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Sunday, November 15, 2009

The week in review

So I’ve spent the last few days at the NJ State EMS Conference in Atlantic City. I have a love/hate relationship with conferences (of any type), mostly because I am not as much of a social creature as many would believe. However I do love the opportunity to get away from life in general for a couple of days and there is something to be said for a quiet hotel room and the ability to order room service.

They had some national level speakers there this year, which was fortunate for me. Having seen the names in print so often, it was interesting to hear the actual voice behind the text. Dr. Bledsoe offered a review of the recent research regarding prehospital intubation. While I approached the topic feeling defensive of my own abilities and with a sense of dread, it was hard to argue the science being presented. I walked away with an appreciation for the situation we’re currently in regarding our scope of practice and a sense of futility because I do not know if we can truly surmount the issues at hand.

For the record, he remains an advocate of prehospital intubation – but there are significant issues in education and competency that should be addressed if we’re truly to be the apex providers in the skill. Skill dilution, O.R. competition, and competency evaluation – these are all trends that we already recognize and know to exist; we can’t pretend that they do not. Yet we see it all the time, we are all guilty of treating the yearly competencies like a joke. Or perhaps we take steps to avoid the skill, or turf it to our partners if we’re unsure. If we do not take ownership and work to become experts on an individual basis, we have nobody to blame but ourselves if future generations find the ability taken from them.

I also had the opportunity to see A.J. Heightman speak for the first time. If you do not know the name then you’ve never picked up an issue of JEMS magazine. He was animated and down-to-earth, I enjoyed listening to him. He did a talk on management lessons taken from the TV series M*A*S*H. It was humorous and injected with anecdotal experience and real case studies that were applicable. While I cannot say that I learned a lot of anything new, it was thoroughly enjoyable and I truly appreciated the analogy. He also spoke at one of the lunch presentations, on professional image. I think he did a very good job pointing out just how much perception people can get from our exterior appearance and practices.

Dwain Pegues spoke on recreational drugs that was, not surprisingly, very well attended. He is a terrific speaker, and it was fun. In fact when his time was up he still had more information, so more than 2/3 of the room didn’t even bother getting up – we listened until they kicked us out.

Dave Langley & Dr. Brabson spoke on the new STEMI Triage Guidelines, which are official as of well … yesterday. It’s exciting to be part of the vanguard that introduces a new practice. This is the first new protocol in awhile that can really, truly, without a doubt, save lives if enacted properly. Based on the Trauma Triage model, it shouldn’t be too hard to adapt and hopefully we will see a difference for people who might otherwise die from an acute myocardial infarction.

Vinny Cisternino did a great talk on Hyperbaric Oxygen Therapy, focusing on treating for Carbon Monoxide poisoning. I can say that I learned the most new material here; it was interesting and also cutting edge as far as monitoring goes. It made me want to go research more on when to suspect possible exposures. (Even if Macs don’t appear to have spellcheck, it was still a pretty presentation.)

Entertainment-wise most of us stayed at the Tropicana. While commuting to the Sheraton is not always convenient, it’s less expensive and there’s plenty to do there. Plus who can say no to an Irish Pub right on premises? Ri Ra’s made a lot of money off of everyone. Thaedra introduced me to Irish Car Bombs, evil evil woman that she is. Jason Manes, Dave Strange and I had an absolutely fantastic meal at P.F. Changs and then Dave and I tried out Cuba Libre’s the next night. It was really great food and terrific conversation, it was so nice to be able to do that.

The M*A*S*H Bash was a really good time. I would’ve liked to see a better turn-out; hopefully we can manage that for next year. The guys put in a tremendous effort recreating the “Swamp” and the detail and scale were amazing. Klinger (Tim Brown) arrived dressed for an afternoon tea, parasol and hoop skirt impeccable. Sally was most gracious to her fan club. MB is always a blast to spend time with and it was great meeting new folks as well. The surprise of the night was Mike Stitley, it was so awesome to see him after so much time. If they do it again next year I hope that we can really make it another great time.

I guess that about sums most of it up. I think a lot of people forget that one of the advantages to conferences can be just reconnecting with your peers. Friends and former co-workers who you have not seen in awhile, but with whom you share a fraternal bond that remains. You can pick up the threads and catch up, share some good food and conversation and become richer for it. Walking away with memories and new friends, as well as a CEU or two, is really not such a bad way to spend a couple of days.

Maybe I’ll see some of you at the next one.

Slainte’


Saturday, November 7, 2009

And then the big brown dog came ...

Warning: if reading about my desk or any of the other emotional topics I’ve ever posted about have upset you or made you cry – turn back now. This is your only warning.

Every once in a while I will go to ridiculous lengths to do something nice for someone I care about. Chris wanted a dog. “But you have dogs, don’t you?” Why yes, yes we do. The reality is that they are my dogs, there’s really no mistaking that. They sleep at my feet, follow me everywhere and I am quite certain they exist secure in the knowledge that on some days I am the only thing between them and a well-placed bullet (if you ask my husband). So, daddy wanted a dog of his very own. One that would be devoted to him and he could have by his side and not consider canine homicide.

While at work one night we were perusing breeding websites for Presa Canarios, the breed that he was really interested in. Expensive and difficult to get we were just window shopping. After all, we’re more of the “yank from the jaws of certain death” type. Most of our wee beasties are from shelters or dumpsters. In a moment of pure serendipity our friend Vashti happened by and looked over our shoulder and said, “Oh you like Presas? My friend and I just bred a pair.” We went to see them; there were two left, gangly creatures with monstrous paws and velvet-covered bricks for heads. As exciting as it was, we discussed it like grown-ups and came to the conclusion that even at the reduced price she was kind enough to offer that it just wasn’t a good idea. Or at least that’s what I let him think.

Within a couple of weeks I had the covert operation all worked out. I brought Heidi in on the plan, it was the first significant secret we got to share and she worked hard not to slip around her father. Under cover of a trip to Morristown on an errand I drove a bit further and picked up this hulking chocolate brown puppy. Tucking her safely in the backseat I promised her a good life and headed home, where the kids were waiting to help me surprise Chris for our anniversary with a puppy of his very own.

On the hour trip home, I suppose she named herself. Little whines of trepidation turned into crying, the car ride did not agree with her young constitution. A short time later the crying turned to that grunting sound that equates to doggy retching. By the time I crossed into the Delaware Water Gap she had managed to fill James’s car-seat with partially digested Puppy Chow and she had earned her name – Banshee. For bean sidhe, the wailing Irish spirits of legend.

He was surprised. He fell for her big brown eyes and now had a dog of his very own. The other dogs didn’t fall for her quite as quickly. In fact within the first week they had lured her out into the woods and left her there, presumably in the hopes that a bear or other unlucky family would find her. We found her huddled under a tree, waiting for daddy to come save her.

Presas are territorial creatures and Banshee was no different. We were her family and this was her home and intruders were treated with suspicion and adolescent hostility. It was difficult for a time, trying to teach her who not to try and eat, but she did eventually figure it out. Except for the UPS guy, up until the end she still hated the UPS guy … She did not like being left alone, even on the nicest days when you would think all a big brown dog would like to do is lay in a sunbeam and enjoy the weather. Sure she liked that just fine, so long as she could see her family.

She filled out to an impressively muscled machine, yet never figured out just how strong she really was. This was likely a blessing to the other dogs, she was always bottom on the totem pole to them and even when she could have beaten them soundly she did not. She was gentle with the children, always – except maybe Owen who liked to roll around on the floor and wrestle with her until she was dragging him around like a favorite chew toy.

She hated the rain and the snow and would go on strike about going out in inclement weather. She could hold it for hours and hours and hours if it meant she wouldn’t have to put her butt in the snow or stand in the rain. Despite her physique her favorite activity was sleeping, she was an expert in four things – eating, drooling, sleeping and guarding the perimeter as our whiskey-tango security system. Oh and barking, always the barking. Even Meredith learned “Banshee shut up!” as one of her first sentences.

Above all, she was daddy’s dog. She could hear his truck before anyone else, she listened to him above anyone else and when the day was done she would curl up in a ball at his side and stay there until he awoke. She always had to be touching him when she slept, it didn’t matter what you did – even when you never saw her moved she would somehow scoot across the bed so that she was touching your leg or back, sleeping soundly (and yes snoring) with her velvet-covered brick of a head tucked in snugly at your side.

A few short months ago she was outside and if you can imagine this ... barking. All of a sudden she yelps with pain, as if someone had just struck her. I was looking right at her when it happened, there was nothing I could see that happened yet all of a sudden she couldn’t put weight on her front paw. It got better for awhile but then the joint blew up again. Chris took her to the vet; we anticipated an injury or more likely Lyme’s disease. A few hours later he calls me, incredulous. “How do you feel about osteosarcoma?”

Bone cancer?!? She’s five years old! She’s in her prime! You’re kidding me right? No, no they weren’t. Turns out it is more common than we thought, especially in large dogs. It’s aggressive, it travels and the options are heartbreaking. We could amputate the front leg, to the tune of $2000 and maybe buy her a few more months. We could add chemo to that, for a few more thousand and perhaps buy her more time but likely not. In 90% of cases by the time you can see it on X ray it’s already traveled and also to the lung. We were stunned and heartbroken. Without treatment, two to four months at best. The best option was to make her comfortable and ride it out as best we could.

Piece of advice? Don’t research canine bone cancer on the internet, it will devastate you. Google is not always your friend.

Ignorance of course is bliss in its own fashion; she had no idea what was wrong. She would just adjust and carry on. First on three legs, she still found the energy to guard the front porch. Within a few weeks one of her back legs began to fail. On two legs she became unsure and for a time we thought that her perhaps the end was looming so much sooner than we anticipated. Then one afternoon she climbed down off the couch, steadied herself (fortunately the two working legs were on opposite sides) and headed out the back door. Head up, tail wagging - it was business as usual and she was Hoppy the wonder dog. She got up and down the stairs and still curled up in her dogball at the foot of the bed. It wasn’t to last though, the insidious disease was relentless and was taking her abilities from her.

The children knew she was sick, we do not lie to them. They would bundle her in blankets on the couch and spend hours with her, just like she had always done with them. Curled up on the couch, you could almost forget what was going on, as they would assume their favorite positions with her and watch TV, idly feeding her all the choice tidbits from their meals without fear of reproach. As she grew weaker, they were all active in helping us with her. Watching my son coax her into drinking small amounts of water or broth or listening to Meredith tell her about her day would send me scurrying for a private corner to cover my tears.

Finally both back legs failed, though she would still try if you asked her. This absolutely magnificent dog was reduced to being carried like a child; she could no longer climb the stairs or share the bed. She could not patrol her yard or even pull herself up to look out the bay window. But if you asked her she’d pull herself up, she would try to obey and then look at you in confusion as her withered limbs would not cooperate. Most telling of all was that she could no longer bark. People could come and go and at most she would give a strained cry to remind us that this was against the rules, but she could no longer do her job.

Growing up she was always putting her giant head on your lap, usually to try and use her mental powers to get you to feed her. But she would be content to just lay her huge head there so you could stroke that incredibly soft fur. One morning as I was cleaning her with some warm water, she pulled herself over to me and put her head in my lap. I looked into those huge brown eyes and I had no answers for her. I knew that her time with us was almost done.

Banshee lost her fight on a dreary, rainy autumn night. My husband has lost one of his dearest friends. Her chain still lays on the deck, half-hidden under piles of dead leaves as it hasn’t moved in some weeks. The doghouse stands abandoned; the other dogs never had any use for it, it looks like a sad little hovel. The yard is silent. The other dogs bark of course but that whining litany what would say, “Daddy let me in, I don’t want to be by myself” is now over.

The children are old enough to understand death now; they are trying to make sense of the loss. About why we couldn’t do anything about it, why did it have to happen. Having them focus on happier memories seems to help, pictures and stories and above all – the fact that she isn’t in pain anymore, that that is a good thing.

“Mom, I wish Banshee didn’t have to get cancer.”
Me too buddy, me too …

Rest in Peace Banshee
2004 – 2009

SEPARATE LIFETIMES

We who choose to surround ourselves
with lives even more temporary than our
own, live within a fragile circle;
easily and often breached.
Unable to accept its awful gaps,
we would still live no other way.
We cherish memory as the only
certain immortality, never fully
understanding the necessary plan....

--- Irving Townsend ---
"The Once Again Prince"
Owen and Banshee.
 And then the big brown dog came ...
 A boy and his dog
.The newest addition.
 Oh the humanity!Storytime
 Now I lay me down to sleep, a big brown dog at my feet.That was some good cake.
 

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