So, first and foremost I highly encourage everyone to do their research and find some cool stuff that interests you. This specific amendment got me thinking about a whole bunch of things that I can’t help but wonder, especially in relation to what my media feeds me. The 14th Amendment illustrates that America’s citizens, either born here or naturalized and under its jurisdiction, are equally covered and protected by the written laws and shall not be deprived of any rights, privileges, or immunities, pending any disobedience to said laws. But this thing is 5 sections long. Again, find it, read it, check it out and interpret it for yourself. You might just like what it says. Still, I couldn’t help but have a whole bunch of questions about some of their section and exemptions.

The text identifies votes made my whole persons residing in each state, but excludes citizens who don’t pay taxes. Specifically, it excludes any votes made by “Indians”. In my mind, they were here first. They kinda don’t NEED to pay taxes… In my mind, they should be treated with a lot more respect and recognition, rather than the shitty deal we gave them after nearly killing off their entire bloodline. Sometimes we’re assholes.

No one should be a politician or even remotely involved in governmental politics if they have ever engaged in insurrection or rebellion against said governmental system… Does that make sense? I believe that if someone has ever tried to go be a dick to us and our country, they should NEVER be elected to public office. Ever. So… why the hell does Congress have the power to overturn this declaration? It’s almost like they are allowing conditional permission for defiance, transgression, and disobedience against our country. Does that sound like shenanigans and malarkey to anyone else…? Or am I not seeing the big picture…

Highly possible that I’m missing something or simply naïve to how this whole thing operates. Either way, enlighten me and let me know what you think about our 14th amendment!{jcomments on}

Dave Ramos

HCA

Transgender Response

 

              Last semester I had a Human Sexuality class and it really opened my eyes to a lot of things. I was able to grasp a more firm understanding of what different gender identities are and how people identify their own personal sexuality. Prior to this class I wasn’t uncomfortable nor was I prejudice toward anyone with a different sexuality. Having Dr. Hastings in class with us was a pretty great way to reinforce to respect I have for people who feel strong enough to “come out of the closet” and share the most intimate and vulnerable aspects of their personal lives. It was very nice. Unfortunately there is a huge misunderstanding that we as a society hold toward people of different orientation and belief. We see it every day with racism and harassment. People of a different color or religious preference seem to be on the receiving end of unsubstantiated negativity. Throughout history, especially in America, we have seen so much discontent and inability to accept people for who they are. It makes me very upset, actually. Slavery, racism, sexual harassment, bullying, slander… the list of our culture’s disgust is, in itself, disgusting. As of late, we as a culture have come so very far in our ways of acceptance and the institution of organizations that seek to empower every individual to stand proud and confident in who we are, how we identify, and what drives us to continue on and thrive in life. Beginning to understand other cultures, other traditions, other identities, and other preferences is a huge step toward social harmony. As far as transgender issues are concerned, I feel like America needs to bring the same intentions that we had with civil rights and gender issues to the table with LGBTQIA in a stronger effort to allow America to truly be “free and equal”. That starts with people like Dr. Hastings who are strong enough and willing to educate and share knowledge on these issues that previously have been considered “taboo”, “blasphemous”, and/or down right unacceptable. In the last 100 years or so, subpopulations of our nation have begun to stand tall and speak out in opposition to repression. Personally, I think more and more people need to stand behind the concepts of equality, freedom, and acceptance. The First Amendment illustrates the right of self-expression. Anyone who chooses not to uphold those rights for other citizens should be held in opposition to the law. Harassment and repression, bullying and violence, psychological terrorism bestowed on those who choose to live in confidence of their own lives is absolutely unacceptable and those inflicting should be chastised…

Medically, I have had a pretty good understanding of the process involved with transitioning into a different gender. There is a massive portion of psychological counseling and verification that needs to be involved. I do think that a predetermined amount of therapy and counselling should be mandatory to educate and increase the understanding of the full encompassment of what gender reassignment truly means. Maybe the same requirements could be instituted in tattoo shops…? Hormone therapy, along with surgical manipulation, is the crux of the transition as I understand it. Education and counseling is important for the individual in this as well so as to avoid any misinterpretations of anatomic and sexual changes. I feel like the social and interpersonal relationships may be the most important part of transition. Not for validation of someone’s choices, but for fully embracing one’s identity. Being honest with others, in this case friends and family, gives a person the ability to truly be honest to themselves. Sharing personal intentions and desires with friends and family solidifies those same values within. Along the same lines, opening one’s self to potentially inflammatory truths will really expose who cares and who doesn’t. This is a great indicator who should remain present in someone’s life.

In regards to insurance coverage… this gets sticky as situations develop. Normally, I would imagine that insurance covers many, many procedures that are both needed and cosmetic. Gender reassignment may be extremely important to someone with life altering gravity. Some insurance companies may classify this procedure as cosmetic whereas the individual may see this as a mandatorily needed change for overall wellbeing. As far as I am concerned, if you’re paying for insurance, that insurance company should cover a significant portion of the expense. HOWEVER… in the case of Bradley/Chelsea Manning, our tax dollars should NOT be contributing toward that gender reassignment. Good, bad, or indifferent, this American is in confinement and has limited rights. S/he is entitled to their desires of gender identity reassignment, no doubt. But while in confinement, their rights and medical expenses should be significantly limited. That is a procedure that can wait until after a jail term is fulfilled. Personally, I think Manning wanted to change genders in an effort to avoid a testosterone filled prison facility and end up in a female population. I may be wrong. In the back of my mind I hope I am. Regardless, I feel that prisoners are not entitled to cosmetic procedures on the taxpayer’s dime. They are in confinement for whatever reason and that automatically restricts their rights, their entitlements, and their privileges. But if John or Jane Doe feels that they need to be reassigned as a different gender or that they have mismatched genitals and they are subscribing to an insurance policy, by all means that insurance company should be obligated to help pay for the expenses of the procedure. Isn’t that the point of having insurance…?

 

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I get wisps of being back in the Army all the time. Certain things, triggers, send me back and put my mind back into an environment that I left a long time ago. A few things really come to mind when I think about it. Specifically the green Purell hand sanitizer immediately puts me back in the Internment Facility’s medical tent where we provided healthcare to detainees. I remember being in the tent, walking out toward the latrines. There were sanitizer pumps everywhere. We carried this stuff in our pockets everywhere we went. The smell bites my nose today just the same as it did ten years ago. The sharp scent takes over my senses and I can feel the heat and dust again. I can hear the drone of the fans, pumping air in and out of our tent. I can feel the wooden floor bend under the weight of my boots as I walk from one end of the facility to the other. I remember the med boxes we created and stocked. I can’t remember what the hell my teacher said was going to be on our test last week, but I sure as hell remember that medical tent. Hours and hours and hours and hours were spent in that tent taking vital signs, translating signs and symptoms, cleaning and sterilizing, incisions and drainages, scooping out ear canals, flushing wounds and changing bandages, counting and dispensing medications, IV’s and injections, dental, optical, and trauma management. We were given the opportunity to work on trauma casualties a handful of times, not as much as my second deployment, but still exposed nonetheless. I can still hear the sand and gravel as I walk to the TOC and back to my CHU. Fucking hand sanitizer…

Some people send me back. Not always in a bad way. Being around military buddies, especially those with whom I’ve served, makes the “Dave” persona fade away under the brutal and headstrong SGT Ramos, self-proclaimed-savage with the “Do As I Say, Not As I Do” mentality. Always for the team. Always full of motivation and morale. Always trying to improve and progress. Others who bring out the SGT Ramos in me are typically knuckleheads. If I had my way, I would smoke the dogshit out of these kids I see. Common sense was ingrained in us as professional Soldiers. Apparently those same values aren’t universal… I can only handle so much stupid and kind of blame myself for overreacting to a lot of it. The more I look around my environment and the media, the more stupid I find. The more stupid I find, the more anxious I get. The more anxious I get, the more I want to lash out at the stupid. And then I end up on the radio with Baker and end up losing my cool and trying to play verbal damage control of my big mouth… Bottom line up front, stupid people make my jump back in to SGT mode and I want to skull-drag these morons across the pavement. …and then I realize that I’m no longer in uniform, I am no longer a SGT, I am no longer an authority figure in the eyes of most. I realize that I am just like them, in the same boat trying to make it to tomorrow. I’m trying to make a living on the means that I have acquired through experience, training, circumstance, and opportunity, just like them. I am a student, just like them. I am a father, just like them. I am a worker, just like them.  But I am a veteran, not like them, with skills, training, morals, values, and ethics, not like them. I have sight and forethought, not like them. I have opinions and strengths, not like them. I have intent, direction, and goals, not like them.

Right now I’m getting those same feelings of being on the tail end of a deployment, counting down to reuniting, counting down to the plane ride home, and counting down to being in a solid embrace once again. We’ve all heard the stories of redeploying troops being turned around in the air just to go back and fight on. We’ve heard the advice to not believe that you are home until your boots are on the tarmac. We’ve all heard those horror stories. Most veterans have lived the tales that the civilians dread to hear. I was about 80 days from coming home when the orders came down for us to have an additional three months added on to our deployment. I unintentionally find myself in the mindset of counting down. The countdown for some reason is coupled with dread and a sense of frantic analysis. Time is always a factor, giving me deadlines and anxiety and stress. Life and death has been made tangible for me in the passing of minutes and seconds. Time and distance are always present in my life, themes that never seem to lose their lingering negativity. There always seems to be a sense of distance between myself and the things around me. I am still trying to get over that. It’s hard to ignore sometimes. The distance can be seen through my eyes, felt in my heart, and heard in my voice. It plays a part of who I have become. Always present yet feeling isolated and alone. I don’t like the feeling of being alone on a deserted island while surrounded in a sea of people. For some reason I can’t shake that feeling of being alone. I know I am not alone. I know I have friends and family who care deeply for me. I know that I have true, lifelong companions that I can rely and count on until the day that I do. But one thing that has always stayed with me is that sense of being downrange, present in letters and phone calls, yet still feeling like I am on the other side of the world.

 

I am home. That’s what I keep telling myself… I am home.

I remember the first time I had a patient that I felt comfortable calling mine. I had dealt with plenty of patients leading up to that point, both in real world and training scenarios. By this point I had already treated wounds and dispensed medications. I had given IVs and helped pop pimples you wouldn’t believe. …actually, you probably would…

But this one guy was mine. I didn’t have my squad leader with me, I didn’t have any of my other team leaders. It was just me, my gear, and my radio heading out to the compound I was assigned to. I didn’t even have my weapon. It was late, probably around 9 or 10 so it was dark, but the moon was out. With the exception of the compound lights, I couldn’t see all too great. When I got the gate I saw an old guy that I remembered from previous exchanges. He was sitting in a chair sort of slumped and slouched, looking upset and distressed. I was nervous as shit for so many reasons… I was so anxious I thought that I’d hear my heartbeat in my own ears louder than anything the stethoscope could pick up. As I got closer to the gate I saw more and more people hovering around this guy. This was the entertainment that night or something because there was a solid group of interested individuals gathered around to witness what very well may be the passing of this old man. If I wasn’t nervous at first, now I have a freaking audience who is going to completely judge me by my medical capabilities. This is about to make or break this continued relationship that I am creating. I see these guys almost every day. I give them their medications. I change their bandages. I investigate when they tell me it hurts. I make sure they don’t die. Almost every. Single. Day.

I was called out because we had a call for an elder man with chest pain and breathing complications. I tried to recall and replay all of the training and events relevant to this moment. How many times had I ever heard “crackles” or “rales” or “stridor” or “wheezing” or “gurgling” or felt an irregularity…? What does an arrhythmia feel like? What does it sound like? What does it mean if his pulse is too fast to count? Or dropping as I take it? Not strong enough to find? Is his blood pressure so high that his eyes are starting to turn pink? Can I even take a blood pressure? What the hell is it telling me? Are his pupils constricted or dilated? Do they react? Can he even hear me over these people? After I talked to the guards I got to my old man. I tried to talk to him to him to relieve some of my stress, just random chit chat and verbalizations of what I’m doing. I was talking for more my comfort rather than his, no doubt I was rambling in chuckles… This old man couldn’t speak my language and couldn’t possibly understand anything I was saying to him. Great…

This was the first time I could remember counting this man as my personal responsibility as a medical professional in a war zone. This was huge for me and I assumed everyone was looking at me to see how well this plays out. I’m brand new to the unit, brand new to the clinic, brand new to Iraq. If I fuck this up, this is going to set the pace of my military career… Game on, let’s see what I find…

Turns out body language is universal and you can’t create symptoms that aren’t there. This dude was fine. He got up and left after our chat. And an ammonia inhalant…