30 October 2006

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.

25 October 2006

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.

24 October 2006

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!

22 October 2006

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

20 October 2006

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.

10 October 2006

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.

09 October 2006

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.

01 October 2006

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.