Gani

Welfare check.  The superintendent lets us in.  The apartment is a poor man’s hoarderville, open boxes and dirty clothes stacked as high as the unwashed dishes in the sink.  The man is sitting at a table with his head in his hands; a chess board in front of him.  For a moment, I fear he is not breathing, but when I nudge him he moves.  He turns slowly and stares blankly at me.  I ask if he is okay, but he doesn’t answer.  I nudge him again but he is out of it.  I try to get him to squeeze my hands, but he doesn’t follow any commands. Still, he has a decent pulse and his breathing while a bit slow is even. His medications are on the table alongside the chessboard.  I read the labels.  Metoprolol and HCTZ for hypertension, furosemide for CHF, simvastatin for high cholesterol, coumadin for atrial fibrillation and blood clots, allopurinol for gout, metformin for diabetes, oxycodone for pain, colace to soften his stool. As I reach for each ...

Recently I was driving down a Hartford Street in my white red and blue  paramedic response vehicle when I saw a single black man walking on the side of the road  with a bicycle.  He raised his middle finger emphatically and stared at me without smiling as I went past. I was perturbed.  I thought for a moment that I should pull a U-turn and confront him, asking why he gave me the finger.  Me, of all people.  I ran through a silly dialogue in my head where I gave my pro-black credentials (2 black wives (one current, one ex), 3 black kids (1 black, 2 biracial), a life-size standup poster of Obama with a Bob Marley tee-shirt on (“Hit Me with Music”) that has been in my kitchen since before Obama’s first inauguration.  Plus I am currently enrolled in an anti-black racism class where I am learning a shit load I did not know about our history and what it means to be black in the US of A.  Also, for twenty-five years I have served and cared for people in...

On the Sunday morning sidewalk Wishing, Lord, that I was stoned ‘Cause there’s something in a Sunday Makes a body feel alone. “Sunday Morning Coming Down” – Kris Kristofferson Twenty-six people in Connecticut died of overdoses on the four Sundays of this past April. Twenty-one males.  Five females.  One was aged 15-24, eight were 25-34, six 35-44, four 45-54, five 55-64, one 65-74.  I don’t know their names, what kind of lives they lived, or who they loved.   Twenty-six deaths was the most fatal overdoses on any day of the week in a month so far this year.*   I don’t believe people overdose deliberately.  But I believe some overdose deaths are unintentional suicides of despair.  The person using the drugs knows that the amount of drug they are doing at the time may lead to their death, but they are so sick and forlorn and tired, and often so deeply alone, that they throw an extra bag or two in the cooker in hopes the pain will go away and t...

Rainy Sunday in Connecticut.  I am doing laundry, lifting weights, cleaning the house, playing chess, listening to a chess instructional video, doing homework from my anti-racism course, and cooking dinner all at the same time.  Too busy to write a blog post. I admit to being nervous about the election on Tuesday, and have been having difficulty concentrating, bouncing around from preoccupation to the next. I got my haircut this week, the first one in over a year.  I was on my way to the barbershop back in March when  they locked the doors for the shutdown.  I was a minute late.  They wouldn’t open the door.  So I grew my Corona do and secret stache, too (hidden underneath my mask).  While I enjoyed feeling like I was in my teens again back in the 70’s, the hair got a little unmanageable.  I’d throw my medic pack over my shoulder and the strap would catch on my hair.  Annoying. Plus with winter coming, we had our first snow when I wor...

Connecticut saw its COVID positivity rate jump to over 6% last Thursday.  Our seven day average remains 3% for now.  Cases, hospitalizations and deaths are all up.  The flat line we enjoyed this summer has turned decidedly up and threatens to go parabolic. The last three shifts I have worked I have done cardiac arrests.  All have been elderly who were somewhat independent, but with many comorbid conditions.  They all felt ill in the recent days.  All were connected to areas where there were known COVID cases.  None were tested for COVID.  Could these be independent deaths or were they the work of the greatest serial assassin of the last 100 years?  Will they be counted eventually in the COVID numbers or will they just appear in the “excess deaths” category?  It has already been estimated that there have been 300,000 excess deaths in America this year, meaning 300,000 more people than would have been expected to die in a normal year, ar...

In the summer of 1977, when I was 18, my best friend Brad and I drove 1400 miles across the country in an old Oldsmobile Cutlass.  We had no plan other than to see America.  We started off in New England, headed to Washington D.C. and then down through the Blue Ridge, Virginia, North Carolina.  We jutted back out to the coast to Charleston, South Carolina,  where we body surfed in the ocean and swam among porpoises..  We went down to Statesboro, Georgia, where we drank in a juke joint and ended up watching two local heroes duel in a street race.  We crossed the Florida panhandle, went through Alabama and Mississippi,  In New Orleans a Louisiana lawman with mirrored sunglasses threatened to lock up for sleeping in a park.  We drove clear across Texas, with a stop in Juarez, Mexico where we bought colorful rugs and switchblade knives. At nights we slept in the car, sometimes paying $5 to stay at a KOA campground so we could use the showers.  O...

Johns Hopkins University Press is running a sale on public health books, and my new book is in it! Save 30% on Killing Season and other select books with code HPHB when you purchase before 11/6:  http://bit.ly/publichtw Killing Season will be published April 6, 2021. from Medic Scribe https://ift.tt/2HiGQVZ via https://ift.tt/33YfKfD https://gani.vn/ #thucphamchucnanggani #gani.vn https://gani-blogvn.blogspot.com/ https://gani.vn/

The new American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care guidelines were released this morning. While the AHA does a major update every five years, since they went to online updates a few years back, the changes are not as momentous as they once were. After reading the executive summary, here are the key takeaways that affect EMS. Adult Basic and ACLS Good CPR remains the bedrock of resuscitation. Double sequential defibrillation is permitted but it usefulness if not considered established. EMS should first attempt an intravenous access before intraosseous. While IO access has become increasingly popular, its efficacy compared to IV is considered uncertain. IO access should only be attempted if IV attempts fail or are not feasible. For me, not feasible would be in a person with no veins, including jugular. Epinephrine should be administered as early as possible in cardiac arrest patients with non shockable rhythms. Epinephrine should b...

Lay rescuers should not wait for naloxone to take effect before activating 911 in patients suspected of opioid overdose. Trained EMS responders when treating an opioid overdose patient in suspected cardiac arrest should focus on high quality CPR (compressions plus ventilations) before considering the use of naloxone. These are two recommendations from the American Heart Association’s latest 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care released this morning. 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Here is a key line:  Because there are no studies demonstrating improvement in patient outcomes from administration of naloxone during cardiac arrest, provision of CPR should be the focus of initial care. Naloxone can be administered along with standard ACLS care if it does not delay components of high-quality CPR. Whether you are a lay person or a professional providers, for...

Our hospital has banned bandanas, gaiters and masks with exhalation valves from their universal masking requirements.    This includes all visitors to the hospital, who will be given a surgical mask on entry if their mask does not meet the new requirements.  Additionally staff can only wear homemade masks if they are covering surgical masks. I know the biggest debate in the country today is about wearing a mask or not.  Science says yes.  Non-believers say no.  But maybe in those areas where universal masks are common and science is dutifully followed, we should be recentering the debate on the quality of the masks if we really want to protect people and hold COVID at bay. The COVID ACT NOW map shows Connecticut, Massachusetts, New York and New Jersey -the states hardest hit in the early days of COVID — have all gone from YELLOW to ORANGE in recent days. Even New Hampshire and Vermont who have at times been Green, are now Orange.  (Orange means at r...

My old boss, former United States Senator and later Governor of Connecticut, Lowell Weicker used to say, the mark of a great country is not how it treats its richest citizens, but how it treats its most vulnerable.  Yesterday, we witnessed President Donald Trump emerge from Walter Reed Hospital, chopper on Marine One back to the White House, stride across the lawn, mount some stairs, stand on a balcony like an emperor and then rip off his face mask and smile (smirk depending on your view).  The same man earlier tweeted “Don’t Be afraid of COVID.  Don’t let it dominate your life.”  He later declared that COVID was less of a threat to people than the simple flu. (COVID has already killed more Americans than the last five flu seasons combined.) In a matter of days, he had gone from a man with a high fever, needing oxygen to again assume the throne of the most powerful man in the world.  While in the hospital, he had received world class care, including two drugs ...

Enrolled in a college course at UConn.  As an employee at the UConn Health Center, the one credit class is free to me.  It is all online. The first assignment was watching this video. Here are the lyrics: You should’ve been downtown (word) The people are risin’ (for real?)  We thought it was a lockdown (what?)  They opened up fire (damn)  Them bullets was flyin’ (ooh)  Who said it was a lockdown? Goddamn lie Oh my, time heals all but you outta time now (now)  Judge gotta watch us from the clock tower (true)  Lil’ tear gas cleared the whole place out  I’l be back with the hazmat for the next round  We was tryin’ to protest, then the fires broke out  Look out for the secret agents, they be planted in the crowd  Said, “It’s civil unrest,” but you sleep so sound  Like you don’t hear the screams when we catchin’ beatdowns  Stayin’ quiet when they killin’ niggas, but you speak loud  When we ride, got...

Wayne Cabral died a couple days ago after a brief illness.  Wayne stopped working for us a number of years ago when he went to work as a paramedic for one of the area towns.  I worked with a few times when he was an EMT over twenty years ago before he became a paramedic himself.  He was respected by us all.  Also a super nice guy.  I never saw him without a smile, even when he was down.  He’d flash that smile and it made you feel the world was a good place.  Even though he didn’t work for us, I still saw him often at the hospitals when he was bringing his patients in.  I saw him just a couple weeks ago.  He was the kind of guy you didn’t just say hi and nod to, you wanted to stop and really say hi, good to see you, man. A Go Fund Me Page has been set up for his family.   Memorial Fund for Wayne Cabral I’m sixty-two myself now, at the age when I am starting to see ghosts, and instead of being alarmed, I am reassured by their sigh...

I just finished reading The End of October: a Novel   by Lawrence Wright.  This book had incredible timing as it is a thriller about a pandemic that hit the bookstores in April just as COVID was becoming a household world and fear.  The virus in this book is COVID on steroids and the story is apocalyptic to the 9 th degree.  Still, it was an interesting journey with many moments that seemed similar to today’s events.  The biggest one for me was the desire to blame a disaster that arises out of nature on another country, and instead of working together globally to protect all humankind, countries fight each other, and the results are predictable. from Medic Scribe https://ift.tt/3iuZ6aS via https://ift.tt/33YfKfD https://gani.vn/ #thucphamchucnanggani #gani.vn https://gani-blogvn.blogspot.com/ https://gani.vn/

Peter Nicholas, a writer for The Atlantic, who covers the White House, wrote an article on August 27, 2020, called “White House, Petri Dish.”  In the article, he referred to the White House’s West Wing where the President and his top advisor’s have their offices as “ a corona virus breeding ground.” White House, Petri Dish The article is getting a great deal of attention now that the President and many of his advisors as well as other staff and leaders have tested positive for corona.   He described the west wing of the White House as a poorly ventilated cluster of small offices where many staff members gather in close groups, without masks.  In his article only the maintenance people wore face protection.  While certain staff members were evidently tested on a regular basis, many others and visitors such as himself were not and could easily introduce the virus to an area where it could be easily spread. It raises the question for us in EMS to consider.  Are...

In the next to last draft of my new book, Killing Season: A Paramedic’s Dispatches from the Front Lines of the Opioid Epidemic , I quoted a former user, as saying “heroin withdrawal is so painful, it hurts to even blink.”  She further said, “Withdrawal is so bad, I wouldn’t even wish it on Donald Trump.”  She clearly was not a supporter of the President or his policies on addiction.  Understandably. The publisher’s copy editor, suggested I remove the Trump part of the quote, as it might needlessly alienate some, without adding anything to the strength of the story.  He had a good point.   I deleted the quote. There is an old saying that you don’t talk politics or religion at work (or with friends).  I try to avoid politics, but it is hard in these times to not speak up or let it be known where you stand on the issues of our time. All that aside, I do not wish any ill harm on Donald Trump.  Having seen the look of fear in too many patients with...

It’s that time of year, I get to practice as a nurse.  I got my R.N. a number of years ago, but I only actually touch patients as a nurse at flu shot season.  While going to nursing school, I got my EMS clinical coordinator job, and that combined with still working full time as a paramedic pretty much killed any time to do nurse work.  The R.N. after my name definitely helps with giving me more credibility working in a hospital where nurses play a powerful role in administering the place.  I went to nursing school in the first place to have a fallback if I got hurt or if overtime dried up.  I imagined working full time as a medic, and part time as an ED nurse.  I will likely go to my grave as never having had to put a foley in anyone.  Every year I get to give flu shots to my fellow paramedics and EMTs.  Not that giving a flu shot involves anything a paramedic doesn’t already know, but in this state paramedics can’t give them.  Has to be an ...

There is not a lot of methamphetamine use in Connecticut.  I rarely encounter patients high on meth as a paramedic.  I understand there is a fair amount of meth use in certain subcultures in the state, but in general those subcultures rarely generate 911 calls.  We are a huge opioid fentanyl state. That may change.  I attended a seminar on meth use today (METHAMPHETAMINES 101 FOR PUBLIC HEALTH taught by Justin Alves of the Boston Medical Center, sponsored by the New England High Intensity Drug Trafficking Area) that was very informative. The word is that meth is coming.  While fentanyl has been moving westward, meth evidently is moving eastward.  Here are some of my notes from the presentation: Stimulant deaths are on the rise, but they are often linked with opioid use. Polysubstance use with methamphetamine is the norm.    It is often used with alcohol and amyl nitrate. Stimulants are used by about 2% of the population, but by up ...

  It has been a great summer here as far as COVID goes, low numbers, very few cases.  On the ambulance we all wear our face masks, and I wear a face shield when I remember to grab it, and while I carry my isolation bag into the scene with me, I haven’t put on a gown for months.  The fire department, who used to gown their crews before it seemed they even stepped out of their trucks, is rarely seen in gowns anymore. This week, the NBA finals begin, the hockey Stanley Cup was decided, a full slate of college and NFL games were played and major league baseball begins its playoffs.  Not that long ago, it seemed they were talking doom and gloom that all these seasons would shut down again once they tried to start.  Those declarations haven’t proven true.  Yet.  Breaking news today of an NFL team -the Tennessee Titans – who have had a number of players test positive putting next Sunday’s game in jeopardy. It is overcast this afternoon with periods of mist...

As posted a few days ago, I am pleased to announce Johns Hopkins University Press will be publishing my newest book, Killing Season A Paramedic’s Dispatches from the Front Lines of the Opioid Epidemic .  The book will be released in April 2021, but is available for preorder now on Amazon. Preorder Here The book tells the story of how I went from a new medic 25 years ago who believed that heroin users had major character flaws and that telling them to just say no or they will end up dead or in jail was the solution to the problem, to a proponent of harm reduction, which recognizes that addiction is a chronic relapsing brain disease and whose victims deserve our compassion and not our scorn.  In the book I share the stories that users have told me after I have resuscitated them, stories that show how they were all normal like the rest of us until fate, usually an injury or illness sent them down a difficult path they couldn’t have imagined and which many were powerless to sto...