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.

City of Ghosts

In the bygone era of life without GPS or smart phones (or cell phones for that matter), one actually had to learn how to navigate the streets and find your way from point A to B in an efficient fashion.  This was done by begging for permission to drive, becoming best friends with one Mr. Hagstrom , and purchasing one very precious commodity - a little red book that was the Newark Cross Street Guide.

With these tools in your arsenal you could set off on a nightly safari through the wilds of Newark, touring the skeletal remains of a city that was still mostly in shambles from the riots of twenty years earlier.  The crumbling architecture jutting up in the darkness like the dessicated carcass of a half-devoured creature.  In a landscape that was vastly different without the power of sunlight to chase away the beasties, there were hazards both human and non - all victims of time or apathy.

Night after night you set out again and the streets begin to look familiar to you, details that were once alien to you begin to weave together to define a place, an area, a city.  The cobblestoned sections on Jelliff grumble beneath your tires, where once shod horses moved smartly over.  You learn which has a short light, where the blind corner is, how to find *&($^& Synott Place on the first shot via one way streets.

You learn that you can take Broadway all the way to Clifton (the city not the street) if you so chose, that MLK is a party dress for High Street and that Irvine Turner Boulevard is just a pretentious moniker for good old Belmont. Tracing the wards like the swirls of a fingerprint the city and all its unique facets begins to imprint itself into your memory, it becomes your friend.  Knowing the streets takes you where you need to go, true - but it also can take out of where you should not be.  Understanding how to get on and off the highways that girdle the city can mean the difference between 5 minutes and 25 minutes.

Driving down ITB there were no pretty townhouses in manicured layouts, just a scarred ward pockmarked with empty lots and debris - overlooking a slight valley which harbored a row of high-rise public housing which epitomized everything negative about life in the inner-city.  A menacing row of darkened structures that harbored any number of grievances both from violence or poverty.  Most of the time you stick to the high ground, sometimes discretion is the better part of valor.  However if you're called then so you must, and you make the turn off of ITB and head down into the valley of darkness.  You did this via Montgomery Street.  Only ... Montgomery Street didn't have a street sign for a decade or two.

No matter, for we all heard the same thing when we started out.  Wide-eyed, clutching our little red books and trying to pay attention the guys would say - "Just make a left at the old Krueger Brewery."  There, sitting on the corner like a weary sentinel overlooking the ruins of a war-torn nation were the crumbling remains of a massive brick structure.  Partial walls valiantly standing at attention even with their metal vasculature torn out and cruelly exposed to the elements.  Paneless windows staring opaquely out across the empty lots, lifeless and broken.  Doors tottering on broken hinges and bricks randomly tumbling down like broken teeth.  There, nestled in among the obscenity of of a city decimated by hate and poverty was lonely vestige of a city that once thrived, teeming with opportunity for all comers and a functioning economy and unique cultural fabric.

Night after night I made the left turn, glancing at the silent hulking mass as I would sigh and try to steel myself for whatever I would be confronted with just a few blocks further.  It became a familiar site, a friendly vista and mental touchstone - because eventually I could say "I know who you are.  I know what you were, and so do other guys out here."  That sentiment just didn't apply to the sad ruins of an old building, but to an entire city as well.

Eventually the "renaissance" arrived at good old Belmont Avenue and the city decided that it would no longer harbor the creaking corpse of a century gone-by.  With much fanfare they announced that the brewery must go - they defiled her even more than time did, filling the crevices with explosives meant to bring her down.  Wearing a shiny hard hat and playing to the media the plunger was pushed ... and much in line with the history of this city the brewery thumbed its nose at them, refusing to fall without a fight.  Eventually it lost the fight and with a shuddering groan and the shrieking of twisted metal it gave way to the Newark of the next century, forgotten and alone - all evidence of it now is completely gone, shiny townhouses and a pretty little street sign mark where this behemoth from Newark's past once stood.

The old must give way to the new, it's a cycle of renewal this city cannot afford to be without.  Yet with a history as rich as this one has, it would be tragic for it to be lost without even acknowledging its once vibrant life.  Watching the fabric of the city and the landscape change has been a unique, exciting and sometimes sad experience.

For nobody knows this city better than those of us who trace its fingerprint day after day, night after night.

"I know who you are.  I know what you were, and I'm not the only one."

A Chapter Quietly Ends

Twenty-one years (and one month) ago, I met an extraordinary young lady – when I was still a teenager myself. We were clustered in the lecture hall, separated by project, working hard to hide any nerves. About to embark on a personal investment that would last a couple of years and for some of us, the next few decades, we looked around for familiar faces and that sense of camaraderie that is common among soldiers, inmates … and paramedic students.

We were forced to introduce ourselves to the group, lay out our gang colors (MICU project) as it were. She stood up; long hair flipped into huge Farrah-esque wings and proceeded to tell us that she was the youngest living kidney donor on the east coast. She had allowed them to saw her in half at the ripe old age of 18 and take one of her kidneys for her brother.

Obviously we survived school, though not without effort. Forced to do a mandatory class presentation it became apparent that this was not going to be one of her strong points. To this day I can tell you the topic she had to cover – “Differential Diagnosis of Chest Pain.” How do I remember this? Because in her usual thorough manner she had prepared a comprehensive handout to accompany her talk. Which was fortunate, because she lost all ability to speak when at the podium. As a group we took pity on her terror and with the help of her handout the rest of us helped coach her through “her” presentation. Now? She’s a poised and articulate presenter, able to educate and relate to people of all levels of education.

We graduated and set out to settle into our new professions, but never once were we really apart. When I started per diem at Clara Maass during its “Golden Age” (and yes I’m sorry, it really did have one), she was there – and our friendship, our partnership, began to develop. The alumni know the time I’m talking about. When practical jokes were the name of the game – when you had to dismantle booby traps before entering the office, or scramble frantically to locate “misplaced” equipment. Or the powder … always with the freakin’ baby powder.

She and I tried to deliberately OD on caffeine at the Arlington Diner, only to have to try and start an IV on an elderly woman in Lyndhurst after NINE cups of coffee in a row. We got “grounded” and confined to the office, so proceeded to put prison bars on the door and stage a sit-in in the parking lot. When my car got broken into in the parking lot, we went to the Belleville police station where she proceeded to make the car thieves cry with her ferocious diatribe on what would happen if she ever caught them on the wrong side of her grill. It was a good time to be young and learning your craft, it was truly fun. And every Monday night it was off to the Park Pub in Nutley for wings and laughs.

With a little arm-twisting I convinced her to come to UMD, and she’s been there ever since. And so things went. We’ve been partners, roommates, best friends, and completely fed up with each other. We’ve gone sledding in stokes baskets, been commandeered by the police, and set ambulances on fire. We’ve laughed and cried and couldn’t stand the sight of each other, year after year. We’ve been drunk together, sober together, driven a thousand miles together – just to heal a broken heart. Beyond those thousand miles are a thousand little stories, laughs shared and small adventures that make life a sphere and not a straight line. And of course the ones of which I shall never speak of aloud (though she might, she tends to fold under interrogation). Then of course, there’s Mexico …

There are friends who you know and can walk away from. Then there are those where you can have a huge gap in time, and pick up exactly where you left off. Distance doesn’t matter, time doesn’t matter, your histories are so intertwined that they are the family that fate forgets to give you – they are just there. She went on to other tours and other partners and so did I. Eventually she made it onto the flight team and started a whole new aspect of her career. But just like everything else that she sets out for, she did her best to do well and succeeded.

It is so funny how short people’s memories are. The nature of the job, and of life I guess, is that it never stops. Jobs come in, units go out and the faces change. There are legends that get handed down but over time even they lose their impact, save to a precious few. A few that gets less and less with each year and each generation. It’s like we just fade into the background, even well before we’re actually gone.

You know her as Nancy Orlowski. I know her as Nancy Souza. A whole generation ago she was known as “Sweaty,” “Short Stack” and the “Pit Bull.” You know her as the senior medic, the flight medic, or perhaps you haven’t met her or spoken with her at all. I know her as she was, and as she is – one of the best paramedics I’ve worked with. We are losing a resource that cannot be replaced, and that’s the part that I grieve for.

Today was her last day, and with the exception of a few the “system” will not notice.

But I will.

Our cert numbers are just 31 apart; we are just 6 months apart in age. We got married a year apart, had our children with a year of each other. We were in each other’s weddings and at one point or another have shared everything in our lives. And tomorrow when I go to work – for the first time in twenty years she won’t be there.

Nancy – I wish you love, I wish you luck. This was a good decision for you and for your family. I understand how hard this was for you to do, more than most. Don’t be afraid, you’ve never backed down from a challenge and you’ve accomplished more with sheer tenacity than anyone I’ve met. I wish I had the drive that you do. We'll keep the light on for you.

We’re all still here for you.

I am still here for you.

Love always, your friend
– Tracey

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.