You da' Man
James, Tripp, and Jim drive up in the black Mercedes from 137th in Harlem to Fisher's Island to meet Chris and to play some golf at the Island Club....Chris is a member... a perk of his gig as Island Doctor...the initiation fee to join the club might ordinarily be as much as $100K.
The Island... it's in New York State but just off the coast of New London, Connecticut.... is really an extension of the North Fork of Long Island... if you look at a map you can see the connection... the line terminates in Stonington, Cn....broken by the 'Race' a body of fiercely turbulent fast-moving water between it and Plum Island which has a sinister reputation as the site of the Department of Agriculture's obscure research of animal biological agents. The South Fork of Long Island extends parallel along the coast of Connecticut and Rhode Island diving underwater past Block Island but resurfacing again in Martha's Vineyard.
Her legacy is that of a blithe-spirited, cigar-smoking, bourbon-sipping, poker-playing socialite who drove a team of six horses. She was a lifelong fan of volunteer firefighters after watching them battle the blaze that destroyed her family’s San Francisco home when she was 5. She was the patron of station No. 5. Her gift to the firemen was San Francisco's Coit Tower.All three hope for an 'adventure.' Adventure' is a word used among the extended Ingram family to refer... with a little tongue in cheek... to small unexpected events during the normal course of things, as an adventure, pronounced as in French with emphasis on the 'ure' dragged out and with air expelled through the nose...that is nasal. The word was adopted many years ago in Paris. Katherine had invited, as was her wont, a stranger she met at Alliance Francaise to Thanksgiving dinner. He was Turkish-German, dark-skinned, dressed in black, slight and shy. All tried to make him feel comfortable. Katherine asked him why he had come to Paris. He brightened up, raised his head from his chest, smiled for the first time, and with great pride and bravery, announced: "Pour l'adventure."
In case it's not obvious, the guest at that dinner was so self-effacing and small that it was hard for anyone there to imagine him involved in the great adventure so the association developed...an 'adventure' was small but delightful...because of his great burst of enthusiasm at the moment.... variation in the normal routine.
At Bridgeport, just off the I95 to New England, they stop and pick up Ping, at her apartment there that she purchased when working for GE Money, and trade cars to her big Jeep... although it only gets 8 miles/gal... but manages 4 plus a dog and the golf clubs and has a great map screen and voice driving directions...inviting a passenger to play with it during a drive. The navigator's directions are in a matter-of-fact-woman's voice and it appears to interrupt whenever, randomly, any conversation to say 'turn right on Blogget road in 200 yards.'
On the way out of town, James runs into "the Coffee Factory" in old Bridgeport around the corner to get coffee for everyone before they continue the trip.
In the car, James discovers that his Verizon Voyager cell phone has the same 'navigator' function as the expensive Jeep Cherokee display panel extra... plus it has traffic reports...and it includes also the turn by turn instructions...!
A discussion ensues:
Jim: "Do you suppose that there is a service that tracks cellphones from cell tower to cell tower and calculates speed and reports on map congestion points?"
Tripp: "If someone doesn't provide that service we should do. Dad you need a job." He says it smiling. Tripp thinks of his father as a 'maven' as described in Malcolm Gladwell's book the 'Tipping Point.' He has concluded that a maven is great to have if you need detailed information. But often a maven is eager to relate more than you really want to know about something.
James: "I'm afraid it's too late...look.".. he points out.." this display has highlighted areas that indicate congestion points."
James: "It looks OK...wait the screen seems to have frozen...I guess the cell service is spotty along here." He leans back in his seat, shaking his head...cell phone technology is indispensable yet incomplete.
The conversation then drifts:
Jim: "Ping are you looking forward to your new job in Shanghai?"
Ping: "Yes and no. It's new...a good company...Heidrick and Struggles...I will recruit CFOs for international companies with regional offices in the Far East. But it will be hard work. I will have many colleagues who have similar responsibilities in other specialties such as CIOs...some from Australia, Great Britain, China...and my Chinese colleagues...they get paid less, work twice as hard, and are very smart. It likely to be an exhausting, tough environment to work in."
Tripp: "What's the income spread in China, Ping...you know between the CEOs say and a worker. Is it anything like here...the great disparity....250 times sometimes?"
Ping: "Maybe greater...you know there's the philosophy: You work hard...you're successful...you get the rewards and you keep them."
James: " Well, look at Lehman Brothers. What about the rewards there? The upper levels of the company made millions doing deals in derivatives but don't have to pay it back when the firm goes into bankruptcy because the deals go bad."
Jim: "I think all this is an argument for progressive tax rates and high estate taxes."
Ping: "But why should successful people pay more than less successful. They earned their rewards."
Tripp: "Ping be careful, you know Dad loves this discussion. He will pull your chain."
Jim: "What a delightful American idiom: 'Pull your chain.' What does it actually mean?"
Tripp: "Dad in your case, I think it means to take a position that you know is contra to another's for the somewhat perverse pleasure of seeing them become slightly uncomfortable trying to defend their view."
Jim: "I think that definition works." He smiles. "Ping, is there a similar idiom in Chinese? I think one literal meaning is to pull the chain of a monkey to cause it to chatter. Maybe that translates better."
Ping: "I'm sure there is... Chinese is a very idiomatic language also...but I can't think of it at the moment.
James: "Ping I've often wondered about Chinese sense of humor.
Ping hesitates then relates: " My Chinese friends laugh at the western sense of humor that manifests itself in Confucius jokes... for example, Confucius says: 'Man who lives in glass house should change clothes in basement.'
James: "That's interesting. What is there about that joke that is funny to you?"
Ping: "It's the awkward abbreviated wording and the juxtaposition with Confucius, I suppose, who wouldn't have said anything like that."
Jim: "But back to the subject. I think someone's financial success is not only a result of virtue...such as hard work... and equally maybe, even more, a function of genes, family environment, and a consequential simple adeptness at commerce. And all material 'success' is based on the exploitation of the 'commons'...the earth's resources...that belong to everyone equally."
Some of us have commercially relevant inheritance and physical and mental adeptness. Some of us are encouraged by our environment to diligently hone that natural adeptness into expertise. Some of us do not. Those that do and achieve commercial success through gift and focused preparation should pay more into the community because they have benefited more from the commercial meritocracy that the US has created as the paradigm of 'success.' Higher progressive taxes are a fair bargain in my opinion...the more 'success' you have at exploiting the commons the more of the emoluments of success you should share with the less adept...right?"
The traffic is light and they arrive at the ferry in New London early. Tripp grabs the first slot in line, positions the Jeep, returns to the group standing in front of the ticket office and they continue the discussion as they wait. James scans the row of old buildings behind them along the old waterfront that surrounds the ferry terminal trying to identify a coffee shop...he's caffeine depleted.
Ping: "But what a fatalistic philosophy. And American's think Asians are fatalists. Why should anyone work harder if they don't get more rewards? It's a matter of simple economic justice. I don't buy this 'economic determinist' stuff."
James: "Yeh, big Jim..what do you say to that?"
Tripp: "I think I agree with Dad...maybe for the first time.
I just think that much of a person's reactions to opportunity is some unpredictable proportion of innate capacity and preparation. So life's a chance... I agree. You know if I am confronted by a requirement to make a rapid decision to save a life...I have no idea of what I would do...maybe clutch... not because I would not want to respond heroically, but because I simply maybe don't have the instant clarity of mind that immediate reaction requires."
The ferry whistle interrupts the conversation and Tripp drives the Jeep onto the ferry ....and allows himself, as do all the other passengers who take cars over, in good humor to be abused verbally by the guy who directs each driver as he backs his vehicle onto the lower deck ...
actually visually abused because rather than saying something when the driver doesn't respond correctly to his not always unambiguous hand signals...he stares at length... stock still...with evident disgust and loathing...and the driver gets the message...'you're an idiot and you don't deserve to go on this ferry to my island.'"
Ping, James, and Jim walk gingerly across the 'plank' onto the deck and clamber up the stairs to the observation deck. The conversation does not return to the earlier subject. Ping stares out toward the island in the distance perhaps thinking of a similar scene in China.
Instead, the group passes the 45-minute ride to the island exclaiming about the weather...and the water and the boats... and the large General Dynamic plant on the shore...are submarines still being built there?...the graceful catamaran ferry destined for the North Fork of Long Island less than 10 miles away... and the golf game scheduled for immediately after lunch.
That evening the five return from the Island Club course. After lunch they had first hit unlimited practice balls... from large wagons filled with balls and a scoop to fill smaller plastic baskets.....on the driving range...a supreme pleasure for all who had had to pay $.25/ball at Chelsea Piers in the City...and then played 18 holes on the Scottish links-style course from which the waters of the Sound are visible on almost every hole.
James and Chris and Tripp make dinner...cooking T-Bone steaks on the grill outside on the landing and fixing a large salad. It is late, all are flagging after the long day... it's maybe 9PM... the dishes are piled in the sink after the dinner is finished...when the two-way radio Chris keeps in his apartment, over the Island Medic Clinic building, crackles:
First radio voice: "screech....(that sounds that two-way radios emit when keyed on and off) Where the hell is the doc? Why doesn't he answer the call?"
Second radio voice: "Where did you say the accident is?"
First radio voice: "Suzie...It's off the third fairway of the Hay Harbor Club ...it's just across the street from your house."
Chris after locating the radio on the desk: This is Dr. Ingram...What's going on?
Second radio voice. "Chris... this is Suzie. What took you so long to answer your radio?... we've got a report of a car accident on the golf course and the driver has a possible broken leg."
First radio voice: "Doc, can you get here...the driver of a 'Big' Club van is in bad shape. Over"
Chris: "Bring him here to the Clinic. Uh...Over." stumbling, unaccustomed to using the stylized language of the emergency radio.
First radio voice: "We can't, Doc...we can't get him out safely. The van missed the curve, ran through a wooded area, and careened over a hill and down front-end first into the fairway of the fourth hole of the golf course. The EMTs, the fire department, and the police...we are here and we are having trouble getting him out of the van."
Chris: "What's his condition? Is he conscious? Over"
First radio voice: Deep face and head lacerations, bleeding, and a broken lower leg. I can see bone.... and no, he's unconscious."
Chris: Have you pulled the ABCC procedure? If not, do it now. I'll be right there...Stabilize him. Organize your resources. Out"
Chris: "James will you go with me? I think I am going to need help."
James: "Let's do it." And he donned a jacket and flip-flops...a breeze had sprung up....and walked out onto the landing and down the stairs to the little Toyota Corolla parked in the area behind the clinic.
The fourth hole is just 5 minutes away on the small island. Automobile accidents are rare. There are only a couple of hundred full-time resident families and normally there's no hurry to get any place that would require excess speed.
The emergency lights from the fire department are set up. The gasoline generator putters away. The white van reflects the light. It tilts awkwardly toward the front... its rear wheels slightly off the ground... nose down in the grass of the fairway. The small steep hill over which the van plunged emerges at the extremes of the circle of light. The lighter sea, a mile away, brightens the horizon, pushes up the dark into the sky.
Maybe 20 people line the road or stand near the van... milling. Police, fire, and Suzie Parsons who heads the Island community medical board and lives across the road from the golf course have arrived. Five volunteer EMTs surround the van trying to help...but the doors are not open ...one man is inside sitting in the passenger seat leaning over the driver... blood is evident...a buzz of rapid conversation as the medics interact.
Chris and James reach the van, clambering over a fence and across the fairway. James realizes that the injuries are greater than he first imagined. His flip-flops will not do. He returns quickly to the car and puts on the only thing available ...his golf shoes
Chris: " I want him out of there and onto a stretcher."
EMT leader: "Doc...we're struggling a little here."
Chris: "Suzie, I'd like for James to help here...Extraction from a vehicle isn't my skill. I need this man where I can work on him. He may have head or spinal injuries."
Suzie: "He can't. He's not on the insurance. No way!" Suzie is an anomaly on the island. She is a member of one of the old families whose determined efforts have kept Fisher's in its pristine condition...perhaps the only beachfront along the East Coast that isn't exploited commercially or by private owners who insist on beach frontage. Yet there remain remnants of the original town population...the fisherman who occupied the island early in the island's life. Fisher's maintains a school...other municipal facilities...a library...and Suzie spearheaded the drive to raise the money to improve the medical facilities and to provide a full-time year-round doctor in residence.
Chris' mother, Katherine, while vacationing several years ago met. Maria, the resident doctor, while walking on the beach. The conversation which ensued revealed that her son Chris and Maria were former classmates at Columbia. Maria lives in New York with her husband and children. She essentially commuted to Fisher's after having served as a backup physician when she was an ER-resident at New London hospital. She was seeking someone with whom she might 'share' the job. Eventually, Chris succumbed to the charms of the Island and agreed to act as the resident physician for three months each year. He started this year.
Chris: "Suzie...I need help...this man is in bad shape. I need to determine if there are back, neck, internal injuries. He must have slammed hard into the steering wheel and maybe hit his head against the glass. And I don't see a seat belt. But he can't be moved without immobilization. James knows how to do that...He's an EMT with FDNY. I need his help! What if your guys move this guy inexpertly? Isn't that a potential source of greater difficulty"
Suzie looks around, thinks for only a moment, and agrees: "OK do it."
James confident, at ease, sizes up the situation up...thinks through the next steps... he's sensitive to the pride of the local EMT group...all are volunteers.
James to the EMT team: "Who is the team leader? Lloyd?...OK, Lloyd...look this is your thing, but I have done a lot of these. I work downtown in New York for the FDNY. I'm willing to pitch in. It looks like you guys have made a good start. My name is James." Lloyd is a burly guy with large hands. His face is sunburned even in Winter even in the glarry light of the headlights of the emergency vehicles....the kind of guy who you want on your side.
Lloyd: "We'd like your help, James. We don't see this so often."
James: "First I want to immobilize his neck and back. It looks like you've got the bleeding under control and the leg splinted. But I want to take a body first limbs last approach."
In the FDNY the theory is that an injured person will die from a body wound faster than a limb wound so the first order of business is the 90 seconds physical. This 'quick hands' procedure is practiced often during FDNY EMT training. James can do it blindfolded. ...e.g.,..inspect the ear canal, check to see if a pus-y clear fluid is present indicating concussion. The idea is to pass the hands from head to thighs feeling for any abnormality testing with fingers the voids in the body where blood might pool from internal bleeding. If the patient is conscious, an EMT applies the 3 times 3 procedure where a patient's extremity is touched and the patient's reaction noted and asked three questions to determine alertness...What day is it?
"I want to remove him from the van so Chris can examine him. But I want to get the backboard in there and I need a way to back out. Do you have the "Hurst" tool to cut the windshield away? Also, do you have a collar, shoulder straps, spider straps, head rolls ready?"
Lloyd: "No Hurst...just JOL, but the rest... yes."
James: "Yea, well my mistake...we call JOL "Hurst" in the City...but Hurst is the manufacturer...maybe we will not need the JOL. Can we get the back doors open and lay down the passenger side seat?"
Lloyd: "Yea, great idea. We can slide the backboard in and move him over."
James: "First I want the collar on and I need two guys to reach in and hold his head still."
EMT Leader: "Charlie, Stacy, take your direction from James."
James: " Stacy, hold his head with both hands. Use your index and second fingers to press slightly at the base of the skull on each side. Once you locate the spots and get your fingers in place do not relax, until I say so ... and that's going to be after I have inserted the collar and strapped him to the board. Got it? You've got to be prepared to move with him as we nudge him over to the passenger side. Charlie, help me with the backboard...grab the collar...have the spiders at hand."
Slowly and carefully James, Stacy, and Charlie extract the driver and immobilize him on a stretcher. Chris examines him...checks the compression on the lacerations and tests the stability of the splint.
Chris: "Let's get him to the dock. James and I will go across with him to New London with you Lloyd. Call it in."
The Fisher's Island Medical Committee has organized the delivery of medical services for the island. Among the units are the volunteer EMTs and a fast boat that can transport patients to an emergency room in New London.
The ambulance arrives at the dock with Chris, James, and Lloyd. Randy captains the boat or "the Sea Stretcher" as they call it... Its twin 250HP Yamahas are purring. The boat has a catamaran hull. The twin hulls reduce the motion of the boat when the waves are up. A stretcher carrier is rigged athwart-ship on gimbals that allow the stretcher to counter any movement of the boat and remain oriented upright and level. The gimbals are ingenious. Just as is a compass on a boat, the stretcher is mounted within two concentric circles attached at four major points 90 degrees apart, so that any abrupt acceleration causes the stretcher to dip or any sideways motion as the ambulances careens around a corner to maintain its orientation to the horizontal. James had never seen anything like the setup and he makes a mental note to determine if the design could be adapted to the FDNY ambulances. Today an FDNY EMT, in a fast ride with an ill patient, braces, and wedges the stretcher cat-i-cornered into the back of the ambulance so as to minimize any shifting during tight turns or rapid stops.
James worries about shock, motions to Chris with the drip line against the roar of the wind and the engines, obtains a nod from Chris, sets up a drip line to reduce shock, holds the patient steady while Chris straddles the stretcher, moves with the motion of the boat, finds the vein and inserts the needle.
Chris checks the patient's pulse rate and blood pressure, peals an eyelid open to examine his iris. The patient regains consciousness and his signs stabilize. His eyes brighten when he recognizes Chris from the Club and he realizes he's with a doctor.
James helps Lloyd fill out the report that must be presented to the receiving EMT team.
They arrive at the New London dock. An ambulance waits. James accompanies the stretcher to the ambulance.
James turns to Chris: "Does this qualify as an 'adventure'?"
The large New London-based EMT leader watches James and crew approach, then checks the patient, nods with satisfaction at the setup, touches the neck collar, tests the spiders, looks over the paperwork, turns to James, and with his thumb turned up from an outstretched hand, says:
"You da Man!"
