Happy Christmas!

This year was totally weird. Not only because it was my first year away from home, but I worked Christmas eve and Christmas day also. It didn’t really feel like Christmas yesterday, especially as we had a surprising amount of calls. Also it’s been unseasonably warm here. I’m learning that there is no such thing as a traditional Christmas anymore, and I’m okay with that.

Santa came to our house on Christmas eve morning as Andy and I both had to work Christmas day. And by ‘Santa’ I mean Santa, the big man, the real deal. He has an amazing network, and is always on top of things. He’s unpredictable, and always has a trick up his sleeve. He brought me a crock pot and a sleeping bag, and some salt and pepper shakers. I’m going to be trying out the sleeping bag at work tonight, I can’t wait. Speaking of not being able to wait…it’s only about 20 more hours now until I’m back in the old line state! And 14 of that will be taken up by work!
After work on Christmas eve, I went to church here for the first time! Working nearly the entire weekend has pretty much precluded me from any church going. I was happy to go, especially on a special occasion. I have so much to be thankful for.

On Christmas, other than working, Andy’s parents came to the station and made us all breakfast which was really awesome. Then the calls started, and we didn’t get back to the station until the shift was over! We had a NICU run with twins! They were so cute, and weren’t terribly ill, so I could happily enjoy admiring them.
After work we had Christmas dinner at Andy’s parents house which was delicious and fun.

Now I’m off to finish packing!

The Home Stretch

In less than five days I’ll be back in Maryland for a week. I have never been so excited to be going home! It’s really impossible to explain, so I won’t try. Maybe in the upcoming week I will. Sorry that was really uninformative.

So, I’m working the next four days straight, I’m pretty excited. Why? Merely because the time at work will mark the passing of days, and might give me something to do. Oh, and the double time on Christmas day.

Work was pretty much uneventful this week. One of my colleagues had a patient with a dissecting abdominal aortic aneurysm last night. The patient coded when they walked in the hospital door, they were all freaked/excited. By the way, a dissecting AAA is where your aorta splits, and blood fills the cavity the dissection forms, and its basically really, really bad.

Ooh, also, my roommates saw not one but two moose in the back yard! We were all very excited and there was much rejoicing. Hopefully they’ll make some more appearances throughout the winter. And I can catch one, and ride it.

Well, now its 4 days 18 and a half hoursish, but who’s counting?

File under 'other'

On Wednesday I had two interesting overriding thoughts in my day. After our first two calls which were kind of fun. I said “I can’t believe we get paid for this.” It’s just amazing, I can poke people with needles, chat with interesting patients, cheer people up, occasional save a life, or at least try, and they pay me. But, by the end of the day, I said “They’re not paying us enough!” I’ll spare the details of the most disgusting call I’ve ever been on. I pretty much hope that I never have a more revolting, horrid call. That’s all really. It’ll be a hard call to trump.

I worked a whole 911 shift with Andy, it was totally weird, and totally cool. It’s hard to believe they’d let two UMBC graduates run an ALS truck. A scary day for the local citizens. We only had three calls which is fine by me for the night shift, one was an overdose. I almost said: “I’m sorry that you just want to sleep, but I’m afraid you’ll sleep, like, forever.”

Other than that, I actually hung out with my roommates, went to best buy for the lighting, got a fever that cowbell refused to fix, and bought cross country ski boots! I’m ready for snow now and ready to fill my would be kayaking hours with falling over in the snow.

Google search term of the week: “inject saline face freak” Yet another that makes anyone wonder what the searcher was looking for. Whatever it was, I’m pretty sure they didn’t find it here.

Lost in okay calls and love

It’s amazing how familiar I’ve become with the city I work in. My partner and I were both from out of town when we started, and we have found our way to every call without assistance. Well, on Wednesday a call went out to Apple Ave. I looked it up in our map book, and there was no apple avenue, only apple street. “Oh, apple street, we know where that is!” So we headed on over to there, and couldn't find the correct address. We called our dispatch to inquire. They say, you know apple ave, near the airport. My partner and I looked at each other. We were nowhere near the airport. What the heck! I didn't even know where to look in the map book now. I called up dispatch again, and got the cross streets, which luckily were in the map book. We ended up with a 15+ minute response time, but at least we know where apple ave is now (other than not in the map book.) Luckily the patient wasn’t critical.

On Thursday we were called for a car into a house. Whatever this call was about, I wanted to know. So we ran over there and found a car, that had indeed been run into a house. It got interesting when I discovered that the car was parked at the time. The cars owner was there, and I asked him if he was hurt, and he said “No, I was inside the house.” I was a little confused. It turned out that the car was parked on the street, someone in (reportedly) an SUV, crossed the center line, slammed into the car, forced it up a hill and into the house. In the process, the car was soundly destroyed. But the house was okay. The SUV in question: nowhere to be found. We found it pretty amusing to leave the scene of a car v. house and say “In service, no patient.”

Sometimes the local concert arena allows the customers to drink during the concert. This led to a guy who um, drank a little and face planted into the sidewalk. I couldn’t tell if he was confused because he hit his head, or because he drank so much beer that I needed to air out the ambo after we delivered him safely to the ER.

Then there was the guy with more complaints than my last 20 patients combined. He called us in the middle of the night, and then wasn’t quite sure if he wanted to go. Oh, at that hour of the morning, you’re going. I’m awake, and so are you. He complained of arm pain, back pain, neck pain, coldness, a headache, and some other problems I don’t want to mention. Then he had a great answer to my favorite question. “How long has all this been going on?” “Oh, off and on for about a month.” Why he chose 5am to call us is a mystery akin to that of creation itself.

I’ve also now experienced my first New Hampshire snow storm. So far, it feels just like Maryland. The drivers are just as bad, and I think all the streets are going to be white from now until May, not due to snow, but to the ridiculous amount of salt they use.

Have I mentioned lately that I’m in love? And have I mentioned lately that long distances relationships are nearly unbearable? Who invented them?! I want to know, I will hunt them down, and question "why, why why!?"
But at least I know that with this one, the love will not fade. (why? well, because I have awesome taste in shoes, of course!)

Marathon

Last week I worked six days in a row. The most interesting calls are already posted, I’m afraid. In three days, I did 38 hours in interfacility work. That yielded one call worth remembering. Have I mentioned recently I’m not a fan of transfers? Oh well.
This patient had stepped on a low shelf in the grocery store and reached up to the top shelf to grab something. You know this story can’t end well! As she stepped down from the low shelf, she caught her ring in the lip of the top shelf. As her body kept going, her finger was stuck and her ring degloved, snapped, and twisted her finger nearly off. At the ER she was told they would amputate. Well, because that is a very frightening word, she wanted a second opinion. That’s how we got involved to take her to another hospital. It was good times as I got to a. give narcotics and b. see the x-ray. I must say it was probably the coolest x-ray I have ever seen.
The rest of the weekend was the usual fare, none too exciting.

Google search term of the day “work in progess” Please note the misspelling of the word ‘progress.’ If you search for that in google, I’m the first site there!

2nd Google search term of the day “ice cream is good for flu patient.” Ah, yes. Ice cream is good for all patients, whatever ails them!

Complaining of?

I worked a shift on Tuesday to make up for having last Sunday off. It was interfacility transfers and we were pretty busy, but I got to work with my roommate which was good fun. I think that’s the most time we’ve spent together since I moved here. We have completely opposite schedules.

On Wednesday we were pretty busy and had a few interesting things. We started with a woman who had a TIA (transient ischemic attack = mini stroke). I’ll admit she had me a little worried, but as soon as we got her in the bus, her symptoms began to subside. It was a relief for me, but I’m so glad she called us.
Shortly after we had a lady with nothing wrong with her except for an overly concerned daughter. We did our old standby call and took yet another older lady to the hospital who thought we were all commies.

I would call the seizure in the dentists' office the most entertaining of the day. The patient on the chair had a seizure, the dentist called and we spent 10-15 minutes convincing the patient that he did, in fact, have a seizure and that he should go to the hospital. To illustrate to us the seriousness of the situation, the dentist pointed out to us that he even got the oxygen bottle out, I assume their only emergency equipment. I think this tank was circa 1970, weighed 50 lbs, and has had the same non-rebreather mask hanging off of it for at least 5 years. Once the patient could remember his last name and address, he was a pretty cool guy. For the last half hour of work, I finally got my nap out.

Yesterday I went kayaking. Yes, kayaking, the day before December, in New Hampshire, in a t-shirt. It was hella windy, but a good workout, and perhaps one of the last of the season, but you never know these days.

I started work with another seizure patient who I believe also had a little beer on board, making it impossible to distinguish between postictal behavior and drunkenness.
Then we had a couple of calls that fall into the category of “Grade D BS” or patients with no real complaint. The first was for trouble breathing. We arrived, found the patient sitting in his wheelchair talking up a storm to the fire department. (typically people with trouble breathing do not talk without signs of slowing) My partner began questioning him, and yielded nothing. First I overhead right sided weakness, then back pain, then my partner asked if he could walk outside for us. He was quite willing and jumped right up.
I began to get a little irritated. In the bus, I asked, so you’re having trouble breathing? “Well, not really.” Okay, so what is it? “I have this back pain...” Turns out he had it before, it went away, it’s not unusual, it’s not constant, sinus rhythm on the monitor. I asked which hospital, rolled my eyes at my partner, and started driving.

Around 2am we had a similar patient. The call came out as trouble breathing, we arrived and found a woman with no complaints and no obvious medical problems. She walked to the bus, we buckled her in, and I had to ask: "So, what's going on?" "Well" she explained, "I had a dream that I had shortness of breath, I woke up, and it turned out, I was short of breath." "Um...Okay. Are you still short of breath?" "No, I feel fine." I promptly pulled out all my hair.

We ended the evening/morning with an assault at the police station, and later, an assault at the local college.

T-giving weekend

I would give this thanksgiving weekend a rating of about 22.6 on a scale of 1-10, 10 being the best thanksgiving ever, 1 being no thanksgiving at all. Surprises, turkey, double time at work, Christmas presents, planning, frivolity, love, and general good times abounded.

Not much really exciting or overly holiday related happened when I worked Thanksgiving night. Basically I was able to hang out with my baby for awhile at work, and I was woken up about every 3 hours after he left. We had a fall, 2 non cardiac chest pains, quasi choking, and some other stuff that I can’t even remember. The choking was real, but resolved by the time we arrived, it was also marginally holiday related. I guess the rest of the city was in a post thanksgiving stupor of some sort.
We also had a guy who’s finger got twisted into a pneumatic drill. It pulled the skin a bit, but nothing horrible. Controlled bleeding and such. I patched it in to the hospital as I saw it (nothing to get excited about) and when we arrived we walked the patient into the first trauma bay, and we were greeted by a fair amount of staff (especially considering it was about 4am) all wearing their trauma gowns and masks and looking very serious. I felt a bit silly walking the patient at that point and I wondered if I said anything weird on the patch that would lead them to believe that it was really bad. I chalked it up to them being bored.

On Saturday we went to Boston to see the Bodyworlds exhibit at the museum of science. All I have to say is that it was really creepy, even to me, but worth every penny. It was super cool and good fun, as was the rest of the science museum. After that we drove aimlessly with our crappy map and ended up at a nice market type place where we ate clam chowder, watched some street performers, and basked in the glow of a fun, bustling Christmassy city.

The rest of the weekend was just plain awesome, although we didn’t do too much. We visited a lot of stores, and enjoyed being together.

Great Patient Conversations

nurse: “Have you had any surgeries?”
patient: “Apricot!”
everyone in hearing distance: “Wha?!”
pause: (pauses)
nurse: (in her infinite wisdom) “Can you show me where the surgery was?”
patient: (points)
nurse: “Oh! Your appendix!”
everyone in hearing distance: (stifles giggles)

me: “We’re going to move you over to this bed, okay?”
patient: “I’m gay?!”
me: “What? Oh, no…”

Google search term of the week, perhaps century: “society for the promotion of hubcaps.” You know what a philanthropist I am, especially when hubcaps are concerned. They really need all the help they can get. Support your local hubcap! All four of them! When you see a stray or abandoned one on the road, pick it up. Put them to good use.

Oh yeah, this weekend we had yet another kid who swallowed a coin that didn't quite make it all the way down. Kids!

Ow, my apricot!

Pics and missed calls

The best call of the week was not even my call. If it had come out 5 minutes earlier, it would have been my call, but alas. It was a motorcycle versus car, and the trauma team was activated at our local hospital almost as soon as the ambulance was on scene. Partial leg amputation. We were at the hospital when it came in, and I got to do what anyone else wanted to do: see it. Ooh, it was gross! The patient was taken to a level 1 trauma center about 10 minutes later, although I don’t think there was any hope of saving the leg.

Things were a little slow otherwise, but on almost every call I had a student with me. Still weird, but pretty sweet! Oddly, I’ve enjoyed giving away the few trade secrets I have to new people.

Finally after many dreary days, I went back out on the water today. Since I came back from Maryland, it seems, it has been raining and miserable. Pisgah and I had a nice paddle and it felt really good to enjoy the sun again.

Also, finally, I’ve added pictures from the end of summer.

Some more kayak spots. I think I’ll retire from taking pictures of lakes, they all look the same, unless I catch a sweet sunset or something like that.

Also, some of New Hampshire, Maine, and Massachusetts, that I’ve taken during my travels of the last few months.

Enjoy!

Odd choices and butter knives

Twice now we’ve been called to the same corner for psych problems. We’ve arrived to find a lady in her late 50s-60s flanked by six or seven police officers. No matter what, this is a curious situation.

The first time this happened 2 weeks ago, the lady looked harmless, but had probably consumed some alcohol containing beverages. There were bike police, at least 3 police cars, one with a very friendly dog in it, and the paddy wagon. One of the cops said to me “Good luck with this one.” My partner went up to the patient.

partner: “Come on, let’s go.”
patient: (refuses)
cop who warned me: “You can either go to the hospital, or go to jail!!”
patient: “Well then, I guess I’m going to jail!”
everyone: (incredulously) “What?!

When people are given this choice, no one, and I mean no one chooses jail. I mean, why would you? Going to the hospital can sometimes be a get out of jail free card, as you are probably crazy. We were all justifiably shocked, but at this point, my partner and I slowly backed away before she changed her mind.

The second time we were called to this particular corner was almost exactly a week later. This patient was not only in her 60s, but walking with a walker! She was definitely heard before she was seen, as she was screaming her head off about random things. Again, bike police, paddy wagon, and a slew of other police cars. An officer leaned down to me:

cop: “Good luck with this one.”
me: (this sounds familiar)
cop: “Yeah, she pulled a knife on us earlier.”
me: “Great...um, you mean like that one?”
patient: (had pulled a butter knife out of her purse and began waving it wildly at the surrounding officers)
cop: “dammit!”
cops: (wrested the knife from the lady, took her purse away, and smiled sheepishly at us)
patient: “That’s okay, I’ve got more at home!!”

We finally got her in the ambo after she determined that we were not communists and my partner buckled her in safely. The patient continued to shout randomly, expletives and otherwise such as “Poland!” and later “Slavery!!” She also told us the wrong name, and said that she was “22!!!” when we asked how old she was. Thank God I was driving because I was totally caught in the giggle loop. I’m glad she didn’t stab me, because if I had been stabbed with a butter knife by a 60 year old lady using a walker, I could have never told the story.

She didn’t make any more threatening gestures and we left her in the capable hands of the hospital security officers.

If we go back to that corner for another out of control retiree, I’m going to be freaked out!

Happiness!

Directly after my night shift last week, I flew down to visit my boyfriend. I’m pretty sure this trip is in the running for ‘greatest surprise pulled off ever in the history of surprises.’ My family knew, his family knew, and he was left completely in the dark, hilarious! His mom and I were in cahoots, and she convinced him that his father had a coworker coming over for dinner. Perfect motivation for him to clean his room, and leave his clinical on time. Predictably, he called me when he left his clinical, and I talked to him as he drove home, unbeknownst to him, closer to me. When he arrived, he said he’d better go as this coworker was there. Okay, I said, covering my excitement with mock disappointment.
Within minutes he realized that the coworker was me, and I was greeted with a probably 10 second open mouthed stare while we all laughed at his expense. Ah…

It was so hard to keep that secret! I feel weird disclosing it even now as it was shrouded in such secrecy.

Well, after the surprise we had an awesome week. We went on a hike, to the movies, to a couple parties. It didn’t really matter what we did, it only mattered that we were together. The surrealness of being his girlfriend is fading, and the nice is shining through.

I can be best described as content, even with the distance between us...for now. They say good things come to those who wait and I’ve never believed that more than I do now.

Also, I looked at jewelry, found my favorite place in the airport, decided my claddagh ring looks good from this angle, and became unequivocally happy.

Highlights of the Night Shift.

Last weeks shift is pretty much a blur, but more on that later.

Car accident with nasal injury. Unbelted, no airbag, a sharp stop, a pole, and something I’m not sure of caused our patient to have cut his nose from bridge to tip. The bleeding was more or less controlled before we arrived, we checked it out, took a collective yikes! and covered it back up.

Wacky cardiac rhythm. It was so wacky that I actually sent it to the hospital using the wonders of technology before we got there. I was dead excited that they received it successfully. The doc pulled me aside to inquire, and I showed him all the 12 leads I had taken and he came to the conclusion that he didn’t know what to call it. It was like a sinus beat, then a couplet of sinus beats (that looked different from the first) followed by a pause of about 5 seconds. Then the pattern would continue. Sometimes with sinus beats, sometimes with possibly atrial beats, and sometimes with ventricular beats. That’s confusing! Well, either way, the patient was virtually asymptomatic which was sweet, and we resolved her chest tightness with a nitro and some oxygen.

Car accident with a record seven refusals! It was a difficult scene to reconstruct, but my patient had had her license for what I believe to be another record of two days! She was very sweet anyway and her fault or not, I felt terrible for her situation.

We also got new computers installed in the trucks. They have great potential for coolness and handiness, I’ll keep you posted on them. Currently, they’re not programmed so that computer makes a good table, and our other computer makes a good lamp.

Highlights of the Day Shift.

The wino in the woods. The patient was passed out pretty far off the road. It really looked like a shady scene from law and order, but it quickly lost that luster after the cop pulled a huge, now nearly empty bottle of wine from her purse.

The woman who ran her suv into the side of a building. Not too much damage to either, but I had a difficult time holding in my laughter.

When I squished, crushed, damaged, injured, messed up my finger in the cot. It was my fault for having my finger there, but man did it hurt! To illustrate the seriousness of the situation, I jumped up and down in front of our patient and her family, put ice on it, and recently even put a band aid on it. Serious stuff. Unfortunately, it has hurt more in the last couple days than it did a week ago.

The call for the bus accident. Bus accidents usually go in a couple directions: really annoying, and really annoying. Well, this one wasn’t so bad. Apparently, the ‘incident’ occurred about 30 minutes before we were called. All of the passengers except two were rescued by another bus, and when I got there, stepped on the bus and saw only two passengers, I wanted to jump for joy. The driver was forced to come to a short stop, and everyone was thrown around a little. Out patent hurt her knee, no biggie, except that her companion had a lot of groceries which needed to go somewhere. They sorted it out with the bus people (who I’m sure were willing to compensate for the groceries in exchange for not suing them.)

Also, CHF, sick people, and crazies as always.

Fasting? Try Money

Last night shift was pretty sweet. I slept in relatively uninterrupted comfort from about 0145 to 0630. We started the evening with a local student who, after playing a game of organized sports, collapsed on the sidelines. We arrived and he was pretty out there but responded to pain and us shouting his name. The coach informed us that the student is currently celebrating Ramadan, and hadn't eaten since about 5 o'clock that morning. It was about 6pm when we found him. So, we start a line and took a sugar, and it was only 44. Well, that's not normal, especially if you haven't eaten in 12 hours. So we gave him some glucose and thiamine and he perked right up. I love calls where it feels like we're actually helping people. It was my first experience with a call as a result of a religious holiday, and I was pretty fascinated. I learned a lot from the patient, that is, once he was conscious.

That was pretty much the highlight of the shift as far as I remember. I was pretty excited to get a fair amount of sleep, as I had planned to go kayaking right after work. I changed clothes (added layers) and got on the water around 0730. It was early enough that a fog was rising off of the cool water, making for a very eerie kayak trip. It was about 33 degrees when I started, but I stayed pretty warm. Most of the fog had burned off by the sun as I finished a couple hours later.

Most of my weekend was typical although we were a bit busier for some reason. The most interesting call was for a kid who had swallowed a coin, roughly the size of a quarter. This would have been fine, except that the coin was too big, and got stuck part of the way down. The ER here tried direct laryngoscopy (pretty much looking down his throat) and decided the coin was too far down. Since it was a three and a half year old, they didn't have a bronchoscope small enough to retrieve the coin, so we took him to a more specialized hospital. The kid was doing fine otherwise. No trouble breathing, vitals were good, I was pretty much not concerned that anything stupid would happen en route. I talked to the doc briefly who basically told me that if the patient developed any problems, that I could knock him out with some valium use my laryngoscope to look, if I saw the coin "Pull the sucker out!" and if not, just "shove a tube in there." I found this pretty amusing, especially if I had to do it. The kid did fine on the way there, and I'm sure that the offending coin was removed shortly after we dropped him off without complication.

Finally caught up

Today started out with a chest pain call. En route it was revealed that his chest hurt only because his internal defibrillator had gone off 3 times. This call had potential. It had potential until I walked in the door, found a well dressed, reasonably healthy, asymptomatic patient. Monitor, O2, IV, and we’re off.

Also, a possible broken leg, morphine for everyone!

We had our first flu patient of the flu season who made my OCD flare up, forcing me to decon the whole ambulance. Whew! I felt better after ensuring that all surfaces that I regularly touch were antibacterialized.

Other than that I became blissfully aware, I think I learned what being in love feels like, and decided KT Tunstall is completely right.

And, the rest of the calls

A cute kid who learned that grabbing a knife is not the greatest idea. Her new favorite pastime was yelling.

We've visited a few public places recently. A seizure in the mall, a back pain in a bank, and a fall at the dunkin’ dounuts. We resisted playing into our stereotypes and left without coffee or doughnuts.

A patient complaining of leg pain. Yes, I’d have leg pain too if my legs were as big around as my torso. I cannot even describe this patient to you; it causes me to lose my appetite. How people can treat their lives this way, I don’t know. I was thoroughly disturbed and skipped lunch.

A lovers spat that ended with assault with a bottle, belt, teeth, and HIV.

I did an overtime interfacility shift and we got posted to a local hospital and did nothing for several hours. I went out to the truck for a nap and I think that I got nap whiplash. I fell asleep and snapped my head back up so quickly it hurt. It didn’t stop me from more napping though.

I think our most interesting call last week was for another person who was a fan of huffing computer dusting spray. I could barely believe it, and this person was older than me! When we arrived, she was being held down by her father. She broke free and ran past us while the family was yelling at us to stop her. Um…I’m sorry, but she seems pretty mad, and I don’t want it to be at me. The police came and she calmed down a whole lot, handcuffs usually do that to people. We took her in while she ignored us completely. The day before she had huffed herself into unconsciousness. Addiction is an amazing influencer, I can only hope she realizes this and takes the help that’s offered to her.

Can I borrow that black cloud for awhile?

One Monday I did an overtime shift. I was pretty excited because no matter what I did, I knew I was getting paid reasonably well for it. My partner was a new medic (newer than me, believe it!) who started the evening by informing me that he has a black cloud following him. I figured together we’d make a nice gray cloud that would allow us to sleep. We had calls spaced out enough for me to be really tired Tuesday morning.
The highlights included a car accident with 6 patients and a sexist firefighter whom I may later thrash. Three women were on scene from my company, and this guy managed to leave them all seething. It’s a talent, I assume he’s been perfecting it for forty years or so. Note to self: next time I see him on scene, ignore completely.
Later we had a call that came out as unconscious. En route we were informed that CPR was in progress. My partner and I divvied up the skills, and the tube was mine, sweet. Just as we arrived on scene the engine company reported ‘possible cardiac arrest.’ “Huh?” We both thought. So we grabbed basically the entire contents of the rig and moved in. I walked in just as the firefighters were pressing ‘analyze’ on their defibrillator. I could see that the patient was definitely out of it, but breathing on his own. “No shock advised” reported the AED. I threw him on our monitor to reveal a sinus rhythm as my partner confirmed a pulse. “Hmm…” We both thought.
We put him on the backboard straight away and moved into the ambulance. I told the wife to call her children, and we were doing all we could. Once I saw the patient in the light of the ambo, I figured it was a stroke, unconfirmed, of course. I put in an oral airway with no problem, and prepared for a tube. He was too clenched, and had a deep down gag reflex, so I abandoned the attempt. Dammit! Just as the IV was established, he started seizing, so we gave him valium, and I bagged him as his breathing rate fluctuated somewhere between zero and thirty. We were both hoping the valium would relax him enough to give him a tube, but nope! Once the seizing resolved, he continued to breathe on his own, keeping his sats up and me satisfied. We transported quickly.

The rest of the shift was full of patients whom I forgot completely. Hurrah for overtime.

So, Last Week

My parents came up north for a little visit, and we did all kinds of local things. On Sunday we sent to the seacoast and enjoyed hanging at the beach when no one else is around.
On Monday we went to Salem, MA and burned some witches. Well, actually we didn’t because it turns out you need a permit to burn witches in Salem. But, you can put supposed witches on a large scale to see if they weigh as much as a duck.

On Tuesday, we went to a shaker village in Canterbury, NH. I learned that shakers are totally weird. Weird like a highly organized pacifist cult. It is fairly amazing that they lasted so long, and had thousands of followers when their membership was based on adopting orphans and recruitment. The shakers lived in completely self sufficient communities, made their own clothes, food, buildings, etc. Okay, I’ve even bored myself at this point, so I’ll stop.

Finally, on Wednesday we went to visit the LL Bean flagship store in Maine. I got a new hiking day bag, which will hopefully inspire me to go hiking more often. It’s pretty sweet. We all had a good time surrounded by retail. Dad and I had a most delicious clam chowder at a local restaurant. I’m no expert, and I usually dislike seafood in general (I know I am a poor Marylander and New Englander) but this cowdah was awesome!

We relaxed and packed up on Thursday before I had to go to work. I thoroughly enjoyed myself during our little vacation. I was happy to show off our home improvement skills and our little one stop light town. I think they had a good time too. I didn’t even mind having an inflatable bed take up 90% of my office because I found the whole idea to be pretty hilarious.

More EMSie updates to follow soon. I am so far behind, I can barely remember what I’ve done lately. Good thing I write it down!

Mourning

The procession of police officers from around the state and around the country march proudly and solemnly through the streets downtown. The main roads are blocked off and I curse as I realize there’s nowhere to park and I’ll now be late for work. Then a wave of terrible guilt forces me to retract my curse. At the station, purple and black bunting has been hung carefully, the trucks are pulled outside, the crews standing in front of them as the procession passes by. A gesture of our sadness, our wish we could have done more, performed a miracle, saved his life. I miss the funeral on television as I am driving to the gravesite; we're there to represent the company, to show we care. As we wait at the cemetery, the fire department arrives and hangs an American flag from their tower truck. Marines prepare for the 21 gun salute and bugle taps. The procession arrives, and I hold my breath as the hearse and limos pass. The procession continues with what looks like the entire police force. I try to read the faces of the other officers there and find sadness, exhaustion, guilt. It seems they’re holding their wives and husbands a little tighter today. We stay outside of the cemetery, I can do without seeing most of it up close.
The strains of bag pipes fill the air and I look at the black band over my paramedic badge. I think of a person I didn’t know, that I’ll never know. A person who would have protected me from harm, gone into a situation while I looked out for number one, a person who would have kept me safe. Safe without question.

For him, I can only pray. Pray for his family to have strength, pray for his sacrifice, pray for this senseless world, and pray for those who continue to keep our scenes safe, or streets safe, those who put our minds at ease. It's not enough to say, but thank you. Thank you.

Link

Link

Comments!

I tried to take a picture of the highly reflective and ridiculously large paramedic patch, but it was just too reflective!!

edit 10.22.06 11:13pm: Okay, so it's not actually a picture of the vest, merely what I thought would be an amusing picture to illustrate how large and reflective the patch is. I couldn't really find the picture that I was envisioning in my mind.

And, yes, a super sleuth found me out at work.
Super Sleuth: "Are you 'A work in Progress?'"
Ellie: "Uhhhhh...."

I was a little surprised, to say the least. I guess I'll just have to stop badmouthing every one at work. And to think, I was just about to post my list of people to kill in order to get a better full time schedule, oh well.

edit 10.22.06 11:16pm: I wasn't discouraged by you finding me out, I just haven't had the time to write! More to follow soon...I hope

Didn't get much sleep

Lack of updates to be made up for immediately.
Last night started out with a diabetic problem at our local arena. Sounds simple enough, right? Well firstly, the circus is in town. We got to go in before anyone else and see them cleaning up and what not, it was cool. Also, since the arena is across the street from the station, we have had regular zebra and camel sightings.
So anyway, this guy was acting pretty normal and his sugar was 67. We kicked it old school and had him force down a delicious tube of sugary gel. Well, he hated that but we figured that if his sugar went up, he could be on his way like he wanted. After finishing that, we checked again, and his sugar actually went down. Dammit! His mental status was deteriorating as well, so we went to start an IV to give him a quick solution. Four attempts later, we still don’t have a line. Dammit! So, I go out through the gathering crowd and grab the glucagon. What an annoying drug. Draw the saline up, inject it into the other bottle, shake it, draw it up, give it IM, only this guy had such thick skin that the needle nearly broke off, it was crazy!
So, we finally actually treated this guy and wheel him out to the bus. I hate when cut and dry becomes not so cut and dry, but that’s what keeps it interesting. His sugar and mental status were improved when we arrived at the hospital.

Our next call was for psych problems. I swear, every other call that goes out is for psych problems. I don’t understand it. We made our way there and we were warmly greeted by the patients daughter. Apparently her mother was trying to leave the house and find her husband, which is fine, except that it’s 2 am, raining, and the husband died 14 years ago. This is a sticky situation, I can tell. So I get the background, and the patient has done this before, but not recently. I talk to her, and she’s pretty with it otherwise. She knew most of her birth date, and got the first three digits of the current year right. She didn’t appear to be a threat to herself or others, she was perfectly willing to have a nice chat. The daughter could not legally forcer her to go to the hospital. It’s getting stickier, like maple syrup. I’m not really sure what to do, and can’t envision a good ending to our scenario. We tiptoed around the fact that her husband would never answer the phone, and spent about 20 minutes convincing her to go with us before I asked if she’d let us test her blood sugar. “You’re so nice…sure!” Luckily for us, it was over 500 (way high), and we finally had our bargaining chip. It’s a lot easier to say “Let’s get your sugar level sorted out.” than “We think you’re losing touch.” She happily came with us after this, and hopefully she’s getting the help she needs.

We also had a sprained ankle, the most pointless call ever, and a very spry 90 something year old with abdo pain. It's been a while since we had a busy night shift. It seemed that every time my head hit the pillow I was asleep, and 10 minutes later I'd be woken up again.

Eye Candy

Monday I drove about 250 miles in search of foliage and crafts. Random, yes. I drove north to go to a craft show. It turned out that the craft show was sub par, but discovering this was well worth the drive. I went up to Franconia notch state park, and enjoyed ogling at the white mountains. I hadn’t been in this part of the state for probably more than ten years, when I came here on vacation with the fam. That’s when I got to see the old man in the mountain, God rest his soul. I drove for miles in the White Mountains National Forest, lost the other tourists and found Zen.

I decided to get home without using the highways, so I picked my way carefully through many towns, and beautiful autumn scenes. I found lots of hikes that I’d like to do whenever I’m not alone, and eventually stumbled upon Lake Winnipesaukee. At 72 square miles, and with a shoreline of about 288 miles, it is one of the largest lakes in the country. I managed to find one of the public boat launches (thank you Alton Bay!) although I think I technically needed a permit of some sort, but information was limited. It turned out that after searching for a boat launch, and then dodging the innumerable speed/recreational boats and their wakes, it was more trouble than it was worth. But, I’m glad I went.

So, I can say I found a lot of New Hampshire, the New Hampshire that tourists see and enjoy. I can see what brought hundreds of thousands of cars to the lakes and white mountain regions.

Ow, my eyes!

I’ve forgotten to mention that I finally got my squirrel vest at work. Really it’s just a fleece vest to keep warm in the frigid northland, but it has my name on it and stuff, and the absolute highlight is a large and reflective patch on the back that says “Paramedic.” It is awesome. I think it could be larger and more reflective, but then it might blind people if they shine a flashlight at my back.

I’ve been kayaking a lot. I went four times last week. On Monday it was wicked windy, about 10-15 mph. It was making the water really choppy and wavy. It was so much fun. I got all wet, but it was good fun. On Friday, it was really cold. I had to wear a jacket for the first time in the season, and I wished that I had invested in kayaking gloves already. But, I am working on a great callus on my right thumb which is pretty hardcore.


Work wise, I have had four relatively uneventful shifts. On Wednesday we had an abdo pain who I gave phenergan so as to prevent her breaking my #1 rule of riding in my ambulance, no vomiting. Our next call was for a guy who walked into the station, in search of detox. We ended with a chest pain which resolved with nitro before we even got there.

On Thursday the most entertaining call was for a possible overdose. We found our patient who had taken heroin for the first and probably last time. No, not because they stopped breathing, but because she was completely freaking out. She was crying, sweating, hyperventilating, complaining that her head hurt, that her bones hurt...drugs are bad. Then we had zero calls from 1a-7a, sweet!

Saturday and Sunday we had, like, a billion BLS calls, and a femur fracture to close out the weekend with some morphine.

Night and Day

After all the excitement of my day shift, I was all hyped up for my night shift. But it turned out that they were, well, like night and day. We only had 3 calls in 14 hours!

Also, my weekend shifts were pretty boring as well. I got very far into my book, watched more football than I have in my entire life, and did my favorite work pastime, got paid to sleep.

This was also the weekend of the fair here. I did EMS standby for a while Thursday and Friday. I must admit, this fair is pretty cool. I watched a woodsman contest on Thursday. Here, people rolled large logs, threw axes, sawed blocks of wood, and my personal favorite, used an ax to chop a piece of wood that they were standing on. It was pretty cool, and nobody chopped their leg off by accident.
I also enjoyed fried dough, apple crisp, hot cider, and a sample of maple syrup cotton candy. That’s right, maple syrup, poured into a cotton candy machine, and made into delicious clouds of diabetic ketoacidosis. It tasted awesome, but I’m pretty sure that if I, or anyone else for that matter, ate a whole bag of it they would die, but what a way to go.

While we exited the maple syrup house we got our fair quote of the day from a kid ready to enjoy what the fair had to offer: “Yes! I love sugar!”

On Friday I went to the fair in the evening, and took in some horse jumping, local arts and crafts, and some local color. Second fair quote of the day:

Dad: (angrily) "You’re goin’ to see the animals!!"
Kid: (sadly, and possibly crying) "Okay..."

Friday night we almost had a search and rescue operation in our one stop light town. We were called to stage at the station, and soon went to the house where an 90+ year old had apparently wandered from their house. It was 46 degrees out, breezy, the terrain around the house was a swampy lake, and next to it, a steep gully. The search would have been horrid, but probably short.

But it turned out that the spouse of ‘lost person’ who had woken up to discover that they were gone, actually forgot that the patient was taken to the hospital the day before. Whew! We could all go back to bed.

Drug Box Awesomeness

The greatest call of the day/week/month came out as chest pain. We arrived to find our patient who only spoke Spanish with no translator in sight. Oh yeah, what made it a pretty hilarious call as well was the fact that I had a paramedic student with me.

So, the student started to attempt doing his thing, although none of us spoke comprehensible Spanish, while the firefighters went to get the stair chair. When they returned, one of them for some reason inquired “Why is she on a nasal cannula?”
Although I’m sure that some of my colleagues would point to the paramedic patch on their left shoulder and say “That’s why!”
I, however merely attempted to explain that I believe a nasal cannula has more uses than for tying things together. Where a mask can feel constricting, a nasal cannula can deliver oxygen without raising the anxiety of the patient, the patient can still get a relatively high concentration of oxygen, and although you think she appears to be ‘gasping for breath,’ I think she is doing alright, also her pulse ox is 99% and why am I still explaining this to you? We need to get out of here.

After stairing her down three flights of ridiculously steep stairs, we got her safely outside and in the ambo. Vitals, monitor, IV. I follow my partners gaze to the screen of the lifepack 12 to discover SVT, which is basically when you’re heart is beating uncontrollably and abnormally fast. She was going at a rate of 186 at one point, about three times faster than my resting heart rate.
Luckily, an English and Spanish speaking neighbor materialized out of nowhere and knocked on the ambo doors. She didn’t mind translating for a minute for us. The student, bless him, tried to explain vagal maneuvers to the translator, which I think the patient understood, but they did not help her. (If you stimulate a particular cranial nerve, sometimes tachycardia can be ‘broken,’ this is what we were attempting)
When that didn’t work and the translator unfortunately left, I decided to break out the adenosine. This is a drug best described as a chemical defibrillator. It essentially can stop the heart, and cause it to (ideally) reset to a more normal rhythm. I had never pushed it before, so I was a little nervous, plus it was difficult to explain to the patient that she was about to feel more than a little weird. (‘Muy mal’ was all I could come up with, but she already felt bad.)

So I drew it up and handed it to the student who, I later learned, couldn’t believe we were carrying out a textbook case like this. I prepped a flush, and we pushed. It’s an exciting drug because you have to push it really fast and then flush it immediately so that it goes through the blood stream very quickly. Then we all stopped and waited. Seconds ticked by, then suddenly, just as we had almost given up, the heart rate went from 180s, 160s, 120s and then ended up hovering around 110. I could barely contain my excitement. “Esta bien?” I asked, and she shook her head yes, looking relieved and quite a lot better.

Now, I love all the drugs in the drug box, but it seems that every time I use a new one, it becomes the reigning favorite. Although we didn’t get the characteristic period of asystole that can sometimes happen with the drug, it was still amazing.
Every once in a while this paramedic thing really comes in handy.

Are my pupils equal?

When I got to work, I stepped up into the back of the ambulance and rammed the top of my head right into the doorway. I wasn’t sure which hurt worse, the top of my head, or my neck where it got hyperextended. Oh, it was throbbing. I stood there in the truck, blinded by my trauma, and thinking I had broken my neck. I wondered if my ear was leaking fluids, if my pupils were equal, and if I was bleeding. In a few minutes I could clear my own c-spine, but I continued to damn the tones, sirens, peoples voices, and any movement that caused me to feel my pulse in the growing goose egg on my head.
It’s better now, although I had to comb my hair very gingerly today.

Our first call was to assist the police with an unknown problem. They were trying to serve a warrant and the arrestee was claiming that her doctor told her not to leave the house. So, they called us to check it out. We walked in and a spry looking woman was sitting there, smoking a cigarette and yelling about going. She kindly showed me her most recent discharge papers which did say ‘no strenuous activity’, but nothing about leaving the house. I suggested that we call her doctor to confirm, and she immediately jumped up and became perfectly willing to go with the cops. Well, that was easy.

We later went to the same street to assist the police with the aftermath of a bat and pipe fight. Everyone involved was refusing care, so we left it as police business. A few hours later we had a call to the police department. Turns out one of those involved learned that after the beers wear off, it really hurts to get beat with a bat.

Another call led me to several fruitless conversations including this one:
me: what’s going on
firefighter: He’s got MRSA.
me: Okay, but what’s wrong with him?
firefighter: Oh, I don’t know, but he has MRSA.
me: (checks gloves and goes in search of answers)

It turned out that there wasn’t really anything wrong with the patient, but his wife insisted that he go. I got about as much information out of the home care nurse as I would have out of a stranger on the street.

We also had a chest pain, back pain, and I’m sure some other stuff mixed in there. It was a good day, we were only on station for about 30 min total. One of the most exciting calls of my career to be posted shortly (I hope.)

Holy Cow, it’s the Fire Department!

After a long dry spell of interesting things to blog, it seems that in one day I’ve had at least a months worth of excitement. I can barely handle it! So. I’m going to start from the beginning (of my day that is).

Around 130 am today, Andy woke me up, and said “There’s smoke in the house.” What! I am not the easiest person to wake up, but I think I am getting better and faster at going from zero to competent, thanks to work.
I threw on a coat and opened the door to the hall and was met with this horrid, acrid smell of some sort of burning substance. Hey, I’m no firefighter. So, Andy was sniffing around the house trying to find the source of it. He was already up because he is a responsible volunteer type and was going to go to a real call that had come out a few minutes before he stepped into the hallway and smelled this smell. Instead of going to the original call, he decided to have some more firefighter types come over and check it out. So as the emergency apparatus came up the driveway, it was crazy, I felt like that kid from A Christmas Story, looking out the window excitedly shouting “Holy cow, It’s the fire department…geeze, it’s the cops!”

So, some fine citizens of our one stop light town came with a fire camera and Andy finally followed his nose correctly, right to a melted measuring cup on the heating element of the dishwasher.
I immediately stopped packing the truck with all of my prized possessions, and went outside to find Lou who, like the teacher she is, was at a safe distance from the house with the dog.

Then we opened up all the windows and tried to air out the dishwasher. I think it’s fixed now, but we’ll never measure 1/4th cup again. Oh well.

The rest of my totally exciting day tomorrow, I hope.

Hometown Madness

Last week after a day at work, I got up early and flew home, amazingly cheaper and much faster than driving. It only took me about an hour of flying time to get to the Baltimore area. From there, the parents found me and we went directly to the fair in my hometown. We are crazy about the fair in my family. Relatives come from even farther away than NH to enjoy it. There’s something about it that entices us back; the food, the entertainment, the nostalgia.
Because the fair has such a draw, I saw a great many of my family members, almost as many as Christmas time brings.
The fair is never complete without corn dogs, laughing hysterically during a wild ride on the tilt-a-whirl, getting heckled by carnies, running into about 50 people you know, petting some cows, posing with a tractor, and doing some serious people watching.

We also got to enjoy the annual demolition derby. Hilarious and awesome as usual and hopefully next year my cousin will get a few more hits in before his car dies.

I got back and went to work that night. I was uber tired, and luckily nothing overly taxing happened. We had a back pain, a nose bleed, a chest pain, and something else I can’t remember now. The chest pain was kind of annoying.
Me: "Is you chest pain sharp or more dull?"
Patient: "Um, it’s really, um, it’s just this pain..."
Me: "Uh...Does it change when you breath in or move around?"
Patient: "I'm, uh, I'm not sure, just a pain..."
My brain: "I'm going to freak out now."

Pretty much every exchange with this patient went like this, earning her the title of ‘poor historian.’ Basically we just worked it up and went to the hospital.
So far today we’ve done 4 BLS transfers, that’s about as entertaining as it gets!

I’ve learned that it’s really weird to go on vacation to your hometown. Coming home from college, I was living out of a suitcase in my own room. Coming home from, um, what can also be described as home, I was living out of a suitcase in a room that somehow resembled my room. But I didn’t feel sad, it was just bizarre. I was happy to realize that I could still navigate around town, and felt entitled to complain about the changes that have occurred in my absence.
Is it everyone who is unwittingly and forever tied to their hometowns?

No place like home

A proper update very soon, until then, a nutshell. Smashed up cars, whiny patients, the family, life long friends, air travel is brilliant, great food (corn dogs, hot turkey, funnel cakes, cotton candy, and pretzels), and being on vacation in my own house is straight up weird.

90 days, memory gone.

Since last we met: Um, a 10 month old w/febrile seizures, an increasingly crazy lady, a car accident with 3 refusals, one girl in big trouble, a guy who put his hand though a window (unfortunately a window that had glass in it), a lady who needed to be picked up off the floor at 4am, and some other calls which I totally don’t remember.
Also, I got my 90 day review (so now, they can’t fire me on a whim.) I can hardly believe it’s already been that long!

I’m off to Maryland tomorrow to enjoy family, friends, cars smashing into each other, piglets, and delicious hometown fair foods. Woot!

Socks and Saws

Patient complaint of the day: “My feet are cold.” We found her sitting on the floor outside of her apartment. How she got there was a bit of a mystery. Apparently she fell down in her apartment, and found it to be a good idea to crawl outside with a blanket, her purse, and her shoes. She ‘needed’ to go to the hospital so she could get her medical records. And her feet were cold. When she started moving she writhed in pain and exclaimed “My leg’s asleep!” Between us picking her up and putting her on a chair she made the greatest decision in the history of decisions and said she’d call a cab.

Then we had a call for cardiac problems. When we arrived, we found a lady looking totally fine sitting in a clinic. The doc took a 12 lead as part of a pre-op check up and found some changes indicative of a heart attack. They hadn’t done anything for her, and why? She was completely fine. Asymptomatic from the time she walked into the clinic to when we left her in the ER.

The best call of the day was for a laceration in the meat department of a local grocery store. As the patient put it, he had a fight with a saw, and the saw won. We had the tip of one finger in a bag (or was it a piece of pork?) and the others were down to the bone.

Also, a sick lady and two fender benders without injury.

Long Enough?

Five years.
Is that long enough for television specials, dramas and documentaries, two theatrical release movies? One, “Flight 93” which made almost 31.5 million dollars in the US alone. More recently, “World Trade Center” has made 55.6 million dollars so far. 87 million dollars, for who? Were these movies made in case we forgot? To remind us of what humans are capable of? As scare tactics?

I still see faded "United We Stand" stickers on cars. I think we’ve forgotten what we’re standing for. It is a day of national mourning, and five years later, those responsible still roam free. Because the president puts a wreath on ground zero we're supposed to feel safe, comforted, of one mind?

I read an article in JEMS about EMS providers who are literally dying from materials they inhaled during the clean up. People who are left with 33% of their lung capacity, bills they can’t pay, rare types of lung cancer, having to quit the job they loved because of debilitating long term effects, lost in debt, and suffering daily with respiratory distress. Maybe they could use some of that 87 million.

PS. Don't forget to vote tomorrow.

The miracle drug

We’ve had a whole mess of calls where ice cream could have been realized as a powerhouse drug in the prehospital environment. Amiodarone is to cardiac problems as ice cream is to everything else.

We had a call for a fall. We found an 80+ year old lady who fell from standing and broke her wrist, her pelvis, was knocked out for about a minute and ended up with a concussion as well. Osteoporosis is a harsh reality, so keep eating that ice cream!

Guy having pain from his sciatic nerve. Treatment: Ice cream topped with morphine.

Chest pain with sinus arrhythmia 100-160. Treatment: Ice cream with bits of nitro in it. Worked like a charm.

We had a lady with more complaints that all of my previous patients put together ever. "I can't feel my legs, and my arms hurt, and I have heartburn, and yeah, now that you mention it, I am having trouble breathing. Also, my back hurts, I can't stand up, I feel tired. I'm thirsty." I said: "Here's a quart of breyers, call me in the morning."

A woman who got pushed into a wall by her crazy mother. "You're sure you want to go to the hospital, because I think this ice cream will change your mind."
Crazy guy who wanted a cigarette, how about a bowl of cookies and cream instead?

In addition: hypoglycemia, hyperthermia, headaches, and crankiness in general. Forget ice packs, just rest that bowl of mint chocolate chip on your bumps and bruises, amazing.
I’m ordering my in-ambulance freezer right now!

*not suitable for patients with lactose intolerance.

All we could do?

It was supposed to be easy, but these things never are. When I entered the house, from downstairs I could hear the fluid in her lungs. The patient was dying. The family, initially prepared for this event, had been enduring her tortured breathing for an hour now, unsure of what to do.
The daughter, who could legally decide, didn't want her transported, and only really wanted her to be comfortable, nothing invasive. I was at a bit of a loss as to what to do. Lasix would only delay the inevitable and what she really needed was intubation, among other things. With a pulse in the 40s I tried to explain to the family that it was quite serious. I realized we were treating them more so than the patient, they only wanted to know that she wasn't in pain. So, we gave her oxygen and I attempted a line, but the lighting was terrible and she had no veins. I found myself able to think about nothing other than how horrible the situation was. Midway though my IV attempt, my partner leaned over to me and said "I think she stopped breathing." I felt sad relief come over me as I realized just how quiet the room had become and felt for a pulse, there was none. Like me, the family had not yet realized what had happened, and I had to tell them.
I was glad that the patient got what any of us would have wanted. To die at home, surrounded by family and friends. I just wish I hadn’t been there too.

The spice of life

We had a patient who had been huffing. ”Huffing?!” I thought, “who does that these days?” But indeed the patient had been doing it, and the mother produced the can to prove it.
a. you are much older than 16, the age where I thought huffing, if it were to happen, would happen.
b. it is not 1995, which is when I think the last reported case of huffing occurred.

A lady found a bump in the sidewalk that caused her to crash her motorized wheelchair. The second motor wheelchair wreck in my career, and in this one, the chair came off worse than the patient. She was refusing before we were over the threshold of the store she had stopped in. I wanted to slip the card of my favorite lawyer in her purse, but alas, he works out of state.

I think I had my first ‘sick person’ who actually turned out to be a sick person. Lots of calls come out as ‘sick person.’ It’s like the default category for calls where dispatch may or may not know what’s going on. Usually these calls turn out to be things like ‘fell in the bathroom’ ‘fainted’ or even ‘cardiac arrest’ but for some reason or another, the call is categorized as ‘sick person’ usually due to on the phone confusion.
But this guy was actually what I envision when I think of ‘sick.’ He’d been not feeling well in the tummy and threw up. That’s it. He didn’t seem into it, but his wife was insisting that he go to the hospital via ambulance while she’d follow us in the car. What?! It was like these people never lived life. I felt like saying “We are ambulance people, we come in peace. You are in a state which we call ‘sick’ which usually does not require any immediate medical attention. I prescribe…” looks at watch, “12 hours time, and you’ll feel much better.”
But instead we helped him to the ambulance and to the hospital where I’m afraid he spend most of those prescribed 12 hours being bored to tears in the ER.

At about 4am we had a chest pain call. I hate this general time of the day. I always feel disoriented if I’ve been sleeping. We arrived to find a guy sitting in his living room clutching his chest, sweating, and generally looking like crap (yes, that’s a technical term.) We got him in the ambulance and gave him the full ALS work up. His pain went from a 10 out of 10 to a three with a couple nitros, and the 12 lead was completely unremarkable. Whew! We set out toward the hospital and arrived without incident.

In addition: A teenager acting totally weird. Psych? Drugs? Simply being a teen? Who knows? A leg pain call that took less than 30 minutes start to finish, and a fainting that we couldn’t figure out so we did what we do best; went to the hospital.

Bloggie Benchmarks

A work in progress is celebrating 150+ posts and 7100+ hits! Yay. Certainly there are blogs that get that many hits in one day, or even one hour, but hey, it took me a year and a half!

I'm going to celebrate by going to bed early and working the entire weekend! Woot!

(if you want to buy me gifts, I'm sure we could arrange something, for the good of the blog, of course!)

I’d been gettin' a vibe…

We headed to a call for seizures. We figured something else was going on when two police cars showed up too. The relatives on scene said they were worried that the patient had a seizure and was refusing to let them in the apartment. The patient had a history of being combative when postictal (the state someone is in after having a seizure, typically they are confused and out of it, occasionally to the point of being violent.) So, we headed up to the apartment which turned out to be about 400 degrees, with the patient lounging in a chair looking totally fine. The relative insisted that she go to the hospital to be checked out and the patient jumped up and appeared to ready herself for a trip to the ER.
On some calls, okay, on most calls you get a vibe of some sort. Sometimes it’s nothing, or that something doesn’t add up with the patient and their situation, or my favorite, when the vibe you feel is that of crazy. Just as this particular vibe was washing over me, the patient rushed forward and grabbed a bag so full of trash that things were spilling out of it, shouting “I’m not leaving without this!” and ran out the door. One of the cops went after her, and we all followed down the hall, down the stairs, and out the door. I thought that she had bolted, but had actually been putting the trash bag in the trash room in the basement. The patient then said, “I’m not going to say anything else.” stepped into the ambulance and laid down on the cot. My partner and I looked at each other, shrugged and stepped in behind her. From here on in, the patient did indeed not say anything else and refused to do anything but sit there.
I buckled her in and drove to the hospital. Just as I was pulling into the driveway and heard my partner saying things like “don’t unbuckle those seatbelts” “were almost there” and “don’t do that!” I looked in the rearview mirror and saw that their faces were inches apart, so I threw it into park, ran around and opened the back door. I had absolutely no plan as to what to say or do after that, but the patient looked at me, released my partner and jumped out of the ambulance before I could even shout “Hey!” My care level for her was at it’s absolute lowest at this point, and I didn’t even care that my supervisor watched as my partner and I threw up our hands and watched her walk into the ER. My partner was unharmed, although her radio mic was broken. We were both happy to be rid of this patient.

Vacationland

I did something really vacationesque with my day off, I went north, and when northerners go north, it can only mean one thing: Maine. Many New Hampshireites, Masstonians and Connecticut-people choose to have summer homes in Maine. It seems these places can be placed on a spectrum. On one end there is a beautiful, huge home with every amenity you could hope for and a classy grocery store close by. It overlooks private beach where you can watch the dog and the kids splash around in the surf while enjoying your break from the office. I’m sure there’s a light house in there somewhere too.
On the other end of the spectrum is a simple cabin with basically no amenities, in the middle of nowhere on a virtually private island. The nearest road as well as the nearest grocery store is more than 30 minutes away. Space is rented to park your boat on the mainland as there’s no other access but the sea. You enjoy the smell of fresh cut wood as you lounge in an Adirondack chair counting different types of pine trees and water birds while contemplating life.

My Maine mini-vacation was the latter. Pat’s parents own a little place, and when he told me he’d come pick me up at the marina, I was beside myself with joy. We took the little boat back to a secluded cabin lacking electricity and indoor plumbing, but full of character and promise. We took a hike around the island enjoying the odd geology of an island that seemed to be made of purely rocks and trees, beautiful trees. We spend quite a bit of time sitting on the porch, talking about various things or just enjoying the silence and seclusion. We took the boat out to explore the other islands and look at some of the beautiful sailboats and houses people have out there. Pat showed me my first osprey, which I found pretty cool. The whole thing was very Thoreau.

On my way there I stopped at the ever-growing LL Bean store. The LL Bean store. Since my last visit, many years ago, they have added two more buildings and many products. My Christmas list grew a little after my visit, and I found myself with a new dry bag as my current one is starting to fall out of the category of ‘dry.’

A different kind of job**

He's upset, and they can tell. He has good reason to be. The ambulance is there to take his dying wife to a hospice home. She won't be coming back, nothing will ever be the same.

The paramedic expected a frantic family and when they met she could tell that they were only calm on the surface. The call quickly became a bit of a complicated situation as the patient was on the second floor and any movement caused her agony. The husband immediately questioned the quality of a two woman crew and their ability to get his wife out of the house successfully.
Undiscouraged by this common misnomer, the crew weighed the options of different ways to get the patient out of the house. The stair chair was not even a choice, carrying the stretcher in was a bad idea, and it turned out that the movement required to use a scoop stretcher was too much for the patient to handle. Finally, they settled on a long backboard to minimize movement. A bolus of morphine was administered before anything was attempted. Once the patient was secured, it was a difficult climb out of the house and into the ambulance, but the patient seemed comfortable. Although it was not the smoothest moving they had performed, the crew felt relieved that they had not added to the patients distress. It is always best to stop and rest, rather than endanger the patient.

After the patient was carefully moved to the hospice house bed, the husband expressed his displeasure with what he perceived as ineptness of the crew and their inappropriate equipment. What they had seen as reasonable options and careful guess and test, the husband saw as wasted time with tortuous, antiquated techniques and equipment. What the ambulance company saw as a competent crew, the husband saw as two women who were not strong enough or qualified to remove his wife properly and safely. He seemed blinded by his pain, unable to see that the crew had done their job well.
The paramedic tried to explain that they were only trying to do what was best for his wife, but as she spoke, she found it difficult to explain the thought process involved with complicated extrications and almost impossible to explain that a scoop stretcher has practical modern uses, although it looks archaic.

What the husband didn’t know was that the paramedic’s heart was breaking from the moment she realized that this call would not be what she was used to. They weren’t taking the patient to a place to be healed, they were taking the patient to a place where there was no hope. From the moment she read the patients age, from the moment she walked in the door of the house, from the moment she realized that she would play a part in changing their lives forever, her heart broke. Every time she reached for the patients hand to be sure she was doing okay, a heavy feeling in her chest threatened to overwhelm her. The fact that the husband’s mind was not put at ease, that he was unhappy about his wife’s transport, and that she had inadvertently aggravated an already horrible situation that was beyond her control, killed her.
As a paramedic, as an EMS provider, as a human, she had been taught to solve problems. Trained to mediate, to mitigate impact. Training that was failing her now, as she could offer nothing more than an apology, do nothing but to realize that grief was his motivation, and wish that she knew how to comfort him.
In her own mind all she could do was relive the call and know that they did the right thing and that this was simply a problem she couldn’t solve.

** A fair warning: This post is based from an interfacility call I had recently that I can’t get out of my mind completely. And when you can’t seem to forget an interfacility call, it usually means it was very unpleasant.**

So, what's the address?

The most curious call of the weekend came out as a ‘warm response’ which is for whatever reason what we call a ‘hot’ response for our interfacility trucks. What does it mean anyway? You either use both lights and sirens (hot) or use neither lights or sirens (cold), with no in-between.
Anyway, the call was dispatched through our operations center, and they’re not exactly adept at dispatching emergency calls.
“Warm response to 683 main street, that’s 683 main street just west of the city line, they say it’s about four houses away from the city line but it’s 683 main street. the house has white siding on top and brick on the bottom, they’re going to leave the garage light on for you, it’s just outside the city boundary, but its 683 main street, warm response, uh, for diabetic problems.” I can’t make this crap up! He was dispatching this call for minutes, while we have to stand there incredulously waiting for him to shut up long enough to say “we get it already, show us en route!” We’ve gotten quite adept at reading maps. I’m surprised he didn’t go on to add “they have a green lawn with bushes and trees out front. There’s a car in the driveway, and a mailbox at the end. It’ll have the house number on it which is 683 main street, and it’s not in the city, but right outside of it, it’s a paved driveway, no gravel, asphalt…”

So, we got there quite easily and found a patient with hyperglycemia. The house was awesome, though, completely lined with books. I walked in and got that lovely smell of old paper, knowledge and education. I could have stayed all day picking the brain of the patient about her life while browsing through their massive book collection.
But alas, what made the call curious was that they had called 911, the fire department came, and subsequently, more or less, refused to transport the patient. I found this highly irregular, given the reputation of the fire department, and given that the lady had taken her insulin, eaten nothing, and still had a blood sugar of >400, which is not exactly a situation you can take lightly. So we got her to the hospital (perfectly willingly), and I advised her daughter how to make an inquiry/complaint at the fire department. She wasn’t exactly outraged about it, but I told her my concerns. I felt a bit like I was betraying an ally, but refusing patients?! That’s not something I can really tolerate.

A 24

Unfortunately, you don’t get a 3 day weekend for free around here. My traded shift landed me with a 24 hour shift yesterday. But, it turned out to be not so bad. The first half of the day was on a transfer truck. We had a long distance call that made me an hour late for my night shift. Too bad it didn’t count as overtime.

911 wise, we had a very good night. I got to miss a call for a lady who fell down and needed to be picked up. So, my first call was for a girl who was “unresponsive.” She did a very good job ignoring painful stimuli, failed the ‘you won’t drop your arm on your own face’ test, but when we asked her to stand up, she did, so I’ll admit I was a bit baffled.
We learned she had a history of eating disorders and the rest of her history was sketchy at best so we gave her the good ol’ coma cocktail. Well, her blood sugar was good so she didn’t need the D-50 and I don’t think she needed Narcan either, but last time we had an ‘unresponsive’ the nurse on the med radio asked if I’d given Narcan. “Um, pupils are equal and reactive and breathing rate is 16 with no evidence of IV drug use.” She insisted that I try it anyway, which I didn’t. But anyway, we tried it this time, (‘cause why not?) with no change. We also gave her thiamine, which was cool as I’d never done that before.
She was looking a bit better by the time we arrived at the hospital, and she was talking to me. She told me she hadn’t eaten in days.
I hope she gets the help she needs.

Later we had an interesting car accident involving a girl who was high running into a car full of guys who were drunk. My patient was lying in the back seat, confused, and drunk out of his mind. We got him all c-spined and what-not and he stopped asking what happened, and seemed to understand his situation which made me feel better about his chances of having a head injury. We got him into the ER and the nurse asked him his name, and he gave her a completely different name than he had given me. I stuck around for a minute only to hear him give a different address, social number, and birth date as well. I informed the nurse of this and hopefully they sorted out whether he hit his head too hard or those ‘few beers’ were clouding his memory.
After that I got to sleep for five hours. Hurrah!

Today I’m loving NH because I can’t believe it’s August and I’m happily enjoying a mug of hot cider, ah heaven.

Playing in the surf

A new batch of photos for you today, mostly of, well, the new boat of course! The fun we had trying to kill ourselves on the ocean, and some other fun stuff!

Kayak Spots







New Hampshire







The Truck

3 day weekend! Ewing’s here! Pisgah’s here!

On Monday we went to the beach. We spent 4 hours hopping over waves and surfing (sometimes successfully, sometimes not so successfully). I learned that it’s great fun when the nose of the kayak is being forced underwater by the power of the wave, forcing you to accept your fate of being rolled up into the wave. But the new boat did well, and when I timed it right, the surfing was all it was cracked up to be and more! Although, it’s a lot harder than it looks. I killed my arms and abs trying to keep the boat straight as the waves pushed us forward surprisingly fast. Needless to say there was salt and sand everywhere, and we had to spend lots of time hosing everything down, and I still think I’ll find sand somewhere we didn’t think of in a few weeks.

Tuesday we took the Pisgah and a borrowed 16 footer out on a huge lake in Manchester. The boat proved fast, straight, smooth, and generally fantastic.

Commodore Ellie

14 feet long, 23.5 inches wide, 55 lbs, 9000+ cubic inches of storage, pro flex backband, adjustable foot braces, deck bungees, bow and stern hatches, recessed anodized aluminum deck hardware, all standard features on the new, royal blue rotomolded polyethylene kayak.
Yes, an unexpected and yet welcome acquisition, to what you could now call, the fleet.

Research was carried out covertly and an ingenious plan was hatched and set in motion just a few short days ago. First, it seemed worth the $150 shipping just to see how a 14 foot long 50lb box would be delivered. Then, through a series of unforeseen events, a friend from home (where ironically the boat was readily available) found out he was able to come visit.
“Hmm, you’re coming up here?”
“Yes.”
“And you’re driving?”
“Yes.”
“And you have that kayak rack you bought a while back?”
“Yes.”
“And you love to go shop around at that nice outdoor store?”
“Yes.”
“I’m hatching an ingenious plan…” (drums fingertips together, and laughs maniacally)

A few days later and we found ourselves admiring how awesome it looked on top of his car. So buy me an unusually large hat (you know, the really big one) and call me commodore!

More on how it handles in waves and on the flat to come soon. Pictures of it in the waves and on the flat coming soon. What we’ve been up to the last few days, and what I’ve been up to the last week coming as soon as I sit down long enough to type for a while.
Oh yeah, it's name is Pisgah made by Liquid Logic. As they put it, it's pisghalicious!

143

Not much entertaining has happened recently, but some exciting things are in the works. So, some random thoughts to tie us over:

1. In this state, kopapa has become like an accessory, like, my Chihuahua. I have to carry it everywhere I go, because you never know when you’ll stumble upon some water begging to be paddled. I should get a Louis Vuitton bag for it or something, to make the carrying easier. “Ooh, lovely bag.” “Yes, it’s for my little kopapa!” (insert collective ‘aw!’ here) Granted, an 8’6” purse would be a little cumbersome and generally frowned upon in most department stores, but what if the mall had a large fountain?

2. Does it bother you that there are instructions on toothpaste tubes? Are there actually people who are going along, ready to brush their teeth, only to discover that all the toothpaste was at the bottom of the tube? What to do!?
“For best results, squeeze tube from the bottom and flatten as you go up.”
Wow, thank goodness for instructions.
Are there people who find themselves walking down an aisle at wal-mart then happen to stumble upon shampoo. “Ooh, what’s this? Soap? for your hair?! This is fantastic, how does it work? Oh look! Instructions.”
Oh, the education I’ve unwittingly taken for granted all these years.

3. What’s the purpose of independent accreditation if you only follow their rules completely when you know they’re coming?
At work we’ve been repainting walls, cleaning things that haven’t been touched in 2 years, waxing ambulances, buffing floors, locking up all our needles, and tons of other things that are indeed thorough and nice, but not standard practice. The question wandering around the employees has been, if now, why not always?

4. I paid 4.50 for a movie that sells new for 29.99. Isn’t the internet wonderful?

Solving Problems

The other night I went out with my roommate and some of her friends from around here. One asked me if I had I saved many lives yet. No, but I have solved a lot of problems.

Last week we spent 40 minutes on scene trying to be good humanitarians and enjoy the social work aspect of this job. A lady had back pain, got a prescription for said pain, took a few, prescription is subsequently stolen by supposed junkie. Lady’s back pain is now worse, calls 911, we show up.
Well, I started with calling the pharmacy because she couldn’t remember the name of the drug. Yep, it's a controlled substance. Then, we call the police department and walk her through making a report. We were on hold awhile. In the meantime, my partner gets her a coke and she has a cigarette. Finally, I call her doctor, who wants her transported anyway as this is not the first time this has happened. So, we end up transporting after all.
When we got to hospital, I waste even more time having to justify my long on scene time to the supervisor. Oh my God, trying to help people without having to take them to the hospital?! Not every call requires medical care? What a far out concept, and it almost worked this time.

Our night started with a kid who fell off of a jungle gym. Why do IVs always make kids cry!? Some other notable times I've made kids cry: an asthma attack, a pedestrian v. car (but she was screaming her head off anyway), when I punched that clown in the face, and when I informed that kid of the harsh reality that teletubbies aren’t real.
In the middle of the night we had an assault. The patient had a chipped tooth and wasn’t sure what to do. Call your dentist in the morning, we advise, they’ll set it right.
In the morning, there was a power outage. Lady is on oxygen all the time, and the concentrator needs power, lady calls 911, some of our colleagues show up. They plug the oxygen line straight into the tank, turn handle counterclockwise, problem solved.
Lady realizes that her nebulizer runs on electricity, calls 911 again, we show up. We give her a neb, show her how to plug it directly into the tank, perform miracle to bring power back on, problem solved.

Today was spent doing BLS transfers and having my first experience with the wheelchair van. Yes, they must have been in dire straights to take a double medic crew off of their critical care ambulance in order to complete a semi-long distance wheelchair call. Such excitement I have never known. Ooh, you can cut that sarcasm with a knife!
One patient who broke her femur in a car accident and was headed to rehab asked me for a cigarette. I decided not to inform her that this was a perfect time to quit.

The first step

The house is very neat and well kept. Not a speck of dust or dirt exists. Family photos are lovingly arranged on the mantle, and the days paper is folded neatly at the kitchen table. She herself, is a spry, healthy seventy something grandmother. A widow who lives alone in her large house.

For weeks now, a man has been stalking her. He has broken into her house, stolen her things, destroyed tranquility that existed in search of valuables. She has been forced to change the locks on the doors, hide her jewelry and purse, and call the police to her quiet neighborhood many times.

It all started when she hired him as a painter. He never finished the job and ever since has been lurking around the house. He has disguised himself as various things; a painter, maintenance person, landscaper. If only she had known this before. An altercation with the stalker has even left her with a black eye. A man willing to do the unfathomable act of assaulting an elderly woman. She's put three locks on every door, and yet still he manages to penetrate this supposed security.

The police have all but ignored her pleas for help. Each investigation has yielded no results, no leads, no resolution. "How can this be?!" She cried the last time the police came. "He was here in the house! I saw him in the bedroom, going through my things. I ran down here and called you." The police try to explain that they've searched the whole house, inside and out and have found no one. She begins to feel that calling the police is futile. She is incredulous over their inept response to her calls, and must take her own action. She threatens to assault anyone who enters the house with a pan or a kitchen knife. She strategically places potential weapons throughout the house, ready to defend it.

After countless sleepless nights, she decides to leave the house she raised her children in. She can think of no other way to be rid of the man who is tormenting her on a near daily basis. She can no longer endure the endless hours of worry, the mental anguish, and the curious stares from prying neighbors.

Worry and concern overwhelm her family, and her son comes over with a solution. With him is the social worker that's been trying to help her, but seems as useless as the police. A police officer is there too. “What is going on?” She wonders to herself, “Why is there an ambulance parked outside?” The son explains that because of this man causing her to be frazzled and abused, they think it's a good idea for her to go to the hospital to be checked out. "Checked out?!" she demands, "What do you mean by 'checked out'?" He's worried about her, he claims. "It's not me who should be 'checked out' it's him! He's causing all these problems. That's why I’m going to leave this state, it's the only way! I don't want to go anywhere but far away!" The police officer then tells her she has no choice but to go. "I am insulted! You're doing this to me," she shouted at the son, "I'll never...I'll never forgive you for this."
It's clear she's not willing, but she says she’ll go. It takes 20 minutes of searching to find her purse because she can't remember where she's hidden it so that he can't find it.

Soon, she'll be told that the man, her tormenter, doesn't exist. He never has. It's she who has been moving her things, there has never been a break in, and a fall is to blame for her black eye. She will refuse to accept this truth.
But, eventually, she'll put the evidence together, realize what's really been going on, and sadly begin to doubt everything she ever believed in, her reality warped forever.
And, one day, she'll forgive her son.

New Layout! sort of

I was struck by a sudden need to change the look of the blog. I spent many hours deciphering css code on the template and doing a lot of guess and check work. I think it’s come out alright. A little more bucolic feel than the other layout, and a lot less generic.

This weekend was typical and atypical. Saturday was pretty routine, but we did get to use the always fun lights and sirens to go to a trouble breathing call. Sunday was bliss. 2 calls in 12 hours. The first was a 911 call to my one stop light town which was like a work reunion. Three other employees were there to greet us (who are also on the volunteer department here).
Our second call was another trouble breathing. We’ve really been getting a rash of those come to think of it. I’d say at least half of our calls in the last week or so have come out as trouble breathing, shortness of breath, asthma attack, oxygen deprived, not breathing enough, CO2 retention, cardiac arrest (which counts), and if we were British; difficulty in breathing.
Anyway, it came out as an interfacility emergency call, so, lights and sirens again! and…wheeeeeee! We also had the added bonus of a student along with us. This is still a bizarre reality for me having just ended my stint as a student.
I surprised myself when I realized I was really enjoying precepting this student. Coaching IVs, discussing heart rhythms, and considering making him do the patch to the hospital. It was good fun. I especially liked when he said he thought I had been doing this for a long time. I let him in on a little secret in EMS and medicine in general. Even if you’re not sure, look like you are. Sure, I’ll break out the protocol book to be ensure to get it right, I’ll get crazy nervous, be scared, and have many CRAFT moments (can’t remember a flipping thing), but nobody’s in on it but me. And everyone reading this.

Well, I hope you enjoy the new layout!