The Hidden Paramedic

by Angela Self, MD, TCMS President

This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.

I remember working as a medic in New York and New Jersey and loving what I did all day, every day (and many times all night). When I got “the call” to go to med school, I knew that it would be years before I could do anything clinical—at least eight years. My first procedure was at 14 years old at Southern Nevada Memorial Hospital (now University Hospital), when a surgeon let me round with him on a patient and told me to pull the tube straight back. I pulled out a chest tube at 14. Where do you go from there? Well, the day I went back to taking food trays to rooms and getting the nurse when a patient needed their bedpan to be emptied. After high school, I started taking dental x-rays, and I took great x-rays without even using the rings and film holders. I spent those moments in the darkroom praying and soaking in the blessing of the esteemed opportunity that I had been given as an almost dental assistant. Those x-ray skills thrust me into a career in dental and then oral surgical assisting. 

When life brought me back to my home state of Texas, I got my first job as an oral surgical assistant. Dr. Robert Thomas Perry hired me after looking at my résumé, which was handwritten on a 11-by-14-inch sheet of legal paper. Full disclosure, when he asked for my résumé, I did not know what that meant; he explained that it was a list of my experience. I was just about 21 years old by then, so he was an early inspiration for me. We would drive to remote sites to perform oral surgeries and I would read board review material to him for hours and hours as we drove from College Station to Corsicana and Huntsville. I learned so much about oral surgery from these hours of drives, which always included a stop for Blue Bell ice cream. 

Dr. Perry and his wife, a CRNA, were very well liked in the community, though he struggled to establish great referral patterns from the general dentists. While he was away doing his oral surgery training, two other oral surgeons, Garrett and Gray, had set up practice. Their winning personalities and ability to network between Bryan and College Station proved to be a barrier to Dr. Perry getting much business in this good ole boy country. Dr. McElroy did send us patients. Dr. McElroy is known to have left Thanksgiving dinner for an emergency; he even showed up at his office to meet a patient with a severe toothache one Christmas Day. That patient was one of my relatives (I got him on multiple holidays). Dr. Perry had me credentialed at both local hospitals and one in another town. At St. Joe’s in Bryan, I went through a week-long orientation in the OR, watching various cases so that I could assist Dr. Perry there—I knew all of the instruments he used and when he used them. I didn’t just see oral surgeries; I had a front-row seat for everything that was happening in the OR that week. I remember watching a vag hyst (in horror) and then a breast biopsy where they had to go ahead with a mastectomy right then, after the frozen section came back positive. I was a high school graduate dental assistant, and I was in the OR. 

You think it’s difficult to get someone to take a statin? Try telling them you’re going to put a tube down their throat. 

I first started assisting Dr. Perry in the OR when he performed orthognathic surgery that included down-fracturing a maxilla. I was so happy and fulfilled in my work. I had arrived. When the local hospitals stopped using CRNAs in the mid 80s, Dr. Perry had to move his family back to Ohio, where he had trained. Sue, his wife, was actually the breadwinner. Dr. Perry once had a farmer pay him with a side of beef (tractor accident). Another elderly woman paid him by making fabric holders for his surgical instruments. He was not the only oral surgeon that I worked for who depended on the income of their spouse to stay afloat. After crying every day for two weeks over having to leave Dr. Perry due to the imminent practice closure, I moved back to New York, where I had lived right after high school. I went to work for another oral surgeon there and I also joined my volunteer ambulance corps.

I was a trainee at the South Orangetown Ambulance Corps when I took my EMT course and then immediately followed with my medic course, which I studied at White Plains Hospital. I worked in Rockland County with my ambulance corps and in Westchester County as part of my medic class. I remember being in Yonkers, where the medics put on bulletproof vests at the beginning of their shift. I drove around White Plains looking for an address where there was a patient with a GI bleed. The police kept telling me to step it up (the patient was bleeding out from varices). Basic Life Support (BLS) transported the patient before I arrived as I was not familiar with White Plains, having lived in Rockland County and only commuting to Westchester. I remember once, when responding to a cardiac arrest, we found upon our arrival that the husband had coded, too. I had to decide which code we would care for, and which one would have to wait for the second unit to arrive. 

One time I regretted having taken this career path—it was in the moments before arriving on-scene at an accident involving a train. Thank God for my partner, who also worked for NYC EMS at the time. He was a calm and reassuring voice as we worked with the PD to locate the body parts. This was important, because when daylight came there would be parents driving kids to school and the carnage would be seen in the light of day. There was the time that I dropped my partner at a call with the volunteers (we worked as a pair from a fly car, which is used to carry equipment, and would split up as needed). I arrived at a scene where the wife called about her husband, who was unresponsive. I had to speak to the wife in a calm, reassuring way as I dragged her husband by the feet from the foot of the stairs to the middle of the living room floor where I would intubate, put on the monitor, start an IV and work the code until another BLS unit arrived to transport him to Nyack Hospital. An awake intubation on someone in distress from severe congestive heart failure is an exercise in coaching a patient. You think it’s difficult to get someone to take a statin? Try telling them you’re going to put a tube down their throat. 

I knew I wanted to go to med school, but it wasn’t to be in New York, and I didn’t apply anywhere else. While working in White Plains I met fellow medics George Kiss and John Brebbia. They were both students at Saint George’s University School of Medicine. I also knew Dr. Stuart Rasch, an ER doc at Nyack who was an SGU grad. I applied. I got in. I went. I continued to work as a medic per diem during my breaks from school. I worked for several companies at one time—Mamaroneck, Portchester Rye, and Larchmont, which were volunteer agencies with paid medics, and Rockland Paramedic Services and Clifton-Passaic MICU in Passaic, New Jersey. The relationships that I made still endure. The experiences that I had continue to keep the paramedic in me alive. I miss days when I would arrive at the home of an elderly person having an MI or pull up on the scene of an MCI (mass casualty incident). The other day I was talking to a close friend on the phone, and he mentioned in passing that his dad was short of breath. The last time someone mentioned that in passing (in the pulpit at a church), they ended up in the cath lab getting stents the following day. This time it was a friend, and I knew his dad. I calmly asked, “Do your parents mind if I come over?” Though it was late at night, they agreed. I got dressed and went over and did a medic questionnaire and exam which led to an ER visit and hospital stay. Though the family is thankful that I was there, I am even more thankful, because they allowed me the opportunity to remember life when I would wake up and be excited to go to work every day, all day (and many times all night).

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