Facing a new year

As the sun sets on what would otherwise be another passing Tuesday afternoon, I take stock of the past year and prepare to usher in my second day of being 29. Though I have yet to greet that unyielding inevitability that is 30, it's funny to note that already my birthdays have become surprisingly insignificant to me. I acknowledge the many gracious pronouncements of cheer from my friends and family, but inside I feel as though it's just another fading sunset. I imagine that, eventually, I will reach an age where I will welcome and cherish each day of my dwindling youth, as a musician may desperately hang on the final notes of a sad song, but until then I am still convinced of my eternal and unburdened 20s.

It was an incredible year, and I changed my life in many fundamental ways. I laughed a little longer. I worked a little harder. I cherished my friends and family, spilled a little blood, shed some tears, and ultimately I gained the confidence to be the man I always hoped to be. I gave a little, and I took a little, and I always remembered to love.

I let go when it seemed impossible, and I faced some demons when they were most irascible. Some remain, tickling at my subconscious with unrelenting ferociousness. I will battle on, with the new weapons of wisdom that derive with age. Most of all, I will never surrender to fear.

So let's see what 29 has to offer. I'll let my willingness to explore light the way to these vast new adventures.

Milestones

It occurred to me today that I have arrived at a particularly meaningful point in my journey to be a medic. As of yesterday, I've pulled as much knowledge as I'm going to pull from books about being an EMT. Classes and labs have ended, and all that stands between me and an Emergency Medical Technician certification is as follows:

* 140-question written examination over two terms
* Practical examination over medical and trauma patient assessment
* National written examination covering an entire 1,200-page textbook (70 to 140 questions)
* State practical examination over every skill in the EMT scope of practice: Patient assessment (medical and trauma), oxygen administration (mouth-to-mask, nonrebreather and nasal cannula), spinal immobilization (seated and supine), splinting (joint and long-bone injuries), control of bleeding and shock, and defibrillation.

I've learned an astounding amount of information about how our bodies work, how our bodies react to injury, and how to keep people alive using basic life support measures, despite the best efforts of our bodies to kill us. These include:

* Conducting effective CPR on adults, children, infants and neonates.
* Administering several medications, including: High-flow oxygen (to treat hypoxia), nitroglycerin (angina and acute myocardial infarction), epinephrine (anaphylaxis), inhalers (asthma and respiratory distress), activated charcoal (overdoses and poisoning) and oral glucose (hypoglycemia associated with diabetic emergencies).
* I can recognize and immediately treat people who are moderately or severely injured -- or near death -- from any of the following scenarios: allergic reactions, diabetic emergencies, respiratory and cardiac emergencies, environmental emergencies (hyperthermia, hypothermia, drowning), head, brain and spinal injuries, soft tissue injuries (lacerations, abrasions, avulsions, burns, amputations, eviscerations, gunshots, stab wounds), musculoskeletal injuries (fractures, dislocations, sprains, strains), poisonings and chemical exposure, behavioral emergencies, acute abdominal distress (appendicitis, peritonitis, internal bleeding), shock, venous and arterial bleeding, pediatric emergencies, and neurological emergencies (stroke, seizures).
* I can, believe it or not, successfully deliver a baby, including post-delivery care, and I can recognize and provide interventions for common obstetric complications, including breech birth, prolapsed cord, eclampsia and pre-eclampsia, placenta previa and placenta abruptio, and premature birth.
* I know how to interact with and properly assess injured kids at all ages, which is generally understood to be the hardest part of this line of work, as well as geriatric patients.
* I can use big, impressive-sounding medical terms, but I know that the key to good patient care is effective communication, respect, quick thinking, and knowing my shit. I know that I can gain somebody's trust -- even somebody who is in severe distress and fearful of dying -- simply by kneeling down to his level, looking him in the eye, asking for his name and saying I'm here to help.

I still have tons of education ahead of me. I will learn the difference between how things are done in textbooks, and how they are done in the real world. And although I will soon be an EMT, I still have a few years of school before I'm a paramedic.

But, as of now, I've accomplished what I initially set out to achieve: I can save lives. And for that I am humbled, excited and terrified.

Sunday blues

Lingering moments of quiet reflection seem to be a limited commodity in this bankrupt world. I think if everybody took a few moments during their day to stop everything and think about life outside the normal stream of consciousness -- be it a fleeting acknowledgment of their lives or a whisper of a contemplation -- the gain in happiness, self-improvement and ease of mind would be immeasurable.

My reflection for the day: I'm sitting here in my cave, reading about the finer points of delivering babies in preparation for my test tomorrow, and wondering why oh why am I not outside enjoying the nice weather with my friends -- far away from this town. I worry that my goals are infringing on my adventurous spirit. I need to find some kind of balance, lest I go batshit crazy, or even worse find myself the lonely soul in a crowded room.

Also: Fuck Canada!

A lesson in subtlety: Newspapers rule and all other media suck my ass

As you can probably guess from hearing me rant about journalism, I'm an old-school newspaper purist. I don't trust any other form of media, nor do I have much faith in the capability of other media to achieve the same level of quality or serve the same vital watchdog role as newspapers.

So you can imagine why I'm so depressed that newspapers are starting to suck.

Without quality newspapers, along with their vibrant staffing of superior reporters and funding for investigative projects, the state of American journalism is dead. The current downfall of print already is painful and debilitating, but you can bet that it will be much worse when we eventually rely solely on press release re-writes, gotcha celebrity drivel, weak oversight of our continually corrupt government and unskilled, agenda-driven Internet bloggers.

How can I know this? Simple concept: Newspapers drive American journalism. No other source of information plays such a crucial role in feeding other forms of media than print. In TV news, assignment editors are expected to read the newspaper to gather story ideas. Radio cites newspapers, and newspaper reporters are featured as expert witnesses to the dealings of the day. Internet journalism -- a phrase I use in the loosest possible sense -- would cease to exist in its current form without the luxury of linking to or quoting from newspaper stories.

Even if newspapers simply move their operations completely online, thus transforming Internet journalism, it's still hopeless until a miraculous new funding model can be introduced. Online revenue models for newspapers don't begin to make up for the advertising dollars that print sales used to provide, which in turn allowed for the kind of staffing and talent necessary to be the superior form of media in terms of quality. Currently, a majority of newspapers are giving away their content for free on the Internet. There surely needs to be something between free and profit that allows newspapers to thrive on the Web, and right now nobody seems to know what the hell that might be.

A story out today found that newspapers still provide a vast majority of the original local content, while the Internet only graced us with 6% of original reporting. The study also found that competing with the Internet -- that is, competing with a medium that provides its content for free -- is leading newspapers down a dangerous road of posting press release re-writes online just to get the information out quicker, and then sometimes not even updating or writing legitimate stories to follow up.

If you're unfamiliar with the concept of press release re-writes, let me give you a brief overview: It's a bullshit, lazy way to be a journalist. An organization sends the reporter a brief statement of "facts" that the journalist then re-writes in his or her own words without fact-checking or even really providing any original thought. The "story" is then regurgitated back to the masses as if actual journalism were done. This is the kind of reporting that has become necessary, according to the study, in order for newspapers to convince the American public that they are still relevant, in the sense that they are able to vomit out questionable material at a fast enough pace.

We can gather from all this that the Internet is not only killing newspapers -- it's actually destroying journalism. The daily newspaper model of researching and carefully crafting stories may not serve us in our give-it-to-me-now culture, but it damn well works out when it comes to providing quality, factual, reliable, credible information. Journalism schools don't really teach you to write; they teach you to think, question and analyze. We can only hope that those skills eventually fit in with the American desire for instant informational gratification.

Don't get me wrong -- I enjoy the luxury or reading my news online. But if a newspaper staff isn't writing it, and a city desk isn't editing it, and a copy desk isn't fact-checking it, then it's simply not credible for me. Working in the American newspaper industry has given me a certain perspective and expectation for quality journalism, and I'll stack it up to any other form of media in the world, hands down.

What I've learned, 2009 edition

Some personal lessons from a very long year:

* The fear of rejection is much more debilitating than being rejected. If living in fear is slavery, then taking a chance is your liberation. I'll learn this lesson a thousand times; one of these days, I'll take my own advice.

* Following your dreams should always be painful and agonizing. That way, if you take your licks and stay on track, you know it's the right path. The reward is true happiness.

* I either don't understand love, or I don't understand women. Either way, money can't buy it.

* Soul mates exist. And no, you never really get over it.

* I realize now that I'm part social conformist and part emotional anarchist. That is, I often act within the boundaries of the group, but I never compromise my feelings. Those I own completely.

* Successful people learn how to solve problems, not seek blame for them. This can be applied to every aspect of life.

* Never talk shit. It's a fact that your target is in some way better or more talented than you, and you're probably just jealous.

* Journalism is dead. Americans killed it. Americans, and greed. I hope somebody revives it in my lifetime.

* Most people want to make a million dollars. I want to save a million lives. It's corny but true.

* The first time I glide a duel-lumen tube into somebody's esophagus, I'll know I've finally made it.

EMT perspectives

I've concluded, based on what I've learned so far about the EMT experience, that one of the greatest road blocks to good patient care is an inability to empathize with the sick and injured. Undoubtedly, this shortcoming can result from any of several circumstances, be it complete burnout from dealing with horrible situations on a daily basis, skewed motivations for being a medic in the first place, or inexperience with the feelings of terror associated with the receiving end of a true emergency.

In short, if you can't empathize as an EMT, you're either sick of your job, too full of yourself to express concern, or simply can't conceptualize what it feels like to think you're about to die.

Inherent in this line of work is a tendency to feel excited about being involved in true emergencies, which carries with it a double-edged sword: In order to take part in a true emergency, somebody needs to be truly hurt. We hear medics -- both career and those in training -- excitedly tell stories about the latest mayhem as if they're comparing gleeful war stories. Does this mean these medics inadvertently enjoy seeing people in pain? Or do they just enjoy the rush of helping people get through that pain? Obviously, this career includes a hero aspect that, combined with the chemical reactions of high-pressure situations, can affect your mind like a drug.

I'll tell you one thing: The patient in crisis would be surprised to learn that his or her traumatic experience is just another exciting story for the medics. Then again, maybe the thrill of a call is what keeps people in this career sane long enough to retire.

I'm approaching this from the view of somebody who has yet to go out on a call or be exposed to an overly traumatic emergency situation. But I find myself getting eager about the prospect of seeing these things, and I wonder whether this is the right perspective to take. When it comes time for me to decide what kind of medic I'm going to be, I think I have to find a balance between my motivation to help people in a professional, skilled and empathic manner, and my urge to experience the adrenaline associated with crazy and gruesome situations. I imagine that if you lean too much one way or the other, you ultimately become an ineffective emergency provider.

My journey begins

I was reflecting the other day to a friend that life can be equated to a series of significant events that, once experienced, can never be relived the same way ever again. I listed off some examples from the top of my head: first sleepover, first kiss, first time driving, first graduation day, first marriage day, first birth, first night living away from home.

Most optimists would say that the challenge is to make all the insignificant events that happen in between -- what you're doing here, now, at this moment -- matter for something. Unfortunately, this root beer I'm drinking will never taste quite like the first time I ever tried root beer. But it's still sweet, and it still bubbles in my mouth, and I can still remember the first time.

If I had a book of significant events in my life, I would include an entry for the first day of my first Emergency Medical Services class. It wasn't as much what I learned as what I didn't learn.

I would love to say that I had some cosmic epiphany during this first class about the deeper meaning of dedicating my life and well-being to people who will meet me in their worst possible circumstances. I would be humbled to report that I was so inspired by the instructor's words that I found the underlying reason for my desire to be slapped by the harsh palm of reality. At the very least, it would be nice if I could deliver a significant explanation for this journey on which I've embarked -- to be a paramedic.

I can do none of those things.

Maybe it's because I don't need an explanation. Maybe my drive for logical reasons for everything that happens in my life has broken down. I feel so overwhelmed by the weight of this journey that I can't breathe. I ache at the notion that I'm making the wrong decision.

Then I remember that day last term in my biology class when I discovered the meaning of my path. I saw a girl collapse out of her chair, and I didn't think; I reacted. Here's another one for that book of significant events: First emergency. I was at her side in a blink, and I watched her open her eyes as I was bending down to check her breathing and pulse. I looked at her, and she looked at me, and we shared a moment of panic. That moment affected me deeply. She's OK, I thought to myself. Or did I say it out loud? Then, the rush of chemicals, the dizzy feeling in my head, and that internal knowledge that I was experiencing a deep, human feeling with her: the fear of the unknown.

I was still kneeling. I looked down at my arm; it was still clutching her shoulder. I'd put it there to gently shake her when she was momentarily unconscious. My mouth was dry. My vision was clear and focused. I asked if she was OK. She looked confused. Finally, she nodded.

The exhilarating panic was replaced with relief. She was breathing, and I didn't have to crack her ribs. When I looked around the room, I was shocked. I was the only one there.

I felt something that day that I'd never experienced before, and it's not something you read in a book. It's not something that an instructor can dictate to you on the first day of your first EMS class. It was facing the unexpected with confidence and accepting the fear. It was exciting. It was frightening. It was beautiful.