Mile Low Club

My screams can be heard throughout my body and soul. They sound terrified, like I just hurled back the shower curtain to reveal a giant spider whose legs are so long they touch all four corners of the bathtub, and is glaring at me from all 10 eyes. They sound horrific, like the screams from a thousand monkeys being chased by a thousand wailing house cats in heat. With fiery torches. Finally, my nightmarish screams are so ghastly, my body and soul retreat to the darkest corners of my mind and curl into a fetal position, rocking and drooling against the inside of my cranium.

But you don’t hear any of this. You see my screams manifested externally as withdrawn aggravation, difficulty concentrating, and white-knuckle anxiety. I remember pre flight-anxiety life. I’d happily slop all of my belongings into a suitcase, pick out just the right magazines and novels to read on the plane, refill my ipod with the latest and greatest hits. I thought the airport was an exciting hub of energy and intoxicating chi, and I never forgot to pack anything. 

On February 19th, I spent the morning of my mother’s birthday feeling unfocused and anxious. I put off packing all morning, hoping if I didn’t pack anything I wouldn’t have to fly, which is completely opposite of my usual organized, prepared, resourceful self who would have had everything packed the week before. Around 4 hours before take off time, I began gathering the things I would need for a five day vacation starting in Baltimore, then on to DC. I packed casually, as if the plane ride wasn’t happening: my favorite outfits, jewelry, Nook, laptop, several pairs of glasses/sunglasses, contact lenses, workout clothes and my new Brazil Butt Lift exercise CD, bathing suit, and walking clothes for the Zoo and Smithsonian days. I dressed and got myself ready for the ride to the airport and flight as if it were a certainty that the plane were crashing, and I wanted some of my personality in life to come through via my burned and bloodied corpse. Sure, it’s morbid but I choose a lacy red tank top under my favorite red shirt, a comfy but cute pair of Victorias Secret jeans, my favorite black boots which have just enough of a heel to be sassy but also allow me to walk longish distances in comfort and are so scuffed the left one has a hole somewhere that allows water to osmose in from even the slightest puddle or humidity level. I adorned myself with my Pandora bracelet, owl ring, zebra print ring, and bright blue glasses with red on the rim and interior. The perfect attire to underscore the twisted, horrified expression that will overwhelm my face on the downward spiral into the ocean, mountains, field in the middle of nowhere...or wherever the plane decides to malfunction and begin to fly vertically, instead of horizontally. 

I know what you’re thinking: Duh, why do you think bars are positioned suspiciously close to departing gates?! Indulge in an alcoholic refreshment to sedate some of these unnatural fears! I tried that. 2 Bloody Mary’s later, which was about 25 minutes before take off time and the loudspeaker at Gate 19 announced there would be a minor delay due to the incoming plane being late. 30 minutes later they announced a delay of unknown length due to a “leak in one of the lavatories.” Over an hour after departure time we finally boarded the plane. I sat down, buckled up, perused a Sky Mall, made jokes with my daughter, and people watched while the others boarded. I complained about the wretchedly oversized luggage people are allowed to bring as carry-ons. I wonder if all airlines allow this, or just the one I usually travel on? Then I scoffed while other passengers got physically assaulted by said wretched people trying to wedge their kitchen sink stuffed bags into the compact overhead bins. Even though it’s completely illogical because if they checked them, the bags would still be on the same plane, but whenever they cram those bins so abnormally full, I feel like it contributes to or will cause the inevitable infernal descent. When the engine went into gear for the shimmy to the runaway, my condescending sneering stopped abruptly and I remained in a seated position with my eyes clenched shut, every muscle in my body contracted, and an arm wrestling death grip on the seat arms. My respirations alternated between barely breathing and taking gasping deep gulps of no-oxygen-because-the-airplane-is-just-about-to-spiral-downwards-into-a-fiery-crash. I also tried to let myself be comforted by my sweet daughters kisses on the cheek, comforting hand holding and rubbing my arm. My husband mostly just stared, presumably wondering if he was going to have to perform CPR, or some other unnatural act in my airway to restart my breathing.

The flight was a mere hour in length, and besides an extended wait and then change of carousels at baggage, the rest of the flight went by without another hiccup. The flight went without problems, but my forgotten makeup bag that included all of my facial essentials, contact lenses, and eye moisturizer was a big prob. I spent the rest of the trip complaining about having to squint my eyes because I couldn’t wear sunglasses, wearing newly purchased but inferior make-up, and applying blush with my fingertips. As I write this and relive the horror 2 days later from a hotel room, I suspect flying anxiety is being channeled back into my existence. I noticed this when I got up to use the bathroom and had a little tickling session with my daughter on the way, during which she bit my leg (I overlooked that one as her justification for tickling torture).  When she kicked my ear so hard it turned red, throbbed, and invisible blood trickled out of it, is when I loudly vowed I would never tickle her again, ever. After lying supine on the floor looking bewildered and disoriented for a few minutes, she promptly locked herself in a small hotel room closet along with the ironing board, extra linens, and hangers that don’t come off the hanging rack. She didn’t come out until the pizza delivery guy knocked on the door, allowing me to finish writing this whole blog. Hmmm, on second thought, maybe I WILL tickle her again :)

Verbal Shavings of a Reformed Speed Meister:

I have a confession to make. And I’m making it privately, in this blog. I’m not proud of what I’ve done, or the people I’ve “passed away” to do it. 

*hangs her head in shame*

If you’re still reading, and not already repulsed by my loathsome behavior, I’m asking in advance for your understanding: Please don’t hate me and recoil at the very hint of my namesake.  And for the love of all that is speedy and swift, don’t tell anyone!

*deep, cleansing breath*

I used to speed all over town and country. I have an awesome vehicle that I love very much, and it goes fast. If you were in front of me only doing 75, I would inch right up to your hind end until you moved out of my way. I even became something of a law-breaking braggart: “Why don’t you let ME drive, we’ll get there faster,” I’d scoff. 

Drivers of mere “other vehicles,” be they fast or slow, who would attempt to pass me would be automatically entered into a game of vehicular “Cat and Meister.” This game would proceed thusly: You would try to pass me, I would speed up and prevent it then slow down enough to give you hope, and another chance. You would try to pass me, I would speed up and prevent it etc...ok, aggressive, arrogant, dangerous, and downright STUPID, I know. If it’s any consolation, I never did that with my daughter in the vehicle. 

One sunny afternoon found me in a dazzling hurry to drop my sister off at EMT school. A lazy, hazy stretch of pavement unfurled before me, and I was eager to burn some rubber all the way to Bridgewater. As I accelerated smoothly down Route 140 in the left hand lane, neither playing Cat and Meister, nor tailgating or trying to intimidate slower drivers, I soared right past a State Police vehicle nestled into the grass at a rest area. Apparently, his radar gun started smoking, then imploded as it registered my miles per hour. 

I saw him before he started moving and even though I knew he’d nab me, my foot reflexively cowered away from the gas pedal so I wasn’t certain how fast I was going. After I safely navigated the rumble strip and situated myself in the breakdown lane, a stern, thoroughly-lacking-even-a-molecule-of-a-sense-of-humor-even-in-life-outside-of-highway-patrol face hovered just above the bottom of my window opening. Hey it’s not my fault my SUV is a monstrously tall, mammoth Tank! “License and Registration, please,” he barked. I handed him the documents. He went back to his cruiser. The Travelocity Gnome in a Policeman’s uniform hobbled back to the bottom of my window and handed me a piece of paper and an envelope and muttered “You can appeal at so-and-so court.” 

I looked at the paper, with its fancy matching envelope. It was a TICKET! I JUST GOT A SPEEDING TICKET? 

WHAT? This can only be because he wasn’t tall enough to see over the door frame and into my cleavage! 

Nope. It was because I was doing 83 in a 65 and I DESERVE every dollar of that $220.00 ticket! I deserve to have my license taken away for that! I call myself a Paramedic, out there helping people? I could have been a fatality for some poor, happy Intubation seeking Paramedic student! I’m a disgusting human. 

So I reformed. I set my cruise control now, 99.9% of the time. I don’t try to use my Tank to intimidate safe, law-abiding fellow drivers. As for Cat and Meister...well I had to wean myself off of that one. However, I weaned in the slower speed lane, challenging the Left Hand Lane Speeders who were driving like my Old Self. I’m happy to report, at this juncture, my Old Self is a thing of the past!

Yep, I even backed Vehicular Unfamiliar
into my driveway :)

Karma visited me the other night. She reared her cause-and-effect inducing head during a pitch black, frightening, involuntary trek I made on the backroads from Fairhaven to Lakeville on Wednesday, February 8, 2012. I was forced into this situation by my loving and beautiful Aunt Cheryl aka “Dinga.” On a ride back from Boston that evening, Dinga verbally pledged her like new, Queen sized mattress to my sisters’ bed (my sister lives with me and was in desperate need of a mattress upgrade). By the time we neared Dinga’s home in Fairhaven, her plan had snowballed into this dismal, non-negotiable reality: I was going to help her load the mattress in her husbands truck (which I have never driven). I was going to navigate unfamiliar backroads all the way to my home in Lakeville, with NO GPS (which I had never navigated before). I was going to maintain a modest speed because she was NOT going to provide me with any means to secure the mattress in the open bed of the truck (I begged for a rope, a bungee cord, dental floss...ANYTHING to provide a measure of securing the mattress to the truck.) 

“Oh, Please,” she waved away my pleading concern with a well manicured, bejeweled hand and shot me a look worthy of a gaggle of maggots feasting on a bucket of rotting Kidneys. “That mattress is wicked heavy. It’s not going anywhere. You’ll be fine, it’s not even windy out. I have people coming over at 6:30, get going.” I am her favorite niece. No, really, I am!

I put my cat-tail between my legs and began the nerve wracking, 20 mile-35 minute drive to my Home. About 10 minutes into the drive, when I transitioned into a more rural area with lenient speed limits, I felt the headlights of the car (s) behind me assault my already anxious spirit. Clearly my foreign-vehicle, restrained-speed, mattress-transporting, terror-inducing situation was not going to be supported by anyone else traveling on these here roads. They flashed me. They tailgated me. They accumulated into a funeral procession of twinkling high beams in my rearview mirror. They tried to intimidate me by speeding up and slowing down, and coming to so close to my bumper I thought they would dislodge the mattress. Sound familiar?

Dear Dinga, thank you for the mattress!
Expect Bungee Cords for every gift
I get you for forever :)

Yes, I was a blubbering victim of my own game. My bad behavior was the cause, and the effect was 3 wrinkles, 12 grey hairs, and 72 hours of acid indigestion. Thanks, Karma, Dinga, and Law Enforcement. :)

I am a 100% completely reformed Speeder! 

Niki’s delicious Beef Stew, which also happens to be the BEST in the WORLD :)

Picture me, in a bowl! And you, with a spoon, eating me! :)

      What, you think my title is too pretentious? NEGATIVE. This is the best Beef Stew in the  world, which I will now extend to The Best Beef Stew in Existence, which I will further extend to The Best Beef Stew that Ever Has or Ever Will Exist, Ever. 

That being said, this is not a meal to make post haste, or with the clock ticking in tune to the hunger pangs in your stomach. This is a stew that requires, nay, demands finesse and the results are well worth it. Like almost all stews, it’s better the next day. Sometimes I even cook it the day before, just to get that Next Day Numminess.

Before I begin any recipe, I gather all of my ingredients, including cookware, and set up my working station. I usually plan on being in the kitchen awhile because I clean and organize as I go, and I just generally like traipsing about the kitchen! I love my kitchen, I love to cook, and I love Mise en Place. Mise en Place translated from French means “putting in place.” The Culinary Institute of America defines it as “everything in place.” Either way, it refers to the pre-measuring, washing, and chopping of ingredients that will be used in the construction of culinary delights. When I mention that I chopped this or diced that, and placed into a prep dish, I’m not kidding! I have a few sets of different sized bowls, condiment cups, and cutting boards/mats that I use for my Mise en Place.  And I always prep everything first. Hey, it’s my world...you’re just reading in it ! :)

They do kind of look like lemon slices, eh?

My least favorite part of the preparation of this Stew is searing the Beef cubes.  For starters, it contradicts my obsessive impulse to keep things clean. I’m not even close to being a messy cook but no matter how careful I am, searing splashes and drips greasy oil into crevices and onto surfaces I would prefer remain clean.  However, I never skip this step because it caramelizes and browns the sugars and proteins on the surface of the meat, resulting in a flavorful surface crust. Some theorize that it locks in the meats’ meaty juices as well, though it has been proven that searing actually de-juices meat. I’ll let you google that one on your own, to save myself 3 paragraphs :) Secondly, searing all those Beef Cubes, however hearty bite sized they may be, takes awhile. Thirdly, it’s a two handed job. Maybe even a three handed job with all the transferring of floured beef (another inevitable mess) to the skillet, turning to sear all sides, then transferring out of the skillet and starting again with another batch. And it’s hard to cook with one hand and drink a glass of wine with the other when you need all three hands for searing!

Whole Daikon

The ingredients list is mildly lengthy and you’ve probably thought: “Daikon? What the sam holy hill is Daikon?” Daikon is an Asian radish and is a staple of Macrobiotic Cooking (more to come on Macrobiotics in my next blog!) In this recipe, it not only adds nutritional value, it picks up the flavors of the stew quite remarkably, and adds to the overall heartiness. Due to the radish’s appearance and the way I had cut them, the first time I served it to a friend she said, “Did you put lemons in here?”  This was before she had her first bite and her eyes rolled back in her head, and men in loincloths had to be called to fan her back into consciousness. Yes, THAT good. The stew, not the men :)

Don’t skimp on or be nervous about the beer. There’s no alcohol content or taste, just a complex and delicious depth of flavor that cannot be achieved if you skip this step. The first few times I made this I used two cans, then because of the sheer quantity it makes I tried three and as my mother always says: “WOWZA!” It gives the stew an unidentifiable deliciousness that takes it over the top! For me, fresh herbs are a necessity but dried can always be substituted. The ratio is is 3:1 of fresh to dried. I always remember it as 1 tablespoon to one teaspoon.  Celery leaves are one of my favorite "secret ingredients." I use them in any and every recipe that calls for celery.  Mushrooms: Yummm! I love mushrooms. I’ve tried them in this recipe two different ways. I’ve sauteed them in the pan after searing the beef, reserved them, deglazed the pan and cooked the other veggies, then added them back at the end. This gives them a sear and a texture that is noticeable and absolutely divine. Alternately, I’ve just thrown them in with the other sautéing vegetables and called it a stew. I prefer the former but usually do the latter because its much easier! 

Stop stewing on it and make this stew! I’m 100% positive you will agree it’s the Bomb Dot Com! And for all of you who have been following Tony’s threatening purple and gold harassment of my front door I feel confident I have your vote: We’re going PINK! :)

Cook, Mise en Place, Cook!

I love Yew, Stew Recipe: 

2-4 lbs. Beef Brisket, or Top Round London Broil etc. cut into hearty bite size chunks

4 tablespoons Flour

1/4-1/2 cup Canola Oil

2-3 14.9 ounce cans Guinness Beer

3 cups Beef Broth

1 cup Red Wine OR 4 cups total Beef Broth

2 lbs. Portobello Mushrooms, sliced/diced as you prefer

2 Onions, diced

3 stalks Celery including leafy tops, diced

3 carrots (I leave skin on), sliced into half moons

1-2 cups Daikon (skin on), sliced into half moons. (may substitute turnip, radish, rutabaga, or other root vegetable)

5 cloves Garlic, minced

5 potatoes, cubed ( I lke to use red and leave the skin on)

3 tablespoons of Vinegar such as: Malt, Red Wine, Sherry or your preference. 

7-10 sprigs fresh Thyme, chopped to make 1.5-2 teaspoons

10-15 leaves fresh Sage, chopped to make 1.5-2 teaspoons

1 sprig or less fresh Rosemary, chopped to make 1/2 teaspoon

4-5 Bay leaves

1/2-1 teaspoon of Crushed Red Pepper, or to taste

1/2 teaspoon Salt and Freshly Ground Black Pepper, or to taste

1. Toss beef cubes in a bag with flour, salt, and pepper and shake until evenly coated. Heat oil in a cast iron skillet and sear meat on all sides. Transfer seared meat directly to heavy bottom or large stock pot/dutch oven. Set skillet aside.
2. When all meat is seared and in the pot pour in beer and bring to a boil. Boil until beer has reduced to about 1/3 of original volume. Add beef stock, cover, and simmer 45 minutes to an hour or until meant becomes tender. 
3. Gather a few small and large prep dishes. Chop and add the onion, carrot, celery, daikon/turnip to a large prep dish. Dice and add the potato to another and cover with cold water to prevent browning.  To a small prep dish add minced garlic. To three more add the rosemary, sage, and thyme or leave them in little piles on the cutting board. 
4. In the skillet used to sear beef cook mushrooms and set aside, if doing this as a separate step. If not, add onion, carrot, celery, mushroom, daikon or turnip and 1/2 teaspoon each of rosemary, sage, crushed red pepper, bay leaves, and thyme and cook until onions are lightly browned. Add garlic during last few minutes. By this time meat should be tender.
5. Add veggie mixture to meat/beer broth along with potatoes. Cover and simmer another hour or so. 15 minutes before serving add remaining herbs and vinegar and set to lowest simmer possible. Also, if you sauteed and reserved mushrooms separately, add them at this time as well. 
6. Enjoy your one pot , delicious, hearty meal! Ok, it does take more than one pot :( But, you have to time to clean all the other pots while it simmers for the last hour making it a one pot meal for at least an hour! 

Elevator Etiquette and the EPD

The last few months have placed me at the mercy of very busy elevators at Boston Hospitals. This has proved to be an experience akin to eating glass, or allowing a vicious canine to slowly tear an appendage from my conscious and unwilling body. Part of the torture is the sheer amount of time spent waiting for the elevator to arrive, especially when facing more than 6 sets of double doors leading into the cars. One would think with that many elevators patrons would be zinging in and out like ping pong balls. Instead, it’s like the pace is set by turtles riding on snails’ backs. 

Regardless of how quickly a person can move into and out of the sluggish cars, some basic rules of etiquette must be observed! If the budget were unlimited and I were the lawmaker, I would even appoint “Elevator Police,” to enforce the rules. The first, and most blatantly disregarded courtesy of elevator etiquette is STANDING IN FRONT OF THE DOORS AS THEY OPEN SO YOU CAN BOARD THE ELEVATOR. Hello, Captain Obvious? Ever consider that people might need to get OFF the elevator, and they can’t do that if you’re blocking the only exit with your impatient body mass? Doesn’t it make more sense to give them a few precious seconds to egress, thereby making more room for your impetuous frame? Press Button. Stand near button just pressed. Watch passengers depart. Board elevator. All too easy. 

If elevators had ears they would probably jam a traction cable into their tympanic membrane. The elevator police would definitely be working overtime writing out tickets for inappropriate conversations. An elevator ride usually lasts anywhere from a few seconds to a few minutes. During that minuscule expanse of time, please refrain from discussing the intricacies of your surgeries, bowel movements, or elderly mothers’ dental insufficiencies. Save the complaints about your mate’s sexual inadequacies for a nice conversation from the privacy of home. Standing in the corner attempting to chat discreetly about your drunken debauchery doesn’t cut it, either. It’s an ELEVATOR. We can hear you, no matter where you stand. 

Policing the elevator would be a full-time job. Ticket writing alone would account for a large portion of duties. Sizable fines would be solicited for discharging bodily functions in the elevator.  The amount of funds collected would be directly proportional to the vileness of the body function expelled into the confined elevator space. Egg Salad Burp? $100 fine. Blowing your sinus infection into a tissue then looking at the nasty green mucous? $200 fine. Passing the undigested gassy remnants of a black bean and cabbage lunch from your most distal hole into the only oxygenated air source elevator patrons have to breathe? $400 fine, at MINIMUM. Keep your bodily ejections contained until you’re off the elevator, even if it means severe cheek-squeezing and abdominal cramps!

The elevator officers will also be writing tickets for moving violations. If you called the elevator at the 3rd floor and plan on riding to the 19th, stand at the back of the elevator. If you called it at the 1st and need to get to the 2nd, take the stairs. If you have a twin stroller with two drooling infants crammed into it and the elevator is already 3/4 full, wait for the next one. When you board the elevator, if it’s not possible to reach the number buttons, politely ask the elevator rider closest to the buttons to push “5.” And by Cracky, if you are the human responsible for reproducing the pediatric cretin who just lit up every floor with their curious, stubby little finger do NOT expect the rest of the elevator population to think it’s cute or endearing in any way. Don’t teach your offspring to push buttons by pushing ours. Elevator PD, arrest them! 

The elevator is not the place for racing, discussing, exposing, or expelling. It’s a bad time to attempt to fit a round body through a square hole. It’s not the environment for flirty or casual conversation. It’s not a playground, dumping ground, or breeding ground. It’s not a cafeteria, kitchen, or dining room table. Don’t use it as a classroom, chatroom, or bathroom. Keep your hands in, your eyes down, and your holes closed. The EPD may be patrolling an elevator near you!

Anyone interested in applying to the EPD (Elevator Police Department), send applications to: nichole@paramediccooks.com :)

Keep It, Tool

I saw you there, in the shadows. You were unformed, shapeless; yet I could see your crouched position, ready to pounce. I saw you watching me, but I pretended not to notice. Though you had no face, I could see your empty gaze and the grainy orbits where your eyes would be. From your amorphous mass I could discern venomous fangs, gnarled and arcing over an illusory bottom lip, the sharp points at the distal edges piercing back into your own skin. 

By pretending to afford your privacy and avoid exposing your voyeuristic nature, I hoped   to quell your inherent compulsion to scrutinize opportunities to cause misery and despair.  My plan will never be realized. Into your core a thread of utter depravity has been weaved, and you thrive on any molecule of angst you can create. 

There in the shadows, you are content to wait. There are many others like you that are with you, yet you’re alone. You feel alone, you know you’re alone, you don’t want to be alone, but you can’t be any other way. Suddenly, your misery-radar goes off! You spy a chance to make someone completely hopeless, and despaired. In this case, you can take something that person wants, even though you don’t need it, or want it. When you acquire things you have no use for, an unrivaled feeling of accomplishment comes over you. You feel powerful. Successful. Iconic. 

You’re an utter failure.

Your unformed shadow moves. It is excited. It occupies space though it is not fat, or tall, or round. You slink across the expanse of space like a large jungle cat. Your mouth gapes open and a silent scream pervades the air. Your plan is foiled. I am the successor. You have what I wanted, for that moment. Keep it. Store it in your curio cabinet of vile immorality. I’m already over it. I have my sights set so far beyond your 

oppressive blackness, not even the dispersion of your oily filth could smother me. 

You lose, loser.  We’ve both made spectacles of ourselves. But mine glitters. 

House Hunting!

Front Door (pre-moving in)

       Why is home buying such a grueling process? I’m certain the amount of papers to sign, initial, review and “keep for your files,” are equivalent to more dead trees than it would take to build 17 log cabins. I understand the importance of documentation to protect the interests of all involved, but is all the lawyer jargon really necessary? I’m not a simpleton but wouldn’t it be easier to just list questions directly instead of all the useless political, constitutional, and ceremonial technobabble? For example, because apparently the threat of Natives of this Land quick marching to claim the property you just purchased is a tangible, highly conceivable possibility, you are encouraged to pay an extra fee to buy the insurance that protects against this event. Instead of pages of explanations, clauses, and provisions, why not just state the questions, unfluffed: 

1. Do you want Peaceful Ancient Tribal Men or Women appearing unexpectedly to claim the land you just bought?                                                                              

_____YES  _____NO     

     2. Would you like to spend ____ amount of dollars to feebly protect the land you just bought in the event the aforementioned claim is staked?  

                   _____YES        _____NO

Done. Was that so hard? One thousand, four hundred sixty-eight trees will thank you!

Personally, I am DELIGHTED the home-buying process is over! Not just because I feel as though I have purchased my dream house, also because I’m happy not to be dealing with all the personalities involved in the house search. There are so many real estate agents, lawyers, brokers, lenders, sellers, appraisers, home inspectors, insurers, permitters, and town hall personnel to deal with, it’s like a day at DIsney, except without the “best place on earth” theme! Almost every one of them listed comes complete with their own set of paperwork, fees, and (sometimes offensive) personalities. Not to mention all of the time spent attending house showings, meetings, signings, phone call placing and returning, emailing, and internet searching. It’s like having another full time job, only I’m paying the (competitive) salary to SOMEONE ELSE! 

My absolute least favorite part about the whole process was the bidding war. I expected the sellers wanted top dollar for their property, and I’m sure they expected I wanted to pay bottom dollar. After about a year of internet searches and actual home showings, not to mention a several month hiatus when it became just too overwhelming, I stepped foot in the house, and knew it was THE one. Our first offer probably sent the sellers into intense paroxysms of laughter, followed by two letters that would be used ad nauseum throughout the bidding combat: “N-O” In the end, we paid a few cents shy of the asking price, I got my dream house, my husband got a few ulcers, and the sellers probably got a night filled with champagne glass clinks, sneers, and snickering finger pointing to the suckers who just bought their property. More of my least favorites include the fact that we had to pay closing costs (on HGTV the buyers NEVER pay closing costs, what’s up with that?), the hugely extended closing date (sellers insistence), the problems found at inspection, and especially the unprofessional, unknowledgeable, unseemly, amateurish, smarmy, and acutely obnoxious sellers agent.

My Recipe Nook (pre-moving in)

My favorite part about the whole process of course, is the end result: MY NEW HOUSE! I attended many home showings before being introduced to “The One.” Within minutes of walking through the door, I knew it was The One. I consider it my Dream House, even though I looked at many houses that were bigger, more expensive, and newer. We close June 17th and I am counting down the days by milliseconds! I’m so excited, every time I look at pictures of the house I get butterflies in my stomach, a faraway look in my eyes, and the words “I do,” automatically form on my lips. My kitchen has SPARKLY granite countertops, slate stone flooring, and a built in “recipe nook” complete with desk, book shelves, and its own sparkly granite desktop. There’s a custom pantry built around the refrigerator that has shelves that slide out, and the dishwasher....Oh, the dishwasher is TWO DRAWERS that can both be loaded and set separately. How awesome is that?!! There is two bathrooms that are completely updated with beautiful stonework, one with a jetted tub, and the other with a huge stone tile shower and cedar closet! 4 bedrooms, a fireplaced living room open to the kitchen, huge upstairs bedrooms with cute little dormer alcoves, and while the cellar is clean and free of water damage, it isn’t finished but has a half wall of built-in cabinets and a work bench/counter. The garage enters right into the kitchen, I even love the stairs leading to the kitchen entrance. The backyard is absolutely amazing, and has the potential to be the “outdoor oasis” I fantasize about. I already have paint colors and themes picked out for every room, a whole boatload of brand new furniture waiting to be delivered, and holiday/party menus planned! I CAN’T WAIT! This is the second most excited I have ever been in my life! The first was waiting to see what my little baby girl would look like :) 

Start flexing....cause come June 17th I’m going to need plenty of muscle to move all of this Internet Shopping into my new house! Expect good food, friends, and fun...and plenty of parties in Lakeville, MA! WOOOOO-HOOOOOO! 

Waste Space: A Paramedic's modern interpretation of how wee should pee

Why do women always complain about men leaving the toilet seat up? By the same standard, shouldn’t men complain that women leave it down? I’ve never understood that gripe. I couldn't care less about where the hell the toilet seat points. What I feel piqued about is the urine droplets that splatter all over my makeup, perfume bottles, clothes, flat iron, and toilet paper that I’m going to use next time I go to the bathroom. Seriously? Who decided that men should joggle the urine from their bits? It’s like a pee windmill that glazes every surface within a 10 foot radius! Eww? 

Okay, so due to some relatively significant gender plumbing discrepancies, men have the option of standing when they urinate. Does that mean they have to stand? Cmon men, we won’t think less of you if you sit down on the toilet seat to pee. You sit on it for other things, right? (Thank heavens there’s no “shaking” to clean that !!) Furthermore, if standing is just too monumental an advantage and convenience to renounce, whats wrong with taking a square of toilet paper and gently dabbing at the bits? Did the inventor of toilet paper intend that only women should use it in excess? No. Blot the moisture away with TP, the same way royalty might dab at the corners of their mouth with a vicuña linen napkin.  

Let’s examine the real issues here. I have two. One is in the present, one is in the past. The present one is the urine that my personal belongings are showered with multiple times a day. I’m not talking about perceived scientific molecules that may or may not be found on my toothbrush following a specific and rare laboratory test. I’m talking about the actual alligator tears of pee that encoat my personal effects....you know, the ones that I use EVERYDAY. Yes. I ingest large amounts of others peoples’ urine over time, from the light spray that mists my beloved items repeatedly. Daily. Endlessly. So do YOU.

The past issue is with the person who taught, retaught, and enforced the practice of jarring urine from the male bits with an obnoxious amount of convulsing. Where is this human, and what gave them the idea that useless kidney scraps should be drizzled in bathrooms across the world? Possibly when the reality of a satisfactory homestead was a fair amount of rock also capable of absorbing the mineral nutrients of kidney excretion, it was acceptable to sprinkle the living space with renal detritus, but no more! Pee belongs in the septic system, and nowhere else. 

This blog is my challenge to Mommy’s, Daddy’s, Nana’s, Vavoa’s and the like: Stop teaching male counterparts to shake the waste from their fritter-sticks! Teach them to blot, dab, sit, or any other means to evacuate the urine from their bits! Make for cleaner bathrooms. And homes. And places of waste! Don’t think co-ed bathrooms...think co-ed places of position, designed for modern interpretation waste spaces. Waste spaces with toilet seats that neither go up, nor down. I’m not saying it should be communal, but if it were it would be alot cleaner if one gender didn’t atomize urine. 

I DARE you to innovate the way we pee. See you in waste! :)

How Dare you judge ME?!

ParamedicCooks.com is proud to conclude our FIRST Recipe Contest, complete with recipes collected, judging executed, and prizes awarded! I’m glad to see this first contest reach its final destination, and I learned much in the process. For me, the best part was accumulating a phenomenal collection of recipes! The hardest part was judging. I knew I didn’t want to judge recipes myself, for several reasons: 1. Too Personal: I predicted my first contest would yield alot of recipes from friends, (yes, I haunted them. No shame :) and I didn’t want to be put in the position of choosing favorites. 2. Little Resources: I felt strongly about judging recipes on taste. That would mean cooking all recipes, which is impossible in a residential kitchen with one (amateur) cook. 3. Criterion: Besides taste, I wracked my brain on other criteria to judge recipes. The best things I initially came up with were: Taste, Name, Appearance. These proved to be the most unreliable criteria possible, as you will see. 

Collecting recipes was the easiest part, and fun! For my colleagues, I goaded and harassed them until they proffered their best recipes. I conducted mini-contests on the website and gave away ParamedicCooks.com pens, planners, t-shirts and other prizes as rewards for submitting recipes. I emailed the Human Resource departments at major EMS departments and procured local supporters and recipes in other states. I advertised in JEMS and established a presence in Canada. I cooked boatloads of the recipes being submitted, and learned a whole slew of stuff about cooking techniques and different ingredients. Submissions came in waves, and I more than welcomed the high waves. One of my favorite recipes that I had a chance to cook was Mulligan Stew. Not only did I get schooled in roux creation, that stew has one of the best, most unique flavors I have ever tasted! There are so many more I want to cook. One of the most interesting recipes I received was a steamed pudding. I haven’t cooked it yet, but I did a bit of research on steamed pudding. There’s an amazing lot of history behind this dish! Unfortunately, the young cook who submitted this recipe was neither 18 years of age, nor EMT certified which were both part of the guidelines for submitting a recipe for this contest. However, I hope cooks near and far, young and old, use that young persons’ passion and boldness as an inspiration for getting in the kitchen and getting to work! 

After wracking my brain for weeks, and the contest deadline drawing near I had an epiphany: Who better to judge a recipe contest than REAL Chefs? Sure, it may sound obvious but for me, it was genius. I set my mind to the task of gathering up all the chefs I knew personally and I came up with a total of: ZERO. That’s when I remembered a wonderful resource nearby, who’s facilities I had in fact (unsuccessfully) attended during  my high school years: Greater New Bedford Regional Vocational Technical High School!   I whirled off an email to Voc, which was answered within 1 day directing me to the chefs of the culinary department. In the span of another 24 hours, a real Chef Instructor had read and answered my email, by the name of Henry Bousquet. Henry and I agreed to meet 2 days henceforth, at GNB Voc-Tech, and I arrived with laptop, flyers, pens, and planners on the ready. Chef Henry, like a true Chef, zeroed in on the main elements of my visit: how to judge a recipe contest?! I felt inadequate about my own ideas for judging because I knew I couldn’t cook and taste every recipe, many of them had been renamed by me to incorporate some quirky medical terminology (eg. “Sebaceous Sausage Bread and Tachycardic Enchiladas), and only some entrants included pictures. Henry and I developed judging rubrics and a plan. The rubrics consisted of specific criteria to judge all submissions. The plan included two phases of judgement. During the second phase, Chef Henry proposed to cook the final 8 recipes, and invited me to come TASTE them all! I felt like an Iron Chef America judge! And then, with an open heart and empty stomach, I said unto Chef Henry in the words of the Chairman’s uncle: “ALLEZ CUISINE!” :)

Unfortunately, judgement tasting never came, overshadowed by other priorities and resources for a school that serves 1800+ students. Luckily, the two judging rubrics the chefs and I had originally created served well, and actual judging was completed in two rounds: The first round used specific criteria to judge down to the final 8, and the second round used different criteria to judge down to the final 4 winners! The final judging round incorporated the freshmen class of 2014 to assign a points score to the final 8 recipes. Congratulations Falgoust, Brody, Guidry, Richard, Shelton, Norcross, Bourg! Special Thanks to Ms. Andrews for her time and dedication to the field of culinary arts! Keep Cooking!

I’m very proud to still retain those judging rubrics and the criteria I learned to judge with from Chef Henry Bousquet! There aren’t enough words in the dictionary to express my profound thanks to Chef Henry and the Chef Instructors of the culinary arts department at GNB Voc-Tech, and to the awesome up and coming Chefs of the Freshmen class of 2014. THANK YOU SO MUCH! I can’t wait to welcome more, and more winners of ParamedicCooks.com recipe contests! Good Luck Everyone! 

Dear Stupendous Students 4,

Myself and Mark McGraw, Director of New Bedford EMS
and one of my "expert" consultants on intubation. 

How do you feel about intubation? Do you think it’s important? Is it one of those skills that can be taught, or does it have to be practiced to be learned? Why do so many practitioners fail at intubation? Before we can answer those questions, lets talk about who is required intubate. Paramedics? Yes, all of them. Nurses? Only some of them. Doctors? Only some of them. Stew on that.

So every Paramedic can intubate, and we learn to intubate during our relatively short approximate 2 year training. Anesthesiologists train for over a decade. Certified Registered Nurse Anesthetists train for close to a decade. Does Captain Obvious need to make a sudden appearance to point out which way I’m going with this? Treat intubation like the privileged skill that it is, and do it right every time. My Paramedic Instructor used to always say, “There’s no excuse for a bad tube.” He didn’t mean you will never intubate the esophagus, he meant have the proficiency to recognize and reverse an esophageal intubation immediately, and the professional responsibility to check tube placement efficiently and frequently. He s right. There is NO ever-loving excuse for a bad tube. There is no pothole, patient movement, or “someone else’s,” fault for walking into the ED with a misplaced ETT. This is precisely the reason we have stethoscopes, capnography, end tidal Co2 caps, esophageal detector devices, visualization, condensation....etc! I mean really, with all of these tools at our disposal to check placement, IS there any excuse for a bad tube? 

For this blog, I sent out a survey to a select few Paramedics I know, that I would consider “experts” in the skill of intubation. It is interesting to see that 4 of the 5 answered the same exact to some of the questions. The fifth didn’t answer any at all and only said “Read Dr. Bledsoe’s articles on ‘The Disappearing Endotracheal Tube.” The questions were as follows, and the answers are summed up by me from the 4 that offered their advice. 

Q: What blade do you prefer and why?

A: Unanimously every medic preferred the Macintosh 4. All surveyors agree it has the versatility to give or take away “blade room” with more or less fingers applied to the base, alternately making it a Mac 3. It was also noted to easily lift the epiglottis when necessary, easily displace the tongue when necessary, give a “light” touch to a more delicate airway, and be used a straight or curved blade. Stellar advice to this question: “Don’t get married to a blade, folks. Anatomy differs and that’s why there are so many blades.” 

Q: Tips for holding the laryngoscope?

A: The majority agreed to hold the blade close to the handle next to the hinge, or at the bottom of the blade in the palm of your hand. One described it as placing your baby finger off the handle and under the blade to “choke up,” on the handle and get better control of the blade, lessening the tendency to lever back on the handle. Stellar advice to this question: “Hold it firm and keep your wrist locked. When you lift, go up and out. Pretend you’re aiming the handle at the intersection where the wall meets the ceiling. Not up, not forward, but right in the middle.” 

Q: Tips for identifying landmarks/cords?

A: Most agree it is most important to recognize anatomy, look at lots of pictures, and realize people have different anatomy that is not always text book looking. One very experienced Paramedic says “Don’t crawl into the patient’s mouth-get back from the patient to improve your visual perspective.” That line of thinking gives perspective to the “difficult tube” scenario because how often do we want to take a closer peep at that which we don’t understand, such as the mucous/blood filled airway?! In other words, step off! Check it out from a distance. Stellar advice to this question: “Know your cuneiform and corniculate cartilages ; where they are, what they look like and where they are in relation to the vocal cords. It helps greatly to recognize them especially with a deep, anterior patient. If you can identify them then you know the cords are above.”

Q: If you had to summarize successful intubation into one sentence, what would it be?

A: Everyone agrees that preparation and positioning are 2 of the most important considerations for consistent success. Here are the 4 sentences: 

1. It is imperative to be 100 percent familiar with the anatomy, don't play with it and move purposefully, watch the tube pass the cords, don't let go of the tube until its secure and recheck often.

2. Pre-planning, help, pre-positioning, insertion, confirmation, and affixing.

3. Successful intubation is the ability to manipulate the airway with a laryngoscope, visualize the cords, place an ET through, inflate, secure and confirm.

4. Set your patient up for success, positioning is the key. 

Q: Other advice/wisdoms/experiences?

A:  All 4 agree that intubation is a true skill that requires plenty of practice. It is one of the most important skills we perform and should be mastered. Line up ears to sternum for difficult intubations and create a ramp like towel or blanket roll to prop the shoulders up. In the absence of C-spine precautions, don’t be afraid to manipulate the head, flexing and extending while visualizing with the laryngoscope and noting how the different movements open and close the airway. Always use a stylet! Most patients with an anterior airway are usually deviated to the left. Stellar advice to this question: “Take 10 sec and set your patient up for success!!!”   

I’m so glad I sent out that survey, and thank you very much to the medics who answered. You guys are so awesome your middle initials are A, you should work for Awesome EMS, people should address you as “your awesomeness,” your cell phone carriers should be Awesome T&T and you should talk on an A-phone, you should have your own TV Network called “The Awesome Channel” that features only shows about how awesome you are, and you should all have a talking mirror that says “you look Awesome today,” every time you look in it! 

It was interesting to see the same advice being repeated consistently among the 4, especially know your anatomy, prepare yourself and your patient for intubation, prop the shoulders, hold the blade with your hand near the hinges, and check and recheck your tube! For the students who ride at NBEMS: The airway bag on all of our trucks is in an outside compartment on the drivers side of the ambulance. That means the driver almost always carries that bag. For that reason, oftentimes it is the driver who intubates, although some medics prefer to intubate their own patient since they will ultimately be responsible for transferring and documenting the tube. Familiarize yourself with the location and contents of this bag, possibly even feel out the crew for what their preferences are when it comes time to intubate. Don’t wait until you’re smack in the middle of a cluster to fumble around for equipment or permission! 

I hope this blog has made you recognize the importance of mastering this very difficult skill. Study airway anatomy repetitiously! Go back to the classroom and practice. Talk to other Paramedics, Nurses, Doctors, Respiratory Therapists and anyone else that intubates about their successes...and failures. NEVER deliver a bad tube. Stellar advice on this subject:

“Think before acting; it is better to come in with no tube than a bad tube...” 

Dear Stupendous Students 3,

It’s the moment you’ve been waiting for! That time of the blog when we talk about your two favorite things: Intubation and starting I.V.’s! I’ve pondered: why do Paramedic Students, and Paramedics, for that matter, have such a doting infatuation with these two skills? Sure, doing them, and especially doing them well is important but are they really worth writing home about? The best thing I can come with is these two skills are a couple of things that really separate Medics from Basics, Nurses, and other related health care providers, and elevate the practice. In this way our anxious, desperate little egos are sated and stroked with all the vigor of the overweight birthday boy eating cake!  

Because IV Chapters in most texts have to focus on more than just venipuncture, and the fact that its a skill that requires hands on practice, I see alot of students struggling. Mostly they make the same common mistakes, which are easy to correct. Over the years, I’ve developed some reliable tactics that have made a better puncture-er out of me, and will make a better puncture-er out of you! First, I’m going to challenge some of those narrow, tunnel visioned little minds out there with my IV philosophies: 

HEINOUS and BOGUS I.V. MYTH #1: “Go Big, or Go Home.”  When I hear the utterance of this faulty logic, my blood boils redder than the words they are typed in. I hear the distant wail of a cargo barge’s horn, and I have to block my ears so the steam doesn’t scald the person standing near me! That is the single most ignorant, uneducated, egotistical, pathetic, my-life-is-so-worthless-and-my-self-esteem-is-lower-than-a-dead-persons-blood-pressure-but-I-try-to-be-cool-to-impress-people *deep, cleansing breath,* declaration I could possibly hear someone say. The fact of the matter is, introducing intravenous catheters into the different arms, and different skin, and different vasculature, and different circumstances of different people (noting the pattern, here?) requires skill that goes beyond plucking the green package from the I.V. tray. Yes, I said it, in case you only inferred: Professionals who choose to blindly start large bore I.V.’s with no indication of necessity are weak, mindless robots who lack the skill to adapt to the situation at hand (no pun intended, lol).  For precisely the reason there is different sized catheters, there are different sized situations that justify them. 

A “shock trauma” pt with a significant mechanism and a pressure in the toilet, large bore I.V.? YES! 

A 90 year old female that weighs 85 lbs and has a tummy ache, and her arthritis is acting up, and she hasn’t moved her bowels in 3 hours, and....large bore I.V.? NEGATIVE. 

A 56 year old male, pale and diophoretic with persistent chest pain after fixing that gutter his wife has been nagging him about, radiating down his L arm, unrelieved post NTG, with ST elevations on the 12 lead, large bore I.V.? IF YOU CAN, 2 of ‘em, EN ROUTE and transport to a cath lab. If you can only get 1-2 20g, that is fine, you have lots more to worry about with this patient than sticking in an 18g, and a 20g works JUST AS WELL.

A 24 year old female with chronic abdominal pain d/t intestinal HAE requesting pain control (out of Percocets), otherwise in stable condition in no obvious distress, large bore I.V.? SERIOUSLY? Do you have to do it just because you can? Will you go big or go home? I would rather see you go home. Blood transfusions, fluid resuscitation,  and CT dye can all be infused just as easily through a #20 as they can a #18. Bottom Line: It is BARBARIC to use large bore I.V.’s outside of necessity, just because you can, especially in the hand. Get over yourself.

HEINOUS and BOGUS I.V. MYTH #2: “They pissed me off, so they got a 16 in the hand.” Ok, Romper Room is closed for today, come back in 9,742,886 hours after you grow up! I understand why some people say this, it’s to just to let off a little steam and vent a bit. I’m all about that, hey this is a tough job, right? It’s the folks out there who actually do it and brag about it that make me want to cannulate their sclera veins. Which I would do, because they “piss me off.” Haha, kidding! Seriously, students and medics: If you think saying or doing this makes you look ultra snazzy and powerful, it doesn’t. It is a naive and weak way to practice, even when you’re mad because American Idol just got interrupted to haul around the obtunded ETOH illegal citizen. Get over yourself. 

HEINOUS and BOGUS I.V. MYTH #3: “Well, they were gonna do it the hospital, probably.” This statement can go both ways, it can actually be applicable, or it can indicate Cookbook medic practice. What I want to emphasize is: Do it because you feel it’s appropriate, not because you know someone else will. Own your decisions, skills, and actions. Outside of gross incompetence or assault, I can’t think of many circumstances where starting an I.V. would be negligent, but I still want to encourage students to start developing confidence in their own assessments, interventions, and decisions. Get into yourself! 

Let me state clearly, I am not trying to bash my fellow medics, or single out any one person. I know plenty of Paramedics who I think are super fabulous, that I have learned alot from, who I have known to advocate one or more of these philosophies. Maybe they learned from their mentors, or maybe they have other arguments to support their convictions. These are solely the opinions of my own shattered, pea-brained little mind! ☺ 

Starting from the Top: 

1. Do a Skin Assessment: Does it look/feel papery thin? Use less pressure puncturing the skin. Does it look/feel thick and coarse, and the pt. tells you they are a construction worker, or someone who stays out in the elements alot? Use more pressure puncturing the skin. Is the pt. on coumadin/lovenox/other “blood thinners”? Be wary of the increased risk for bleeding/infiltration/hematoma. Is the pt. on Prednisone? Even a small gauge needle will obliterate the vein, it will look like subdermal vein implosion, be wicked careful! Is the pt. hyperglycemic? If so, their veins can be hardened and very difficult to cannulate. Think of it like this: high blood sugar=candy-coated veins. Doing a thorough skin assessment takes about 10 seconds, and will dramatically increase your I.V. success rate. 
2. Get Gabby: Nothing makes a patient, or any human for that matter, more uncomfortable than a muted caregiver performing foreign and painful procedures on them while they’re in pain, distress, or discomfort. If you’re feeling kind of nervous and awkward being a student with 2 or more medics, firefighters, and police officers watching and judging your actions, can you imagine how intimidated the patient feels with all of these unfamiliar people, plus the addition of painful or misunderstood interventions?! Use your voice: explain what you’re doing, talk about their complaint, give some feed back, use humor, etc...the more at ease you appear, the more at ease they will feel and trust me, you will get more thanks and acknowledgment for simply making someone feel comfortable than you will for “saving their life.” 
3. Applying the Tourniquet: I’ve found that applying the tourniquet about 4-5 inches above the elbow is the most practical and effective practice. It effectively engorges the veins from the distal end of the arm to above the AC. It also prevents unnecessary relocation of the tourniquet after unsuccessful attempts or poor vasculature. Also, that tight tourniquet hurts! If possible, tie it over the sleeve. A tip on using a blood pressure cuff as a tourniquet: I don’t advocate this as a rule, but it works in a pinch. Apply the cuff around the upper arm like you normally would, and pump it up slowly to about 40 mmHg or until veins are distended. Do not inflate it completely as it will cause pain and possibly bruising, and become an arterial tourniquet restricting blood flow to the whole arm. Also for veins that just refuse to appear, a second tourniquet placed distal to the initial tourniquet but proximal to the area you will be scouting works well. 
4. Get Prepared: Gather all of the equipment you expect to need for this I.V. start, including 2x2’s, tape, even the glucometer if you routinely check CBG’s with the sharps. Set up and prime the lock set, or drip set or whatever you use to flush the line. Open the alcohol prep, betadine swab, bioclusive dressing and whatever else you use, except the angio cath (for sterility). I cannot stress enough how this simple act of gathering, preparing, and placing your equipment next to you will help your success. It also gives that tourniquet time to work, and keeps you focused and organized. 
5. Find a Vein: Here is the single best I.V. tip I can offer, but it won’t help a lick in your internship: Learn how to feel the vein. Palpate it with the pads of your fingers. My absolute golden nugget of wisdom is to train one hand to have your palp fingertips. I use my non-dominant hand, so my L hand can feel a vein decades before my eyes can even see it. Start practicing with your “tactile vein hand,” on EVERY I.V. start, even when a vein is standing up and getting its flirt on, to get used the feel of them. It is described as “spongy,” “springy,” or that it “gives” under pressure. To me, they feel like little tubes of moon bounce material, and I visualize what the distended, engorged vein looks like underneath the skin. It won’t take long before your palp hand is heavy, and “this pt. has NO VEINS, dude,” will be a thing of the past. 
6. Prepare the Vein: Veins need love, too. Please do not forcefully slap, spank, thump, or flick them. Flattened veins may need a little help perking up, and I agree it is acceptable to use the pads of 2 or 3 fingers and tap to plump them a bit, but roundhouse kicking them in the face is not acceptable. Hanging the arm down and employing dependent gravity, having the pt. pump their fist, even using a few extra alcohol preps and rubbing briskly over the site (get some friction heat going) are all options to get that vein really engorged. Use care and discretion when applying brute force to a vein, and remember: it hurts!
7. Feel that Strrrrretchhhhh: The second most valuable tip I can offer is a simple one: Hold the skin taut! Whether you’re initiating in the hand, forearm, AC, or foot this rule applies:  Apply enough counter tension to the skin to anchor the vein, and set up a smooth surface for the needle to pierce through the skin. This is the most common mistake I see students make! HOLD THE SKIN TAUT. Be sure not to press into the vein causing it to occlude and collapse, just pull the skin with enough tension to anchor the tissue and vein underneath it. 
8. Venipuncture: Telling a patient “Ok, it’s going to be a biiig stick,” is the equivalent of telling the drivers seat “Ok, here comes my biiig butt!” Make it understandable or at least relatable, “This is going to feel like a pinch on your arm,” or “It’s going to sting/hurt for just a sec,” etc...just don’t say it’s going to be a “big stick.” A big stick comes from a tree limb, and if you go after a patient with one, you’ll have more to worry about then the semantics of your I.V. starts! On holding the angio cath: Familiarize yourself with the equipment you’re using. Too often I see students who are not holding the equipment properly, and we carry the same I.V.s as St. Luke’s where I just saw them for weeks doing hospital internship?! I don’t get it, but I am more than happy to happy to demonstrate and explain how to use the equipment I carry. Simply put: Bevel up, which coordinates nicely with the little tab sticking up near the top of the colored catheter hub. KEEP YOUR FINGER ON THAT TAB AT ALL TIMES, until it’s time to advance the catheter. 
9. Stay Focused: The rest is home plate material, but stay focused! At NBEMS we routinely use I.V. sharps to check CBG so don’t lose it, throw it on the floor, or get something all bloody with it. Hand to one of us, or set it near the glucometer. If possible, clean up after yourself!  Staying focused and following simple actions through to the end trains your mind to do so on auto pilot, even on the more complex actions, such as intubating. If you’re always cognizant of where you place the laryngoscope after ET placement, you won’t lose, cross contaminate, or damage it. Stay focused, and follow all tasks through to completion. 
10. I pick things up, I put them down: Or, in this case I put things in your vein, I take them back out. With the exception of discontinuing an unsuccessful or “blown” line, in the field we don’t pull too many I.V. catheters, but it’s still worth saying: When you do remove a catheter, apply pressure with the 2x2 directly after the catheter is out, not during the removal. If you apply pressure while removing the cath you risk complete transection of an already sheared catheter (causing a foreign body embolism, yikes!), and for a long dwelling cath, you basically squeegee off all of that biological goo clinging to the catheter and expel it into the pt. Eww! Plus, it plain old hurts more to apply pressure while pulling the line, so don’t do it!

Read, study, print these tips, if you like! I guarantee they will make a better “sticker” out of you! These tips are designed to enhance your skill, not teach it! Now, get out there and make me proud, EMT-Paramedic Interns! Tune in next week for my Intubation tips and tricks and blog!