Guest Blogger Bryan Allen Fierro | Palpate

Fierro presents “Places and Images: Writing Home”, his 49 Writers Reading & Craft Talk Series presentation.  

Today in the mail I received my Alaska paramedic certification. It basically states that for the next two years, in the state of Alaska, I am allowed and deemed capable to perform very specific outlined duties under the guidance and licensure of a local physician. To recertify this licensing, I had to accumulate 120 hours of CME, or continuing medical education, in various topics. I took classes in pediatrics, general medical, trauma, and advanced cardiac life support. Over the course of two years, one of two things usually happens for any paramedic: you either accumulate more CMEs than you could possibly use due to ongoing required training, monthly shift meetings, and a whole host of online opportunities from well-versed educators worldwide, or you get to the end of your two years with the expiration clock ticking away, only holding a couple handfuls of hours needed to meet the deadline. It can be stressful to think that your license could be easily stripped away with one swipe of a State of Alaska medical board audit. It happens I am sure, though I have never known anyone to experience such a stripping. Let’s face it, at the end of the day, the process is mostly administrative and not truly an indicator as to the proficiency of the medical provider. Don’t get me wrong, as I understand the need for accountability and structure, but the question begs: How do we grow?

I couldn’t tell you how many continuing education check offs the best medics I know have. The barometer of a paramedic has always been based on how he or she performs during high acuity situations. Continuing education never enters my mind when I look at my co-workers, thinking that guy there is a good paramedic. I remember the first time I heard that phrase spoken about a fellow paramedic while working in Las Vegas, Nevada. At the time, I thought to myself, I hope someone says that about me someday—hoping the eulogy of my career would end with some sense of moderately high praise and affirmation, spoken on the heels of a twenty-year tour dedicated to uncompromised patient advocacy, and sound decision-making.

I like to think I have earned my way into the club of good paramedics, but it isn’t for me to decide. I’ll leave that to my peers and the people whose lives I have touched on their worst of days. How do I think I arrived at this point in my career? I touched the work almost daily in one form or another. I have assisted thousands of patients—the list is long: heart attacks in all its varying degrees, strokes, rollover and T-bone accidents, drownings and near drownings, stabbings and gun shot wounds, two-three-four story falls, heroin overdoses, electrocutions, multiple cardiac arrests with very minimal save rates, and to date, eight births (all successful deliveries by mom.) None of it was easy in the beginning, especially with such a steep learning curve and little time to spend analyzing, improving. I hate to admit this, but when I didn’t know what was wrong with a patient, I faked it as any good medical professional would in an effort to keep the patient calm and the supportive crew, calmer. I have a catalogue of mistakes I have made over the years. There’s no escaping the growing pains. Many times it is out of your hands simply because sometimes people die and there is nothing all the training in the world can do to save them.

There are days when everything clicks just so, the days when all the sick and all the hurt look exactly like all the sick and all the hurt I’ve ever seen in all the cities I have worked. And then there are the days when I think I never learned a damn thing, that maybe I am a fraud. I have been a very reluctant patient to the development process over the years, but never more so than when I thought I might like to write my stories.

During my training years becoming a proficient paramedic, I stopped doing the one thing I wanted more than anything—writing. I instead spent all my time building muscle memory for emergency medicine. When I finally reached the point I could slice out time from my fire career to pursue other interests, I set my sights on finishing graduate school. I spent the better part of three years attending a low-residency program in Oregon where I read countless books on craft, attended AWP conferences and panels, sat through endless author readings. I searched out and met my contemporary literary heroes, whose books I had often returned to when I felt there was nothing else in this world worth reading. The stacks of handouts and how-to manuals overflowed the shelf space in my office, but did little to make me a writer.

It wasn’t until I applied the same discipline to writing that I had used in becoming a good paramedic that I began to see real transformation.  Just how mandated continuing medical education had not made me successful in the field as a frontline paramedic, textbooks and handouts did nothing to organically allow my writing to grow. Each craft demanded the same approach: touch the work daily. Palpate and examine it. For me, that meant jumping in to offer to start IVs so that particular skill did not deteriorate. It meant spending time with a sentence that has been ringing in my head, looking for a place to live on the page before it eroded away. How you spend time with the work on a daily basis is really a matter of degree and varying disciplines. You can pin yourself down for a thousand words every morning after first reading and capturing the images and sound from your favorite poet (mine is Phillip Levine, whose powerful ruminations on work help me bridge the two tasks I aim to perform well). Or, you can spend hours revising the same sentence until it is unrecognizable. How you engage craft is personal. The degrees are of your own making, and the discipline, your own doing.

The pay off? There are many, but some don’t present themselves for some time. If you spend considerable and consistent time with your work, and dig your hands deep into the dirt that is the foundation of your craft, you will be rewarded.

One day you walk into a family’s home on a mid-week, early morning, on the worst day of the owner’s life, to find your newly released book sitting on the kitchen counter, a bent, creased spine as if it were recently read. You push it aside to make room for your medical gear, not saying a word. Your crew will throw you a sly smile of acknowledgment as they begin to care for the patient. They know what you have sacrificed. And they are proud of you. You have taught them something. And it is in this brief and fleeting moment that you realize you have done everything in your power to connect with your fellow man through story and heartache.


Bryan Allen Fierro, author of Dodger Blue Will Fill Your Soul (The University of Arizona Press), received his MFA in fiction from Pacific University in Oregon in 2013. He won the Poets and Writers 2013 Maureen Egen Writers Exchange Award in Fiction, and placed in both the 2013 Hemingway International Short Story Contest and Masters Workshop at the Tucson Book Festival. His stories have appeared in the literary journals Copper Nickel and Quarterly West. Originally from Los Angeles, California, he has lived in Alaska for thirteen years, and currently works as a firefighter/paramedic for the Anchorage Fire  Department. Dodger Blue is his debut book of stories.

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