66606

Topeka. 

      I feel like I am getting the geography under control.  The map books really suck.  really suck.  Literally home made.  Don't understand it.  I think it has something to do with, you really should just know your way around.  It feels like the old days when a ton of responsibility was placed on your shoulders as an EMT and MEDIC.  Many more drugs in the drug box. Much more vast set of protocols. etc.  When the new GM came into town he brought his ideas to the staff and asked what they thought of them.  He, Ken Keller, asked the staff to participate in the routing plans for posts as well as stocking and staffing.  Many of the ideas are what is standard in EMS these days, very similar to the way Paramedics Plus is doing things.  The difference is that when a new entity rolled into town, he respected and listened to the incumbent staff and used their experience to better shape this new system.  I try to imagine what ALCO would be like if we would of had more say in things.

     I have yet to be held over.  When I get off at 0300, I am the 4th 'truck' available.  Typically we are cleared for end of service (EOS) at 0200, we stay on the radio until 0300. then clock out.  No holdovers so far.  

     Many of my old habits still exist here in Topeka.  Some good and some bad.  Its refreshing to have to evaluate yourself, or have someone do it for you.  After so many years it is not that hard to fall into bad habits, and really who will coach you or inform you of you slipping in certain areas.  Nobody will.  Your skills will fall off and not a soul will, or is asked to, help you out.  Occasionally after you screw up you will be put into a peer review situation.  Usually in those situations you will feel like you are fighting for your job and your performance will reflect that.  I don't understand why we can't set up a coaching situation that is not punitive.  My partner and I would occasionally ask ourselves at the end of a call, STAT or not, what could have been done better and what went particularly right.  I have found many small areas in my practice where my habits had become lazy.   I have been forced to reflect on how and why I do this job.  I truly and honestly appreciate this opportunity in my career and in my life to reevaluate and grow.

Image of the 1966 tornado that rolled through the center of Topeka.  16 people killed.

     One of the habits I apparently brought over is this.  Often time in the back of an ambulance I will ask the patient where they are from.  In Oakland the answers varied widely.  A large influx of people in the 40's, 50's and 60's from the south.  It feels like a majority of them had something to do with the shipping yards.  Many people from the North. Seattle, Portland and Canada.  Some from the South. L.A., Mexico, S. America.  I met people from Africa, a large Ethiopian, Eritrean population, people from Europe, many, many non-English speaking Portuguese (?).  It varied so much I never got tired of asking and sometimes felt cheated on STAT calls that I didn't get to know more about my patients personal life. Selfish, I know.  

     The Topeka Zip Code is 666_ _.  Love it.  When I ask people where they are from here, ONE, only one person has been from someplace other that TOPEKA, and they were from somewhere within the state.  I've met a few people who have traveled to unknown parts, some to visit and some to live, but they all have returned, eventually.  I think Topeka may be a black hole.  

     I met a guy who has lived in the same house for 63 years, every day of his life.  through floods, the 1966 tornado.  Nothing could get this guy to move.  I feel like I move sometimes just to mix things up.  Certainly staying in Oakland would have been easier.

     Lastly,  I think we should coin a word to describe a patient who calls 911 for doing something to themselves and then the expected/desired effects happen.  for example.  

- "I have loose stools for 3 days after I started taking this laxative everyday".   OR

-"My heart feels like it's racing after I smoked some crack and took some Ecstasy".  OR

-"I invited my boyfriend over, who I have a restraining order against for beating me up, He came over and beat me up".  

I'm sure we all have a million of these stories.  Please share.  I remember Moose telling me in my internship that "When you hear hoof beats, don't think Zebras" meaning sometimes the problem is right in front of your face, don't try to over think it.  I think we should call these Zebra Calls.  But I am open.

KANSAS.

We’re still on the vineyard for a couple of more weeks.  It really is beautiful.  There is a lot of work and it is HOT, but working with family is a really nice feeling.  The family has been a little excited to have us here. It feels like every weekend somebody is coming over for a show.  Truckstop Honeymoon, Split-lip Rayfield and Goddamn Gallows.

Goddanm Gallows at the Crossroads KC

Or a ball game.

   Typical training at AMR is 2 weeks. Or at least in ALCO it was.  In Topeka things are a little different.  With only 5-6 units up at a time, sometimes you have to hustle to make things work, and that’s what we do, make things work.

 

 

Pic of the new AMR paint job.  Gas not Diesel?

     We got pulled out of our 3^rd day of training to assist with a stand-by.  Easy work.  A “religious freedom rally”.  Not exactly sure what they wanted, It does say ‘In God We Trust’ on our money, what else do they want?  I saw one sign that read “Keep the State out of our Church!”  Funny, I could of sworn I saw a similar sign at an Occupy Oakland rally.  It read “Keep your Church out of our State”.   It seems to me we all want the same damn thing.  I saw another sign that read “HATERS GONNA LOVE AND PRAY” Not sure what that meant, but the young man was sure proud of it.  The Fred Phelps crew was there – The Westboro Baptist church – singing pop songs, Mariah Carey and what not.  Had no idea what that was about.  If you can stomach it the “churches” website is www.godhatesfags.com Their typical array of signs were out and I didn’t feel the need to talk with those sorry fools.

      Typical training on Friday and then we were told to report to our FTO shift.  Medically, I feel fine. Not nearly as worried as I thought I’d be.  The Geography is going to be a trick.  I remember looking at some of the new guys in Oakland and saying “It’s a freaking grid, what don’t you get about that?”  Topeka is a grid and days 1 and 2 have been a headache.  My FTO has been a medic for one year and an EMT for 2 years before that.  He realized pretty quickly that I could handle bizniss (I’ve got Town Biz on my resume, Bizrali Special Forces in full effect, those in the know, KNOW) when it comes to the back of the ambulance.  He promptly placed me in the drivers seat and sent me on my way.  I couldn’t tell which way was North or South after the sun went down.  No Thomas Guide map pages either.  They give you an address and you are supposed to arrive there within 6 minutes.  I’m getting it.  My FTO, John Noonan and I run calls a little differently, but he is a really good medic and I look forward to learning from him over the next month.  John laughed out loud at how many people I talked into going to the hospital.  Honestly all of them went, I know how AMR likes it and technically I am still new.

     AMR Topeka is now a NON-UNION shop.  The story is a little fuzzy to me, but here is the jist.   AMR Topeka was in affiliation with the Teamsters, which everybody I have spoken with, seemed to have liked.  Then NEMSA came in and changed everything and eventually and rather quickly, the workers voted to disband the union.  I am not a fan.  I have been a union man for most of my working life.  So here are some of the changes I have noticed.  I am not sure if they are union related or not but here goes.

-         NO C-7’s.  I was told we eat when we can and we don’t get paid for any missed meal period. PERIOD.  Food options in town are limited at best.

-         NO Strike Pay.  No differential for working an overnight shift. Same pay day, night or weekend.  I do have to admit that because no union was involved AMR was able to give me a pay that was higher than was expected.

-         You are allowed to clock in 7 minutes prior to shift. You are given that 7 minutes to check out your ambulance and then at your start time you have to be on your radio and available for a call.  Head Quarters is a status 2 post and it seems that dispatch is letting the crews hang out at HQ for awhile to finish the check out, but you are available for service.  Two shifts in we have been sent to cover the HQ post about one hour prior to end of shift, but you have to stay available until the very last minute of your shift.  I haven’t been held over in the first two days.

The North side of Topeka, North of the Kansas river.  It IS the bad part of town. Guess what they call it.  OAKLAND!

( I think this post got screwed up, 2nd attempt)

2nd day of training.  So What is different and what is the same?  That is the question.
      EVOC videos.  OMG soooo boring.  I couldn't help but think of Millard and Bill.  We finished the videos early and were left to ourselves to find something to do.  Four of us(3 EMT's and me, 2 of the EMT's are from the Topeka area but have little experience. Myself and Clint have no idea where we are going). We were assigned to restock some of the trucks to help orient us to how they are stocked.  In the barn today I heard multiple times "HA, only in Topeka" much the same we used to say in Oakland.  GSW to the face (shotgun slug x2), little old lady in her house, in the summer with the oven open and on, regular upon regular upon regular upon regular.  Much the same as Oakland. Really made me feel at home. Unlike Oakland 5-8 ambulances staff the streets at any given time.  Topeka has 2-4 12 hours units on a daily basis and three 24 hour ambulances, they have houses for the 24 hour crews, but unlike ALCO they are not assigned specifically to one of the houses.  They get moved from post to post and when they are at one of the houses there is an attempt to keep them there for as long as possible. After FTO time I will be placed onto a 24 hour unit.  At one point in the afternoon, 10 or so calls dropped with in about 10-15 minutes.  Calls waiting and I am standing around listening to it on the radio,  HELL.  Finally the supervisor made a move to have one of the EMT's get into a unit and go out.  Another unit had the fire department bail on them, (that sounds familiar) then had the patient slip into pulsing V Tach.  They called fire back but the supervisor and I went en route and found them about 3-4 miles from the hospital, they literally stopped in the middle of the street, had me jump out of the supervisors rig and into the back to help out.  This is more like it.  Finding the crest of chaos and surfing it into the hospital. And here is the kicker.  We went out in unit 203.  After ALCO shut its doors, AMR sent our rigs all over the country. three of them came to Topeka.  One of them had a hole on the inside and many people were curious as to how that came to be, I don't know. Unit 203 had an 'Andre the Giant has a Posse' sticker on the back.  Amazing.  Robby Willkom placed that sticker on the bumper of 05-779 2 years ago, and here I go on my first call in Topeka in the same ambulance.  I made it clear that sticker was not to come off any time soon.  They understood.  
     This is what family sounds like to me.  I love you till the end.  I may not like you some of the time and other times I do.  Sometimes I am SURE I have annoyed you more than a little, but when the chips are down and my heart is on the line, they understood.  The sticker stays and a small part of what made home, home will be treading the waters of Topeka Kansas with me.

Day One

2nd day of training.  So What is different and what is the same?  That is the question.
      EVOC videos.  OMG soooo boring.  I couldn't help but think of Millard and Bill.  We finished the videos early and were left to ourselves to find something to do.  Four of us(3 EMT's and me, 2 of the EMT's are from the Topeka area but have little experience. Myself and Clint have no idea where we are going). We were assigned to restock some of the trucks to help orient us to how they are stocked.  In the barn today I heard multiple times "HA, only in Topeka" much the same we used to say in Oakland.  GSW to the face (shotgun slug x2), little old lady in her house, in the summer with the oven open and on, regular upon regular upon regular upon regular.  Much the same as Oakland. Really made me feel at home. Unlike Oakland 5-8 ambulances staff the streets at any given time.  Topeka has 2-4 12 hours units on a daily basis and three 24 hour ambulances, they have houses for the 24 hour crews, but unlike ALCO they are not assigned specifically to one of the houses.  They get moved from post to post and when they are at one of the houses there is an attempt to keep them there for as long as possible. After FTO time I will be placed onto a 24 hour unit.  At one point in the afternoon, 10 or so calls dropped with in about 10-15 minutes.  Calls waiting and I am standing around listening to it on the radio,  HELL.  Finally the supervisor made a move to have one of the EMT's get into a unit and go out.  Another unit had the fire department bail on them, (that sounds familiar) then had the patient slip into pulsing V Tach.  They called fire back but the supervisor and I went en route and found them about 3-4 miles from the hospital, they literally stopped in the middle of the street, had me jump out of the supervisors rig and into the back to help out.  This is more like it.  Finding the crest of chaos and surfing it into the hospital. And here is the kicker.  We went out in unit 203.  After ALCO shut its doors, AMR sent our rigs all over the country. three of them came to Topeka.  One of them had a hole on the inside and many people were curious as to how that came to be, I don't know. Unit 203 had an 'Andre the Giant has a Posse' sticker on the back.  Amazing.  Robby Willkom placed that sticker on the bumper of 05-779 2 years ago, and here I go on my first call in Topeka in the same ambulance.  I made it clear that sticker was not to come off any time soon.  They understood.  
     This is what family sounds like to me.  I love you till the end.  I may not like you some of the time and other times I do.  Sometimes I am SURE I have annoyed you more than a little, but when the chips are down and my heart is on the line, they understood.  The sticker stays and a small part of what made home, home will be treading the waters of Topeka Kansas with me.

first day-eve

     I said before that it feels like I am speaking a different language than the people of Topeka, sometimes.  Today is Saturday,  I start work on Monday.  Training really,  WORK will start a week or two after that.  It's an amazing feeling to be new at a job, but come in with such high expectations. It seems everybody I have spoken with from AMR Topeka, has at one point said, "Oh, you're the guy from California."  I know that I know what I am doing, but there is still some pressure to perform.  I think that actual medicine is probably 20% of what we do in Paramedicne.  I think the other 80% is personal relations with your patients, the community, the police, the hospitals, your co-workers and who knows who else. Confidence in who you are and your abilities is essential on scene and in the the back of an ambulance.  I will have to find a nice balance between the 'Yes sir, No Sir' culture and the confident, command of a scene that is required to succeed.  Honestly, I think this will be exciting and only make my medicine better.  I am really starting to get excited.
     I went into the AMR Topeka HQs yesterday to handle some paperwork, uniform fitting, they also do a physical test prior to starting work.  So lets start with the similarities to ALCO, especially AMR.  My didactic with NCTI and my internship were a very difficult time in my life.  Possibly the most difficult thing I have ever had to do.  To many things in the air, trying to juggle to much. Literally the day I got my Paramedic card in the mail, I showed up at AMR ALCO and applied for a job.  Truthfully I had been there a week prior and picked up an application. I met Katrina Kover that day.  She grabbed Josephine from me and held her while she answered my questions and gave me the application packet.  After all I had gone through to get to this point I was immensely intimidated to take the next step. Katrina made me feel at home in a place I was terrified to be.  When I walked into AMR Topeka yesterday, Mina and Melody had made me a hand made gift/welcome basket.  It was special and touching. I felt that 'home' feeling again. I have uprooted my family and left the only EMS world I had ever known to arrive on their doorstep. I can't explain how comforting it was to have Mina and Melody on my side. On the first day they knew who I was and where I was from.  They went out of their way to make me feel welcome and ease the transition.  Thank you to all three women.
     Mike Taigman, a very busy and very intelligent man with a lot on his plate.  I remember the first time I met him.  Mike looked me in the eye and listened too what I had to say, then very slowly and methodically answered all my questions.  If you are patient, Mike will unleash a wealth of knowledge on you.  He won't force it down your throat, but if you wait, shut up and listen, you will not believe how much you can learn from this man.  Ken Keller is similar and different.  If you give Ken an inch he will talk your ear off.  Ken is a very busy man with a lot of things on his plate. Ken excused himself from his busy day and walked me through the entire operations. He showed me the workshop, the offices, he explained the airway bags and the system in general, he showed me two of the three ambulances that got sent over from ALCO  (I couldn't immediately recognize which ones they were). Ken spoke the entire time.  Just like Mike, if you are patient and willing to listen, it will be worth your time.
     The last thing,  I am meeting people here everyday that have helped me and my family get to Kansas.  I would like to thank each and every one of you.  Thank You.

Last Day In ALCO

     The ball is rolling so fast now.  Really It's kind of done rolling, this thing is done.  I wondered and worried about my "last day".  I've heard so many stories about how people went out.  Traumas vs 5150's.
      I was able to pick up an overtime shift with Robby Willkom.  My first day ever in EMS was with Robby and Rich Riggs roughly 6 years ago.  If I remember correctly, I showed up at ProTransport a little before 0500 to find Rich and Robby slapping the shit out of each other with zip tags.  Little did I know then how much sense that would eventually make.  We went out on this BLS ambulance and honestly the most memorable part of the day was the Subway we got in Berkeley.  I do remember that day, the ever so slight hierarchy in the ambulance.  Robby drove and Rich sat in the passenger seat.  I sat in the back with my face poking through trying to figure out what we were doing and who these people are.  I ended up doing a lot of ride alongs and had many, many people jamming their face into the front with, I'm sure, similar thoughts about me.  I tried to keep in mind my feelings that first day whenever I could.
     So Robby and I got to go out last night.  I tried hard to not whine while at work, and the folks who throw temper tantrums about being in a particular zone, kind of bug me.  You are at work, just go to work.  Last night dispatch sent us to Hayward, we complained and explained and amazingly enough we were sent shortly to Oakland.  What would be in store for us while we were there tonight.  Coincidentally Rich Riggs called Robby chat about other stuff.  We tried talking him into jumping on and riding along with us tonight, he declined.  I got nostalgic about silly things.  I am going to miss the 'what are we listening to?' game. ( the answer is always the same, ' I'll listen to anything', they won't.) driving down Broadway and being stuck in the traffic, the crowd at the Paramount.  I wanted to eat at every place I'd ever eaten. Coffee at every coffee shop.  We ended up a little over caffeinated.  Without specifics, we ran 6 calls,  an average night for a Thursday in The Town.  I knew half of our patients by first name.  I could have seen anything tonight. I think this was an appropriate way to end a journey.  I was able to say goodbye to OFD, my partners and co-workers as well as my regulars.
    I don't think I can explain how much I have loved this town.  If you know me you know I can go on for days about the specifics that I adore.  I will say that this Town is not perfect, who is?  Nobody has ever been fool enough to think it is.  I love the willingness Oakland has to try, frequently fail and occasionally blow the worlds mind.  I will miss what this place has given to me and my family.

I was born in L.A.

I was raised in Arizona

I left home and moved to San Diego

I visited Memphis

I became independent in the nightmare called NYC

Seattle was just a dream

I became a Husband and a Father in Oakland

I think Kansas will be enlightening 

On the last day of November in 2011, I worked my last day with Alameda County AMR.  That night I arrived at Paramedics Plus and was the first paramedic unit in the streets for them.  Johnny Gonzalez and I hold that honor.  I spent last night, approximately 5 months after the transition, at ANOTHER going away party, mine.  It is tiresome to say goodbye to good people on a weekly basis.  The AMR crew was, and is my family.

     So here I am 2 weeks away from a new job with a familiar company in the center of the State that is the center of the country.  Topeka here I come.  I think what I want this to be is a open book for my ALCO family as well as a fresh eye for my new AMR family.

     My fears of leaving everything that I have here runs deep.  I feel that I have a comfort zone here, with people I know and trust to bounce crazy ideas, go over calls, etc.  I know Oakland like the back of my hand.  I have not gone through a day in over a month where I didn't know at least one of my patients.  I don't know any other world.  I have been shot at, sort of.  I have rolled in a side-show with my ambulance, whoops. I have been attacked by dogs and people. Nobody has tried to eat my face, yet.  I have never flown a patient out with a helicopter, that sounds fun.  I will miss this place like you miss an abusive step-father.  I will miss the way 586 handed me my ass on a nightly basis. I will miss getting flipped off, while driving code 3 to a call and enroute to a hospital.  I will miss John George Pavilion and the way they treat the ambulance like a burden on themselves. Actually, I'm not going to miss that, all that much.  The FNG's, I am sure will rest a little easier knowing that I won't be in a desperate panic to get to 10th and Clay to show them a new restaurant that just opened.  Cochesa has some LEGIT pozole.  I will miss the late night bull sessions at Highland hospital, handling 5 different posts from that parking lot.  I will miss the confidence I had in bringing truly emergent patients to Summit and Highland and knowing I am placing my patients in great and capable hands, even if I might disagree with what they are doing.   I will miss the history I have with the staffs to speak my mind and be heard.  Suffice it to say, I will miss this place.
   
     Expectations.  Wow.  I've spent more than a few sleepless nights with theses thoughts in my head.  I am pretty sure it will not be as busy as Oakland, probably a little more like South or East county.  I have been told that they do not 'fly' a lot of people.  OK.  I imagine that people are people and they will get sick and I will arrive to assist them to a hospital.  I worry that I will have a difficult time communicating to a rancher/farmer from Kansas that has never met a California kid like me.  I have assessed people in my limited Cantonese, Spanish and Hyphy.  Will I be able to communicate the same way to the people of my new home?  We'll see.