Baseball and EMS

People ask me what I do in winter when there's no baseball. I'll tell you what I do. I stare out the window and wait for spring. – Rogers Hornsby

I am a few days away from sitting staring out the window.  Hornsby was right.  What else is there to do without baseball?

Okay, maybe this would be a poor use of my time, but it does make me think about EMS as baseball and vice versa.  We can sit around quite a bit too…granted not usually staring out the window, but are we focused on the current season?  In both EMS and baseball a few things are fundamentally similar.

One, the job is inherently physical.  In EMS, we move patients from point A to point B.  In baseball, you move runners from first to second thru third, hopefully home, more often than the other team does.

Two, the job requires a degree of sophistication that can not be just physical.  Sure, you may be a big bruiser who can smash homers or lift patients, but if you can’t determine the difference between a fastball (normal sinus) and a cutter (atrial fibrillation), you aren’t hitting home runs.  Realistically, you aren't even getting on base.

 

EMS is interesting in that like baseball, we have specific groups: infielders, outfielders, pitching staffs; much like managers, EMTs, and paramedics.  Like baseball we even specialize.  We know that in every 911 service there is one trauma junkie black cloud that can handle the proverbial mass casualty of hemophiliac children who drove into the glass factory with ease just like the greatest of closers.

Third, both jobs require practice.  I know, I know I’ve been droning on about skills and people practice, the last several posts.  Apologies, but I am disciple for the mindset that muscle memory drives actions in crisis.  I am also a disciple for the thought that as heart rate goes up, IQ drops exponentially faster.  Granted in EMS if you let the game come to you, your patient may become apneic, but this drives home my point of perfect practice in drills makes perfect execution when the time comes.  You practice intubation with your backup roll not because you aren’t going to be able to get the ET on Fred the Head, but because you have to get yourself into the mindset of having the backup for when you misjudge your current patient’s Mallampati score and get into trouble.

 

I get it...practice is boring and you already got it right, but I'm not in this game to get it right, I practice so I can't get it wrong.

Anyone remember the fall of 2001?  No, not September 11^th…in this case I am referring to the ALDS where Derek Jeter makes the flip to Posada to tag out Jeremy Giambi.  Why was he even in the vicinity of that play?  His answer: because I’m the third backup.  THE THIRD BACKUP!?!?!

Again, many days we aren’t even thinking about our first backup…maybe we should. 

There are a million more factors that go into success and could be added to this conversation about EMS and baseball.  I am still a fan of family and it applies equally to EMS as baseball.  Similar to EMS, baseball is an extended family – on the road together for months out of the year – and for many of us we are with our family, months out of the year. 

Success in the field of EMS or on the field of baseball usually still revolves around passion for what you are doing.  Do you want to take care of the sick and the injured?  Do you want to grind out game after game, practice after practice?  Do you have the self respect to prepare, the intelligence to make good decisions in your life?  Are you enthusiastic every morning when you walk in for shift change or do you have to be drug to the dugout?  Where are you with your team?  Are you the one superstar on your team or are you part of a high functioning group?

 

It's a topic for another day the issue of being the one person fighting the good fight and not having a team around you.  It's something I have to find a way to address, but teams mean 2 + 2 = 5 or 7 or 3.  It depends on the team and whether or not a single player or manager is trying to carry the load themselves or if they are allowing everyone to participate...the learners to learn, the doers to do, and the leaders to teach.

Anyway, I hope you figure it out, because it’s World Series time and I want to be a player on a World Series team…especially if the game is EMS.

 

Skills Practice

National Registry prescribes certain steps to take with various skills for the emergency medical technician tests which they have developed.  They list out the points which a student needs to perform to pass their end of course skills evaluations.

 

These steps form the basis of how we perform various skills whether they are traction splints, IV starts, or even ubiquitous patient assessment.  These skills in most states form the basis of whether or not we are allowed to work in EMS, but are they really measuring what is important?  As I have noted in previous articles on skills training, I am both an advocate of skills training and regular practice.

 

Some would argue absolutely…skills practice is a necessary part of the job, without which, success would be all, but impossible.  A few out there might argue skills practice impedes didactic lectures that would help our EMS community better understand the pathophysiology and assessment of Ménière's disease or some other pet topic which they feel requires more discussion.

 

For me though, the biggest skill missing to me is the interpersonal one.

 

I apologize in advance as I am going to be bad here and not even argue on behalf of the patient.  Sorry, I am arguing the interpersonal skills of dealing with co-workers and fellow healthcare employees.  I know, I know, this is barely patient care related and surely has nothing to do with political issues or baseball, but we do a lot of education in our classes, but the class I guess we miss both in EMS education, many work environments, and school for that matter seems to be how to develop the interpersonal skills needed to deal with difficult co-workers.

 

Let’s face it, how many of us enjoy dealing with the rude, insensitive patient who probably drinks too much?  Most of us raised our hand right?  We are willing to do it because that is the job so we put on the smile and play the game to do the right thing by our patient, but when we get back to the station, how many of us still deal with the rude, insensitive person who instead of being our patient is now simply our co-worker?

 

I know I have gone through partners and had both great partners who we could anticipate one another as if we had been married for years.  I have also had partners that despite express communication about whatever did not seem to understand where I was headed or where I wanted to go with things.

 

Now I find myself thinking about how we can add this training into our EMS paradigm.  If it’s the personal touch that is missing, maybe this is where we should concentrate our efforts?

 

 

 

 

Empathy and Strength

This is a tough topic: Alzheimer's and dementia.

Thus far I have not had to deal with it except in third person as a citizen watching President Reagan's health deteriorate after he had left Washington, but as many of you know, I write for the Dallas Morning News Community Voices section.

One of my colleagues if you will, Catherine Ehret, had this piece published based on her experience with her mother.  I ask you to read it and sit back and think.

I bring it up today because I nominated it for the best of the early submissions in our group and was amazed at the professional columnist's take on it.  It doesn't matter who, but I was amazed at the ticky tackiness of writers who criticized the piece.

For me, I found it to be genius.  It has the true heart of good writing which includes an utter honesty about the situation the author is facing in the very non-fiction reality which she and her family exist right now dealing as Catherine notes "It’s strange to write in the past tense when your subject is still alive."  There is no gloss covering what was clearly a loving, but perhaps somewhat distant relationship.  This was a great column in my mind and I hope you will think so too.  When I read it I immediately empathize with her situation and am not-so-secretly happy I am not dealing with the issue, but I also admire the rock of strength that Catherine clearly has - both the medical situation her mother has and submitting herself to the arrows of "friends" in an open critique session.

The whole issue makes me think of the people with the blue pencil in our lives who are editing or trying to edit away.  Sometimes I have to ask what is their purpose?  Are they trying to make us better or just more like them?  Either way, go have a great Wednesday and be careful who you let edit your life.

Team requires work

Okay, so I am guessing this is becoming a teamwork blog week.  What does Big Tex and the StateFair of Texas have to do with teamwork and three smiling faces.

 

I guess mostly it has to do with the idea that lots of bosses talk about pulling for the team and pulling in the team’s direction.  I do get the sentiment that players on a team pull in the same direction for a greater good, but sometimes managers talk the talk about pulling in the same direction and don’t do anything to help you pull in that direction.

 

Well, this week isn’t that.  I am up on the edge – perhaps ready for a fall or ready to start climbing the next hill in front of me.  I am trying not to be prideful because it is a safe statement that pride always walks in the room right before a fall in emergency medicine.  We will see where things go with this fork in the road, but I feel prepared, I feel ready, and I believe I can perform to expectation and beyond and I look forward to finding out where I am right…and where I am wrong, BUT…that has zero to do with teamwork.

 

What does have to do with teamwork though is the opportunity to see your family when you are away from them.  When work and family conflict, managers as often as not usually expect the family branch to bend in favor of work.  Not today.

Instead I am standing in front of the new Big Tex at the State Fair on Dallas ISD’s Fair Day with my three school age children and I am there in large part because my current preceptor who has been preparing me for my above mentioned fork in the road recognized the opportunity to make sure my head was clear, my mind relaxed; so I could walk into my challenges next week ready to go with the experience and preparation I need to be successful on these tests, but also in this career.

For those managers who are confused, let me ask if there is any question whether or not I am pulling in the direction my current manager is headed?  All I need to know is where to pull and for how long?  She has shown her loyalty to me just by taking care of her people.

Not every manager is courteous, thoughtful, judicious, and prudent with how they utilize their staffing.  The managers who don't possess those qualities we call managers and supervisors, but those who do ...are leaders.

Sacrifice and Dedication

I heard a co-worker complaining recently about their position within healthcare and whether or not someone else was making more money.  I wasn’t sure how to answer the issue since I may be one of the new people making more money, but it and a recent Twitter post did get me thinking about sacrifice.

The original comments didn’t bother me too much as I was offered a position and a salary.  I also majored in Economics at George Mason University once upon a time and one of my professors, the eminent Walter Williams noted people always say they don’t get paid enough.  His answer was “rubbish.”

He would retort that when you went to a store that sold a gallon of milk for five dollars per you may think it was expensive, but if you bought it, you didn’t think it was too expensive.  Once, you think the milk was too expensive at five dollars per gallon, you wouldn’t buy it.  His analogy for work was the same.  Your employer offers you ten dollars per hour to leave your leisure activity whatever it is and trade that time for hours spent under the direction of your employer, i.e. if you weren’t getting paid “enough” you wouldn’t come to work.

Perhaps that is a reason why some people use their sick days for mental health days, but the argument has always made sense to me.  It has also made sense to me that sometimes we want more than we have, but we are not necessarily ready to trade our time or we can’t.

In any case, I recently took a different job in emergency medicine than I had had.  I did so with some risk involved.  I had a good career going and was in a pretty good routine, but it was time for a shake up which brings me to the Twitter post.  Someone posted a note I had written them thanking them for the suggestion I should follow the dream I have had for years and all but abandoned when he and a colleague suggested I not give up quite yet.  I am glad they did so as the encouragement and follow up has led me on an entirely new course.

The path I am on now is a course of action which has me energized and hoping for great things.  I hope it allows me to be the medical provider I want to be, i.e. the guy you call when you are out of options.  Obviously this doesn’t come without some sacrifice, but perhaps I am now ready to take on the accompanying requirements that go with this pursuit.  I guess we will find out soon enough, but I pray that my goal wasn’t just to get the job, but to do this job well.  Again, we will find out.

I have a lot to live up to at this point, both those that put their neck on the line for me – not just the ones who think they put their neck on the line and the people who have guided me over the years to be the provider I am today.  I appreciate my family who has sacrificed time away from daddy so he can pursue this and who has built the blueprint by which I can be successful.

It’s a course of action I have mapped in my head a few dozen times before only to be told no.  A course of action I may have been ready for didactically, a course of action I may have been ready for skills wise, - but perhaps not ready for mentally.  I think of the Rascal Flatts song bless the broken road.  Obviously, that talks about all the broken relationships that leads to the right one, but perhaps their song Forever is more appropriate.

I was off duty when a call came in for the transport of twins who were born at twenty-three weeks.  The care of the mother of these children and the two children themselves is obviously high stress, intense, and high stakes requiring not only the best we have, but everything we should want to do for these people, not patients.  Perhaps a sacrifice I made some time ago keeps in my mind that “though you’re gone, you’re still here, in my heart, in my tears.”  I pray my effort will be better medicine than my tears for the others I hope and pray I don’t lose.

In the meantime for my friends in public safety, stay safe and strong.  Remember, you are some of those that provide hope to those that have none.  It is a sacred trust and not one to be carried lightly.

Why Western lawmen are no good on a sinking boat…

WHY?!?  Why me?  Why do I have to be the one person stuck defending Ron Washington?

The Dallas/Fort Worth Metroplex started its week trying to decide if they were Nolan guys (and girls) or JD (Jon Daniels) guys…that was before the reported fist fight between the team CEO and its General Manager.  Gone are Jackie Moore – a guy with fifty years of baseball experience – and Dave Anderson, only one year removed from his demotion from third to first.  Ron Washington meanwhile sits on a one year deal waiting to see if Jon Daniels renews him or not, but the issue is sitting right there in the General Manager’s office.

I know, I know…Jon Daniels is a baseball God.  He knows more about baseball than most people who played the game for fifty years because his vast experience involved with the little league game fully prepared him to play the stats geek to the high school players who were about to be drafted, but let’s look at the year and understand the Rangers over achieved.

 

First off, I predicted 86 wins and no playoffs.  The team hit 90 wins and while not in contention to do anything in the playoffs, was on the cusp.  Remember, they didn’t have Neftali Feliz in the rotation, i.e. who should have never been there.  Matt Harrison went out early and Colby Lewis was never ready from injury.  Between the three, I have to imagine they would have found at least five extra wins, but let’s face it, they didn’t need five extra, they needed one regular season win more and they would have been in the post season.  With all three, I think you have to wonder if the AL West doesn’t end a little different.  Certainly, Cleveland or Tampa Bay comes to Arlington.  So, it was a rough season.

At least Jon-boy as there.  He was good enough to bring us Lance Berkman.  Hey, I can’t lie.  Nothing says dedication like begging a guy from his hospital bed to come play for your team like JD apparently did with Berkman.  And for $10 measly million dollars we got an over-the-hill 1B/DH who produced a wannabe ginormous six bombs and a .242/.340/.359 slash line while he joked about bombing Wrigley Field less than twenty–four hours after the Boston Marathon bombing.  Brilliant pick up there JD…no power, no average, and just like school in July, no class!

I know JD is supposed be the Greek god of Baseball GMs, but let’s look at the career.  This was Daniel’s first year as GM on his own.  Every other year he has had the leadership of Nolan Ryan looking over his shoulder guiding him.  Everyone brings up the Elvis Andrus trade where the Rangers got Andrus and everyone else for Mark Teixeira, but who was looking over his shoulder making sure that the trade wasn’t a Livan Hernandez for Mark Teixeira trade?  Also, while we give JD all kinds of credit for deals like that, what about Adrian Gonzalez who was sent to San Diego for…who?

I know, I know…what’s in the past is in the past, but JD did zero for the team this year.  Alex Rios was an okay pickup at best and Matt Garza was a net negative. 

Alex Rios did at least add another six homers in almost half as many as Berkman and hit a respectable .280/.315/.457 while only drawing a $13M dollar salary.  Meanwhile, Garza made only thirteen starts for the Rangers and could only win four of them, while losing five, and drawing no decisions in the other four only requiring $10.25M per.

The granddaddy of all bad decisions though had to be forcing Jurickson Profar up to the majors and playing him all over the place while he contributed almost zero to the team.

Everyone calls Profar the next Jose Reyes, but in his first 300 at bats, he hits only .234/.308/.336 while making eight errors.  Really?  Everyone was talking about trading him straight up for Miami’s Giancarlo Stanton.  Ha!  It would appear now that, you couldn’t get a healthy Brian Roberts for him – as maybe he aint that special – yet JD had to force him up and expose it to everyone.

For Rangers fans, I think you might want to consider that you missed the playoffs this year and have some giant holes to fill.  First, designated hitter, and a catcher if AJ Pierzynski departs for the press box.  Then there is the question of can the rotation do again what it did this year, i.e. I am hoping no one is buying World Series tickets for next year or the year after because I think you are in full blown rebuild mode at this point.

To the questions, can the rotation repeat its success, I am guessing no, as even Mike Maddux is looking for a reason to leave and is considering the job he wouldn’t interview for a few years ago.  Keep in mind that as good as the pitching was, they were only ninth best in batting average against and tenth best in ERA.  As far as Quality Starts go, they ranked twenty-fifth, only allowing three or fewer runs in the first six through less than half their games.  There are only thirty teams.  What?  Hello?  Do you hear the phone ringing there JD?  I am guessing it is the bullpen phone with that kind of performance out of starters.

Meanwhile the team batting average was a very good .262, seventh best in the majors, yet were still behind the Los Angeles Angels.  For some reason they could not deliver when they had to yet the excuse was always if only the offense would score more runs.  Well, they did score runs, but the overall team was wrong.

The game belongs to Wash, but the team to JD.  Who messed up the stew Mr. Daniels?

This would be what we call bad: no ‘when it counts’ offense, no plate setters, and no pitching to go with.  All of that makes it very difficult to claim your personal greatness Mr. Daniels, when the results are anything other than a World Series win.  Let's face it, if you don't win the last game of your season, it isn't a good season.  No matter what.

This is all before we get to the middle infield issue of Kindler-Andrus-Profar.  Well, the Rangers decided it was a good idea to pay Ian Kinsler $15M a year for a guy who wasn’t that good a 2B, then signed Andrus long term to play SS all while having Profar in the wings who now plays…where?

The answer to the question above: why western lawmen (aka Texas Rangers) are no good on a sinking boat…because they don’t even tread water well, except when they are on their high horse which for the Rangers I just don’t see anytime soon. 

So we care what the people think?

President Obama decided he would insert himself into the naming issue of the Washington Redskins that continues to show up from time to time.  This time he claims "I don't know whether our attachment to a particular name should override the real legitimate concerns that people have about these things," he said in the interview, which was conducted Friday at The White House.

As I have previously discussed about this issue, this is a topic this seems to show up when we need a diversion from say real issues, but this being the President and all, I will listen up.  Afterall, if he is concerned about what people think about issues, perhaps we should look at recent polling on Obamacare, or even the Affordable Care Act - which is showing itself to be anything but affordable for the average family.

According to some families, the ACA is thought to be a bad idea by 44 percent of those polled versus just 31 percent of those who thought it was a good idea.  The numbers are even more drastic, 45 to 23 when you ask whether or not the ACA will have a positive impact on the nation's health care.  So...if it is really polling you want Mr. President, let's have that conversation, but your signature achievement would end up getting turned over - probably as quickly as the Redskins are doing this year with their turn over issues.

As usual the President seems more interested in being a celebrity President than a leader President.  Another sad day for the American populace.