All the World's a Stage

“There are four ways, and only four ways, in which we have contact with the world.  We are evaluated and classified by these four contacts: what we do, how we look, what we say and how we say it.” ~ Dale Carnegie

On the short list of advice I would consider truly valuable to a person newly entering EMS as a career field is this:  “Never get involved in a land war in Asia.”

No, wait … wrong venue (though you get extra credit if you know the reference) – it’s really this:

“Every day that you are out there is one long job interview.”

Regardless of what area of the country you work in, EMS by design is a small field.  Whether the distance is measured by county, region or state, the gap between you doing something epic (good or bad) and the people on the other end of said area finding out within the week (or day) is actually pretty small.

That was true before there were smart phones and YouTube.

One of the tried and true cautionary adages for anyone working the public sector is that you never know who you are talking to, or performing in front of.  It is short-sighted to think that prudent behavior should be reserved solely for the public eye.  Just as true customer service applies to everyone you interact with – including your co-workers, so does your reputation.  To act as if what you say or do in the “privacy” of your truck, station or any other sort of quarters you inhabit does not have a direct effect on professional perception of you is profoundly naïve.  It will likely become an unfortunate lesson for you at some point in your career.

Why is that?

EMS is part of the Emergency Service eco-system and in such an in-bred subculture there is very little you can do while working that will not create ripples in the professional gene pool.  The area you work in may be different, but in my experience it’s rare to find someone who works only one department – or at the bare minimum, have friends or family in multiple departments across multiple branches of service.  

To enjoy some longevity in this field it’s important to realize that the person sitting next to you today may be the one across the table from you when you need a job next month – or next year, or five years from now.  If you do not think that your actions on everyday routines is not being noted and mentally filed, think again.

We function in a tiered system, a hierarchy by design.  Each rung of the ladder has those that struggle to reach, those that hang on but never get a foot up and those that climb it with ease after some practice.  Every level has eyes upon it.  If you are a sloppy EMT with poor skills who becomes defensive about correction, you are going to end up losing valuable learning opportunities and chances to be coached into becoming a better clinician.  Perhaps you will find yourself having a difficult time entering a paramedic program.  If you are a lazy paramedic who revels in doing the bare minimum, then at some point you may find it very difficult to gain additional or new employment, even though you carry the same card as everyone else.  When you attend educational programs, do you show up on time, prepared, engage in the class?  Those classes are often taught by the people who will make the decision if you’re worth an investment later on.  Where on the ladder are you?

This scrutiny and its effects holds doubly true for paramedic interns.  You should bring your absolute “A game” to every one of your clinical hours.  If you think that as the student you are beneath notice guess again – hiring a brand new medic with no mileage on it is a true gamble.  Especially if that medic did not come from within the system and you have no idea what their performance ability is.  Rest assured however, your preceptors know exactly what you are (and are not) capable of.

None of this has anything to do with your direct patient interaction; the average person really has no idea what the true quality of the emergency care they’re receiving actually is.  I know quite a few EMTs and Paramedics who are absolutely beloved by their patients and other agencies because they are so nice and accommodating in person.  Yet behind closed doors these people rarely come to work on time, uniforms are incomplete or optional, they do not check their vehicles or follow SOPs regularly, they only take education that they are absolutely required to and that is under duress – is this starting to sound familiar to anyone?

While having coffee at shift change at my part-time employment a couple of years ago, I waited for my relief to come in.  There I am in a line position, with the same responsibilities as anyone else.  This was a newly certified paramedic – as in brand new, first shift as a second.  Ever.  They walked in late, uniform undone, boots unlaced and from the moment they came through the door they complained about having to be there.  This was followed by an indignant rant on how they were not given the shift assignment they wanted.  There was no move to take report on the truck, or even obtain the keys and radio and make a suggestion that they might be planning to at least check their vehicle out.  Most of my interactions with them since that day have been in a similar vein.  This person is always looking to take the easy way out, shortcuts wherever they can find them.  There is no drive to be anything more than the minimum necessary.  

In my full-time job my role is a little different and I am one of the people responsible for hiring.  Fast forward this unfortunate interaction a few years and now that same person is looking to me for work.  As much as nobody likes to be the bad guy, the reality is that hiring someone is an investment of money and man-hours.  Just like any other type of investment you have to look for the best return you can get.  Needless to say that person was not a successful candidate, the person hired in their stead had less experience but far more drive and is moving forward with developing this as their career versus just a job.  It is not always enough to be a good provider, this is a profession and if we are to be treated as such then the realization must be made that you need to be a good employee as well.

If you are familiar with the idea of “six degrees of separation” (or Kevin Bacon) then you know that it is the concept that everyone is six or fewer steps (by way of introduction) from any other person in the world.  If you know EMS then you know our degrees of separation or even shorter – down to two, maybe one step away from knowing someone who knows you.  People in the position to hire or advance you have usually been in their respective field for longer than ten minutes, in all likelihood it is more than ten years.  This means they know A LOT of people, probably more than you do and certainly enough to get some decent intel on what you are *really* like.

We interview dozens of candidates a year, reputations notwithstanding.  A poor work reputation is not a death sentence, merely a burden or obstacle toward professional development.  Poor reputations can be overcome with time, effort and someone willing to be objective and honest.  We often take on people with “baggage” from other departments because we know what the issues are and if they demonstrate enough value then very often a clean slate and new environment is just what the doctor ordered.  However that is not as easily done when you have direct knowledge of someone regularly engaging in the exact behaviors you are looking to avoid in your hiring.

Any advice I have for interviewing is not much different than you will read in any number of professional development articles – be on time, dress well, bring your documentation, prepare your answers, do your homework and have some questions in return.

But in this very small field, what do you do when you find yourself sitting across from someone who you know might not have good reasons to hire you?

Own it.

From the moment our fledglings walk into orientation we tell them the same thing – be honest at all times.  Own your mistakes, be accountable for your behavior, do not push something you’ve done off on a pallet of weak excuses.  The same holds true if you know you have a poor track record.

Do not avoid it; if the subject comes up discuss it objectively.  Answer questions fairly, do not shift blame.  Accept the onus that comes with it and make clear your intentions to avoid repeating those same mistakes in future.  Make the person interviewing you believe that you if given the chance you will prove that while you may have baggage, nobody else has to carry it for you.  That given the opportunity, you will be a good investment – a solid provider AND employee.

Own it.

The rest is easy.  Once you’re given the chance then you come to work (on-time & in uniform), be nice, take sick people to the hospital and then go home.  The rest will work itself out with time and consistency.

Please take this as a cautionary tale.  Evaluate your work habits – are you a good employee, or just a good provider?  Look at your interactions – not with the patients, but with those you must work with and rely on to be there for you.  Is your job performance a reflection of your attitude and do you want it to be indicative of who you are as a provider?  Are you looking to move elsewhere in the field and what is your professional reputation going to do to help or hinder that?

My very first job offer as a paramedic occurred before I ever had a card.  It was as I exited my clinical test for National Registry.  I was sitting on the steps, trying very hard to keep the anxiety attack at bay and maintain my composure now that the practicals were done.  One of the evaluators (not mine) came and sat with me, we’d never met before that day.  After he finished talking me off the ledge, he introduced himself as the director of a paramedic project about an hour away – he shook my hand and told me when I had my card, I had a job.

I was taken aback; I thanked him and said, “You don’t even know me.”

His response was, “No, but the people whose opinions really matter do.  Keep up the good work and call me when that card comes in.”

I never forgot that.

What's in a Name?

"What's in a name?  That which we call a rose

By any other name would smell as sweet."

~ William Shakespeare, Romeo and Juliet

This is my 25th year working in the city of Newark; officially more than half of my entire life has been spent working alongside some of the best providers in the history of this still relatively young profession.  To work in Newark, to succeed at working in Newark, is to have it become ingrained as part of your identity.  Even those long gone from our department still wear it proudly somewhere on their person - whether it’s as obvious as a shirt or as subtle as a different perspective on the world in general. 

You cannot see what we have seen and remain the same.

To the outside world, misconceptions swirl around us in murky eddies of grudging respect and poor assumptions.  People are often surprised to find out just how much medicine we actually do and how quickly we can do it in.  Necessity is not only the mother of invention; it is the rock on which we hone our skills shift after shift.  In this environment we are given no other choice.

Do or do not, there is no try.

Please do not misunderstand, my rose-colored glasses shattered long ago.  We are not a department filled with saints and prehospital paragons.  We fail as much as we succeed in all arenas; there is no pretty picture here.  It is a ghetto, it is violent and it is poor in many places, our trucks are often held together with more hope than screws, hours are spent on street corners, the clientele is often more angry than grateful, the living conditions we enter range from executive to horrific, we do not get slurpee machines or warm receptions at the ERs - and it never … stops.

Still we come back, shift after shift, each one changing us just a little bit more - a fraternity forged in filth and exhaustion, picking each other up time after time (even if we do not like each other).  Eventually you find that despite it all, you are given three remarkable gifts. 

The first is experience, period.  A year spent in Newark is equal to five years or even more spent working somewhere else.  For sheer volume and patient contact alone, this is professionally invaluable and if you use it to your advantage it will make a tremendous difference on the type and quality of provider you are. 

The second is fraternity.  When presenting our department to the city not too long ago our Director, John Grembowiec said “We are not providing you with a service; we are providing you with a system.”  You are now part of something larger than yourself that relies on your individual performance while wearing the uniform in order to carry it forward.  You were given the patch to wear, yet every day you come to work you earn it over again in some fashion.

The third is a gift you will not immediately recognize, but one that will grow on you slowly - deepening with each turn of the season until it is a part of you.  That is the gift of an entire city that you will come to claim as your own.  A city with a remarkable history, defunct canals and ghost-laden ruins, centuries-old cobblestones and scars from riots - three and a half centuries of all the good, the bad and the ugly of America, yours for the exploring.  You will know this city better than your hometown, become invested in a geography not your own because it will make you good at what you do, and in the end because you want to.

That is what it means to work in Newark.

What does this have to do with names?  It means that as pointed out elsewhere by Dan and Terry, the change in our name and our patch does not change who we are.  I have worked under the “UMDNJ” logo my entire time here, yet by and large it means nothing to people outside of the area.  Yet “I work in Newark, NJ” gets their attention every time.  

UMDNJ brought an era of growth to a scarred city; it is (was) the single largest employer in Newark.  It became synonymous with trauma care and has provided the administrative umbrella under which we have worked hard to become one of the most comprehensive EMS systems in the state, if not the country.  Things come to us when we need them; UMDNJ was that for the city and for us.  It is time to close the umbrella; we are strong enough to withstand the rain on our own.

Tomorrow I will go to work and those big red letters, which have served as a beacon for so long, will be different - that will make me a little sad.  I will drive past the place where NorthSTAR first landed and I will cross the same rocky parking lot that I have since 1988, go into that “temporary” building I walked into when I was still 18 years old and have the same opportunity I am blessed with every day I’m there - to work with some of the best in the business doing a job I sincerely enjoy. 

I am not a patch, I am not an ambulance driver, I am a Paramedic.  I am not UMDNJ, I am not University Hospital, I am Newark EMS.

Damned glad to meet you.

Sea of Blue

 

A lifetime ago, when I was brand new - entering a fledgling profession in an impossible environment, I walked into a sea of blue. Industry icons even then, if you wore the patch then it meant something. It meant you were expected to be resourceful, thick-skinned and better at your job than the average person. If you could manage those things, you found yourself standing on pillars of strength found nowhere else, and a wall of blue at your back when you needed it the most. If you could not manage those things ... well then you would either get better or get out.

It's all well and good to talk about "the good old days" but they weren't better or worse than now, just a different dynamic and a different generation. Because we were forced to work without a lot of resources, we made our own - we were our own. You did not have unit tracking, you had peers who could reserve a portion of their brain just for keeping track of where all the other units were - if you called for help someone had paid attention. If you were going to a disreputable location, there was no concern that you would be alone - another truck would slide silently up and wait quietly outside, just in case. If you screwed up (and we all did), you faced the gauntlet of blue that let you know in no uncertain terms that what you had done was not about you - but a reflection on everyone dressed just like you. And that ladies and gentlemen, was simply not acceptable.

We were the leaders in the field, the state. We didn't go to conferences, we hosted them. We wore our battle scars proudly, demonstrating clinical expertise that was hard won. It didn't matter what the outside world thought, because we knew what we had to do to get through each shift and we expected the person sitting next to us to do no less. It was a fraternity where the expectation was excellence and being a part of it meant you had earned some swagger.

If you wore the patch it meant something.

Time marches on and with it comes change. The generations and priorities change, procedures and practices change even though the job itself does not. Frustration from within and without takes its toll, and apathy and exhaustion erode even the strongest landscapes. Faces come and go in rapid succession and the old guard is too weary to lift its head to invest, the bar begins to lower under the weight of having to carry all these strong spirits faced with adversity from all sides.

Over time it has lost its meaning, becoming merely part of your uniform and no longer a facet of your professional identity. We have been looking for meaning that has been lost, buried under a pile of bureaucracy and trapped in the throes of a struggling institution. Despite all that, the job has not changed and neither has the patch - the morale and camaraderie is a completely different story. In losing that we lose our pride and some of our strength.

When Billy said he wanted a team in the METI games, it's nothing we hadn't considered before. Previous feelers met with apathy and this is something you cannot force people into doing (except maybe for Glenn Vogel). Then we got contacted by OEMS who said that they had almost no competitors registered and would any of the projects step up to help. Shortly after he put the email out asking for interest, I got contacted privately by someone who was interested. It was not someone I would have considered as being interested, but they said they felt that this is just the thing that would be a "shot in the arm" for the department and they wanted to throw their hat in and try.

Before we knew it, we had eight teams willing to give it a shot and the games were on. All of a sudden it was the topic heard everywhere; with us trash talking on the inside and the people on the outside looking on in absolute surprise. We were the buzz around the state ... and not for a bad reason.

These guys came on their own time to practice, studying protocols and doing sequences over and over again, trying to do it better each time. And with each passing week, there was more support from both inside and out. NorthSTAR opened the hanger and spent hours working with their simulator and then with the teams, working together and bridging the natural distance that often happens between us and the flight team - even though we all wear the same patch.

As this week grew closer the support became even more palpable, people long gone who had worn the patch offering words of encouragement and support and resurrecting the sense of pride that we all once shared.

Thursday morning, with the sun barely over the horizon, the gallery opened for orientation. When Billy and I walked in there what we saw was a sea of blue. Eagerly clustered around the simulator, they mauled it and hammered the technicians with questions. I'm certain it was overwhelming to the other teams, I know I would be.

Professional, squared away, obviously taking this seriously. As Bill and I stepped back and looked on, an unbelievable amount of pride swelled up in me. One of the people from the state came and stood by us to watch for a moment. We said to him, "those are our kids." He looked at all the blue, all those patches moving over the simulator and all he could say was "That's really f***ing cool." He's right, it really was - and we hadn't even competed yet.

The rest of the day was a blur, a flurry of non-stop activity. As we were learning the flow and preparing the first team to go on, as I was pinning the mic to Joe Sapienza's chest I kidded that it was like getting your kids ready to go to prom. It really was more like working backstage at a Broadway show, with so many teams we had to get them out, restocked and the next ones set up and in, ready to go.

When the first team went on it was a new experience for every one of us and we had no idea what to expect. As they moved through the scenario, I don't think we could have grinned any wider. It was immensely satisfying to watch our guys go in there and settle in and roll with each quirk of the simulator and the situation presented. Supporters moved in and out of the viewing gallery all day. Dr. Scott made it a point to stay for every team; her grin was even bigger than ours. By the end of the day the viewing gallery was packed. As teams came out the sea of blue would roar to life in support, team photos and smiles all around. They mingled with the other teams, making new friends and proving that we're not unapproachable or anti-social.

Team Honey Badger set the mannequin on fire. Brick City Medics electrocuted it and made a pretty light show. The Little Bricks threw the wrench in the works by speaking to the hostile bystanders in Spanish. Team Angina held it together in the face of some unprofessional behavior and provided awesome BLS care. Every single team went out there and did their best; it was obvious and great to watch. The whole day will be one of my best career memories.

At the end of the day, two of our BLS teams occupied spots in the finals. While the ALS teams did not place, the judges said that the scores were extremely close and the results were determined by a matter of mere points. With only a few weeks to prepare, no simulator experience and wearing the patch, we were absolutely a force to be reckoned with and the mark of it was present throughout the competition and the conference.

The feeling has carried over - there was new life in everyone there. The M*A*S*H Bash was a blast, everyone enjoyed themselves and as we clustered in the back hallway for group photos it occurred to me that we have not had such department pride in years. The words of support and encouragement we have received from alumni, friends and professionals all over have been amazing. We have had compliments from vendors, officials, outside agencies and individuals. We are back on the professional map after a long silence, and it is all due to the work and absolute courage it took our eight teams to step into that arena or onto that stage and perform under the microscope of peers and beyond. I salute each and every one of you and you will never realize how much it meant to me personally and I'm sure Billy as well - to see us carry it through with such success.

You wear the patch. It means something again. Thank you.

To the rest of the state?

See you next year ... yeah baby, that's what I'm talking about.

Better out than in.

I do not normally do this, but this irritated me very much and since I know that I have pretty much no recourse save maintaining my own personal standard, at least I can get this out of my system.  Who this applies to does not matter; it can be applied in some portion to anybody anywhere anytime.  If this scenario is not familiar to you, well then I am very glad to hear this.  And if you are reading this and are taken aback and say “I would never do this” … well, I bet you somebody who has or does. 

I have plenty of friends here that are volunteer providers – I can safely say that this does not apply to any of you, so please accept this as a generalization, consider the reasons behind it, and remember that according to Forest Gump, professional is as professional does – being paid has nothing to do with it.

And do not think that I am being “holier than thou,” there are just as many slackers on the paid end of the fence.  It doesn’t matter what your affiliation, it’s the profession, the vocation that you’re representing every time you walk onto a scene.  Don’t just do your job, do it well.

Dear Random First Aid Squad Crew:

I do hope that I am directing this to the correct person or people, after all – it was hard to tell what (if any) your affiliation or level of training was, seeing as how you all walked into the apartment in T-shirts and jeans.

I am truly sorry that this little old lady had some pain which woke her up in the wee hours and frightened her, resulting in a call to 911 at zero-dark-thirty hours.  Believe me when I sincerely say I can empathize with being pulled from the comfort of a warm bed and summoned out into the chill rainy night.  However I would like to respectfully request that in future, you refrain from saying just how much you don’t want to be there right now, and just how much you would rather be back in bed … especially after my partner and I just spent the ten minutes we were there before you reassuring the nice lady that she is not bothering us by calling 911 in her time of need.

Curiosity leads me to ask if there was anything going on outside of the apartment, because it became a little awkward when most of you stepped outside to continue your conversations – leaving the one young gentleman as the only one inside to manage the patient move and the stretcher … including lifting it.  He was helpful and did the best he could to work with us; apparently he had not read the guidebook yet.

In trying to complete my documentation I’ll admit I’m a little baffled.  I’m not quite certain at what point the patient condition deteriorated so rapidly that you felt the need to barrel down the wet back roads at upwards of 65 mph (more than double the posted speed limit for most of the ride), on what was initially a routine transport to a local hospital.  What I do know however, is that my partner, the patient and your crewmember were all in the back of that truck.  Perhaps you have yet to see the end of that particular ABC Afterschool Special, but I can tell you that it ends very badly and usually with bagpipes.

I absolutely understand the premise and motivations behind the volunteer system, most if not all of the fellow providers started in this field on a volunteer agency, myself included.  I appreciate that there are people out there who are still willing to give the true gift of their time and attention back to their communities.  However the reality remains that just showing up only gets you points on a Glasgow Coma Scale and does very little to actually help the people you’re claiming to serve.

If you are not up for it, if you do not feel like getting out of bed, if your personal issues are going to prevent you from being 100% there for the patient when they need you – then please use the option that I do not have, stay home.

Believe me, I won’t hold it against you.


Into the breach ... one last time

Sometimes all that glitters, really IS gold ... much like the badge they just handed me.

Several months back I had mentioned applying for a promotion.  After going through alot of soul searching, three torturous interviews and much personal angst -- the hospital took away the position due to budget, four hours before the pick was supposed to be made official.  I took that as a sign and went back to my life and career as it was.

Now that the hospital's recovered, a couple of months ago they re-opened the position and approved it as a permanent position for the department.  This time around it was only two torturous interviews and a moderate amount of personal angst.  The rest has been a whirlwind.

I got the promotion, I am now the Training Supervisor in charge of QA/PI (quality assurance / performance improvement).  Basically I'm the clinical educator you see if there are problems or if training/remediation needs to be developed.  I have a workstation in headquarters and my own seperate office.  My own office, name on the door (eventually) and everything.

My schedule changes effective this coming Monday -- weekdays for now, reasonable hours, flexible.  I don't have to wait for relief or worry if I'm a few minutes late.  If my kid has an appointment or I need to do something during the day, I just change my schedule.  For the first couple of months I am supposed to work 5 days a week until I'm settled, after that I can adjust it how I prefer.  It's days, but if I start at 6am I'm out by 2pm.  That means I get home in time to pick up my son from the bus and spend the balance of the afternoon and evening with my children.  Plus I will get to have family dinner and put them to bed each night.

I get holidays off, damn.  Now what I am going to use an excuse to get out of FFF (forced family fun)!

This really is an enormous change for me, probably the biggest one of my adult life.  Yes yes, marriage, children, house, I was able to evolve with that.  But being a street medic is what I do, it's been part of who I am for two decades now.  I cannot fathom that I don't have to put on the uniform Saturday night and go to work.  That I will have to worry about traffic and parking, with a whole new sea of faces to become accustomed to.  That I will go to bed at a "normal" time and won't be up and chatty at 3am for no good reason.  That I have my own fax and voice mail, a staff of two and folks calling me "Chief."  I can't lie and say I'm not overwhelmed and half-tempted to scurry back into the anonymity of the box.

Everyone has been really supportive and I was actually surprised by the sincere happiness and complimentary comments I've gotten at the news.  It's been very bittersweet, knowing that I have to leave some of them and that my relationships will change.  Some of the ER nurses cried when I told them, others jumped up and down for me and one or two cussed me out for leaving them.  I at least had one last night with my partner and my team.

I am a superstitious creature by nature, nobody can do the job that I have for as long as I have -- and not realize that there are more things under Heaven and Earth than one can shake a stick at.  So I do tend to read into things, looking for omens and portents.  After I found out that I'd gotten the promotion a few things happened, someone crashed "my" ambulance, my belt cracked and ... my boots broke.  I have never had that happen before, the heel weld came undone and was just hanging from the boot.  All I can garner from this is that perhaps I should take the freakin' hint and realize that it's alright to move on and accept the change.

I made Chris fix my boots with Gorilla glue so that I could wear them one last time.  Once more, into the breach ...

Wednesday night was fairly painless as far as work goes, but internally it was excruciatingly poignant.  I kept thinking about, "this is the last time this" or "won't have to do this anymore."  Charlene and I managed to keep up brave faces, but she's one of my best friends and we've been full-time partners for two years now.  Anyone who's worked in a related field knows how strong a partner relationship can be and saying good-bye to that was awful.  The dispatchers final gift was to make sure I did practically no work, I guess so that I'd have time with everyone.  They evenly dispersed my assignments to other units, or the other guys picked them up voluntarily (even when I tried).  At midnight they called everyone back to headquarters where as tradition dictates they had a "surprise" cake waiting for me.  Char tried to fib about why we had to go back, but ... duh.  A couple of the other Chiefs were there and one took my arm in his and escorted me into the conference room, instructing me that he did not want to see tears.

There in that room that hasn't really changed in 20 years, stood a couple of dozen people -- some of which who I've spent half of my life with.  They clustered around a simple decorated chocolate cake that had my new assignation on it in big colored frosting, "Congratulations 419!" They applauded me and I was doing alright, until Charlene spoke up.  She thanked me and told me that it was because of me that she'd turned out as good a medic as she had, and that she'd miss me.  And naturally once the tears started they made sure to take lots of pictures, the bastards.  The other Chief spoke up about his memories of me and the group lapsed into reminiscing about old times and the people gone before.  All throughout assignments kept coming in and folks would go in and out, I noticed this because it reminds me of the nature of the business.  It really doesn't matter that I'm leaving, the jobs will still come in and folks will still go to them.  The world does not halt for me or because of me, there are plenty of others that will come after who will make their own unique marks.  Yes, I know I'm not leaving the department, but just because I'm there does not mean I'm still *there*.

The sun came up as it always does, the shifts changed and the next tour went to work.  Charlene and I sat outside and watched the business, not looking at each other too much because doing so made us glassy-eyed and we were determined to avoid a breakdown.  I passed her my scissors, the red-handled trauma shears with an oxygen key attached that come with me to work every night.  Told her that they were the keys to the Kingdom and that I'd taught her all I could, it was her job to be the alpha female now and make sure folks do the right thing.  Then the day went on without us.

I hope that I do a good job, I think I will and I am looking forward to the change and the challenge.  It doesn't make this any less difficult or less emotional for me.  Charlene put it best in talking to a frightened patient we were working on one night.

"Don't worry.  This isn't just our job, it's what we do."

It's what I do.  I'm not sure what it is I *do* now, but hopefully I'll be able to make it my own.

New day, new breach to travel into.