The Book: Dancing In Dreamland

Dancing in Dreamland: The Book

Memoires of a Post-Neo Dharma Bum
and
Confessions of a Mad Philosopher

                            Chazz Vincent

Table of Contents

Prologue
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
Introduction
Freedom
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
Déjà-What?
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
Arrival
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
Love/Hate
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
Outlaws
Your Standard of Living
Impermanence
Until You Can Remember
Faces of Death
No Way to Treat a Lady
No Last Kiss
We Own the House of God
Transfer Logistics
Rewind
Improvise, Adapt, and Overcome.
Logistics, Logistics, Logistics
Or Else
Re-Animation
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
Diversion
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
Zero
Post-Neo-Survivalist
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

Prologue

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 toFrank 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
Moment.

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
And
Eternity

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
Holocausts
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.
Introduction

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
Dangerous,
Noisy,
Inefficient,
Disorganized,
Irresponsible,
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.

MODES OF TRANSPORTATION OF THE SICK AND INJURED.

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.

Déjà…what?

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
return?”
(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