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I’ll Be Seeing You, An Alzheimer’s Story


Alzheimer’s scares me.  I suspect it does many people.  I cannot hardly think of anything more devastating or tragic than having your mind slip away or watching helplessly as a loved one’s mind fades into confusion, and ultimately oblivion. All of which is to say I was a bit queasy when I got the assignment to profile a woman with Alzheimer’s, or more accurately to profile a family and their odyssey with the afflicted loved one in their care.  But I was struck by the love this family has for each other and for their beloved Lorraine, who was variously a wife, mother, grandmother to them. The way they rallied behind her is a testament to the family.  Of course, not all families are as close or loving, and not all Alzheimer’s victims are fortunate to have such attentive support.  If you’re in the mood for a sentimental story that is based in fact, than this might be your cup of tea.  The piece originally appeared in the New Horizons.

 

 

I’ll Be Seeing You, An Alzheimer’s Story

©by Leo Adam Biga

Originally published in the New Horizons

I’ll be seeing you in all the old familiar places, and in all the old familar faces…

Blessed with the voice of an angel, the former Lorraine Clines of Omaha enchanted 1930s-1940s audiences with her lilting renditions of romantic ballads as the pert, pretty front singer for local bands. Billed as Laurie Clines, she was also featured on WOW radio’s “Supreme Serenade,” whose host, Lyle DeMoss, made her one of his “discoveries.”

From an early age, she used her fine singing voice to help her poor Irish Catholic family get by during the Great Depression — winning cash prizes in talent contests as a child and, after turning professional in her teens, earning steady paychecks singing with, among others, the Bobby Vann and Chuck Hall orchestras at area clubs and ballrooms. After the war, she gave up her performing career to marry Joe Miklas, an Army veteran, semi-pro baseball player and Falstaff Brewery laborer. The couple raised seven children and boast 17 grandchildren.

The memories and meanings bound up in such a rich past took on added poignancy at a recent Miklas family gathering during which Lorraine, a victim of Alzheimer’s Disease since 1990, sang, in a frail but charming voice, some standards she helped popularize in the big band era. Her family used the occasion to preserve her voice on tape, thus ensuring they will have a record of her singing in her senior years to complement the sound of her voice on platters she cut years before. While even advanced Alzheimer’s patients retain the ability to hum or sing, Lorraine has clung to music with an unusual ardor that reflects her deep feeling for it and the significant role this joyous activity has played in her and her family’s life.

“There was always music in the house — singing, records, dancing,” daughter Kathy Miklas said. “When we were little we each learned two songs Mom recorded, “Playmate” and “Little Sir Echo,” and we all learned how to dance to “Ball and the Jack.” At their mother’s insistence, the Miklas kids took piano lessons and at their father’s urging, they played ball. “We really were lucky Dad loved sports and Mom loved music. It was a great combination. They made sure we did both. It was a nice foundation to have,” daughter Theresa Ryan said, adding the family participated in neighborhood talent shows and competed in softball leagues as the Miklas team.

 

 

 

 

Even though she went from headliner to homemaker, Lorraine never stopped making music. She harmonized doing chores at home. She sang lullabies to her kids. She broke into tunes on holidays and birthdays. Away from home, she taught music at St. Adalberts Elementary School, vocalized in the church choir, led singalongs on family road trips and performed for her children’s weddings. Ryan said she and her siblings knew that whenever Mama made music, she was in a merry mood.

“You would get a yes if you asked her a favor while she was singing. You knew that was a good time.” Even now, despite the ravages of Alzheimer’s, music continues to hold a special place in Lorraine’s mind and heart. In a reflective moment one September Sunday afternoon Lorraine commented, ‘We gotta get all the music we can.” And then, as if remembering how music enriched life for her and her family despite scant material comforts, she said, “We haven’t had a lot of other things, but we sure have had a lot of music.” Accompanied on piano by Carolyn Wright, Lorraine found most of the words, with some prodding from husband Joe, to ballads like “I’ll Walk Alone” and “Girl of My Dreams.” When she got around to singing the bittersweet “I’ll Be Seeing You,” which is about being true to an absent loved one, Joe broke down in tears — the lyrics hitting too close to home.

“Not having her around” is the worst agony for Joe, who loses a little more of his wife each year. “It’s hard to live alone,” said Joe, breaking down with emotion. As he has seen Lorraine slip further and further away into the fog that is Alzheimer’s, he has had to content himself with memories of “the good old days.” He said, simply, “We had some good times.” A son, Joe Miklas, Jr., said the cruel reality of the degenerative disease is that it feels like losing a loved one, only the afflicted is not dead but stranded in a dementia that makes them increasingly unreachable. unknowable, unrecognizable. They are present, yet removed, their essence obscured in a vague shadowland of the mind. “Physically, she’s there, but she’s not Mom anymore. We’ve lost our mother and yet she’s still here.” Kathy Miklas describes the experience as akin to “a slow grieving process.”

Bill Miklas, the youngest among his siblings, is convinced his mother is, on some level, aware of the prison her impaired brain has confined her to, although she is unable to articulate her predicament. Evidence of that came only last year when, Kathy Miklas said, her mother confided to her, “‘I think something’s wrong with me, but I don’t know what it is. It makes me feel bad that people are having to do things for me that I used to have to do for them.’”

The sad thing, Bill said, is “this disease has forced her to be isolated, not only from those around her, but from herself. She has to live within her world. She has to travel this journey, for however long, by herself. It must be very frustrating to her to realize when she talks she’s not making sense. She can see the reactions on our faces, but her pride won’t allow her to show she’s debilitated. It’s hard for her to look me in the face and say, ‘I don’t remember your name.’ Yet even as debilitating as this disease can be…she still likes to sit and talk, and she’s still a happy person.”

As Alzheimer’s evolves, its victim presents changing deficiencies, behaviors and needs. Mirroring the patient’s own journey are the changing emotions and demands felt by family members. Just as no two sufferers are alike, the experience for each family is individual. Every step of the way, the Miklas clan has made Lorraine’s plight a family affair. “Everybody just kind of took their part in it and did what had to be done,” said Ryan. “I don’t know what I would have done without them,” Joe said of his family’s pitching-in. Not everyone always sees eye-to-eye on how to handle things, but the Miklas’s remain united in their commitment to do right by Mom. And, no matter what, they’ve stuck together, through thick and thin, in illness and in health. “We’ve kind of become our own support group,” Joe, Jr. said. “We don’t always agree, but we always communicate, which is the key.”

Married 54 years, Joe and Lorraine hail from a generation for whom the vow “for better and for worse” has real import. That’s why when she was stricken with Alzheimer’s he put his life on hold to become her primary care giver at the couple’s home, where she continued living up until about a year ago. Lorraine’s first symptoms were shrugged off as routine forgetfulness, but as her memory deficits and confused states grew more frequent and pronounced, her family could no longer ignore what was going on. It all began with Lorraine making repeat phone calls to family members without knowing who she was dialing and not remembering she made the exact same call just minutes before.

Ryan said, “At first, we laughed it off among ourselves. It was like, ‘Oh, did Mom call again to ask who’s making the turkey for Thanksgiving? I told her 10 times.’ And then, we got a little upset with her. We’d say, ‘Mom, would you pay attention. You’re just not listening.’ There were other signs. Normally a precise, productive person who kept on top of her large family’s many goings-on, she could no longer keep track of things. She let the house and herself go. She grew disorganized. And she seemed to just shut down. “I think one of the things we first started noticing is that she just wasn’t doing as many things as she was doing before,” Kathy said. “One of the striking differences was she’d always been very organized and efficient” but not anymore.

Concerned, Kathy convinced her mother to be evaluated by the University of Nebraska Medical Center geriatric team. “When the doctors said she didn’t have any physical reason for this — that it’s probably Alzheimer’s — I was totally shocked,” she said. The entire family was. Lorraine went on living at home with Joe. “I think our family…was in denial,” Bill said. “We didn’t want to mention Alzheimer’s in front of Mom. I think a lot of us thought there was a mixed diagnosis. That, you know, it’s not really Alzheimer’s — Mom just forgets things. It’s not that big a deal.” From denial, the family gradually accepted Lorraine’s fate, the diminished capacity that accompanies it and the demands her care requires.

To get to that point, however, the Miklas children first had to come to terms with how their mother’s condition was affecting their father. “We were all kind of going on with our lives,” Ryan said, “but I don’t think we were focused too much on the disease because Dad was there to do the day to day caring.” As the disease progressed and Lorraine grew more unmanageable, the job of caring for her 24/7 consumed Joe’s life. He halted his active recreational life to attend to her needs. “Dad started to give up a lot of the things he likes to do,” Ryan said. It got so that it was dangerous leaving her alone, even for brief periods, and no longer possible for anyone untrained like Joe, now 79, to always be on call. Overwhelmed by it all, he could no longer hack it alone, and that’s when the family began the long, winding odyssey to find the right care giving situation.

 

 

 

 

Kathy, a private practice speech-language pathologist, steeped herself in Alzheimer’s — from possible causes to drug therapies to support services to care providers. “I felt like I could deal with it better if I understood it. So, I started talking to the Alzheimer’s Association and reading lots of stuff. As a family, we shared information about what Alzheimer’s is and what goes on with it. I didn’t want to miss an opportunity to do something or to have something because we didn’t know about it.”

Family members also attended conferences to glean more understanding — from health professionals and family care givers alike — about what to expect from Alzheimer’s and what adjustments the family could make to ease things for themselves and for Lorraine. For further insight about her condition and how to manage it, they consulted one of the world’s preeminent Alzheimer’s experts, Dr. Patricio Reyes, director of the Center for Aging, Alzheimer’s Disease and Neurodegenerative Disorders at Creighton University Medical Center. “We just lived and made adaptations and accommodations as needed,” Kathy said. “We knew not to ask Mom to do certain things because she wouldn’t remember them and we reminded her to do things she maybe still remembered how to do.”

The family explored several care giving options: first, enrolling her in a respite day care program; next, arranging for a home health nurse to come each morning to assist with her personal needs; and, then, when respite/home care was no longer sufficient to accommodate her unfolding illness, they sought more intensive aid.

“In November, we decided it was not a good idea for Dad to have to constantly be on duty all the time,” Kathy said. “We could see his health deteriorating from the stress…so we started looking at nursing homes.” Lorraine was placed in one, but the family found its medically-based approach and strictly-regulated environment stifling for their mobile, verbal, social mother, who felt uneasy in such a restrictive setting.

According to Kathy, the site “just wasn’t set-up to handle somebody like Mom. They had everybody get up at seven, eat breakfast at eight and go to bed by seven-thirty. Well, having been a singer — Mom never gets up at seven and she’s used to going to bed at about one o’clock in the morning. Plus, they had her heavily medicated. One night, they called and said, ‘Your mom is having a behavior episode we can’t manage.’ Well, I got there and she was having ice cream with a nurse. She was fine. Mom was very frustrated because in her mind this was her house and at night she got terrified. She would ask, ‘Why are all these people in my house?’ After a month of that place, we decided it wasn’t working out.”

Searching for the best care facility for a love one means weighing many complex issues and making many difficult decisions, not the least of which are financial. Although the nursing home was unsatisfactory, it did have the advantage of being Medicaid certified. As the Miklas’s looked around for an alternative, they discovered most quality care centers do not accept Medicaid patients, are cost prohibitive on a private pay basis and, even if the family could afford to pay privately, they would face a two or three-year waiting list.

“We were struggling with what we were going to do,” Kathy said. That’s when they found new hope and the right fit in Betty’s House, a residential assisted care facility, where Lorraine resides today. Where, at the large, institutional nursing home, Lorraine was anxious and irritable, the family has seen “a dramatic difference” in her mood at Betty’s House, Kathy said, adding: “It’s been a godsend. It’s small and home-like, not like a nursing home. The lady who runs it, Mary Jo Wilson, cared for her own Alzheimer’s-sticken mother for 10 years. She knows how to do Alzheimer’s. She knows what you say, when you argue, when you don’t argue, what’s important, what’s not important and she teaches her staff…that you give residents praise and tell them how happy you are they’re there, and I really think that positive feedback is part of the reason Mom’s been so calm and so happy the past few months. She’s doing well.”

And, relieved from the pressure of daily care giving, Joe Miklas began doing better, too. “Now, he can relax,” Kathy said.

Joe is just relieved Lorraine is situated where she seems at peace. “She’s safe. She seems to be happy,” he said. “They’re very good out there. The owner does a hands-on job. She’s always around, supervising things. She’s got some good help. It makes a lot of difference. I try to make it out there every other day if I can. Lorraine talks about coming home, and I’m not sure whether she has this (he gestured to mean their home) in mind or what. I thought she considered that (Betty’s House) her home. It’s hard to know.”

He does know she’s content whenever she breaks into song, as she did upon overhearing a conversation he had with another visitor to Betty’s House. “We got to talking about music when Lorraine suddenly sang ‘When Irish Eyes Are Smiling’ and she just took it up right from there.” Anything Irish elicits a response from her, said Kathy. “She’s always been passionate about her heritage. St. Patrick’s Day was a big day at our house. She’d sing Irish songs. Even now, when you mention something about being Irish, she’ll go into her version of an Irish brogue” and maybe start up a song.

Music remains a vital conduit to the past. “Still, in spite of all the things she can’t do, if you put a microphone in front of her, she turns into Laurie Clines, the singer,” Kathy said. “Her body moves as a singer. Her voice changes and her intonation, her breath and her rhythm become that of the singer again.” This transformation was evident the night son Tim Miklas appeared with his band, the Pharomoans, at Harvey’s Casino. “I went down into the crowd where Mom was and we sang “When Irish Eyes Are Smiling” together. That was pretty special,” Tim said.

Family and faith have defined Lorraine’s and Joe’s lives. Growing up within blocks of each other in south Omaha, each lost their father at a young age and each began working early on to support their family during tough times. They attended the same school and church, St. Adalberts, but didn’t start dating until after the war.

“I thought she was the prettiest girl in school,” Joe said, “but I didn’t think I had a chance to get a date with her, so I just kind of put it out of my mind.” After marrying and starting their own family, the pair made sure all their kids attended parochial school, scraping together the tuition from his modest Falstaff salary, and even saved enough for family vacations. “Family was very big to her and she passed that on,” Theresa Ryan said. “I think they both wanted that family environment and worked very hard to achieve it.” Bill Miklas added, “One of their man ambitions was to raise a great family, and I think they did a wonderful job.”

Through the process of Lorraine’s sickness, the Miklas’s, always close to begin with, have drawn ever closer. If there’s anything they’ve learned about dealing with a loved who has Alzheimer’s it is, Tim Miklas said, “to try to maintain the courage to go on and make sure that person is still a member of your family. Maintain your relationship with that person as much as possible. At some level, some of the things get through to them.” Whatever the family occasion, Joe knows his wife still “wants to be part of it, that’s for sure.”

Kathy Miklas advises others to “really value the time and the experiences you have with your loved one because you don’t know what it’s going to be like three months or six months from now. Like many people with Alzheimer’s, physically Mom’s going to last a lot longer than she is mentally.” Another piece of advice she has is: “Give people choices. Give people dignity and the ability to have some control over their lives. For example, giving my mother the choice of when gets dressed eliminated a lot of arguments.”

In the end, this Alzheimer’s story is about the enduring love of a man and a woman and of a resilient family. “Theirs was a very subtle love,” Bill Miklas said of his parents. “It was something you always felt. The same with the faith they lived. It was a constant. There was never a question — never a doubt. It was a very stable reality. I think Mom taught us a lot about faith and about commitment — to ourselves and to our family. She taught us not to focus on what you don’t have but to enjoy what you do have and to find the value in that. Somehow, if I can take that to my family than that will be Mom’s greatest legacy.”

I’ll see you in the morning sun and when the sky is grey.  I’ll be looking at the moon, but I’ll be seeing you…

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ER, An Emergency Room Journal

June 16, 2010 2 comments

To be honest, I was hoping for something dramatic to happen in the ER that agreed to accommodate for a few nights my hanging around, asking medical staff and paramedics and patients questions and taking voluminous notes. Nothing much did.  That is to say, a stream of patients came through presenting all manner of problems, but nothing over the top sensational occurred.  I think I still managed a good story out of the assignment. You be the judge.  The article appeared in The Reader (www.thereader.com) as a kind of companion piece to another story I did based on ride alongs with paramedics.  You can find the paramedics story on this blog as well. It’s titled “Merciful Armies of the Night.”

ER, An Emergency Room Journal

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

 

Hours of Boredom and Minutes of Terror

Hollywood portrayals of hospital emergency rooms depict white hot action zones where medical drama and staff intrigue continue nonstop. What’s a real ER like? Recent visits to the NHS University Hospital ER found a medical treatment center, social laboratory, educational classroom and last refuge all in one. An intersection where the gallery of humanity meets and various trends surface. A mission, a haven, a hell. Or, as one ER nurse put it, “We deal with the heart of Omaha here.”

Like many staff, nurse Susie Needham feels the ER is THE place to be on the frontlines of medical care due to its fluid nature, one she summed up as “hours of boredom and minutes of terror.” Unlike television’s ER, long tedious stretches can grind by before a single trauma arrives. Then again, a run of critical or extreme cases can suddenly pile-up, kicking a slow shift into high gear. As Needham put it, “From moment to moment, it can change.

Most people that work here are attracted to the fast changing pace and the variety of different patients we see. It’s never the same. You have to know a lot about a lot of different things, and that’s what keeps you on your toes. It makes it interesting.” On a Friday night in April Needham, a pretty freckled blonde with an impish smile, tended a diverse mix, including a bronchial pediatric patient with difficulty breathing, an adult drug abuser suffering withdrawal pangs and a drunk woman ostensibly there for stomach pain but whose battered body and frayed psyche told a more sinister story.

For the most part, ERs treat a procession of fevers, coughs, sprains, aches, cuts, bruises, breaks. Purely routine stuff. Unless it’s happening to you, of course. Since one person’s trivial complaint may be another’s dire crisis, everyone is treated the same. No condition is refused. Nothing is taken for granted. Trained to assess and treat serious problems, medical staff try first ruling out any life-threatening cause before looking at non-critical or non-medical issuses. Most ER medical staff possess extensive critical care backgrounds, but it seems all ERs (the step-child of acute medical care) are not equal.

“Unfortunately, emergency medicine is still the only speciality where you just need a license to practice, so it’s kind of a buyer-beware situation,” said NHS Chief of Emergency Medicine Dr. Robert Muelleman. “At University, we require physicians be board certified in emergency medicine (spending a minimum three years residency in emergency medicine and passing written and oral exams). It helps ensure a certain standard of care or level of competency. Nationwide, probably only between 50 and 60 percent of practicing emergency physicians are board certified, but I think there are more, better trained board certified physicians today than there were 10 or 15 years ago.”
picture disc. On busy nights (Sundays are worst) patients stack up and long waits ensue. Triage nurses sort cases on an as-needed basis, with the severest seen promptly and the mildest set aside for a kind of walk-up window service, Fast Track. But again, unlike TV, where patients sweep through the ER unchecked, the real world entails staff documentation-communication for all patient admissions, treatments, releases. In terms of volume, University Hospital recorded 27,018 ER visits last year, a slight rise from 1998. Traumas typically account for about 3.25 percent of all cases.

Not long past dusk on St. Patrick’s Day things were unwinding surprisingly slowly in the ER considering this was a designated trauma night (meaning area rescue services were to feed trauma patients there) on a Friday holiday known for alcohol-related injuries. Earlier in the day, staff treated a 43-year-old Omaha man knocked unconscious in a bar fight. Michael Kimball was brought in comatose. Massive swelling in his brain forced doctors to remove his skull to relieve the pressure. (Editor’s Note: Kimball never regained consciousness and, two weeks later, was pronounced dead. Police cited insufficient evidence to file charges in the case.).

Hours later, during a protracted lull, staff lingered about “the hub,” the ER nerve center,  bantering in the irreverent MASH humor used for stress relief. Attending physician Dr. Paul Tran made a colleague, Dr. Rick Walker, envious by describing his sound sleep the night before, a rarity after the rush of a nine-hour trauma shift. When not hanging at the hub or crashing in the staff lounge, docs, nurses, techs and residents use computers and charts to monitor the condition of patients in surrounding non-critical care rooms and trauma bays (a total of 16 beds), to track the progress of lab workups, x-rays or other procedures and to file paperwork. A large grease board hanging high on the wall is smudged with running patient status reports. This checks and balances system aims to avoid patient-bed-meds. mixups

The staff perked up that night at the static-filled emergency band radio (always droning on in the background) report of a CODE 3 (critical medical) case en route, with an ETA of five minutes. Staff are uncanny at hearing the calls headed their way and ignoring the others. The paramedic’s sketchy details described an elderly man who fell and hit his head outside a Bag ‘N’ Save. The man, whom paramedics found minus vital signs, had been shocked back to life. With the clock ticking, Dr. Tran, a slight Vietnamese native with a gentle bedside manner, conferred with colleagues on whether to summon the trauma team, a kind of in-house medical SWAT squad on call to treat the most severe critical care cases, or to handle things themselves.

 

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It Never Gets Better
Dr. Walker, a beefy man whose pockets are invariably overstuffed with paperback novels and stethoscopes, has spent his entire medical career in emergency medicine. He said part of the appeal for him and others is the extreme nature of the work. “I think it’s very challenging, and that’s a large aspect of it. It’s also a big adrenalin rush, and as I’ve assessed my life and career I’ve come to the conclusion I’m an adrenalin junkie, and I think that’s probably what did it for me.”

He said being exposed to the tragedy that accompanies trauma extracts a certain toll:

“You see bad stuff happening here, and it’s stuff that, you know, can make you cry, like kids dying. It’s tough and it can really get to you emotionally, and so what you have to do is build up a wall because otherwise you’d be breaking down every time you saw something like that and you could not function. That wall tends to stay up most of the time and the last few years it’s become an issue in my personal life.” Nurse Jackie Engdahl said it takes a special breed to work there, “Oh, definitely, Type A personalities make good ER nurses. You have to be very aggressive…very assertive because of what you deal with. You deal with not only ill and injured people, but intoxicated people and drug-induced and psychotic people. You gotta love a good challenge and you gotta be strong enough to whip into shape when the going gets tough.”

For trauma nurse coordinator Kathy Warren, it’s a matter of staying focused no matter how horrendous the reality before her. “Some of these cases are just horrible looking when they come in. You just have to totally ignore that and focus in on the task, so whether you’re starting the IV or helping the docs with procedures, you detach yourself and just click into gear. You can’t get nervous. You have a job to do,” she said. Warren, whose job entails her dealing with family members, said staying composed is hard when working with parents who’ve just lost a child. “Sometimes I have to step back for a few minutes and take a deep breath. When I get home after a case like that, everybody knows its been a bad day as soon as I walk in.”

Added Susie Needham, “People think you get callous or something, but you don’t. Some of the things we see are heart-wrenching and no matter how many times you’ve seen them it still really bothers you. It never gets better.”

Things finally began heating up again on St. Patty’s Day once the Code 3 patient was wheeled in on a gurney by paramedics and lifted onto a bed in the T2 trauma bay. The heavy-set man of about 65 lay there in a coma, a breathing tube inserted in his throat and an IV snaked into one arm, his big hairy belly billowing up and down as a bevy of ER medical staff hovered over him to keep him alive. “I need, STAT, six units of platelets…” a nurse called out. “Tell respiratory to bring a vent, please,” called another.

Then, when someone barked, “I need another set of hands up here,” a tangle of arms belonging to eight nurses, techs and docs converged to perform, seemingly at once, multiple tasks, from hooking up a ventilator to running a blood pressure line to starting a new IV to drawing blood to attaching EKG electrodes. “Sir, there’s going to be a tube going down the back of your throat,” one of them said more out of habit than out of any expectation of a response. Lying there, totally exposed and vulnerable, his life completely in the hands of these angels of mercy, the man, referred to then only as John Doe due to a lack of ID, was an anonymous soul brought back from the very brink.

Time is of the Essence
Time is critical in trauma or near trauma scenarios like these. That night’s charge nurse, Scott Miller, said it involves quick, precise coordination and communication. “Everybody swarms in to get the job done as fast as possible. In a case like this you have Dr. Tran coordinating and everybody trying to feed information to him as to what they’re finding at the same time as they carry out his orders.”

When the whole trauma team is activated, a whole slew of specialists — from surgeons to anesthesiologists to radiologists to lab techs — converge on the spot, making teamwork even more essential. According to Kathy Warren, “You have a lot of people and everyone has a different role and, hopefully, they know their role so they’re not getting in your way and you’re not having to tell them everything. It usually works pretty well, and it’s amazing the amount of things that can be done for a patient in a short amount of time when you absolutely have to. But that’s what a trauma center is supposed to be able to do.”

Emergency care often starts with the rapid response of rescue squads on the scene. Paramedic Tom Quinlan was among those responding to the 911 call that found Doe lying unconscious. “He was not breathing. He didn’t have a pulse. So we started our CODE 99 (for clinically dead cases) protocol, which is intubate him, start an IV and do CPR. We ended up shocking him a couple of times. We finally got a pulse back and he continued to breathe for us on the way to the hospital,” he said.

Added Dr. Tran, “Time is of the essence here. After so many minutes, it doesn’t do any good, so it’s all speed and skill. The man probably experienced sudden death when his heart went into fibrillation, meaning it didn’t pump any blood and, so, the brain promptly became unconscious and he fell down and hit his head and only by actions of the paramedics did he come back. He was extremely lucky to have had everything done in that time, otherwise he would be dead by now.”

Dr. Tran said the fall resulted in “about a five-centimeter hematoma on the back of the head.” Since Doe was found unresponsive and bore a scar on his chest indicating a history of heart surgery, the question on Dr. Tran’s mind was whether the patient’s vegetative state was due to the fall or to some new cardiac event. Not wanting to overlook a potential cerebral cause, he called in part of the trauma team after all. As Scott Miller, explained, “We’re assuming now he had some sort of heart event that caused him to fall and hit his head. We will be doing a CAT Scan to make sure there’s not something else going on, like a big bleed in his head. We don’t think that’s the case, but you can’t always tell for sure.”  Later, it was confirmed a cardiac event did trigger the trauma.

As for the long-term prognosis, Dr. Tran said, “I’m not sure of the condition of his brain function later on.” By then, Doe was identified and his family contacted by nursing resource coordinator Regina Christensen, who met with family members. Part of hers dutie entails fielding inquiries from news hounds looking for material. She noted with incredulity some sound disappointed when a case is upgraded from critical to stable condition.

When treating a trauma, there is no room for bruised feelings. The required care  must be delivered NOW. Hashing out differences can come later. One of the reasons nurse Jackie Engdahl likes working in the ER is the maturity of the people working there. “When I worked in other hospital areas there were very clashing personalities and people always bickering back and forth. But here, it’s not that way. You say whatever you want to say to someone and then it’s over and done with. There’s never hard feelings.” And, she said, where some physicians resent or reject nurse input this ER’s docs welcome it. “The doctors here work really well with the nurses. The doctors trust our judgment and they really listen to us. They allow us to do a lot of things, which is nice.” What about departmental romances? “There used to be between the nurses and paramedics,” nurse Janie Vipond said. “It just depends on the group you have at any given time. But, yeah, it happens.”

I Felt I Was in Good Hands
Amid the controlled chaos of an unfolding ER trauma, staff attend to myriad details, not to mention other patients. For the trauma patient whose life hangs in the balance, it can be a surreal experience of wailing sirens, flashing lights, antiseptic smells, probing instruments, strange faces and endless questions. There is fear, confusion, agony. There is even a strange sense of peace. Beverly Harter, a 62 year-old wife, mother and grandmother, has been there. How she got there is a story in itself.

On May 16, 1999 the Logan, Iowa resident was attending a graduation party at the nearby trailer home of a daughter. Various family members and friends were present. The weather was threatening that afternoon. When the sky turned ominous and a tornado warning sounded, the 12 partiers fled the trailer for their cars in an effort to outrun the storm. But it was too late. With a twister bearing down, they left their vehicles to take refuge in a roadside ditch. Huddled on the ground, exposed to the savage winds, the group was deluged by parts of farm machinery ripped asunder in the cyclone and propelled like shrapnel. The metal shards rained down on them, tearing skin, cracking bone, crushing organs.

When it was over, Beverly’s daughter was dead and two grandkids, both injured, left motherless. Her son endured a broken clavicle. A family friend died. As for Beverly, she suffered a punctured diaphragm, a perforated bowel and two crushed vertebra. Her house was leveled. Ironically, the trailer escaped unscathed. Transported by a local rescue unit to Missouri Valley, Beverly was then taken by ambulance to the nearest trauma center, the University Hospital ER.

Beverly, who remained conscious during much of her ordeal, did not have to be told she was badly hurt. “I knew I’d suffered spinal cord damage because my legs were on fire, and they stayed on fire.” she said. She also knew her daughter “was gone” and other loved ones injured. As for her Omaha ER odyssey, she recalls “bright lights,” a sense of “time standing still” and “a lot of people doing a lot of things and asking a lot of questions. I was really hurting and kind of fading in and out from the sedation, but I was able to answer a lot of questions. They explained to me what they were doing at all times, and that was reassuring.”

Indeed, despite her pain and grief, she recalls feeling calm. “You just have a sense that everybody’s taking care of you and that they’re all working together doing their jobs. I felt I was in good hands.” She also felt the staff’s compassion. “They were extremely sensitive and caring and protective about what happened to me and my family. They knew the devastation and loss we had. I was just overcome by their concern for our well-being,” said Harter, who today is confined to a wheelchair.

Kathy Warren said she used to doubt whether the time she spent with families who suffered a loss made a difference until her own father died in the hospital and she found comfort in the support her colleagues gave her. “I realized how important it is to have somebody treat you with kindness and to let you grieve however you want to and to explain things to you. Ever since then I’ve really pushed staff here to sit down with families and to talk to them. It’s not an easy thing to do as a medical person. Some people are better than others. But people don’t expect us to be super men and women. To save everybody. They just need us to be there.”

Not all exchanges are so pleasant. Patient complaints over long waits get expressed along the sarcastic lines of, “I’m sure glad I wasn’t dying.” Before things get nasty, staff try defusing the matter. “The basic strategy is to make them see you as being on their side,” said Dr. Bob Muelleman. “On the other hand, you want to be very much in control of the situation. If it’s just a matter of them yelling and cussing at you, well, that pretty much comes with the territory. Once in a while there’s kind of a thrashing or flailing out. If you think there’s the potential of them really getting violent you can call in security or police, but normally you can handle it on your own.”

When care complaints cannot be appeased, they are passed-on, in writing, or addressed on-site by managers like Regina Christensen. “It can be anything from somebody upset that their mother’s IV is out to something as complicated as a gang-related situation where the patient himself or his family is threatening staff. It’s just an array of things,” she said.

The Truth is Stranger Than Fiction
Meanwhile, back on St. Patrick’s, a drunk middle-aged woman involved in a domestic dispute came in with an aching gut. However, the night’s triage nurse, Susie Needham, recognized bruises and marks as signs of physical violence and sexual assault. After questioning the woman, a horrific tale of prolonged torture and bondage emerged that prompted ER staff to follow procedure and report their suspicions to police. Acting on the medical staff’s input two officers, who earlier arrested the woman’s boyfriend on misdemeanor assault charges, returned to open a rape investigation.

According to Needham, “If people come in here with traumatic injuries that don’t really fit their stories, we call the police.” Often, she said, such patients prove to be victims or perpetrators of a crime. Surrounded by staff and police in a room concealed by drawn curtains, the woman cried out, “I can’t take it anymore. I don’t want to take it anymore.”

After examining the woman a visibly shaken Dr. Tran said, “It’s one of the most remarkable cases of domestic violence I’ve ever seen. She has multiple problems. Number one is domestic violence and sexual assault. Number two is chronic alcoholism. Number three is a low platelet count. Number four is what appears to be an upper GI bleed.” As part of hospital policy in such cases, staff called in a domestic violence-sexual assault counselor to apprise the woman of her rights and refer her to appropriate community resources. But, as ER staffers say they’ve seen far too many other victims do, the woman rejected police-medical entreaties to undergo a forensic exam, something required for a criminal inquiry, and declined pressing rape charges. She was admitted and treated for medical problems.

“What do you do?” a frustrated Needham asked. “That’s tough,” Dr. Tran said, “because once enough time passes, the evidence is lost. We can’t do anything. You have to respect the patient’s wishes. Patient autonomy is everything. Why did she refuse? Oh, fear, love rejection, sensitivity. Who knows? Unfortunately, it’s common.”

Bizarre, believe-it-or-not episodes are also common in the ER. Take the time an obnoxious drunk showed up with a fierce but inexplicable pain in his belly. After sleeping it off, he staggered up from his cot and only then did the ER doc notice a speck of blood, on the sheets, which upon closer inspection turned out to be from a tiny hole, splayed by burn marks, in the man’s back. Apparently, he had been shot but was too drunk to recall it. Sure enough, an x-ray revealed a bullet lodged in the abdomen.

Or, take the time a stabbing victim arrived cut entirely from stem to stern, his entire rib cage exposed, yet conscious enough to describe the whole bloody fillet job some whore performed on him. Or, the time a man fell at home on a fireplace iron and walked in the ER with a small wound on his neck which, upon further exam, proved to be a deep puncture penetrating his cervical spine. For Dr. Muelleman, who treated all these cases while working in a Kansas City, Mo. ER, such incidents fall under the heading of “the truth is stranger than fiction.”

 

 

 

 

 

Perhaps the most frustrating cases are those involving entirely preventable injuries, especially those incurred while victims engaged in some high-risk, reckless behavior, like a young man Dr. Muelleman treated in Omaha who crashed his car while out joy riding and ended up paralyzed from the neck down. “I don’t call them accidents anymore,” he said, “because an accident suggests an act of God. I call them injuries because when people put themselves in these circumstances something is going to happen that didn’t have to happen.”

Anybody-Anytime-Anything
As ERs are traditionally the 24-7 stop-gap or catch-all of American medical care, the entire spectrum of need shows up there. In most public hospitals, no one is turned away, regardless of insurance status or ability to pay. “The emergency department is the safety net for many people seeking care who really have no other place to go, said Dr. Paul Tran. “Admittedly, there’s going to be abuse of the resources because this is reserved for emergency cases, but who’s definition of emergency is it? A toothache at 2 a.m. may be an emergency to you, but it may not be to someone else. We are here to take care of people from all walks of life and with conditions as minor as a toothache or as serious as a heart attack. And from that standpoint, it is very satisfying to provide people the last resort they need and to get the instantaneous gratification of turning them around.”

Given its open door policy, “the ER is where you really see the cross-section of humanity and so, if there are social ills, you seem them in the ER,” Dr. Muelleman said. “Some of the ills we deal with are domestic violence, drug and alcohol issues, child abuse, lack of immunization and lack of access to health insurance. Another segment the ER picks up on are the acute psychiatric and homeless populations.” He said in an era of managed care, ERs play an increasingly large social service and public health role. “

So, if we’re dealing with intoxicated people we try to get them in a shelter or detox center. If it’s an abuse case we bring in social workers, police and protective agency professionals. If we’re dealing with domestic violence, we make sure patients understand the resources available to them.” Nurse Scott Miller is “troubled” by how many kids he treats who “are not well cared for” at home and “very frustrated by the large number of people with legitimate psychiatric problems who can’t get seen” due to a lack of psychiatric beds locally. He said, “I’ve spent many hours fighting on the phone, calling medical staff at home, to get people admitted in the hospital when they don’t really have a medical problem. But when no psychiatric place will take them, we can’t just send them home.”

Dr. Muelleman said where ERs have always tried educating patients about prevention safeguards and optional resources, “Some have gone to the extent of smoking cessation and substance abuse counseling. I’m just reviewing a grant for a hospital to screen Type II Diabetes, which is not something you’d traditionally think of as an ER doing. There is a real move toward ERs getting involved with public health, even things like bike helmet giveaways. Some have even gone as far as to give pneumonia and flu shots. Even here, during seat belt awareness week, we do educational stuff to let people know about the importance of seat belts.”

As a survey of ER web sites will attest, there is debate in the medical community over the all-encompassing role of the ER. On this subject, Dr. Muelleman takes a pragmatic position. “You can’t select why people use the ER. Once they’re here, you can’t ask, Why are you here again?, although you may be tempted to. I mean, I support the notion public health policy in America should be changed to help take care of people’s health needs in a more comprehensive fashion than just having them go to the emergency room, but given that’s not the case, the mantra in the ER continues to be — anybody, anytime, anything. That’s exactly what it is. Should we change medicine so that doesn’t happen? Well, yes, we should, but in the meantime we’ve got to do what we can to help people.”

 

Merciful Armies of the Night, A Ride-Along with Paramedics

June 16, 2010 2 comments

To date, the only ride along I’ve done as a journalist was for this story following paramedics.  I enjoyed the challenge of reporting and scene description the assignment presented.  It’s the type of project I do from time to time in order to push myself out of the comfort zone I sometimes get stuck in.  The story, which originally appeared in The Reader (www.thereader.com), was meant to mimic and ultimately transcend the television and film depictions of first responders. Perhaps I’ll do a ride along with police officers or detectives sometime.  A companion piece of sorts to this one is also posted on the site — a report I filed based on a few nights observing things at an ER.

 

 

OFD Medic 1

 

Merciful Armies of the Night, A Ride-Along with Paramedics

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

The Paramedics Corps
Cutting through the humid summer night, Medic 21 is a rattling five-ton metal box of thunder-on-wheels. The Omaha Fire Department (OFD) rescue squad rushes to another emergency on the near north side. Flashing red, yellow and blue lights pulsate with the same urgency as the wailing siren’s cry that help is on the way.

Two licensed paramedics are assigned Medic 21 on the C shift: Capt. John Keyser, 38, a fair-haired, well-chiseled 12-year veteran of the OFD and Kathy Bossman, 28, a pretty brunette in her third year on the force after a short stint with the Lincoln Fire Department. Partners since last October, the pair work out of a firehouse at 3454 Ames Avenue, one of nine stations in the city housing rescue squads alongside fire engine companies. Anymore, every Omaha firefighter is trained in at least basic Emergency Medical Technician (EMT) skills. Some own intermediate or EMTI ratings. Others, like Keyser and Bossman, are full-fledged paramedics with the most rigorous Advanced Life Support (ALS) training on the force. Paramedics are usually attached to rescue squads, although some serve on fire rigs.

The OFD paramedics corps numbers 147, nearly triple the total from five years ago. Omaha Fire Department Emergency Medical Services (EMS) Battalion Chief Jim Love said this planned jump in personnel came in response to an increasing workload caused by an ever-expanding city: “Last year our medic units responded to 23,558 calls for medical assistance and transported 16,400 of those people. The year before, we responded to 21,272 calls. Our calls are growing at a rate of 4 to 6 percent a year. The population is not only getting larger but it’s getting older, so we’re seeing an increase in the elderly and their associated medical problems.”

Paramedic training is intensive, entailing some 1,000 hours of classroom and field experience, including interning in clinic (hospital) settings and on ride-alongs. A more rigorous curriculum is being implemented in 2001. Omaha EMS Chief Medical Director Dr. Joseph Stothert, head trauma surgeon at NHS University Hospital, said today’s paramedics are more skilled than in the past: “They have better education and better quality assurance in place and I think generally the care in the streets is much better than it was 10-20 years ago. Not only are they able to do more, but they are able to understand more and sort out what’s going on with the patient and to begin treatment before they reach the hospital.” He said things have progressed to the point that medics follow protocols or standing orders to guide their assessment and care in the field where before they called hospitals and awaited orders via radio phone. “Through the years I think the level of confidence has increased in the paramedics because of their training,” he added.

Here I Come to Save the Day
As the gleaming ambulance barrels through traffic (most of which parts to let it past) to the scene of an emergency the vibe inside the squad is part thrilling and part somber as the laconic medics steel themselves for whatever crisis awaits them. With their hearts racing, they are like soldiers driving into a battlefield. Their reactions must be swift. Their minds sharp. As they run through routes and protocols in their head, they keep an eye out for rogue motorists and cock an ear to the radio for updates. They take seriously their role as rescuers. Theirs is a single-minded mission of mercy — responding to a frantic plea for help. It can be anything. A diabetic reaction. An asthma attack. A cardiac event. A gun-shot wound. A personal injury accident. Poisoning. Heat exhaustion. Childbirth. It can be anybody. A child. An adult. Someone hurt in a car, on the street or in their own house. It can be a cop or fellow firefighter, victim or assailant, average citizen or public figure. You name it — these professionals have seen it in the line of duty.

Medics pull 24 hour shifts and no matter when the 911 call comes in — the middle of the night or the fat of the day — and regardless of what it is — a routine health problem or a genuine medical crisis — they show up ready to lend aid. Even when driving conditions stink or the medics are starving sleep, they respond the same. There is a temptation to view them as heroic Calvary riding-in to save the day. That is not how they see themselves, however. “I certainly don’t feel like any knight in shining armor. We’ve just doing our job,” Keyser said. “I really do enjoy helping people. That’s probably the biggest reason why I chose this profession.” His partner, Bossman, added, “It’s nice to be able to help people and to be able to change their life or improve their life in some way. Every time they call us it’s an emergency to them. They appreciate us being there, and that’s a good feeling.”

The anytime-anything-anybody drama of the job is one of its major draws. Even though most runs are routine, no two are ever quite the same. “One of the most appealing things is the excitement,” Bossman said. “It’s a big adrenalin rush. When you get the blood and guts, it makes it more exciting and interesting. You know you’ve got to step it up. You’ve got to move faster. You’ve got to get more things done. You’ve got to use all your skills and training.” Said Keyser, “One of the reasons I went into this is because it’s very challenging. The sleep deprivation is hard to deal with and the stress level is very high.” That stress — of being on call all hours of the day and night to make emergency medical interventions — has a flip side too. “You can get too wrapped up in this job. If you let the pressure and stress mount, all it does is kill you a little bit at a time. That’s why I’ve always thought one aspect of being a good paramedic is recognizing when you need to get away from it,” Battalion Chief Love said. Field medics like Keyser know the demands can overtake them if not careful. “I’ve got at least another 12 years on the job, but I don’t want to be on the rescue squad that long because I don’t want to get burned-out. After a 5-day rotation, I’m exhausted. I have a wife and three kids I want to enjoy,” he said.

On the Run
Medic 21 is among the two busiest EMS units in Omaha. It annually vies with Medic 40, at 45th and Military Avenue, for the title of most runs. The unit is responsible for a wide swath of Omaha — from Bedford Avenue north and from the Missouri River to 72nd Street west. Given that Medic 21 serves a low income area, some residents rely on the EMS system as a mobile clinic and taxi service. “In our territory we seem to have a lot of patients who don’t have transportation to the hospital, so they call 911 even if they have the flu. You treat them the same even though you’re frustrated because it’s 3 in the morning and you’ve seen this patient before and you know there’s nothing seriously wrong with them,” Bossman said. “We tend to see a lot of really young mothers who don’t know much about caring for their kids. We try to educate them a little.” Then there are the repeat customers. “We’ve got quite a few regulars. Most have legitimate medical conditions, but some don’t necessarily take care of themselves very well. They don’t take their medicines like they should and that can worsen their condition.”

Jim Love was a firefighter-paramedic on the streets before taking a desk job. He worked out of Station 21 and said his field experiences there opened his eyes to some things. “I didn’t realize the abject poverty that exists in certain parts of our city until I actively went there, walked into these places, took care of these people and transported them to the hospital,” he said. “I mean, I’d seen poverty on TV and read about it in the newspaper, but until you actually touch it and work with it, you really can’t imagine. For lots of people, we’re their source of medical care. They don’t go to doctors.”

With 3,113 runs made last year by its three crews, Medic 21 is the reigning champ among Omaha EMS units. Through August Keyser and Bossman are averaging 9 runs per 24-hour shift and are 50 ahead of last year’s pace, but on this day (August 10) they are still awaiting their first more than half-way through their shift. “This is highly unusual,” Bossman said. “That’s the thing about this job. A lot of times you’re waiting for something to happen and other times you leave the station and then don’t get back for six hours,” said Keyser. No sooner do the words leave his mouth than an alarm sounds on the overhead speaker alerting personnel to a rescue call. Keyser and Bossman clamber aboard the squad, fire up its engine, roll out of the garage and tear onto rush hour-choked Ames Avenue. With Keyser manning the wheel and Bossman the radio, a 911 dispatcher relays the nature of the call. “Medic Unit 21, there’s a 90 year-female with difficulty breathing…a neighbor became concerned when she didn’t her from her…called police…the female was found on the floor…apparently fallen…police are on the scene.”

Lady in Distress
Less than 10 minutes elapse from the time the call is received to the medics’ arrival on the scene. It is a red brick apartment house at 52nd and Northwest Street. Police cruisers and a fire engine are already there. Curious neighbors and onlookers gather on the small porch or watch from the street corner as Keyser and Bossman stride into the residence carrying an arsenal of emergency medical supplies, including a portable heart monitor/defibrillator and a case filled with meds, IVs, airway supports, bandages, slings, etc.

Police deny access to a reporter along for the ride, citing the tight quarters. The officer guarding the front door, Juan Fortier, describes the situation while Keyser and Bossman treat the elderly patient inside. “A friend hadn’t heard from the resident since Tuesday night at 8. She came by, hollered for her and got no response. She tried entering, but the inside chain was locked. So she called us. We came, we assessed the situation, notified our supervisors what we had and we decided to go ahead and force the lock open. We got inside and the 90 year-old resident was lying on her back on the floor next to her bed with one leg kind of folded up under her. She was still conscious but somewhat discombobulated. She had obviously been there awhile. We just tried to comfort her with our voice and let her know help was here,” he said. Police and rescue squads respond to several such calls each week. Most turn out fine.

Minutes later, firefighters hustle to fetch a backboard and gurney and soon are carrying the patient out on the stretcher, a bag valve mask applied to her mouth, and secure her in place on the squad. With the patient, Olive, designated a CODE 3 (critical condition) Keyser and Bossman tend to her in back while a firefighter takes the wheel. It turns out Olive lives alone and has no family in state. The only prescribed medication found is for some unknown cardiac condition. In cases like this, when a patient cannot provide answers and there is no family member to consult, medics lack basic information to complete a patient history.

Teamwork
“A big part of our job is information gathering,” Keyser said. “Our first job is to assess the patient and determine if there’s a life threatening situation. Then, the most important thing is to find out the history of what brought this person to require our care. We try to get as much of the history as we can for the doctors.”

 

 

 

Firefighters often reach a scene first and provide care up to their level of training. Once medics arrive to take over, firefighters remain to assist — providing extra sets of hands and eyes. This team concept is at the heart of EMS. “Most of us have worked together for a long time and everybody knows what needs to be done,” Keyser said. “Firefighters will get a stretcher or set-up an IV or get oxygen going. If we don’t see it being done, we’ll ask for it.” Bossman added, “The firefighters we work with are real good about helping out. They’ll jump in and do whatever needs to be done.” Love said having EMT-qualified firefighters on-site is essential to the continuum of care that extends from pre-hospital settings to the ER. “The important thing about having EMTs on the fire trucks is that not only do they get there quickly, but they take base-line vitals which give the paramedics something to compare with when they take their vitals. It gives us another indication as to whether the patient is getting better, getting worse or staying the same.”

In critical or trauma scenarios, time is everything. “We’re always racing the clock,” Love said. “Our goal is to get somebody to the patient’s side with at least basic level training within 5 minutes and to get someone there with advanced training within 8 to 11 minutes. We try to reach those goals at least 90 percent of the time.” According to Keyser, “Depending on how critically injured that patient is, their best survivability is if they can be treated in the ER within an hour of their injury. It’s called the Golden Hour. We try to get everything done we can in 10 minutes before the patient is loaded on the squad and we’re on the road to the nearest trauma center. We’ll do everything else en route.”

In Dr. Joseph Stothert’s view, “For about 90 percent of the patients paramedics see, their care is absolutely vital and life-saving, including persons in or near cardiac arrest and persons involved in (serious) motor vehicle accidents. Now that there is a defibrillator on every fire and rescue apparatus, there’s been a steady increase of patients we’ve been able to resuscitate earlier.”

With Olive in tow, Medic 21 speeds to the nearest hospital, Immanuel Medical Center, as Keyser radios her condition: “We’ve got a 90-year-old female who has been down apparently since…” During the bump-and-grind ride Olive is dimly conscious. She cannot speak, responding to questions with only her tired eyes or feeble nods of her head. “Can you point for me where it hurts?” Keyser asks. “Olive? Olive, we’re going to give you some nitro on your tongue. Your lungs are full of water. I want you to lift your tongue up for me. There you go. Good girl. Here it comes. Open wide.” Olive weakly responds. Her mottled face is splayed by vomit and pinched in pain. Her eyes close. She is barefoot. Totally vulnerable. Her vital signs are continually taken and any abrupt changes noted. All the while, Bossman comforts Olive by holding her hand and applying pressure to a bag valve mask over her mouth, timing her squeezes in concert with the patient’s inhalation.

“For the short amount of time you’re with patients you just want to try to do something positive. Sometimes, that’s nothing more than holding their hand and talking to them while you’re riding to the hospital,” Love said.

Keyser tries getting Olive to respond again (“Olive, we’re going to help breathe for you, okay? Olive, can you open your eyes again?”), but she has fallen unconscious. The medics scramble to intubate her with a breathing tube and suction out excess fluid clogging her airway. Amid the cramped space the medics handle equipment and perform procedures in a kind of choreographed dance. They anticipate each other’s moves well. Few words need to be spoken. They work with calm precision and dispatch, forming what Love likes to call “a fine-tuned patient care machine.”

Later, after delivering Olive to the ER, Bossman recaps the run. “She had fallen out of her bed and was on the floor since Tuesday night. She was already dehydrated. She’d been vomiting and had it in her mouth and in her lungs. That caused her to choke and quit breathing. It could have been real bad. If her neighbor hadn’t checked on her and called the police she could have choked to death. She got a little bit worse en route. She quit responding, although her vital signs stayed pretty good. We intubated her to clear her airway. She’s actually pretty stable now. Her airway’s secure. She’s getting plenty of oxygen. They’re going to x-ray her to make sure she didn’t injure her back when she fell.”

Breathing difficulty is a call medics often respond to and make a life-saving difference in. “Outside of critical emergencies, the assessment and treatment of airway problems is where they tend to help people the most, such as people with asthma or people with chronic airway diseases,” Dr. Stothert said. Medics also routinely help diabetic reactive patients make dramatic turnarounds.

Heeding the Call Again
After its crew restocks supplies and completes paperwork in the ER, Medic 21 no sooner pulls out of Immanuel when a new call presses them back into service. It is a  new mother seized by severe back pain. The squad heads east and in no time at all reaches the wood frame residence near 46th and Bedford, where a fire engine crew is present. The petite patient, Sandy Dace, sits in a kitchen chair doubled-over in a spasm of pain. Her tall bearded husband Dennis stands over her, holding their red and wrinkled 5-day old baby boy in his arms. At the bottom of a staircase a boy of perhaps 8 peers with wide-eyed wonder and fear at the rescuers tramping in and out. It turns out Sandy underwent a prolonged labor marked by acute contractions, before a Caesarean section was performed. It is thought her pain is related to the childbirth.

“I got up to go to the bathroom when I heard Sandy crying. I found her just like that. She couldn’t get up. And with him (the baby) here, I had to call somebody. It was maybe 40 seconds before I heard the sirens. It was great when you showed up. You guys are excellent,” Dennis tells the medics. As he follows his wife to the door, he says, “I’ll be up at St. Joe’s as soon as your mom gets here. Okay, dear?” “Okay,” she replies through clenched teeth.

En route to St. Joseph Hospital Sandy grimaces with each jolt during the shake-rattle-and-roll run. She tightly clutches the handles at the side of the gurney to brace herself. “It’s kind of a bumpy ride, so we’ll take it easy on the way there,” Bossman tells her, but while the ride proceeds at a slower than normal pace it is just as jarring as ever. Dace remains stoic, only uttering a sound when answering Bossman, who tries taking her mind off her discomfort with easy chatter.

Built on an unforgiving truck frame, rescue squads are notoriously noisy clatter-traps that ride like bucking broncos. Many have been in service for a decade or more. It is not unusual for odometers to read 100,000 plus-miles. And those are hard, stop-and-go miles. Units often break down with a wide array of mechanical problems, forcing even older, less reliable reserve units into service. “Our rescue squads are on their last legs,” is how one paramedic put it. With so much wear-and-tear, it is no surprise then that perhaps the number one complaint by customers is that “the ride is terrible,” said Love. Squads are nicknamed “puke boxes.” Three brand new units were purchased recently (for $117,000 each) and their increased size and smoother ride makes medics stuck with older models rather envious.

 

 

 

 

The squad transports Sandy Dace to the ER just before 7 p.m. and by the time Keyser brings the empty gurney back out, a LifeNet helicopter lands to stretcher-in a middle-aged patient critically injured in an industrial accident. As for Dace, she is logged in as a CODE 1, which signifies no real medical emergency and no treatment performed in the field. She simply gets a check-up in the ER.

Stories from the Frontlines
On the way back to the station, the medics make a fuel stop at a City of Omaha depot where broken-down cruisers, squads, rigs and plows are warehoused for repairs and spare parts in what is known as “the boneyards.” Life at “21s” or any firehouse is a communal thing. Except for captains, who rate their own rooms, everyone, men and women, share spartan dormitory-style sleeping quarters. It is a high testosterone environment. We’re talking big men wielding axes and saws and handling mammoth rigs.

As the lone female (one of 20 among 600-plus fire division field personnel) Bossman is still something of a curiosity. While a Clint Eastwood pic plays on a big screen TV in the rec room, she explains how it takes a certain kind of woman to thrive there. “If you’re the type who gets real upset at a crude joke, you’re not going to last very long. You can’t be overly sensitive to those things. You just have to go with the flow.” She said when she started she was subject to a “feeling out” process that closely scrutinized her ability to handle the job and to be, “one of the boys,” in effect. “Once they saw I was okay with their cracks and I could pull my own weight, then there was no problem.”

Down time is variously spent doing paperwork (a detailed record of every run must be logged in a book and on the computer), washing down or cleaning out rigs, rapping with the guys, grabbing a bite to eat, zoning out in front of the TV or catching some Zs. When a visitor asks Keyser, Bossman and Love to share some stories from the frontlines, they gladly oblige. Like other EMS professionals, they say the toughest cases usually involve children.

“I remember the first SIDS (Sudden Infant Death Syndrome) case I ever went on. At the time I was an EMTI with a little baby of my own, so it really kind of hit me hard,” Keyser said. Bossman recalls a CODE 99 (CPR in progress) case. “What was thought to have been a SIDS baby was revived but it never regained consciousness. It later turned out to be a shaken baby. That had an impact on me because in the ER I was comforting the mother and father and, later, when I found out it was (allegedly) the parents that had done this to the baby, it really bothered me,” she said.

Suicide runs are hard to forget. “You go there and, of course, there’s nothing you can do. You call the police and while you’re waiting you see pictures on the wall of family and friends. It hits home that this was a human being that had a life. It gets you thinking, What got them to the point they felt they had to do what they did? Those are the ones that really stick with me.” Love said.

Bossman said a disturbing run she and Keyser made was to the residence of a man with critical pulmonary edema. “It appeared to be treatable when we first got there,” she said. “At his house he was talking to us, but then he went downhill real fast in the squad. And at the hospital, despite everyone’s best efforts, he died. Sometimes, despite a perfect treatment, the patient may still not make it. It can change at any time. That affects you because you see this person getting worse and worse, and you want to help them, but you can’t…Over time, I guess you just learn that regardless of what you do the outcome is sometimes out of your control. It’s kind of hard.”

“Bad runs” of this sort often prompt a Critical Incident Stress Debriefing or CISD, an informal talk therapy session for every EMS staffer at the scene. The fire division’s chaplain, Rev.. Chuck Swanson, leads the sessions. Select cases are also chosen for run reviews, where crews and supervisors analyze what went right and wrong.

Ready for Anything
At 8:50 that August night, the crew’s brief R & R respite is interrupted by another call. A young woman has dislocated a shoulder fending off an assailant near 24th and Camden Avenue. She screams in agony, “Oh my God. It hurts. Oh my God.” The police are there sorting out the incident. “They’re are always a welcome sight to us,” Keyser said. The patient, tears streaking her face, screams all the way to Immanuel. This is the first in a series of four straight runs Keyser and Bossman make that evening. Next, it is a young asthmatic, Reggie, with difficulty breathing. He’s tried his inhaler, but it’s brought no relief.

The medics arrive at his house and find a scared little boy struggling for breath. They administer Albuterol with oxygen. He breathes easier but a trip to the ER is advisable. Aboard the squad an IV is started. The medics calm the boy down, assuring him how brave he is. Calming kids is “half the battle,” say the medics. When Keyser asks “Have you ever ridden in an ambulance before?” Reggie replies, “Yeah,” and reminds them they treated him once before — for bruised ribs. On the way to Immanuel a much-improved Reggie points out the rear squad window, shouting, “There’s my mom,” waving to her following closely behind in the family van. Upon arrival at the ER a relieved Reggie announces, “I can actually talk now.”

The last two runs are routine. A woman complains of a host of problems, including difficulty breathing. She is quickly stabilized with oxygen, yet continues acting distressed. Her husband explains, “She gets like this when she’s upset.” It seems the couple had been arguing. The patient declines a trip to the ER. Later, Keyser attributes her symptoms to anxiety, which he said can mimic many medical conditions. Then it’s off to an assault call only two blocks from the Medic 21 home base. Police surround the victim lying in the middle of Ames Avenue. The intoxicated man has been beaten about the face by two or three assailants and has  suffered cuts and bruises. Keyser and Bossman dress his wounds and take him to University Hospital. He smells of alcohol, sweat and blood.

By the end of the run it is around midnight and the medics are ready for a break. “When you’re super busy or you’re up many times over the course of the night you’re sleep deprived,” Bossman said, “and that just makes your reaction time slower. You have to think longer and harder about decisions that during the day might come real quick. That’s when it’s helpful to have a good partner. You work together and figure things out.” When a call awakens crews from a sound night’s sleep it is not uncommon, Keyser said, for hazy mates to slam into doors or each other amid the darkness and the mad dash that ensues to reach a rig or squad.

The wee hours find medics intersecting a surreal scene of crowds hanging out in parking lots or cruising the jammed streets. “It’s a different world down here at night,” Keyser said. “Once, we saw a family pushing a baby in a stroller at 2:30 in the morning.” Added Bossman, “It’s odd. There’s bumper-to-bumper traffic. We somewhat gauge how busy our night is going to be by how many people are out.” At time like these the intrepid medics are urban explorers in search of their next adventure. “It’s always something different,” she said. “Part of being a professional is being ready for anything.”

Lauro play “A Piece of My Heart” dramatizes role of women in war zones

May 19, 2010 11 comments

Vietnam Women's Memorial

Image by cliff1066™ via Flickr

This is a story I did about a play whose subject matter brought me into contact with some women who fulfilled various capacities during wartime service, whether as nurses or USO performers.  The women I interviewed are sort of the real-life equivalents of some of the characters in the play.

The story originally appeared in The Reader (www.thereader.com), and I hope you find the words of the women, fictional and nonfictional alike, as gripping as I did.

 

Lauro play “A Piece of My Heart” dramatizes role of women in war zones

©by Leo Adam Biga

Originally appeared in The Reader (www.thereader.com)

 

As U.S. military action in Iraq unfolds, old war stories take on new capital. With women now on the front lines, their wartime roles gain added import. While their presence on the battlefield is new, American women have participated on the sidelines of war — as nurses, clerks, reporters, missionaries, performers — for generations, only their legacy seems lost in the heat of combat.

But since the 1993 dedication of the Vietnam Women’s Memorial in Washington D.C., a bronze sculpture by artist Glenna Goodacre of three fatigue-wearing females comforting an injured soldier, women have begun writing and talking about their wartime service as never before, the fruits of which can be seen in the acclaimed play, A Piece of My Heart, running now through April 27 at the Blue Barn Theatre.

Playwright Shirley Lauro based the characters of her impressionistic drama on interviews with real-life veterans, including those profiled in a book of the same name by Keith Walker. Lauro uses fast-moving vignettes to tell the larger story of American women in Vietnam. The six women characters represent varied backgrounds, roles and attitudes. There are military nurses, from stalwart Martha to sweet young Sissy to flower child Leeann. There’s the aristocratic Red Cross “donut dolly” Whitney. There’s the hard-ass intelligence officer Steele. And the playful, soulful USO trouper MaryJo. Whether sewing sutures, spreading cheer or performing on stage, they are angels of mercy for soldiers trapped in a hellish quagmire.

The women cope with laughter, tears, booze, pot. Some erect “the wall.” Others fool around. The nurses regret not knowing what happens to the boys whose bodies they patch up and spirits they boost. They fear no matter how many lives they save or how many smiles they elicit, they never do enough. Then, when their wartime service is over, they return home as forgotten as their G.I. brothers, wanting to put the war behind them but finding they can’t.

 

 

 

 

Even though each character tells her own story, they really all speak in one voice about the shared female experience of being thrust into the surreal, carnage of war. Regardless of where they hailed from or did their tour or what job they held or beliefs they espoused, they were all volunteers who elected to go there.

“The common ground we had, which is why I felt so strongly about honoring these women, was that not a single one of us had to be there,” said Diane Carlson Evans, a veteran in-country Army nurse who spearheaded the creation of the women’s memorial. “We were not drafted. We were not conscripted. Nobody put a gun to our head and said, Go to Vietnam and do your duty. We could have stayed home, got our master’s degree, had our kids, played golf and tennis and had a good life. But every one of us — Red Cross, military, USO — said, I want to do my part, and did during a very unpopular war. We didn’t have a lot of support from home, from peers or from our country…We just thought it was the right thing to do.”

Evans, who made remarks before the Blue Barn’s April 5 show, used her appearance to givr tribute to “the diverse contributions women made” in the war. “I am proud of the women I worked with and how hard I saw them work and how they asked for nothing in return. It was always, Do I need to give blood? Or, Can I work an extra shift? It was that always going above and beyond and never complaining because we had a job to do. I saw how these women saved lives at the risk of their own. And I just believe so strongly they deserve credit from a grateful nation. A grateful nation that needs to acknowledge they participated in a really extraordinary way.”

The story of women’s wartime service is, for many of us, unknown. “I’m just so glad this story’s being told because I lived through Vietnam and I didn’t hear nothing about the nurses…not a thing,” said Omaha actress Phyllis Mitchell-Butler, who portrays Steele. “The nurses went through as much as any of the soldiers. They saw the devastation first-hand. I’m just amazed how long they kept themselves together with all that inside them. All they had was what was inside and they had to keep that. They couldn’t let it go.”

In her role as state commander of the Nebraska Council of Vietnam Veterans of America, Dottie Barickman, who served at Offutt Air Force Base in the Vietnam era, has come to appreciate what women did in that war.

“I’ve never walked in their shoes, but I’ve heard their stories and I understand what they mean when they say they sacrificed their youth and their emotions. They were the nurturing ones for a lot of young boys hurting over there. Combat soldiers always mention to me that if they ever saw a nurse it was like Welcome Home, and that is what these women were…a touch of home that took them away from that war zone for a few hours.”

The stories in A Piece of My Heart echo those of thousands of women that served in Nam or nearby environs. Diane Carlson Evans is one of them.

“I was 21…right out of college…and I was assigned first to the 36th Evacuation Hospital in a beautiful place (Vung Tau) right on the South China Sea beach. I didn’t feel the war there as much as I did when I was transferred up north…to Pleiku, in the central highlands jungle near the Cambodian border,” Evans said.  “I was with Two Corps supporting the 4th Infantry Division (in the 71st Evacuation Hospital).

“The war was very different there. It was the spring of ‘69…a pretty bad time. The 4th Infantry had something like a 75 percent casualty rate. I was made head nurse in a post-surgical unit where the patients were very sick. We had them on respirators and blood transfusions and chest tubes. It was very hard to see so many young men with such horrific wounds. We had to deal with patients dying on us and, in triage, we had to deal with setting aside dying patients to attend to the most salvageable ones. We blamed ourselves. We carried the guilt. And we were young…and so on our little time off we filled our days in human ways, whether it was playing volleyball or getting drunk or doing drugs or going on dates or falling in love.”

 

 

 

Playwright Shirley Lauro

 

 

In addition to the stress of dealing with crushing trauma patient loads, the threat of death was ever near. “Pleiku was not a safe area. We were under attack many times. We got to know the difference between the outgoing artillery and the incoming rockets and mortars that would fly in and hit our hospital, sending shrapnel everywhere. We were not only worrying about our patients — we had concern for our own safety,” said Evans, a Helena, Montana resident.

Since getting the Vietnam women’s memorial installed, Evans, whose efforts to make it a reality took 10 years, has become THE champion for female volunteers in that conflict, focusing her efforts on “encouraging women who served to share their stories…so we can understand what the memorial is all about.”

She helped start a storytelling program at the memorial site and on the web that invites women to speak their piece. She said telling it like it was is “very painful. It takes a lot of courage for women to admit how scared they were some young soldier was going to die on their watch or how they were so tired they could have made a mistake or how they were sexually assaulted or harassed. All of this anger and anguish comes out in the play.”

An admirer of the Lauro work, which had its debut in Philadelphia and has been performed across the country, Evans feels it gets to the heart of women’s Vietnam odyssey. “It does not show our service through rose-colored glasses — that we were all these heroic young women who went off to save the world and wore white halos — but instead it shows we were young women who went to Vietnam and did the very best we could amid all this crazy stuff going on. That’s what makes it very real, very authentic.”

As the war in Iraq rages on the director of the Blue Barn show, Susan Clement-Toberer, feels the conflict lends the play added urgency.

“Knowing that it’s happening now it brings it all very close and deepens everything we’re doing,” she said. “It’s real, just like the stories of these women are all real…taken from a myriad of interviews with different women.”

Cast member Erika Hall, who plays the USO entertainer, said, “You know, before it was important to do this piece, and now like it’s necessary.” Most of the cast and crew are too young to remember the war and therefore have immersed themselves in it via books, articles and tapes and by talking to actual veterans.

“What an interesting learning experience this is for me,” Hall said. “I was born after Vietnam and, you know, you read about it in school but you don’t really understand what they (vets) went through.” In her own research Clement-Toberer said she was surprised to learn “the extremes the women survived. I knew Vietnam was a dirty war, but I just didn’t realize they (the women) saw such extremes so quickly. I understand now why these women went and what they mean by honor…they believed in their country. It’s just a very strong feeling in what is right and what is true and what needs to be told.”

The characters have real-life counterparts in Nebraska. Lincolnite Judy Knopp, a former Army nurse at Camp Zama, Japan, treated G.I.s choppered in from Vietnam; Martel native and longtime Lincoln resident Brenda Allacher toured Nam as a member of the all-girl country-western band The Taylor Sisters; and Marie Menke of Superior, Neb. was a fellow Army nurse with Diane Evans at the 36th evac in Vung Tau, regarded as an in-country R & R site except for the grueling recovery and care that went on there. For vets like these, Vietnam seared into their memories and hearts the best and worst of humanity.

“I joined the Army nurse corps and in six weeks did my basic training at Fort Sam Houston and went straight to Japan…Camp Zama, 35 minutes southeast of Tokyo and an hour by chopper from Saigon. I was charge nurse in the orthopedic ward of a 1,000 bed hospital,” Knopp said. “Back then, we had to make our own IVs and pump our own blood and everything. After the Tet Offensive we were working 12 hour shifts, seven days a week. They used to call us the zombie squad. We didn’t even eat. We went home and slept…then came back. We’d have 30 to 40 evacs a day…20 to 30 surgeries a day, just on my ward. One-half of our cases were dirty wounds…shrapnel wounds or single and multiple amputees. Guys with half their faces blown off. One young man I especially remember…Billy. He was 18. He’d stepped on a land mine and everything was gone from the belly button on down. He was unconscious. We were pumping him full of blood. You wanted to save him but…you wanted him to go, too, because there was no way he could live.

 

 

Brenda Cover (reduced)

Brenda Allacher

 

“The guys, they were so young. They used to call me grandma and I was 22. They were all like little brothers. We used to stay up with the guys at night who were crying over having killed women and children. They had a real hard time dealing with what went on over there and the stuff they had to do to survive. A lot of ‘em came back injured and a lot of ‘em we never saw again. We never knew what happened to ‘em. The ones going back to the states we’d iron their uniforms, sew on their patches and go to the chopper to kiss ‘em goodbye. I have very fond memories of the guys and just atrocious memories of the wounds.”

She still regrets how, when her ward was busy, “there was no time for dignity with death…to get patients prepared and stay with ‘em and see ‘em through it. It was like, OK, this one’s dead, clean out the bed…there’s another one coming in.”

A Piece of My Heart cast members marvel at what women like Knopp endured at such a tender age. “They all have stories of their first day…just like in the play where my character takes off a soldier’s boot and his severed foot is in it,” Christine Schwery said. “They were so fragile and so young and yet they survived,” Julie Huff said. “With a lot of alcohol and a lot of drugs,” Schwery chimed in. “Yeah, but they survived and they saved a lot of lives,” Huff added.

Riverdale, Neb. native Marie Menke, then Daake, was a 22-year-old nursing school grad when she got to Nam. Nothing could prepare her for what she saw:

“I was pretty naive about the war. It was very shocking to most of us to see the kinds of wounds and the tragic loss of life,” she said. “It just shouldn’t be. My thoughts about the war didn’t matter because we were there and people were getting hurt and we had an enormous job to do. We were tremendously needed. It was beyond comprehension almost. The nurses did do a lot but most of us downplayed it. We were just there to do our job and to take care of patients and to support them.”

Besides caring for American G.I.s, nurses treated Vietmanese, including children.

An estimated 265,000 American women service in support of the war. U.S. Army estimates place the number in-country  between 10,000 and 12,000. Most were nurses, either Army or Marine enlistees or even civilians attached to field hospitals or more rear echelon units. American Red Cross volunteers were so-called “donut dollies” — a sort of comfort girl corps boosting morale with their short-skirts, smiles and care packages. Others were entertainers touring under the auspices of the USO or, like Brenda Allacher, as contract entertainers via private booking agencies that provided minimal security and scant creature comforts.

 

 

Blue Barn Theatre’s Susan Clement Toberer

 

Allacher, then known by her stage name Brenda Allen, got to see a lot of Nam during her three-and-half month tour in ‘69. She has bittersweet memories of her time in Chu Lai, a central coastal area manned by the Americal Division:

“That was one of our favorite places because we had privacy taking a shower. I remember the commanding officer, ‘Big Daddy’ Richardson, said, ‘I’m going to work your butts off, but when you come back at night your favorite food and drink will be sitting in front of you.’ And it was, too. Lobster and blackberry brandy and Cutty Sark scotch. We’d do five and six shows a day for that man,” she said. “The men, they just wouldn’t let us quit and we weren’t about to leave those boys. The guys were just absolutely beautiful. They called me ‘Crazy Legs’…I’d do wild dancing and kick my legs up. They just went bonkers.

“We’d come back exhausted. One night, we’d come back from a show and a few of us were in the officers club drinking when there was a loud CLAP and the building just shook. A G. grabbed me and threw me down under the bar.” It was the start of a prolonged mortar attack. “We took 16 rounds over a period of four or five hours. We just laid there on the floor and got drunk. I was so scared. Around daylight a young man came running in, shouting, ‘They got a nurse at the 312 Surg-Evac,’ which was like a block away.”

The victim, 1st Lt. army nurse Sharon Ann Lane of Canton, Ohio, was the first Army nurse to die under hostile fire in Southeast Asia and one of 68 American women in all — military and civilian — to die in the conflict. The incident shook Allacher to her core.

“What really gets me is it very easily could have been me, and not her.” she said. She recalls happier times there, too, like when the Taylor Sisters did an impromptu show for Nebraska National Guard troops, leading off with “There’s No Place Like Nebraska.” “The tin roof went off on that quonset hut. They just went nuts.” Or when she was secreted away to give a private performance for some special ops forces who, upon her finishing, “lined up and saluted me” she said tearfully. “As I was walking out, the commanding officer placed his Green Beret on my head.” She still has it. “I wouldn’t trade those experiences for anything.”

Allacher and Knopp have made the recognition of women’s work in Vietnam a personal mission. Together eith Evans they are featured in a NETV documentary, Not On the Frontline, that follows their story from the wartime service they rendered to the emotional “culmination” of seeing the women’s memorial dedicated, something Knopp worked for as state coordinator of the project. More recently, Allacher, who describes herself as “a straight shooter…full of piss and vinegar,” was instrumental in bringing A Piece of My Heart to the attention of local theaters. She and her big booming laugh have become fixtures at the Blue Barn.

For Allacher, Knopp and Evans, the stories told in the play and documentary are part of the healing that’s taken place after the war. Acceptance of women’s service has come slowly, even as they have died alongside their veteran brothers from Agent Orange-related illnesses and have suffered from post-traumatic stress disorder.

Evans said there was once resistance to honoring women’s war record because “I don’t think people wanted to look at women as warriors — as soldiers. But women are soldiers, too. We fought just as hard as the men. We just fought with different instruments.” Or, as Judy Knopp puts it, “The guys were on the physical front lines, but we were on the psychological front lines trying to hold it all together. And we did it with a loving heart.”

Seafarer Doug Hiner and His Cuban Medical Supply Runs

May 11, 2010 3 comments

Sailboat in San Francisco Bay

Image via Wikipedia

A couple acquaintances introduced me to Doug Hiner and he immediately got on my radar as someone I’d like to profile when I learned he regularly sailed down to Cuba on missions that were partly about delivering medical supplies and partly about secreting back contraband, as in cigars.  Hiner is a wheeler-dealer type who denied the illegal trafficking at the time I interviewed him, then expressing upset at my story’s suggestion that he engaged in anything like that, but subsequent events confirmed his smuggling activity because he got caught in the act down in Florida and faced serious federal charges.  He pleaded guilty to one count and received 36 months probation.

Aside from the intrigue, which occurred after my story appeared, his story is really a classic tale about his taste for adventure and his passion for all things Cuban.  A version of the following story appeared in The Reader (www.thereader.com).

Seafarer Doug Hiner and His Cuban Medical Supply Runs

©by Leo Adam Biga

A version of this story appeared in The Reader (www.thereader.com)

More than any other country, Cuba both seduces and vexes Americans. This island of paradoxes is at once a natural paradise fulfilled and a socialist promise unrealized. In a place where bare necessities do not go for want, chronic shortages make hustlers out of peasant and professional alike. Within a closed society and controlled economy, anything, for a price, is a black market possibility.

Fidel Castro may or may not own Cubans’ hearts and minds, but the land and culture definitely hold residents and exiles transfixed.

Social/economic problems don’t change the fact that Cuba, at least geographically, is a tropical island idyll. Sun, ocean, jungle, mountains — much of it pristine. Politicians/bureaucrats aside, the people embrace life with a live-and-let-live Latino insouciance. Music, dance, food, art, love, sun, surf. Fun prevails, if not for all, for tourists.

Omahan Doug Hiner sees the schizoid nature of Cuba every time he sails there on his 53-foot cutter, the Vitamin Sea. He captains the Tampa-docked boat on voyages that transport medical equipment to hospitals and clinics on the island. He’s been making runs like this to Cuba for seven years, a period when official American policy toward that intransigent Caribbean nation has gone from rigid to ultra hard-line. Embargoes of one kind or another have limited trade with Cuba and, in some cases, denied aid.

 

 

Doug Hiner

 

 

 

With Fidel’s recent stomach surgery making his mortality and his grip on power a renewed subject of world interest, Hiner prepared for a late December sail to bring in another boatload of supplies. But the gringo’s boat blew an engine, pushing the trip back until this month. He arrived February 10 in Havana, where the gear still sits, waiting for the red tape to be cut so he can move stuff inland.

His artist wife, Christina Narwicz, usually joins him on these maritime adventures but she wasn’t feeling up to it when he shoved off this time around.

The Man and the Sea
Hiner, 67, is a former hair dresser and a retired real estate developer and landlord. He made and lost a fortune. He’s not oblivious to the political realities that hold Cuba hostage in a state of suspended animation. Far from it. He has strong views on what Cuba and its paternalistic neighbor to the north should do to ease restrictions and tensions. His awareness of Cuban medical needs drives his missionary trips there, even as he brings in and takes back his share of contraband.

His journeys go well beyond idol curiosity. Hiner and his wife feel they have a fair handle on Cuba by virtue of not only having traveled there several times — it’s 15 trips and counting for him and about the same for her — but their stays usually last weeks or months at a time. They get around to different parts of the island and really immerse themselves in the place.

“We’re not tourists, we’re travelers,” Hiner said. “A tourist wants to have MacDonald’s no matter where he’s at. We like to enjoy the cultures of different countries and not live like Americans. We try to blend and be friendly with the people, and that’s all it really takes to be accepted. They love Americans, especially if you’re friendly to them. They don’t like the ugly-American types.”

Whatever motivates him, he ultimately makes these journeys because they put him in touch with three of his favorite things — sailing, the sea and people.

Though he grew up in landlocked South Dakota and Nebraska, Hiner long ago felt the call of the open sea.

“I’ve always been fascinated by the sea,” he said, “and I’ve always had this dream of having a boat to sail around the world.”

Years ago he and Christina “were planning to do a sail around the world …” when his “business fortunes changed,” making such a trip “impractical.” Circumnavigating the globe is not such a passion now, not with the expanse of warm southern waters to explore. “You can spend your whole life in an area like that and never see everything,” he said. “The Caribbean is a whole chain of islands. We’ve never been to Colombia or Central America, so eventually I’d like to do that.”

Besides, it’s the carefree, unrestricted, port-of-call lifestyle he enjoys, more than the challenge of seeing how far Hiner can push his sailing skills.

“A boat is like your home. You’ve got everything on it. You’re totally self-sustaining … It’s a real nice feeling,” he said. “You can anchor anywhere you want for nothing. We spent a couple New Years Eve’s anchored off of Key West, one of the liveliest New Years places in the world.”

Still, the allure of cruising wave and wind is like the call of the sirens — hard to resist. Half the challenge is dealing with weather and the other half comes with the inevitable mishaps.

“Weather on the high seas — that’s your biggest danger,” Hiner said. “We’ve gone through some pretty turbulent stuff, some accidentally, some on purpose because we had to. But it’s never been a safety issue. You’re never really out of ear shot of weather” reports via radio/radar.

Nature-related or not, things do go wrong. Take the couple’s 1999 trip to Cuba for instance.

“Going down on the second trip we blew out the sail. We ran into some bad weather. We had to have it repaired. It’s usually mechanical problems. It’s like, not if it’s going to break, but when it’s going to break. The last time we left Cuba the autopilot failed and we had to hand steer for 40 hours. Oh, and coming back from Cuba once we lost our fresh water pump, so we had no engine. There was no wind and we drifted for a day-and-a-half or two days before we finally got close enough to Key West to get a boat to tow us in.

“Our boat is about 20 years old and it needs extensive rewiring and stuff and I really haven’t been able to afford that, so we just kind of patch things together. It’s safe but it’s always a little bit of an adventure.”

Sea-faring is an apt avocation for an inveterate beach bum who, whether inland or coastal, enjoys kicking it with friends over drinks in the Old Market, where he developed some of the first condos, or partying on his boat.

He enjoys the simple, well-done pleasures of good food, good drink and good company. His wife’s the same. The residence they fashioned from an old brick-faced bar and parking lot on South 13th Street reflect their shared interests. The grounds’ richly decorated Great Wall that fronts 13th Street has a gated entry whose mammoth door opens onto a large courtyard filled with her plantings.

Hiner’s no stranger to graceful living, as he once owned a Fairacres mansion “back,” as he likes to say, “when I was rich and famous.” He made big bucks and moved in tony circles in the ’70s and ’80s. Then it all crashed. He alludes to a business partner running his development company into the ground.

The house, featured in the Spring 2000 edition of Renovation Style magazine, is designed with walkouts along the length of the courtyard that connect to a wood deck, creating a veranda. The interior opens up to a loft master bedroom and guest quarters, revealing a 32-foot-high ceiling and a bank of large windows that stream light in. At one end of the property is a screened-in porch. At the back of the lot is Christina’s well-lit studio. It all works toward a cozy hacienda feel.

As soon as he laid eyes on the spot he knew “it was exactly what I had in mind.” When he bought the former Glass Front Bar it was only a shell. But, he said, “I had this vision.” He designed the place himself. The work fit neatly into his years of “retrofitting old buildings. I’ve always had a knack for design and style and just living comfortably.” The result, he said, adheres to “the European concept of zero lot lines…where you basically use the whole property. We don’t have a back yard or front yard or side yard — we have a court yard. The same with our house. We utilize the whole house. We don’t have formal spaces. It’s just more practical and creative in my estimation. It’s just a feeling of well-being.”

His passion for this getaway within the city dovetails neatly with his ardor for Cuba. It always comes back to communing with people.

“It’s just a wonderful country. The people are so friendly and so caring and loving,” he said. “It’s hard to explain. I’ve traveled all over the world and I don’t think I’ve ever been to a country that is so warm and safe. There’s virtually no crime in Cuba. It’s true there’s a policeman on almost every corner, but the people there are so law-abiding. They’ll steal, but their attitude is, ‘If you don’t lock your bicycle up with a chain or padlock, then you must not want it.’ I’ve never had anything stolen off my boat in the marina and I can’t say that in almost any other country.”

Years living under the thumb of a dictatorship has its palliative effects.

“If a policeman on the corner points to a driver and signals him to stop,” Hiner said, “he’ll almost come to a panic stop to obey the order. They wouldn’t even think of not [stopping]. A police chase over there would be unheard of.”

Back to the contradictions bound up there, he said Cuba can seem chaste one minute and carnal the next. “It’s a real straight-laced island. Pornography is totally illegal. Drugs — zero tolerance. One marijuana cigarette would throw you in jail for a week before you’d be expelled from the country and told never to come back.” On the other hand, he said, “Cuba’s a very sexually open country. Even though prostitution is illegal…a lot of people are shocked by the young women that are readily available for sexual encounters. One, there’s a serious lack of men on the island. And two, their culture is not uptight about sex at all. I mean, geez, if some foreigner wants to give you twenty bucks, that’s even better.”

Besides, he said, “Cuba’s all extended families — there’s four-five generations that live under the same roof, and so it’s everybody’s responsibility to help support the family group.”

While Cuba prides itself on a system that accounts for citizens’ basic needs, rampant poverty compels most everyone to be on the make.

“You see very little begging, yet the young Cuban kids and the old folks are out hustling for the family,” Hiner said. “Everybody is sort of doing whatever needs to be done to provide extras. They have to have some access to dollars to really have any quality of life.”

Amid all this naked human need, Cuba takes great pains to put on a good face. “They sweep each block of Havana every day. If you don’t have anything to do, they’ll put a broom in your hands,” he said.

By Western standards, he said, Cubans lack everything we take for granted. He tries to give friends there some creature comforts otherwise unavailable to them.

“I’ve taken personal things down for people, like a microwave oven or VCR or DVD player, because all that stuff is illegal. Everything’s illegal in Cuba. Mainly, if it plugs into the wall, it’s illegal. They have an energy problem and they’re just trying to keep people’s lives basic.”

 

 

Even more basic than that, he said, he brings items like toothbrushes and razor blades that are “not a big deal here, but are a big deal there.”

He’s also brought back, on consignment, works by Cuban artists he and Christina sold in Old Market art shows, the proceeds going toward supplies for the artists.

Beat the Bushes, ‘Bend a Few Rules’
He’s sympathetic to the plight of the Cuban people, whose deprivation goes deeper than a lack of material things, to essential services. Sure, Cuba provides free health care, but many clinics and hospitals lack equipment and technology that can not only improve care but save lives. And while average Cubans and natives of nearby Latin American countries have access to free care, some medical centers are reserved for the elite. It’s why he got involved as a medical supplier in the first place. His awareness began on his inaugural visit to Cuba in 1998. The marina in Havana introduced him to fellow travelers, including many Americans, some of whom became a model.

“I met a lot of people that first time. A lot of just normal people. Some were bringing medical equipment on their boats down there,” he said. He soon discovered an informal network of doctors and suppliers. “As I met people in the marina and friends of theirs I was put in touch with various doctors and got lists of things they needed.”

Over the next year Hiner beat the bushes and made contact with “various organizations” that run aid into Cuba.” He cultivated the names of key suppliers, like Jack Oswald in Chicago, and key recipients, like surgeon Gilberto Fleites in Havana. When Oswald, who works with a group called Caribbean Medical Transport, ran a check on Hiner’s then-fledgling medical mission activities he was duly impressed.

“The medical equipment he gets is a cut above most of the stuff humanitarian aid groups get and I’ve been doing this a long time. His stuff is absolutely flawless,” Oswald said. “I went with him on his last trip because he was packing some really heavy equipment…I came from Chicago to help him figure out a way to put some of this stuff on the boat without it sinking. We put thousands of pounds on the bow…and you no longer could see to navigate…so we had to have somebody at the front of the boat calling instructions out to the captain just to avoid the reefs and boats and weather we came across on our way to Cuba. It got a little adventurous here and there.

“I’ll tell you, the guy’s fearless, he really is. He’s mission-oriented, there’s no question about it. Almost militaristically I might add. He doesn’t really let anything get in his way. Some of the stuff he does is a bit risky. And sometimes he doesn’t have the money, the equipment or even the plan…but he just keeps doing it. I think both sides are willing to let him operate, maybe even bend a few rules here and there…because they know what he’s doing is valuable.”

 

 

Joining Oswald, Hiner and his wife Christina on the voyage was a Cuban American physician who brought medical supplies to a cousin physician in Cuba. The Americans also brought art supplies for an artists collective there. Oswald said of Hiner and Narwicz, “They just know a whole lot of people and they just really enjoy Cuba. The folks I met that know them are like family.”

On Hiner’s first supply run in 2000 he was introduced to Dr. Fleites. “I met Gilberto and his wife Teresa and they were really neat people and we became really close friends and we had a really wonderful time there,Hiner said.

Hiner calls Dr. Fleites “a bit of a renegade. He ran the national cancer institute in Havana. He was on the Cuban ethics board. He tried to get some doctors removed from practice because he thought they were killing more people than they were saving,” Hiner said. “But his superiors kicked him off the board because he wasn’t ‘a team player.’ He still performs surgeries … but only on important people because they know he’s very, very good. He’s sort of like freelance. It’s kind of a bizarre situation.”

The Omahan’s “become sort of an emissary” to Dr. Fleites. “I get lists of stuff from him” the Cuban medical community “needs,” he said, “and come back and hustle my friends. I know a lot of doctors from when I used to be rich and famous.” As Hiner’s refined his networking, tons of things get donated — once, an entire operating suite. Omaha’s Children’s Hospital donated an anesthesia machine. He works with established humanitarian nonprofits that authorize him use of their license for delivering free medical goods abroad. Much of what he takes there goes to Pedro Kouri Institute of Tropical Medicine, an AIDS hospital directed by Dr. Jorge Perez. It’s not an impersonal process for Hiner, who’s visited there and other sites he’s supplied. He’s impressed by Cuba’s “incredible medical system.”

What began as annual trips became twice-a-year voyages. Their last trip, in 2005, they were in Cuba four months.

He’s transported medical gear worth hundreds of thousands of dollars, including mechanical operating tables and surgical instruments ranging from forceps to retractors to endoscopic devices. The goods ship to a central location and, when there’s enough for a full haul, he loads a truck and drives it to his boat in Tampa. After everything is securely stored and lashed aboard, he rigs his boat and sails for Cuba. Once there everything must be checked and approved by customs officials, a process that can take weeks. Various government stamps and seals are needed. From start to end, a single supply mission can take months.

He cuts what red tape he can with “gifts” to marina workers and ministry officials.

For the current trip, he amassed a large inventory that includes an entire delivery room donated by a hospital, complete with delivery table, incubators and monitors. So large is the haul he left half the load in Florida for a return trip next month.

Donations have never been better, but he said navigating the bureaucratic waters to get them to Cuba has become more problematic. He blames the Bush administration for “tightening travel restrictions,” especially since 9/11. He said the feds have made it harder for the nonprofits he works with to obtain or renew licenses. The main clearance he needs is from the U.S. Coast Guard that grants free passage through “an imaginary security zone between Key West and Havana that no one can define.” Without the permit, he said, “they can seize your boat, fine you $250,000 and put you in jail for 10 years.” When things were more “more relaxed,” he could slide by. Not now.

There are also new Commerce Department and Council of Foreign Currency Control approvals needed.

Cuba’s hardly immune from bureaucracy, but the tropics make the paperwork and graft more bearable. Besides, as “well accepted” as Hiner is there, he can play Lord Jim. He hopes a meeting he’s been angling for with Fidel, whom he admires, happens one day. He knows just what he’d say to the dictator. “I would tell him he needs to make more opportunities. The people there are very industrious but he keeps stifling any kind of private enterprise,” Hiner said. “He’s getting old and overly restrictive. I would tell Fidel, ‘You’ve got to loosen up. If you were a young man today you’d start a revolution against yourself.’”

To Cuba with Love
Ironically, Hiner’s romance with Cuba may never have happened if not for an accident. It was late 1998. Doug and Christina were on one of their Caribbean sailing jags and had put into port in Jamaica. There, Christina took a fall and broke her ankle, putting her in a cast. He hired a young Jamaican boy to help him crew. The trio sailed to the Camyan islands, where Christina’s pain worsened. Doug sent her home by plane. That left Doug and the boy. The idea was to make for Florida, but Doug knew the boy would be denied entry without papers.

“So, we decided to go to Mexico,” Hiner said. “I got in big trouble there because, unbeknownst to me, a Jamaican needs a visa to get into Mexico. They almost threw us in jail. I talked my way out of that.”

Next, Hiner set his sights on Key West, but learned that, too, was off-limits. Desperate, he asked officials, “Where can we go?’ ‘Cuba,’ they told him. “So, the next morning off we went to Cuba. That was my first time. We were there almost 10 days before I was able to get a plane to fly him out to Montego Bay. And while in Cuba I just loved the country. When I got back home I told Christina, ‘I loved it so much we need to go back there.’” Go back they did.

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