Daily thoughts

Sounds of Separation

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the sounds of separation reverberate

across the valleys and the vales,

to some they are sounds that integrate

to others, they lower the veil



Oh to have the adhan chanted in the same tower

from which the bells toll daily

instead the sounds that ring out, rip the air apart

their ringing reaffirms our separation



slave bell, unity bell, prayer bell, it tolls regardless

the tolling of the bell that divides

the minaret, mosque, synagogue and cathedral

shout out and chant; a call for unity, that divides



the bells toll for those who are near

to hear the sounds of separation.

the division bell continues to ring out

oh for the sounds of peaceful silence

 

© 2016 Michael D Emmerich

TECHNOLOGY IN MEDICINE

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TECHNOLOGY IN MEDICINE

Past, Present and a Possible Future – Help or Hinder

Published in Sanguine, journal of the ECSSA June 2015

Technology in Medicine, a topic many in EMS chat about, and if we have been in service for 20 years plus, we have then been privileged (or cursed) to see significant changes across the board with regard to equipment, patient care, protocols and drug therapies. Many of us have actively pushed for change and new equipment; be it with regard to fluid therapy, bleeding control, pain management and airway management. As one who has been active in certain areas pushing for change, we sometimes miss the most crucial approach to patient care; neatly summed up by Hippocrates (400-ish BC)

Cure Sometimes. Treat Often. Comfort Always

The classic approach to patient care has always been underpinned by the following:

  • Arrive at a diagnosis by patient consultation and physical hands on examination

  • Confirm ones diagnosis via various diagnostic devices

  • Reaffirm ones diagnosis by means of special investigations

Will technology change this approach for better or the worse?

If we look back at history, we see that not all new technologies have been readily accepted by the medical community. Many were viewed (are viewed) with suspicion. In the 1930’s some doctors doubted an X-ray image of the chest was as reliable as a physical examination. Devices threatened to replace the diagnostic expertise of the traditional doctor. Many doctors have valued their clinical experience over machine-produced information. Other technologies initially failed because doctors or patients found them impractical. The ECG was only useful when it became portable and reliable enough to be used at the patient’s bedside.

We need to also seriously review our progress in Medical Technology with regard to changes that offer only incremental benefits but at much higher patient care cost. The focus must be on evidence-based product development, manufacturers have to be able to show their products and new technologies will add value to their customers. Does new technology automatically translate into better patient care and most importantly improved patient outcomes.Plus we need to ask the question; who is their customer, the patient or the medical practitioner? If we as practitioners treat our patients as customers, they will act like customers, we need to be very careful of venturing into a quagmire such as this.

The entire patient/medical practitioner relationship is also changing, as the patient has access to a wider range of medical information, our patients are possibly smarter (maybe). Patients have access to more medical information, with the end result, that at times, they might be less trusting and prone to ask more questions of their medical practitioner. As practitioners we must be open to this new questioning patient and be willing to answer more questions than we did in the past.

Taking cognisance of all of the above: what is the health care practitioner to do?

There is an acknowledged gap in the “bench to bedside” cycle of medical discovery and its implementation in clinical practice, which can mean a gap of years changing “what we know to what we practice”.Hence the treatment of patients in an emergency setting should not only be concentrated on developing new technologies, but must also involve proper training and skills development; medical talents needs to be honed. New technologies MUST always mandate new skill sets, protocols and procedures.

An area of import in my opinion in medical development is patient information. The more information we have on the patient at hand, will allow us to render more appropriate patient care. Information and knowledge management is critical in helping with the decision making process and thereby improving patient care. Many medical practitioners believe that patients should take an active role in managing their own health information, because it fosters personal responsibility and ownership and enables both the patient and practitioner to track progress outside scheduled appointments and at times of a medical emergency. Patient smart cards is one way to grapple with this issue of information. It will allow patients to upload their health records via a flash drive and carry their information with them in their wallet. Information may be accessed through cloud-based storage and encrypted systems anywhere in the world, or plugged into medical smart readers. Medical practitioners can update to cloud technology in real time and the patients own medical doctor can be alerted to changes in the cloud files.

Another key area where technology can aid us in having more information at our fingertips is via a “differential” diagnosis or problem list, which is accessed via the cloud and links to our patient file and further information we input. After we have reviewed the patient “history” and examination. (e.g. is this appendicitis? a urinary tract infection? constipation? inflammatory bowel disease?) The practitioner must then troll his memory banks and innate knowledge base, or one may need to consult texts/online sources to check up/confirm their thinking. Cloud based technology could aid us and speed up the confirmatory differential diagnosis. As their is no doubt much room for improvement in the current approach, with many practitioners currently relying on their tacit knowledge base at the frontline which, while mostly effective, is subject to human error. Once the differential diagnosis or problem list is drawn up, then a related treatment plan could be formulated, and treatments in the form of procedures and/or prescriptions for medications may be suggested by our cloud database.

Emergency Medicine must continue its current academic trajectory, to keep pace with the challenges that technology brings to our patient care. If academic training lags behind the technology curve our practitioners and therefore our patients will be the poorer. We must ensure that there is now technology/practitioner gap as we continue to push the boundaries in improving our patient care. The danger of technology, is that it has the ability to make us lazy and self reliant. It has become noticeable in certain areas of emergency medicine how our reliance on technology has allowed us to forget the three cornerstones of good medicine, diagnosis, confirmation and reaffirmation; of which the diagnosis and confirmation are reliant on us having a hands on approach to our patients (which is becoming a dying art). Good solid diagnostic skills will always be an essential tool of medicine, especially emergency medicine, we forget this at our and our patients peril.

The Fading of the Day

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Inspired by the song On the Turning Away by Pink Floyd; I paused to write this poem

Light is changing to shadow

And casting it’s shroud

as the day fades to gray

and then shifts from gray to dark

before we long for the promise of a new day

we need to cling to the dark



even when it is dark, it's not dark yet

as it is always darkest, just before the dawn

as a new day beckons with promise, on the morn



the shadow shroud enfolds the world in gray

and teases with a promise, as the gray flickers to dark

with the dark is a promise of a new day

when the morning slivers slice back the dark



that sense of expectation, that it is never dark

there is always a new beginning

no matter how dark yesterday felt

today can be the brightest day yet

as we continually move through the cycle of life

light dark light dark …. light

© 2015 Michael D Emmerich

The Sonnet of Silent Conversations

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“I’m there, you’re there

We are silent in each others presence”

A thought I pondered on which led me to write the sonnet below ..

the beautiful silence between lovers

the solace in the silence

where words are not needed to uncover 

the hidden messages of compliance



the beauty of the silent bonds

that tie two stars into the same orbit

an orbit that does not require one to respond

other than in a soft touch or knowing look

as a means of expressing ones love



intimate hushed companionship, as such

reinforces the strength of silent conversation

the intimacy of conversing by touch

heightens the silent smiles and wink of flirtation

unity in our silent separateness leads to stronger ties that bind

© 2015 Michael D Emmerich

Is Religion the Greatest Threat to World Peace?

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With or without religion, good people can behave well and bad people can do evil;

but for good people to do evil — that takes religion.

Nobel laureate Steven Weinberg

The day we as a global nation choose to live for causes and not support ones that are worth dying for; will truly be a great day. Sadly it is a long way off. It will take tolerance and peace having to become more sacred than dogma and blind unquestioning arrogance for that to occur. When questions can be asked without having to fear for ones life, or risk being shouted down in the name of some religion…as they fear the questions (or maybe it is the answers the fear), that will be a day to treasure.

The religions that dominate our world today are made up of fossilized dogmas, that have been excavated from the mud of our past. They hale from a by-gone era when man created religion in an attempt to better understand his world. We now have science, evidence based research and rational questioning minds, which is the antithesis of many religions. This bygone dogma was forged in a world and culture so foreign to the one we live in today, but yet those beliefs are still held as sacrosanct and untouchable. As a result of this outdated dogma, evil deeds are allowed to breed, not by distorting or changing the teachings of scripture, but by obeying them. There is much material in every religious tradition that teaches violence, intolerance and hatred.

When a person believes, truly believes, that they know God’s will, they become almost impossible to reason with. Scientific research and evidence is thrown out along with rational thinking and the bath water. This is because most religions teach that faith – belief not supported by evidence – is not just acceptable but commendable, and is the sign of a virtuous person. Reasoning with a person in the light of the above becomes nigh impossible, as religious morality is not grounded in humans needs and desires, but in the will of god. Beliefs that weren’t based on evidence to begin with usually can’t be changed by evidence. Hence religious faith becomes very dangerous; when a religious believer chooses a course of action that’s evil or harmful, efforts to persuade them to stop will be futile. After all, if God has told them to follow a certain path, any opinion to the contrary is the devils work, and must be resisted, forcefully if needs be.

Religious leaders (and many of their followers), from all religions; oppose abortion, birth control, gay adoption, same-sex marriage, woman’s rights, euthanasia, to mention but a few — they want to control how people are born, marry, raise families, how they die, who they vote for, what to eat/not eat and which wars to fight. They want to barge into ones life during our most private moments and impose neigh, force and demand an adherence to their rigid, paternalistic creed. They know best how life should be lived, they have no qualms in seeking to intrude upon the lives of others at the most important and personal of moments.

Differentiating the evil that religion can perpetuate and the goodness in some people who practice religion seems fair up to a point, but how can one, for example, be both Catholic and good given the Vatican’s hundreds of years of torturing and murder, and currently, its favoring image over children? It is akin to being a good Nazi, which is exactly what its pope believes himself to be. When you base your “faith” in books that brim with divine violence, like the Old Testament, doesn’t that lead to more violence, at least in the defense of your “faith”

Sadly religion is never about what humans really need, but about what “god” supposedly needs humans to believe and do. The fact that religion is not about human needs is exactly what makes religion so pernicious. In other words, no matter what you believe, you do not have the right to hurt or curtail the rights of others, or to disproportionately benefit yourself at the expense of others.

It’s a far nobler a pursuit to wrestle with questions of ethics than to evade our responsibility and just parrot edicts that were written down thousands of years ago. It’s too easy to not have to really think about the consequences of our actions when we can just point to a book and say “but God said so.” We don’t understand maths because we take it on faith, in all other realms of our universe, we do not use faith as means of understanding its inner workings. Leaving it to faith is coping out, and it is the same as throwing up our hands and saying I don’t need to know, and deciding that some higher power will reveal all to us in good time. In my opinion, that stance does not get us any further as a species. It only leaves us standing still; unable to progress and make life better for everyone.

In closing let me end with a philosophical statement… which turned into a religious statement … and then totally ignored by religions…

‘Do unto others what you want done unto you.’

Confucius

557 BC, From the Analects 15:23

“One should always treat others as they themselves wish to be treated.”

3200 BC, From the Hitopadesa

An Idiot Wind Blows

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a wind is sweeping the land
no wait, across our planet
the wind blows through the halls of power
no country is sacrosanct


mediocrity our new political watchword
on a good day!
on every other day
we would be considered blessed
to have mediocre leaders


the wind of the bigot
the ignorant
the illiterate autocrat
blows with vigour
no stone left unturned
all that stand in the way 
bashed, broken, ripped apart


theocracy takes flight
the hot air of idiocy
blows with venom
from the open gaping
vacuous mouths
of our elected leaders


even when they are eloquently
hoisted on their own petard
their praise singers and chorus lines
run to the fore
like court jesters of old


the halls are silent
laughter is absent
intentions are real, deceitful
wrestling power and control
from the blind electorate
who have realised to late
the error of their ballot cross
has now become a cross they cannot bear

© 2015 michael d emmerich

The Red Light Train

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rain falling, mist rising, darkness beckons.

I clamber out of bed to join the red light train

bare feet on a cold concrete floor

soon shod feet on a metal pedal

as you push down, to join the red light train



cresting the dark hill the train stretches out before you

you latch onto the back 

sometimes with care other times with annoyance

so begins your day, for most, so begins everyday



the train has life and pace of its own

each day is a new train, always dynamic, ever-changing

it moves at its own unique pace

like a slinky, up and over the rolling hills

expanding and contracting 

moving at the pace of the slowest
 


Like life...

the train does not encourage one to look beyond the red lights

getting on and off causes frustration, 

it takes time, patience and determination

once you commit, you're hooked

that's why it's refreshing

to not ride the train everyday



Like life.....

one needs change, new challenges, new trains

a chance to ride the rails alone, breaking new ground

create your own red light train

trail-blaze your own path

create new uncharted rails

be your own red light train

driving into a new sunrise

 

© 2015 Michael D Emmerich

EMS – You Can Never Leave

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Last thing I remember I was running for the door

I had to find the passage back to the place I was before

“Relax,” said the night man, “We are programmed to receive

You can check out any time you like but you can never leave”

EAGLES – Hotel California

EMS is like the Hotel California: “You can check out anytime you like… but you can never leave” the memories, faces, successes and failures will always be with us. They dim at times over the years, but they are always there. I read a thought provoking and honest analysis on being a paramedic a few months back and have been mulling over her post, digging through ramblings from my field journals and the skeleton of a story I have been working on for about 2 years… these all prompted me to ramble further…

The blog post that triggered this article is: Unless you’ve been there, you wouldn’t understand: A Paramedics farewell to the job. Posted on February 10, 2015 by Di McMath

https://dimcmath.wordpress.com/2015/02/10/unless-youve-been-there-you-wouldnt-understand-a-paramedics-farewell-to-the-job/

One of the key issues for me is the ability/or lack thereof to detach from what we are doing and seeing; this drags one into the massively dehumanising temptation of EMS. I do feel that this dehumanisation is both inexorable and dangerous – as practitioners we need to know how to halt or slow it down. After 30 years of emergency medicine practise; I am still not entirely sure if we can entirely halt the process, which is why we can never fully check-out.

Being a fan of the poetry of Wilfred Owen, and as I reread his poems on a regular basis, I was drawn back to his poems during this thought process and found some further insight on reading “Insensibility”:

And some cease feeling

Even themselves or for themselves

Dullness best solves

The tease and doubt

The poem plays along the interesting juxtaposed lines of detached versus involved, and the varied degrees of these mindsets. Those of us in the profession have over the years dabbled with both approaches, the trick is for each individual to find his/her own balance. That is all part of the process of slowing down the dehumanising process. Finding this balance is key, if we do not, then we are doomed to keep repeating the mistakes of our past (mistakes as regards emotions and those of a clinical nature).

Emergency Medicine has the ability to dehumanise and diminish or renew and expand our powers of feeling. It is our choice to decide which path to follow. We realise soon on in our profession that this is one of the many choices that we have to make. How we deal with this choice determines how we deal with another key critical decision we as practitioners in the field are confronted with at numerous times in our career. Who lives or dies, or why do some people die despite our best efforts; and the pain of admitting defeat and saying okay, we need to stop now, the patient is deceased.

It is on these crucial scenarios, that I have to agree with the title of Di’s blogpost:

Unless you have been there you wouldn’t understand – Its sounds trite, but it is so true.

Trying to explain this process of immediate Triage, that at times needs to be done in very short time frames, less than a minute, is very difficult. Those are some of the choices we can never walk away from, and even when we do make them we cannot stop thinking about “What If?” the curse and bane of every paramedic. The cursed ability to second guess yourself long after the fact on an ongoing basis. It is here where we as emergency medicine practitioners are faced with the dehumanising and diminishing or the renewing and expanding of mental and medical health.

The goal of our profession should be a living force in the quest for and prevention of human suffering, but that sometimes comes at the cost of our own mental health. As we enter, continue in and exit this amazing profession, lets consider the cost to those we have served and continue to serve. All we can do as practitioners is warn, and that is why the practitioner needs to be truthful.

Updated:

Read these 2 poems I wrote on the cost of service:

https://mikesnexus.com/2017/04/23/at-what-cost/

https://mikesnexus.com/2016/10/30/god-is-in-session/

Lights Camera Affluence

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The following article is of my experiences, thoughts and observations as a set medic on film shoots, they have mostly been for the advertising industry. I have been working on film sets quite a lot lately, all about making ends meet (see closing comments). I am keeping it short and not alluding to any specific shoots/products or locations.

For the worker bees a day begins early and ends late, it is not uncommon to work in excess of 14 hours a day, excluding travelling to set., this can continue for days on end, leading to tired workers, who then make mistakes. The longer the shoot (hours and days) the more likelihood of injuries. The medic is one of the worker bees, one of the first to arrive and last to leave, we also serve a safety supervisory role (although with very little power, unlike in the construction industry where we can stop poor unsafe work). The medic fills a strange role, we are an essential service, shooting cannot happen without our presence, but that’s were it it sometimes ends. We are the adult baby sitters of the film set industry.

It is a strange world within a world, a peculiar insular existence, divorced from the reality of the day to day grind of the real world. It is possibly a very jaundiced view of society at large, on a micro scale. Although at times some of the hierarchy takes their positions to the extreme (in my opinion), with their strange demands and need for someone to always be at their beck and call. It is a world of chaperones, chauffeurs, PA’s – whose primary function is to be an espresso on tap machine (everyone has a PA, except the medic). I asked one of the PA’s how some of these people (senior crew and foreign actors) cope at home; the reply was classic: “They must still live with their mothers” 🙂

Summer shoots are possibly the worst (as the daylight shooting hours are so much longer); and the medics primary role is to dispense sunscreen and having to tell foreign actors and crew to drink fluids and apply sunscreen, which they never do… and then you have to assist them later gggrrr. An area of the industry that sits uncomfortably with me is when the child and baby “actors” that get trotted out, they at most times have no say in the matter and their parents seem to live their acting lives out , vicariously through their children or babies. Adult actors have a choice, but the kids not. They live a bored restless existence on set, in some cases just wanting to go home. The medic has to make sure that they are looked after and on hot summer days doing outdoor beach shoots this taxes one to the extreme.

I do battle to deal with the mindset of some of the people, and then their are the worker bees like myself (who have been doing this for years) and for them it is just a job, and is not office or desk bound, and for that they are happy. Many of these individuals acknowledge the concerns and issues when we sit and chat on the many slow days. It pays the bills and puts food on the table or their kids through school. They choose not to look beyond that. I suppose if one digs deep enough in any profession you will encounter similar issues, that the worker bees just live with.

The cynic in me has now come out… so stop reading if you do not want to read my cynical exposition of the ad/film industry.

When you look at the money spent on marketing to sell your next burger, cool drink, car, or dish washing liquid. Is it worth it? The cost of your next purchase carries all this marketing embedded in its base cost price, would it make the cost of goods cheaper if ad budgets were smaller?

Many jobs are created by these industries, but at the end of the day does the advert actually add value to the product? To what end is this entire process, as it becomes hugely self sustaining, and reliant on the general public to keep buying into this process, to which they are more than willing to comply.

A Sonnet of Requited Passion

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Trying my hand at writing a sonnet… lets see how it goes (my first sonnet) inspired by and dedicated to my wife 🙂

Oh the journey of danger

Begins with the form,

Of one who is not a stranger

But rather with a burning storm


Passions unleashed by ones love

As the dangerous flowing curves

Of her female form are void

Of all clothing and other womanly reserves


Laid bare to the silhoutte

Of the fading streaming golden sunlight,

As the two-tone colours on an artists palette

Raising raging desires to a height


All these passions can only be sated

Once heightened passions have abated

 

© 2015 Michael D Emmerich