “Every time I leave this place for more than a day or two, you start acting like you run the place, but until you learn to start thinking before you do something stupid, that is not going to happen until I die. But I swear to God that you are going to give me a heart attack and put me in an early grave! Is that what you are trying to do?”

The younger man deftly does a side hurdle over the railing and lands next to his father as nimbly as a cat, oblivious of the twelve or so feet that had been separating them. The old man flinches and shakes his head, but smiles as he cuffs the younger man on the back of the head. As he kneels next to the man in the flowerbed, he rolls the motionless victim over, the still-blindfolded man gasps, which startles both the other men who leap backwards, stumble, and fall.

“Carajo!” they both exclaim in unison as they cross themselves. “Esperde! The old man strokes his chin with his right hand, the large stogy trapped between his index and middle fingers. “I got an idea…put this culo in the back of your jeep and call the doctor. Tell him to meet you at the hospital. Maybe we can turn this into something smart yet….

Rueben, who had been sitting on the grass where he had fallen, now leaps to his feet, but not before Sonja had taken the opportunity to crawl into one of the cuffs of Rueben’s victim’s trousers. She had no idea where she was going, but she acting on pure impulse, as if on a mission. Forces beyond her comprehension motivated her actions now. Miguel was not even a distant memory, a mere anecdotal footnote on her timeline. This was all about the perpetuation of the species and the cycle of life. This is the real stuff of which women’s intuition is made. Although women may understand a little of it, men have absolutely no clue at all. God was Alive and Magic was Afoot, and the stew of future generations simmering in Sonja’s abdomen, like Dr. Frankenstein’s progeny, only needed that vital spark of life that was soon to be discharged, one way, or another.

There are probably as many theories about the nature of life and the existence (or non-existence) of the Soul as there are logical and ethical incongruities in the platforms of either American political party. And that is precisely what they are: theories. Speculation. Faith is what we believe in the absence of proof.

So, let us just agree to consider the following items as possibilities.

Neither matter nor energy can be created nor can it be destroyed, but it can be changed in form from one to the other. That which can be said to possess Life also possesses certain measurable forms of energy, and these energies possess predictable patterns, and in some cases, even rhythms. That which we call inanimate does not possess these energies, at least as far as we know, or generally speculate.

When something ceases to be alive, where does the energy go? When a new life begins, from where does this new, individual source of energy come? There are those among us who are inclined to believe that the Laws of Conservation of Mass and Energy might apply to the realms of the Spiritual as well as the Physical Universe.

Now imagine Sonja, pregnant and heavy with newly fertilized eggs, nestling in the cuff of the pants of a man whose life energies are draining from his body almost as fast as the internal hemorrhaging from his bruised and ruptured internal organs are distending his abdomen and collapsing his lungs.

If you place a magnet against a piece of ferrous metal long enough, eventually some of the magnetic energy will be transferred. Transfers are often accomplished by way of concentration gradients. Sometimes gradually, and sometimes very quickly.

Neither Matter nor Energy can be created, or destroyed, but they can be changed in form.
(Just the same, God or no God…where the fuck did it all come from?)

(Sometime later, in Fort Lauderdale…)

Two pilots sit at a bar, hunched over their drinks. The establishment’s décor is the kind of generic aviation theme that you could see at just about any private airport bar, but this particular one is decidedly tropical in motif. In addition to the obligatory antique propellers and faded photographs of vintage aircraft (and pilots) of days long gone, the walls are paneled in pecky cypress, that gray-brown, worm-eaten wood so stereotypically indigenous not so much to the Florida Everglades as to Florida bars. In the previous hundred years, there were never that many “cracker shacks”, fish camps, or hunting lodges, as there now are Everglades theme bars. As a result, the once plentiful and cheap local cypress is so scarce and costly that imitation distressed lumber is more likely to adorn anything built less than thirty years ago.

This particular bar is located within walking distance of the FBO (Fixed Base of Operations) where they have recently hangared their jet. Although they are on “standby”, they have been told that it will not be long before their next flight. The business they are discussing now may indirectly involve company operations, but it is not anything that they would have wanted to discuss in the presence of the ubiquitous on-board cockpit recorder. Even now, their voices are so subdued and obviously surreptitious that, had anyone else been within earshot, or even seated at the bar, it would have been suspect for clandestine content.

“Are you sure this is safe?”

“Nothing except War, Death, and Taxes are certain.”

“And the truly wealthy don’t pay taxes.”

“I know a lot of rich people that pay taxes.”

“I didn’t say rich, I said wealthy.”

“What’s the difference?”

“Between rich and wealthy?”

“Yeah, what do you mean?”

“The guy that owns that aircraft…he might be rich, but the guy who owns the company that makes that aircraft is wealthy!”

They both laugh, and shake their heads. Truth was that most owners maintained a visibly affluent lifestyle of conspicuous consumption, never paid any bill they didn’t have to, and frequently cheated on their taxes. Both Jake and Ross had been stranded in distant cities all over the US after landing in some FBO, only to be greeted by Federal Marshals with warrants and court orders to seize the very aircraft they had just landed, because the “loaner” engines that they had been using while the originals were being rebuilt were more than six months overdue. Sometimes the owners had the money to pay, and sometimes they didn’t, but it is not uncommon to have to get a court order to get paid. (And really wealthy people don’t need to cheat on their taxes, because they can legally avoid paying them in the first place.)

“Jake, all I can say is this: just keep your mouth shut, and you get an easy three grand. I know this guy from when I used to run freight out of here. For the price of my captain’s cash, I can get a kilo of blow. I have a guy waiting in Ft. Lauderdale who will pay me enough to more than make it worth our while. Best of all, the owner will never know because I can use our fuel card for expenses, and what we make will provide the money to replace the captain’s cash, plus our profits.”

“What about the pick-up and delivery? There are all kinds of people watching any unusual activity in these places, and plenty of incentive to dime us out, once they get their money from us, or even kill us, and keep the whole thing.”

“I am telling you, this is a lock, and here’s why: we don’t even have to leave the airport to take delivery, because the supplier has a vested interest in our safety.”

“How so?”

“Because he’s also our client.”
“Are you shitting me?”

“It’s a fact. When I saw the name on the manifest, I made a call to one of the sons, who had done business with me before. I expected him to be a little offended with trying to do business in the middle of a family tragedy, but he said that was OK by him, ‘cause it gave them a chance to recoup some of the cost of the flight, and after all, business is business. Truth is, I was a little surprised with how matter-of-fact he was about the whole thing. Then again, it’s been my experience that these spics would sell their own children, if the price was right.”

“What do you expect from people who learn how to conduct business by pimping their own mothers and sisters?”

They both break into paroxysms of laughter again. In fact, they both needed the money. Ross, the captain, was too old to ever get hired by a major airline, and had only recently made the transition from freight to charter. Although charter was considerably more lucrative, he had already realized that his life had fallen far short of his dreams, and if he was going to ever save enough money to retire before he was too old to fly, he was going to have to capitalize on whatever opportunities he could.

Jake, on the other hand, was not only younger and smarter, but he was a better pilot as well. Although he had been earmarked for the Air Force Academy, one winter in Montana, while flying freight, his crew had overloaded his “Super Connie” so badly that between the icing, and the extra weight, he failed to clear the trees at the end of the runway, and crashed, fracturing both his femurs in the process. The FAA had ruled the crash was due to “pilot error”, in spite of the fact that he had been ordered by his boss to take the flight, against his objections over the weather and the fact that the crews routinely overloaded the planes, and lied on the manifests (at the unspoken urgings of the owner).

That was a customary FAA ruling. If it isn’t an obvious mechanical failure (that couldn’t be spotted during the pre-flight), then it will be ruled “pilot error”. After the ruling, even his father, a retired Colonel, had not been able to pull enough strings to get him into the academy. Nor was Jake ever able to win his way back into his father’s favor.
No Form, no Emptiness.

Wheels Down

Forty-three thousand feet. Around two miles higher than any commercial flight. Mach 0.82. Five hundred miles per hour airspeed, more or less, plus your tailwind or minus your headwind. (The Jet stream sometimes travels at over two hundred and fifty miles per hour. Although your relative ground speed could easily exceed the speed of sound (with a tailwind), your actual airspeed is still relative to the air around you. At somewhere above Mach 0.8, the Lear 25 will start to buffet and shake, although the airspeed alarms are set to go off well below that point.)The End of the Innocence heralds arrival into Hispaniola in Jeff’s headphones as we begin the long descent into the airspace above Hispaniola.

“You’re more than a few decades late, Don.” He mused. ”…Innocence? Why not announce The End of Relativity?…Wait!…better still: The End of the Relative Innocence….”

Jeff forgets that he is the only one to question Mr. Henley’s relevance…(“The Relevance of the End of the Relative Innocence?”) due to the fact that both the musical selection itself, as well as his clever repartee are trapped within the virtual space between his own noise-cancelling headphones, and the musical selections are his and his alone. Also, at O-Three Eighteen Atlantic Time, it is doubtful that anyone else really gives a shit as You’ll Never Make a Saint of Me continues to conjure the ambience of a climate so steamy and dank that even the roaches carry their own towels. It is the same climate responsible for the venerable Cohiba. Bridges to Babylon indeed. Thanks, Mick. If you’re a rock star, being a bad boy is a prerequisite, but if you are a paramedic, it is a definite liability.

He often wondered if other people spent so much of their lives like impostors, actors, or undercover operatives just trying to get through an average day…whatever that was. One man’s ceiling may be another man’s floor, but the life of any paramedic, let alone an international flight medic, does not encompass any frame of reference common to the average citizen. Cops experience a similar kind of isolation, but most possess a more simplistic and fundamentalist point of view and belief system that also insulates them, and gives them a sense of belonging, or fraternity within their own ranks not common to most medics. Some call it “Traditional Family Values”. Less kind individuals might be more inclined to call it a substitute for rational or creative thinking.

Being possessed was no substitute for belonging, especially in a profession that thrives while eating its own young. Even an Advanced Aero Medical Transportation Specialist is at its basest denomination, just a glorified, high-tech airborne teamster…a mover of living meat. No True Believer in much of anything, his independence had rendered him the proverbial man without a country, an expatriate Dharma-Bum with “tendencies…toward a multiple personality disorder” and “bipolar features”. (…professionals denied he had any true manifestations of Multiple Personality Disorder…)

They bank, pick up the next vector, and continue the descent into what might yet prove to be The Heart of Darkness. If he was trying to set up his own foreshadowing, it was lost, at least as far as he was concerned. His mind was elsewhere. As the former Eagles drummer extols the virtues of Forgiveness, he contemplates the pearl of an epiphany that has taken him well over two and a half decades and six matrimonial…well, let’s refer to them as romantic expeditions (more like continuous Leaps of Faith from frying pan, to fire, to broiler, to fire, or frying pan to frying pan…) to comprehend. It was unfolding like the petals of a Lotus blossom as the common ground, the Gestalt, and the connectivity revealed themselves, introduced the next factor, and moved on like the links of a Caterpillar Tractor tread as it clanked through the jungles of Hispaniola.

To be the hero of One’s Own Hero is to Steal Fire form the Gods
(from Navajo wedding vows)

Love and Marriage

Those matrimonial Leaps of Faith usually proved to be not so much “from the frying pan to the fire”, as to “from one frying pan to another”…you can’t really escape your Karma, or your problems with what might appear to be a quick fix. For one thing, as overwhelming as some of our lives appear to be, they are our present situation, or our present circumstances, even though they are the sequelae of our basic natures.

Marriage is of course, a complex series of compromises involving two sets of Karma. As complicated as that can get, it really comes down to the fact that two lonely, unhappy, and/or misguided people do not equal one happy couple. Although Jeff believed that Love was the one true purpose of life, he still defined it in terms of how good it made him feel, as if the right love with the right woman would make him happy. So until you actually break the cycle, you don’t escape your problems, you just exchange them, like returning a faulty blender to a department store, only to trade it for a faulty VCR.

Of course, the real problem is that although we may realize true happiness through love, as long as we require reciprocation, we are still stuck in the same cycle of desire and sorrow. It is not until we can experience love independently of its return that we can know it for what it is. It is our expectations that lead us to our disappointments. Fear, risk-taking, and danger are thrills to be enjoyed that cannot be transcended without having been experienced. But whether you call it cyclo-thymic, or manic-depressive, or bipolar, the roller coaster is not the only ride at the carnival.

When you can love another selflessly, just to love them for who they are, as they are, without limiting that love in terms of how they complete your ego, you can love fearlessly. And if you can love one person unselfishly, eventually, you may learn how to love everyone as yourself, because once you see the interconnection between us all, life and love become seamless. Not perfect. Every day is not bliss, but you can learn to embrace the inevitable with style. Jeff was not unfamiliar with these tenants in much the same way that many learned people have at least been introduced to the concept of Relativity, without necessarily fully grasping how it applies to their everyday lives, and recognizing those connections.

And so it was that Jeff had exchanged a Lace-Curtain Mick Princess Artist/Heiress for an Arabian Slum-Goddess Call-girl, for a Hillbilly Cocaine Cowgirl, for a Shanty-Irish ex-Nun/Nurse who couldn’t kick her dirty habits, and a Child-Bride Stretcher-Bunny before he had met Stella.

Although Jewish by birth, she was essentially a Nihilist with an obsessive-compulsive disorder. She was also fourteen years younger than Jeff; that is to say that the year that she entered Kindergarten, Jeff was commencing his sophomore year of college. In high school, she had become a Stoner, and one of the many casualties of the Southern California School System who had dropped out after her brother had died and her parents had divorced, only to return, finish school, and finally receive a nursing certificate.

Ironically, she had originally enrolled in an EMT course, but had been “bumped out” by a Los Angeles County fireman who decided to enroll at the last minute, and got preference. Although she was a damn good nurse, it had not been her first choice, but it was a choice she had made that led her and Jeff together. Later, she would embrace Wicca. For a time, her spirit flourished with her new-found belief system, but the surgeries, and the pain medications had left her spirit as impaired as her body had become, and she lost her will, as well as her way. Although she would experience episodes that seemed as if her powers, as well as her raison d’être had returned, her coping skills with the mundane details of everyday life were not especially strong, and proved to be no match for analgesics and Xanax.

And now the soundtrack for this movie we call Jeff’s life segues, as Counting Crow’s A Murder of One chronicles one of his deepest secret fears: …”All your life is just a shame, shame, shame. All your love is just a dream, dream, dream…Open up your eyes and see the flames, flames, flames…Your wasted life is such a shame, shame, shame….”

How could one life be so simultaneously rich in experience, and yet so financially impoverished? How is it that a man could know the love of so many women and still be so lonely…lonely, yet never alone, yet on so many levels always alone?

He had been taught that somehow, happiness, satisfaction, and the comfort of a life well lived was something that could only be discerned in relative terms, in the twilight of one’s life, and in retrospect.

Both classical Western intellectual dogma and Zen seemed to converge on that one axiom, that you spend your whole life preparing to die…properly, where one viewed the vast tapestry of your life, saw that it was good, took your last breath, and exhaled the satisfaction known only to those who knew that they were going to a better place, or at the very least, moving on, transported by means of tickets paid for by the life well-lived. That was what he had been taught, yet it seemed far more likely that no matter which path one took, no matter what you did, at the end, your final realization was not whether or not you “blew it”, but rather a long series of revelations of when and where you “blew it”.

Every choice you make precludes some other choice that would have resulted in some other consequence. If it only involved choosing between good and evil, heaven and hell, the lady or the tiger, or life vs. death, it all would be easy to divine. In fact, most of his choices had been between whether to get a good night’s sleep before the SAT exams or practice for some Battle of the Bands, followed by a few stolen hours and kisses with Ms. Right Now. (Of course, she thinks she’s Ms. Right…but more likely at best, a future ex-wife). While “watching the submarine races” may be a term indigenous to the South Jersey Shore, every town has a “Firestone Alley”…(it’s where the rubber meets the road). The guy who gets the academic scholarship to Harvard probably doesn’t spend much time down Firestone Alley, but years later, when he realizes it’s too late, he will be left to wonder…no better off than the under-achieving adventurer struck late in life by ambition and avarice.

Most people view the lives of others with envy because they never realize the price each of us pays for the choices we make, and the consequences that are their sequelae.

Is it possible to be afraid of too much truth?

The mouse eats cat food, but the cat-bowl is broken.
(Zen Koan)

Later on, other versions of the big and little choices made between responsibility and pleasure still point to the same conclusion: it’s not “…always either sadness or euphoria…” but at the time, it’s just another choice gone unnoticed as soon as it is made, and the thread that connects it to the great tapestry of our lives is no more recognized than the slow, inevitable progression away from where we thought we were headed.


The other preoccupation that had dogged him for years was a feeling of being just a hairsbreadth from some sort of huge realization that would free him from the enigma, the dilemma in which he felt so trapped…(before shaking loose the mortal coil of existence). And at the same time, he could actually feel himself avoiding it, recoiling with the fear of standing on the precipice of some great abyss in order to view one’s life from afar, but terrified somehow of the realization he thought he desired, for reasons he did not understand. It would not be until several years later that he would come to realize, through reading Pema Chodron, and doing Tonglin Practice that the very realization that would set him free would also suck the breath from his brain, and his soul. His Deepest Secret Fear was a realization that had the capacity to rob him of his sanity more easily than enlighten him. Once you face your ultimate truth, it has the capacity to stun your spirit beyond recovery. In this case, Jeff was lucky beyond the telling, as most of his life had been. At least, that was how he viewed it. Where others may see only calamity and tragedy, he would be the first to point out that he was still alive, un-incarcerated, non-committed (to the care of any specific facility), employed, and married with children. In his mind, he still had options, even though he had hedged his bets to their limits. His children somehow gave him a unique sense of purpose he had not known until then.

Everyone has a different ULTIMATE TRUTH with the ultimate potential to crack your reality, although it appears that the real differences come mainly from perspective, or point of view. But that is for another time, later on, as you will see….

As “A Murder of One” continued, he thought:

“That’s it! There you are, trying to protect what you think you have, only to realize that you are imprisoned by what you limit…why is it that women blame the men in their lives if they aren’t satisfied with their lives…’not fulfilled’ (…and I don’t mean sexually)? Who said it was my job? If some really exciting stranger comes along, and he convinces her that I ‘tell her when she’s happy…tell her when she’s wrong’…like some bird in a cage…she will resent me for trying to keep her. It’s no wonder that so many men are afraid to make a ‘commitment’. If you try to protect her, she resents it…resents you. You’re not supposed to fix her problems; you’re supposed to listen to them. The very things you do to be responsible and stable, make you boring. By the time you get finished trying to bend your nature to her will, you might as well be her girlfriend.”

It’s ironic that women are rarely attracted to what they make of the men with whom they fell in love. Later, when an attractive stranger comes along, now you seem boring.

Each of us is responsible for our own happiness. Trying to convince anyone that if you don’t make them happy, it is somehow your fault is emotional blackmail. If you buy into that, it will suck the life out of you like a vampire on a fourteen year old boy.”

Jeff was on a roll…”embrace your deepest secret fears, for they will set you free…throw yourself into the void…it’s not the fall that kills you…it’s that damn sudden stop…you either learn to fly, or else…(or else you don’t)…but fear and boredom will kill you more surely…it just takes longer…like trying to pull a Band-Aid off a very hairy place…it’s best done like you mean to do it…fearlessly…it will hurt a whole lot less….”

“Fidelity” was re-affirming everything he had already realized. Once again, Todd Rundgren was doing the score for this film of his life. Of course, Jeff was the one who had put these songs together…it’s like we already know everything we need to know, even when we don’t understand what it means, because we are trying so hard to wake ourselves up from that hypnotized dance we call our lives.

There was that story about Walt Disney being cryogenically frozen…a friend had suggested he wasn’t dead, just in suspended animation. Well, if death is suspended animation, then the Un-Dead, the Zombies who are so afraid of Death that they are also afraid to really live are in an Animated Suspension. The doomed…missing links who take up space and diminish the life force…sucking up energy and subsisting on about half a soul at best while they do the Saint Vitas Dance to a tune written on waves of polypeptides…talk about ‘Sweet Emotions’. …someday the glove will be on the other hand…”

We Judge Others by their Actions, but we Judge Ourselves by our Intentions.
(LSD-Induced observation, c. 1969)

He kept thinking about the letter that he had finally left…the one he had written several dozen times before, but never let her read. ”By the time I get to Santiago, she’ll still be sleeping…hell, by one p.m. she’ll still be sleeping…if she keeps eating those Xanax like they were Tic-Tacs, she may not even notice the letter taped to the mirror.”

What can you say about a drug that’s also a palindrome? “Xanax…no wonder you can’t tell if you’re coming or going…” Not likely to be a marketing slogan any time soon, but you have to admit…it sure seems to be more than a coincidence.

The real problem was that there had ceased to be any purpose to either the comings, or the goings, at least as far as imperatives were concerned. She had worked so hard, and suffered so much. He thought that if he removed the necessity of daily work at a job, she might have the opportunity to pursue the more esoteric and sublime aspects of Life. Jobs may come and go, but the work of our lives remains, whether or not we realize the difference between the two. Instead, she had completely lost her bearings, her horizon line, and her frame of reference. The road to hell is paved with good intentions. The road to her hell had been paved with his good intentions.

And in reality, as much as Jeff believed that he would have to solve Stella’s problems to find his own happiness, it would be years before he would come to realize that his own happiness was right in front of him all along. If you withhold your enjoyment of the present moment, as it is here and now, then it is you who are your own worst enemy. Placing expectations of what conditions must be present for you to allow yourself the ecstasy of the present moment is to deny your own joy. You don’t have to bury your head in the sands of denial. Just accept what is, as it is, and keep moving. To focus on whatever becomes the past as soon as it happens, or to worry about what hasn’t even happened yet will only drown you in either negativity and criticism or fear. Sure, things could be better, but they also could just as easily have been worse. Forget better or worse and you might just stumble upon gratitude all by itself. Abandon the distraction of criticism of others as a scapegoat to prevent facing your own self-imagined shortcomings, and you might just strip away the hypnotic illusion of the fear with which we surround ourselves. If you recognize that with or without a God, our existence in the Universe is a miracle beyond our imagination or comprehension, then you don’t even need to wonder where all that matter and energy came from in the first place, or if there was a first place at all.

“If all things return to The One, to where does The One
(another Zen Koan)

Stella Wakes Up… (Well, sort of)….

Stella’s day would begin pretty much like every other day; uneventfully, with a cigarette. Whatever. Six o’clock, nine o’clock, eleven o’clock. Whenever. When Jeff was gone, the kids got themselves up for school. They fixed their own breakfast, walked the dog, and got themselves to the bus stop on time. When they got home, they did their homework, and usually fixed their own dinner, and washed their own dishes. Jeff had taught them to be self-sufficient. On the weekends, they often did their own laundry. Stella had taught them not to expect too much in terms of maternal parenting. Whether awake or asleep, it was not at all unusual for her to spend more than twenty hours per day in a reclining chair with the television on, eating, drinking, smoking, or all of the above. She had virtually stopped reading anything but the program guide and an occasional title credit more than a year ago. A set of cordless stereo headphones helped complete the isolation.

She took off the headphones, and looked for something to drink to wash down her morning medications. First, something to wake her up, then another cigarette. When all went well, she managed to actually finish it and put it out in the ashtray before she fell back asleep. In forty minutes to an hour, she would usually be back awake, once the medications took effect. When they didn’t go well, she was awakened to find herself on fire, having ignited her bathrobe with her cigarette, which their youngest son had some time ago re-named her “smoking jacket”.

Next came the trip to the bathroom. Emptiness all around. The kids are ready in school. The dog is asleep in the living room. She returns to her chair.

“(Shit…three hundred fucking channels and nothing to watch that is worth a damn. Nothing at least that I haven’t already seen four or five times.)”

Nobody to even complain to about it. When she does finally get up, if she finds chores undone, or not properly done, she goes into a rage, but there is still no one to hear it until the kids or Jeff get home. And when it all has been done and done well, she becomes even more depressed, because whether or not she will admit it, even to herself, she is nearly useless. That is probably why it is so hard to please her. Her dissatisfaction has become her empowerment. The more that those around her try to satisfy her whims, the more of a tyrant she becomes, so long as her subjects, enslaved by their devotion to alleviating her suffering continue in vain to win her approval. Minimal acknowledgement negated by strategically juxtaposed fault-finding and criticism precludes those servile to her requests from becoming too complacent; she thereby maintains her subjugation of those around her who are victimized by their love and devotion. Although it often becomes a classic presentation of what could be called cripple syndrome, it is highly unlikely to represent a conscious thought process so much as an inevitable series of stimulus-response-mediated reactions resulting in programmed behaviors learned by both the subjects as well as the object. Jeff was no stranger to recognizing this syndrome in patients under his care, although he proved very slow in generalizing how it applied to himself. Stella was therefore incapable of recognizing her abnormal reactions to common, everyday frustrations. How do you discuss feeling useless and lonely, when you can’t quite put your finger on what it is that makes you feel so bad? Suppose you never let yourself admit what you feel? Substitute fear with anger; you can run, but you can’t hide from yourself. If you compound the illusions long enough however, you can lose yourself.

It wasn’t that her pain wasn’t real. For some people, pain is an obstacle to be overcome in order to do whatever it is that gives passion to their lives. Without the passion, without the raison d’être, the pain becomes the focus, and no amount of narcotics can erase the pain of a life without purpose, especially if they become the only purpose you can remember. And so, she became her disease.

Five operations and endless diagnostic procedures later, she barely functioned any more. Eight years of moving backwards. She so wanted to feel whole again, but didn’t know where to start, let alone identify what the real problem was. She blamed her husband for working too hard, or too many hours, yet the longer he was home, the less she functioned, and the less she felt needed, or essential to much of anything. Jeff was just grateful that she was there at all, since his chosen occupation required someone to be at least present in body while he was away at work, whether it be a twenty-four hour shift, or a two-week tour. Single-parent medics faced an entire set of complications and entanglements that intact marriages, no matter how bad did not, if bereft of family or friends to support them. The kids left her exhausted, and overwhelmed. When they were at school, she was adrift and aimless, but when they were home, all she could do was rant. She might get out of her chair every five to ten days, and go decerebrate over all the household chores left undone or not done to her exact specifications. Three boys doing two or three loads of laundry every two or three days, plus their own dinners, dishes and homework go unnoticed if you never get out of the chair.

Then there were the semi-regular “crises” that occurred when she ran out of either cigarettes, or Xanax, or one of her narcotics or amphetamines. Even the slightest attention to detail would have allowed for a plan to renew the prescriptions, or get another carton of cigarettes. Instead, at eleven PM, or fifteen minutes before Jeff’s departure for a flight, Stella would announce that she was about to run out of one of her necessary addictions.

On the rare occasions that she woke up (courtesy of copious quantities of prescription amphetamines) with enough initiative to undertake some “project”, she would labor maniacally without regard for fatigue or injuries, only to collapse, in spasms and pain, back into the chair, followed by the perfunctory self-administered narcotics, in a seemingly endless cycle, devoid of either satisfaction or respite. On other occasions, she would get so “tweaked” that she would compulsively take apart some household appliance, the Water pic, or the weed-eater for no apparent reason, with no clue how to restore it to working condition. Sometimes, she achieved amazing results, but more often than not, it would result in the demise of the offending devise.

It had not always been like this. When Jeff and Stella first met, she was one of the most beautiful, intriguing, provocative, and beguiling women he had ever met, which was saying quite a lot for Jeff, who had never wanted for the company of beautiful or intelligent women, since his divorce from his first wife. She too, was charming, and at least his intellectual equal, as well as an accomplished fine artist, and he adored her in a way that he thought would have been impossible with anyone else except a first love, but once she left him to go to live in Paris with a friend of his, the only way he knew to escape the pain of her rejection was to immerse himself in a life of Sex, and Drugs,, and Rock and Roll (actually, anything but Country Music), Art (especially beautiful artists), Martial Arts, Weapons, sports cars and just about anything that came under the heading of an acronym he had used for the name of one of the bands he formed, which he called the S.P.I.D.E.R.S…an acronym for Sex, Politics, Intrigue, Drugs, Espionage, Rock and Roll…and Sex again, just for good measure, as it was truly his Alpha and Omega.

It was the early seventies, and the whole world was not just watching, it was changing dramatically and fundamentally in a way that embraced cultural, social, political, and sexual revolution, and Jeff found himself increasingly drawn toward controversy and the eventual turmoil so often associated with change. He bore more than a casual resemblance to a textbook case of compensation for either his real or imagined shortcomings by showcasing his decided advantages of physical attractiveness, intellect, and sexual prowess. He was not tall, and he did not exude the kind of macho swagger that some women so often find enchanting, and he was by no means rich, and did not grow up in an atmosphere of either financial or social privilege, but women frequently referred to him as “cute” and he possessed a sort of boyish charm and good looks and at his best could mesmerize the birds from the trees with his outgoing, but unpretentious intellect and offbeat humor. At his worst, he was overbearing to the point of appearing arrogant as far as using his advantages, especially his intelligence like weapons.

He also possessed a pathological disdain for jealousy, which was usually misunderstood. It wasn’t that he didn’t care; in fact although he was no stranger to casual sex, his greatest pleasures involved embracing the thrill of danger in loving deeply and letting go at the same time. Fearless love unfettered by either insecurity or envy balanced by a selfless desire to share every wicked fantasy with someone he trusted enough to embrace the angst and pangs of risk against trust and faith. He felt most alive challenging that mixture of danger, pain, and unflinching exploration of this new frontier of human emotions.
He also discovered that women are more likely to indulge in gossip about their sexual adventures than men. Few seemed to either realize, or care that their tall tales about their exploits would further enhance his reputation for sexual prowess. His bisexual girlfriends even used him as a pussy magnet to lure even more women (especially the bi-curious ones) into his bed. For years, it seemed like the line would never end.

By the time Stella entered his life, he had once again condescended into the security and stability of engagement to a mademoiselle eighteen years less timeworn and a lifetime less sagacious, a former paramour during a previous unsuitable matrimonial pairing. Somewhere between hero-worship and paternal surrogate, her demeanor, complexion and features gave the impression of a wholesomeness that for some unknown reason, reminded him of a fresh glass of buttermilk, provoking impulses of wicked debauchery and unfettered perversion, like Little Bo Peep in crotchless panties, but dim-witted, clueless and emotionally juvenile, a characteristic he tried in vain to overlook, (at least until the swelling went down)….

He met Stella on a double-date with a friend he met working municipal EMS, who worked for the same private ambulance transport company where his fiancé worked.

The two couples had planned to meet at a theater that specialized in showing a mixture of old classics, art films, and cult features in a cabaret atmosphere with small tables for drinks and light dinner fare replacing the customary rows of seats. Jeff and Danielle had arrived early and secured a table for them, so Jeff went back to the lobby to await Rob and Stella’s arrival to usher them back to their table. As he stood there waiting, he tried to imagine what she looked like, to see if he could picture her before they met. Rob, ever the gentleman had opened the door for her so she entered first, and as their eyes connected, so did Jeff’s heart. Dark-haired yet fair-complected, her deep brown eyes spoke paragraphs of descriptive phrases like soulful, passionate, endearing, nurturant, playful, and mischievous, yet they also betrayed a yearning for unfulfilled desire that Jeff knew all too well that he immediately felt compelled to satisfy…all in an instant that would take much longer to inadequately describe than it did to experience. Jeff was so smitten that he temporarily forgot the agenda that had led him there until Rob followed behind her. Finding himself grinning like a star-struck idiot, he managed to regain his composure enough to greet them appropriately by the time they reached him even as disarmed as he was by her. What so transfixed Jeff was not simply beauty. Jeff had met his match, his soul-mate, although as struck stupid as he was at the time, he failed to realize the implications.

By comparison, the rest of the evening went relatively uneventfully. Jeff was no stranger to duplicity, and realized he would have to refrain from allowing himself to betray what he was only to truly realize much later. What was not concealed was how well the two women had bonded so quickly. At the end of the evening, as the two couples stood in the parking lot idly discussing nothing in particular, Jeff found himself obsessed by the impulse to drop the tailgate of his truck, pick up Stella by the waist, place her on it and fuck her brains out right in front of Rob and Danielle. He couldn’t escape the feeling that she was having the same fantasy.

The next time they met, she suddenly asked him if he had ever looked over the edge of the roof of a tall building to imagine what it would be like to jump over the edge. Not that she actually wanted to, but just to imagine…the seconds before the impact…what would be the last thing to go through your mind?…(other than your asshole). She gave the impression of someone confessing a deep, dark secret, as if she was testing Jeff to see if their psyches really operated on the same plane. Initially Jeff launched himself into an abbreviated discussion of the Id versus the Ego, only to suddenly add “…it’s like finding yourself obsessed with the urge to moon your relatives at a family reunion…or is that just me?” That was the first time he experienced the pure pleasure of watching her explode into uncontrollable laughter. It was to become one of his greatest pleasures, punctuated by her raucous unabashed laughter, which reminded him of a mixture of half cackle, half seagull squawk of a witch in orgasm. It wasn’t the funniest retort in the world, but they were both overcome by the realization that two universes had just collided.

In the months that followed, he watched his fiancée and Stella develop a friendship that further piqued his attraction for her, while both women joked about their mutual fantasy of indulging themselves in a torrid sexual affair, in spite of the fact that they never actually included any mention of Jeff’s participation…at least at first. They even discussed moving Stella in with them. After the inevitable threesome that ensued, he was deluded enough to believe that they might all live together “…in a house by the sea.”

Six and one-half weeks after he married Danielle, (on his birthday) she announced that she was leaving him for a man with whom she had been having an affair for nearly a year. He found himself hard-pressed to decide which of them had been more delusional.

When Jeff went into a tailspin over the demise of his fifth marriage, Stella was there to catch him. More than ten years later, despite all the changes their relationship had endured, they had fallen back in love with each other more than once. He always believed that eventually, they would live happily ever after. More than one mental healthcare professional has stated that the definition of both insanity and addiction is “doing the same thing over and over again, and expecting different results….”

His memories of those early days sustained him no matter what happened.

Even the house in which they were living was a testimonial to the essential insanity of their lives. Two consecutive hurricanes in one month had made their previous home uninhabitable. The real estate housing boom was reaching its apex as the fastest-growing county in North America burgeoned. While “blue roofs” covered in FEMA-issue plastic were everywhere to be seen, investors with suitcases full of money where coming to Florida like a second wave of Carpetbaggers, driving the prices of everything—with or without a roof sky-high to nearly double the price of what it had been less than a year before. (This of course, was several years before the economy, as well as the real estate market “tanked”.)

After several court actions, they were staring down the barrel of a verdict they could not escape, with no prospects of shelter anywhere on the horizon, when less than a week before the sheriff’s office was scheduled to start removing their possessions from their home, they received an offer they couldn’t refuse for a price they couldn’t afford.

A giant rental, four bedrooms, three baths, a fireplace, a garage, an office, and a porch, filled with trash and garbage from the previous tenants, who had stiffed their landlord for the last three months. Literally hundreds of roaches dropped from the ceilings onto anyone who dared enter the premises, scrambling everywhere you looked, feeding on rotting garbage and hiding in piles of dirty clothes in every corner. When the power went off during the hurricane, a giant dead Sea Turtle had begun to rot in the refrigerator. It was waiting for them when they arrived.

The landlady was so desperate that by the time she had been referred to Jeff, she failed to recognize Jeff’s own desperation. Although she had tried to jack up the price by two hundred dollars a month more than the previous tenants had been unable to pay, she finally agreed to take four hundred dollars less, in exchange for moving in “as-is” and to take on the daunting task of all repairs of a house that had great potential, but had been neglected for at least six or seven years. It was still more than they could afford….

If you find yourself standing on the burning deck of a sinking ship, you will jump into shark-filled waters.

The house was haunted by more than one extremely malevolent spirit. One of the previous tenants had gone completely insane, claiming that the neighbor’s dog wouldn’t stop staring at her, and had to be carried out in restraints, screaming obscenities as the neighbors stood on their lawns, gawking like hillbilly tourists at DollyLand. Jeff and Stella were prepared for the cleaning, disinfecting, painting and repairs that were required. They even recruited the services of Jeff’s cousin to facilitate the ordeal, but they were not prepared to conduct an exorcism, at least not at first, but as luck would have it, both Stella and Dee were practicing witches.

When Jeff’s long-lost favorite cousin had first contacted them, several months before the move (she was also one of “the black sheep” of the family), she was fresh out of rehab and a bad twenty-plus year marriage, and looking for a place to land. Stella and Dee hit it off right from the start, and they often chatted like old friends for hours before they ever met face-to-face. Both were a bit closed and guarded about volunteering their “secrets” to others, but eventually the black cat was out of the bag, and the idea of two witches joining forces had intrigued them both, even if they had not planned on being called upon in that capacity before they had completely moved into their new home.

That was about the time they realized that their new home was haunted….

Doors opened and slammed shut all by themselves. Ominous moans, whispers, laughter, voices, and the sound of walking while dragging something heavy over the tile floors could be heard almost daily. Recordings were made. The women put their heads together, read, and consorted with spirit guides. Rooms were smudged, incantations were recited, and rituals were performed. Although they discussed it, they agreed that since haunted houses frequently burned down mysteriously within a year of exorcism, they would try to practice containment of the malevolent spirits. It was an uneasy peace at best. Photographs taken during that time revealed eyes and faces in the wooden paneling that were not visible to the naked eye. Some pictures contained shadows and swirls of light resembling disembodied spirits. Majik was definitely afoot….

Three Hundred Channels and There’s Nothin’ On….

Somewhere between the “wake up meds” and the fourth or fifth cigarette, she noticed the note taped to the mirror. Stella did not realize that it had been up there for two days, but something made her feel uneasy about seeing it up there. Jeff often left notes for her, either on her side table beside the chair, or next to the television controller, in her lap. Call it women’s intuition, or what you will, she felt an ominous portent before she arose to open it.

“My Eternal Beloved,

Please understand that everything I say to you is out of love, and comes out of my best intentions. We haven’t even had a real conversation in months. When I try to speak to you about my concerns, you ask me if it has to be ‘now’ only to forestall any attempts at real communication. You can read this at your leisure, without interruption, and come back to it as you see fit. No arguments, just read and try to understand, instead of defending yourself. Even if you don’t agree with my perspective, or observations, try to understand that these are also my feelings.

You will find a video on the dresser. Please watch it first. Perhaps then you will be able to remember…and understand.”

She rolled her eyes, and lit another cigarette, sighing deeply, only to suddenly realize that her charade was for herself, and with no audience, it seemed pathetic, without purpose, and an external manifestation of the kind of internal chattering of dialogues and noise in which we engage ourselves within our own minds. Relived arguments, anticipated convocations, self-indulgent rationalizations, reveries, and ruminations, all to block out the deafening silence that we are so accustomed to fear.

Jeff had been a talented filmmaker and videographer, as well as a musician and studio engineer long before turned to emergency medicine as a career, and long before he had ever met Stella. He had even won an award for a documentary he had done around the time they first met, so she was not surprised that the videotape was hand-labeled, and one of Jeff’s own productions, simply titled “Try to Remember”. She was not, however, prepared for what she was about to see.

Black screen. Music fades in. “The End of the Innocence” fills Stella’s ears as her eyes fill with tears as she watches the screen fade in on a scene from a picnic on Key Biscayne over fifteen years earlier, when they first had met, shortly before they were married. ”Remember when the days were long in the road beneath the clear blue sky. Didn’t have a care in the world, Mommy and Daddy standing by…”

The images change, and fade to scenes from the Florida Keys. The boat races at Islamorada. Sunsets at Mallory Square and Big Pine Key. Takeoffs and landings they had shot together at night from Perimeter Road at Miami International. Scenes around the pool at their first house. Holidays and birthdays with family. Touching memories, even though they had been tinged with a sense of foreboding of things they had never anticipated.

The screen fades, and Gimme Shelter opens to scenes of Hurricane Andrew. While they were treating victims and patients with special needs at a shelter, their home was destroyed, and their possessions were looted.

Later scenes of the birth of their first child, and their new homes, and various re-locations followed. It had always seemed as if no matter what kind of adversity that had been thrown their way, they always rose again, like the Phoenix, out of the ashes, as if it was all a test for whatever was yet to come. And through it all, they had remained very, very much in love with each other.

The last scene was a single-lens head and shoulders shot of Jeff. “Can We still Be Friends?” by Todd Rundgren fades in. All he said was this:

“Through all of this, I have loved you more than I had ever thought possible. I believed that we completed each other. Most especially, I believed that in completing you, I would complete myself. Somewhere along the way, I became an enabler. We need to separate, if only within our home. The kids would only suffer from separate residences, and we can’t afford it. It’s time we thought about what is best for the children, as well as for you. They are too smart not to already know that this is not what a real marriage is about, and we can at least be honest, and loving with them, and hope they can learn from our mistakes. I can live in the guest room. Hopefully, we can maintain some continuity and love within our household. Other than that, I will try to work as much as possible, and stay far enough away that you will need to learn to stand on your own two feet again. I had always believed that we would grow old together. Now I don’t know which upsets me more, the thought of not spending the rest of my life with you, or the thought of spending the rest of my life with you. There’s a big difference between taking me for granted, and forgetting about me completely. In spite of all the song lyrics to the contrary, I’d rather see you happy with another man, than to watch you slowly die a day at a time while you blame everyone else for your misery. It’s time we went our separate ways together.”

“I can’t expect you to get sober, lose weight, exercise, fix your hair, bathe or dress up for me if you won’t even do it for yourself. Even if it takes hating me enough for moving on with my life to do the same with yours, eventually, you will realize that you have got to clean up your act to find the kind of man you really want. A long time ago, I thought that I was that man. I love you enough to stand aside so you can find out. My love for you is my choice. No one can take that from me, not even you.”

“Shortly after we first met, I remember telling you that I was convinced that eventually we would go our separate ways, not because we didn’t love each other, but because eventually, you would need to learn other lessons that I wouldn’t be able to teach you. Eventually, you will need to move on, to grow and experience Life in your own way, and on you own terms. As much as I loved you, even then, I knew that I loved you enough to let you go. Maybe I hoped that the road you took might lead you back to me, but I always believed that both our lives would be richer and fuller for having known and loved each other.”

“Now I know that I am in love with a ghost, and that I am in a perpetual state of mourning for you. It’s not just because you’ve changed. With evolution, change is inevitable, and something to be embraced with graceful acceptance. You have become a malevolent spirit that refuses to accept that you are already dead, and with death, comes decay.”

“Because I Love you
It’s time to go.
I knew the first time I saw you
I told you so.
Not in vindication
and certainly not without regrets.
Go in Peace with my

Then he leaned forward, very close to the camera, and whispered: “What have you done with my Goddess?”

As she read the last remark, she began to cry, and then to sob. The last remark was the title of a poem he had written for her about a year earlier. It had seemed for a time that it had made an impression on her. Now it appeared that it had actually reached her on a deeply emotional level.

A Fix-up Life…for a Fix-up Wife

There are a few elements common to many emergency services professionals that are often referred to as “rescuer syndrome”. No matter how well-adjusted the individual appears to be on the surface, they always feel the need to do more and be more, and rarely take more than a moment to rest on their laurels, or smell the roses. They never seem to lose sight of the next achievement, just over the crest of the next hill in the road ahead.

Another feature is that they are constantly trying to fix everything around them. Some rescue stray and injured animals. Others renovate run-down houses that have been repossessed, or fix up old cars. It should come as no surprise to anyone but them that they all too often try to do the same thing with the people with whom they become romantically involved. This usually results in becoming an enabler, and the results are often not pretty at all. Much like an untrained person who tries to rescue a drowning swimmer, the rescuer also becomes a victim.

Jeff was a medic who was about to marry his fifth future ex-wife when he met Stella on a double date. Stella was a nurse who kept bouncing back and forth between LA and Ft. Lauderdale (the homes of her divorced parents). At that time, her bi-polar mom was out of work again, and Stella was turning over her checks to her mother to pay the rent, and expenses, (ironically including co-dependency therapy for herself and her mother), while her car payments were going into default. (Once again, we see how the victim victimizes the rescuer.) Both Jeff and Stella were brilliant, charming, and very attractive, but both had serious issues concerning self-sabotage. Jeff even married for a fifth time, despite the fact that he was already (also) in love with Stella, who had also become his fiancé’s best friend.

If you are going to save
the world, first you have to start with yourself.
(As obvious as this may seem)

What is the difference between an EMS War-Story and a Fairy-Tale?
(A fairy-Tale starts out: “Once upon a time…” and an EMS War-story starts out: Now this ain’t no bullshit; this really happened…”)

Jeff was enrolled in his Paramedic training courses when he met Jack. At the time, Jeff was working as an armed guard for a security company, and Jack was working as a bouncer at a local nightclub. Jeff’s hair was relatively short, but permanently disheveled, and he was frequently forced to show up to class in his guard’s uniform. Polyester, and midnight blue, it looked curiously similar to a City of Miami police uniform, except for a few patches. Jack’s hair was nearly shaved over most of his head, but he had grown a cue that had been braided that extended down well past the middle of his back. Motorcycle (engineer) boots, a sleeveless t-shirt, and a black motorcycle jacket completed the ensemble. Jack was tall, and lanky. Jeff was short, and muscular. During breaks, when small groups of the students would stand around together, if Jeff and Jack ended up in the same group, it was Jack who was first to display open contempt and mocking disdain toward Jeff, (who was quite comfortable around all sorts of real Outlaws), who generally regarded Jack as a poser, or self-proclaimed Culture Hero, bent on becoming a legend in his own mind.

As Fate would have it, there were two main groups of the better students; true believers and cowboys. Jack was as surprised to learn that Jeff wasn’t a completely straight, but somehow degenerate cop wanna-be as Jeff was to realize that Jack was also in about the top ten percent of a fairly large class. Regardless, Jeff quickly realized that both he and Jack were both essentially outcasts, as neither one of them had municipal department endorsement or support, and in fact, neither of them was currently employed in the emergency medical (ambulance) service by anybody. The ambulance company and fire department personnel seemed to be enjoying bear-baiting the two of them against each other. Snide innuendos, japes, jibes, peppered with barbed invective were tossed back and forth like catcalls across a fence. Both were surprised by the quality of thought and the cleverness of the other. Eventually, it was Jack who would quote both Sylvia Plath and Erica Jong in front of Jeff, who had recently won a statewide poetry contest before they finally realized they were destined to be brothers.

A few months later, it was Jeff who was the first of the two to land a job working for a local ambulance company. Jack had migrated south after being fired for who-knows-what at the company for which he had been working. Eventually, they managed to get partnered on a BLS rig….

A dozen or so shifts passed uneventfully. Segue to a nondescript house in a slightly rundown suburban neighborhood on the outskirts of the city proper (in more ways than one), where the ambulance sits parked, with its motor and air conditioning running, with Jeff in the front passenger seat, waiting, and monitoring the radio for calls. Jack drove the rig to this location, and jumped out, stating that he would be right back, and told Jeff to toot the horn twice if they got a call.

Possibly fifteen minutes pass before the dispatcher requests a QTH (location) from Jeff. Before he answers the radio, he quickly toots the regular (truck) horn on the ambulance. He responds, and Dispatch requests he stand by. Two more, slightly longer toots. Minutes pass. No Jack. Jeff switches on the air horns. Two short, succinct, but insistent blasts that could rattle the fillings in the teeth of the suddenly awakened Dead…No Jack. Dispatch gives a location in the central downtown area of the city. Jeff is already agitated over having gone about three miles outside their zone in the first place, and precious time is being lost. Jeff sets loose a short wail from the siren. He acknowledges the call and address, and states they are in route, trying to circumvent giving his present location. No dice; Dispatch requests it anyway. To lend verisimilitude, he now has to actually start the siren, and in annoyance, as Jack is still nowhere to be found, he turns on the emergency lights, flashers, and strobes. He states “10-9?” (Last contact unintelligible, please repeat.) He is stalling. Dispatch repeats the request. He requests they stand by. Time passes. Jack finally saunters out of the house to the ambulance as if he is strolling in the park. Jeff tells him they have a call, gives the location of it, and tells Jack to handle dispatch.

If Jack seems a bit distracted, it is probably because, as Jeff was only to learn much later, Jack has been inside all that time, smoking crack. Small wonder that, in trying to think up a plausible lie, he tells them they are at a location even closer to their intended destination. By national, as well as county standards, they have only six minutes to get there. They are fucked.

Jeff is angry, but determined. He has climbed into the driver’s seat of the rig while waiting for Jack’s return, and does not intend to fail without a fight. He takes off like Meatloaf’s recently released album, “Bat Out Of Hell”.

In those days, most private ambulance companies utilized the Ford E350 chassis van with a special conversion package that was retrofitted into something suitable for ambulance applications by any one of several companies that did custom van conversions. They were still powered by gasoline engines, usually the 454 Lincoln, topped with a mammoth four-barrel carburetor capable of producing over six hundred and fifty cubic feet of vaporized fuel per minute. Oversize, extra wide tires and Cragar chrome reverse rims helped compensate for the higher center of gravity, (as well as the notoriously low wages.) Even with an automatic transmission, a new rig could smoke the tires from a standing start.

Lights and siren (called “Code Three” response) can do a great deal to not only facilitate an emergent response to a specific destination, but to also inflate the egos of newly-recruited EMT-Drivers. Already adrenaline junkies by nature, making traffic pull to the nearest curb at your command, like Moses parting the Red Sea helps span the gap between your dreams and that sinking realization that comes every two weeks on payday, when you sigh, and think: “Yeah at least I’m not a waitress!…they make more money!”

Jack had a microphone in one hand, and a map book in the other, trying to find the shortest, quickest route to their destination as he continues to try to bamboozle Dispatch as to their location. Again, he eventually gives Dispatch a location that is actually closer to the destination than they really are.

They are now officially and totally FUCKED….

As they race down two-lane streets with cars parked along both sides, weaving and passing in and out of their lane, Jeff tries mostly to “thread the needle” down the centerline of the street. (To drive between two lines of cars, whether oncoming, or the same direction, by straddling the white line.) They both knew that they were betting on their margins.

Suddenly, the car in front locks up its brakes, and pulls right toward the nearest curb, despite the continuous line of parked vehicles along both sides of the street, which leaves the ass-end of a new BMW directly blocking their lane. No problem, swing left, pass, and drop in front again. Except for one thing: a car has just turned around the corner, into their oncoming lane, just as Jeff starts to pass the Beamer. There is not enough width, or distance, let alone time to go around these obstacles without passing through one, or even both of them under normal circumstances….

What happens next is a little difficult to explain, let alone understand, unless you either were there, or have done something similar before, but it goes something like this:

First of all, if Jeff had been forced to plan his actions, they both would have probably died that afternoon. Everything that was done was part of a series of reflex arcs that had been learned at some point or another, even if not in exactly that sequence, except for the parts that were pure bullshit speculation, or SWAG: (Sophisticated Wild-Ass Guess).

Jeff braked hard and spun the wheel hard left (never do this). This put the ambulance into a skid that was so strong, that the right side of the ambulance left the ground. There are mystics who claim that it is possible to bend time. Einstein postulated that both time and space are essentially already bent. Anyone who has ever experienced distortions in the time-space continuum will generally describe the impression that all activities around them have slowed down to some degree or another. From a non-metaphysical standpoint, it may be that under extreme duress, our reactions and perceptions may speed up far beyond normal perception. Under those conditions, it might appear that everything else has relatively slowed down. Regardless of how you analyze it, this was what Jeff experienced. In slow motion, he observed his terrified partner rise what looked like two feet above him, only to release the brake pressure, as he swerved hard to the right, which was a good thing, because while the left wheels were up in the air, with the brakes locked, the unit still moved in an essentially forward direction. As the brake was released just as he was making the right turn, the unit swung wildly to the right, missing the Beamer by no more than half a coat of paint at best, as he jammed the brakes yet again, only to put the left-side wheels up in the air, skidding again. There they were, riding right on the very edges of the right-side tires, which were squealing, and moaning like dinosaurs in the throes of orgasm as the ambulance listed on a gracefully sickening angle, like a sailboat with no crew to hike out on the side-rails. Jeff was now high above Jack, who was locked in a white-knuckle tetany, as if already braced for the inevitable impact. For that brief instant, it seemed like there could have been time to reach for a pack of cigarettes and light one with the electric lighter in the dashboard. It was a fine, clear moment, when an angel could have danced on the edge of a razor. For that one brief moment, Jeff was that angel. Finally, he released the brakes as he steered the vehicle back into the lane, and dropping the two left tires VERY firmly onto the pavement, followed by several very wobbly skids, as he continued to try to correct for the overwhelming inertia of the vehicle. Somehow, impossibly, they had skidded and slid around two inevitable impacts.

Once he corrected the trajectory, Jeff continued to accelerate through the next open stretch. Jack was the first to speak:

“Fuck…that was amazing!”

“What?” was all that Jeff had to say (He was determined not to admit he was just as astonished by what he had just witnessed as his partner was…maybe more so).

And so it goes. It was hardly the kind of story that can be told openly. Drug abuse leading to public endangerment and wanton disregard for the public safety. The preposterously unlikely sort of events of which urban legends are made. Jeff believed he would never have willingly put himself in that position, and yet that was exactly what he had done. In the process, through adversity, he transcended the mundane and commonplace events of his life, and experienced the sublime.

About eighteen months later, Jack tried to slide a rig through a red light more or less sideways, at three o’clock in the morning in downtown Miami, on DuPont Circle, and ended up destroying a new ambulance, and doing something like $100,000 damages to the jewelry store he hit. He later married, and then divorced the EMT that was riding as his partner that day, but in between, he joined the Army, and was given a D.D. for running a black market operation out of the Quartermaster’s Supply by selling antibiotics to a large percentage of the whores in South Korea. He made a small fortune, until he got caught.

Regarding Drug Abuse:
(No Drugs Were Harmed in the Events Described Herein.)

Celebrity Quirks and Coincidences

Cut to Long Beach Airport, in an FBO of some considerable elegance, where it is not unusual to see celebrities of all sorts….

Jeff is seated on one of the long leather couches that ring a conversation pit in the center of the facility. He is wearing his more formal uniform, which is a true “flight suit”; one piece, front-zip, two-tone (Navy and Black), and more pockets than…(you can imagine). A stretch limo pulls up and stops, whereupon a man emerges from the driver’s seat, dressed somewhat vaguely like a chauffeur…perhaps it was the hat…passes around to the back of the vehicle like a pro…ducks head, pivots on left foot as it exits the vehicle. Right foot plants facing the rear as it comes out in one fluid movement and he stands tall and walks briskly as his left hand touches the leading edge of the left rear fender, just in time to pivot again on the left foot as the right foot does a reverse 270-degree turn so as to plant both heels simultaneously, now facing forward, as the trunk opens. The man leans forward in a brisk, almost robot-like singular motion, and grasps the handles of two leather bags. Both are lifted, pivoted and swung outwards, clear of the rear lip of the trunk (this time in a clockwise fashion, so as not to encounter the higher clearance of the top of the left rear fender). He faces forward, then veers toward the Lounge of the FBO.

The walls of the building are predominately glass, upwards of thirty feet in some places, and at ground level it is usually easy to see all the way through the building to the tarmac on the other side, where the jets are parked. It is the straightest route to his destination, a beautiful Gulfstream, already fired up, screaming mechanical choruses of Industrial Motor Noise, Pakistani Jazz, and Venus Gas Music…broad, vast bands of frequencies, rhythms, and beats punctuated by sharper frequencies that shift with the Rpm’s of the engines. Slowly, almost imperceptibly, as mixtures, pitches, and Other Variables are synchronized, the vast noise takes on a musical character that for some is never or seldom heard (i.e. noticed or recognized), yet for others is startlingly apparent. It is so loud, it is dangerous, like the reputed Voice of God, that would “shatter asunder any man”…who should hear the Voice directly. If you work outside at an FBO it is required that you wear hearing protection. Initially, it does not sound so much like music, as much as it is to become aware of the harmonization of this vast range of frequencies commonly regarded as noise…Jeff eventually came to realize that all his favorite pilots seemed to wrestle harmonies from those engines and airframes that were conspicuous in their absence when forced to entrust his life to lesser pilots…. On long flights, especially at night the harmonies, melodies, beats and counterpoint would reveal themselves to him as majestic symphonies to drown out the earworms of Top Forty Radio and commercial jingles that so frequently fed upon his brain like maggots on a rib eye. Jeff almost always heard Music. His dreams had soundtracks, and he usually awoke to daily anthems and ballads alike. They frequently set the stage, as well as the mood and tenor of his day. On some days, only motor noise, screaming or gunfire could drive out the earworms.

Jeff looks up from the magazine he had just picked up from the glass-topped table (a copy of SO RICH AND GLAMOROUS: DON’T YOU Wish You were Me? […a big favorite in places where Conspicuous Consumption is so norm de rigor to the point that it goes unnoticed]). He picked it up because a picture of Joey Pantoliano was on the cover, and the caption alluded to an interview inside. As he looked up, he noticed the face of the “chauffeur”, as they locked in, eye-to-eye, only the heads turned on axis, pivoting, almost owl-like…something very familiar about this fellow…but why?…Jeff knows only about two dozen people in all of California (mostly North Hollywood or Van Nuys), and his mind races through the rogues’-gallery (…”who? where? Was I ever in his home?”…Oh Shit! It’s Henry Winkler….).

“Oh Hi!” He blurts out reflexively, like a monkey discovering a heretofore unnoticed banana.

“Well Hello!” Henry responds in a coyly humorous manner that ever so gently satirizes the familiarity between them.

“So how have you been?” Jeff inquires. It would seem that Jeff had managed to broach that great divide that normally separates the Celebrities from the Hoi Palloi, as both parties were enjoying the seemingly inappropriate familiarity of the exchange.

“Great!…or so they tell me”, he shrugged, “and you?” For just an instant, he had dropped the crisp intensity of focus that had seemed to grant him anonymous passage. He smiled broadly, like Just Plain Henry.

“Just about as fine as frog’s hair…” (What?!?)

“Well, keep up the good work.” Henry chuckled.

Henry now faced forward again, still walking, bag in each hand, but his head tilted backward less than 27 degrees.

As a “Ramp-Rat” (Demeaning moniker for an entry-level worker in the private aviation industry.) opens the door for Mr. Winkler, Jeff shouts: “See you around”. A final incongruous conclusion to this humorous repartee, at least for now….

Cut to Teterboro Airport…Conan O’Brien is towering over everyone around him, a gaggle of at least a dozen people who are all acting like their very lives, or at least livelihoods depend upon this alarmingly tall individual. But something is wrong, it seems, to Jeff, but he can’t put his finger on it…he hadn’t even noticed when they came in. He had been reading a copy of SEEN CAVORTING IN THE HAMPTONS, another ghastly publication devoted to inflating the egos of people privileged enough to warrant notice, and insecure enough to need it.

At first, he thought that Mr. O’Brien was pissed off about something, or that there was about to be an incident, like gradually noticing an unpleasant odor in a room full of people disinclined to acknowledge it. Soon it occurred to Jeff that it was simply the fact that the patently goofy persona so characterized by his television personality was gone. In its place was a sterner visage of a man who was definitely in charge, and not being paid to make anybody laugh, but looked like he should have been paying somebody to make him laugh. Although the Teterboro FBO had a considerably larger lobby, and Mr. O’Brien was at least fifty feet away, there was a conspicuous lack of mirth to be seen anywhere, even for New Jersey.

Cut back to Long Beach Airport, several months later. Jeff looks up from a copy of Cigar Aficionado just in time to catch the gaze of the notable Mr. Henry Winkler. This time, both parties seemed to recognize each other at about the same time, but this time, it seemed Henry was more piqued by the coincidence…but it was Jeff who spoke first, again.

“Hey, it’s you again! What, do you work here?”

“…Actually, It’s always been me…just as it has always been you.” He did not so much even stop as to very slightly slow down as he passed while making the remark.

“Loved you in Little Nicky…” (Where the “much-beloved” cameo appears covered in bees).

“Oh, wow!” He chuckled “…You are a deeply disturbed individual…” he quipped, smiling, and shaking his head, amused.

“What do you expect? You gotta be sick to fly with me…besides, it WAS pretty funny…” Jeff made an imploring gesture with his palms upward.

“See you around, Hank.”

Jeff never saw Henry Winkler again.

High Above The Republic

The aircraft banked hard and the real descent began, down through the clouds…a little bit of weather, and a few buffets. Under power, Lear 25’s have the trajectory of a bullet. A few bumps in a Lear would be more like wind shear in a commercial “cattle car”. He had grown to hate the commercial flights; the Lears had spoiled him…of course, without power, they have the trajectory of a brick…if you fly long enough, you learn to recognize a “flame-out”…shit happens (once in a while). Up to a point, a good pilot can cover up for piss-poor maintenance, but you learn to work for only the best flying services if you are smart.

In the last year alone, he had survived several major flame-outs, two engine fires, a near-miss from a meteor, been struck by lightning, hit a Condor at seven thousand feet, and was nearly blown off the runway by a forty-two knot crosswind while landing in the middle of a “Nor’easter”.

Real vs. Symbolic Power

Soon they would be on the edge of the jungle outside Santiago. La Vega; actually between Santiago and La Vega. At Four AM Atlantic Time, the military still has responsibility for the security of the airport. At four AM Atlantic time, the Army of the Dominican Republic looks more like a grade-B movie stereotype of guerilla rebel forces, and that’s just the ones in charge…you can tell who’s in charge because they are wearing shoes, and have radios.

In many parts of Central America or The Caribbean, uniforms are nondescript, rag-tag, and in fact, anything but uniform. It would appear that insignias are somewhat optional, not especially related to denoting rank, specialty, or branch, and more related to depicting the soldier’s favorite animal…usually something from the jungle, and very ferocious. Again, these are the uniforms of the jefes, at least until dawn…or nine or ten o’clock, or whenever somebody in authority who has the keys to actually open and run the airport shows up. The rest of them look more like paramilitary headhunters (more than a coincidence?…you be the judge). Fatigue shirts are generally open to the waist, and may or may not be tucked into the shorts, jeans, loincloths, or whatever is worn from the waist down. Did I forget to mention the beads, shells, religious icons, feathers and bones fashioned into the festive necklaces?

Remember Manuel Noriega? That guy from Panama that thought a chrome machete was an audio-visual aid for emphasizing key points in a speech by banging it against the podium? It’s another big seller in all the third-world countries in the Western Hemisphere. And whether hanging from a belt by a scabbard, or dangling from the wrist by a leather thong, it does lend a distinctive je ne se quoi to the total picture of the well-dressed militiaman or bystander in this particular corner of the Caribbean.

One might be misled to think thus far, that these fellows would present much too comical a picture to command any real respect at all, but I have left out the piece de resistance that makes all the difference in the world. From Mexico to the Caribbean, indeed, most of the entire Western Hemisphere’s hot climates, it is either the fully automatic, Colt-manufactured M-16 or the Soviet-manufactured Kalashnikov that makes the man. Four-and-a-half-foot-tall Mayans who look no more than twelve years old share this one philosophical tenant with no less than some of the greatest military minds of the nineteenth, twentieth, and twenty-first centuries, and it is this: God did NOT create all men equal…Sam Colt did. The fact that the M-16 was originally ArmaLite Industry’s brainchild, or that Sam took the great dirt-nap long before it was even a gleam in any modern armorer’s eye is a moot point. Perhaps nowhere else in the known world was this more evident that right here, right now, and by that, I mean the ever-present never-present moment, which is essentially any time someone else has an M-16 and you don’t. Time and power may indeed be both relative and absolute, which brings us to our next point.


Although the patient he had been dispatched to transfer was critically injured, it is truly beyond the ken of most air-ambulance salespersons to grasp the concept that at four AM Atlantic time, nothing will go into or out of that airport until…But then again, you have to realize that although most serious members of the aviation community operate on GMT, or Greenwich or ZULU time for good reason, “the guys in sales just get things too confused…” (In spite of the fact that the entire sales pit is ringed by clocks depicting real time in virtually every corner of this earth.) Ironically, these hyenas borne of mutant jackals make several times the salaries of any of the medics, nurses, the flight coordinator, or even the Medical Director. With limited knowledge, and even less ethics, they will make side deals, kickbacks, and broker’s fees even the owner either doesn’t know or care about, at least until the next time his irresponsible “business entertainment expenses and promotional expenditures” threaten to endanger the jewelry, private schools, country club memberships, or vacations that seem to flow so freely as he wails his sad tale of woe about forestalled salaries and shitty healthcare programs.

So Eastern Standard, or Daylight Savings, or Atlantic Time aside, the real issue is that the local militia is in charge of the airport, which is essentially shut down until the guy with the keys, the shoes, the white shirt and the tie shows up, and that won’t be for several hours.

The firemen (there is no need for the more politically correct term “firefighter” in the Caribbean, because there is no such thing as a female fireman here) are as similarly rag-tag and disheveled looking as their military counterparts. When the jet lands, they wander out of their station. There is also no such thing as sleeping through a Lear jet landing, but they seem to emerge more out of curiosity than anything else.

The older jets, like the Lear 25, were “pure jet” engines manufactured by General Electric, unlike the fan-jet engines, such as the Garrett, which uses a fraction of the fuel, and produces a similar fraction of the noise decibels, at the expense of pure thrust. The Lear 25 had the fastest rate of climb in the business, but because of prohibitively expensive safety requirements, like the RVSM (Reduced Vertical Space Minimum), their excessive fuel consumption, and their extremely noisy exhaust, they are destined to become dinosaurs within the next few years. They are already banned from most major airports in the US, except for private executive airports, unless they are operating as air ambulances, simply because of the federal noise abatement regulations. But tonight, this jet has center stage to an audience of clowns. All are either barefoot, or wearing sandals, except for the ones that are wearing shorts and fire boots. The ones wearing bunker coats probably are not wearing helmets, and the ones wearing bunker pants and helmets are probably shirtless, and in suspenders.

“Mañana”, they keep saying (because it is still dark, as if “tomorrow” arrives with the sunlight). An interesting quirk about the Spanish language: Mañana means both tomorrow as well as morning. Jeff’s Spanish is limited, and the locals speak a dialect so full of various Indian nuances and idiomatics that he can’t really tell whether he is outside Santiago, or Santo Domingo. And all he has been told was that his destination is “La XXXXX”. (Never mind exactly where….)

The night air is relatively cool. It is not actually cool, but you can tell it was much hotter during the day by the way the air feels so damp, and a light dew has settled on everything the air touches. As a slight breeze blows air from the jungle onto the tarmac, the dank, organic aroma of the local flora and fauna envelops everyone.

“We’re definitely not in Kansas anymore.” quips Jeff, if only to himself.

At altitude, the air outside the jet, especially at night, is usually very cold, and extremely dry. The pilots don’t tend to use the bleed air from the engines, (which would raise the temperature) any more than they absolutely have to, so it is not unusual to see a flight crew exit the aircraft taking off jackets. The problem is that the bleed air controls never really seem to work the way they are supposed to, and tend to be either “on” (too hot), or “off” (too cold). On Monday, you could be landing in Panama, and on Wednesday, you could be in Yellow Knife, Canada, just below the Arctic Circle. No matter what the season, a flight crew that goes out for two weeks at a time has to dress for any occasion, or season. Tonight, the warm, damp air feels good by comparison.

At altitude, (45,000 ft.) depending on the season, the outside air is usually between minus sixty and two hundred degrees below zero. Depending upon the speed of the descent, it is not unusual to see a recently-landed Lear covered in frost as vapor trails of evaporating moisture waft from the fuselage like smoke. These are the kinds of images that one never sees when traveling on commercial airlines. From that altitude, you can see the curvature of the earth. If you take off at sunset, you may observe four or more sunsets, before you reach altitude. There is an otherworldly quality to this kind of flight, especially at night, and when you land, you feel like you just arrived on the space shuttle. You may grow accustomed to it, but you will damn sure miss it when it is all over.

Initially, the screaming jet engines drowned out everything, but gradually, the sounds of the jungle have begun to tiptoe back onto the tarmac like a jaguar stalking its prey. Night birds, parrots, and God-knows-what resume the cacophony that is native to the region. The quieter it is on the runway, the more the jungle begins to intrude back onto the airstrip, slithering, crawling, creeping, flying, stalking on tiptoes, wings or bellies relentlessly attempting to reclaim what once was theirs alone.

Assessment and Report

About six hours ago, as Jeff was leaving the Florida Turnpike to drive the last few miles home from the previous two flights, his cell phone had rung again, and after the perfunctory apologies and humorous expletives were exchanged, he had turned around, to begin the nearly hundred-mile drive back to Executive Airport.

This was not his usual gig, but the company aircraft was grounded, and his usual steady paycheck was not guaranteed unless he took all the flights he could get. The full-time crew worked two weeks out, and two weeks home, Part-timers had to settle for the “out and backs”, which would eventually terminate where they had begun, but this was not his supplemental income, or second job, so he had to compete. This time, however, it seemed he was considered essential, and would be accompanying a nurse and another less “worldly” medic. The flight coordinator had already sensed that they would undoubtedly be more to this flight than was expected. It wasn’t just about experience. Jeff had an uncanny sense about trouble-shooting, and could improvise solutions out of thin air, seeming at times to connect the seemingly unconnected into a fluid line. And when he was inspired, he could charm the birds right out of the trees.

A name, and a brief medical report describing a form of injury referred to as Traumatic Asphyxia (imagine a train wreck turned into a science project), and the name of the town where the hospital was located was all he had been told (over the phone, while driving, no less). Not that it really mattered all that much. This is a business that can drown you in details, and you have to stay focused on what at least appears at any given moment, to be the important details.

Perspective as it Influences Plan of Action

Of course, what one paramedic considers an important detail may seem insignificant to another, and vice-versa. Paramedics are notorious for their tunnel-vision, which accounts for the adage: “Paramedics may save lives, but EMTs save paramedics.

Years before, Jeff had the opportunity to work for a relatively new county-wide EMS system that catered to a series of seaside resort towns. He and his partner were on their way to breakfast one morning when they were flagged down by their operations manager, who was also a medic. At more or less the same time, dispatch was informing them of what was already obvious. A signal four (also called an MVA, for motor vehicle accident, but now called an MVC, for motor vehicle crash) involving a LEO (law enforcement officer). I say obvious, because it is clearly an auto crash, because the rear end of the deputy’s vehicle is visibly protruding from the mangroves into which it has crashed, perhaps thirty-five yards from the roadway It is also even more obvious that it involved a law enforcement officer, because he was lying supine, unconscious beside the roadway, and everyone passing the scene on the one road that connects every town in the county can clearly see his sheriff’s deputy’s badge pinned to his sheriff’s deputy’s white class-A uniform shirt. Unfortunately, everyone who passes this scene also cannot miss the fact that his sheriff’s deputy’s uniform pants are missing, revealing his non-county sheriff’s department issue “whitey-tighties”. The deputy should have had full trauma precautions (cervical immobilization and long spine board) before he was moved. Although the vehicle had crashed into mangroves, only the front wheels were in any water, which was not deep, and the vehicle was firmly wedged in the undergrowth. There was no fire hazard.

The operations manager had no medical or extrication gear with him, so the primary objective should have been to protect the victim’s airway and manually immobilize his cervical spine, and call for an ambulance. All the above-listed details are at worst, explainable as a good example of how not to manage this kind of rescue scenario, but they are, at least explainable. What to this day, more than fifteen years later, remains unexplainable is why the operations manager chose to remove the pants from this deputy, after having chosen to place him on display, like some roadside attraction? And if he should remove the pants, why not the shirt (and badge) that so clearly identifies him as a sheriff’s deputy? Sometimes it is necessary to disregard modesty in the best interests of a patient’s health and well-being, but not to the point of putting them on display. And when all else fails, at least give them some opportunity for anonymity. (Given only a washcloth to cover my nakedness in some public place, I would choose to cover my face.) In a sense, the sheriff’s badge and shirt are more of an issue than the man’s face, at least as far as not disrespecting the uniform, which is to say, the office of the sheriff. It should have been all or none.

Code Blue on the Ninth Floor

For about eighteen months Jeff worked full-time for a hospital in south Florida. Jeff was no stranger to hospital ER’s, but this would be the first time that he would work for only one hospital full-time. His job was to work Triage and Intake for the district’s Emergency Department. Additionally, he would assist in any area within the department, as needed, starting intravenous lines, assisting transportation or performing additional tasks as required, or requested by senior personnel. He already knew the experience would prove to be stultifying at its worst, but thoroughly underestimated the hospital system’s ability to limit any initiative as regards patient care.

Shortly after his initial orientation, he attended a seminar where he ran into a nurse whom he had known for several years while he worked as a medic in the north end of the county. She no longer worked in the ER because she had been promoted to act as the head of the code team for the hospital, which meant that whenever a cardiopulmonary arrest occurred anywhere within the hospital except for the ER, she would be the first to arrive to initiate treatment. She was in her forty-somethings and had been a registered nurse since Jesus was a teenager, and was extremely knowledgeable and skilled. At the seminar, Jeff noticed that her wrist and forearm were in a brace. She told him she had strained it working a code blue several nights before while administering chest compressions.

“I thought that was what orderlies were for” Jeff quipped “…I mean patient care technicians…” he corrected himself to use the more politically correct term that was now en vogue.
“I couldn’t use them.” she said.
“Why not?” he inquired.
“Because PCTs are not allowed to do CPR up on the floors.”
“Why not?” he repeated.
“It’s called the Hospital Standard of Care”
“I don’t understand. You can’t be effectively running a code while doing CPR at the same time.”
“In the hospital, only a doctor can actually run a code blue.”
“So what do you do until the Doctor gets there?”
“You can’t be serious.”
“As a heart attack, if you’ll pardon the pun…do you remember three nights ago when you worked the double trauma code in the ER?”
“Yeah, I was down there.”
“Well after midnight, the only doctor in the entire hospital was down in the ER running those two trauma codes. I was up on the ninth floor” she said.
“Doing CPR.”
“It took the doc more than twenty minutes to get up to nine, only to call the code the minute he walked in.”
“More than twenty minutes?”
“Doing CPR only?”
“You know I am not the brightest guy in the world, but it seems to me that if that ever happens again, why don’t you call transportation to come help you take the patient down to the parking lot. You could have had a real code working in about six minutes from the time you call 911. We have a duty to act, and no hospital standards to live down to.”

She laughed, but unknown to Jeff they were overheard by someone from administration, who filed a complaint with Jeff’s supervisor in the ER. That was just the first time Jeff was ‘written up” while working for the hospital district.

Life on The Road
This is an aspect of the air ambulance business that is more than a little difficult to describe. For starters, you fly to most of the places you go, so most of your work is done up in the air, but when your day is over, whatever life you do live is on the ground, and away from home. It is a surrogate life, or perhaps more accurately, your alternate life, but make no mistake, as a traveler who spends half of their life away from whatever it is you call Home, everywhere else is On The Road, and yet it is also your home beside the road. Your family probably lives in a house on a street, yet you do not think of them as being on the street. Away from home, even flying, you are on the road, no matter how luxurious your accommodations may be.

Keep in mind, that flight support, back at the office, has no way of knowing what your actual accommodations will be like, unless they have booked you there before. Cost, proximity to either the airport, or the hospital, and reputation all enter into the equation. And if some event, like a major league game, or a convention or trade show is in town, the results can yield dire consequences. Chain operations, like Hampton Inn, or Marriot, are predictably efficient, clean, and the staff is predictably polite and helpful. Individual operations can run the entire gamut, from charming and unique to abominable. (If you find yourself contemplating the name the capital of the state that the stain on your ceiling most nearly matches, you are probably at a La Quinta.)

At first, your life may seem amorphous, and totally lacking any structure, anonymously adrift in a seemingly endless series of isolated missions. You may deeply and significantly affect the lives of total strangers. They may remember your names, but it is highly unlikely you will ever see them again, and their names will most likely be quickly forgotten, even though some of your deeds, accomplishments, successes and failures will become legendary and unite you and your flight crew with your charges. They are not just cases, as often happens in ground transports and hospital care. Much the same way as with emergency care initiated in someone’s home, you remember the people, the settings, the relatives and friends in a more intimate way than you do when you just scoop them off the street, or whisk them away from their jobs for a six minute ride to the hospital. Spending several hours rendering care to a patient (and often, at least one family member) in the cramped confines of a small private jet aircraft is strangely like driving cross-country on vacation in a station wagon with somebody else’s family.

Your flight crew becomes your family while you are on the road. You see pictures of their spouses or significant others, their children, pets, and their homes and prized possessions. You learn their names and hear their stories. You may even learn about their dreams and disappointments. You may disagree about politics, social issues and anything else of which people are capable of having opinions, just like any other family. Somehow though, it is easier to respectfully disagree with each other in a way that most families cannot. We frequently put too many expectations on our blood relations, which makes us more subject to disappointments and resentments than you would with your crew, even though you spend more significant waking time with them than with your “real” family. And because you are responsible for working as a team, you are more likely to be more conscientious with each other.

You have to pack for two weeks. You have to learn to separate what is essential for that seemingly short time, vs. what is superfluous. That does not mean two weeks of clothes. More like four sets of scrubs for hot climates and lounging, and your two flight uniforms, and enough underwear and socks for say, four days, plus maybe one pair of slacks and a shirt or two for when you get the chance to eat at anyplace close enough to your accommodations for the end of the day, which means washing everything every couple of days when you have the chance. Plus thermal underwear, a light jacket, and a heavy coat, some really good leather athletic shoes, and the ubiquitous tactical boots.

Next comes the essential gear like you stethoscope, a small Maglite, trauma shears, a center punch, a tactical knife that folds and doesn’t look too Rambo, and a small emergency tool kit. Most of it needs to fit into your belt holster, plus a small tanker’s bag. Things like a small volt-ohm meter, wire strippers, electrical tape, a few wrenches and Allen keys, a soldering iron, and some light-gauge solder. Jeff lived for the unexpected events that would shut down less ingenious, or worldly medics. If one of the knobs came off the dash on the jet, you could bet that Jeff had the right size Torx wrench to fix it in flight. He frequently repaired broken transformer leads, sensor wires and leaky ventilator connectors. He also brought some amateur radio gear, and was once able to replace a transponder unit that failed in Canada, so they could fly back to the US to find an FAA-approved avionics tech who could certify what Jeff had already done.

Whether you work municipal rescue, or air ambulance, there is a certain kind of ritualistic preparation for either you next shift, or your next mission, and a kind of fetishistic attention to detail unique to the profession. Flashy, spit-shined combat-style boots demand an attention to detail much like what a gear-head will lavish on a prized sports or muscle car. That can take up to an hour, given that there is sufficient time. Show me a medic that doesn’t follow the ritual of the Five S’s (Shit, Shower, Shampoo, Shave and Shine) before the start of each shift, and I will bet you he is already in trouble. It’s as if the facade we put on is a kind of symbolic armor to ward off injury and evil, but it is also more than that.

Jeff was an apostle of Schwartz’s Law: forget Murphy (too much of an optimist); eventually everything East of the San Andreas fault was going to slide into the Atlantic Ocean, and Jeff intended to be prepared for it. He lived for it. “Improvise, adapt, and overcome” was his motto. He was always looking for the hidden flaw, or the unnoticed fly in the ointment, preferably before it turned into what he would call a “cat’s-ass-trophy”. It drove everybody except his regularly assigned flight nurse crazy, but he maintained that the best way to save a life was to not kill the patient in the first place with carelessness or laziness.

Of course, he wouldn’t have been the first well-intentioned person to be drawn into EMS as a way of compensating for deep-seated feelings of personal inadequacy. Well-adjusted, self-actualized individuals do not need to be heroes. There are plenty of accidental heroes, who suddenly find themselves in situations whereby their knowledge, skills and their character are called upon to do those extraordinary acts while bystanders just gawk, or turn away. Jeff admired those people so much that he purposefully sought out situations that provided him the opportunity…especially if it put him in harm’s way, and he had an attraction for controversy that was not at all healthy, at least not for him….

You also have to know what it is that you can bring with you to sustain your self. Jeff frequently relied on electronics texts, gun magazines, and novels by authors that challenged him. Almost every hotel worth more than four hours of your life has a gym, sauna, steam room, a hot tub, and a pool.

The range of quality of their accommodations, sometimes most conspicuous in their absence provided endless opportunities for adventure.

FBO stands for Fixed Base of Operations. The large commercial airports, as well as the smaller private airports all have facilities to accommodate the needs of private aircraft, including air ambulances. They provide a transition point between life in the air and life on the ground. The accommodations can range from opulent to Spartan. At the very least, they will offer fueling services, charts, navigation and weather information, as well as some amount of hangaring, minor repairs, washing and detailing. There is usually some sort of a counter with a display case containing flight-related items for sale. Often, there is a separate flight shop with a more extensive range of items. Caps, shirts, sunglasses, clipboards, flashlights, UHF handheld radios, small to medium sized tool kits, coffee mugs, flight wings and other insignia, aviation calculators, pens and highlighters enough to fill a small room await your perusal during the intervals between landing and “wheels up”. Another thing that police officers, firemen, paramedics, and pilots have in common is impulse buying of items they believe to be necessary or specially designed for their profession. In an FBO, factors like weather, or other factors determining the time between the next leg of your mission, and fatigue, boredom and curiosity may account for many of the purchases made.

If the crew will be “overnighting”, the FBO will either arrange for some sort of shuttle service to the hotel, or provide a loaner vehicle. Some FBO’s may have a small restaurant, or sandwich shop, or your home office may order food to be delivered by a service that specializes in flight-related catering. If there is time to eat elsewhere, the FBO will usually have a map and directions, sometimes with either recommendations or precautions about where and where not to eat; then the crew boards a loaner vehicle in search of nourishment.

The diversity of regional cuisines is one of the factors that make life on the road an adventure in itself whether it be for the quick bite or your real meal at the end of the day. Seafood, beef, pork or even something exotic, like bison or some other local specialty may be deep-fried, steamed, boiled, blackened, barbequed, sautéed, braised, smoked, or raw. As long as they were in the US, Jeff ate whatever the locals ate, except rhubarb, which made him retch, and did not endear him in the South, where it was often proudly offered, and usually home-made, but even the smell of it prevented him from ever putting it near his lips.

Another interesting fact is that even the best pilots were often terrible drivers, and even worse navigators. Jeff believed that it was a combination of the fact that although aircraft travel much faster than automobiles, they moved within a considerably vaster environment. Flight, even in executing “military maneuvers”, required a much more subtle grace than traffic’s close-quartered, rapid demands. Plus the fact that without GPS, radar, and flight plans, most pilots were essentially disoriented. Nonetheless, most pilots insisted on driving. Pilots, nurses, and paramedics are all control freaks, but pilots will be pilots, and unless it involves something medical, if it moves, they consider themselves to be in charge. Once it was established that the pilot indeed had absolutely no idea of where they were, or how to get to their intended destination, the appointed Nagravator (usually either Jeff, or his nurse) would try to give instruction and support. They eventually learned to pay attention while the pilot or first officer was getting them lost, by following their progress (either real or imagined) on a local map. This was several years before useful and affordable GPS units designed specifically for streets or highways became available. Neither Jeff or his nurse ever actually told the pilots about their unspoken, but well-anticipated precautionary assignment, which was usually determined by whoever rode “shotgun”, but then again, there were quite a few items they chose not to necessarily share with the rest of the flight crew….

No discourse about Life on the Road would be complete without discussing what kind of factor that Fatigue played in their lives. FAA regulations stringently (in theory) determine how long a pilot and his first officer can fly in any single day. Strictly speaking, the regulations cover what is referred to as on duty, which is supposed to determine not just “wheels up” to “wheels down”, but the actual time they are working. There are many ways to creatively document everything except actual flight time, and a smart pilot knows how to juggle the numbers without putting everyone’s life in jeopardy, and still accomplish the mission. There was also a provision referred to as something like “Article Seventy-Two” that allowed the pilots to fly their crew only (no patients or paid passengers) to their final destination for the day.

It should be duly noted that no such regulations exist for the medical crew. More than once, “fresh” pilots were sent to relieve “timed out” Captains and FO’s by meeting them at a scheduled fuel stop without even considering the fatigue of the medical crew, who frequently had to start several hours earlier than everyone else, to meet the ground ambulance to take them to the hospital where they would pick up the patient, take report from the hospital staff, and prepare the patient for transport. The entire process frequently ran from an hour to ninety minutes or more, and the destination involved a reversal of this procedure. It was not especially unusual for the pilots to be showered and changed, or even waiting for the medical crew in the bar or designated restaurant before the nurse and medic had even gotten into their rooms.

It was also not unusual for the pilots to do everything possible to prepare for the medical crew’s arrival, like getting their bags into their rooms, and getting a table at the restaurant for all of them. They all did everything possible to support and nurture each other whenever the occasion arose. They were not merely strangers who worked together. They were Family. Jeff’s nurse helped create the atmosphere of bonding and love that flowed freely between all of them. This is not necessarily true of all nurses by any means. It was just her nature to nurture them all, according to their needs. She loved to provide the feminine balance to all that testosterone, and had no issues about proving herself, or imagining being taken for granted, or establishing her pecking order within the group. It simply wasn’t necessary, because her knowledge and skills were the perfect complement to Jeff’s, and frankly, they all loved her. She could be quite tough when the occasion called for it, and as salty as the ocean when she felt like it, but she wasn’t afraid to be tender, and they all enjoyed protecting her on a certain level that allowed her to feel safe just following her nature. Also, she was not merely “Jeff’s Nurse”, as if he was the HMFIC (Head Motherfucker in Charge), because he also regarded himself as “Her Medic”. Everything flowed freely in both directions in an exchange as natural as the coming and goings of the moon and the sun.

It is not at all uncommon to find one’s self feeling anger, resentment, or even hatred for a badly matched partner, especially the later in the day (or night) that it becomes. Training Officers for municipal Medics frequently evaluate the new recruits by comparing how they function in the daytime vs. their “after midnight” personalities to see how fatigue affects both their judgment as well as their temperament. In this respect, Jeff was especially blessed. Katie was very tolerant of Jeff’s generally lascivious nature, foul mouth, disarming humor, and quick temper because he did not direct it at her, and they both believed that she brought out the best in him, and he in her.

Exhaustion is a central theme of Life on the Road. When Jeff worked as a municipal medic, it was a matter of twenty-four hours, plus whatever overtime you chose to pick up. When he started working air ambulance, the flights were “out and back” during the forty-eight hours between twenty-four hour shifts, notwithstanding layovers due to weather, repairs, “time-outs”, and extra flights booked (usually after the fact) for the back trip. Once he had begun working full-time on a flight medical crew, it was for two weeks at a time. In theory that is. If your relief had a National Guard commitment, you may have to start your tour a few days earlier than you had planned, or you may be asked to work for an extra few days. Or the aircraft may be scheduled for routine maintenance, so they send the on-duty crew home early, and then call you in a few days earlier than usual, if a flight is pending.

In the morning, you may start with a flight that picks up in Jamaica (~eighty-eight degrees), with a destination in Ottawa in December, where it is a balmy twenty-four degrees below zero. Anytime you go to altitude, the temperature outside is at least sixty degrees below zero. Using bleed air from the engines is usually an off or on proposition, so unless a patient is freezing their ass off, it is best not to distract the pilots, so you alternately either bundle up, or strip down. Temperature-induced fatigue is no joke, either.

Noise levels are very high. Altitude changes fuck with your middle ears constantly, and high-altitude pulmonary edema becomes a very real risk. Food and alcohol become substitutes for any number of items that may be lacking in your life, and if you exercise too little control over when you consume either of them, many bad judgments get made in the process.

Before the end of most tours, you are so fucking slap-happy and out of sync with everything, that you skip the swims in the pool, the exercise rooms, the saunas and steam rooms, and all the activities that you already know are supposed to keep you sane and healthy…and then what?….

When Jeff finally made it back home, he tried to plan at least one trip to the gun range, just to calm down. He loved the Power and Control of the experience. Not over others…he got enough of that just being a Medic. It is an extremely demanding avocation that requires precision, responsibility, and a taste for controlled violence and loud noise that has the ability to drive out the accumulated fecal matter that Everyday Life, as well as Uncommon Stress exudes into our consciousnesses. Freudian analytical second-guessing aside, there was a profoundly sexual pleasure to it. Orgasms and explosions bear so many similarities that to the uninitiated, they may be regarded as substitutes for each other. Nothing could be further from the truth. We all need to cum; some may need it more than others, especially the ones who don’t realize how much they need it, but only some individuals also benefit psychologically and physiologically…even spiritually from the Other Big Bang. Although after really great sex, one may be disinclined to immediately discharge a firearm, after a session at the range, Jeff often felt so emotionally and physically purged of the poisonous humors of stress, yet charged by the experience and heightened sensations that he felt compelled to discharge his “gun” as soon as practically feasible once he got home. (I know…I know…before you try to label the remark as sublimated violence against Women, just realize that IT’S JUST A FUCKING METAPHOR (literally) based on an obvious pun.) Both Jeff as well as myself love, revere, admire, adore, and perhaps even envy Womanhood in its most gloriously lavish and powerful, yet inscrutable manifestations far too much to even fantasize about harming them…and neither of us ever referred to either a firearm or a weapon as a Gun.

A New Wrinkle

This is a business that requires a person to “shoot from the hip” more often than not, because of the subtle and unsubtle details that are either essentially the same, or different from one scenario to another. Some actions need to function like a reflex arc, automatically. No thinking, just do it. The ABC’s of EMS are: airway, breathing, and circulation (as well as C-spine protection). Almost everything else is variable, and can represent an overwhelming sea of details that can drown you if you don’t have the ability to triage the important vs. the unimportant elements.

Right now, one of the more salient points would appear to be that Jeff is the only crew member that can speak any Spanish, and the owner of the aircraft that was leased for this fight (who is no doubt, in bed sleeping) has screwed up the details for refueling. His pilot is useless. He speaks no Spanish. His credit card is only good for the brands of fuel in Santo Domingo, more than a hundred miles away, and there appears to be a shortage of the legendary “Captain’s Cash”, intended to forestall such difficulties. (At least now we know that we are closer to Santiago.) Normally, “Captain’s Cash” can instantly cut through local regulations, bureaucratic red tape, and even overcome cultural taboos, superstition, and religion with equal aplomb in ways no diplomat or even an ecumenical council could accomplish in a decade. Their American cell phones are also useless, as the owner of the company has been endlessly stalling over picayune details regarding the lease of a satellite phone. Previous attempts to locate a working telephone had been futile, but now that the guy with the fuel truck has arrived, Jeff learns that the fuel station office has a working telephone. He explains to the rest of his crew that he will be going to this phone, and now finds himself following some nondescript character off the airfield, and several hundred yards into the jungle, past a guard’s shack…into the jungle, until a clearing is reached, to reveal a “tank farm”, as it is called, that includes a small structure that houses a telephone.

The Importance of Re-Assessment

From time to time, each of us finds ourselves in situations that, as they unfold, start to resemble a bad dream. This was more like finding one’s self the lead character in someone else’s nightmare. You think you are headed toward a solution to an increasingly unsavory problem, only to find yourself following some guy you don’t even really know away from the last vestiges of civilization (relatively), off the airstrip, and into the jungle of a foreign country as nonchalantly as if it were a stroll around the corner.

No witnesses except parrots, snakes, maybe a panther…(one of the favorite insignia of most Caribbean militia). It’s about then that you start to think, “What the fuck am I doing here?” The fact that there really was a tank farm, and an office, with a telephone instead of a clearing with several dozen Gringo heads atop spears was such a relief that the realization that none of the phone numbers were any good did not surprise or even especially disappoint him. He thought about his kids. Just for a moment, he imagined what it would be like for them to find out, or never really know, and have to grow up without their Dad. And he thought about Stella. Would that be her defining moment, or the beginning of the end? Every time one door closes, another one opens. To him, at that moment, his own existence was inconsequential, except in terms of what it meant to the significant others in his life.

Whether it was an error by flight support (bad number), or Jeff’s lack of familiarity with the Dominican phone system (maybe some area code, or prefix was missing), the phone failed to produce any results. No family. No hospital. No home office. Neither the fuel truck driver nor the local directory is any help, but at least the whole ordeal helps pass the time until the ambulance arrives to take the medical crew to the hospital. In places like this, one has to focus on the pleasant surprises like, “I really expected the diarrhea to last a lot longer than that” or “I’m just glad it was only a flesh wound”, or “Hey, be GLAD it was only banditos, and not the Policia…they would have ass-fucked and killed you before they robbed you.” At this point, Jeff’s experiences revolved around an airport, a drive through the slums to a hospital, and back. He had not even seen Punta Cana’s opulence.

During the walk back to the aircraft, it suddenly occurred to him that small children probably walked through paths like this every day, without a moments’ hesitation. To Jeff, it may have been a jungle, full of mysterious portent and ominous overtones, but to the natives it must be just as natural as a walk through the woods in Ohio. He consoled himself for his fearfulness by reminding himself that this jungle was nonetheless likely to hold snakes, poisonous lizards, jaguars, maybe even insects that can kill you. Every day, children walk to school through neighborhoods just as dangerous and hostile to the uninitiated, even in North America. The farther North you go in North America, the more likely it is that the climate or terrain could kill you in the winter. The farther South you go, the more likely it seems that the animals, environment, and insects will. The American Southwest’s climate can be equally deadly to the uninitiated. And that is just in the uninhabited regions. In the cities, all bets are off, because no matter where you go, on any continent, Man is the most consistently violent, treacherous, and bloodthirsty being on the planet, as well as the most loving, and benevolent.

The Cavalry Arrives

Remember Bluto from the old Max Fleischer Popeye cartoons? Well, here is an interesting point: Bruto in Spanish means stupid, and to a gringo pendejo, the rolled R sounds more like an L. I mention this because his body double is standing beside the jet when Jeff returns from the tank farm. He is wearing a pair of Buddy Holly style black-rimmed glasses, and both of his huge, muscular arms are covered with tribal tattoos right up to where the sleeves had been cut off of his shirt. Jeff soon learns he is one of the sons of our patient, and has brought the ambulance that is supposed to take us to El Hospital de La Vega to pick up the patient.

Despite his rather unorthodox appearance, it is quite clear that Rueben’s authority is as vast as his size. He is not much over twenty years old, but well over six and a half feet tall, and probably weighs over three hundred pounds, lean, muscular and commanding in appearance. Once he learns of the refueling dilemma, he speaks first to the pilots, and then to the driver of the fuel truck. With a wave of his hand, all problems disappear, as Jet A is being dispensed.

Now they can actually fly back with their patient without having to consider (even if only for a moment to which they will never confess) having to sell their nurse into a white slave ring for money for fuel. (At least, for now.) As Alice would say, “…things just keep getting curiouser and curiouser…” (Go ask Alice when she’s ten feet tall…). Better yet, go ask her after two years in a Dominican brothel, having been forced to commit unspeakable acts for dark and mysterious, sweaty gentlemen of indeterminate racial mixtures, never to be seen by her family or friends again, until late one night when her father, having retired to his den, discovers an internet porn site that causes him to suffer a massive heart attack.)…But ah! I digress….

Go With the Flow, and Don’t Piss Off the Locals

Paramedics are not the only ones to be touched with more than a little hubris. Rookie Captains are often similarly afflicted. Jeff’s first trip to the Caribbean with a young pilot who had just made Captain taught him the importance of keeping your delusions of grandeur to yourself.

Upon landing, they were met by a gentleman who is referred to as a Handler, which means that he handles all the details concerning refueling, airport fees, and whatever logistics are required to get out of where you just arrived as efficiently as possible.

As the door of the Lear jet opened, the Handler introduced himself and extended his hand to the Captain, who rebuffed the man as he explained that he would be doing all the arrangements for himself, adding, rather arrogantly to the rest of the crew: “They can speak English. I’ll take it from here.”

When the crew returned from the hospital with the patient, the captain’s cash (about two thousand dollars), as well as all the personal money of the pilot and first officer did not prove to be sufficient to pay all the fees that had been assessed, and two militiamen with automatic weapons had seized the aircraft.

It was not until the Puerto Rican EMT who had been brought along specifically to handle translation went into the Airport Director’s office and did his best impersonation of a physician that the fees suddenly shrank to the customary amounts, and the aircraft was allowed to leave with the critically injured patient.

Transportation of the Sick and Injured

And then there was the ambulance. A Toyota van with emergency lights. Oxygen most of the time, but always emergency lights. A nasal cannula dangles, wrapped around the O-2 regulator. (If you are lucky, they will have “cleaned” it between patients with a little alcohol…). The stretcher will either be something that was sold from a North American ambulance company (for twice the price, after it was too old and worn out to be fixed any more), or locally made with aluminum tubing (if you are lucky) and a welding machine.

If the Smithsonian ever decides to put out an exhibit about the history of the ambulance service, it will eventually have to go to all the Third World countries to round up all the equipment we used thirty years ago. The ambulance windows are open because the air conditioner does not work. Indeed, in many of these countries’ hospitals, only Surgery and Intensive Care units have air conditioning. As a result, the flies are as ubiquitous as Coca-Cola, Mickey Mouse, and Jesus on the cross. Since most of the roads are unpaved, the dust that covers everything with its soft patina goes unnoticed, like some Third-World version of Florentine finish. If you ask if anything works, they will tell you yes, only to later clarify that the batteries, however, are dead.

(A slight aside: Coca-Cola bottled in the Dominican Republic bears the motto (in Spanish) ”bottled exclusively for drinking”…anyone familiar with earlier practices involving “…the pause that refreshes…” for either feminine hygiene and/or birth control (and the theme of an old Fuggs’ song) will appreciate the ironic import of the motto, or disclaimer, depending upon your point of view.)

The difference between Mr. Toad’s Wild Ride and the trip to the hospital is that one is a cartoon, set to rollicking, light-hearted music, and the other is real-time; a Keystone Cop cinéma vérité set to Dominican Merengue. Oh yes, and the other difference: one is entertainment. In the other scenario, you can die in an instant, or worse yet, get horribly injured, wait for what seems an eternity for another air ambulance crew to show up to take you back to Miami, and then either die in a few days, or worse yet, exist in some sort of torturous limbo for six eternities in the ninth circle of hell before a medication error, or some night-shift negligence mercifully allows you to slip the mortal coil, throw off the veil of tears, and then die.

There are a number of places around the world where you are likely to feel your life was in danger just trying to survive a trip across town, whether it be via a rental car, or even a local taxi. Saigon and Rome are frequently cited by tourists as being intimidating to the uninitiated traveler. Rush hour is particularly daunting in any of these places. It is nothing compared to a code-three ambulance ride through any number of Caribbean cities, but Grenada, Kingston, and Santo Domingo stand out in Jeff’s mind. In Grenada, the Hospital was at the top of the mountain on the island. Although the road to the top is barely wide enough to negotiate two normal sized autos, the local ambulance drivers travel so fast that they cover most of the road, oblivious to the hundred-plus foot precipice with no guard rail. In Jamaica, the local medical director, a legendary figure well-known to almost everyone on the island, occasionally escorts the air-ambulance transfers straight through downtown Kingston in his black Mercedes at what feels like eighty miles an hour with only a magnetic emergency Kojac light, pursued by two ambulances running lights and siren, that can rarely ever keep up with him. (In the seventies TV. serial Kojac, Telli Savalas used a portable magnetic emergency light, which he plugged into his dash via a “coil-cord” and placed out the window onto his roof as he went into code three pursuit. They are still popular with many volunteers today.)

Both of these trips caused Jeff to “white-knuckle” all the way from the airport to the hospital and back, but neither trip could compare to a previous ride he had taken in Santo Domingo several years before, during rush hour. The main thoroughfares have three or four very narrow lanes in each direction, and the traffic flows at about sixty miles an hour with only a three-inch-high “barrier” separating oncoming traffic by what looks like about eighteen inches. Virtually every car on the road has a great deal of visible body damage, and the frequent minor collisions are punctuated by cursing, and gesturing, the waving of arms (and sometimes brandished machetes), but no one stops, or even really slows down. Imagine high-speed bumper cars driven by escaped mental patients on Rufinol (Rohypnol). Once, leaving the airport to go to the hospital at rush hour, Jeff noticed a small blue Honda tailgating the ambulance more recklessly than the others were. Next Jeff noticed the driver was openly drinking from a liter bottle of the local rum while swerving dangerously close to the rear of the ambulance as it recklessly careened through traffic that barely parted for the ambulance. The real shock was when he recognized the driver as one of the officials from the airport they had just left, still in uniform, but merely another face in a sea of crazed locals just trying to get home.

(The Rise and Fall from…) The State of Amazing Grace

Of course, it all just depends on what you are used to, when you are in your own domain. Most “old-school” Medics and EMT’s believe that they are somehow protected, in some special state of grace, when they are acting in the course of their duties. Jeff recalled one night, during his training for his first municipal rescue service, driving at well over a hundred miles an hour at night to a wreck on a two-lane blacktop that ran between two adjacent counties. Two ambulances had been dispatched to the forty-plus mile distance that separated them from their patients. One of the Medics in the other ambulance had run out of cigarettes, and wanted a smoke on the way (this was the eighties). Jeff was driving. His training officer handed him three cigarettes, told him to roll down the window, and hand them to the other Medic in the passenger seat of the other ambulance, which was now alongside his unit. This was as much a Rite of Passage and test of Jeff’s nerve (what some might call “Balls”) as anything else. If he passed, there would be no mention of it in any evaluation, but if he did not, although it would also not be mentioned, his career would be, to put it bluntly, Fucked.

Now, risk-management specialists write regulations that forbid the driver from using his radio while driving. Back then, another training officer had told him: “Hell, son, if you can’t drive Code Three (within ninety seconds after the plectrum tones have sounded) out of the garage bay while lighting your cigarette and answering the radio without spilling your coffee, you just ain’t worth a shit!”

Later, Jeff and one of his partners would make it such a common practice to for instance, go into the water to rescue victims before either Fire Department or Coast Guard personnel arrived, that the county administrators required them both to sign a “quit claim” waiver against civil lawsuits arising from their demise or disability secondary to their disregard for their own safety.

Both together, and separately, they more than once received awards for heroism and county-issued Written Corrective Actions either on the same day, or for the same actions.

Comparative Diagnosis
La Vega makes you realize how much we take for granted in North America. The roads are the area where the pavement is more prevalent than the holes…which look large enough for an ambulance to disappear into, only to be sucked straight into an even sweatier and hotter version of The Inferno than the one he is currently occupying. There seems to be a dead dog on every other corner. I don’t know why…it’s just a Western-Hemisphere-Third-World thing.

El Hospital
Then there was the hospital. Imagine a North American urban hospital from Philly, Baltimore, or New York that was condemned sometime around nineteen fifty-six. Institutional green. Here in this minor Caribbean town, it was everything medical that there was. Only Intensive Care and Surgery have air conditioning here in the tropics, that is to say, the only place where the windows aren’t open, and the flies don’t get the first claim on anything they want….

God Gives Us but One Face

Although the nurses and orderlies are only a slightly different genotype than the militia at the airport, it suddenly occurred to Jeff that his perceptions were only weird to him, because he was the outsider, and this was their world. It was at this exact moment that this realization started to crystallize and precipitate right before his eyes. Even the idea that he was the outsider was something that he could either create or negate by a simple realization. He was the one who was making differences, judgments, and creating fear and prejudice. As his preconceived notions began to dissolve, he was also aware of the fact that it was his choice whether he was accepted, or despised by these people who now seemed to be only as different as he chose to see them. We are not talking about phony pseudo-liberal condescension. This was a profound breakthrough in perception. It was as if he suddenly saw that each and every one of the people he beheld had an exact counterpart in someone he had known before, because he was not looking at their skin, or even their appearance, but rather at their countenance, their being, devoid of all superficial appearances.

As they stood together, awaiting a decision on what was to transpire next, one of the orderlies offered Jeff a small cup of Mate Yerba (grass tea). It is a popular drink in Miami in the Latin community, and a real favorite of Jeff’s. They seemed a little surprised to find out that he not only knew what it was, but that he liked it so much. For Jeff, it was a moment of transcendent bliss.

One could say that this would have been a very inconvenient time to have such a realization, but that very sort of statement is just the kind of judgment that would be made by someone who hadn’t reached this particular state of mind. In fact, this was exactly the time to be having this realization, so long as he could just put down all his previous preconceived notions and see that everything was “…just like this…”

He thought of the story of the Buddhist monk who meets one of the Bodhisattvas while walking along the road. The monk has left his monastery to go to the most remote cave he can find in the highest mountain in the country so that he can attain enlightenment. The Bodhisattva is dressed as a beggar carrying a heavy load upon his back, which has him nearly bent double. He asks the monk where he is going, and upon hearing his reply, the monk suddenly realizes he is standing in the presence of a great master.

The monk then asks the Bodhisattva what it takes to achieve enlightenment, whereupon the master simply smiles, throws down his load, and stands upright. At this moment, the monk realizes his enlightenment, and achieves a moment of clarity, or the clear light of mind, whereupon he then asks: “What do I do next?” The Bodhisattva then simply smiles, and bows, and picks up his load again, and continues on his journey.

All this occurred in a great deal less time than it takes to tell the story. Once you stop the internal chatter, many fairly profound things can happen very quickly, so long as you don’t require announcing them, either to yourself or everybody else who happens to be standing there. And for a very long time, that had been Jeff’s undoing, but not today…it’s not as if he didn’t see everything exactly as it is, it’s just a matter of not injecting prejudice, judgment, or condescension into his perceptions. In fact, “…everything is just like this…only this…before thoughts…before words.”

How many people does it take to achieve world peace?

The Performance

Of course, the elevator will not accommodate the stretcher and the flight crew, so while someone from the hospital who is authorized to run the elevator accompanies the stretcher, Jeff and the other two members of the crew walk up the stairs to ICU. As they turn up the last flight of stairs, the relative quiet commotion of the hospital is shattered by a lone female scream, followed by mixed shouting, wailing, and a sort of collective “NOOOOO!!!” that fills every corner of this end of the hospital.

Ten seconds later, they are in front of the unit, only to be confronted by the assembled multitude of the entire family. It is quickly established that “Poppy is dead”, having expired only moments before their arrival. They enter the unit to observe a giant of a man lying supine on a bed with a tube in virtually every orifice that will accommodate one, plus two chest tubes and an abdominal drain. The body is over four hundred and fifty pounds, and is additionally bloated even further from surgeries to remove the spleen, repair the liver, terminate unknown bleeders in the abdomen, and thorax, as well as having received over sixteen units of blood since last night.

Even closed, the eyes are bulging as if they are ready to pop right out of their sockets, and he has the unmistakable mask of “coon’s eyes” suggestive of a skull fracture, as well as what those in the business refer to as a “Laforte Three”, which essentially means that all the bones that are normally attached to the front of the skull, like the nose, the cheeks and the upper mandible have become detached, like a Halloween mask, from the skull itself. The face is so swollen that the skin is stretched tight enough to give it a shiny appearance. The bruises range in color from a reddish purple to the color of slate. This condition does not have a prognosis consistent with a long and healthy life, and is rarely seen on living beings, even for short periods of time.

The doctor in charge tells us “Poppy” has expired less than five minutes ago, which does not seem consistent with the dependent lividity which is present in all the lowest portions of his body, which is to say that a dark pooling of blood has already accumulated in the skin of his back, buttocks, and the backs of his arms and legs. Although rigor mortis has not yet set in, it would indicate his death occurred much earlier than anyone will allow at this point.

Jeff then retreats back out into the waiting area to console the family. Imagine trying to stop a Freightliner eighteen-wheeler loaded with pigs from Wheeling, West Virginia, travelling down a thirty-per-cent grade at eighty miles per hour, with no brakes, by parking your Volkswagen across the road in front of it. Although the Volkswagen undoubtedly has a better chance of success, somehow Jeff manages to establish what passes for empathy with the family. Nevertheless, the oldest brother indicates that the family, by virtue of what was their father’s last request, is now insisting that he should be buried “en Miami”. They also indicate that they want him to go now, on the air ambulance, for which they have already paid a non-refundable fifty-per-cent upfront down payment. Jeff indicates that he will “see what I can do”, knowing full well that the regulations, international laws, and local red tape are going to present an almost insurmountable obstacle, regardless of how adamant the family is about the matter. Then again, it has become exceedingly clear, almost from the moment they arrived in the Dominican, that this family owns the town, and everything and everyone in or even near it. To refuse their request, (which is to say, while it is still in the form of a request) would be foolhardy in the same manner that refusing a Kodiak bear’s inherent right to your recently-caught salmon would be bordering on a suicidal ideation. When you are out of town, you don’t piss off the locals, and if you are smart, you go with the flow of power.

None of this is even slightly comprehensible to the rest of his crew. Both of them were good people, and reasonably competent in their chosen professions, just oblivious. Jeff tries to explain to the request of the flight nurse, who immediately tells him to “Just shut your mouth before you get us all into a lot of trouble”! (The only one who speaks any Spanish at all [which is to say, Cuban-American “Spanglish” acquired on the streets of Miami], and all of a sudden, he is the asshole….)

Needless to say, this is not well received by any of the family who pick up on the drama of what has just happened. Male or female, in the Caribbean, Mexico, or either Central or South America, everyone knows that Chauvinism is a way of life. Hispanic Chauvinism bears no apologetic self-consciousness.

Unlike their more guilt-ridden American counterparts, Latin men wear their Machismo like a battle ribbon, and their swagger and bravado is not only tolerated by Latina women, but it is encouraged. Any male who does not possess it is considered suspect. Don’t get me wrong; women still know how to control the upper hand in Latin America just as well as they do everywhere else in the world, but here it is done under the guise of male domination.

If you forget that, you lose credibility, and things can get very unstable in a hurry. The sudden silence is punctuated by both rapid, and slow turning of heads to see “What now?…” Jeff quickly recovers, and says (in Spanish) “Of course, I have to clear everything with ‘La Jefa’ first, and he shrugs his shoulders and rolls his eyes skyward, which is punctuated by a relieved sigh of laughter by the group. “La Jefa” is a derisive way for a male to identify a woman who clearly doesn’t know her place. “El Jefe” means “the boss”, and it is delineated in masculine gender for a very good reason, which many Latinos would equate to God’s will. By making a joke of it, he relieved the tension and restored credibility in addition to indicating that all is not lost in their quest to have “Poppy’s” last wishes followed.

The oldest brother takes the lead, and offers to let Jeff use his cell phone to call the states, so that he can get in touch with the medical director for final approval.

Meanwhile, the other medic (who has somewhere around eighteen years less experience) goes into a meltdown and takes a mental and verbal shit on everything in sight, ranting about how “…This just isn’t right…I don’t think it’s even legal…we’re not a removal service…this isn’t our job”…blah, blah, blah. Fortunately, although he is Cuban-American, he speaks not even a word of Spanish, and is very young. So intent was his mother to “Americanize” him that he was named Brandon. That, plus the fear in his eyes score him zero credibility, so he is quickly discounted as an inexperienced, babbling Gringo Pendejo, who Jeff easily dismisses.

The conversation with the medical director, however, turns everything around, and puts it all in a clear perspective that borders on genius.

That the flight nurse should try to dominate and control the situation is not surprising. In North America, it is downright commonplace. There has been a longstanding feud between nurses and paramedics from the time that the first EMT ever hit the streets.

This was not the case between Jeff and his regular flight-nurse. Their relationship was based on mutual respect and a natural teamwork and rapport that started the first time they had ever worked together. No competition. They both were very good at what they did, and even when they did not agree, which was not often, they managed to make it all look seamless. But this was not his regular nurse, and she had been taught to follow an agenda that involved putting medics in their place. It is rooted in a turf-war mentality that has crippled the ambulance transportation business since its earliest days.

It is the same way with nurses and medics everywhere. Nurses regard paramedics as a threat to their profession. They are allowed to do a lot of things that only doctors can do, and their training is narrow, and intensive, as compared to the more broad and expansive education that nurses are required to complete. And then there is the swagger, the chauvinistic egotism so full of itself that appears to be standard issue with the shiny boots and the badge. Medics have done a lot to create the ill will to which they have been subjected, and it is not likely to change any time soon.

Oddly enough, a lot of nurses and medics marry, and even raise families. From an anthropological point of view, the whole profession is very new. If Darwin were alive today, I’m sure that he would agree that if nurses, medics, firefighters, and cops keep intermarrying, that one day we will see a new species of human with a jaw that can unhinge like a snake’s, so that they can swallow a whole roast before the start of a shift, with two gallon bladders, and the eyes of a cat for seeing in the dark.

This Medical Director in particular took his knowledge several giant steps further still. He realized that there is a great deal more potential power in controlling action than there is in limiting it. Give the medics as broad and sweeping a set of protocols as the state of Florida will allow, but demand strict obedience to certain guidelines and principals that are clearly reinforced in monthly Quality Assurance meetings. That is real power for all concerned parties.

The Medics were essentially in charge of the field operations, due to the fact that they were allowed to operate on protocols, as set by the Medical Director, while the Nurses were in theory limited by The Nursing Practices Act. Only a Paramedic could intubate, or perform invasive or surgical procedures like crycothyroidotomies, or chest decompressions. Nurse anesthetists and Nurse Practitioners are notable exceptions. The stature of their qualifications ensures them salaries that are prohibitive to Air Ambulance employment. Strictly speaking, Nurses were prohibited from being allowed to write the run reports required by the State Health Department.

The nurse’s conversation with the Medical Director was brief and extremely succinct. What could be heard was this: “Yes, he’s right here…Well, I’m not entirely sure, he’s the only one that speaks any Spanish, but that seems to be true…OK.”

She then offered Jeff the phone. “He wants to talk to you.” What was not heard, but well reinforced to Jeff was summed up by the Medical Director in one sentence, and it was this: “If that man has not been legally declared dead, then he is not dead until I say that he is dead! Now before someone does something we can’t undo, please transport him to Miami for more definitive care.”

For a brief moment, Jeff’s head began to swim. Not because the concept of transporting a “Show-Code” was all that unfamiliar, but because it now meant that a very complex set of actions would have to commence immediately, and they would have to be carried off more flawlessly than if the patient’s life were at stake. And that was because now several lives and reputations would hang in the balance based on the credibility of a theatrical performance.

That Which Passes for Philosophy

Twenty years ago, when Jeff was a paramedic student, he and his classmates had taken up a continuation of a discussion that their instructor had started earlier that afternoon. A bull session fueled by beer and Buffalo wings, centered around the debate of whether Emergency Medicine was an Art or a Science. Somewhere around the second or third pitcher, Jeff had a moment of clarity quite uncommon for him at that point in his life. I say uncommon, because for once, he was able to state something profound without wallowing in minutia for fifteen minutes just to get to the heart of the matter.

What he said was this: “First of all, we are not just involved in Emergency Medicine. We care treat and transport the sick and injured, which means we do so to an audience…the general public. I say that our job is a Performing Art that uses science as a tool to give us credibility.

When it’s all said and done, it’s not as important whether the patient lives or dies as it is that we appear to be competent. Most people don’t really know what they think about God, or Life, or Death, and Religion. Priests have lost their hold on our consciences because they don’t offer the kind of consolation that we need, but we do believe in Science in a way based on greater faith than any religious zealot would admit.

What religion calls Faith, the Scientific Community calls axiomatic. We believe that we have proof in our belief in Science, and that has become our God. When the family, or bystanders observe our actions, if they believe that we gave that patient the very best chance, and that there was nothing more that anybody could do, then they will feel content, and their grief will be mitigated by their focus on our competence, and our compassion.”

Good Acting is not Bad Medicine

What was called for now was to be able to simulate a critical care transport on a dead man, and to do so in a way so well performed that it was capable of convincing the bystanders at the hospital, the local ground ambulance crew, and the pilot and co-pilot of the aircraft, as well as everyone of any importance at the airport.

We all make choices in our life every day. Sometimes it is as simple as “…the turkey, or the fish?”, and sometimes, it does not even appear to be a choice. When faced with a number of unpleasant alternatives, it is important to recognize that there is still a choice to be made. You may not be entirely happy with the menu, but if you are in public, and the choice is to shit or go blind, you do not have a lot of time to waste whining about what is or is not fair, legal, hygienic, or even pleasant. It is not even a matter of what is acceptable. Terms like damage control are more appropriate. What is clear is that anyone who can afford to pay about $10,000 for a non-refundable fifty per-cent down payment just to get there in this corner of the third world, can pretty much snap their fingers and be obeyed, because they live like sultans, at least compared to everyone else, and it is everyone else who will do their bidding. Dirty deeds done dirt-cheap.

Don’t get me wrong; their hosts have been gracious, and extremely polite, but it is also clear that everyone they encounter so far literally hangs on their every word. And just as surely, if they even think that they have been dishonored by anyone, it would be just as easy to push a button, and someone will hang….

From a strictly pragmatic view, it goes something like this: a dead man leaving the Dominican Republic means “mucho trabajo” and would entail several days (and miles) worth of bureaucratic red tape. (It is interesting to note that in Spanish, the word for “work” is also synonymous “trouble” or “hardship”…) Regardless, it is not an option. Refusing the transport, and leaving without refunding their money is also not an option, since the crew is dependent upon their hosts for transportation back to the airport, and it is a long way through the jungle to get there, and many bad things that could happen along the way, and presumably do so on a more or less regular basis.

I am not implying that their clients are thugs, at least not in light of their circumstances. What I mean by that is this: laws (among other things, like perhaps necks) have always been made to be broken by men of wealth, power, and social station. The vast majority of these people in North America would be referred to as privileged, but in the Third World, the operant condition is power, as in “…first we get the money, then we get the power…” and “If given the choice between being loved and being feared, it is better to be feared.” Being bushwhacked by a couple of gringo pendejos would not go unnoticed in this corner of the world. It would give the impression of weakness. Although dealing very harshly with these bushwhackers would not go unnoticed either, it would just be as if it had never happened, and would reinforce the message that it is always bad business to go against the locals when they are in a position of power. It is also obvious that although these people are indeed feared, they are also loved because they take very good care of their own. Not so good that the locals get too independent, but well enough that they are needed. Our hosts are genteel (at least in the context of the surroundings), and extremely polite, but it is as if one is watching gorillas in tuxedos quoting Shakespeare. One wrong move, and the whole deal could turn on a dime. Jeff’s current state of mind is such that he can see all of this in a very clear, albeit peculiar perspective.

(…If you think outside the box long enough, eventually there is no box at all….)

Memoires of a Post-Neo Dharma Bum

(More Like a Short conclusion based on Long Evidence….)

For some folks, this all may seem to be a very long conclusion based on very short evidence, but not for Jeff, and I will attempt to explain why. First, he is a “Boomer”, a term he hated, having coined (or adopted, he does not recall which) the moniker “War Baby”, owing to his affiliation with all the other “Post WWII Baby-Boomers” who eventually became candidates to become fresh meat for the Viet Nam conflict.

To Jeff, the term “War Baby” reduced the equation for his generation to its simplest terms. He was part of the human tidal wave of children born in the aftermath of World War II, which could well be said to be a defining condition for his generation. The Vietnam War was the single most significant defining moment for his generation, as well as for almost everyone alive during those years. The world would never be the same again, as the result of the conflicts that were created by that conflict.

From a strictly Machiavellian (or perhaps more correctly Malthusian) point of view, if the generals and corporate chiefs had had their way, the overpopulation created by the “War Babies” would not have been so significant. Had the war gone on longer, with casualties anywhere near those of WW II, there wouldn’t have been so many of them left.

When Jeff was in school, there was such a shortage of teachers that the common wisdom was that no matter what you studied in college: “get a teaching certificate.” By the time Jeff had graduated, even the sheepskin itself did not guarantee any of them very much. As Bob Dylan had already proclaimed: “Sixteen years of schoolin’ and they put you on the day shift”.

The American Dream was already becoming a nightmare. No longer could anyone afford such a large family as before, and “the pill” was making planned parenthood an actual reality. Fewer babies resulted in fewer students, so schools were being either consolidated or shut down altogether, and it pretty much took a Ph.D. to get hired to teach elementary school.

Over the years that followed, whether it was education, or computer programming, or whenever a really lucrative opportunity would arise, the sheer number of “war babies” that rushed to join the ranks would blow out the demand for them, and business (as well as its formerly lucrative salaries) would be back to their minimalist self in no time at all. If the number of casualties associated with World War II had been inflicted upon “The Boomers” there would not have been such a glut in the population. They were their own worst enemies, just by their sheer numbers.

The dynamics of what happened as they moved along the timeline may have changed, but the principals have not. As more of the War Babies reach the age of retirement, those principles will again rear their heads to upset the economy, social welfare, and healthcare in general.

Southeast Asia marked a turning point for good people all over America. If the bigotry, intolerance, and injustices of McCarthyism and Institutionalized Racism stretching from the railroading of the Rosenbergs to the assassinations of JFK, RFK, MLK, and indeed, even Larry Flint had bred cynicism and suspicion in the hearts and minds of the “War Babies”, Viet Nam had dealt the death blow to the vision of the American Dream that most of them had been raised to believe in and, indeed, even cherish. And all that was necessary for tyranny to flourish was for “…good people to do nothing…” But because they had been raised to be “good people”, they felt forced to do something, and that meant becoming involved. That involvement eventually entailed a criminal record for many who mistakenly or not, believed necessitated being arrested while engaged in various forms of social and political protest.

Would You Die for Your Beliefs?

JFK had been quoted as saying: “When you make peaceful revolution impossible, you make violent revolution inevitable”. Most importantly, the government had long ago made violent revolution suicidal. The very cornerstone premise of our own founding fathers, in terms of forced accountability of the government (of the people) to the people would now necessitate total self-sacrifice. Security and materialism are the undoing of true freedom, at least as far as maintaining it. Peaceful revolution seemed impossible; but if violent revolution was also impossible, then something else would have to take its place. Most of us did not even initially believe as much in revolution, as in evolution, but the rich, the powerful, and the established allowed, or even authorized the FBI and the CIA to do anything deemed necessary to prevent any unauthorized changes from occurring, and the result was that the suppression itself bred a sort of cancer within. (By this point, most people would not understand the irony of the statement that the government was trying to take over the country.)

The War Babies changed the world, for a while, but in the process, they were taught that they could face martyrdom, or at least public ruin, and many opted to “go underground” for their causes. Yet another “nation within a nation”, except in this case, the “nation within a nation” spawned a “nation under a nation. After the Hippy Movement flopped, Jeff preferred to call them Post-Neo Survivalists.

Marijuana and LSD became sacraments of the Neo-Religious New Nation Underground. Once again, the government chose to treat this as a criminal matter, rather than a health problem, just as they had chosen to treat political issues as criminal. It’s not a simple matter of whether or not either of these two issues was “Right” or “Wrong”, but that the people who ran the government made them criminal matters. There was great deal of idealism bred into these young people of this time. Most had been raised by “good people” to “do the right thing”. At first it was a hard choice to make, to become criminals for a cause, but eventually, it became so easy that almost no one even noticed that they had become “casual criminals” in order to conduct their daily lives as they had chosen.

“Casual Criminals”… (blue jeans allowed.)

“We are all outlaws in the eyes of America.
In order to survive we steal, lie cheat,
forge, fuck, hide and deal.
We are obscene, lawless, hideous,
dangerous, dirty, violent
And Young.”
Jefferson Airplane

They did not view themselves as “Career Criminals” because they did not set out to specifically commit crimes to make a living, it just turned out that their lifestyles were being declared illegal by the people who were making a living of preventing any serious changes to the status quo.

In the process, a new breed of “Outlaw” was created, even though the distinctions implied by either label went largely unnoticed by nearly everyone.

Ironically, it was Dr. Timothy Leary (while he was still considered a legitimate doctor) who had postulated the theory of Set Setting that stated that if you treat people as criminals simply for the sake of compliance and enforcement, otherwise “good people” will begin to behave as criminals.

A very happy and economically successful generation of parents who wanted the very best for their children had sent them off to colleges all over the USA. Ethical, right-minded good citizens who had raised their children to be “good people” unintentionally saw to it that their offspring became too well-educated to buy into the hypocritical horse shit that seemed to cover this country knee-deep, everywhere they looked. It is certainly no accident that we shall never see that kind of prosperity, or idealism again in this country. Some would blame it on the drugs, or the music, but the real villain was a liberal arts college education. Unfortunately, it would appear that ownership of property might be linked to certain forms of amnesia…an affliction to which Jeff was in no danger of succumbing.

Unfortunately, the horse-shit is every bit as deep as it ever was, if not even deeper, but the “War Babies” that went into advertising and merchandising have seen to it that the other members of their generation are fairly universally convinced that it is actually chocolate pudding. The holy trinity of drugs of choice have changed from marijuana, LSD, and cocaine to Alcohol, Rogaine, and Viagra. All of it set to the music of the Sixties and Seventies.
Would You Kill to Protect Your Standard of Living?

Although Jeff was certainly a product of the sixties, he was by no means limited by them. We’ve all known sad cases of people who get so stuck in one generation or another that they seem trapped by it, oblivious to the passage of time, and generally unable to adapt or assimilate. This was not true of Jeff, but he did bear an unmistakable stamp of the kind of defining moments that shaped his character throughout the sixties and seventies in particular. Those defining moments determine a great deal about how you cope with Life and its progressions after those points. The trick is to not get stuck or unable to adapt to the inevitable series of changes and progressions that follow.

Many people would link the overall mood and character of the Sixties and Seventies to Sex, and Drugs and Rock and Roll, but they were really more like symptoms than primary causative agents. That is not to say that they did not set a great many things in motion in and of themselves, but the reason that they came of age when they did was because of the forces and influences that came to bear in the fifties.

The simple fact is that the sixties were ripe for rebellion as well as challenges to the existing order and nature of everything. The rebirth of the eternally questioning mind had come to bear upon the West. And it took a rebellion to dislodge the mores and values that had become so firmly entrenched within our culture. As a result, they took on the mantle of Freak and Outlaw within an underground culture fraught with subterfuge and secrecy, which they accepted as an identity, as well as modus operandi long after the trappings of the counterculture had fallen away.

The Sixties was a decade that took twenty years to live out. It represented a cultural impasse between the Old and the New. In a culture that was bent upon making war, this represented a war of ideals and ideas, as well as ways of doing business and pleasure, although the war that was waged started more like a rebellion amongst its practitioners. The Arts changed. Music changed. Clothing styles changed. Not as a marketing tool, at least not initially, but rather a series of what seemed to be natural progressions emanating seemingly out of thin air spontaneously. Madness and genius alike stood hand in hand the whole world round. It was as if something in the air, like radio waves tuned to human receivers provided the atmosphere or common realizations to fit together, like a puzzle that was not yet defined or recognized, that was solving itself. The very fact that Art, Music, Philosophy and Culture enjoyed such preeminent status and importance within a world-wide community of like-minded individuals attests to just how definitively the times represented a quantum leap in social evolution. There had been precedents of many of the individual aspects of the counterculture (Utopian societies, Free Love or Anti-War movements, etc.) that had reared their heads before, yet they were out of sync with the other elements necessary for them to prosper, so they died almost unnoticed, like a species of plants or animals destined for extinction. The sixties was a time when all the necessary components required to nurture the origin of a new species came to fruition simultaneously. Like evolution itself, it had all the time in the world to wait for its defining moment.

From that point on, Jeff had subconsciously perceived himself as a wildcard, a round peg pretending to fit into a square hole insofar as he desired both the comfort and security of semi-respectable occupations and an outwardly comfortable middle-class existence that allowed him a safe haven to take drugs, play whatever kind of music that suited his tastes and whims as loud as he wanted whenever he wanted while he indulged in every imaginable exploration into whatever sexual encounter, excursion, perversion or experimentation that crossed his mind or tickled his fancy. This usually prompted him to choose either industrial neighborhoods or really “bad” neighborhoods bordering on industrial zones.

He had been successfully employed in so many outwardly respectable occupations for so long that by the time he had become a paramedic, it was second nature to him to lead a double life somewhere between Batman and a Fellow Traveler. His intelligence allowed him a great deal of latitude for acceptance of his eccentricity within his chosen profession of the moment, as he frequently employed unorthodox solutions to difficult situations and problems with quite remarkable success. Although he moved freely among his peers, he was never really one of them, yet they generally tolerated his offbeat and frequently off color speech and actions.

It was as if the changes he encountered as the world turned on its course were following some occult grand scheme that kept preparing him for each new challenge he encountered. It wasn’t easy, but he didn’t even realize that there was any other way of doing things, given his proclivity for his more bohemian tastes.

And so it was that the events leading him and his crew to this juncture would seem to have been orchestrated by some divine hand that already knew the outcome long before any of the antecedent events had been set in motion. Whether conjured by some Higher Power, or a product of Chaos, one thing follows another.

The key point being that the polymorphous perverse would appear to have been the operant principle for most of Jeff’s life. Bad, evil, and greedy people not only got away with murder, quite literally, but managed to make a profit at it, while good people found themselves enslaved by trying to live by the rules that the privileged wrote to empower themselves at the expense of those who lived by them. For Jeff, most conventions of society were, at best, somebody else’s rules. It’s not as if he got up that morning and said to himself: “Hey, what the fuck, I think I’ll smuggle a dead body out of a foreign country just to see if I can get away with it”. But given the prologue of the previous thirty years’ experiences, it was just not that much of a stretch, especially since it provided him with a reasonably good opportunity to keep his head connected to his body. The so-called patient was already dead, and when he got to his destination, he would still be dead. No harm, no foul.


This would represent a major ethical dilemma for some, but Jeff was no stranger to ethical dilemmas…but his life represented, in many ways, The Death of Dreams. A surely as he would learn to love something, or someone, he would be forced to lose it. He had developed a decidedly fatalistic outlook about it, yet still he stubbornly tried to hold onto his idealism, his ideals, and his infatuations, regardless of their legality.

From his earliest memories, he had wanted to be a musician, specifically, a guitarist. He had followed that dream, even built a recording studio to support it, only to find himself selling his guitars and amps, as well as drugs, just to keep the studio open, and spent all his time working to sell other people’s dreams, and frequently not getting paid for doing it. He eventually learned that most rock musicians are like overgrown children. Expecting them to pay his bills when they frequently didn’t even pay their own rent is like going to a seafood restaurant with no money, and hoping to pay the bill by finding a pearl in one of the oysters.

After it was all over, for the next four years, he didn’t even have a radio in his truck.

Later, he had pursued a lifelong goal to become a licensed amateur radio operator, like his father, and his grandfather. He built a station that operated on UHF, VHF, and long-range high frequency worldwide. Most of it was tube-powered antiques, and had been hand-built, or salvaged. Now he rarely could find either the time or energy to get on the air. Three hurricanes in twelve months had torn down four separate towers built to support his hand-made antennas.

Auto mechanics had been a passion of his, and after first pursuing imported sports cars, then muscle cars, he had gotten the bug for four-wheel drive vehicles. He loved dogs, hunting, fishing and scuba diving, and his Suburban Assault Vehicle was the steed of choice for transportation involving these pursuits. His motto was: “great trucks are built, not bought” and although his Toyota was new when he purchased it, he immediately began the upgrade and redesign process indigenous to the sport. Bigger tires, more power, wider wheels, a winch, lifted suspension, a second battery, etc. Now, with over three hundred fifty thousand miles behind him, he would soon have to rebuild and restore, if he could ever find either the money or the time…not that he got much opportunity to use it for anything other than going to work.

He owned two full sets of dive gear that hadn’t been wet in five years. Time and money, Time and Money. All he ever seemed to do anymore was work, pay bills, and prepare for his next move. Four moves in five years were exhausting his enthusiasm for much of anything.

And then there was Stella, the love of his life, after five previous failed attempts at marriage. She was fourteen years his junior, and had been vibrant, enthusiastic, sexually breathtaking, and an inspiration. Now she was morose, sullen, addicted, disabled, dysfunctional, and needy. Bad-tempered outbursts of criticisms designed to divert attention away from her own shortcomings did not even fool the children, but it did hurt them, and confused and alienated them more than she seemed to realize.

Until you can remember when you first decided to settle for less than what you wanted, you can never really find your way back home.
(Courtesy of: The Home for Wayward Souls)

The Death of Dreams had definitely dulled his ability to feel any pangs from the seemingly endless stream of ethical dilemmas that seemed more prevalent than ever. Previous occupations and careers not so prone to altruism should have been easier, but not for Jeff, and now it seemed to never end. He had much higher expectations for not only himself, but also his peers, who seemed to thrive on capitalizing on the misfortune or misery of others. He could recall specific instances when he felt his ability to care drain from him like blood from a deep, but not exsanguinating wound.

One such instance came on a single motor-vehicle crash one night while he was working as a municipal paramedic. While attempting to stabilize the patient’s spine, a great deal of money was discovered strapped to the patient’s body in a money belt. As soon as Jeff realized what it was, he had called for a police officer to hold it for safekeeping, and to prevent any questions to be raised later as to his, or his partner’s involvement. Neither the county deputies, not the highway patrol had arrived yet, but suddenly, a DEA agent appeared, and took the money. Later, at the hospital, a highway patrolman had remarked about the amount of cash involved, stating that it had been “almost two thousand dollars, in hundred dollar bills”. The actual amount, by even the most conservative estimate, should have been ten times that figure. It would have been very easy to have pretended not to notice what Jeff had discovered, and split the cash with his partner, but Jeff was something of a “Boy Scout” back then, at least as far as matters concerning this career were concerned. It had been a valuable object lesson.

Faces of Death

The irony of how it could be that caring for the sick and injured involved so many dehumanizing elements was not lost on Jeff. It was his contention that you either embraced Life in all its most grisly and horrific splendor with intellectually detached, clinical curiosity as well as fearless humor, or else you could just try to shut it out, and cover your shock with denial; in which case, your chances of remaining spiritually and emotionally intact would reduce to about zero. What Jeff had not anticipated, however was how quickly he would come to recognize the faces of death.

It was initially a mildly disturbing feeling that he would experience what he attributed to the extremely graphic visual impact of gunshot wounds to the face, cut throats, severed heads, or disemboweled victims. As a protective measure, he would allow his intellectual curiosity full rein. He next realized that there was a certain exhilaration that he identified as feeling guiltless, since it was now his job to make accurate and quick observations, and then act upon them, but there was no denying the Authorized Rush that no “rubber-necking” motorist will ever know. Jeff once described it as “the feeling you get in the pit of your balls if an elevator drops too fast, or during wind shear”. (Several female Paramedics later confided to Jeff that they experience a similar sensation in their perineal region.)

Once he learned to approximate that which passes for composure, he noticed an unnerving familiarity to the faces, and the circumstances. Sometimes, he visualized the preceding moments just prior to death with alarming clarity. He NEVER spoke with anyone about those visions, or the Déjà-vu he felt.

For instance, imagine a long-forgotten Jack-O-Lantern on the Sunday after Thanksgiving. It would appear that sometimes, if you put a shotgun muzzle in your mouth and pull the trigger, that is what you will look like when people discover you. For Jeff, it seemed as if for every “new” face, there was at least one to match it in the archives of his brain, even though he had no conscious prior recollection of them.

Remember how your Mom told you not to make a particular kind of face because one day it will stay like that? It would appear that if you make a really ugly face right before you die, it does stay that way.

Perhaps the most unnerving of all was the beatific look on the faces of The Jungle Boys (Homeless Viet Nam War Veterans living near Pompano Beach) every full moon or so when one of them would “take the train”. At least, the ones that still had faces…imagine embracing a train traveling forty miles per hour, head-on. Imagine doing it joyously, with fearless conviction. It would appear that if you do, your face stays that way, too…(At least as long as your face stays attached to the front of your head).

Nothing will ever displace the image of a fifteen-year old boy who put a shotgun to his chest to try to stop the pain. The blast more or less liquefied the area where his heart had been, but it could not wipe off that look of confusion and pain that had driven him to abandon his life, his family, and himself.

Perhaps even more unsettling is the first time you stare through the pupils of the recently deceased. Penlight in hand, as you open the eyelids to no resistance, you will note that the pupils are fixed and dilated. During the first hour or so, the corneas are still shiny and clear, like clean porch windows on a recently abandoned house. When you look inside, the rooms are all empty, and somehow, you sense a stillness that is not natural to an inhabited structure. Elvis has definitely left the building. The thought, or the feeling has long passed, but the expression remains to mark the moment when the last soul abandoned ship and jumped out.

That’s No Way to Treat a Lady

The next event was a great deal more bizarre, and for Jeff, a great deal more difficult to reconcile in his own mind. In spite of the fact that he had acted “honorably”, and according to the training he had received, he had done nothing “wrong”. In fact, had he done anything other than what he did, it would have been considered criminal, had it been held up to scrutiny, but nonetheless, the experience had upset him, and remains unreconciled, at least for him.

He was working, once again, as a municipal rescue paramedic. Sometime around 10 PM, they had been dispatched to transport a terminal cancer patient to the hospital. She was a rather attractive, mid-fortyish woman with metastatic brain cancer. Although the ravages of the disease had not devastated her appearance (presumably because it had been discovered “too late” for either chemotherapy or radiation), she was heavily sedated, and he had been told that she had not been lucid for several days. She was in no acute distress, but it was obvious that she did not have much time left. He was told that she had experienced three seizures since noon that day. It wasn’t until they started toward the hospital that things started to go wrong.

In order to place the blood pressure cuff on her arm, it was necessary to extend it, palm up, and he had placed the back of her left hand upon his left knee. Before he could apply the blood pressure cuff to her upper arm, she had turned her hand over, and quickly ran it up his inner thigh, grabbing his crotch. Although her eyes were closed, and she showed no other signs of consciousness, she sighed deeply, and smiled a broad, knowing smile as she began to rub his cock the way a wife would do when she is about to prepare her husband for an intimate encounter. There was no hint of salaciousness, or self-consciousness, like one would expect in such a situation. It was as if she was dreaming, presumably about happier times. Or perhaps not. Maybe she knew, somewhere in her subconscious mind, that the end was near. Whatever was in her mind, we shall never know, except that she was unselfconsciously joyous and unabashed by her actions in a way that implied she believed she was doing something familiar with someone with whom she was very familiar.

No Last Kiss
Jeff, although taken aback by this sudden turn of events, coolly and professionally placed her hand back where it was, and spoke her name, changing the subject, and hoping to right this seemingly innocent wrong without even acting as if he was rejecting her, but rather re-directing her attentions back to a more appropriate focus. To no avail, however, as she almost instantly stuck out her bottom lip, like a two-year-old girl might do, in pouting, and a tear began to run down her left cheek. Again, she sighed deeply, as she quietly began to cry. Jeff tried to console her with words that would have no effect. She never opened her eyes. He knew it was a sham to expect her to feel better. Wherever she was, in her mind at that moment, this was not how she wanted it to end. Jeff felt helpless, and his knowledge that he had acted “professionally” and “ethically” did nothing to assuage his discomfort. They brought her to the ER, and she was admitted to a floor shortly after that. Jeff did not mention the occurrence to his partner as they rode back to their station.

The next morning, he stopped in to the hospital, to inquire as to how she was doing. “She died about two hours after you guys brought her in.” was all that he was told by the admitting clerk.

He was never able to shake off the feeling that he had somehow denied a dying woman her last request; and that in the process, he had left her feeling alone, rejected, and heartbroken as she was preparing herself to face the single most terrifying and significant moment of her life. Sometimes doing the right thing can be the wrong thing. It would have been, in either case, but he would be changed by that experience forever. He hadn’t known what to expect, didn’t know what to do, and was left with no easy answer. It certainly isn’t the kind of question you can bring up in an ACLS (Advanced Cardiac Life Support) class, even if you are discussing the ethics chapter….

Not that ethics seemed to plague many of his cohorts. One had even supposedly had sex with a mental patient in restraints during a long-distance transport from one county to another, (both of which would be best left unnamed). When Jeff had casually questioned the perpetrator about it, he was told: “It’s not like she wasn’t into it…hell, she actually suggested it”. (As if this made it OK.) As he stood there, he found himself recalling Alfred E. Neuman’s idiotic expression, extolling “What, me worry?”

During the Iran/Contra Senate Subcommittee Hearings he had the same reaction to watching Oliver North testify, but then again, “Ollie” also bore more than a casual physical resemblance to Mad Magazine’s poster child of denial.

We Own the House of God

But that was then, and this was now (at least it was back then), and such matters, even if they had worn away his pre-conceived notions about right and wrong, were the farthest thing from his mind as he prepared himself to initiate life-saving measures designed predominantly to save the lives of himself and his crew. Over the years, he had learned to pick locks, tap phones, and hotwire cars, as well as other seemingly nefarious skills partly of necessity and partly out of a natural curiosity for autonomy pertaining to forbidden access to items of interest to him. He was not fond of taking no for an answer, and in many ways, his proclivity for a general disregard for limitations in general seemed to have been a prelude to this situation. He grabbed the arm of Manuel, the older, more diminutive of the two brothers, and pulled him aside.

“Excuse me, senior, but I need your help. If we are going to get Poppy back to Miami, there is only one way to do it, and the Doctor may not really understand my more subtle meanings in my Spanish,
so I want you to translate for me so he understands what we must do. It will help insure that we can follow your father’s wishes.”

“Of course. Tell me what you want done, and I will see to it that the doctor cooperates.”

“I hope so…doctors can tend to be very…how should I say, well, strong-willed about being told what to do. I think we need to be as diplomatic as possible to make sure we don’t offend him.”

“Excuse me for saying this, but I think you are forgetting something.”

“What is that?”

My family owned this building, before it was a hospital, and before that, there was no hospital within four hours of here. First, we donated the building, and then we renovated it. It almost pays for itself over the last few years, between volunteer work that is done by former patients, and whatever barter can be arranged for those who cannot pay at all, sometimes it is food, or labor, but my family pays for whatever it takes to make sure our town has a hospital. Oh yes, and one other thing…”

“What is that?”

“We pay the doctor’s salary every year. We brought him here, put him in a house, and see to it that he wants for little. Trust me, senior, you will find him to be the model of cooperation”.

“Well, good. Do you know if there has been a death certificate signed yet?”

“No, there has not. I believe he only passed away as you were coming up the stairs, or very shortly before that. I only arrived about five minutes before you, and had not seen him yet. My mother stayed here all night with him.”

“We need to make sure the doctor makes no official pronouncement, or signs anything, then. It will be as if he never passed away, at least not yet, then we can take him to Miami for treatment. If he does pass away before we land, and we are closer to our destination, we can land with him in Miami, and your father’s wishes can be followed. Anything beyond halfway is called the point of no return.”

“Just between the two of us, I hope that you realize we have already passed that point a long time ago”.

“Si. Yo entiendo. I will inform my crew to prepare for the transport”.

“Muchas Gracias.”

Jeff then came back around the corner and motioned for the other two crew members to approach him, so he could explain their rationale, as well as their game plan.

Brandon, the younger paramedic began protesting immediately.

“Excuse me,” Jeff interrupted “…but somehow I must have given you the mistaken impression that this was an item for discussion. It is not, however, and little time remains for us to salvage what is left of this mission, maintain our dignity, and hopefully keep our heads connected to our bodies. If you cannot, or will not contribute to this mission, just stay the fuck out of my way. Otherwise, I will not lift a finger to prevent our clients from doing whatever it is they do down here to people who get in their way. Forgive me if I seem blunt, but it is time, my esteemed colleagues, to either fish, cut bait or swim”.

From this point on, things started happening very quickly. A portable ventilator was attached to the dead man’s endotracheal tube. Very small volume, very slow inspiratory time. Very slow exhalation of a very small volume of air. This is necessary because the lungs will not inflate any further than that. Titrate to effect of visible chest rise. Somewhere between pulmonary edema, bi-lateral hemopneumothorax, subcutaneous emphysema, abdominal distention, unknown actual time of death, and who-knows-what-else, this is the most the situation will allow, and still look and sound like a patient being artificially ventilated on a respirator. No chest compressions. You don’t start an air ambulance transport running a full-blown Code Blue. The patient has to be stable enough for transport before you start. Of course in this case, the patient is extremely stable, given the fact that he is already DEAD, insofar as his condition is not going to change, as regards any deterioration of his state of health. From this point on, the only deterioration will involve decomposition

Transfer Logistics

Early in the training of every nurse, paramedic, orderly, or doctor you are taught to never attempt to actually lift a patient from one place to another if at all possible. Instead, you use a draw sheet to slide, or roll them from one side of the bed to another or even one bed to another. If your patient weighs as much as this one does, you use at least two sheets so they don’t tear. After nearly twenty-four hours of emergency care, there can be half a dozen sheets bunched up around the patient. Eventually, they would be removed if he were to be kept much longer, but there has not been much time for what passes for housekeeping since his arrival. As a result, Sonja manages to stay hidden from view deep in the folds of the numerous sheets beneath her host.

IV solutions, medications, and blood transfusions are all re-initiated, and placed on battery-powered portable infusion controllers, only to be run at the most miniscule rate possible, just to make things look good. Interestingly enough, it takes a great deal of skill, and imagination to pull of such a deceptive fraud as this entails, because normal values won’t work, and yet you still have to make it look good to everyone who is any position to see, or judge, or draw suspicion upon this charade. Once the patient reaches his destination, there will be the added element of having to explain everything well enough to convince the coroner in Miami. Jeff has already thought about this, but does not intend to bring it up yet to the Flight Nurse, who is by now, just barely managing to maintain her composure well enough to function at all. One thing at a time….

Meanwhile, the family is going through its own set of last-minute changes as well. It seems that, although Rueben (“Bluto”) was originally listed on the manifest to be the sole passenger to accompany the patient, it now seems that somehow, there are “problemas” with his passport, and he won’t be going. Instead, Poppy’s younger brother from New York will be going to Miami.

Although Jeff notices that it seems as if no one in this family has even the slightest resemblance to anyone else in the family, this is not the sort of thing one brings to anyone else’s attention. There is a reggae song called Shame and Scandal; in it, a young man meets and falls in love with a girl whom he later comes to believe to be his half-sister by way of an affair his father had engaged in years ago…, who says ”the girl is your sister, but your Momma don’t know.” Crestfallen by his dilemma, his mother asks him why he is so sad. Upon hearing his source of woe, she sings: “Go Ahead…Marry the girl…your Daddy ain’t your Daddy, but your Daddy don’t know….” Bloodlines and formal marriages in equatorial third-world countries are not quite as cut and dried as they are in many parts of North America. In the scheme of things, it seems like a minor matter.

The ride back to the airport is relatively uneventful; at least to the extent that once you have survived the ride to the hospital, playing it in reverse is not that big a deal. Many Viet Nam vets will tell you that once you have died the first time, every day above ground is a freebee.

Thus far, no one has questioned, or indicated the slightest suspicion about the condition of their patient. In the scheme of things, this is not surprising. Critical Care Air Ambulance teams are regarded like demi-gods in these waters, and there are not too many people in any position to question their ops in the first place. Not to mention the fact, that for all intents and purposes, it looks like a very well-run operation, because Jeff and Tracey know their jobs, and everything being done is not all that much of a stretch from what they would have done for an actual living patient. Short of drooling, or babbling and soiling his clothes, the other medic has distinguished himself by remaining completely useless, a muttering zombie who at least so far has not managed to attract enough attention to himself to constitute a threat to the ops.

Improvise, Adapt, and Overcome

The ability to establish and maintain credibility throughout this operation was essential, and fortunately for Jeff, one of his specialties, even in relatively unsavory circumstances. This was what a former girlfriend had recognized when she had advised him to become a paramedic because he was such an accomplished bullshit artist. When he was in his early forties, he had attended an Italian wedding. The brother of one of his best friends was getting married. The reception was pure old-world stuff, including the tradition of the placing of the garter on the leg of the girl who catches the bouquet. It seems that it is customary that the man who catches the garter is to place it very high up the leg of the girl who catches the bridal bouquet because each inch above the knee is supposed to bring ten years of marital bliss the newlyweds.

The girl who caught the bouquet is at best no more than eighteen years old, and very shy. Jeff was between marriages at the time, and had caught the garter. Sitting in front of Jeff, she appears terribly embarrassed, and has the look of a deer staring down the headlights of an oncoming car. Italian music played as the MC explains the tradition. Everyone begins to clap in unison as the entire scene begins to take on a carnival atmosphere. The girl alternately looks as if she either wishes she could disappear, or that Jeff would.

Jeff looks straight into her eyes, smiles slightly, and motions ever so subtly for her to lean forward, so he can whisper something to her, which she does. His right hand is poised with the garter just below her knee, at the edge of her dress. He looks deeply into her eyes, leans forward as if to share a secret, and whispers: “Don’t worry, it’s OK…I’m a paramedic.” “Oh…” is all she has time to utter. She visibly exhales as her shoulders drop in relaxation and her legs similarly extend forward slightly. She is completely open and unguarded, if only for the instant it takes for Jeff to slide the garter all the way up her leg until the backs of the second and third fingers of his right hand are ever so lightly brushing against the crotch of her panties before she has the time to analyze what bearing Jeff’s remark actually has upon the current situation. An instant later, her rationality, as well as her modesty would return, but that was all the time needed for his flimsy charade to work.

Air Ambulance transportation requires more improvisation and adaptation than most other aspects of Emergency Medicine. Eight miles above the earth, if you don’t already have it, you may need to either adapt something like it, or do without it. In the absence of CAT scans, MRI’s, or even blood labs or X-rays, many of the old hands-on diagnostic methods of physicians of eighty or more years ago have a definite validity in the absence of more definitive methods.

About two years earlier, Jeff had been assigned to back-up his supervisor on a particularly complicated air transport of a patient with numerous cardio-vascular and pulmonary complications. Shortly after take-off, the blood pressure monitor failed. No problem; they had back-up in the form of a conventional manual blood pressure cuff. Unfortunately, pulse oximetry was a secondary function of the B/P monitor. The adaptation for this predicament is a little trickier, but can be compensated for with regular assessments of skin condition and color, oral and conjunctival mucosa color and capillary refill.

The flight was supposed to arrive at a scheduled time, due to the inability of the receiving facility(a long-term respiratory care center) to accept the patient after hours. The patient had required much more oxygen than was originally anticipated, and back-up oxygen was now calculated to be slightly short of what was now needed to run the flight continuously, as scheduled. A call was made to the next available airport to see if supplemental oxygen could be procured. This would undoubtedly take more time that the anticipated arrival at the scheduled destination, due to the lateness of the hour. The alternative would be to declare an emergency, make an unscheduled stop, go to the nearest hospital ER, and wait for the morning. This could also easily eat up all the anticipated profit from the transport, and mar the reputation of the company in the process. Not an acceptable alternative, if the health and safety of the patient could be maintained by any other means….

Jeff had already read the History and Physical Reports, and consultations of the reporting physicians. He recalled that the cardiologist had stated that the patient presented with frequent premature ventricular contractions at a rate of less than six per minute throughout her admission in the ICU. So far, they had maintained her with sufficient oxygen that she showed no PVC’S throughout the flight thus far. Jeff decided that if they lowered the FIO2 (Inspired oxygen content) on the ventilator until she presented with a rate of say, four PVC’S per minute, then they would have more than enough oxygen to reach their destination. It bought them more than enough time to safely complete the flight as scheduled.

Sometimes, an instant is all you need. Sometimes it is a matter of minutes. This was not one of those times. Today would require boilerplate authenticity from start to finish. Nothing short of flawless and seamless would do, but if a glitch did occur, it would require credible improvisation.

In music, one can only really improvise if you are fluent within the framework of the genre you are playing, but thinking about what you are about to do will cause you to choke every time. In Karate, when you perform the kata, you must know the complex series of moves so well that any thoughts about an individual movement would interrupt the flow, sometimes to the point of causing you to freeze altogether. Most of his adult life, Jeff had felt like an imposter, or a child playing grown-up in adult clothes. (Really great uniforms help facilitate the masquerade, but authenticity requires true character.) Twenty years of practice had led him to this moment. There was no room or time for considering the consequences if he failed.

Logistics, Logistics, Logistics…

Once the crew is on the tarmac beside the aircraft, a new demon rears its ugly head. The patient weighs well over 350 pounds, and sprawls cross-strapped to a long spine board, along with at least eighty pounds of equipment, and fluids attached to him, that now have to be loaded into a very small private jet, almost straight up about six feet, only to be tilted about ninety degrees and pivoted so as to clear the bulkhead that blocks unobstructed entry into the plane. Not to mention the fact that he has to go in feet first, which makes it that much harder to prevent the arms from flapping around, and slapping someone in the head or face. And everything seems to want to drain from every orifice, just as he is nearly upside-down, onto everyone under him, trying to push him into the aircraft.

The reason that this is so much more difficult than usual is because the company’s own Lear 25 was downed for maintenance, requiring the use of a leased Sabre jet. This Sabre was ill-suited for air ambulance transport. The flight deck was higher than the Lear, for starters, and the door was too narrow, which compounds the problem with a bulkhead so strategically ill-placed that one would suspect it had been done on purpose, to thwart any effort to ever press them into this sort of service. Because of this, as the patient was pushed and lifted almost straight up, before the end of the long spine board was inside the aircraft, it was then necessary to turn the board and patient 90 degrees into a left-lateral position in order to pivot the entire mess toward the rear of the aircraft, with the feet pointed toward the tail.

Meanwhile, Sonja burrows deeply into the furthest recesses of the tangled sheets to prevent discovery. It is instinctive. Although there is no refrigerator under which she can scramble, the patient is nearly as large and heavy as one. Blattodea Periplanetae will eat and digest almost anything…Nothing is too disgusting for their palates. The rest is left to the reader’s imagination.

Or Else
At this point, everyone races to get to the nearest (forget clean) bathroom before takeoff. (Of course, Jeff and his nurse have to go in shifts, since somebody has to watch the patient while the other uses whatever facilities are available…you could say they have to relieve each other in order to relieve themselves.)

Interestingly enough, day or night, in this area of the world, there is usually a “cleaning woman” with a mop and a bucket standing in the middle of the men’s bathroom, yet no one seems to pay any attention to the fact that she is there, or the fact that the bathroom is never clean.

Small private jets do not have what could actually be referred to as a bathroom per se, but rather a ““potty seat”, which is to say that the jump seat, facing the door to the aircraft may contain a small portable “toilet”. (You pick up the cushion and sit on a hole in the pedestal that has a red bio-hazard bag in it. Most jets of this size have range of about three hours. The altitude and pressure changes have a tendency to push gases and fluids around in strange ways that can be very disconcerting to the uninitiated. In addition, it is an unwritten understanding that “if you use it, you clean it”. Add to this the fact that if you are forced to avail yourself of this “facility”, it will have to be done in the full view of everyone else in the aircraft, save for a shabby curtain hung up expressly for this purpose. All in all, you might as well just shit or piss in your own clothing, and wait in shame to land.

Jeff was well familiar with this, and knew to “govern himself accordingly”. His first experience along these lines had occurred nearly twenty years before, while working ground ambulance on his first paramedic job. The experience made a most indelible impression upon him.


He and his partner, an EMT, had been dispatched to a hospital in Hollywood to pick up a status-post cardiac arrest patient who needed to be transferred to a higher level of care in Miami. The patient had experienced a full arrest, with a return of spontaneous breathing and heartbeat, but had not yet regained consciousness, and had experienced several seizures, possibly the result of the lidocaine “drip” that was being infused. He was receiving three other medications via battery-controlled intravenous infusion pumps. Back in the mid-eighties, each of these pumps weighed about ten pounds each, and only controlled one medication. The patient was a “science project” of critical care nightmares for a newly-certified paramedic, and would take at least two hours transport time in heavy daytime traffic.

As if this were not enough, the night before, Jeff had been out with several of his friends at a local Mexican restaurant. A large quantity of beer was consumed. Were it not bad enough that Jeff’s tastes in cuisine such as this ran toward the excessively spicy end of the spectrum, in retrospect, it now appeared that the bacterial content of his repast may have been equally high. This is always a bad combination.

If you work in an office, you may be able to excuse yourself long enough to purge the contents of your colon sufficiently to allow yourself enough time to get home before the next wave of explosive diarrhea renders you essentially useless as a productive member of polite society. On an ambulance, destined for a two-hour transport of a critical patient, it approaches entering the ninth ring of hell.

If you have ever experienced true Orthomyxoviridae Influenza, you may have an idea of what is about to ensue. For some reason, the initial onset is often preceded by a sharp, cramping sensation that may be caused by the passage of the relatively dry, firm bolus of fecal matter slightly ahead of the deluge that is forcing the last normal turd through the lower regions of your alimentary canal at a rate much faster than it would normally be moving.

Like the immovable object vs. the irresistible force, we have a biological paradox waging war within our own body. The spiciness of the food in this case is now adding an additional dimension to the scenario that cannot be underestimated. Scotch Bonnet or Habanero peppers are at the extreme end of the spectrum of spiciness. Aficionados of these gems have even devised a rating system, measured in Sackville units, to compare the amount of Capsicum Oleoresin (that which makes them “hot”) contained therein. Some of the closest competition, for instance, the Thai Chili, is but a fraction of the potency. In a moment of reckless abandon, perhaps fueled by excessive consumption of ethanol-containing beverages, it is possible to ingest enough of these fiery devils to produce a phenomenon referred to as tenesmus, which is a condition wherein the bowels attempt the purge their contents so forcefully that the rectum may actually prolapse. This is much like dry heaves for the intestines, except that it is exceedingly fare rarer that one would ever face the prospect of vomiting up one’s own stomach. At best, by the end of this ordeal, the victim’s rectum will more probably resemble a florid purple cauliflower than a normal asshole.

Jeff was nervously anticipating his impending gastrointestinal predicament when he realized just how bad a turn this was beginning to take. The ambulance was now several miles from the originating hospital, headed east on Hollywood Boulevard, when he realized that they were indeed trapped in the mother of all traffic jams, the result of multiple head-on vehicle crashes several miles east of them. In both directions the road had become an impenetrable parking lot. A Marathon gas station was a few yards ahead on their right. It might as well have been a mirage, for all the good it would do.

His partner, an EMT, was not qualified to care for, or even monitor his patient, who was at best, only marginally stable from moment to moment. Had Jeff chosen to take an ill-advised chance in a matter such as this, he knew all too well that Murphy’s Law (or worse) would prevail. He had come to believe that in matters pertaining to the care and transportation of the sick and injured, one day everything East of the San Andreas Fault line will eventually crash into the Atlantic Ocean.

It was also doubtful that his partner would agree to take on such responsibilities beyond his level of training or certification. This was not going to “only take a minute”. He had been here before, on a lesser level, and once the purge began, it would no doubt consume the next twenty or thirty minutes of his life, his consciousness, and every other element of his being. He already knew this, as anyone who has ever been in these circumstances can well attest.

When the “bolus” is expelled, for instance, it will be with such force that the splash from the water in the bowl will soak his entire ass. The spray from the stream of shit exploding out of him will resemble brown adobe, far up, under the rim forming deposits impossible to explain in terms of normal trajectory. And it will not be quick, or merciful. It will come in waves. Each time you think you are finished, and attempt to clean yourself, you will be overcome with yet another paroxysm of spastic expulsions, just about the time you try to stand up and fasten your belt. But you will try to clean yourself frequently, because even though you know it is futile and in fact, counter-productive, the burning sensation caused by the combination of stomach acid and its contents, gastric secretions, and the remnants of the hot peppers will be overpowering. Unfortunately, soon your ass will become so sore from wiping that a level of despair will eventually supplant most all other rational thought. Jeff already knew this, and he was most concerned.

Keep in mind, however, that Jeff’s primary concern is still the welfare of his patient. He was at odds to produce a plan of action that would not endanger this unfortunate individual. Just then, the solution came to him: on numerous occasions, he has handed urinals or bedpans to his patients during transports. He was always summarily dismissive about his patient’s protestations of modesty or embarrassment, although now it appeared that the glove was about to be on the other hand.

Jeff’s mind raced as he looked about the interior of the ambulance. A regular bedpan was unquestionably inadequate to contain the impending tsunami. A plan began to form. A trashcan, lined with a “red bag” (for biohazardous waste) would serve as a commode. Crouching behind his patient, with his back almost against the partition door between the driver’s compartment, he dropped his pants and squatted over the trash can. The ambulance was almost instantly bathed in an acrid vapor so foul that one would have expected the air to turn brown. Methane, bile, and stomach acids seemed to fill the air. Jeff’s partner was now gagging, retching, and shouting obscenities. He turned the PA on, and directed the attention of their fellow stranded motorists toward the rear of the ambulance. Although he was howling with laughter, Jeff was thoroughly humiliated. Without warning, the patient suddenly sat bolt upright. He did not direct his gaze either right or left, as he suddenly proclaimed: “My God, man! Do I need to get up? Are you sure you don’t need to be lying here? I think you must be much sicker than I am!” Without further ado, he then fell backward onto the stretcher, never to speak again in their presence.

Would You Live to Perpetuate Your Illusions?

More a Matter of Image than Principle

Idealism is fine, and empathy will make you a better caregiver, but there is a reason why medical professionals distance themselves from their patients. Forget about sweat, more important: Never let them see you shit. This was a hard-won lesson, not soon to be forgotten, and a necessary precaution he never skipped. Regardless of beer, whiskey, spicy food, bad sushi or not, there is not an ambulance anywhere, in the air, or on the ground in which you want to have to take a dump. Not with a patient, or even simply your fellow crew members. Patient care, professionalism, and your own elimination process do not mix. If you were to vomit directly onto your patient (as they are often want to do to you, by the way), you could still maintain your dignity. One of Jeff’s associates once vomited onto an especially gory trauma patient’s face, neck, and chest while working for a local county fire department, but he lost his job. You can feel compassion for their distress, or their embarrassment over such matters, but I adamantly believe with every fiber of my being that they want us to be accessible, but almost aloof, sympathetic, but strangely dispassionate. They don’t want to trust their very lives to someone they just watched take a dump in front of them. In the case of this patient, it is a moot point, but in terms of the comfort and dignity of all of the flight crew, it is a pivotal and salient point.

Wheels Up

Flight plan, clearances, and the go-ahead for take-off seem to go relatively seamlessly, and soon the aircraft is climbing to altitude. Baggage has been checked, and our passenger has been loaded onto the aircraft last, with just one small bag that was thoroughly checked by several customs agents. This is somewhat odd, because Customs usually checks your passengers and luggage on entry, not on departure, but many of these countries require extensive clearances before allowing anyone to depart their land, just in case they owe the government (including the hospital), or somebody important, any amount of money. Sometimes it is so bad, that you have to either trade, or give back the sheets the patients are lying upon before they will let you leave.

The Point of No Return

They are fortunate enough to get clearance to fly over Cuba, which saves a tremendous amount of fuel. Jeff already knows that once they are over Havana, it will be time to finally declare that the patient has expired, because they will be past the point of no return, and will be obligated to finish the flight into Miami as planned. The flight crew does not take this information at all well. Then again, this being a leased aircraft; they are not a part of the team, and have not been on the inside track, so to speak. It should also be noted that these pilots are midgets in a profession of giants, relatively speaking, and the fact that nothing truly disastrous has happened up to this point is miraculous. Jeff has to spoon-feed instructions to the flight crew about the procedures for landing with a DOA, because neither the Captain, nor the First Officer have ever done this sort of thing before, and didn’t know what to do. For that matter, Jeff has never lost a patient in transit before, although he had already learned the procedures, “just in case…belt and suspenders”. In this business, it’s ok to be inexperienced, but it is never acceptable to be ignorant. The only reason for being ignorant is laziness, because there is a written protocol for everything a pilot will ever have to do. Choosing to be lazy and ignorant is just plain stupid.

Good jet pilots are some of the most amazing humans you will ever meet. They are required to virtually memorize, like a reflex-arc, thousands of sequences of procedures, regulations, and protocols for even the most routine operations, like an uneventful take-off, or landing. Then they get sent to Flight Safety, or any number of other schools, to learn what to do in any emergency. They are then put through a series of simulations of potentially catastrophic situations that it might take years of flying to ever encounter, and that they would be unlikely to survive without prior knowledge of exactly what to do, and be prepared to do it instantly. Upon reflection, it would be more accurate to state that merely good pilots can get you killed in a hurry, and anything less than a great pilot is dangerous in a business where it’s all about numbers. You may get away with being stupid once in a while, but if you make a habit out of it, sooner or later, the law of averages will reduce you to a pile of charred and steaming wreckage buried deep into a gouged-out hole in the earth lined with shredded tin that was flown by an average pilot. If a nurse, or paramedic screws up, a patient dies; if a pilot screws up, everybody dies.

Eventually, the pilot and first officer. get on the radio, and call Miami to declare an emergency. Now, instead of being simply met by Customs upon arrival, they are to be greeted by the Miami-Dade Sheriff’s Department, as well as two homicide detectives, if not the FBI and the DEA.

Confessions of a Mad Philosopher

Your entire life is an illusion created by your mind.

If you accept the above statement as being essentially true, it would logically follow that you are the source, and yet, if you believe that you are, then you detach yourself from the infinite if you regard your world as separate from yourself. Imagine. No inside/outside. No me/you. No separate/connected. Our logical minds want to separate things into opposites. Although this is true on one level, unless you understand the connection between the opposites, you limit your understanding.

Being only the source is exhausting unless you can visualize this source as being a tiny pinpoint of the infinite. In their opposition, opposites are interdependent. Good encircles Evil. Black encircles White. Man encircles Woman. Hungry encircles Satiated. Empty encircles Full. Desire encircles Fulfillment. Fulfillment encircles Suffering. Big circles made of an infinite progression of smaller circles, as well as an infinite progression of larger circles. So it is that Yin encircles Yang. The belief system of Dialectics touches on this, but it is not everything.

Everything is connected, but it is not seamless because even the connections have increasingly smaller spaces. Our minds that create differences with words, logic, or mathematics are self-limiting. The mind that can simultaneously see the separate points of opposition of words and logic while experiencing the feeling of the fluid connections between them has the potential to understand that there is no same, or different. There is only this, just this.

As long as you muzzle your questioning and thinking by succumbing to commonly held notions about poor taste, political correctness, blasphemy, obscenity, profanity, etiquette, manners, or other obligatory strictures imposed by polite society, you will never free yourself from the illusions they promote.

There are a great deal many more illusions as well. The Illusion of Freedom. The Illusion of Autonomy. The Illusion of Safety. The Illusion of Health. The Illusion of Choices. The Illusion of Love. The Illusion of Possessions.

For instance, our health care system costs more than any other country in the world, and yet, the quality of our healthcare, in terms of survival rates, quality of life, longevity, and infant mortality are poorer than many other, less affluent countries. It is actually cheaper (and possibly safer) for the Canadian government to pay over ten thousand dollars for an air ambulance to transport a cardiac patient back to Canada than it is to treat them in this country. The percentage of medical errors, misdiagnoses and misadventures is rising dramatically. Healthcare insurance now consumes more of our paychecks than taxes or social security combined, but the disallowed medications, treatments and non-covered expenses still threaten to bankrupt anyone at any given moment. The entire insurance industry is based on cost containment via a routine practice of attrition of claims by way of successive and arbitrary denials.

And Freedom? The most patriotic of us are quick to claim that we are the freest society in the world. That is seriously questionable. We are only as free as our government allows us to be, and that represents a rapidly diminishing quotient at best. We have lost more civil liberties and freedoms in the past forty years than we have gained in the previous two hundred.

The Supreme Court and the FCC have ruled that it is no longer necessary to present equal access to all opposing points of view. Broadcasting is no longer protected from monopolization.

What would once have constituted entrapment is now regarded as a “reverse sting operation” and tolerated in criminal court cases.

DCF investigators are not bound by evidentiary rules, habeas corpus or due process, such as a warrant any more than Fish and Game Officers are. (At least the Fish and Game officers are duly sworn police.)

Then came the Patriot Act. As long as politicians can talk people into giving up their civil liberties and freedoms in order to claim to protect Freedom, there is little hope for things to get better any time soon.

Who will Protect us from our Protectors?

What about safety? Frivolous, as well as legitimate lawsuits and endless product recalls against corporations that consider Risk Management to be an issue of weighing the cost of safer products against the cost of Financial Liability do not account for much in a society that regards our Second Amendment right of self-defense as a Public Safety issue, and labels it vigilantism.

It costs more to fund a fire department for a year than it would to replace everything that burned.

How often do you ever hear about the Police stopping the burglary of an occupied home? Or preventing a violent crime? Or even stopping a crime in progress? While we are on the subject, who decided that Crime Prevention meant taking away your ability to control the means to commit a crime? If that is the kind of (for lack of a better term), Logic that we are going to condescend into, I hope I don’t live long enough to hear about Rape Prevention.

If you have ever been unfortunate enough to have something stolen, did you ever get any of it back? Did you even hear anything about them catching the perpetrators? The rate of apprehension and conviction of Murderers is so statistically low that as long as they don’t live with the victim, and haven’t publicly threatened or attacked them, they will probably get away with it. And new DNA testing suggests that an alarmingly high percentage of our previously convicted killers are INNOCENT!
What about justice? Unlike Civil Court, (an oxymoron), Criminal Justice is becoming more and more of a self-fulfilling prophesy. We have among the highest per capita rates of legal institutionalization in the world, including all the notorious “totalitarian” regimes and “police states” that do not embrace Democracy. (Speaking of which, New Jersey should really seriously consider renaming itself “The Police State” instead of “The Garden State” in the interest of accuracy. For a long time now, there have been a lot more cops than there are gardens.)
Justice is more likely determined by skin pigmentation and money than any other single factor. Add insult to injury by allowing the same racists who would promote business as usual to cite as EVIDENCE the fact that more non-whites are incarcerated than whites because “they” are more prone to criminal activity. (If you can’t identify circular logic, then you probably shouldn’t be allowed to vote.)
You are entitled to the very best Justice that money can buy.
Mandatory Sentencing is currently insuring that (due to overcrowding of the jails) convicted murderers, rapists, and other violent criminals are released in favor of people whose worst crime is to have a portion of a marijuana cigarette in their ashtray as they drive within five hundred yards of a public school, after being stopped for a defective tail light.
Working EMS was having the effect of turning Jeff’s life into a deconstruction process. Life, as it deconstructs, falls away like dominos from some starting point that began the whole unraveling.
First, you get to see people physically deconstructed, either by observing the spirit being separated from the body, or piece by piece, as in what happens secondary to severe physical trauma. If you encounter them in their home habitats, you may also notice the effect of separating from their daily physical lives, their clothes, their houses, and all their possessions.
Step back a little further, and you can see how they are separated from their families, friends, associates, and even enemies. Their hair, their looks, their physiques, their money, influence, and their egos.
As all these connections are severed, moment by moment, molecule by molecule, life dissolves into oblivion, even to the point of decomposition.

In the same way that Life is deconstructed by Death, so also Death is displaced by Life.
Although we live in the only country where you can drive a ten-thousand dollar car to pick up an Unemployment Check, it is also possible to have a job and become homeless. Unless you have ever been homeless, you have no concept of how much hatred the Homeless are subjected. Without a home, most of us would lose our jobs, as well as all those possessions that we thought without which, life would not be possible. Although we were taught in school that in America, there is no such thing as Debtor’s Prison, you can be found guilty of Contempt of Court for Failure to Pay. There are people who have faced felony charges and up to twenty years in jail for Contempt of Court, as Don King would say: “Only in America”.
Although America is one of the wealthiest countries in the World, in terms of GNP, Kuwaitis are per capita, one of the wealthiest people on the planet, due to the fact that they are willing to share their good fortune with their other citizens, even though they are nonetheless capitalists. This is similar to the annual checks that Alaskan citizens receive. In the United States, less than ten percent of the population controls almost ninety percent of the wealth.

God gives us but one true face. We put on the others for everyone else.
(a Koan)

Shrimps that sleep are soon carried away by the tide.
(Another Cuban proverb)

Something Is Happening, but You Don’t Know What it Is, Do you, Mr. Jones?
(Bob Dylan)

Back to Business
Jeff had grown increasingly suspicious of the circumstances surrounding this flight for some time after he had finally gotten the opportunity to relax (relatively speaking), once the flight had gone airborne, and he and Tracey, the fight nurse, had gotten their version of how the patient care report was to be written agreed upon. This is sometimes referred to as “buffing the report”.

They say History is Lies Agreed Upon. In terms of this transport, there were just too many inconsistencies. (In the scenario, not the report). Like the older brother going at the last minute instead of the son, a detail that was overlooked initially in terms of the manifest, that would haunt them later, or the fact that they had just now learned that someone had forgotten to see to it that “Poppy’s” passport (or any other identification, for that matter) went with him on the aircraft. It was also fairly clear, the longer that he was in the air, that this gentleman had not expired quite so nearly exactly upon arrival of the flight crew at the hospital, but more than a few moments before. There had been extensive surgery done to this patient. And most notably of all, was the absence of the slightest semblance of grief from this dead man’s “older brother”. In the awkward silence that ensued at one point, the “brother” began to speak. It was as much what he said as it was what he didn’t say that began to connect the dots…perhaps he realized or at least sensed Jeff’s suspicions, and wanted to draw him out, lest the guise be revealed at the wrong moment, like on the ground, in front of the authorities. It may have been viewed as a moment of opportunity to decide what to do next…just in case.

About ninety miles from Cuba to Key West. About one hundred thirty miles from Key West to MIA, at least by roads. A Lear jet covers a mile in about ten seconds. Even with approaches, and the descent (which is very rapid during an on-board air emergency), they would be on the ground in less than twenty minutes.

“My grandmother used to say: Harsh judgments and self-righteousness are not likely to come from the mouths of those who have stood in the shoes of those they would condemn.”

“And Los camerones que se duerme se vente para la corriente. (“Shrimps that sleep are soon carried away by the tide.”) Jeff’s quick retort (even in Jeff’s clumsy Spanish, no less) takes the man by surprise.

“Si, but that is a Cuban proverb, not from my country.”

“’Ta el mismos…mas u menos, no si pero?
“You even speak Espanish like a Cuban, Como?

Donde mas? En Miami? You work for over twenty years here, and you pick up a lot more than just an accent…but thank-you, senior.

“I didn’t necessarily mean it as a compliment.”

“But I chose to take it as one, nonetheless. I would rather speak Spanglish like a Cuban, than tell lies like a gringo.”

“What does gringo mean to you?”

“Somebody who thinks everybody is supposed to speak English to them, when they serve them their hamburgers.”

The brother finds this very amusing, and relaxes noticeably.

“It doesn’t sound like you are a big fan of John Wayne and Manifest Destiny.”

“My grandmother was Cherokee, what do you think?”

“Then maybe you know what it’s like to be outside looking in, Como no?”

“Si, Jo entiendo, todo y mas.”

“I don’t mean to offend you, but you know, my English is a lot better than your Spanish.”

“No offense taken, but, for one thing, it won’t get any better if I don’t try. Yo puedo me trato.”

“And for another?”

“As a courtesy.”

“To me?”

“And your brother.”

“Thank-you, but not everything is quite exactly as it seems, senior.”

“I was beginning to suspect as much.”

“Sometimes, it is healthy to suspect, yet better not to know too much.”

“That’s why I haven’t been asking too many questions about things that are too obvious to ignore, too difficult to explain, or too dangerous to know.”

“You know, I don’t think you could be a gringo if you tried.”

“Thanks, but sometimes it is good to be able to pass for one, at least to get by in my world.”

“We all do what we have to do.”

“And just what is it you have to do?”

“Take out the trash.”

“Excuse me?’

“My family had a problem. A very large and greedy raton had invaded their ranch. He would have eaten my family out of house and home if they would have allowed it. He thought that he would be protected because he had friends in both your military and ours. He knew things that allowed him to be tolerated for awhile, but the things he knew about those people became recognized as a liability, once he became too greedy, and as I said, he was tolerated for quite awhile because no one knew quite how to rid the family of this pest without attracting too much attention to things best left unnoticed.”

“So why do you tell me these things?”

“I can tell you know more than you pretend not to know, and I need to know what you might do with that knowledge.”

“Suppose I don’t care?”

“First of all, I don’t believe that. You are a paramedico, and you are curious, it is a part of your nature. I don’t think you would actually do something you thought was really wrong, but you might be persuaded to re-evaluate, or at least temper your judgments about certain things. Very few things are actually as black as coal, or as white as fresh snow, but there are a lot of shades of gray everywhere you look.”

“And if you convince me, then what?”

“Let me put it this way: already you have proven to be very helpful to my family, not because you had anything to gain, but because of your compassion, which betrays your good heart. Your eyes tell a different story, however. They have seen too much, and you see both the good, and the bad; the truth and the hypocrisy, although your heart is good, it is no longer pure. You walk a line as thin as the edge of a razor between altruism and pragmatism. Too often, you chose to do what you thought was right, and noble, and you have suffered for it. You are too smart to be poor, but not ruthless enough to be rich.”

“How do you pretend to know such things about me, when you do not know me?”

“I think we were cut from the same cloth a long time ago. I used to be very much like you, and in my business, I have to be a very good judge of character. I don’t need to know your history to know your nature.”

“Suppose you are right?”

“Because of your kindness, compassion, and let us say, your cooperation, we would be prepared to reciprocate your kindness with generosity.”

“Company policy forbids us to accept tips.”

(This is only partially true in the air ambulance business, because pilots are NOT enjoined from accepting gratuities, which they, in turn, share with the rest of the crew.) In this case, the pilots and the aircraft are leased, not a part of the flight medical team. Not to mention the fact that in a decidedly “need to know” situation, they are definitely “out of the loop”. For that matter, at this point, so is the rest of the medical crew.

“We are obligated to you. Unless you accept it, our obligation would be a source of embarrassment, and would bring shame to my family. It is a part of our culture. Since we are in international airspace, I think it would be a good idea for both of us to extend every courtesy to each other in an effort to, let us say, transcend national and cultural biases in a true spirit of international diplomacy.

It was becoming increasingly clear that they were dancing around a subject neither of whom intended to be so indiscrete as to directly address.

Besides, if a tree falls in the woods, and no one is around to hear it, does it make a sound?”

“You would turn me into both a diplomat and a Buddhist?”

“Only in a manner of speaking. You can be whatever you choose to be, so long as it serves our mutual best interests. I can hand you this envelope that has some papers in it. Some of the pages are small, and brightly colored, but they are in a smaller envelope that you can place inside your jumpsuit without any real notice, while I speak with your nurse long enough to distract her. Look at it this way. If you try to betray our mutual interests once you are on the ground, you will incriminate yourself, and if you cooperate, you can do a great deal to help your family, as well as allowing my family to save face as regards our obligation to you.”

“What else?”

“Well, for one thing, this whole event has been very well staged, and many people are involved in ways I won’t bother to try to explain. Your own military officers helped set my family up in our “business” a long time ago. It was orchestrated, engineered, and even tacitly tolerated with the cooperation of your CIA. If pressed, they would disavow any knowledge of any of it, but if they had to, they would eventually claim it was all part of the balance of power in an unstable region.”

The truth is, that every one of them got stinking rich bringing poison back into their own country. And that continued with the DEA and the police. What happened in Chinatown stayed in Chinatown, or the ghetto. None of them thought that their own sons and daughters would ever get involved, and no one cared until they did…but today’s operation will be very predictable, with a minimum of risk. Even those who are not already in our pockets are so predictable, and rigid in their methods, that we will use their own methods to our advantage. We are businessmen. We are connected to other businessmen, some of whom even claim to be legitimate, even though they would not be very successful without us.

“And if I don’t cooperate?”

“Senior, I volunteered to go to Miami, just in case. If this aircraft crashes into the sea, my family’s primary interest would still be served. We both know that there are any number of ways to make that happen, so why risk the lives of all of your fellow crewmembers, as well as your own? To me, it does not matter, as I have recently learned that I have terminal cancer. Do your know what it is like to be willing to die for a cause, for something you believe in that is bigger than yourself, like your own family?”

“I’d rather live for my family, but of course, I see your point.”

“Good, because I would hate to have to sound like I was bringing the safety of your loved ones into the conversation just to make you understand how kindly we regard cooperation with our family, or how sternly we regard those who do not. Our sphere of influence extends far beyond the mere boundary lines of one country or another. ”

“Just to, as you say, take out the trash?”

“This unfortunate gentleman was three times cursed; first by greed and arrogance, and secondly, by stupidity.”

“And the third curse?”

“That he should look a great deal like my brother, especially after his unfortunate ‘accident’ changed his face the way it did. As it is my brother’s wish that our families should retire from the more, let us say, hazardous or unseemly aspects of our business ventures, the similarity between one’s enemies and oneself is a fortunate coincidence. We are now a family of grocers in Miami, and New York. We wish to be left alone and live in peace as legitimate businessmen. My brother had become too well known for that. His official declaration of death will afford him the opportunity to retire in anonymity.”

“Why do I suspect that there is more to this than you are telling?”

“As I said, all is not always what it might appear to be, but sometimes it is not wise to know too much.”

“I can respect that.”

“And in the process, you respect yourself.”

Are there any Beliefs for which You would Die?
More Transfer Details

Sonja meanwhile, has been driven by hunger to carefully scramble out of the numerous layers of sheets to seek further nourishment. What passes for food to a roach is beyond the ken of most people, and driven by the hunger generated by her pregnancy “eating” not “for two”, but for several hundred only intensifies her ravenous desires. For every roach you have ever seen anywhere, there are hundreds that you have not seen pass right beneath your nose. It is one of the gifts bestowed upon Blattodea Periplaneta that helps guarantee their survival. Now the fragments of food dropped within the aircraft, as well as anything else the passes for nourishment are Sonja’s for the taking. Blake’s discarded breakfast, with its foam plastic lid still fastened, provides Sonja with easy access to the treasures within, while at the same time providing the safety of cover from discovery. A short time later, she scrambles into Jeff’s flight bag to sleep.

Three Card Monty

Upon landing, the aircraft was immediately surrounded by Metro-Dade Sheriff’s Deputies, as well as Customs agents. Initially, all attention was focused upon the patient, who had entered the country dead, naked, and with no passport, or even so much as a driver’s license to identify him, except upon the word of his brother, who had not been listed on the manifest, as he was a last-minute substitution for one of the sons.

Mysteriously, the digital photograph that was normally stored in the Florida DMV computers, as it would have appeared on his driver’s license was not on file, or at least, could not be located at this time. Over three hundred persons with his same first and last name were recorded as living in Miami. For now, nothing and no one will move until they get some answers. They are methodical, thorough, and amazingly slow-moving. No one even goes to the bathroom without an escort. The investigators are stone-faced, as if suspicious of no one in particular, and everyone in general. Jeff is a little worried about Blake’s reaction, yet they suddenly let him go for no apparent reason. The ambulance that was scheduled to meet the crew has been cancelled. The engines and the batteries are shut down.

With no air conditioning, and parked in front of MIA Customs in the hot Florida summer sun, any traces of recognizable features were rapidly deteriorating. A morbidly obese male, weighing nearly four hundred pounds, who has lived for between fifty and sixty years engorging himself on Latin food who was a victim of Traumatic Asphyxia, who has been dead for over eight hours, two of which have now been at over one hundred twenty degrees does not invite a great deal of time being spent lingering over details inside the aircraft. Jeff and Tracey both realized that any possibility of refuting their account of time of death, treatment rendered, etc. was long since passed. The longer the detectives ruminated over the suspicious nature of the details of the case, the greater the certainty that what they believed to be the true facts would never reveal themselves, much less be discovered.

Jeff had a lot of time to think as the each of the members of all the agencies involved performed their assigned tasks. It became quite clear that the entire process had been so well-anticipated, that all the orchestrated events assured the success of the desired results.

Then the DEA brought in the dogs. By this point, the acrid vapors from the cabin were so bad that even the dogs had been reluctant to enter the cabin. It would have been pointless to expect them to find what they were looking for, which turned out to be secreted up inside the “Hell-hole”, a mysterious orifice strategically located beneath the tail section where, had the aircraft been a bird, would have corresponded to its anus. It is the home of many electrical breakers, the fuel pumps for the jet engines, and sometimes a spare tire. It is seldom opened, rarely thought of, and virtually never searched. Except of course today. Although the agents had already been tipped off, they did not know the location of the drugs, but as they circled around the back of the aircraft, the dogs went on alert, and one of the agents noticed the hatch.


This was one of those examples of where a big fish feeds one of the little fish to the agents to whom he is obligated, to appease quotas, and keep up appearances. Not to mention the fact that, in so doing, the attention was diverted well away from the prime objective.

Jeff and his fellow crew members were questioned briefly, then released.

“Tell me what you know about this…”

“I don’t know what you mean.”

“Is there nothing you can think of to explain any of this?”

“Only one thought, although I don’t know if it will be any help to you.”
“Anything you can think of would be good.”

“Well, I would say that it just goes to show that although a real bird would only have one asshole, this metal bird would seem to have three…”

“I do not understand. Where are the other two?”

“Over there”, Jeff proclaimed, as he pointed to the Pilot and First Officer.

By having used the “Hell-Hole” to attempt to secret the contraband, the Pilot and First Officer had clearly implicated themselves alone, since its location is neither accessible, nor generally known by medical crewmembers. A short interrogation established that there had been neither the time, nor the opportunity for the medical crew to have been involved, and the fact that the aircraft and flight crew had been leased on a last-minute basis further distanced Jeff and his associates from complicity. Diego, the brother who accompanied the body was likewise considered above reproach, since he had accompanied the crew with the patient.

Also of course, the principals involved on both sides made sure that was the way it went down. The agents in Miami immediately told Jake and Ross that they already knew who they had bought the drugs from, and then told them who they were, as a way of not only protecting the Big Fish, but also giving them the nod and wink, so to speak, so as to let them know they would be taken care of, which is to say, make the problem disappear. A judge would later rule on a minor technicality, and have the case thrown out, if all went well. If not, then Jake and Ross would become the problem….

You always do everything the hard way
(Jeff once read this in a fortune cookie)

The Long Way Home

The one-hundred-mile drive back up the coast would seem interminable. This “day” had begun something like thirty-six hours ago, and several lifetimes had passed in the interim, in more ways than one.

More time to think. He thought about Stella and the kids. He knew he had a purpose; was it all in terms of them? One thing was certain; as long as he guaranteed their safety and security, his wife’s recovery would be neither certain, nor immanent. Ironically, he was usually too busy to have the time to see that she had no feeling of purpose, because she was not essential in the equations upon which we usually balance the operations of our daily lives. It had become increasingly obvious to him that things were going to get a lot worse before they would get any better. He had often thought about the concept of self-sabotage as regards Stella, but tonight, it suddenly occurred to him that in its own way, his life had not been much different.

There is a great deal of difference between self-sabotage, and self-destruction. Many healthcare professionals are self-destructive. They are usually self-destructive for many of the same reasons that they became healthcare professionals. Addictive or obsessive-compulsive personalities born out of massive insecurities and a need to feel needed, to feel important, but most of all, to compensate for overwhelming feelings of inadequacy, are usually the result of a fucked-up childhood, abuse, or unrealistic expectations from demanding parents trying to vicariously live the life they never quite achieved. Is it any wonder they are so susceptible to the God Complex of Paramedics, or the need for Hero Worship that many EMS personnel are so addicted? Self-righteousness and an aura of feigned superiority works for some, at least for a while, but self-sabotage is a distinctly unique character, not always as evident, or easily identifiable.

Paramedics often have an uncanny ability to find fault with just about everything. As regards emergency care and transportation of the sick and injured, it can be usefully channeled into a “troubleshooting” mode for re-assessment. Several years ago, JEMS (the Journal of Emergency Medical Services) wrote an article entitled: “Why do Paramedics Intimidate their Supervisors?” Jeff worked at a station where it had been copied and posted onto the bulletin board. Regardless of the reason, or whoever had posted it, someone had written under the title: “It must be the boots”.

The problem is that most of us don’t really resemble our original selves after a few years in this field. The stress is overwhelming. The fatigue can be devastating. Shift work has been proven to be not as conducive to as long and/or happy a life as similar individuals who work “normal” schedules more in tune with the kind of circadian rhythms that most folks follow. Add to all this the fact that a career in Emergency Medical Services and a stable marriage are about as likely to go together as polar bears and roller skates (although Romance is a decidedly different matter….)

“You’re not a real paramedic (or fire-fighter, or cop) until after your first divorce.”
(Ancient EMS Truism)

No matter how bad your personal life gets, the one thing you don’t want to do is let it affect your career. At least that is what you keep trying to convince yourself, no matter how much denial it takes. A common form of this type of self-deception involves diverting attention away from yourself by focusing on the shortcomings of everybody and everything else around you. So-stated, this would seem like a hopelessly flawed strategy that would never go unnoticed for more than a day…maybe a week at best.

The reason this is not true for EMS personnel is because it is such a prevalent aberrancy. Imagine a fire station, for instance, with, say seven firefighters, including engineers, and drivers, two paramedics, plus a lieutenant, and a captain. Per shift. One is having an affair, and hasn’t been caught yet. One has a substance abuse problem, also as yet unidentified (alcohol is a drug, too. Most everybody drinks too much…we’re talking about more than everyone else. And there are plenty of prescription drugs that initially appear to have legitimate purposes…). One either is in the middle of a divorce, or has just caught his or her significant other in some compromising tryst, usually with someone else they both know in the business, or was just caught themselves. Add to this the fact that you may have to face either your ex-spouse, or his/her new “significant other” at shift change. Any of the above-listed situations may be compounded with a sexual identity crisis, or the crisis may exist all by itself, at least for a short while. By sexual identity crisis, I would include performance problems, gender identity, and the extreme isolation of those individuals who are for any number of reasons, forced into long periods of celibacy, not by their own choice. Then there are the ones who are suddenly forced to face the fact that one or more of their favorite perversions, or fetishes are so far outside of the mainstream that they face ostracism and ridicule at the hands of their peers, now that the cat is out of the proverbial bag.

Many have severe financial issues. Keep in mind, that most emergency services personnel are more than a little obsessive-compulsive, and generally driven by ambition and unrealistic expectations of all sorts. The salaries are in no way commensurate with the education, training, long hours and emotionally demanding circumstances required, compared to other lines of work, or professions. Most of the ones who have kids eventually learn that this is not necessarily a good profession for being the kind of parent we all hoped we would be. If we work more than one job, there is yet another factor to account for the fact that for twenty-four hours at a time, you face a whole building full of people, who, as surrogate family are constantly accusing and defending each other and themselves, yet no one seems to notice. Irish, Italian, Greek, Jewish, Arabic, African-American, and many other cultures with extended families that remain close on a day-by-day basis usually understand this phenomenon more easily than white-bread, middle-class WASPS do. If you can imagine being held captive in anybody’s family reunion, one-third of your life, for twenty-four hours at a stretch then you will know what it is like.

How can you tell if a paramedic or a firefighter is an under-achiever?
(He only works two jobs.)

(More Memoires of a Dharma-Bum)

But Jeff’s realizations of self-sabotage went further than that. To him, they seemed to stretch like a common thread, throughout his entire life thus far. Some might maintain that it would explain exactly why he found himself precisely where he now was. Eventually it all adds up to this: you try very hard to achieve some hard-won goal, only to soon find yourself incapable of being satisfied by your accomplishment. This stems from a two-fold dilemma. Your low self-esteem provokes you to demean any accomplishment that you should achieve. The Mark Twain Dilemma of not desiring membership in any organization that would consider you as a candidate.

Everything governmental, state-sponsored or municipally funded is “Low-Bid”, and The Management convinces you that this is in fact the case in regards to personnel as well. Of course, this is simply endemic to standard policy for most Inhuman Resources Departments, but if you are afflicted by the sickness, you personalize it. Eventually, you will convince yourself that in order to respect yourself you must leave for greener pastures.

You may change careers, seek more education, or pursue a lifetime of endless self-improvement mirages, never really noticing that nothing ever really changes. You can do that with relationships as well. Not only do your problems remain, but at best, all you can hope to do is change problems as you change significant others. As he reflected upon the long and short of it, he realized that whether he ruminated about what might have been…if only…he also recognized that remaining in the circumstances he had chosen to escape would have left him within the same dilemma…what might have been…if only….

What remained unrealized was his acceptance of his present, albeit temporary circumstances, to make peace with the ever-present, never-present moment. The bigger picture. No escape. Accept your present circumstances. They are temporary. If they are good, enjoy them, as well as their impermanence. They are like cut flowers; they remind us of how short-lived superficial beauty, or youth really is. If they are unpleasant, they will eventually change. If you can break the cycle of desire and suffering, the joy of acceptance far surpasses all the endless suffering. To never know desire, lust, passion, or suffering would be to deny the enigma of what it is to be alive. It is possible however, to ride the winds of desire and suffering, revel in both the tragedy as well as the comedy of life and celebrate the paradox of life itself.

As much as Jeff had believed that there was some much more personal, individual answer to the lesson each of us has to find, endlessly repeating the cycle of birth, death, and rebirth, it was now quite clear that it would reveal itself in due time. It’s hard to hear the music over the screaming. Once you realize that the screams are a part of the music, it is easy to hear it all. Just like this….

How many people does it take to achieve world peace?
(Hint: there are over four billion people in the world)

One hundred one-hundred-dollar bills can be hidden away fairly inconspicuously in any one of several cargo-style pockets on the average flight suit. At least, to the casual observer, it could easily go unnoticed. To Jeff, it seemed more uncomfortable than a bushel of live blue-claw crabs in his pants. Ten thousand dollars. It wasn’t the first tip he had ever accepted, but it was certainly the biggest. Ten grand. At that particular moment, although it would solve a number of very pressing problems in his life, it wouldn’t really change his life very much at all. But then again, he knew that he would have done it all over again, for nothing. The incrimination of the money had allowed this thing to happen by allowing the “brother” to trust him enough to do exactly what they both knew he would have done anyway.

Would You Take One Life to Save The Life of Another?…

How Many Lives would it Take to Justify One Taken?

In the end, everything we ever need, or need to be, is right at our fingertips all along. We already possess perfection within us, even if we don’t know it, or haven’t realized it yet. The Zen Master Jo-Ju was once asked if a dog possessed Buddha-Nature, (since The Buddha had once said that all things have Buddha-Nature). His reply (in Chinese), which was “No!” was pronounced: “WU!” (Think about it for a minute…it’s a phonetic pun….) The dog does not have to know that he possesses Buddha-Nature in order to possess it.

Exhaustion was taking over. Any sensible person would have stopped, and gotten a motel room, even if only for a few hours. Jeff was not one of those folks. It was beginning to seem like he had been on this same road for his entire life. In a way, indeed he had. He found himself suspended completely in the moment. He could not recall where he had just been, and was unable to anticipate the next familiar sight until he was actually looking at it. Someplace between Ft. Lauderdale and Ft. Pierce.

“Oh yeah…Turnpike toll booth…Lantana….”

More familiar places appear and disappear on the movie screen that used to be a windshield. It did not bother him at all. He was no stranger to road fatigue, or highway hypnosis. Over the years, he had made friends with them, and they were in fact, his muses.

He thought of an image he had created many times for his children in order to explain the ever-present-never-present moment. Imagine you are riding on a three-hundred mile per hour train. The conductor takes you to the front, where the engineer lets you look through the windshield. That is the future. It is only an anticipation of what you believe is coming. Then you walk to the caboose, stand on the platform, and watch the past disappear. Memories. You go back to your seat, and stare out the side window, very close to the edge of the tracks. You try to focus on a single blade of grass. A three-hundred-mile-per-hour blur. You look down at your feet. You hold your hand, palm up, toward your face. You are traveling at three hundred miles per hour, but within the car, all is stillness. Within the present moment, even your mind does not move.

He could feel a great weight being lifted from within. It suddenly occurred to him that The Fear that had consumed him for so long, that had in fact been programmed into him since before he could even recall, was just anticipation. If you live long enough, you will die of old age. If you don’t, you may live long enough to die of some disease. It could be a long, slow painful death, like cancer, or a quick end from a sledgehammer cardiac arrest, or perhaps a ventricular wall rupture, or maybe something in between. If you don’t, that means that you will die from an accident…of course some asshole will say:

“He died prematurely from a tragic accident”…or…”His life was cut short…”

(Nobody ever says: “His life was too long”.)

What about: “That old bastard was such an evil prick, it’s just a shame he lived so long!”?…Ah! but I do digress…. How can you die prematurely if it occurs precisely at the end of your life?

The point is that we spoil most of our lives living in fear, anticipating the inevitable. It’s not as if we can prevent what is meant to be. Stupid people die every day for good reasons, just like really good, and smart people die for no good reason at all. It rains on the just and the unjust alike. But smart people often avoid dying stupidly every day as well. Just like greedy, evil, and lazy people get exactly what they fucking deserve…just not often enough, and not properly publicized. If the news media wants to do the public a real service, they should try to do a better job of calling attention to the times “When Cruel Douche-Bags Get Exactly What They Deserve”. Film at eleven.

It’s just such a shame to spoil a perfectly good lifetime of present moments with the shitty smell of fear.

There are many things Much Worse than Death

Jeff had seen most of them. We live most of our lives being afraid of dying “too soon”. When you get older, you realize it is much worse to live too long. To outlive your savings. To outlive your health. To outlive your own memory. To outlive your own usefulness. To become a semi-permanent resident of “Gomer Gardens”, which is to say to become a human vegetable to be farmed like so much broccoli in a garden of Lost Souls. The nursing homes keep the beds filled. The medical directors get their thirty pieces of silver every time they send one of their captives back to the hospital, usually by way of the ER. And after each admission, Medicare will pay for another hundred days stay. It’s an industry. Now imagine what will happen when all those “Boomers” are in nursing homes, and there aren’t enough personnel or money to care for them. Those changes in residence will most likely have a similarly profound effect on the real estate market as well.

All too often, we do not extend life. We just prolong Death
(EMS mantra, origin unknown)

The Boulevard of Lost Memories

As he continued his drive along the Highway of Present Moments, he remembered when they had re-named the Florida Turnpike the Ronald Reagan Highway. At a time not long after the ex-president had been diagnosed with Alzheimer’s, Jeff had suggested to his co-workers that the DOT should therefore now remove all the entrance and exit signs, as well as the mile markers. Few saw, or shared Jeff’s sense of humor, and this time was no exception. He had also suggested that the President’s claims as to not being able to remember, or recall the events for which he was questioned during the Iran/Contra Scandal hearings had forced his subconscious mind to make it true, like a self-fulfilling prophesy.

Too much fatigue to either remember or anticipate a road he felt like he had been on for his entire life. It occurred to him that, at least for the moment, he, the ex-president, and this road had that one feature in common. For the moment, it seemed very apropos, and he felt at peace, and laughed out loud to himself. Desire is suffering, but we can joyously embrace the suffering of Life, and in so doing, come to know what it is to be alive. We spend far too much time and effort either reminiscing, and wallowing in old memories, or eating ourselves alive with fear anticipating an unknown future. Or instead, this very moment, you can choose to be an active participant in tomorrow’s memories. It’s your choice….

Perhaps Stella will liberate herself from the shackles of “being her disease”. Jeff had believed that facilitating her enlightenment would be his salvation. More likely, his enlightenment might end his participation in her enslavement. He only wanted to be there for it if his own presence wouldn’t prevent it.

One thing was certain, however; this was the end of the trail, as far as working as a paramedic. The spell was broken. Twenty years was long enough. He had paid back his debt. It was time to move on.

Perhaps the money would make a difference. It occurred to him that it wasn’t enough money to really change his life, and just as quickly, he realized that no amount of money ever really changes anybody’s life the way they think it will. And in so doing, he came to a realization that no amount of money could have ever bought.

Jeff finally realized that after all those years, he had betrayed himself. He had betrayed the very essence of his being. This was one of the big truths he had been glimpsing, only to turn his head away from in fear…the truth he thought he craved so much, but feared so greatly. He had turned his back on his art, his music, and his most cherished talents because of fear, and loneliness, only to embrace even more fear and loneliness that rushed in to fill the void that had been created. He had been running from that realization ever since and now it was upon him like hungry wolves running down a lost child in a snowstorm. It made him gasp; the realization was so sudden, so merciless, and so complete. He did not perceive it as especially cruel, since cruelty implies some pleasure derived by its deliverance. This was just simple unflinching truth. It was he who had turned his back to his own muse. He had lost his way and had fallen from an almost divine state of grace that few are ever lucky enough to even witness, let alone possess for more than a moment at best.

After falling upon hard times and even worse company, he forgot most of the best and most valuable things he had ever known, even though it seemed he had known them from his earliest recollections. When it seemed he couldn’t have gotten any more lost, or sadder, he tried to make amends, or perhaps to do penance by devoting his life to saving other people’s lives. On a very superficial level, it had worked, but he had become a victim of desire and greed in the process once again, simply because he could not recognize that what he really desired could not be satisfied with the objects he unwittingly tried to substitute. He suddenly remembered the many times that he had been obsessed with the drive to create, and express himself. There, at least, had been a cycle of desire and suffering with which he felt comfortable. Always more, and yet never enough. Money had almost no bearing upon the equation, at least not at first….

He visualized a rat chasing its own tail as it scrambled through a maze in search of some piece of cheese he had never actually even seen. There is pathos in comedy, and comedy in pathos.

For those who feel, life is a tragedy. For those who think, life is a comedy.
(More fortune-cookie wisdom)

He also realized that although his departure from what he had perceived as his crafts had been necessary on a certain level, it did not have to be permanent. He had continued to flounder because of his lack of balance. We make errors of omission, as well as commission, and that which we fail to acknowledge will eventually force itself upon us in such a way as to either bring about our ruin or our salvation.

A great calm settled upon him. In his realization, he saw not only what needed to be done in terms of balancing his life, but he also sensed a lack of urgency heretofore unknown to him. Finally, the connection had been made between knowing and understanding. In the process, the difference between what was important vs. unimportant became exceedingly clear. A flood of images of his follies followed. He felt neither shame, nor remorse, only the regrets for the consequences he had brought upon others that he could not change. And even that seemed to fit within the scheme of things. Although we all bring a certain adversity into the lives of some of those we encounter, those adversities are the key to not only their enlightenment, but also our own as well. Although it is frequently not done out of any desire to further any interests but our own, we hold within us the ability to recognize those consequences as an opportunity for self-realization.

Your conscience is like a small voice inside your head. If you ignore it long enough, it will stop talking to you.
(Old parable from the aboriginal and native tribes of what is now called North America
Seeking enlightenment through words created by your mind is like trying to hit the moon with a stick.
(Isn’t it?)

Next came the blinding flash of light, with a monstrous booming concussion of sound, drawn out into a long groaning, grinding, scraping, and screeching. Blackness. Emptiness. Gradually the sounds began to return. First, voices, shouts and screams, then the wailing of sirens, and the yelping of ambulances. Jeff suddenly finds himself sitting on the hood of a police car. No one seems to notice him, but eventually his attention is drawn to the sight of his truck, smashed almost beyond even his own recognition. The next sight would have taken his breath away, had he any to give. His shock turned to horror to see firefighters dragging what appears for all the world, to be his body from the wreckage. His mind races. Can this be what he fears it is? The paramedics surround his body as he races to where they have lain the body. He realizes that although he may have raced, he hadn’t run, he just went to the body without a step. This further unnerved him, at least, in a manner of speaking. One medic was now listening for breathing as another attaches ECG electrodes and searches for an identifiable rhythm. There is none, save for an occasional agonal ventricular beat, unaccompanied by any pulse. And Jeff recognizes his own face within the smashed wreckage of this corpse he is viewing. He expects to pass out from the sight of it, and realizes why he can’t.

“My God! This is it! My life is over, and yet…here I am…what next?”

He looks down. No feet. He wills his hands to raise to his face, the way we all do, unconsciously, thousands of times a day. No hands. He walks beside a fire engine, and looks into the mirror. No face. No body. Yet he still possesses self-consciousness; an awareness of an existence…but what?

This is just too much to bear, and Jeff tries to scream to no one in particular, which is just as well, because he now realizes that in addition to having no body, he has no voice…he feels as if he is falling backwards, head over heels. Spinning in a slow, flat spiral for what seems like an eternity, until he realizes that time is an illusion, created by the mind, that does not exist. Of course, once you are dead, this is much easier to grasp, as philosophical premises go. Then again, once the illusions that the mind creates are stripped away, there is no longer any need for philosophical premises about anything; it just is, and before (or after) words, it is self-evident.

If You Think Death, You Make Death

Eventually, Jeff stops screaming, stops attempting to control everything, and finds himself standing in front of a house. He has no idea why he is here, so he just goes through the door, which is to say, he just goes through the door. Pure spirit. Pure being. And yet, nothing special. The realm of magic is not self-conscious.

Jeff realizes that he is standing inside the entrance of an immense, palatial mansion. Although the architecture is modern, the interior is filled with objects and furniture from every conceivable period of time. It is a beach house. He realizes that he has no idea what his name is, or how he got here. As his panic subsides, he realizes that he really doesn’t care, although he can’t explain why.

As he wanders from room to room, it becomes apparent that although the occupants of each room are engaged in some activity that centers around a sort of theme, each of the occupants seems largely unaware of the occupants of the other rooms.

Within the main themes of Sex, Religion, Politics, Societal Protocols, Etiquette for Their Own Sake, The Abundance of Wealth, and Conspicuous Consumption, (or the lack thereof), Austerity and Aestheticism are repeatedly explored according to the mores and customs of every imaginable culture. Each room is distinctly different. From Sacred Sex to every imaginable perversion known to Man…or Woman. From capitalism to Cannibalism to Communism to Tribalism. Body Modification. From Catholicism to Wicca. Orgies, Ritualism, Music, and Art of every variation.

It was there that Jeff first saw the Ultimate Post-Neo Survivalist. He entered a room whose walls bore only the encryption, “What have you done for yourself since you learned to dance (after the Music stopped….)? Jeff had coined the term Post Neo which he defined as a survivor of the Age of Magic. Jeff later began to refer to those of his ilk as Post-Neo, since the real survivors are those who still possess the ability to love, and laugh. Then he saw her… the Ultimate Post-Neo Survivalist, something like Betty Boop on Acid. A lot more lewd, and much more mysterious….
While others merely endure, she flourishes. A freelance dance stylist/entrepreneur of The Apocalypso, a mad rumba, half Foxtrot, half Tango, set to electric Flamenco guitars backed up by The Hammers of Hell on Percussion. The only dance step permitted in Dreamland; someday she will be the only instructor.

Created by accident during a highly secret experiment wherein several rogue paramedics, a back-alley sex-change surgeon, and a psycho junkie nurse attempted to transplant the brain of a Mad Scientist into the body of the Whore of Armageddon, (a hermaphrodite, and former Valedictorian of the Miami Catholic Girl’s Academy). When the Dance begins, she starts by blowing seven perfect crack-smoke rings out of her pussy. The finale is so bizarre that few men who have witnessed it have ever escaped with their sanity, in spite of the fact that the women spectators instantly understand, and even smile…while some eventually join in. Here, there is no danger, there is no fear, and nothing is insane or forbidden.

Bands are performing in some rooms, while orchestras play in others. String quartets, duets, solos, and ensembles of every genre. The scenes change from day to night in what seems like a matter of hours. On the beach, nude sunbathers and the modestly attired are in attendance. As the scene changes rapidly from night to day, people are surfing, swimming, sailing and fishing. For the most part, they seem oblivious of each other, and their various differences, although deep inside the house, down in the basement, groups of people are endlessly criticizing some other group, or philosophy of which they are aware, and take strong exception to each other’s differences. They plot against each other, devising schemes to prevent those others from the pursuit of their various perceptions of Happiness. It occurs to Jeff that these people are magnifying miniscule differences in outlook or opinion, and in so doing convince themselves that their differences are mutually exclusive of each other.

From newborns to living fossils, as well as the recently deceased, from room to room, numerous babies are being born, according to every known social custom, while in other rooms, countless funeral practices are being observed.

Foods and every sort of beverages are everywhere in abundance, although some choose to ingest nothing. All sorts of drugs, too numerous to list, many of which are unknown to Jeff are everywhere he looks. While some people read, others are writing. Some watch films together as others are engaged in making them. As he wanders through the palatial surroundings, Jeff becomes increasingly lost, only to turn a corner back upon some strangely familiar scene, only to become lost again. As drawn as he is by curiosity, or even desire by each of the scenes he observes, or even participates in, he can’t help wondering what is going on in the next room, so he rarely stays anywhere in particular for what might otherwise be a long time.

As confusing as the continual rapid passages of time have become, Jeff’s perception of Time becomes increasingly distorted. He finds himself constantly wondering how long the Party will last. How and where is/are the host(s) and/or Hostess(es)? What Time is It? What is time, anyway? What other rooms are there, as yet unseen? What am I missing somewhere else, right Now? When is Now? What is Now? Why is Now different from Then? Is it? Where did I come from? How did I get Here? Where is Here, anyway? Jeff finds himself increasingly more preoccupied with these thoughts and questions as he wanders from room to room.

Brief glimpses of seemingly familiar faces come and go, but Jeff can think of nothing to say to any of them.

As he enters yet another hallway, Jeff is met by a strangely beautiful, nude pansexual being who somehow glows from within. It recognizes Jeff, and calls him by a name that he can neither remember nor pronounce although he nonetheless recognizes as his one true name the moment he hears and simultaneously forgets it.

It says: “I know where you really need to go, come with me.” Although he hears the voice clearly, as if it were being spoken within his own head, there are no visual cues that the message was actually being physically spoken by the Messenger.

He/She leads Jeff to a room that generally resembles a beautifully paneled Library, full of books up to the ceilings, with rolling ladders, and invitingly overstuffed leather chairs, and disappears as mysteriously as he/she had appeared. A dreamily animated fireplace pops and crackles by a long table, loaded with an abundance of snacks and all sorts of drink. Candles and subdued lights were in abundance everywhere. An ambience of serene lights and aromas permeated the room, and hung in the air as heavily as the smog in the San Fernando Valley. Although there is a gentle murmur of conversation in addition to the sounds of the fire, Jeff notices that within the room, it is otherwise silent, and no sounds of the outside goings on are audible.

The other occupants are genuine and friendly, as well as disturbingly familiar, albeit unrecognizable, and they immediately include Jeff into their discussion, which centers around the following points:
• As they are all as bereft of their memories as Jeff was, they tried to figure out who they really were.
• From where had they come?
• Who owns this property?
• What is it that is being celebrated?
• How long is the Party supposed to last?
• Where will they go after the Party is over?

In a sudden flash of insight, Jeff is overcome by the realization of having been in this room before, in spite of the fact that he does not remember having left it, or why?

He does not have the opportunity to share this with the others, as they are becoming increasingly agitated by their insistence on learning their individual identities, and arriving at a mutually agreed-upon purpose. The discussion becomes increasingly heated, louder and more oppressive. Some members are ranting so fanatically that they cannot hear what the others are saying. As obsessed as each of them is with each of their questions, none of them are willing to consider the validity of anyone else’s answers. Their voices become higher pitched and more shrill until Jeff is forced to cover his ears and shut his eyes. He screams in frustration until every bit of his breath is gone. Then there is only blackness and silence.

When Jeff finally opens his eyes again, he finds himself at the entrance of the mansion, with no memory of having been there before, and no clue as to his identity.

Gasp! Jeff sits bolt upright in his bed at home, surrounded by darkness. He jumps up and races to the mirror to see himself again. He runs outside, naked as the day he was born, to find his truck in the driveway. He howls like a wolf at the moon, and races back to his bedroom, to the arms of his wife, who looks quite alarmed, and in fact, amazingly sober.

Closer examination showed that she was also sweating profusely, and smelled ever so slightly of shit and vomit. She was sniffling and shaking a little, more of a slight tremor, like she was suffering chills, but her eyes were wide-open, and clearer than Jeff could remember seeing them in years.

“Welcome home…I was a little hurt by the way you ignored me when you came in, but you looked half-dead…like you were sleep-walking. You didn’t even answer me, and I wanted to tell you that I got your message…in more ways than one. We have a lot to talk about in the morning, but for now, I am just so glad you’re back. It’s time we started over again, from the beginning, but not from the beginning, if you know what I mean.”

“Did you read my letter, or watch the video?”

Stella seemed amazingly calm, loving, and attentive. For the last few years, these were not qualities that Jeff would have used to describe her demeanor, whether she had read and watched or not. He held his breath.

“Yes, I did. For a full day, I was livid with anger, and took enough Xanax to put a normal person in a permanent coma, but since only Death is permanent, eventually, I woke up, and your words were still there, and I realized that it was just a day later…so I decided to get sober. You should be glad you weren’t here for that!

The kids pretty much stayed on the other side of the house, and went to school, and fixed their own dinner like usual, except that for once, I was aware of how little they needed me to get through an average day, and that hurt. It shook me up to realize that I didn’t need to tell them to stay away, or leave me alone, because they already were, and had been, for a long time. I resented feeling like they needed me to be their maid, and forgot that they had also learned to live without me as their Mom. I realized that I felt like I had to get sick, or be in some sort of crisis to get your attention, but the more dysfunctional I became, the less you paid any attention to me at all, unless there was an even bigger crisis. I resented you for being so dependable and steady, until I realized that I had forced so much responsibility on you that you really didn’t have enough time or energy to spend on somebody who was never going to get any better. I know it was partly because of money, but I felt like you were shutting me out.

I wanted to feel like I was your equal again. That meant getting off of the drugs. I’ve been sick pretty much ever since, but it has been getting better over the last twelve hours or so. I really need to take a shower, and brush my teeth, but can I get you anything before I do? By the way, what was the running and howling all about?”

“God! I love you so much! I just had the weirdest fucking dream! It’s like I know we are going to be OK, no matter what happens…It’s like this weight was lifted from my soul…we already are OK, and I don’t even have to worry about it. I know you already know it, too, somehow….”

“And you don’t even have to die in the process…at least not yet, and probably not any time soon…besides…it won’t do any good to worry about any of it….”

“Wait a minute!…what did you just say?”

“I am saying that I had the same dream…or maybe you could say it was a vision…or maybe you could say it was a spell, for two days now. I kept calling you to join me, but you were too full of yourself to listen…we can talk about that later…but first, I want to see the money! I don’t know how much…I just know there was a lot of it…I want to see it.”

“How do you know about that”?
“The money?…well most of my visions are in kind of general terms…I knew you have been through some kind of ordeal that involved a death, that wasn’t your own…you were in danger for awhile, and I tried to send you protection, and I tried to summon your spirit guides, and tell you to follow them.”

“All this was in the dream?”

“Baby, life is a dream. If you think of it as a movie, it should be pretty clear that if you don’t like your movie, change the script. Edit the film. You are the director, the writer, the cameraman, and the star. You told me that a long time ago, but you usually forget your own best advice. Time is an illusion. Heaven, Hell, and our so-called present lives on Earth are connected, separated only by the illusions we create in our minds. Everything we believe to be residing in either the past, present, or future is actually occurring simultaneously. Not only that, but it actually is possible for two objects to occupy the same space if their densities are sufficiently different. Density appears to be a product of velocity, at least according to some theories of relativity.

So what we perceive of as being past events could exist as an infinitely slower series of progressions, and the future could exist in an infinitely faster-occurring series, like water poured into a glass of sand, for lack of a better analogy.

What we interpret as the present moment is merely a theoretical concept to provide markers, or references, like X and Y axis’ as our consciousness moves through what we believe to be our present lives. Neither matter, nor energy can be created, or destroyed, but it can be changed in form.

The life force of our souls is the most rarified form of energy there is, and it passes from one body to another like renters moving from house to house. That energy can be cohesive and focused, like some beautiful hologram, or as incoherent and unfocused as a dusty forty-watt light bulb in a West Virginia shithouse. Not only that, but there is no reason that two or more souls can’t occupy the same being at the same time, although when they do so in harmony, it is regarded as a gift, but without consensus, it is regarded as schizoid madness.
Most religions try to discourage that sort of thought process because it doesn’t tend to produce large congregations of followers. The scientific community is too busy trying to distract the general public from noticing that their fundamental axioms are just as dependent on faith as most religions.

Now here’s where it gets a little tricky: think of our present lives as being real in the sense that we live in these bodies that have a finite lifespan, even if virtually every aspect of our perceptions are built upon a series of delusional fantasies programmed into us like some giant series of self-sustaining hallucinations. Each of our lives traps us in an essential enigma that represents the paradox of our existence, like some riddle to be solved. We are so addicted to our illusions that we can’t separate ourselves from them long enough to actually experience the joy of the lives that are literally slipping through our fingers. First there is a mountain, then there is no mountain, then there is. Deconstruct the illusions, and then you can see what really is. Getting sober isn’t easy, you know. I had to focus on something completely outside myself. Between spells and visions, it’s been a wild ride”.

“I am amazed…it must have been”.

For once, Jeff was speechless. Once again, two apparently separate universes had collided in harmony, resulting in a momentary rapture of pure bliss. They both knew that there were no guarantees of anything, except impermanence, but what they did know, they both knew together. One mind of no mind, or Mu-Shin: Mind like Water.

All he could say was: “I never knew that you even paid attention to such things…that’s pretty deep stuff…I should have known better than to underestimate you. Just when I thought I was ready to give up on you because you had given up on yourself, you go and save yourself. I should have stopped enabling you by thinking I could solve your problems for you. I empowered your own victimization. ”

She bit her lip pensively, as if about to speak, then stifled herself. Jeff picks up on this immediately, as his expression changes quickly from inquisitive to imploring. As she squirms visibly while shifting her weight from her legs to her buttocks she settles back into a more comfortable position. She takes a long breath before she cautiously begins to explain.

“…well, there’s more to it than just that…A great deal has happened to both of us since we last were together…but in a little while, you will come to understand all of it…in the meantime, trust me, you have nothing to worry about…no charming stranger has swept me off my feet, or anything melodramatic like that. When you first came in, it hadn’t really sunken into my consciousness yet, and I was so glad to see you that everything seemed so normal and natural.”

“What do you mean?

“We’ve got a lot of catching up to do…while we still have the chance…it will all become self-evident when the time is right, and for now, the time has come for reconciliation and re-discovery. Don’t worry; you only think you are tired because of conditioning. Let me take you past all that…beyond even Tantric…or Majik…the Union, of the Woman and the Man….

As she spoke, he heard the song begin to play. Jeff was distracted for only a moment as he tried to rationalize how she had managed to do that so well. The timing was perfect. He had seen no remote controls, or anything else to explain their synchronicity.

“So tell me…what would you like to do with your Goddess?”

As Jeff stood up to embrace her, he felt the room start to spin, and his ears began to ring. Too many hours on the road, too few hours of sleep, and poor nutrition or hydration had finally taken its toll, and instead of embracing his wife, the floor rose up, and beat him to it. He was aware of a loud bang, like someone striking a large cardboard box that had been placed over his head. It was deafening, but painless.

Next, he became aware of a knocking sound, like someone at the door. He didn’t feel like he could move and he felt like every bone in his body ached, and worse yet, weighed several hundred pounds. He felt like he could not even open his eyes. He called out to Stella:

“Who the fuck is that at this hour? Can you see who it is, Honey?”

“It’s ME! She cried out. “Let me in! Open the door for Christ’s sake!”

“What are you talking about?” He shouted, more than a little annoyed, as he opened his eyes, only to discover he was still sitting in the cab of his truck. The engine was still running, the headlights were on, and the front bumper was firmly pressed against the house.

Stella opened the robe she was wearing, exposing her naked body as she pressed her large, pendulous breasts against the window.

“Don’t you want to come inside? If you show me the money, you can come any place you want, but you gotta unlock the door and get the fuck inside the house unless you want to do it in the truck, and as long as you’ve been gone, I’m not going to suck your cock until you take a shower!”

Jeff began to laugh, and shake his head as he unlocked the door and staggered out of the cab of the truck. His legs buckled slightly, and she grabbed him, to try to keep him from falling to the ground.

“My God! You smell like ass and ball sack! I mean it! You REALLY STINK!”

They both were laughing hysterically as they staggered toward the house.

“Before you ask, the answer is yes…if the question is ‘Did I see the video?’ or ‘Did I get the point?’, or Did I get sober?, or ‘Did I really have the same visions?’, but most especially, ‘Do I really want you to fuck my brains out on a big pile of money?’ All the other questions will require answers that are just too complicated to be discussed until after the swelling goes down and you can’t cum anymore, so don’t bother asking until a lot later…”.

In his delirium, Jeff did not notice Sonja jump out of his flight bag. There was a very good chance that as long as she and her babies stayed out in the woods that surrounded their house, peaceful coexistence was a great deal more likely than in Belfast, Palestine, or even Boston. Welcome to Florida. Viva La Estates Unidos.

That night, as they made love, it seemed that time stood still…the night that lasted for a thousand days. No fatigue, no awkwardness, and definitely no fantasy left unfulfilled, even between two lovers that had been together more than ten years. One continuous orgiastic rite of pleasure, they both lost track of how many times they made each other cum. They had once again fallen back in love with each other.

“To Be the Hero of One’s Own Hero…To Steal Fire from the Gods.”

One Big Family

Roaches. The transmogrificated soul of a despot and murderer. A Dog, two Cats, three kids, an impaired Nurse turned Witch, a licentious cousin and unemployed Witch, hell-bent on proving herself to be Jeff’s incestuous half-sister and a Post-Neo Survivalist Paramedic trying to wrestle with the concept of Life after 911 in a house full of disembodied spirits. Squirrels in the attics, and outside in the trees. Snakes everywhere. Armies of Armadillos bunkered down in nests deep below the house. Bugs galore. Plenty of room, as long as neither camp encroaches upon the other, but when they do, you can be sure that one will be invited to dinner by the other one…an offer that can’t be refused.

If you say life is funny, it is. Considering some of the options, it just might be no worse than the lesser of many, MANY MUCH greater Evils. From a Zen standpoint, it’s not good, and it’s not bad. From a Zen standpoint, you shouldn’t make good, or bad, or better, or worse…In fact, it has been said (and the paradox is duly noted) that if you even open your mouth to speak, already you are wrong. However, for literary purposes, let’s agree that life is funny, if you mean odd, peculiar, and even rancid, or tainted (as in “…does this taste funny to you?”).

If the soul of a murdered murderer were to be transmogrificated into the collective consciousness of an egg sack full of Blattodea Periplaneta, the inherent Organic Justice Potential would, to many, about equal the possibility that eventually the Kharma would be resolved, even if it took five hundred lifetimes. We all have within us, with each passing moment, the opportunity to rectify and resolve the worst difficulties in our lives.

Of course, we cannot “take back” what we have done that we wish we hadn’t, and we cannot prevent anything from happening that is beyond our control, but we can make peace with ourselves, as we are right now, and through acceptance of our present circumstances, understand that everything we need, we already have, and everything we need to be, we already are. Everything and everyone that comes to us is here for a reason, and brings something to us that we need to learn.

And if Jeff used the good fortune of all his previously miserable momentary circumstances to inspire a story that could provide both he and his Goddess the means to go their separate ways in peace, they just might do exactly that…together.

The next morning, Jeff and Stella awoke to the sounds of their children letting her parents into the house. Neither of them was expecting their arrival, especially together, since they had been divorced for years. One lived in Lauderhill, and the other in Los Angeles. Before they could dress, they realized that everyone was weeping miserably. This made even less sense, so they hurried out to the living room to find out the source of the mystery. No one noticed them enter the room. They tried to get their attention to no avail. They turned to each other in disbelief.

“What the fuck is going on?” Jeff blurted out.

I’ll be damned if I know for sure, but if what I think is going on has already happened, you will come to understand…eventually. You could say we have an eternity to figure it out.” Stella replied.

After a bit of eavesdropping, they discovered that Jeff’s parents were also due to arrive tonight by airplane, from over eight hundred miles away, and that they would be picking them up from the airport, all amidst sobbing and hugging. The mystery continued.

Then came the first real shock. Jeff looked outside to discover his truck was missing about the time he heard them discussing his “accident.” His body was not scheduled to get to the local funeral home until the next day.

They turned to each other in disbelief.

“This is ridiculous!” shouted Jeff. I’m right here you assholes!

No comments from the peanut gallery.

Stella began to sob as they listened to how Stella, while trying to detox drowned in the bathtub when she had a seizure. She was already in the funeral home. Rescue had taken her to the hospital early last night.

Well, that explains the rest of what I hadn’t figured out, I guess. I didn’t want to just dump that on you last night…We were having too good a time….”

“How did we do that? It had to be real…I still remember every detail so clearly…How…?”

“Never underestimate the power of Denial, or of Will. We still have unfinished business between us. I was so afraid I wouldn’t see you again, when I first suspected….”

“We were so programmed into our routine that it was just natural to continue to act it out until….”

“Speaking of acting out…you realize this means we can’t be seen, or interrupted no matter what we are doing at the time…”

Stella and Jeff immediately launched themselves into the most frenzied, lewd, lascivious, and licentious display of carnal perversion either of them could imagine. Right in front of their family. It was exhilarating. It was wickedly funny without any guilt or guile.

“How are we still here together?” Jeff asked Stella as they held each other. “How is it we can still touch, and feel?”

Stella walked into the kitchen, and tried to pick up a plate, to no avail.

Doors and walls were no problem, as long as you don’t mind passing through them (which they did easily), rather than try to open them (which they could at least not yet accomplish. They learned how to slam them shut fairly quickly, which eventually proved to be one of their initial communications breakthroughs with the family.

And so it came to pass that I was called upon to look after their children. Between Life Insurance, Social Security Benefits for the three orphans, Accidental Death and Dismemberment policies on both of them, Jeff’s state retirement, and the mysterious ten grand found on Jeff’s body, they had enough money to purchase the house. I was well known and liked by both Jeff and Stella’s parents, and they knew that their kids adored me as much as I did them. I had no children of my own, and my additional income helped support all of us.

It took a long time for Jeff and Stella to make contact with me, and I had to enlist Dee’s support and talents to allow them to provide me with the rest of the essential details I needed to complete the story by communicating with me, often while I dreamed or when I meditated. We did EVP recordings using digital recorders in empty rooms. Other times we asked questions while the recorder was running and analyzed them later. We also used one of Jeff’s short-wave radios connected in a most unorthodox fashion matching a ground rod to the antenna input. Once we found the right frequencies, I eventually discovered I did not even have to turn on the radio. Simply putting on the headset allowed me to listen to whatever Jeff or Stella had to say. Once they learned how to communicate with us (and vice-versa), they proved to be a couple of chatterboxes, and I spent many hours reviewing the recordings we made. Both Jeff and Stella were intent on having their story told and communicating with their children. It was the grandest of stories replete with details I could never have learned otherwise, but it took a huge toll on my psyche before I could get it all sorted out, and Dee and the kids helped cover for me after my breakdown, until I could finish Jeff and Stella’s story, as well as my own.

I have had no desire to publish the recordings, or to make them public for two reasons; one of which is to avoid surrounding myself or the kids to the controversy and substantiation that inevitably ensues when such a claim is made…in this respect it is only a means to an end. I have no claim to make because I have no point to prove, and no desire to try to communicate with anyone else’s deceased relatives or loved ones. I have been admonished for being selfish, but I have a higher purpose to fulfill to Jeff, Stella, and their children. I do not wish to compromise what we have discovered, nor do I wish to make money from, or create a following of believers to whom I would be obligated, as well as enslaved. The existence of similar phenomena is well-documented, and provided me with a dearth of technical data and methods to employ. I am not about that. At least not for now. I am grateful to simply believe in something…something that does not require proof as much as experience. My experience. It cannot be transmitted. You have to find it for yourself.

And now we all live together…in a house by the sea….

Author’s Note:

The story you have read is true. Only the names, places, times and events have been changed; but not to protect the innocent. Fuck the innocent; it rains on the just and the unjust alike.

Most of the elements that were changed were done so because of potential lawsuits, and investigations spawned by numerous local, state, and federal agencies that are paid to punish people for participating in many of the activities described herein. For that reason, please be advised not to waste your time trying to solve some crime that you think may have been committed. Better to use this story as a new set of eyes to view the future, and be the wiser for what you might learn.

Even guilt and innocence are highly subjective terms at best, and I seriously doubt that any of you are in any kind of position to judge anybody else’s behaviors. Self-righteousness is a highly suspect character flaw. Jesus realized that a long time ago, although it didn’t seem to do him much good as far as predicting the malice and avarice of the crowd to which he was playing….

Never Underestimate the Power of Large Groups of Stupid People
and so it is now, as it ever has been….

Not all of this necessarily happened in the same place at the same time, and there are more than a few embellishments, but no totally unfounded Urban Legends. Some of the elements of this story never actually happened to either Jeff or the author at all, having been described to him by several of his associates and mentors, many of whom were also notorious liars, smugglers, burglars, drug addicts, perverts, telemarketers, or dangerous psychopaths. Some of them also used to be paramedics…that however, does not change the fact that the story is, in fact, nonetheless, true. It is true to human nature, and in some form or another, either has, or will eventually happen just as it was told, more or less.

There are those (either in or out of the medical field) who may believe that this is just the sort of thing that will do grievous harm to the air ambulance industry, or the reputation of paramedics in general. Some may be younger paramedics who just weren’t there when the industry was growing, and need some kind of mythology to bolster their egos and identities. Unfortunately, there are way too many of these weak-minded Pollyanna’s gravitating to this business in the first place, just like the newbie (or wannabe) firefighters who got all teary-eyed watching Backdraft. First of all, get over yourselves, then stop and think about it for a minute. There have been literally hundreds of books and movies made about doctors or nurses who did all sorts of unspeakable acts without having the public (or even other doctors and nurses) generalize about the entire medical profession in the process.

This is a story told by a medic who came of age, so to speak, in his mid-thirties during the mid-eighties. The story itself is about events from the first five years of the new millennium.

The ambulance business is even younger than professional law enforcement. Years ago, before paramedics, they were all either ambulance drivers or the town cop, (who was usually the town bad-ass, a sot, a bigot, and a bully), and it was just easier to give him the keys to the jail than it was to try to find someone else to lock him up.

First came Police Academies. Law enforcement came of age and got respectable. It still took another decade to weed out the old guard, and the nightmares that were associated with them. Some were good, and some were not, but they were the only ones to get the job done back then.

In much the same way, most of the first ambulance drivers actually worked for the local funeral home, and yet no one ever stopped to question any conflict of interest. Much later, EMT-Paramedic certification programs began to lend some of the same air of respectability to the ambulance business as academies and certification programs had done for law enforcement.

We are still in the throes of that transition, but it is nearly over. Back in the eighties, there were few applicants with no other previous life experiences to draw upon. We all had been and done more than a few other things in our lives, and hadn’t been programmed since we were sperm to become EMT’s or Paramedics. The game was new and all the rules hadn’t been written yet. Most of the few rules that did exist have long since been rewritten by risk managers and legal departments.

Now it’s all about playing safe, and being good little citizens. Yes, back then, we were all cowboys, but it was a whole lot more interesting. By the time this particular plot rolled around, we were a few years into the New Millennium, over twenty years later. Most of the Author’s colleagues have either risen to power in administrative or managerial positions, or have dropped out of the industry completely. Several of them may still be in jail. No one in their right mind would choose to be a street-level Paramedic for the rest of their life, but shit happens…People are people. Period. Paramedics, Doctors, Nurses, Firefighters, Police Officers, Judges, Teachers…blah, blah, bah…ad infinitum. At least we finally figured out (especially as far as priests and Congressmen were concerned) to TRUST NO ONE. If we had regarded them more like fallible human beings, they not only might not have been able to get away with so much, and they might not have been led to believe that they could have in the first place.

We have come upon Strange Days indeed, when you are safer having Ozzie Osborne (or even a middle-aged Paramedic) baby-sit your children than either a Catholic Priest or a Scoutmaster. Just think of this as a very provocative true story, and don’t be so quick to judge the characters, or the author, because if you do, the joke’s on you.

(More Confessions of a Mad Philosopher)

(By the way, in case you were still wondering how many people it takes to achieve world peace, the answer is one…)
(Guess Who?)
The answer to the question: “If all things return to the one, where does the one return?…”


And (inhale)
Five (exhale).
And (inhale)
Four (exhale)
And (inhale)
Three (exhale)
And (inhale)
Two (exhale)
And (inhale)
One (exhale)
And (inhale)

The Crowning Glory of Man’s Inhumanity to Man
The Crown of Destruction
The War Babies lived in the shadow of The Bomb. My loss of innocence, a chain reaction of reactions triggered by the images, stark and surreal of rolling, boiling fire forming the ominous mushroom of the Crown of Destruction:
of Dachau
of Auschwitz
of Treblinka
of Bataan
of London
of Dresden
of Berlin
of Nagasaki
of Hiroshima

No one is safe. No one is a civilian. Non-combatant victims. Corollary damages. The cost of doing business when the business is War. None of us would ever be the same. We lived in the shadows of enough nuclear weapons to destroy the earth many times over with the knowledge that there was no place to hide, nowhere to run.
Man had created Satan in his own image,
and God in his antithesis.
Ten years old
No God
No Satan
No Heaven
No Hell
Only Dreamland,
Where mannequins go to die, their eyes burned out by the fire of a million suns.
A little village, made to look like Anytown, USA, where every living room, bedroom, or kitchen is a department store display window in Hell.

Home of the Ultimate Post-Neo Survivalist.

If you were a Post-Neo, you grew up believing that the Nuclear Holocaust was inevitable, and only a question of time. To this day, it seems miraculous that it hasn’t happened yet. It is not surprising that so many War Babies can’t grasp a feeling of permanence in their lives. Just as well, as Life is a study in Impermanence. The reflection of the Crown of Destruction in the soon-to-be-shattered glass of a department store display window in Hell.

In the distance, the drumbeat of the Ghost Dance echoes all the way into Dreamland, where I alone am dancing.

Desire is said to equal suffering, but if you stop labeling, and making differences between good and bad, one is left to wonder: “Is suffering bad?”

If you say yes, you fall into a thousand Hells with no hope of escape.

If you say no, you only see part of the picture. Your head is a dragon, but your body is a snake. You cannot split a diamond (or an atom) with a hammer. Embrace the joys and accept the consequences.

You could ask a dog about the Moon, or simply howl for yourself.

The End

This is what we don’t want to face by ourselves. This is why people invent and seek religions to tell us what to do, to figure it out for us. We keep blocking our consciousness about this concept, because it terrifies us, and as a result, we are never ready for the inevitable. It has been said that it isn’t the fall that kills you, it’s that damn sudden stop, but with life, it is that long fall that seems to fuck us up so bad.

It goes like this: We all know we are going to die, but we try not to ever think about this fact any more than we are absolutely forced to do. The really hard part isn’t the actual death. It’s the fear of it that paralyzes our brains, and our souls. The fear of everything that leads up to that last moment. Think about it. We start out like empty vessels, then we prepare ourselves for what we think our lives will become. That almost never happens, and then we try to keep adjusting for the unanticipated events that keep happening instead of what we planned.

Sometimes even that works out to some extent, but just about the time that the chaos begins to subside, we suffer a stroke, or a heart attack, or our beloved significant other dies, or we are faced with burying our own children. Or we lose our life’s savings through no real fault of our own, or we lose our minds. Eventually, we outlive our usefulness, and even our own memories. We try to support this fantasy that involves the perfect, happy ending to a life well lived, when in our heart of hearts we know that in all likelihood, that will be the farthest thing from what actually happens.

I’d rather drop dead in the middle of a dead run than to die slowly sitting in a pile of my own shit.

Our culture worships youth, and fears death, so we keep people alive artificially far beyond any humane purpose, save for commerce, and we hide them away from our sight, so we don’t have to watch them die so slowly.

We are born into ignorance and die in despair. In a moment of unusually profound sorrow, I came to believe that throughout life, we are in fact alone. We are born into this world naked and screaming. And from that moment when we are separated from our mothers, each of our lives becomes a singular experience, and no matter what we do or where we go, we only really have ourselves and even that is temporary.

To live is to suffer, and to feel sorrow for our condition. It was much later that I came to see the connections that existed between myself and my world, and the very temporal nature of life itself made those shared experiences that much more treasured, and not to be taken for granted. If we are very lucky, there may be some happy moments; there may even be a lot of them, or we may be blessed beyond the dreams of common men, but the inevitable is what it is, and there is no escape.

You can spend your entire life complaining, and waiting for things to get better, or you can start living tomorrow’s memories now, in the present moment, knowing that things will eventually get much worse. Best to not make good or bad in the first place. It is in our acceptance of the essential sadness of what it is to live and die that we find the sublime joy of realization of the truth of our impermanence, the realization of the folly of the illusions created by our minds, and words through thinking, and the clarity of seeing everything exactly as it is: just this, only this. Stop making opposites, like good and bad, or even better or worse. Stop judging everyone else’s actions, and concentrate on your own, but don’t be so judgmental about yourself either.

Some days you will be disappointed, or embarrassed, but most of the time, everyone else will be so preoccupied with their own imagined shortcomings that they will never even notice, and all that embarrassment will have been wasted…and if they do notice, too fucking bad. You can’t be any better than you really are, no matter how hard you try to fool everyone else, and especially if your try to fool yourself.

Eventually, it comes down to this: You can spend your life worrying about The Meaning of Life, or else just find some meaningful moments in your life everyday. The big, overall meanings may come as occasional epiphanies, or all at once, at the Very End (if you are actually conscious at the time). Regardless, you can’t force anything…

The Snake only Sheds Its Skin
When it is Time to Shed Its Skin

Mostly, we are faced with making constant choices about what we are going to do with all that time before we die…

No matter what choices you make, you are just filling up time. Paint the ceiling of the Sistine Chapel. If you do it for fame or fortune, big deal. In the scheme of the Universe, it is just mindless doodling. Do it because it fulfills a need within you to express yourself, and you approach the Sublime, at least while you are in the act of doing. If you find a way to share that joy of inspiration with others, then there is no need to bask in your own glory.

It always beats watching TV.

I started with mundane, everyday chores that were necessary to maintain a clean and relatively orderly life. Do it with purpose as a conscious choice. If that doesn’t float your boat, try living in filth until you are sick of it…. Being personally involved in maintaining your everyday life reinforces the connections you share with the world.

If you are intent upon performing Great Works, never forget to enjoy and nurture the little everyday joys of friends, co-workers, and your family. It’s a pyrrhic and hollow victory to sacrifice your Life for Fame and Fortune.

By embracing the eternally-questioning mind, you can get stuck in an unsettling thought or state of mind that can leave you breathless, cold, alone, and afraid, with no evidence of any way out. If you question long enough, you will experience it eventually. It is different for everyone, because it is the source of your one most essential flaw, and deepest secret Fear. We are all enigmas, paradoxes, and Koans of contradictions that form the basic nature of our character that is somehow, in and of itself, incomplete, like a riddle. If you could see yourself as the main character in a novel written by you, would you possess the strength of character and insight to be able to see yourself as you really are, complete with consistent inconsistencies, lapses of judgment, and weaknesses, in all of your unselfconscious ignorance? You would have to step completely outside yourself to do it. When you do, ask yourself “Who am I Now?” You may not be able to speak the words to describe your insight, but your understanding will surpass any words.

One step follows the other. Never lose sight of your dreams, or your everyday life. No one can pretend to be able to figure it out for you. You have to find it and do it for yourself. Truth will present itself pre-eminently, as long as you don’t cloud your judgment with dogma, prejudice, or assumptions from those who would make themselves rich by promoting their doctrines, even mine…. Trust that you will get everything you need to be whatever you are supposed to be, which is actually what you already are, and you will know what that is as soon as you get it. Just don’t ever look away….

Is There Enough Heaven Tomorrow to Make All This
Worthwhile Today?

Is There Life After Zen?

Zen is not the journey. Zen is not the way. Zen is not the map; it is not even the compass. First, you have to decide where you want to go, and what you want when you get there, or then again, you may choose not to decide, and simply walk the face of the earth until you decide where you do want to go. Or you can simply remain motionless. Zen itself involves more a priori assumptions than many devotees would care to admit. They say, “Desire equals suffering”, and thereby imply that suffering is bad, and in the process, injure the eternally questioning mind that would kill the Buddha to feed a hungry dog. In many ways, Zen resembles Henry David Thoreau’s account of life on Walden Pond insofar as it represents one’s personal attempt to find a very personal accounting of what is essential, or what it means to be alive. Who am I? What do I want? This is an account of examining the values each of us may choose to find, or attach to the elements within our lives to separate what we want from Life from what we do not want. In any case, eventually we are lead back to the Here and Now.

How do you distinguish between Eternity and Infinity? Intelligent Design presupposes a Maker of All Things who usually promises Eternal Life in Heaven in reward for Faith and Obedience. Eternity in Heaven has a beginning (sometime later) with no end, and is based on time. Infinity is not time dependent, because it has no beginning or end, and does not require belief in the existence of a maker to explain our existence, or any separation between Past, Present, or future. “With Infinite Time, Monkeys, and Typewriters, eventually one of them will produce Shakespeare.”…Or a universe.

Do you need the threat of Hellfire and Damnation just to be a good person?

Faith is what we believe in the absence of empirical proof. Faith in the axioms of Science is no different from Faith in Religion. Whenever possible, assume nothing. An open mind is sometimes referred to as “Mu-Shin”, or “Mind like Water”.

Our desires are in effect, our motivation for all of our actions. There is no free lunch. Our actions are all connected to consequences and sequelae resulting from those choices. And they are also separate. Although even the connection between actions and consequences may be considered axiomatic, it may be true that they are random, separate, and isolated events, devoid of any intrinsic purpose or meaning. The truth is, we just Don’t Know. If you can differentiate ideas from beliefs, it is much easier to maintain an open mind, as well as a closed mouth. We all have an opportunity to differentiate those choices from what we may have regarded as The Inevitable.

Is there Life after you lose your faith? By that I mean, can you live your life without believing in fairy-tales and illusions? Can you step away from those unfounded beliefs and accept the pain and disappointment long enough to realize and implement the course of your life in a way that assumes nothing more than what is absolutely necessary, and recognize how precious and unique each of us is living this one life we have here and now? Eventually, you even step away from Buddhism, and Reincarnation. I was drawn into Zen by the same forces and influences that led me out, or perhaps beyond. My acceptance of No Form, No Emptiness provided me with a clean slate upon which Majik wrote a story for me about The Secret Lives of Everything around Me. The Occult Pleasures provided by the Life Forces that flow so freely between all living things, as well as the objects which I previously regarded as inanimate. Life’s energies are everywhere. If God has spoken to me, I have not yet heard Him/Her. For now, that is enough. I have no need of any Deity that is jealous and angry and needs to be worshiped and feared, given sacrifice, or told to kill in His/Her name. I already have a government that does that now. I may be left with more questions than answers, but my Quest energizes my existence and reminds me that even unanswered questions provide me with a purpose that Lies cannot. Since my destination is unsure, I am content to simply enjoy the journey.

And if that is enough, then leave it alone, at least for now. The only thing worse than inventing mysticism is accepting someone else’s secondhand God. Fear of not having belief is more likely to prevent you from truly experiencing it. It’s like orgasm; if you are afraid you will come too soon, you will; if you are afraid you won’t come, and try to fake it, you won’t, because you are too wrapped up in the Act. Just let it all be, and then see what happens…If and When you actually perceive and feel Majik, or sense the animation of objects, or hear colors, (or voices), do not be afraid; but rather invite them into your life, because they are yours and yours alone…

Some people hear Voices, others hear Music. Listen to them both, but Dance to the Music and don’t be afraid to question the Voices.

Zen has been compared to a wheel. Form is Form, Emptiness is Emptiness. (O degrees). Form is Emptiness, Emptiness is Form. (90 degrees). No Form, no Emptiness, or Nirvana (180 degrees). Magic, Insanity, and Miracles, (270 degrees), eventually leading back to Everything is Just like This, Only this, Just This. Form is Form, Emptiness is Emptiness. (360 degrees). (The honorable Seung Sahn said that in Dropping Ashes on the Buddha.) If the wheel is always turning, then the Past, Present, and Future become one.

There is not only Life after Zen there is Life while practicing Zen, Life outside of Zen, and also Life before Zen. Eventually, there is no inside, or outside, or before or after. There you are, back on the three hundred mile per hour train, staring at your hand. What that means remains for you to discover for yourself.

Final Confessions, Rants, Lost Rights, Last Rites and Wrongs

And so he witnesses Trauma,
as he heals their trauma,
and in so doing, suffers trauma,
and also inflicts trauma, all of which affect him
in different ways that are also the same;
and those effects resonate among themselves,
regenerating sums, and differences,
as well as products of their interface;
heterodynes and overtones alike.
Eventually, the effects become overwhelming
…a symphony of broadband noise
resonating and harmonizing within itself within our beings.
Perception is the Mother of Harmonization.
Recognition is the Father.
Their children are the players.
Improvisation is the Dirty Cousin with secrets to share,
(like the knowledge of Good and Evil
…and Jazz.)
Music is the Family that Plays Together.

Without humor, we are lost. Even gallows humor has a certain kind of optimism within it, since it depends entirely upon an audience to usher it into existence, even as we are ushered out, so as to transform it into history and legend, if only for a moment…each of us has within us, our own audience to our solitary experience of Oneness with everything. Alone in our unity, we find singular companionship.

Hope is what enables us to persevere, even into oblivion, fueled by curiosity, inquisitive challenge and mischief; it is the perverse spark that ignites the fire of everything aberrant, deviant, and rebellious, provoking the Imp and the Id alike as they encircle each other like Yin and Yang in a binary covalent orgy of fallacious cunnilatio. Ambiguous, but hardly ambivalent…God is alive and sex is afoot. Always, whether we choose to ignore it or not, zapping from pillar to post, constantly discharging and recharging alike in an instant, and an eternity, all at once. Feel the spark of the current that passes between us, thereby confirming our existence, as well as our animation. Tantric; tactile, palpable sensory sentience, the galvanic awareness of both ourselves, as well as each other, thereby confirming our ontological reciprocation. The comingling of the vapors, the moistures, and the electrons between concentration gradients and differences in potentials, always in flux as fission evokes fusion. Convergence of matter yielding energy that empowers convergence of Mind. Mutually interdependent confirmation of Existence, Life, and Intelligence. Love seducing Logic as Romance beguiles Reason. The Father, the Son, and the Holy Provocateur; God and Goddess alike, We are One

In Search of Cinnamon

Posted in Confessions of a Mad Philosopher, Memoires of a Post-Neo Dharma Bum, Much Too Good For Children, Possibly Dangerous to Everyone, Sexual Action/Adventure with tags , , , on April 18, 2013 by dreamlanddancing

Within some of the darker venues of the Sex-for-Fun Community, (especially Bondage & Discipline or Sado-Masochism) it is often necessary to establish “safe words” that clearly communicate that the line of demarcation between “fun” or “play” has been crossed over into danger, fear, or revulsion. This is a very important distinction that can only be made on a moment-by-moment basis to prevent serious injury or even permanent psychological harm…or at least that is what My Advisors tell me….

When I learned of this, I was fascinated by the idea of pushing the envelope of experience so far that one does not even presuppose that the limits are known before the experience begins. Most of my life has been spent trying to dance on the Razor’s Edge between Wisdom and Insanity, Danger and Doom, or Ecstasy and Injury, so the concept of an “Out” word was a heretofore nonexistent luxurious indulgence for any risk-taker such as myself to seek safe harbor in Stormy Times.  

For this and many other reasons too myriad to chronicle here, I do not have a lot of close friends. I consider all my dearest long-term friends to be Survivors for many, many reasons, not the least of which being their experiences with me. My intentions were (almost) always good, but when the stakes are high, even the slightest “slip betwixt the cup and the lip” can be disastrous. Inevitably, I forget to consider that we are all not necessarily reading from the same sheet of music, or dancing to the same drum….New friends are at the greatest risk. My Zeal to Communicate and my Enthusiasm to Share are often not mediated by careful or sober consideration of Consequences. I worry for them; usually after the fact….

This time, we have a “safety word”, even though we’ve not had much opportunity to really explore the limits of depravity or perversion in any way resembling our capacity for imagination or appetite…(It’s a new friendship) so our “safety word” (Cinnamon) is more symbolic of our desire to be provocative without provoking disdain or revulsion…to never want or need to look away, or to back off the accelerator, because we believe that somewhere each of us has a perfect match for our most daring and adventurous inclinations, impulses and indulgences. It is the Sexual Equivalent of Playing Chicken.

I recently saw a video on Theoretical Physics that explained how The Immovable Object and The Irresistible Force  would, by definition pass through each other…Suppose No One Blinks? No One Turns Away?

We are both obsessive-compulsives, so it is our nature to pursue our Quest even though it may lead to our destruction because if it doesn’t, we may well realize even a moment of Perfection and Bliss sufficient to Discover World Peace…each of us, within ourselves, long enough to share it within our separate worlds. Perhaps it is the separation of our worlds that allows us to indulge ourselves in the abandon of Anonymity and still be Best Friends.

A long-lost Best Friend once suggested we explore a particular Perversion together, whereupon I asked…”But will you respect me in the Morning?” She answered “You Fool! Be GLAD I don’t Respect you now…but if you’re very, Very Good…I Might….”

Cinnamon is not in the vocabulary of the Fearless, no matter how hard you search for it…and the harder you search, the more Fearless you become.


Justa Juxtaposition

Posted in Erotic Poetry, Much Too Good For Children with tags , on April 8, 2013 by dreamlanddancing

Scratch & Sniff
Snatch & Sniff
Snatch & Stiff

Sounds by Charlie Mingus
While performing Cunnilingus
You worshipping my Dingus
Come Inside and Cum Inside.
A liter of Tequila and
A bucketful of Oysters
To make us both quite boisterous
All I require is You.

Kush, Cocaine and Fellatio
Will get you by no matter where you go
It’s no accident they call it Blow
But it’s better when you Suck.

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