02 May 2016

01 May 2016

18 April 2016

OD

(This may be the first in a series of posts where I outline how I am trying to love the job again....maybe.)

Suddenly all of the lay people I know are asking me if I am noticing an uptick in overdoses. The truth is that I have.  As the supply purchaser at work, I can barely keep up with buying BVM's (which can be used to breathe for people), nasal atomizers (a handy tool that lets just about anyone squirt narcan up their noses) and narcan itself (the handy drug that reverses heroin overdoses). 

The number of overdoses in America has (temporarily) captured attention.  This is how we are killing our youth.  For EMS, it is all too routine.  Never in my career did I think I'd hear medics (including myself) act so indifferent to patients that are on the brink of death.  I am not being over-dramatic- these people die.  They die often, because you can only not breathe for so long.  But most don't die.  Somehow they chip away at their nine lives and come back from the brink, only to overdose again.

I have been thinking about all of the recent overdoses and and how causally we take them now.  I missed an IV on one of these patients and heard with a chuckle "Oh, he's better at finding his veins than you are." from my colleagues.  Oh. HAHA.  But this is just one example of how we see these patients as not 'real' and as sub-human.  Yes, they lie to us. Yes, they don't believe that they were nearly dead.  Yes, they are unappreciative.  Yes, they are often homeless and unemployed. 

How easy it is to forget how shitty their lives really are, How easy it is to forget that these people are sons and daughters, fathers, and mothers.  Most of us have never truly been addicted. I mean sure...I love candy, chocolate, and playing video games, but those are not actual addictions.

I (do, but) shouldn't judge a person who is so addicted to something that they would do it over and over again to their almost guaranteed demise. I do not understand addiction that ends in ruined lives, children in foster care, and squalid living conditions. But I don't have to understand any of that.  What I have to remember is that these people are human and so am I.  Bad decisions happen.  I could just have easily made the same bad decisions, but somehow I didn't. Addiction is real.

I have to believe that these people want their lives back. They want their kids. They want jobs and to be members of society. I have to believe this because I feel myself falling into the idea that it is okay to joke and judge about addiction.  It is too easy to judge them, write them off, and fantasize about letting them die.

No, we cannot mourn for every ruined life or every dollar wasted, but we as EMS should be trying harder.  I am tired of being the band aid.
So, like John Oliver I want to lay out a rant and then set a challenge.  Mostly for myself.  There is no point in preaching if I can't enact a plan of action.  I have set a personal challenge to start with compassion.  I want to take a moment to remember that addicts are people, people who need help, and just happen to be in the business of helping people.  I want to learn my local resources for these people.  I want to no longer accept refusals from these patients (but that's probably another post) and get them to the next step.

The last overdose I had woke up and said "I was going to go to rehab tomorrow".
I most sincerely and overly-heroically said "Well, now you have a tomorrow."

13 April 2016

Quebec

A few months ago, my sister proposed a trip.  Without thinking too hard, I immediately said yes to a winter trip to Quebec, Canada.  Now, I love trips that require special equipment and apparel, but this was next level for me.  From booking to leaving, my entire winter wardrobe was turned over, bolstered, improved, and tested.  As possible -20 degree temperatures loomed closer, the panic set in.  Are these boots really going to keep my feet from freezing?  Are four layers enough?  Will my mittens fail?  Will all of my digits snap off and I will get them all replaced with socialized medicine?

Happily, on our coldest day (-15 at noon), all of my fears were gone.  If anything I was more likely to have a heat stroke upon entering any establishment, as it is difficult to shed 15 pieces of clothing and still be able to browse.  The cold is a chore there.  There is no running outside to get the mail (well, maybe for locals).  There is no leaving anything in the car overnight.  There is no hitting snooze because getting ready to go outside is really like preparing for space travel (as in it takes a team to dress you). 

The cold there is part of the culture.  It's an ever present element and a source of pride at the end of every winter. (we survived!)  Québécois are a hearty people who know how to have fun in the snow.  They are so good at it that even I felt like I loved it.  We went snowshoeing, glissading, tobogganing, snow tubing, and, best of all, dog sledding.  (Seriously, dog sledding was the most exhilarating and terrifying thing I've done in a while.  It was awesome.) We went to their winter carnival in Quebec city and ogled at a hotel made entirely of ice and snow. 

I learned much, especially that one can get British candies in parts of Canada, roads to not need to be plowed and salted, and we (mid-atlantics) are really, really bad at winter.

Also, they really take their French seriously there.  Yes, yes, I am the last person on earth to realize that in Quebec people really speak French and many only speak it.  My French consists of a bloody-ear inducing count to 10, so this really was a shock.

It was an awesome and exhausting long weekend and I really can't wait to go back.  But, maybe in summer next time.

11 April 2016

PA Update

I know that so many of you are waiting for an update on "Wild ass plan-apply to PA school". Well get ready! Basically, it's boring. I am slogging through my last prerequisite "Intro to organic and biochemistry". Did I save the best for last or what?! Truly, this is the class that I know I will struggle with. How do I know that? Well, it's been two weeks and I already am!
This class is offered at several schools but is accepted for all of the programs in my state. When we had our obligatory introductions on the first class, it became clear that I am not alone in my wild ass plan. Indeed, the competition for these programs was never made more clear. 28 out of 30 students want to be PA's. 28 out of 30 students went home that night and cried themselves to sleep. Those that hadn't already done the math of 1000 PA school applicants for a class of 35 were for the first time feeling the pressure.
It's a mixed bag of backgrounds and ages.  I am probably not the oldest aspiring PA, but the young ones are...so young.  My favorite part of talking to them is when they muse "What is the fastest, easiest way to get patient contact experience?"
As a good paramedic, I take this time to promote volunteer EMS and encourage them to take a 15 week class and get out there and treat some patients.  It's a win, win, win situation for them as far as I can tell.  I can only hope that we can, at the very least get some good EMTs out of these aspiring PAs. (Those who don't think that 15 weeks is too long.)
While exchanging backgrounds, I did worry that everyone would hate me as a pretty well qualified Paramedic, but it turned out that...no one has even asked what I do.  Ah, youth.

UPDATE TO UNPUBLISHED POST.
Now, many more weeks in, I still am terrified of this class.  Not one assignment as solidified an acceptable grade one way or the other, instead, as predicted, I am teetering on the edge of something okay, and something very annoyingly not okay.
But...I will keep plugging away, making attempts to understand the un-understandable.  If at a loss for direction-forward!

15 February 2016

Blogiversary 11

I've retrodated this post, as although I was thinking of dear old bloggie on the 15th (our actual anniversary) I was not near a computer. In fact, for the first time in a couple of years had an actual reason for not celebrating the blogiversary. I was lucky enough to be on a long weekend to Quebec with my nieces French class. Don't worry, I sent it a post card. (Bonjour, thinking of you, wish you were here. You know, normal greetings to an intangible object.) I am happy to report that on the trip, I didn't freeze to death or lose any digits as predicted by most (including myself). So, I am now wishing the blog a happy anniversary. I guess I've been 'better' at keeping but still not great. Between work and school and work and television, time for blogging has been limited. The traditional gift for the 11th anniversary is steel. (Hence the I-beam). But now I will be forming at least a couple of posts about how seriously Quebec takes their French and how just plain crazy it is to live in a place that goes to -15 F on a regular basis.

04 January 2016

Calls

How about a good old fashioned call round up?

A pleasantly confused old lady with a fever. 'Would you tell me your birthday?' Huge, mischievous smile 'No.' 'Alright, you do what you do.' 'Thank you for a great dinner.' 'Anytime.' 'I'm so glad that's over.' 'Yes. Me too'. (Continues to hospital).

A kid that ate iron supplements. PS. this can be VERY bad for adults but especially children. But in the first stages, all I had to deal with was another kid whom didn't quite like me.

A kid who stabbed themselves with an adult epi pen. PS. I don't really know how bad this can be especially when everything is fine after 45 minutes. Poison control agreed in this instance.

A delightfully bright elderly lady with basically nothing wrong with her. When I stood her up from her chair she was about a head and a half shorter than I am. There was a pregnant pause before she said. "That's as high as I'm going to get!" "Hey, I wasn't going to mention it." I said innocently. "You wanted to. I could tell." I want more patients like her.

A patient with flank pain called at midnight. Within the last week they'd been seen in the ER three times for the same thing. No primary physician.

Someone with a pulse of 35 and a BP of 70/p. Both very not good. But a patient I can treat?! Amazing. Lots of generic chest pains and sick people: aspirin, zofran, yay yay yay!

08 December 2015

Expectations

I had a recent encounter with a family who had expectations for me that I didn't meet. They called for their unconscious family member.  Having met this patient before, I work very hard to not fall into 'The boy who cried wolf' mode.  I take every call seriously until otherwise informed. 
This person was unconscious.  Or were they?  It is my job to figure out why they're unconscious.  I see they are breathing sufficiently, I pry open their eyelids and look at their pupils. I feel their pulse on their wrist.  I pull out the glucometer to check their blood sugar.  This is when the yelling started.  "Why are you doing that?!"  When I fail to match their anger, they get angrier.  "I don't know why you're doing that.  [they] don't have a sugar problem!"  Again, my answer is too calm.  I continue my assessment, take their blood pressure, and wait for my partner to return with a device to get their limp body out to the ambulance.  More abuse comes my way "I don't even know why we called you." and "You know what?  I don't like you!" is shouted at me.  Meanwhile they were refusing to answer any of my questions, produce medications the patient was on, or tell me anything of any use including the patients birthdate. An observer may have thought that I stood there with my arms crossed and did nothing.  They may have thought I was smothering the patient.  They may have thought I was requesting unreasonable things.

The whole thing really took me aback.  I really didn't know what to say, knowing that anything I did say would spark more anger, so I landed on "I'm sorry I'm not meeting your expectations."  But really I meant, "Please tell me what you want me to do?"  "This is standard assessment and treatment for the unknown unconscious person (who isn't dead)."  "There are only two of us, I'm here assessing this patient and my partner is getting ready for transport, this is how it works." 

But are these people thinking "I wish that the people I called to help us were as hysterical as I am."?  Did they want me to throw the patient over my shoulder, carry them down the stairs, across the yard and into the ambulance?  Did they want me to inject a miracle elixir?  I really don't know, and frankly, I don't think they did either.  Somehow, even though they call us for our expertise and experience, that isn't good enough unless they hear what they want to hear.

So where does the solution begin?  I wish I could tell you that I counseled these people and they came around and we all held hands and skipped through a field.  But I don't know how to fight such unearned anger. They don't know that their expectations are skewed, but I am certainly not telling anyone that in the heat of the moment. 

Patients are usually non medical folk, they're scared, they're at the end of their rope with chronic illness. There is certainly a lot more heartache and trouble in their lives than in mine, but does that mean I have to answer for that?  All medical providers are just the patsy, the scapegoat.  We are people who can be blamed for problems larger than ourselves.  We are in a society where more emphasis is placed on the temperature of a drink than the quality of patient care; it's hard out there! An individualistic society that blames all problems on everyone else.  A society that forgets that there are 6 billion other people who are all trying to be the lead in their on life story. 

Okay, I'm sorry.  I rant.  I think I only wrote this down to make me feel better.  I guess I do.  The problem still goes unsolved. On this small scale, I decide to fight anger with kindness.  Maybe one day it will work.

26 November 2015

Take the time

The other day we went for a medical alert call.  The good ol' "I've fallen and I can't get up." call.  These are some of my favorites.  Sometimes they are over fast.  The patient is embarrassed, we pick them up, put them in a chair and they thank us but want us to leave before the neighbors see the ambulance outside.  Sometimes we get to break stuff.  If all the doors are locked and the patient can't get to them to open them, things get broken which is always good fun.
And, sometimes we get to stay a while.
In the last year I've picked people off the ground many times, but one lady about four times alone.  I don't mind going to her house because she is fiery, funny, and likes to talk.  Boy does she like to talk.  The last time we were there we picked her up, cleared away the mess she had inadvertently made, took trash out and whistled at her new pet bird. 
On this occasion, one of our volunteers who works in a big town was rushing things.  He couldn't wait to leave, which he was free to do at any time, but I sat at the kitchen table with our patient.
Because I knew her and he didn't, I wanted to take the time, be sure she was okay, be sure she felt safe, be sure she was wearing shoes instead of slippers which is why she keeps falling.
The rusher did leave but made me think about this aspect of the job. I think it is as important as anything else we do. 
I have been having difficulty recently connecting with humanity.  These calls have become my primary way to do just that, and taking time is the key. 

Some of the only calls I can remember of late are these social calls.  A woman who couldn't work her new portable oxygen tanks.  She was an old immigrant, full of energy and, once we got her oxygen working busied herself trying to get us something to eat.  I called her doctors office, her son, and gave advice to her neighbors.  We fixed her a coke and went on our way.  15 minutes of our day where I actually felt like I did something.

My old partner and I picked a guy up off of his kitchen floor.  His thankfulness broke my heart.  A retired marine with an ailing wife in the nursing home.  He had struggled for ages to get up before calling.  We picked up the trash he had upset, vacuumed coffee grounds from the floor and petted his cat. 

I am retelling these to remind providers that we are working with humans.  If there is no need to rush out, what is the big deal to take a few minutes and make sure these people are squared away before we leave?  No, this isn't medicine.  It isn't saving lives, but it is doing what we had set out to do when we sat down in EMT class:  to help people.

I know being able to take this time might just be a luxury of working in a small town, but sometimes people just need someone to take the time for a chat, or to solve their menial but real problem.  Maybe all they need a cold coke and to know that someone cares.