Chopin’s Piano

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The old city center of Krakow, Poland (Number 2 in my top 3 favorite places in the world) is surrounded by a series of parks. Actually, it is only one park, but it is transected by several major roads. In one of the divisions in a glass display is the wreckage of Chopin’s piano. This artifact was destroyed by Nazi soldiers during the invasion of Poland in WWII.

When I look at this display, I wonder what was going through the minds of the soldiers that did it. Chopin was recognized around the world as one of the greatest musicians of all time. Everyone was listening to and could recognize his music. It was perhaps “the song” of many couples. It put children to sleep (probably some adults too), and people lined up to hear him play his piano.

Those soldiers were in all likelihood not well educated nor cultured. Is that to say all German soldiers at the time were not? Certainly not. After all, it was the soldiers of the German high command that refused to destroy the city of Krakow because of its beauty and artistry. Somebody was smart enough to see the value in it, despite being told it was made by a lesser race. But these were not foot soldiers. They were generals.

A similar situation played out a couple of thousand years prior, when conquering Syracuse, Roman soldiers killed Archimedes, despite orders specifically not to. Perhaps because the soldier thought he was an educated arrogant asshole and he wanted to demonstrate how important a foot soldier really was? Archimedes is an extraordinarily important figure in history and modern medicine. The LVAD device is actually an Archimede’s screw. (which he developed to pump well water)

In all likelihood, these common foot soldiers did not know what they were looking at or what they were doing either. Though they probably believed they were in the right and acting in their best interests.

I started my blog mostly to write what I was thinking about medicine. It’s philosophy, things that could improve it. Parts of it I disagree with and potential solutions. A way to convey my introspections. Some of it was ranting. Simply because I am passionate about what I do, it is the defining factor of my life, and I don’t like to see it done poorly.

It was only by chance I wrote a peace on the failures of EMS providers and their implementation of EBM. I am not sorry for that piece, and I stand by what I said. I approved all the comments for posting, despite them being overwhelmingly negative. Strangely enough, despite these comments, the piece was an overwhelming success. Not only did it drive traffic to my blog beyond anything I could have ever imagined, it actually proved the point I was attempting to make.

In one of the earlier paragraphs, I specifically stated there would be a plethora of people who would vehemently deny the problem because they as individuals had an education. Either they didn’t read, didn’t understand, or somehow doubted my ability to predict a reaction that is no different from what has been happening for decades.

I was particularly entertained to the point of replying of the doctor who doubted I was a doctor because I was disparaging another healthcare provider. Because as we all know, (insert heavy sarcasm) doctors don’t regularly complain about nursing or any other healthcare provider. (I am not saying doctors should complain about nursing, but we would all be foolish to pretend it doesn’t happen.)

“We are part of the team,” was a common thread, more colorfully worded. I haven’t figured out which team yet, I am compelled to think that the water boy is part of the team, but I might supply some intriguing insight to this.

For mental security, most healthcare providers must believe what you are doing is helping. I have forgone mental security because the fact is some patients actually survived in spite of my efforts. You see, I worked on an ambulance when escalating doses of epinephrine was the standard of care. When CPR was stopped for undeterminable lengths in order to start an IV, drop a tube, check for pulses, or push a drug. My competency was judged by my peers on whether or not I could intubate, start an IV, push a tackle box full of medications (including multiple antiarrhythmics) into a patient, and declare them not only dead, but really most sincerely dead. (Be honest, how many of you recognized that from the Wizard of Oz?) Around 2005 we decided that maybe focusing more of quality CPR and less on those “life-saving medications” was important. There is but one logical conclusion, we weren’t helping, we were hurting. But I am ok with that. Why? Because every time I see a patient I promise myself to learn and do better. I spend my off time mostly learning to do better, holding all practices, both former and proposed under unrelenting scrutiny. From the system to the individual, nothing is sacred.

There is another fact US EMS providers overlook. They are not paid for their medical ability, they are paid to drive people to hospitals. If you don’t believe me, ask some of the operations directors about the specifics of billing. Consider why interfacility transport companies exist? Actually the whole US EMS system is purposefully designed with “go to the hospital” as the final pathway. There are some efforts to make an exception to this, but they are in relative infancy compared to other modern nations.

Speaking of which did you know that the requirements to be a paramedic in the US would not even qualify you to work on an ambulance in the entire rest of the civilized and most of the developing  world?

Not once did I criticize the desire of US EMS providers to help people. But that is different from ability to help people. It is very different from commitment to help people. Once again, I will point out there are individuals that may be committed, but the industry as a whole is actually committed to being as uncommitted as possible. After all, if you raise educational requirements, people will have to pay money to meet them. Volunteers might go away except for a few extremely dedicated people which already exist, and people may have to come to terms with the fact that maybe they, like me, were not helping people after all.

But instead of addressing these issues, the same arguments I have witnessed for decades play out the same way they always did. With responses that are so similar to those posted on the internet since it became publically available, (yea, I predate that too) that I actually think it is the same blowhards saying the same things everywhere with a predefined copy and paste hotkey.

Like the foot soldiers of yesterday, they plan to crush any opposition under their righteous force, with a mentality that reminds me of Alfred Lord Tennyson, “Ours not to reason why, ours but to do and die.”

Unfortunately, I have not seen a US EMS provider step up like the General who saved Krakow and in doing so declared it the seat of local power to preserve its beauty and cultural value. But you can clearly witness the comments of the foot soldiers of US EMS who would enthusiastically throw Chopin’s piano out of a window with their ignorance and zealotry. For this they want to be called and given the respect of professionals?

Here is one last fact of life, digging a ditch for 20 years doesn’t earn your right not to dig a ditch. Education is what gets you out of the ditch. Taking a stance against education because you are already good enough is so absurd it is laughable. As I pointed out with the flawed use of EBM, not being educated does not somehow make you capable to do what educated people do.

While I appreciate your passion on the matter, calling me an asshole, whether I am or not, doesn’t earn you any respect. It doesn’t make you more capable. It may make you feel like part of the tribe, which makes you feel like you belong to something. But look at it for what it really is Don Quixote, because that is exactly who you look like.

You may think pointing this out to you makes me an asshole, but I will leave you with this thought. I know and can manipulate your ignorance and passions with so little effort, that I could start a website playing to them, convince you to buy some worthless products, like a t-shirt, that praises your mentality, and use the proceeds to buy myself and family nice things.

The only reason I don’t is because I think somebody who would take advantage of you in such a way would be an arrogant asshole.

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2 thoughts on “Chopin’s Piano

  1. mpatk, Paramedic, M.S. Chemistry

    All of the problems you mention with EMS (lack of education, tribalism, defensiveness) have their root in one thing that you mentioned: Current EMS management systems largely have a vested interest in NOT changing things. Hell, virtually NOBODY wants the system to change.

    The two largest models for EMS transport are fire-based and private ambulance based. Fire based certainly doesn’t want increased educational requirements for paramedic. Fire fighting and the associated HazMat, rescue, etc…is a complex enough job; nobody would be able to handle both fire fighting and paramedicine at the needed educational and training levels. Private ambulance companies make their existence by keeping salaries as low as possible and the supply of providers as high as possible (i.e. easily replaceable employees). The general public doesn’t want to pay more taxes, which kills discussion of EMS as a separate public safety entity. Given that not-so-benign neglect, who except a very few dedicated souls will get any sort of specialized degree in order to be underpaid and ignored/marginalized by management when the same level of education (ABN or BSN) will get you much better pay and working conditions as well as an advancement path (RN -> NP/PA and maybe to M.D.)?

    Is it any wonder that some of those “foot soldiers” become angered when you blame them for sins mostly the doing of their “commanders”?

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