31 August 2006

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.’

30 August 2006

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.**

28 August 2006

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.

25 August 2006

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.

23 August 2006

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.

22 August 2006

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!

16 August 2006

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?

12 August 2006

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.

11 August 2006

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.

08 August 2006

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!

07 August 2006

A work in progress

I'm toying around with the look of the ole blog, so hang on while I pretend I actually know what I'm doing.

For your viewing pleasure

Some new pics for you. A few of my new favorite kayaking place, and some photographic evidence of ocean front property in New Hampshire. The dragonfly is some experimentation with the manual zoom, which I’m pretty excited about.


Kayak Spots

Other stuff

04 August 2006

The solution to and cause of all our problems...

The other night I met my first regular.
me: “How much have you had to drink today?”
regular: “A lot!”

Later we had a call come out as an ‘asthma attack.’ When we arrived the pt. was lying on the street writhing around like a fish out of water with her friend all up in her business trying to calm her down. We quickly popped her into the ambulance and I set about getting her to chill long enough to listen to her breath sounds. This proved impossible, so I decided to giver her a neb anyway, if she thinks she’s having an attack, whether she is or not, it’ll help her chillax. That lasted about 2 minutes before she threw it off, and continued to writhe around and breath heavily and loudly. "Hmm," thought I. A quick consult with the friend, revealed she only had three drinks and nothing else. Everything else appearing normal, we set off toward the hospital. Gradually, she calmed down replacing the dramatic breathing with shouting expletives at nothing in particular. "Only three drinks?" thought I. The friend continued to shout encouraging words from the front seat, only to have the patient reply loudly with some very unfriendly things about her. "I would resent those blonde comments, if they weren't so entertaining," thought I. I could barely contain my amusement.

The friend, who was initially terrified at thinking her friend couldn’t breathe, began to see the hilarity of the situation, and that her friend was merely hopelessly intoxicated. Around the crescendo of the patients’ angry, drunken tirade, the friend said incredulously to us, “I can’t believe you guys do this every day!”
On the way back to the station, my partner and I concluded that those kind of calls were worth getting woken up for.

The rest of the evening/night/morning was filled with an hour extrication from a house, our rig taken apart and put back together, some sleeping, a possibly drunk person; who definitely drove into another car, and finally, 15 min before the end of shift, a treatable patient.

03 August 2006

Requirements for Human Powered Water Travel

Lily pads dance on the surface of the wind blown water. A pair of loons dive for fish, and a heron flies over without a sound. The sun breaks through the clouds forming odd shapes on the trees and water. The silence is complete but for the wind blowing through the trees and the rhythmic splash of the paddle. A lone kayaker is able to find zen, completely in love with the world.
To think, I almost didn’t go today because I forgot my paddle at home.

02 August 2006

Birthday Surprises

I’ve never had to go to school or work on my birthday before. Hurrah for summer birthdays! But, today at work was very enjoyable; 3 calls 0 transports.
First call was for leg laceration. Ooh, goody, trauma! When we arrived we were informed that the pt. had cut herself shaving and had bled through a towel. Ooh, goody, uncontrolled bleeding! We pulled back the makeshift dressing, to reveal…um, where is the cut, exactly? That pinpoint lac was making all this blood? Then the pt. demonstrated her predicament by standing up, which made blood literally gush from this miniscule wound. Well, that’s interesting. Quick history didn’t reveal anything significant, except varicose veins. There you go. I knew shaving was hazardous to my health. The patient decided to have her husband drive her to the ER. Very wise woman.
Later we had one that came out as a cardiac arrest. Adrenaline, check. I stopped for two seconds to take a deep breath and chillax. I got my wits about me as we found the location on a map, and I even remembered to grab the auto pulse, (a cool automatic chest compression machine we are supposed to be field testing).
On the way there my mind was racing. “Ooh, I’m nervous…or excited, I can’t tell! God, I hope I don’t mess up. Can you believe I have a ride along for this call?! Clear this intersection, I’m gonna get my tube! What if I don’t get my tube…Boy, I’m nervous. Stupid car, get out of the way! Oh God, I know people who live on this street! Just put the pads on, the rest will fall into place. Oh, thank you, it’s not at their house. We're here, put it in park, gloves, stethoscope, okay...”
Turned out there was nothing to be done. Oh, EMS and your trickery! I was pumped, I was ready!
I filled a different role as I explained to the family that there was nothing we could do. A birthday dichotomy.

Finally, we had an abdo pain who decided not to go, despite continued pain and lots of wheezing; too bad I’m not a kidnapper.

At the end of the day my partner bought me a blizzard. Unfortunately, not the snowy kind, as we could have used it, considering it was over 101 degrees today. But, you know my feelings on ice cream…yum!
Andy’s mom took us out to dinner and I got a delicious piƱa colada. Since then I have been opening and enjoying the many cards and surprises I received today in the mail.
Thanks to all who sent such kind messages on my 1st birthday away from home!

01 August 2006

Pre Birthday Birthday surprises!

Today was just lovely! As it is technically my weekend, I got to sleep in, hang out, surf the net and what-not. In the afternoon, (don’t ask me why I waited until it was a zillion degrees here) I found a new lake to kayak on. It took a about 30 minutes of driving around to find the public boat launch, but it was well worth the frustration. Oh, and by the way, Onway Lake is actually not accessible off of Onway Lake road, as any sane person may think (so, logic doesn’t always win.) Anyway, beautiful, giant lake. Fascinating geology, (pictures pending) lots of places to explore, and I even got to see some loons. I learned that watching people learn to water ski is pretty entertaining, and once they get the hang of it, riding the wakes from their speed boats is also pretty entertaining.

When I got home, Andy and Louisa made dinner, and then surprised me with cake and ice cream! And presents! So, I am now currently enjoying a new scented candle, and tomorrow at work I get to show off my new squirrelly radio strap. Fantastic!

Google search term of the day: “becoming a paramedic + getting over fear of blood” It might help, you know, a little trial by fire. Becoming a paramedic can also get you over your fear of driving erratically, lifting heavy objects, and talking to people.

I've also added a picture to the previous post to clarify any geographic questions.