Excellence and Camaraderie

is born of adversity. A memoir.

I am a fixer. When something is wrong, I get this overwhelming urge to simply make it right. To make it better.

As such, I spend a long time focusing on what is wrong with the world, life, etc.

That is not to say I do not notice when things go really well or are really good, but it is infrequent that they cannot be improved.

This week, I was surfing social media, when I saw a post from an old colleague and friend I used to work with.

It seems since I came to Europe, a long time ago, that while life outside of work is infinitely better, my career has crashed most spectacularly. Not from any poor decision or mistake on my part, but from a irreconcilable conflict of culture.

I am from gen X America, where you always knew who #1 is, and #2 didn’t count at all. Fearless, determined, independent. If nothing else, we are autonomous and never fear making decisions. Even with imperfect or incomplete information. said in one of my favorite movies:

”The only rules that really matter are these: What a man can do, and what a man can’t do…”

From the time I or we could understand our parents, there was only “can” and “will,” none of this European idea of “I’m not comfortable…” I offer my loyal assurance, my nor anyone else’s comfort ever mattered a damn.

This “can" do” mentality is not unique to me and is found globally in people who become champions, the best of the best.

Metrohealth Medical Center in Cleveland, Ohio was one such place.

The first encounter I had with the hospital was early in my fire department career. It was at the scene of a multi-fatality motor vehicle accident, and as part of that event “Lifeflight” the hospital’s very own helicopters were summoned to try to help 2 of the 5 victims, who ultimately later died…

But the event was memorable and inspiring. It is often said that when people need help, they call the fire department. But it was apparent, when the fire department needed help, they called Lifeflight.

Among the emergency medical services of the area, all which were part of the fire department except for the city of Cleveland itself, which even having its own EMS service, still had fire department rescue units.

In our eyes, the nurses and doctors on those helicopters were nothing short of God-like. They represented not only the highest level of medical skill and ability, but also humanity’s finest endeavor. To attempt to help the sick and injured and use any amount of resources to do it. No matter who that person was.

I know they were not the only hospital in the US, much less the world, to do that, but they were “ours.”

The hospital itself was legendary. After all, if these superheroes on the helicopters were not fixing people themselves on the street, the place they were going must have been nothing short of miraculous.

Spoiler…

It was.

Several years later, I went to paramedic school. As part of the requirements to become a paramedic, “clinicals” or clinical learning rotations are mandatory. In addition to EMS units, it required mandatory rotations and skills performance in various hospital departments. We were given a list of hospitals we could perform these requirements in and when I saw Metro on the list, I don’t remember who else was even on the list.

The choice was obvious to me.

Strangely enough, not one other of my paramedic class picked that hospital. Which was good for me, because that meant I had no problem scheduling my hours.

The reasons my classmates gave were anything but educational. “It is in a bad neighborhood.” “It is downtown and you have to pay to park.” “It’s old and dirty.” “Nobody has time to explain anything because they are so busy.” “Hospital X is closer to my home.”

I ended up doing all of my hospital clinicals at Metro. Even the ones that were not offered to students there normally. (I once had a high school teacher ask me if I thought I was was the exception to all rules, to which I replied “I am an exceptional person…” just before I was sent to the principle’s office for discipline.) How did I manage to have educational rotations where they were not normally offered? Well it came down to “I met some people…”

I waited in line at the triage window of what was known as “the old ED.” (Emergency department.) It was well…Old…The waiting room smelled horrible. Decades of dirt, despite constant cleaning had dulled everything from the drop ceiling to the tile floor. Even the bullet proof glass that separated the triage nurse from the “patients” seemed to have a coat of dirt fogging it up. I did have to pay to park my car. I did drive past the pimps, prostitutes, drug dealers, and illegal gambling establishments to get there.

Since I worked for a local fire department during the day, and my paramedic school was during the day my hospital clinicals were all scheduled at night.

A poet friend of mine a few years earlier wrote “The night belongs to lovers and thieves, so be a thief of the heart.”

It is fair to say that my heart was stolen on that first night.

What I found was not what I had expected from a legendary hospital. It was cramped, there were far too many patients for the space. Equipment was at once everywhere around and yet nowhere to be found. The staff, which comprised of an attending (consultant) physician, 1 or 2 resident doctors (sho/registrar) a handful of nurses, probably no more than 5, and 1 or 2 paramedics, taking care of dozens, if not a hundred patients in the waiting room, plus all of the major trauma patients in a region of more than 1 million people, and it seemed like every ambulance in the city. There were so many patients in fact, there was a set of “chairs” which were 3 blue seats (chairs) connected by a steel bar, and it looked like they had been stolen from a bus station or park somewhere.

When I introduced myself to the first nurse I came upon, I was directed to the charge nurse, “John.” Who at the time looked way too busy to deal with a new paramedic student, but was surprisingly kind. He assigned me to another nurse with the warning “if you are here, it is like you are staff, we need you to help out as best you can. If you don’t know how to do something, tell us, and we will show you, then you need to do it on your own.”

Did I mention this was my first day?

The nurse I was assigned to was positively awesome (If you are reading this you know who you are, we talked about it before.) she taught me how to insert IV catheters, when and why, and then purposefully sent me to the most difficult patients to practice on. I remember apologizing to the chemotherapy patient after my 10th attempt to insert the catheter and her simply telling me it usually took 10 or more times no matter who was doing it.

The routine of triage, diagnosing, testing, and normal ED functions, was broken by a pager (bleep) which alerted the charge nurse of an incoming trauma. Who would then select staff and pull them out of this normal activity to take care of that.

At the time, Metro was a level 1 (highest level) Adult, pediatric, burn and trauma center. The only level 1 surviving within 200 miles.

The “trauma bay” had 4 beds, and one of them was designated “pediatric” The room as I recall was 242. (I might be wrong on the number, it’s been a long time.)

Trauma at Metro was a champions game in a champions league. The hospital got all the patients who were really “sick” (seriously injured) and more than a few who could have been, but weren’t.

The trauma that “counted” was gunshot wounds. Counted, because a running tally on the number of such patients per shift was actually kept. Stab wounds, car accidents, etc. simply didn’t rate keeping track of… Aka a lot…

With each shift, I had seen more, done more. I was taught mandatory paramedic skills like intubation and surgical cricothyrotomies, not on mannequins or trainers, but by the trauma surgeons on actual unstable patients.

Anything I was capable of learning I was taught, by anyone who was capable of teaching it, many times a physician/surgeon, usually a nurse, rarer still a paramedic.

To use a colloquial phrase, it was “balls to the wall” from the time you walked in the front door, to the time you left 8-12 hours later. There was no “lunch,” there simply wasn’t time. There was no place in the hospital at that hour to get lunch. Unless one of the nurses gifted you a turkey sandwich from the patient tray, which was usually all used up by the patients, within an hour of starting shift. You certainly didn’t go out in that neighborhood at night.. Unless your goal was drugs or prostitutes.

Contrary to “not having time for me” what I found was quite the opposite. Everyone had time for the new guy, the students. Every person working there was expert in their craft and confident in their ability and position. I can’t remember ever calling anyone there by their title. Just their first name. A question could be asked of anyone, from the director of the department to the long-time environmental services guy, Santos, at any time. They would help, even coach, and explain as much as one could possibly learn.

After a few months, the charge nurses started asking me my schedule for coming in. I discovered that in busy and capable hospitals, anyone who volunteered to show up, whether paid or student, was a part of the team. Part of that was teaching and coaching the new people. Teachers teach what they know, and these teachers were the best of the best.

It by now should be no surprise, that when I went to John one night and told him I would not be able to come in for a week because I had mandatory clinicals that I had to perform at another hospital, he picked up the phone and dialed “Marianne” one of the director’s of nursing for the entire 12 story hospital, with multiple out-buildings on campus, and arranged that anything I needed for my hospital clinicals would come from Metro. Next thing I knew, I was doing rotations in the pediatric intensive care (PICU), operating room, or cardiology. I was even invited to some of the educational events for doctors.

I volunteered, worked hard to be an asset, and now I knew people…

Just after I finished my paramedic class and was saying my last-shift good-byes, as I did not meet the minimum experience requirements to apply for a job as a paramedic at Metro, I was working at the fire department, when an elderly lady presented at the FD, and said she needed a bandage for a cut on her ankle. It was Marianne! Seeing me in a uniform and not a set of scrubs for the first time, she said “I know you from somewhere. Why did you quit Metro?”

I explained I didn’t quit, I was just a student there. Now I was a paramedic and no longer a paramedic student, I was not eligible for employment, because it required 5 years of experience minimum.

She told me she would make a call…

That call didn’t go as well as either of us hoped and we were told that the 5 year rule was because the insurance company that covered Metro demanded it.

But with more experience than many career paramedics, I started looking for more “exciting opportunities…” The first of which would present itself as an exchange program in Bratislava, Slovakia, where they were asking experienced paramedics to go to Slovakia to help train the country’s first ever class of paramedics practical lessons.

For years, whenever there was a “bigger” more challenging opportunity, I signed up for it.

I told one employer as a condition of employment, I demanded the busiest EMS station in the State, on the busiest unit, in the worst neighborhood. Because the poor places is where the action is. Consequently, where the best providers are. He asked me if I was sure and assigned me at once. The people I found in that ‘hood and the adventures there did not disappoint.

Some years later, an unknown number rang on my very first cell phone. It was John. From Metro…Telling me he was the new person in charge of the department and was tasked with putting together the best ED possible, and offered me a spot.

To be an official part of the team at Metro!!? When can I start? (it was a Tuesday afternoon) his reply “Monday. Night Shift, 7p to 7a.”

I felt like a superstar. Metro had called me! I had no idea how anyone even had the number, cell phones were not a thing when I was last there. It was still the pager era.

I was then called back by John a few moments later and told I had to have an interview with HR on Thursday, but not to worry, I was hired, the deal was done. 7p to 7a, Monday.

That interview did not go anything like HR expected. At the end, she told me it would be 2 weeks before she could forward the results of the interview to the department head, “IF she decided to recommend me.” I then just met her gaze and said “John told me to start Monday. 7p to 7a.” Her response “don’t I have a say in this?” my response…”No…”

I was back in the old ED. Some faces I knew, some I did not. But those I was familiar with were in far greater number. Working in extreme conditions attracts a certain type of person. It is not so much a camaraderie built on position as it is having experienced a shared misery and come out together on the other side, worse for wear, but still alive, and with a couple of wins under one’s belt too.

But the old ED was not forever…

A new ED was to be built.

And I was there…I have pictures…Displayed prominently on my desk even 20 years later today. I have a glass block commemorating it. Next to those pictures.

98 beds, 6 trauma bays that could be converted to operating rooms. Beds A through F in the hallways. “Chairs” were gone…Plaster traps in some of the sinks for splinting and casting. Carts full of IV supplies. Our own mini-lab. Dedicated ED CT scanner, 6 Xray rooms, and an ultrasound suit. 24/7/365. Not s spec of dirt to be found anywhere.

But the staff and the job were still the same…The most dedicated. The best of the best to be found anywhere. Lunch was still a random event no matter how hard anyone tried.

There was the same experiences. Helicopters landing with trauma patients who had been in a car crash on the freeway, the drug dealer shot down the street delivered by ambulance, some rodeo cowboy gored by a bull, or an Amish kid with most of his arm missing after getting cut working in a sawmill. There were the frequent flyers we knew by name. There was the racist drug dealer who was beaten by his clients so much, not only do I still remember his name, I remember his medical record number. There were internal disasters, when we received so many patients we were overwhelmed and our disaster plans fell apart. There were external disasters, both natural and man made, which delivered us patients beyond what any lesser people would not have been able to cope. There were assaults on staff members. There was kegs and eggs at The Pioneer after a busy 12-hour shift, at 7am. Or this dirty little diner I forgot the name of down the street where we gave each other “after midnight names,” (You know who you are Red Devil and Summer Rain.) After a prostitute’s mother caused quite a scene in the waiting room looking for her with her real name. There were the cops who helped and protected us behind the new bullet proof glass.

The reputation remained. Ask anyone in the region, “If you get hurt or seriously ill, where do you want to go..?” A cop even let me out of a speeding ticket once on my way to work after seeing the Metro ED parking pass on my car window. “If I get shot tonight, you’ll be taking care of me.”

The dedication to teaching, being better, improving, never stopped when I was there. I learned more from the experienced experts there than I have from anyone or anywhere since.

The people of Metro are Medicine’s elite. The best of the best anywhere, who have gone everywhere.

They pushed me into medical school. Promising they would “make a call,” to get me back. Which once again, turned out not to work. But not for lack of some really influential people trying…

Some of my students and mentees from there have retired. I remember their first days with fondness. Some of my colleagues have died. Their knowledge and abilities honored. Their person and morals remembered. Their dedication and presence witnessed.

I am told that because of economics and politics, the hospital is not what it was. Services cut, facilities downgraded.

But I have no doubt that the people there are the same as they have always been. Doing the same things. Under the most extreme of conditions.

A shared experience and misery that keeps us who still live in daily contact, 20 years later, across oceans.

A shared ideal and goal.

To help those who need it most, when it is most needed. Without pretense or judgement.

To raise up the new guy/girl, student. To freely and completely teach all that is known, to both those who stay and those who go.

This last week, Metro helped put whole blood on EMS ambulances. To help people faster. Moving the needle ever forward.

The only other time I have seen anything like it was when I was in the war in Afghanistan.

Same people. Same ideals. Same shared misery.

There are books and speakers and videos on how to mimic the military in the civilian work place. None of them work.

What works is the shared misery of being asked to do more than what is expected, not from time to time or for an award or medal. But to make it a habit. To do it all day every day. To depend on, to advance, and to recognize the people next to you in that time.

For there is no other way to be the best of the best. There is no other way to be elite.

”Those who know understand. Those who do not know will never understand.”

I encourage new readers to adopt the ideals.

I thank those who have stood on the line beside me.