The call comes over the radio and Ryan and I respond to a fall in the front lobby of the hockey arena. An elderly woman has taken her walker down the escalator and ended up falling down the last few steps. I take the call and carefully start assessing her, the poor woman has a slight mental impairment, a host of medical problems and is frightened and shaking like a leaf.

I check her shoulders and neck, running my fingers along her collarbone to assess stability. I check both her arms, running my hands down the bones to feel for deformities or swelling, watching her face for grimaces or any other indication of pain. All I find is a tender bruise starting to swell up just above her elbow; pulses, mobility, sensation, grip strength and everything else is normal. I check everything, running through the full assessment just to be sure. As I release her from my care, I tell her all I found was the bruise on her arm, but to go to the doctor and get checked out later if anything continues to hurt. Completely confident in my assessment and treatment, I fill out my paperwork and contently return to our seats in the stands to watch the end of the game.

Two weeks later, she approaches me at another game, her arm encased in a very supportive sling. "You know my arm that you said was just bruised?" She says with a slightly accusatory tone, "It turns out I broke my collarbone. I went to the doctor and it hurt more than all of my surgeries put together." Slightly dumbfounded, I stammer out an apologetic response while trying not to second-guess my basic assessment skills. As we part, I turn to Ryan in shame, "I thought I nailed that call, I checked everything! She had no pain, no swelling, no deformity, no instability, no nothing!" I barely hear his consolatory response as I'm lost in my own embarrassed thoughts.

I know I wouldn't have run that call differently if I came across it again, but I still feel bad that I missed it. I thought my skills were oh-so-good, I was getting cocky, especially in front of the newer members. I guess we all need to be knocked back to earth occasionally, even if its by something as simple as a broken collarbone.

Discord

The performer revels in the adoration, the screams and cheers of thousands of fans. He hears them scream his name, sing every lyric of every song and raucously applaud everything he says or does. I hear the scream for help, the cry of a frightened fan with blood running down her face. I hear security shout for me as yet another person staggers out and collapses against a pole, or is carried out by anxious friends. I hear the same stories time and time again, from nearly every patient who walks through our doors.

He sees them jump up and down with excitement, he sees the wide smiles on their faces, the signs splashed with his name and his T-shirts on every body. He sees attractive young women winking at him and smiling suggestively as they bare much in their concert attire. I see the police hauling yet another obnoxious drunk out of the crowd, tossing him out before he creates yet another patient for me. I see the blood hit the floor, drying into deep red-purple stains, a surprisingly beautiful colour against the dingy tile. I see knees buckle as people collapse, their pale and sweaty faces showing fear through their weakness. I watch the crowd closely, picking out those who will soon join me, seeing potential patients in every corner. I see a scantily clad woman fighting to stay upright on huge heels as she stumbles around in a drunken haze, eventually failing miserably and hitting the floor in a pile of skin, makeup and beer.

He smells the smoke from the pyrotechnics mingling with the odour of alcohol and sweat from the massive crowd. I smell the fruity tropical drinks in the vomit my young patient is spewing everywhere, I smell the alcohol on the breath of every patient who stumbles in. I smell smoke and blood, beer and vomit. The inescapable odour permeates my uniform and my hair, searing itself into my very pores.

He feels the thunderous bass shaking the stage beneath his feet, he feels the touch of frantic hands against his feet, his legs, his hands. I feel the grip of a drunk young woman on my hand, her fingers locking through mine in a desperate attempt to regain stability. I feel the swelling grow in a broken nose, I feel my sweat on my forehead as I try to stem the ever-rising tide into the first aid post.

He sings of the glories of alcohol, I see none of it. The young women who came in attractively dressed now slump to the floor, skirts riding up and shirts hanging low, with no control over themselves. Men who come in quietly leave with an escort of blue, or stumble out in a cloud of profanity. I spend the entire evening treating what alcohol has done to these people, and can't help but realize the discord between my experience and the ones glorified in his songs.

Concerts

March seems to be concert month around here, which is a welcome break after the long, slow winter. There are several large ones approaching, and I find myself looking forward to the preparation, setup and organization of these events. I love being the control person, running the show from the pre-duty briefing until the debriefing at the end. I carefully set up my teams based on qualification and experience, sending them out to pre-arranged locations at the pre-arranged times. I rotate them often enough to keep them from getting bored, and shuffle them around to maintain coverage when calls start pouring in.

We prepare for the worst when setting up before every concert, our entire triage area is designed to manage mass numbers of casualties. We prepare a drunk section where they can vomit peacefully with limited mess, water is set up for the fainters and splints and backboards are laid out for the unfortunate souls who venture into the mosh pit. Our tent stands guard at the entrance, a post through which all must pass in order to maintain order and control. I brief the teams, giving them the layout of the show, times, attendance numbers, radio instructions and assignments. As much information as I have, I reveal. I want my responders to be fully informed, holding back information to preserve a sense of power and control drives me nuts, I always strive to be fully open.

Hopefully, this month will go smoothly and the concerts will prove yet again to be a learning experience for everyone involved. I do my part by making sure all the extra stuff is taken care of, freeing up the responders to respond to calls and treat patients to the best of their ability. Hopefully, having me at the helm and on the radio allows them to focus on their job and not worry about anything else. I love treating patients, but I'm loving the organization and dispatching side more than ever.

Politics and Patients

Standing on the balcony and watching the milling theatre crowd below, I am struck by a sudden realization. The politics don't matter, I can deal with the issues and squabbles that have plagued us recently, because I do this for good, unchanging reasons. I do it for the people below me, for the experience and joy of treating a patient, to help a person out in their moment of need. I can look every single person here in the eye and say, "I do this for YOU." I experience a new pride in the crest on my sleeve, a renewed joy at the rank on my shoulder, a feeling of fulfillment and joy in my job. I do this for the patients, they are what matter, nothing else, and I will stick with it.

Anger

I watch the concert from a safe distance with my earplugs in, but it is still deafeningly loud. There is more black than the average funeral, as weirdly pierced, spiked and tattooed teens wander aimlessly around, charging into the concert room when the main band comes on. Nosebleeds seem to be the order of the day, courtesy of the frenetic mosh pit and flailing arms. A slightly older guy comes storming out of the crowd, blood streaming down his face, his arms, his clothes, the floor. I sigh, glove up and grab a mess of paper towel. Here comes another one.

He storms over to the wall and kicks it, hard, then whips his sweater at the nearest garbage can. I shake my head at his display of temper and walk over when he appears to have calmed a bit. Handing him the stretch of paper towel, I touch his arm and beckon towards the first aid room. He storms into the room just ahead of me, then lets loose a curse and kicks my trash can, bending it in half and sending bloody gauze and other debris cascading over the entire floor. He then proceeds to brutalize the helpless wheelchair, cursing and yelling about the injustice of his nosebleed. "HEY!" I yell, angry that I will have to clean up after his mess, angry that he is disrupting MY safe place, MY treatment room. "WATCH IT!"

He turns with clenched fists and takes a few threatening steps towards me. Thoughts fly through my mind like lightening, "I'm about to get punched, Ryan is going to KILL him, this is going to hurt, WHY didn't I call in my partner or security???" At the same instant that he starts moving, I do as well. Stepping outside, I wave to the nearest security guard, who comes running. Still mad at the guy for being such an ass, I re-enter the room and lose it on him. "WHAT THE HELL DO YOU THINK YOU ARE DOING?" I shout at him, "SIT DOWN AND SHUT UP NOW, OR I WON'T TREAT YOU, I WILL THROW YOU OUT OF THIS ROOM AND HAVE YOU THROWN OUT OF THIS CONCERT! Now calm down, and sit your ass down, NOW!" He looks taken aback, and as the security guard enters, he finds a blood-covered man cowering on the cot. "Everything ok?" he asks. "Just fine," I answer, "He was just a little upset." He nods and steps out the door, leaving me with the patient who is now extremely contrite, apologizing for the mess, for his anger, even for his injury.

I help him stop the bleeding, clean the blood off his hands and face and send him on his not-so-merry way. The look on his face when I started yelling at him sticks with me, I can't help but laugh as I clean up the mess and remember his incredibly abrupt change in behaviour. I guess redheads have a bit of a temper after all. ;)

The Concert Hall

The singer is incredible, he has an absolutely amazing voice. I had been a distant fan for a while, I like his music, but not in a rabid, buy all his CDs the moment they come out way. After the first song though, the goosebumps covering my entire body just don't go away, and I'm on the edge of my seat, awash in the rapture of his gorgeous voice. All the stresses and cares of the world melt from my mind as he sings, Christmas carols, Worship songs, his own songs, he just keeps singing and singing.

A hand on my shoulder breaks me out of my spellbound reverie and I jump, startled back to this world. Jakob leans over me, "We've got a call down front," he stage-whispers, "do you want me to take care of it so you can watch the show?" I quickly shake my head no and follow him across the back of the theatre. As much as I was enjoying this man's voice, my purpose for being here is to treat patients, not to kick back and relax.

The usher leads us along the side of the theatre, passing rows and rows of people who drag their attention away from the stage to gaze curiously at us and whisper to each other. We stop stage left, 3 rows from the front, in perfect view of the stage and the entire theatre. I make my way down the aisle, which thankfully, happens to be one of the widest rows in the place, and stop where the head usher is crouched in front of an elderly woman, slumped over in her seat. She gives me a quick report as I sidle up beside her in the dim light.

"She was feeling faint, dizzy and nauseous, with severe pain in her right foot since this morning." I nod and crouch by the woman, running through the assessment questions to try and rule out major issues, like an MI or stroke. A few minutes later, I am relatively convinced that although it is nothing too serious at the moment, we need to get her out of the theatre seating where I can do a proper assessment. Since she says she is unable to walk, we bring a wheelchair as close as possible and lift her into it.

By now the entire auditorium is watching us, and the performer knows it. I am completely focused on my patient, aware of but not focused on anything around me when the music stops. "I don't mean to draw attention to it, but I see we're having some difficulty in the front here." I hear a melodic voice say, and I look up, straight into the singer's eyes - he's almost close enough to touch, staring down at us with loving concern. "Why don't we pray for this woman's healing, and thank God for her life...." He begins to pray for her, for her healing, and for us. In slight disbelief, I carry the wheelchair-bound woman up the stairs as the entire crowd joins him in prayer, then applauds.

We head for the stage door exit, as the woman has requested an ambulance, and she's just not 'right' enough to let her go home. I don't know what was happening with her, but judging from her 6 million index cards full of allergies, medications and conditions, I'd say it was beyond my ability to treat. Just before the paramedics arrive, the performer comes backstage to see the women, wishing her well, and nodding his thanks at us. Since I am a complete professional, I certainly did not grin like a fool for the rest of the evening....

Just because we can?

I had an 'asthma' patient not too long ago, who came over to me freaking out, gasping for breath, moaning, crying and clutching her chest, throat, face etc. I sat her down, stared her straight in the eye and told her directly to calm down. I coached her breathing for very few cycles before realizing that she was, for lack of a better expression, full of it. She would gasp and spit, choke and sputter, then look up at the scoreboard and cheer raucously for her trailing team. She would be close to death, then pick up her cell phone and start texting her friends. A colleague of mine walked over and asked, like I was completely inept, why this asthma patient was not on O2. Ummm....because she doesn't need it?

A few weeks later, I was running an event as control when one of my teams got a call for an injured cheerleader. She had been kicked in the head, rather hard, as she fell from the top of a formation. The trainer had walked her over to our post and sat her on the back step of our ambulance. She had a nasty headache, as well as nausea and dizziness. She did not have neck pain or tenderness, and from all accounts, had not actually fallen onto her head. I know I wasn't at the call and didn't assess her myself, so perhaps it is unfair to criticize the team's treatment. They put her in a KED (since she was sitting down), and were preparing to backboard her as EMS showed up. The paramedics checked her over, WALKED her to their stretcher, placing her on it sitting up comfortably, and left for the hospital.

A little girl turns her foot at a kid's event, my partner and I head over to check her out. She is sitting on the turf, no tears, no obvious look of pain on her face. She winces slightly when I touch the lateral edge of her foot, but there is no instability and only minimal swelling. Placing an ice pack on the injury does wonders to relieve the pain. My partner pulls me aside and asks if I'm planning on splinting it. I say no, and explain when he gives me an incredulous look. I am not putting a small child in a massive, uncomfortable knee-toe-splint for an injury that just doesn't seem to logically require immobilization. Sure enough, she is up and running around by the end of the event.

Over-treating patients seems to be a rampant disease among many of the people I work with. The "Just because we can" attitude drives me insane, and I strive to counter-act that whenever possible. On our training nights, this attitude is clearly visible among many of the responders. When we focus on patient assessment techniques, vital signs and theory, people are bored and disinterested, brushing it off as been there, done that. This is even the case among responders who are and always have been terrible at patient assessment, obtaining accurate vitals consistently, scene management and the like. As soon as we pull out the equipment, however, people get more interested. Backboards, the KED, crazy splinting stuff, people would rather do that than practice the oh-so boring, routine steps of assessment and treatment. There is also a great tendency to jump on the chance to 'practice' their skills on a real patient. I don't like that mindset, but sometimes I worry that I am under-treating in response to their over-treatment. I guess it has to be a fine balance, and always, always with the patient's welfare at the forefront.