trophy

it's been two weeks since i've seen her, and my first thought, which i unknowingly say out loud -- loud enough that a guy who i'm walking past replies "what?", which startles me -- is "jesus, she is one hell of a dirty girl." and I think, quietly to myself this time, "yeah, she may be dirty, but she's all mine."

it has been a tough winter. too much snow, too much cold, and always, as usual here in the pacific northwest, too much rain for way too long. and the weather has taken its toll on her. but today the sun is shining and i'm looking forward to spending some time alone with her.

as i grab a railing and step on board i always remember one of the golden rules of boating -- one hand for the boat. i've fallen out of boats before, always into lakes, but never into the cold puget sound. it wouldn't take long to drown or die from hypothermia here. the water never changes much from around 45 degrees. and the one other guy on the dock has left, leaving me alone, as i'd hoped. if i had to fall, i'd much rather fall in the warm caribbean, or in the waters off cabo, where we vacation. but that too would scare me. i've caught great gilled monsters in those dark deep waters and the thought of being with giant toothy creatures, who i'm sure recognize my stink, taking their well-earned vengeance on me, makes me shiver.

my wife, the best catch of my life by the way, and i bought this 20 foot trophy barely a year ago. we bargained a good price with the owner, although with the economy the way it is now, it's probably not worth what we paid for it. but it's ours. and we've put lots of wonderful hours on her. it wasn't exactly the boat we were looking for. we wanted a 24 footer. but when we found this 20 foot hard topper, almost brand new with less than 15 hours on the 4-cylinder cummins diesel, we changed our minds and made an offer.

bow to stern. port to starboard. i give her a good look-over.

yes, i'd rode her hard and put her away wet. her deck is scuffed with black marks from the rubber coating that covers the wire mesh on the crab pots, which are lashed to the top of the boat, reminding me of the dungeness crab feasts we enjoyed last year. there's green mold in the corners of the deck near the scuttles and in the two fish coffins, along with a bit of dried blood. the windows have some salt caked in the edges where the winter rains haven't hit to wash it away. nothing soap and water won't fix -- and a good waxing -- when i pull her from the water.

while in the back of the boat i open the battery box and switch on the batteries, then step into the small, narrow cabin and kick over the diesel. she starts almost instantly even though it's been two weeks since she last ran. she blows a light, wispy-white smoke from her exhaust until she warms up. the smoke is annoying and i wish i knew how to keep it from happening. maybe some day i'll check my owner's manual.

i unlock the cuddy and step down inside. the carbon monoxide alarm is sounding like a fucking banshee, not from the poisonous co gas, but because the boat's batteries are low. with the engine running to recharge the batteries it'll stop its shriek in about 10 minutes. i tell myself to wire the damn thing through a switch so i can shut if off -- but i know it'll probably never happen, just not high enough on my priority list.

the small cuddy is dry. i keep an electric heater going down here to drive the moisture out and keep mold away. sometimes i find a bit of water in the cuddy -- fresh water, not salt, so i know the hull doesn't leak -- but not this time. every time i step into the cuddy i remember that the reason we were looking for a 24 footer was to find a boat with a larger cuddy. one we can fish and water camp in comfortably. but the small cuddy will do for us now. there's room for the fishing gear when it's not being used, a porta-potty, and cushions to sleep on. and the boat has a heater that works off the diesel when it's under way so the cuddy and cabin are always toasty warm when we're on the water during lousy weather.

climbing back out i settle into the captain's chair in the cabin. the day is sunny, but cool. there's not a lot of heat in our low washington march sun, so i switch on the diesel heater to low and open the vent into the cabin. in less than 15 minutes i'm warm enough to shed my jacket, and as an added bonus the co alarm finally shuts up.

i switch on the marine radio and listen for boating traffic. it's pretty sparse, not many pleasure boats out today in the middle of the week. eventually a commercial ship comes up on channel 16, announcing to the mukilteo ferry that she is coming through their waters, and then the radio goes silent again.

"amanda" by boston is playing on the stereo when i push its power button. how strange and intriguing. boston is one of my favorite groups. and there was an amanda, many years ago, in one of my past lives. i find myself singing along and smiling with the memories.

i snap open the one can of cold beer i brought along. usually tequila is my drink of choice when boating -- sometimes too much tequila, i have to admit -- and yes, i am aware of the dangers of drinking and boating. but now the slight alcohol buzz, the smell of saltwater, the diesel's hum, and the breeze all combine with the sun beating into the cabin. i remember fish caught and lost. stories told. friends come and gone. adventures had and hoped for. this is reality.

code 4

code 4: firefighter radio slang for cpr in progress.

it's outdated slang. and the only ones who still use it are the old dinosaurs, like me, or the newer firefighters who like to carry on the tradition and heritage. i also still tell dispatch to "start me a card" when we have walk-in aid calls at the station. i know that dispatch has not been using time-stamp cards for almost 20 years now, using instead computer-driven dispatch systems that automatically record times and addresses from the moment the 911 call is received to the time a vehicle is back in service ready to respond to the next call.

but it's muscle memory in my brain. all of the dispatchers know what i mean and respond back "received, cpr in progress."

it's just after 4 a.m., 0409 hours by the time on my pager. the lights in my room come on and the station alarm is sounding, or at least they should be, telling us that somebody is having a bad day and expecting us to make it better. for some reason the lights and alarm aren't on -- which is unusual -- usually the system works. but my pager is making enough racket to wake me.

"female, unconscious, not breathing." we'll empty the station on this call.

within moments we're all up and heading to our rigs. i have a two-man engine company, a two-man aid unit, a three-man medic unit (including our rookie), and me on the battalion car, at our station. i also have another station east of town with three personnel ready to respond if we need the manpower.

the call is close to the station and we arrive in just a few minutes and find police doing a pretty good job of cpr in the bedroom. i think we have a great relationship with our police department. they help us out a lot and i hope they feel we return the favor when it's needed.

overall, the call doesn't look good. the patient is mid-50's, somewhat overweight, and obviously has an underlying medical history. fifty-year-olds don't just suddenly collapse and quit breathing. but we go to work. doing our best. always expecting a good outcome.

we move the furniture around to give us some working room. there's never enough room or enough light. the medic gets the monitor hooked up and his meds out while the emts get an airway in place so that they can breath for the patient and then start compressions. the cops move out of our way. asystole -- no heart beat.

the patient has poor veins, so after a few attempts at the arm, an iv is started in the patient's leg using an io gun. this line will feed directly into the inner space of the patient's bone -- where the blood cells are made. the medic gets a good line, and it flows freely. this is where the meds will be injected.

the emts are doing a good job of cpr. compressions are a lot of work and i make sure that the personnel rotate out before tiring. thankfully we have a lot of people on this call. i send somebody out for additional oxygen bottles and also call dispatch to request a chaplain to our scene. the medic drops a tube down the patient's throat to make breathing for the patient, with our bag-valve-mask, easier and more efficient. we are ventilating the patient with 100% oxygen, giving her the best chance of survival.

the person who called 911 is not giving us as much medical information about our patient as we would hope. we're not sure of her previous medical history and have no idea what prescribed meds she may be taking. this is not unusual. often family members and friends are too grief-stricken to talk with us, or simply just don't know. if only everybody wrote this information down (like the vial-of-life program), and put it where we could find it -- the refrigerator is where we always look -- valuable time would be saved.

finally a chaplain arrives and i feel much better. our chaplains are trained in caring for the family members and always seem to be able to get the info we need for patient care.

now the team is working like the proverbial well-oiled machine and the medical magic is starting to happen. but after a few rounds of meds things aren't looking all that good. the patient is not responding as hoped. we just can't seem to get a heart rhythm going and the medic is considering calling medical control at the hospital and asking for guidance. after another round of meds and a change to a fresh bottle of oxygen he makes the call to the on-line medical control doc.

it's been a long call. we've been on-scene now for 30+ minutes, which is the norm for a cpr call. we're starting to run low on meds. we're starting to wear out. we carry the same meds in our medic unit that the hospital uses during cardiac arrests -- epi, atropine, bicarb, and more. if this incident had occurred in the hospital the timing and application of meds and procedures would be the same.

the medic is on the phone with the doc discussing the call. we stop cpr again to check for a heartbeat -- what? we've got a rhythm on the monitor. not a life-sustaining rhythm, but one that we can work with. the medic tells the doc "looks like i got work to do" and hangs up. our pace quickens and our mood brightens. the patient is still not breathing on her own so we continue to use our bag-valve-mask and oxygen.

as the medic goes to work the heart rhythm gets stronger and better. we load her up on the stretcher and get her into the ambulance. i assign personnel to accompany the medic in the back of the ambulance for compressions, ventilations, and charting. once again i'm glad we have enough well-trained people on the call. the rig speeds away with lights and siren for the 15 minute ride to the hospital. she continues to improve on the way in.

it's an hour later and the crew pulls back into the station. the medic still has to complete his paperwork and enter the call into the computer. our patient is still critical, but has been admitted to the hospital for further treatment and observation. we discuss the call and talk about what went right and what we could have done better. all in all, we're pretty satisfied with how it went and how she's doing.

my dad died of a heart attack eight years ago. he lived in another town. i know many of the firefighter/emts and medics who worked his call. the scenario was similar, but unfortunately with a different outcome. i was in seattle when he collapsed and mom called 911. during the incident i received a call from the captain of the crew, a friend of mine, that was working his code. as i was driving to mom and dad's house he explained everything to me that was happening. i could actually see what was taking place. i knew they were doing everything that could be done. and i knew what the outcome would be. and also that they would feel bad, for me and themselves, for not being able to bring dad back to life.

since dad's death, every time i go on a cpr call i can see my dad lying there with the crew working on him. and it makes me want to work that much harder and push the crew that much harder too. it's not a sad thing, it's just a vision, a reminder of what you expect of us and how hard we train and work to make it happen. sometimes the magic works, sometimes it's just smoke and mirrors.

one of the things i've realized, after 25 years of doing this, is that we -- or maybe just me -- see way too many dead people. and it can make us indifferent, hardened, soft, emotional, a bit nutty, and combinations of all of these and more. it's kinda like a multiple-choice question with the correct answer being "d - all of the above." but my hope is that it gives us the respect for life -- in those around us and in ourselves -- that we deserve. and it reminds me that life is not forever. that i need to make the most of it.

and that i need to remind those around me of that too.

gracias por sus rezos

i'm home safe.

another successful mission to guatemala.

another life-changing experience.

on february 11th, just before midnight, i boarded a continental 737 for my destination of el paraiso, guatemala. included on board the plane were 20+ others in our mission group -- doctors, nurses, dentists, nutritionists, pastors, techs, assistants, people looking to help. some, like the doctors and dentists, have specialized training. others, like me, a pa (plain-assed) firefighter, just want to help in some way.

after a change of planes in houston and a long layover, we landed in guatemala city and easily made our way through customs. all our meds, equipment, and handouts had been packed in large plastic crates and were labeled with their contents. guatemala customs barely took notice of what we were bringing in. i think they are pretty used to having mission groups visiting -- and there are always other groups on our plane heading to different locations.

a bus was waiting for us, along with our guatemala hosts, susy and helmer, and we were on our way to antigua for a day and a half of sightseeing and aclimating to the time and cultural differences.

antigua is a beautiful city. guatemala's ancient capital. it is surrounded by volcanoes, one of which is active. there are numerous schools teaching spanish for the traveler and is the recommended jumping off point for guatemala visitors. guatemala city is large, dirty, and sometimes dangerous. antigua is small, clean, and set up for the tourist trade.

but antigua has changed a lot since i first visited in 2001. gone are the masses of street peddlers and beggars. now the streets are cleaner and the peddlers fewer and more polite -- not harassing you, but still applying just enough pressure to make the bartering fun. but gone too are the students from all over the world. i remember walking down the streets hearing german, dutch, english, japanese, and many languages i didn't recognise, along with the spanish of the citizens. i hope this is only a temporary thing, maybe due to the poor global economy. if you ever get a chance to visit guatemala, antigua is a must-see -- especially during easter week.

i made my self-required visit to frida's, a local hangout for ex-pats and travelers. i have never seen any locals in here, unless they were accompanied by visitors. the food, drinks, and atmosphere are great, and i brought along gary (our mcgiver) and joel (one of the dentists). we were soon accompanied by more of the group. they know just where to find me.

that evening i had dinner with claritza and her family. claritza is my spanish teacher from my 2001 and 2002 visits to antigua. she teaches through a spanish school called probigua and also on-line through skype. i'd give her a plug here but i can't find her business card.

i must digress ... i need to thank those who make my trips possible. first, my wonderful and loving wife, for not only allowing me the time away from home and duties, but also for her encouragement in me searching out new adventures. my employer and fellow chiefs, for rearranging their time to cover my shifts, which gives me the extra time off needed. my family, my two daughters -- both health care professionals -- for their love. and my friends, for your prayers. thank you.

after dinner that night, a good sleep, my last hot shower for a week, and the next day sightseeing and souvenir shopping, we'll be heading to el paraiso on a 10-hour bus ride into the jungle.

the bus ride isn't all that bad. although the roads here are mostly dirt, full of chuckholes, and the drive is long, the countryside is beautiful, and my fellow missionaries (funny, i don't think of myself as a missionary), pass the time talking, sightseeing, and sleeping (along with some vertigo just to keep it exciting). we stop for lunch at a mall (mall? it seems so out of place), and continue on our way, finally arriving in el paraiso late afternoon after changing buses in the town of fray.

our clinic will be set up sunday in the village's nazarene church, after services. we will move the pews around, forming areas for greeting, vitals, nutrition, exams, dental, and pharmacy. it will take us all sunday afternoon. we also unpack all the crates and set up the equipment.

it's sunday morning, sunday school for the kids at 0800 and then full services at 0930. church here is a bit different, especially because it's in quiche, the local language, but also because: the women and children sit together, the men all sit to one side, and kids are allowed to roam freely -- and the men are very passionate during prayers, crying and sobbing.

a translator is supplied so that we can understand what is being said, and he invites us to the front so that we can sing a song and be introduced. cindy, doctor mark's wife, plays the electric piano and we sing along. i know nobody here understands what we are singing, but they probably recognize the tune. it's a good thing i have a booklet with the words in it because i don't know the hymn. i think we sound pretty good and everyone claps for us.

after services we break for lunch. we bring in our own cook, food, and bottled water and we are fed very well all week. meat, potatoes, rice, tortillas, beans, lasagna, cereal (with soy milk), eggs, ham, spam (i love spam), and the regular foods we eat at home. we've brought a propane stove and this time a refrigerator. three squares a day.

setting up the clinic goes pretty smooth -- after we've broken open the cases and figured out where everything is supposed to go. about half the people on this mission are new, but they seem to have a sense of what needs to be done and we all work well together. putting together the pharmacy always takes the longest. we put the meds in alphabetical order -- mostly -- but group items like the pediatric meds, cough suppresants, and lotions.

while everybody is setting up their areas, the locals watch through the windows and doors. pretty soon there's a group of kids in the church and someone has blown up balloons and exam gloves for them to play with. everyone's excited, both us and the villagers, to get the clinic going monday morning. we're finally done around 1900 hours, tired, dirty and ready for dinner.

this is our third year in el paraiso. the first year we had pit toilets and bucket showers from rain water collected in cisterns, taken behind black plastic curtains. before we arrived our second year we were told they had a surprise for us and when we arrived last year we found flush toilets and real showers. the village had devised a method to pump water into overhead cisterns and use gravity and head pressure to supply the water for the toilets and showers. two real toilets with real seats to sit on. two real shower heads (although the water was cold), to stand under. pretty close to heaven! we do have to sleep in tents inside the area of the church that is the school rooms. this part of guatemala has scorpions, tarantulas, malaria mosquitoes, and lots of other big and nasty bugs. we found two scorpions in the sleeping areas, and one in the kitchen. one tarantula was captured in the clinic and are almost always found in the bathrooms.

clinic starts first thing after breakfast monday morning. we're all set to go. this year i'm assigned as half a doc -- i do patient histories and chief complaints, after which i pass them on to doctor mark for physical exams. in the past i worked taking vitals and in pharmacy. it's all fun and hard work too. when taking vitals you get to meet all the patients. pharmacy is taxing in making sure you're filling the right prescription. patient histories and complaints is triage. doctor mark asks me what i think is wrong with the patient and what i would prescribe. by the last day, and with doctor mark's help, i'm getting pretty good at figuring what is wrong with the patient and what they should be prescribed. it's similar to what i do as an emt, but here i get to carry through and diagnose and prescribe, which i don't do as an emt. one year one of the docs had me suture, which was cool.

our patients run in age from babies to the elderly. almost all of the children and adults complain of headaches and muscle pain -- from working all day in the fields in hot weather -- plugged ears and stomach complaints. the babies have fevers, measles, scabies, giardia, and chronic diarrhea. many are constantly tired and i prescribe iron to boost their energy.

i must use an interpreter because of the quiche language. some speak of bit of spanish, and i also speak a bit of spanish. so we're able to practice together. it's fun, but sometimes heartbreaking. i always ask about their diet, what they are eating, and if they have a good appetite. it wasn't until the third day that i realized that what was being interpreted to me as "poor appetite" actually meant that they weren't able to eat because they had no money for food. when i visited guatemala in 2001, with rita, my spanish teacher from shoreline cc (and the best teacher anyone could every have -- thank you rita), it was the first time i was exposed to a third world country and true poverty. here were people living in mud shacks, dirt floors, with thatched roofs. no fresh water. no fresh food. everything they owned, which wasn't much, was within their reach. some had farm land to work. some goats or chickens. everyone bartered and everyone, at times, went hungry. no health care. no education. no security. i've seen poor conditions here at home, but nothing like this. and this is why i return.

between the medical and dental clinics we saw 1010 patients. most with the normal illnesses you and i put up with day to day and simply go to the grocery store and buy over the counter medicine. i can't tell you how many teeth the dentists pulled, but it was a lot. we also saw patients who had strokes and cardiac issues, who probably wouldn't make it until our visit next year; one fractured forearm on a boy from falling during a soccer game; a machete wound on a foot; a hernia; many lymphomas; ob/gyn issues; breathing problems; pretty much a little bit of everything else that comes through a busy er.

i think the best thing we give these people is an education in nutrition and hygiene. maureen and her crew do an excellent job at this. it seems to me that each year the people are a bit less sick than the previous year, which means they are eating a broader diet, washing their hands, and not drinking water unless it's been boiled. it wouldn't do much good to keep coming back year after year without the education.

this post has become way too long, and maybe too boring, so i'll finish here. but i do want to plug two websites. the first is kiva.org. at kiva you can make a difference by donating money for mini-grants to people and groups in third world countries. and when you get boared and need diversion, instead of playing solitaire, go to freerice.com. at freerice you can learn a language, or math, or another topic, and in so doing make donations of rice to feed a hungry world.

thanks for staying until the end.