Working Code: A Beginning
“You should write a book!”
I hear this a lot from people, usually as we sit around regaling each other with “war stories” from the Emergency Department or the streets. “Yeah. Probably,” was my usual reply. But then I stumbled upon this – Substack. That gave me the idea that I could do short essays, interviews, whatever, and maybe people would want to read them. I’m not a skilled writer, but I like words, and I have stories. I also know tons of people in the fields of medicine, paramedicine, law enforcement, fire suppression, and forensic medicine. So, I thought, maybe some interviews could be thrown in! I have long thought about how nice it would be to write and preserve stories, but I never saw myself having the time actually to write a book. Chunking along in Substack just might be the answer. So, here goes.
Working Code – what does that mean? In emergency medicine, a working code is a CPR-in-progress resuscitation when a patient is moving towards the light (or is it away? I never am sure). It triggers a large EMS, fire, and police response in the field and an impressive array of nurses, techs, advanced providers, and physicians poised to receive them in the ED. It also refers to the Code of Silence which is not the omertà of the Mafia (well, usually) but is the bond this collection of people have with one another, connected by the mud and the blood that tracks across our worlds. The silence is both protective and destructive. Love, fear, exhilaration, and despair become the working code of brotherhood and sisterhood of those that come through the glass doors intersecting the outside world to the Emergency Department.
First, a little about myself: my current profession is an emergency physician. I am now in a small critical access hospital in the Blue Ridge Mountains of Virginia. Three years ago, I left a much larger and busier emergency department after 25 years of service. The environment had become untenable for me, and my 90-day notice expired not long after the initial onslaught of the COVID-19 pandemic in 2020. Including residency, I have been in the Emergency Department for nearly 30 years. That’s a lot of patients and a lot of stories. But wait! There’s more!
Before medical school, with an inauspicious new career in the geophysical industry, I started volunteering as a paramedic in Texas, reluctantly becoming a fire captain. I spent ten years doing that, then entered The University of Texas Medical Branch in Galveston, then a residency in Emergency Medicine in Winston-Salem. I moved closer to my childhood home and my now-deceased parents and settled in for those 25 years. By accident, I accepted an appointment as the medical examiner to the city and county, investigating deaths for 18 years. While doing that, I bumped into the local police department’s SWAT team and became its tactical physician. To add to my self-induced unnecessary challenges, I then became a sworn police officer, serving with SWAT and patrol for 15 years until nagging knee and back issues forced me to resign. I still help with training, but I miss patrol, where I discovered how large the intersection ellipse is in the Venn diagram of the Emergency Department and the police department consumer base. Not surprisingly, the same people danced in both circles! Sometimes, I would see a patient while I was in uniform, and they would look at me with foggy perception. “I know you, don’t I? Did you arrest me before?” No, sir, but I did take a zucchini out of your ass on Christmas Eve. See? Stories.
I hope you will read and follow and share and invite. And if you are in this realm of the emergency services and have an exciting, bizarre, poignant, disturbing, or fulfilling story to tell, please reach out, and I may use your story in a future installment!