Be well. Practice big medicine.

Editor's note: He's been a long time gone, but now he's back. Norm Rooker returns with this great piece that stitches the soundtrack to a lifetime spent in EMS. Enjoy. - HN

A couple of weekends ago I was driving across the New Mexico high desert and singing along with the Village People for all I was worth with a big ole grin on my face and joy in my heart. The reasons were many and involved both past and present. I was returning from a family farewell sendoff for our oldest granddaughter who is married to Steve, an Air Force “wrench turner”. They were being transferred from Kirtland Air Force base to Germany for a four-year tour and we had a family get- together to say our goodbyes and wish them well.

Vicki and her sister Katie decided to use the trip down to Albuquerque as the first leg for a five state road trip out to California and back. As I had a watch to cover the next day, I drove down separately and thus, was able to play “my” music and sing along as best I could on the way back.

Which isn’t always pretty as I have trouble carrying a tune in a bucket. If I can’t hit a note, I simply change to a key where I can. Its rare to get through an entire song in less than 4 or 5 keys.

But that was not the sole reason for the smiles. Rather it was for the memories I had attached to many of the songs. Like running hot to a cardiac arrest call to Jefferson Starship’s “We Built this City”.

It was early 1986 in east San Jose. Cindy Petretto and I were running hot through mid afternoon traffic for a cardiac call, CPR in progress. And what job isn’t made better without a good sound track in the back ground?

We had a classic rock station cranked up, radio KOME (yes, that is a real call sign and they’re still on the air) and while they played a number of rock classics as Cindy threaded us through the just out of school afternoon traffic, the song that was playing as we pulled up on scene was that Starship classic.

Like so many of our cardiac arrests, first responders were already on scene and CPR was in progress. The patient was in a coarse v-fib so we did what we always do, gave her a 200 watt second ride on the lightning and, surprise of surprises, shocked her right into asystole.

Unfortunately a not all that an uncommon but unintended outcome for this V-fib treatment. So now our patient is flat lined and we were attempting to stimulate her heart back up with various chemicals so we could shock it again. Hopefully with a different outcome.

I was on my A game that day and not only got the tube on the first shot but also turned around and sunk an EJ, as the patient had nothing for veins peripherally and Cindy wasn’t having any luck in either arm.

We worked that code to the point of calling it and Cindy was on the telephone with a Base Station Attending getting permission to do so when the patient’s heart said “enough already” and decided to rejoin us. I have never seen this before or since but our patient’s heart spontaneously converted from Aysytole to a perfusing sinus tach. (4 rounds of Epi 1:10,000 and 3 mg of Atropine tends to make the heart beat a little faster, when it chooses to respond.)

“Wait a minute doc! Forget the pronouncement, I need a Dopamine order!”

“What????”

Cindy and I brought our patient into Valley Medical Center, The Big Valley, where she was admitted to ICU but did not survive her event and passed away for good two days later. We received a nice thank you note from the family not only thanking us for our efforts, but also for giving their family a chance to get together and say their good byes to their mother, grandmother, sister, beloved wife, etc..

It was signed by what we guessed was the entire family. While Cindy and I had succeeded in telling the Grim Reaper “Not Today!” for our patient, and had a fantastic, make that great field save, we were humbly reminded both that it is not a true save unless the patient is able to resume their normal life and that we had not anticipated how many lives our efforts were actually making an impact on.

Or another rock classic, Lou Reed’s “Walk On The Wild Side”. Vicki and I had quit our jobs with St. Louis EMS and were working for Medevac covering the southern half of the City of San Jose and Santa Clara County while we were waiting to get hired by the City of San Francisco Department of Public Health Paramedic Division.

Anyway, back in 1985 we had a pair of young medics, Ramon & Terrel, who were decent medics but just a little to full of themselves. (Those of you who know me will realize that this is somewhat akin to the kettle calling the pot black but trust me on this one.) They always acted “cool” and called themselves Ghetto Medics.

While east San Jose certainly had its rough and lower economic neighborhoods. There was no way either Vicki or I could classify them as ghetto. Especially after having done my paramedic training in Detroit and working for the City of St. Louis for five years.

So when the two of them would get a little too wound up in some story of their exploits I would start singing, actually chanting, this Lou Reed anthem.

“I said hey babe,

Take a walk on the wild side.

Where all the colored girls go doot, ta doot, da, doot, doot...”

They would eventually give me a puzzled, slightly frustrated look and change the subject.

Eventually these two young studs decided to really earn their self anointed title and left us for employment with the private ambulance service that had the 911 contract for the City of Oakland. I ran into one of them several years later when he was going through his check rides to be hired on with the City of San Francisco.

After catching up with each other’s lives I asked him if he understood now why I was always singing Lou Reed’s greatest hit around them.

He looked me dead in the eye and said Vicki and I were right, they had no idea what a ghetto was until they went to Oakland.

Or another 80’s rock classic Glenn Frey’s “The Heat Is On”, a great song to run code to. It was the late 80’s and my partner and good friend Mike Whooley and I were working nights in the Tenderloin and Mission districts of San Francisco. Mike and I were the “can do” crew. We also had developed the reputation as the attitude adjustment crew as well and were frequently tasked with those “problem” calls.

“Fine! You want paramedics. I’ve got just the paramedics for you!”

We always knew when some caller had really cheesed off dispatch when we would be dispatched to “adjudicate” a situation.

I was a bit of an adrenaline junkie and liked to let the momentum of the calls carry me through the watch. After working 24s in east San Jose where I was lucky to get 2-3 non-consecutive hours of sleep a watch, working 8s, 10s and later 12-hour watches were a breeze. Beat me, whip me, don’t even have to feed me as long as I could swing by a 7-11 for my Big Gulp Diet Coke. Just give me the calls and get out of my way.

Fortunately Mike humored me by trading the quiet districts of the city to the other night crews so we could stay down town where most of the action was.

He always went along with my efforts to poach other crew’s calls if they sounded like they were good ones and on more than one occasion on slow nights he would turn and smilingly say to me that he could see keeping me entertained was going to be a challenge.

Yeah, I was a red hot medic and this was one of the reasons I earned the moniker, the 911 Cowboy, as we were riding herd on society in the ‘loin. (The Tenderloin district of San Francisco. Allegedly so named because during the hey day of the Barbary Coast days the police were reputed to be so on the take that they could afford to purchase tenderloin for their meal breaks.)

Anyway, the testosterone and adrenaline flowed, people were rescued, at least from their immediate circumstances and occasionally, lives were even saved. The truth of EMS is that the vast majority of our patients are going to live in spite of us, not because of us. However, our efforts can have varying degrees of impact from just simple acts of kindness to significant mental and physical impacts on the healing and recovery post event that caused 911 to be called in the first place.

The action, adrenaline and sometimes the down right “You are never going to believe this” stories that went along with all of this were just icing on the cake. Fortunately, Mike, while a good deal more cynical and realistic than I was, felt the same way.

Back to Glenn Frey, Mike and I were having a kick ass night on the ambulance. A “big sick” Cardiac Asthma call that we, actually Mike, recognized and treated appropriately with Nitro and Lasix rather than flog the failing heart harder with an Albuterol treatment. This was followed by several assaults and one very drunk but highly entertaining street denizen who initially wanted to kick our asses. Either together or one at a time, our pleasure.

Digressing slightly but still keeping with the theme of music and EMS, I was driving and Mike was attending and we “assisted” this citizen into a sitting position on the squad bench of the ambulance and seat belted him in. Mike chose to ride in the Captain’s chair as I drove us to San Francisco General Hospital. The patient kept up a running but losing tirade with Mike who was letting out some rather pithy lines that had me chuckling.

At one point the patient started complaining that we didn’t like him and we were just picking on him.

That’s when I jumped in with my contribution to the show. It had only been a couple of years since the movie TOP GUN had hit the screens. My wife Vicki’s favorite scene from that film was the volley ball game. She wanted to put a drip pan beneath the movie screen to catch all the excess testosterone flowing from those glistening bodies.

Mine however was the initial bar scene where Tom Cruise makes his opening moves on Kelly McGillis. With that in mind I chimed in, “Oh Mike, I think our friend has lost that loving feeling.” And then the two of us started singing.

“You never close your eyes ...”

At first our patient protested that we were making fun of him but we said no and that we were sure he knew the words and to join in. By the time we arrived at the hospital we were all in harmony, mostly on the same key and having a good time.

As we escorted our patient into the hospital he was thanking us and telling us we were the first people in a long time to just treat him like a person. Amazing the unifying power of music can have when applied judiciously and at the right time.

We were laughing as we cleared the hospital and headed back down town. We tuned in to an oldies station and had just parked the ambulance in a dark parking lot when we heard my wife Vicki calling the ambulance that was responsible for covering the Mission district for a stabbing. The call was at the northern edge of the Mission not to far across the border from downtown and me being me, well actually us being us, we jumped the call.

As I lit it up and came charging out of the alley onto Polk Street the oldies station chose that moment to drop “The Heat is On” into the play list. One cool sound track to be running hot on.

The streets were empty at that early morning hour and the song was still playing as we arrived on scene two minutes later. A back alley parking lot with two lone police officers and a large black man laying in a pool of blood with five stab wounds to the chest. He was unconscious and not quite at the Guppy breathing stage (agonal respirations) but was definitely spiraling down.

As I bagged the patient, Mike cut the guy’s shirt off, being careful not to cut through any of the stab holes and did a quick assessment. He then cut the rest of the guy’s cloths off to ensure that we didn’t miss any other injures and then sealed his chest wounds.

Mike shot the ET tube and we had a police officer bagging the patient as Mike and I loaded him onto a back board. Just as we horsed this guy onto the gurney and were fastening the straps, Engine 36 arrived on scene.

Quick load and with a firefighter driving the ambulance and a second one in back bagging the patient, Mike and I each got a large bore IV going and secured by arrival at the hospital. From time of dispatch to arrival at the hospital was 11 minutes.

We were definitely all over that call. Between us and trauma services at SF General our patient survived his injuries and now every time I or my crews have a “kick ass” watch, the sound track in my head always starts with “The Heat is On”.

But not all my music EMS memories are the happiest. While it sounds cliché, several of them are bittersweet. Like the Village People’s song “YMCA”. And to a lesser extent their other two big hits, “In The Navy” and “Macho Man”.

To set the stage, when these songs were first top 40 hits in the late 70’s, my first wife and I used to Roller Disco to them at the World of Wheels skating rink in Ann Arbor, Michigan. No, we didn’t wear tight polyester jumpsuits with sequins or anything like that.

For one I was a hard working EMT and we were putting me through paramedic school. But we owned our own skates and the rink only charged us $4 as a couple because I was an EMT with the understanding that if anyone took a tumble, I would go over and initiate assessment and care.

So for us it was an inexpensive date and clad in sweat pants and sport shirts, we did our “thing” beneath the swirling lights. Including doing the YMCA.

Flash forward 7 years to San Francisco. We had four large male nurses working primarily swings and nights at San Francisco General Hospital’s ED, Mission Emergency. These guys were all big, I mean pro football linebacker big. And gay. Big John Taylor, Vinnie, Tony and Mark. Collectively they called themselves the Four Queens. And they were a blast to work with.

Because back then, nights and swings was where it was at to work EMS. No bosses or brass around. No stick up their butt lifers or sycophants. Just folks with medium to high energy who wanted to get the job done, and generally wanted to do it well.

But the pace was also fairly frenetic. We never had enough resources, either in the pre hospital, ED or crisis mental health to meet the demands/needs of the public we served. So we had to help each other out to get the job done and make it through to the end of the watch.

And humor was a frequently employed tool. For instance, John had a button collection and wore a different one every day. Buttons with phrases like, “your lack of preparation does not constitute an emergency for me” or “you must have mistaken me either for someone who cares or has the power to do something about your problem”. Or one of my favorites, especially in light of the frequent surrealistic nature of some calls, patients or turn of events, "I don’t think we’re in Kansas anymore Toto”.

Sometime during a busy watch, we would seek John out just to see what the button/ message de jour was.

And if some patient tried to get rough with one of the staff or our medics, everyone jumped in. Well almost everyone. Some of the med students hadn’t got it yet. We restrained so many patients or brought in so many patients in four-, six- and sometimes eight-point restraints that we would sometimes get “judged” on the quality of our work.

Back then, DPH medics were authorized to carry handcuffs. We had in-service training and SOGs that essentially stated that if you had to take a patient down and restrain them, go to the steel to get them under control and then as quickly as possible, switch to soft restraints.

We carried the sheepskin-lined soft tie restraints. The kind you can still find in Adult or Marital Aid catalogs marketed under the title of pleasure restraints. On more than one occasion after we and some SF Police officers or firefighters had tied down a patient acting out or chemically out of control due to alcohol or some other mood altering substance we would have one of the officers inquire if we had an extra set as he/she and his/her wife/husband, boyfriend/girlfriend had some special romantic event coming up.

Generally we were able to accommodate and would give a quick in-service on how to utilize them appropriately. Both for restraining and how to do so in a way that was safe and the “patient” couldn’t undo them yet could be quickly released as needed.

I took it as high praise when on one particularly busy full moon weekend night I brought in a very loud and obnoxious QID, Queen In Distress, having a hissy fit enhanced by meth, in six-point restraints and Tony announced in a voice loud enough for everyone around to hear that I tied them down so good that he was making me an honorary Bondage Queen.

Or at the end of one busy night watch when I was held over by a late call and was in the nurse’s lounge writing up my chart when Big John came in wearing civvies. I had actually never seen him before in anything but his clogs, scrubs and button de jour.

So it was with a little surprise when I looked up and observed him in motorcycle boots, starched blue jeans and a tight sports shirt. But what really caught my eye was that he had a bunch of colored bandanas in his back pockets. I don’t mean just stuffed in a pair of multi-colored wads but rather precisely folded, starched and neatly stacked exactly an inch apart so you caught the full spectrum of colors.

There was a yellow, white and red one in his left hip pocket and a red and purple ones in his right. Big Vinnie walked into the room somewhat similarly attired and also sporting multiple but different colored bandanas similarly stacked in each of his back pockets.

As the two of them talked I finally screwed up my courage and asked a question that I knew the two of them would end up giving me way more information on than I wanted. But self restraint had never been one of my stronger points so I stumbled ahead.

“Ah, John, Vinnie, I know you guys can’t have such runny noses that you need to carry all of those bandanas. Um, do they have some significance that I’m not aware of?”

Vinnie laughed as Big John turned and flashed me his classic smile and stated “Norm, you have to remember, you’re not in Missouri anymore.”

From there I learned that in the gay community at that time there was an entire color code to sexual acts. And that what was displayed in the left pocket was what a person liked to receive and what was worn in the right pocket was what an individual liked to give.

As they went on at great length to explain what each color represented I was thinking that this was actually a pretty neat system and would have made the dating scene a whole lot easier in the hetero world as well. Especially back in those awkward junior high and high school days.

While I was thinking this Vinnie piped in that this also held true for the S&M leather set. That if you wore a pair of handcuffs through the left epaulette of your leather jacket, that meant you liked to be on the receiving end vs. through the right which indicated you preferred to be the dom.

As I was taking this all in I suddenly realized that I wore my handcuff case on my left hip because I started out in this world left handed before my first grade school teacher, a nun who had left the order to have children but hadn’t left her iron ruler behind “encouraged” me to learn to write right handed.

I blurted out to both of them. “Guys, don’t get the wrong idea, I wear my cuffs on my left side because I’m left handed!”

They laughed and told me I was safe as my “reputation” as an honorary Bondage Queen was well known.

They left me to finish my report as I, now almost beet red, hustled to finish my PCR and make relief before the day time dispatchers decided to abuse us again.

Or the time when Mark took it upon himself to inform me that the Village People were a gay group. Naively and incredulously I exclaimed “No! How can that be? My wife and I used to roller disco to them.” As I quickly demonstrated my mastery of the YMCA arm movements.

Again I got the “You’re not in Kansas anymore.” speech and eye roll. I learned that in most big cities YMCAs were where young men of the gay persuasion would go to when they first hit town to meet similar interested men and to learn the local lay of the land. That the Y was considered a hot pick up spot for the new in town gay crowd.

Through all of this I was flashing back to my membership as a kid to our local YMCA and attending two separate YMCA day camps and wondering if I had missed something. I sure didn’t remember any of those kinds of activities going on.

As Mark went on to describe each of the stereotypes of the Village People in the gay culture suddenly their song Macho Man took on a very different perspective. And even though I was a veteran medic of four major cities I was feeling very naive.

(Now in my defense, I didn’t watch VH1 or music videos so I actually never saw the actual videos till I looked them up for this piece. If I had seen them there was no way I could not have known.)

Or the time Big John embarrassed the snot out of a new group of doclings. San Francisco General Hospital was a teaching facility, so it was institutionalized that each July 1st a new group of first year med students would arrive from all across the country. Many of them equally or more naive then I apparently was.

We nick named them doclings both because they were not full fledged doctors yet, just as a paramedic intern is not a full fledged medic, and because they would follow their respective attendings like ducklings following a mama duck. Looking for guidance, reassurance and protection. Hence the term, doclings.

So one late hot July night, Mike and I had brought in a particularly obnoxious drunk in six-point restraints. The SF General Institutional Police assisted us in transferring him over to a hospital gurney and re-restraining him before we brought him into triage where he was evaluated and triaged to the “male ward”. The name was a hold over from a previous era but had now come to mean the non-acute medical ward. Regardless of gender.

So Mike and I parked our still verbally abusive patient who was taking full advantage of a phenomenon we came to call “the freedom of restraints”. We hypothesized that an individual, when interacting with the public at large had to exercise a lot of self control in what he or she said or did as the consequences for saying some things could lead to a serious "butt whoopin’" or worse. Consequently, some patients would maneuver events or the situation to the point where they would be tied down. Now they could say anything and no one would assault them or exact retribution as they were tied up. They were free to let their mouths run wild with a fair degree of impunity.

Such was the case for this one individual. He must have mixed his booze with meth or coke as he kept up a running tirade all night into the wee hours of the morning. It was now 5 AM and Mike and I were bringing in hopefully the last patient of the night. Who was triaged to the Male Ward.

As we walked into the ward, we observed our mouthy patient still going at it. There were three doclings working at the table in the middle of the ward, attempting to catch up on their charting before morning rounds and each would periodically look up with an annoyed expression when our earlier patient would spout off.

As we were taking all of this in, Big John entered the ward from the opposite door to share some information with the Male Ward charge nurse. As soon as he entered, our restrained patient started in on him by shouting “Faggot!” “Faggot!” “You F***ing Faggot!”

To which John stopped mid floor, stared at the patient and then turned to the table full of doclings, put his hands on his hips and called out in a loud voice, “All right! Who told?!”

Mike and I burst out laughing as all three doclings turned beet red, ducked their heads and began scribbling furiously into their respective charts.

Through the years there were many more supporting and entertaining interactions. Us against management. Either ours or theirs. Like the time a new ED director decided that he was going to get control of the ED nurses and they responded by wearing large buttons or white scrub shirts with the phrase “No Handmaidens” emblazoned on them. Or when one of us got injured in the field.

However this was back in the late 70’s through the 80’s. And the medical and gay communities did not know what we know now about AIDS. We lost all four, John, Vinnie, Tony and Mark, over the years to that nasty disease.

At Big John’s wake, Tony brought in a shoe box full of John’s button collection and each of us was allowed to take one as a keepsake for John. Vicki and I still have ours in a nick knack box on a dresser.

So every time I hear the song YMCA, I smile and when possible sing or dance to it with great enthusiasm. The lyrics and tempo remind me of those past friends and fellow “Code Warriors”. Especially the way the voices, still singing enthusiastically, never stop but rather just fade off into the distance at the end.

Take care & be safe everyone and I promise not to go so long between essays.

___

YouTube links for the songs referenced by Norm:

We Built This City

Walk On The Wild Side

The Heat Is On

You’ve Lost That Loving Feeling

In The Navy

Macho Man

YMCA

This was the key phrase that averted a minor catastrophe and put the best end to that was playing out to be one of those "you'll never believe this" mini-dramas at two in the morning last fall, around a tree, in downtown Ouray, Colorado. My bride and I had been peacefully asleep when one of Ouray PD's finest special-called me.

When fully-staffed, there are only 17 full time law enforcement officers in Ouray County; divided between the County Sheriff, the Ouray City Police Department, the Ridgway Marshal's Office and the enforcement rangers for the Ridgway State Park. That's not a heck of a lot of law enforcement for 542 square miles. The agencies back each other up but you can be on your own for a while until help arrives.

I wasn't special-called because officer Biggs, of course nicknamed "Smalls"
needed, to quote the movie 'The Princess Bride,' "the Brute Squad". Nope, she wanted me there to pick up the pieces when she tasered this one particular drunken bubba's butt.

To set the stage, in the City of Ouray, population 973, we had been having periodic problems with marauding bruins coming into town and going dumpster diving. To compound the problem, somehow the bears seemed to know that this would be a particularly long and cold winter for them. How they knew we would end up receiving 178% of normal snowfall science has yet to figure out. Anyway, throughout the month of October we were having even more than the usual number of marauding bear "visits".

It just so happened on this particular evening that three Texas elk hunters, down on their hunting luck, were drowning their sorrows at the Silver Eagle Saloon when one of them spotted a bear crossing Main Street.

Like any fine somewhat inebriated self respecting Texan would do, they ran out and gave chase to said bear.

Frankly, if the bear had hauled off and decked them, it would have served them right but then the bear would have had to been put down by the Colorado Dept. of Wildlife. So our smarter-than-average bruin turned and high tailed it towards the hillside.

The problem was that he had just finished gorging himself of the contents of several trash cans so he was lumbering a little slower than usual. In turn, our highly motivated but judgmentally-challenged Texans, who were whooping and hollering, were gaining ground. Not to mention generating numerous calls, at least for us, to 911 for disturbing the peace at almost two in the morning.

When Officer Biggs caught up with the group, they had chased the bear up a tree. But that was not the worst of it. Not by a long shot.

The boldest or drunkest of the group had climbed up the tree after the bear because, and I quote, he was going to "Whack it in the butt!".

So why was I special-called? Well the telephone conversation went something like this..."This is Norm." I have long had the ability to sound like I'm wide awake when awakened from a sound sleep by radio traffic or a phone call, even while the brain is still rebooting up.

"Norm, I need you right now." Officer Biggs informed me in a tone of voice that spoke volumes.

"I'm finally going to get to tase someone and I want you here when he falls out of the tree."

Over the top of voices shouting in the background and Nicole telling someone to get down now, right now and she wasn't fooling, she went on to tell me, "I'm the only one from my academy class who hasn't tasered anyone yet, but that is about to end tonight so get down here now."

More shouting in the background and other noises I couldn't quite identify and Nicole ordering someone down again. "Look, just get here." And she hung up.

As I struggled out of bed, disturbing our cat who let me know that she was annoyed, my bride asked what the call was about. I told her I wasn't quite sure but it sounded like Nicole was about to taser someone.

Vicki called it right as she rolled back over, "Probably some drunken Texan. This time let the police take him down."

OK, you can take the medic out of the city, but some of those muscle memory instincts don't always stay behind. There had been a couple of calls over the past three years where I had "adjudicated" a situation and then realized that law enforcement was there and it was in their job description to do so, not mine.
So properly and appropriately chastised I finished dressing and drove the short mile and half to Nicole's location.

There was Nicole on one side of a swaying 45-foot pine tree and two fellows on the other hollerin' up to their buddy about 20-feet or so up in the tree who was still insisting that he just wanted to "Whack it in the butt!".

The Ouray County Sheriff's deputy was responding to back her up but he was way up in the north end of the county and still about 10 minutes out.

Nicole had her taser out and little blue flashes of electricity were arcing between the dry stun electrodes as she gave several warning cracks on it to let everyone know she was serious.

She gave one last command for the fellow to come down now. Right now or she was going to fry his butt!

"You better come down now Cody, she really means it and she's more than pissed. She's Mama Mad."

Apparently the term "Mama Mad" caused some preconditioned survival neurons to kick-in and take over. All of a sudden our belligerent tree climber turned docile as a boy scout, climbed down and stood in front of Nicole, all five foot four of her. With his head hung down and in a soft voice totally different from his early hollerin' he apologized.

Nicole said a few more things. All three of the now humble and chagrined Texans stood towering over her with their heads hung down and mumbling a chorus of "Yes ma'ams" and "No Ma'ams.". Nicole ended up taking a field report and let him off with a warning.

Our young tree climber and his buddies promised to never, ever, ever chase a bear again or otherwise make rowdy in town and walked back to their motel.

Nicole turned to me and instead of saying thanks, said "Damn! I'm still the only one from my academy class that hasn't tased anyone yet."

I said something about better luck next time and got back into my buggy and headed back home. On the way home I started playing the little mini-drama back in my head. The obvious turning pint had been the phrase "Mama Mad".

Obviously this has to be a conditioned response. My dad had a phrase that he would use, "You better" fill in the blank, "or heads will roll and tears will flow like rivers." When my brother and I would hear this we knew there was only one correct response and everything else would result in pain or worse.

This wasn't an immediate response the first time we heard those words. We had learned over the years, the meaning behind them. Good judgment is what you get for surviving bad judgment. Yours or someone else's.

But our mother, she had various levels of, shall we say, force escalation.
Everything from reasoning, motivating, to indirect action. She taught my brother and I to start making our own beds by short sheeting them when I was 12. We quickly figured out it was easier to just make the bed then have to get up at night and remake it right just so we could sleep. And she strategically timed this behavioral modification during the winter months so there was no faking it by sleeping between the top sheet and the bedspread or blanket.

But when those didn't work, or we had just plain ticked her off most royally or had otherwise pushed her past her limit, well then, the game was on. And Mama Mad was just not a good time for bonding.

Not that I ever got a whoopin' I hadn't earned, with one exception, it was just that when mom got to that point, even if my brother JD or I held perfectly still, it was only a 50/50 chance that the swat, shot with the wooden spoon or swing of the belt would actually land on our butts. I understood 'Mama Mad' all to well. Having pushed her to that a time or two growing up.

And speaking of games, how many of you remember the 1992 movie A League Of Their Own'? My friend Kenny Darenzo's mom was one of the women who played in the women's professional baseball league during World War Two. She had one heck of a throwing arm.

One day Dick Sterne and I were playing at Kenny's, I think we were 11 or 12. Anyway, Kenny's older brother Bill had done something to tick their mom off. I mean really cheese her off. She was unpacking groceries while we were playing in the den. Kenny happened to look up and spot his brother walking down the driveway about the same time his mother did.

Kenny took one look at her as she was making for the front door, threw open the window and yelled "Run Bill. She's got a potato!"

Bill turned around and started beating feet but he wasn't quick enough. She caught him at almost a hundred feet away right between the shoulder blades, bringing him down in a cloud of dust. She then turned and glared at Kenny.

Dick and I were frozen in place like deer-in-the-headlights but Kenny had no illusions on what was coming next. He took off for his bedroom as quick as he could as Mrs. Darenzo pulled off her sneaker let it fly. Kenny had already rounded the corner and was two steps from his door, but like a Cruise Missile, that sneaker tracked him around the corner and caught him in the back of the knees, bringing him down with a crash.

As I grew up and left home to follow the medic trail. I encountered numerous examples across the races and religions in various parts of the country that reinforced the old adage, "If Mama Ain't Happy, Ain't Nobody Happy".

Whether in the poor or working class neighborhoods of St. Louis or the blue collar neighborhoods of Ypsitucky. That's actually Ypsilanti, Michigan. So many southerners, especially from Kentucky had migrated north to work at the GM Hydramatic Plant in Ypsilanti that in the 70's it had earned that nickname by us emergency responders.

From there to the multicultural neighborhoods of south San Jose to the streets of San Francisco, one thing was constant. In most families, single parent or both, gay or straight, the mother, or the person in the mother role, was the driving force for the family the vast majority of the time.

On more occasions than I can accurately recount I managed to talk my partner and I out of trouble or calmed down an explosive scene by identifying the alpha female and working with them. Once she was with the program, the rest of the family generally calmed down. Or at least stopped venting on us.

This wasn't always possible though. One call in particular stands out. It was a late spring night 22 years ago. 1986. My partner and I had been dispatched to an assault in a low-income apartment parking lot. It was one of those East San Jose surrealistic calls that sort of defied logic.

For one, the Santa Clara Valley had been developed so quickly in the 60's & 70's that there were miles and miles of low and middle income housing in what had only a decade or so before been fruit orchards. Each developer, in turn was able to assign street names to their developments. This resulted in some really interesting themed names for various neighborhoods.

One neighborhood would have wine related themes. Chardonnay Way, Cabaret Lane, etc.. Another was named after various agricultural products.
Cantaloupe Drive, Melon Street. And for some poor married couples, Honey Dew Lane. (The husbands out there will all get this one.)

Anyway, this low income apartment complex was located in a neighborhood where all the streets were named after Disney characters. So we were responding to the intersection of Bambi Lane and Cinderella Court for the assault.

We arrived with a two-man fire unit and two police cars to find a big 16 year old Samoan kid laying unconscious in the parking lot. He had obviously been in a fight and come in second. We c-spined him, backboard, c-collar, sandbags and tape. A nasal pharyngeal airway and high flow oxygen via a non-rebreather mask completed the ensemble.

We had just lifted him onto the gurney and were just about to raise it up to roll it over to the ambulance when we heard a commotion coming towards us. We turned to observe a large Samoan woman running towards us being trailed by what we later learned were her other sons, daughters, nieces and nephews. She was just about my height and size and we were two of the smaller members of the group that arrived.

She threw herself across our patient who turned out be her son and started crying.

I was just about to step forward and reassure her that he would be all right when she started shouting "I told you not to hang out with those boys!" And started punching and slapping her unconscious son.

The oxygen mask and then the c-collar went flying in different directions as she continued to chastise and otherwise vent her frustrations to her unconscious son. I started to step in to intervene when I felt a large hand on my shoulder.

One of her older sons leaned down and said in a low and actually very kind voice. "Don't. When she gets like this it's best not to get in the way."

She was Mama Mad. While I was contemplating his words she finished meting out punishment, cried on our patient's chest for another minute or so and then told him that she loved him and would see him at the hospital.

We hustled our patient to the ambulance before she had a chance to change her mind and repackaged the kid enroute. Documentation? It began with 'the patient was the victim of several assaults' and then went on to describe his injuries, treatments and response to those.

Getting back to the present, as I returned home and made my way back upstairs to annoy our cat yet again because I made her move out of my spot in bed, I bet that patient from 1986 understood what "Mama Mad" was and idly wondered what our tree climbing Texan had done to learn what it meant as well.

Just what is the correct response when this is the initial greeting from someone who knew you from back when? The occasion was the 2008 Fire-Rescue Med Conference in Las Vegas. I was attending the national roll out for the Ambulance Strike Team Leader class. (A good program and one well worth taking by EMS supervisory and middle management types.)

It was the opening part of the class where each of us stood up and introduced ourselves, who we worked for and how long we had been involved in EMS. Because this was a roll out, there were a number of us older dog medics taking the program to evaluate it for our services or areas, so my almost 35 years of EMS experience only earned me a fifth place seniority ranking in the class.

One of those ahead of me turned out to be a coworker for a service I worked for back in the late 70's after graduating from paramedic school and prior to being hired by the City of St. Louis EMS. After he introduced himself and I was thinking that he looked familiar he turned to me and uttered those words.

We all had a good laugh and when you're greeted with a public comment like that from a senior medic your class reputation is well on the way to being established. The ASTL course progressed and while we ran a little long with anecdotes about EMS responses to Hurricane Katrina, various earthquakes in California from the 1989 Loma Prieta Earthquake to the North Ridge Earthquake and more recently, the EMS response to last October's wildland fires in southern California and even the recent papal visit to Washington, DC, the material was all relevant for the tasks that needed to be accomplished.

Afterwards I pondered my former coworker's statement. This was not the first time I had heard this sentiment. Fourteen years earlier at my 20 year high school reunion I ran into Mr. Petty, one of my senior year English teachers. He was walking towards me and when we got close but before I could say hello he stopped dead in his tracks.

He looked at my name badge. After all I had filled out some since graduation and was well on the way to balding, make that bald. Some of that by nature and maternal genetics and the rest enhanced by an ambulance accident where I flew head first into the front cabinets and avulsed the top of my head down to the skull.

While I had serious railroad tracks and a growing yamaka spot, I still had hair on top of my head until that moment. They had to do a skin graft to cover the wound and I was darn lucky that I hadn't broken my neck. I still have an arthritic thoracic vertebra from that accident. But that was five years prior to the reunion and I was healed up now.

Anyway Mr. Petty looked at me, looked at my name tag again, sighed and stated something along the lines that I was one of the ones that he was sure would be listed as among the honored dead by this reunion and that he had actually been surprised to see me at the 10-year reunion.

I just snorted and said 'Nope, I was still here and planned to be for awhile' but at the same time I was a bit taken aback by his comments. After all, it wasn't like I was a hood, stoner or troublemaker in school. It was more that I was not what you would call a low maintenance student or employee.

I attribute this to the times and to my parents. And for that matter my grandparents. My maternal grandmother was an active young lady who lived in the fast lane of her times. Think of the musical CABARET. Grandma Stamat was a flapper and was living the Berlin cabaret and nightlife scene when Hitler's Brown shirts did Krystal Nacht. Being an American citizen she was able to get out but almost my entire maternal family line for her side of the family was lost to the Holocaust.

Her second husband, my mother's step-dad but the man I knew as my grandfather was a loud character. A merchant seaman stuck in Hong Kong during the Boxer Rebellion, a US Calvary man who was part of the American Expeditionary Forces that chased Pancho Via into Mexico and a few years later was in one of the first units to go to France in World War One. He left the Army after the war and worked a number of jobs including being a union "enforcer" in the Chicago area during the labor troubles and organizing in the post war and depression.

My father was an Iowa share cropper's son, the third of six kids, born on my grandmother's 20th birthday. He was an all-state athlete who battled with an abusive father, dropped out of high school at the end of the football season his senior year. And in the American tradition, after meeting and falling in love with my mother, and powering through my grandfather's initial disapproval, pulled himself up by the bootstraps, worked his way through college and became a very successful Chemical Engineer.

I was the oldest of three kids. My brother JD and my sister Meredith were
three years younger. My sister was very severely mentally retarded and
had both Down's Syndrome and Hurler's Syndrome. So from a young age I always had to come straight home form school to help take care of my brother and sister so mom could do chores like grocery shopping and getting dinner ready, etc.

As we kids grew, my parents were moving into the middle to upper middle class. We were living in a suburb of New York City and had the benefits of their hard work. But my parents wanted us to appreciate how well we had it compared to what they had when they were growing up. So my mom came up with the Christmas letter program.

Each year she would go down to the main post office in New York City and read through the letters to Santa Claus. She and my dad would select a destitute family, contact the parent or parents and make sure it was OK, and then get my brother and I involved in providing Christmas presents and dinner for them.

Everything from going through our own toys and picking out something that was in good condition that the letter identified these kids would like, to purchasing, and gift wrapping other presents. Then as a family we would drive into some of the worst parts of New York City and make the delivery.

It was an eye opener and a tradition that Vicki and I continued for several years with our own children.

It was also a time of the early civil rights and women's liberation movements. When I was 11 my mother and father signed up for the Fresh Air Program. This was a program where we would host two inner city kids, Larry and Marshal, for what turned out to be the next four summers.

All this BS about race and other differences mostly disappear when kids just get to be kids. I learned that not all black people are natural athletes. That they were able to get sunburned, too.

Each summer we would go down to Fenwick Island near Ocean City, Maryland. It wasn't until much later that I realized that these weren't really vacations for my parents, however we kids always had a great time.

Swimming, fishing, crabbing and learning how to play draw and stud poker for sea shells. (I ended up with a pretty neat shell collection which I held onto until my junior year in high school when I passed it on to a lovely young lady.)

This was during the mid to late 60's and race relations weren't exactly all they could be in that locale back then. One or the other of my parents had to get up early every morning and accompany us four boys to the beach or to the bay to ensure our safety.

We didn't appreciate this sacrifice back then. We were just four boys between the ages of 8 and 12 having fun. All four of us would be at the beach playing in the ocean and sand all day. The third day we were there was a particularly bright and brilliant day and boy did we pay for it that night and the next day.

Larry and Marshal became such a part of our family that when my parents decided to divorce after my sister died, they waited until the Christmas Holidays so all four of us kids were together before they announced it.

Prior to that sad moment, my mother had also became involved in the Women's Liberation Movement. I was 14 when she began hosting women's self help medical exams at our house the third Sunday of every month. While I had no idea what this meant, it was pretty cool because my brother and I got to go to the movies those afternoons.

I didn't find out what was actually going on until a few months later when my mom sent me up to her room to grab a flashlight out of her bedside drawer and I found a plastic speculum. My 14 year old mind did not have a clue what this was for but I brought it downstairs with the flashlight, holding it upside down and making quacking noises as I asked my mom what it was.

That old cliché about being careful about what you ask for comes back to mind as I was sat down and learned way more than I ever wanted to. At least at that time in my life.

My sophomore year of high school I was on the wrestling team. After a long six weeks of hard practices I had made the decision that it was time for me to bring my jock strap home and wash it. (You know it's got to be bad when a 15-year-old boy decides this garment is to gross even for him.)

By now my brother and I had been doing our own laundry for a couple years. While I was sorting my clothing my mother was trying to come up with a poster idea for the first parade for the ratification of the Equal Rights Amendment by the New York State Legislature.

This is where being a creative smart butt sort of got me into trouble, again. As I was moving my crusty bit of athletic apparel to the whites pile I said something along the lines about putting a bra and a jock on a poster with something about equality.

My mom yells "Brilliant!" and snatches this stained and crusty item from my hands. My pleas to at least let me wash it first fell on deaf ears and that is why my jock strap along with one of my mother's black brassieres and the words, "Ratify the ERA, Connecticut NOW" appeared in what turned out to be one of the most photographed posters of the rally with numerous shots of it in the New York Times and the New York Daily Post.

Needless to say, backing down or shying away from a challenge or trouble was not a family trait.

At that time in my life I was somewhat active in sports. Not a great athlete but game, if a bit on the lazy side. I was active in Boy Scouts and a cadet in the Civil Air Patrol. My squadron ran a ground SAR team.

Through these organizations I took basic and advanced first aid training as well as both the American Red Cross junior and senior lifesaving programs.

I was also in Future Teachers of America and I taught swimming Friday afternoons to the developmentally disabled class as well as wrote and worked on the student newspaper. All of these activities taught me to question what I didn't think was right or pursue the question until I understood it.

The upside was that all of these activities led me to be selected for the second pilot EMT course they ran in the State of Connecticut in 1973 over the summer between my junior and senior years.

One of the downsides was that I sometimes clashed with or challenged authority. Never, ever in a destructive or mean spirited way. Well, I was suspended for fighting once my senior year but that was a provoked situation and testosterone rather than thinking things through got me in trouble on that one. I made the best of it and spent my entire suspension teaching PE over at Western Junior High School.

But overall I was a good kid. I accepted no for an answer, eventually. Never in trouble with the law and a decent, if underachieving student.

The fall of 1974 I reported to Ripon College, in Ripon, Wisconsin. A small enough school that it was possible to be a walk-on and actually make the football team. I had never played organized football before but I was just big enough and apparently just good enough to make the team.

I was a nose tackle. I had never thought of myself as being particularly small but I quickly learned that at 5'10" I was shortest lineman on the team. It turned out I was the shortest defensive lineman in the entire conference.

I learned very quickly, actually with the "help" of my philosophy instructor that physical size was only part of the equation when it came to battle on the line. You see, my Introduction to Philosophy professor also happened to be the offensive line coach.

If I "discussed" an opposing point of view too much in his class that morning, that afternoon he would "borrow" me from the defensive line unit to run what can be best described by Gary Shaw's 1972 book, MEAT ON THE HOOF: The Hidden World of Texas Football, as Shit Drills.

I would go one on one with each member of the offensive line. Pass rushing as well as just your standard one on one confrontation for dominance of the line. Then there was the two-on-one, trap blocking drill. This is where the center or offensive guard in front of me would pull away and I would be hit by the offensive guard or tackle next to him.

I would be pass rushing against five of them protecting the coach who would toss the football just over their heads. I would have to leap up and catch it and they would have to react to my "interception" by stopping me from gaining any yardage. I crawled home from those practices.

Heck, I was the third shortest member of the team. I was lining up against guys so much taller than me that at eye level, I was looking at their neck and in two cases, the number on their chest when we both stood up straight.

As a lineman I was mediocre at best. But I learned how to hold my own and think through ways to use what I had to my advantage. And I never did seem to learn the other lesson my philosophy instructor was attempting to teach me.

As a nose tackle, I was third-string on a two-string team. Ripon being a small college. But on special teams, that was an entirely different story. Man, for an AADD type, it was the best gig on the team. For me, that was where it was at! All that building excitement and noise leading up to the ball being kicked and running down field, the crowd roaring and the wind whistling through the ear holes of my helmet as I lined up on one or two members of the receiving team and just piled into them.

As with many things in my life, it was a matter of luck and opportunity coming together to help me in ultimately being named "Bomber of the Year" by the coaches. But as usual, I am getting ahead of myself.

In 1975, the NCAA, in an effort to cut down on knee injuries made it illegal to throw a cross body block below the waist on kickoffs. Guys that had been playing football since Jr. High and High School had all been taught the cross body block method or to slide feet first into the opponent.

Consequently, in this first season of the new rule, none of them really knew how to hit or block their opponent on kick offs. I learned by accident the first time. I stumbled while trying to turn to adjust to the ball carrier and in a high speed stumbling fall just happened to wipe out the guy in front of me. That's when it occurred to me.

Most people don't want to be hit. No matter what their size. They would rather push and shove. Fortunately I played for a pretty good team and was able to put my theory to test in the next quarter. I picked the biggest guy on the receiving team and cleaned his clock.

After that I would just sail down field, pick my target and take them out -- opening up a hole in the wall for the other members of my team to take down the ball carrier. I never once directly tackled the receiver, although one time I did hit a blocker with enough force that he took out his own ball carrier.

Between the values my parents and grandparents taught me, the responsibility for taking care of those less fortunate or weaker than me from an early age, to that lessons I learned on the football field, to finally, the lessons Liz taught me (see March 16th's column Tough Enough) I apparently was what you might call a high profile EMT and later paramedic.

I never abused patients or derelicts. I never picked fights. For that matter, I never, ever punched anyone. That is an offensive tactic. My father taught me that there will always be someone bigger stronger or faster so fighting is always an option of last resort.

But if you do take that course. You don't do it to come in second. And you never do it to showoff, or bully.

That included Special Operations such as rope rescue, structural collapse rescue, firefighting, Tactical Medic, etc.. Along with some of the interactions at certain fire houses after our "merger of equals" where the Paramedic Division was removed form the San Francisco Department of Public Health and inserted into the SF Fire Department in 1997.

But getting back to last week's Fire-Rescue Med Conference, I ran into another former coworker, Jonathan Chin, who Vicki and I had worked with at Medevac in Santa Clara County, CA back in 1985/86 while we were waiting for the City of San Francisco to pick us up. Medevac had the contract to provide EMS for the southern half of the City of San Jose and Santa Clara County.

Jonathan is a handsome and articulate Chinese-American who quietly radiates leadership and charm. While neither of us were ever partnered up with Jonathan, we often ran into him and his partner, Cindy Petretto at various hospitals. They were a good solid crew. Medically dialed in and they always pulled their share of the load.

One day my partner and I had brought in a middling-serious trauma patient from a motor vehicle accident to Valley Medical Center -- The Big Valley, a level one trauma center. At that time the ER was one long room with gurneys down either side, a nursing station in the center, two trauma rooms and in the back, a sort of three-bed quiet area for less acute patients and folks that needed sobering up.

While I was writing up my PCR, Jonathan and Cindy came in with a huge biker type. I mean pro-wrestler size. Multiple abrasions and reeking of alcohol. As they were wheeling him towards the "Quiet Room" he kept muttering abuse towards Jonathan.

"You Gook", F***ing Gook", "You slimy Gook", 'You..", well, you get the picture.

Jonathan ignored him and Cindy rolled her eyes at us as they wheeled him past and into the Quiet Room. A minute later Cindy came bursting back out.

Paperwork went flying as my partner and I and another crew from SCV, the company that had the EMS contract for the northern half of San Jose and Santa Clara County beat feet for the room while a nurse called security.

I was first through the door and there was Jonathan trapped in a corner between the walls and a hospital gurney. His angry patient was towering over him. But Jonathan wasn't cowering or blustering. He was standing tall in a neutral stance looking up at the belligerent biker.

As I started to take my leap to tackle this guy high I heard Jonathan say, "Lets get one thing straight. It's not gook, it's Chink!"

Now that's being calm under fire. Jonathan has since gone on to obtain his master's degree in administration of EMS, has been the EMS Director for the State of Oregon and now runs EMS for a large county in northern Oregon.

While we were catching up on each others lives, respective families and careers I mentioned the comment in class about a coworker acting surprised that I was not dead by now.

He smiled and stated that while I was never a bully or troublemaker, per say, even with union activities, that the reason some people might get that impression is that I was always in the middle of things. That no matter what, an assault on a coworker, a working condition or a protocol or procedure controversy, I always stepped in and did what needed to be done or said what needed to be stated. And for those that sat on the sidelines, that level of risk taking was seen as either threatening or something that could lead to unfortunate or negative consequences.

I smiled back as his observations made sense to me. And yes, there have been rewards, triumphs, consequences and scars. So Mr. Petty, Professor Boweles and countless others I have known, worked with or for over the decades -- I'm still here and plan to be for years to come.