A Night at the Opry

          A few years ago my wife and I relocated from New York to Nashville. I had retired -- or thought so -- after 14 years in EMS and an even longer hitch in the corporate hierarchy. A lower cost of living, a milder climate and a leisurely lifestyle were good reasons to head south. I meant to sit on my front porch and watch other people go to work.

     It didn't happen that way. I underestimated my attachment to EMS. Nine months of not responding to emergencies was all I could take. My wonky back wouldn't let me return to the streets, so I settled for a part-time position at Opryland, an upscale entertainment complex that's a middle-American Mecca for convention-goers and pleasure-seekers. Less than a year after leaving the northeast, I was a Music City medic.

     Tonight I'm backstage at the Grand Ole Opry, writing this from a small but well-stocked clinic. Yes, I've already done my check-outs, not that it matters much. I rarely see patients who need more than an NSAID. I have a feeling that tonight will be different, though. If you'll stay with me, I promise to describe every detail of hearts restarted, lungs reinflated and limbs reattached. Hey, you have your protocols, I have mine.

     Someone's calling me from the hallway. Maybe I should grab my bag. Maybe I should find my radio. Maybe I should open the door.

     Looks like another case of TB. I don't mean to boast, but I've seen hundreds of them down here. TB (I mean toe blister, of course) strikes young women who favor five-inch heels. There is no cure, and prophylaxis -- sensible shoes -- is widely ridiculed.

     My patient is a world-class performer with many hit songs. Her voice brings tears to the eyes. So does her blister, apparently. It's beyond my scope of practice to lecture her about foot care. A Band-Aid is the most I can offer without consulting medical control.

     As I enjoy the after-action glow of another successful pediatric -- I mean podiatric call, I ponder the possibility of a cardiac arrest in the crowd. I don't know why I do this to myself (my father swears it's not his fault). Perhaps I'm flashing back to similar scenarios in arenas, churches and catering halls up north, where patrons didn't allow even a corpse to compromise their agendas. After considering the cornrow seating and narrow aisles at the Opry, I resolve to treat comatose customers as if I've found them in a familiar setting: between a tub and a toilet. With an audience of 3,000. Now I feel better.

     There's a knock at the door (I really should prop it open). This is probably the big one. I'm thinking anterolateral-septal-elliptical-geophysical MI with such extreme right axis deviation that it becomes left axis deviation. Or something like that. Someone fetch the spare LIFEPAK battery! And electrodes, lots of electrodes! Boil some water, too! Stat!

     Let me preface what happened next with a little background: An old partner of mine once chided me for being so ALS-fixated that I would "hook up a hangnail." I never had the opportunity to prove her wrong. Until now. Yes, the chief complaint was a hangnail. I swear I didn't overtreat it. In fact, I didn't treat it at all, possibly because I was struggling not to blame this patient for all the abuses of EMS I've ever witnessed. For the record, it was BLS before ALS all the way. But if that hangnail had become ischemic… Never mind.

     It's getting late. In a region where biscuits and gravy is considered a food group, how does everybody stay so healthy? Doesn't anyone out there need a real medic?

     Ah, another patient. Sort of. One of the singers managed by my visitor is about to go on stage and needs medication for "frozen vocal cords." Huh? Do they have a protocol for that down here? I knew I shouldn't have skipped the Laryngeal Hypothermia class in medic school. Just as I'm about to concede ignorance to my patient's proxy, I hear the allegedly mute performer shout, "Forget it, I found some ibuprofen."

     Memo to all manufacturers of that wonder drug: Your product could be to frozen vocal cords what aspirin is to MIs.

     The show's over, but I see an elderly woman heading straight for my office. Years of experience tell me she's distressed. Cardiac? Could be. Respiratory? Possibly. I can feel the adrenaline (it's, uh, right here in my bag, next to the atropine). I reach for the O₂, cranking it open as my guest crosses the threshold. "Can I help you?" I ask, trying to sound like Marcus Welby mimicking Tennessee Ernie Ford.

     "You sure can, doc, if you know where the ladies' room is."

     I offer to show her the way, and mention that I'm not a doctor. At this point, I'm not even sure I'm a medic. I shut the tank and the door behind us.

     Okay, maybe entertainment EMS isn't so...entertaining. At least I finished my night at the Opry without being crippled, shot at or slimed. The music was first-rate, and I had time to write this column. There are worse ways to earn a living.

     As William Holden said in The Horse Soldiers, "Medicine is where you find it."

     Mike Rubin, BS, NREMT-P, is an EMS educator and consultant based in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.