May 30th

View from the top of Mt. Tom in the white mountains.

The same view, one minute later.

May 24th

Some baby ducks to brighten your day!
Some baby ducks to make you forget that I posted this two days late!
Some baby ducks that I didn't exactly take a picture of on the 24th. But they're cute, right?

May 23rd

I have a brand new structural firefighting helmet for work. I'm not sure why. I wish I could put better stickers on it. Sorry the picture of the day is pretty boring today. Sorry that my writing today is like that of an eight year old. I'll try to add more describing words in the future. Helmets are fun. This helmet is red. It has a number on it. It will protect me if a ceiling caves in.
The End.

May 22nd

While mountain biking yesterday I had an awesome time and marked my second proper crash (in which I sustained no injuries) But before my pedal caught a root and launched me into the grass, I was making a hard effort to get up a tricky hill. Here, on a particularly vibrant upstroke I managed to squish my foot soundly between my pedal and a protruding root. Immediately I jumped off the bike and proceeded to go into what I like to call a "pee-pee dance" where basically I dance around yelling and breathing like I'm in labor.
Almost immediately my toenail turned a lovely shade of lavender. Driving home was tricky as pushing the pedals sent me into bouts of hyperventilation. It's better today although after a night of working and a day of PALS refresher, I took it home and gave it some ice. I will continue to ignore doctors' advice of heating up a paper clip and jabbing it into the top of my nail. There is no way that is happening.

May 17th

We had a weekend of airway class (which kind of explains the absence of new pics of the day.) The coolest thing they had was a feedback program for BVM ventilations. It was amazing how easy it was to over-bag. It would be great to have this in every CPR class. Too bad it costs $10,000.

May 16th

We have a lot of forms of communication at work. Unfortunately, none of them work consistently. And, if we get any more, my pants will fall down.

May 13th

Okay, so nothing very exciting happened today and I was too busy watching lost to think of something to take a picture of. So here's a good one courtesy of C. It looks really cool in full size.

Multi-sport weekend

On Friday I took ACLS refresher. It was unrelated to the rest of the weekend. When I got home in the afternoon I rode the bike about 14 miles and up two of my greatest nemesis hills.
On Saturday I slept in and in the afternoon C and I kayaked about 10 miles. It doesn't seem like much, but it is a long way in a kayak. In fact, I hadn't done that much in one session in probably two years. It was a beautiful day for it. We had been following a canoe of three people and a little trolling motor. They headed back to the put in about 10 minutes before we did and we arrived back right before they did. This was a great source of consternation and amusement for all of us. It felt awesome, and afterward we had a very nice and unexpected dinner with some old friends.
On Sunday we got up early and drove to Shenandoah National Park. We hiked the 8.8 mile loop to the summit of Old Rag (3291 feet) which includes a "strenuous rock scramble" to get to the top. Of course, he failed to mention that part while we were in the planning stages. The trail started out innocently enough with rocky dirt trails and lovely switchbacks. Then it became more rocky, then the dirt gave way completely to boulders. It was fun, and strenuous, and made me quite nervous, but I kept on trucking and made it to the top among tens of other crazy people. We had a great lunch complete with surprise sparkling cider!
Although it was tricky, and not my kind of trail, the views were spectacular and well worth the hike/climb. It was the most clear views I'd ever seen in Shenandoah. Getting back down was much easier in that I never once feared for my life, but it was all downhill.
Yesterday at work I couldn't gracefully sit in chairs, I had to just fall into them as my quads were completely rebelling. Climbing down stairs was also amusing to watch, I'm sure.
Today I wasn't completely healed but did 12 miles on the bike because I'm a glutton for punishment!

May 12th

Bike time.

May 9th

Kayak time.

Clustery call

Last week I had, for once, a very sick patient. His wife called us for his shortness of breath.
When I saw him, he was sitting up leaning over his knees, pale as a ghost, awake, and breathing, but barely. Within a minute of our arrival, he stopped breathing altogether and started to go sideways onto the couch. Thankfully there were three of us there to drag him unceremoniously off the couch and onto the floor. It was now we could see he had a trach. I was so glad to see it, as given this patients size, he would not have been easy to tube.
The only problem with the trach, as we discovered, was that it was not compliant with our BVM which is absolutely ridiculous, and meant that we could not easily ventilate him. We ended up capping the trach and bagging him the old fashioned way. This obviously worked as he began to be combative as his brain got more oxygen. By then I had an IV in him that was threatening to be pulled out, and he had gone into runs of V-Tach (a deadly heart rhythm) twice. He had self converted both times, and although I knew it was due to lack of oxygen, we gave him some amiodarone for good measure.
It was a struggle to get him out of his house, and I feel that if he had been any further from the door, the story may have had a different ending.
Of course, it was raining outside so I had to replace is defib pads once we got in the ambulance. Luckily, I didn't have to use them. I tested his blood sugar which was over 600 which is equivalent to having maple syrup run through your veins.
We got him successfully to the hospital and he was looking a lot better, even conscious after a few more minutes of oxygenation. I was pretty excited as it was one of those rare times when I can actually say that if they had waited to call or we had taken three more minutes to get there, he would have died.

I was about to leave the hospital when all the alarms in his room went off. So we jogged in there and he was again in V-Tach. For the third time I put defib pads on him, but again he converted.
I hope this never happens to me, as I think it would be very concerning for a patient if everyone ran into your room, looked between you and your heart monitor with worried faces and kept asking if you were okay.
Well, he was okay, he tolerated these runs pretty well and was conscious the whole time. He was pumped full of different medications and later was transferred to a fancier hospital.

There is a lot wrong with this EKG.

May 7th

"Last hill I promise"
Spotted on the bike.
This message was not for me.

Can you freaking believe

After all this visa nonsense that I am not allowed to apply more than three months in advance for my visa. All my crap made it to the expediting service today they called me saying: "Oh, you're school starts in September? You didn't tell me that." I figured it was implied! I figured I could get this done and relax about it for the next five months! Not one FAQ asked when one could apply. The 50 page "Tier 4 of the points based system Policy Guidelines" makes no mention of such rules. It's the UK, why isn't it simple?
Well, he was super nice and all that but guess what? Now come June 23rd, I have to reapply, get my work to write me another letter, get my bank to write me another letter, collect new bank statements, paycheck stubs, pay again for FedEx shipping labels, and go to that shady ass place to get my fingers printed again!

Okay, rant over...for now.
I think the picture of the day will be one of my head exploding.

May 6th

Another rainy day.

In the System

After circling the city block several times, I finally decided on a parking garage in the hopes that where I was actually going would become more clear on foot. After a harrowing experience in the most labyrinthine parking deck I found a space and followed some shady looking signs that thankfully led me to the street. After a few minutes of wandering around and muttering quietly to myself, I saw a large sign pointing me in the right direction.
I entered the building and found the door of the immigration assistance services. On it was printed a list of things I wasn't allowed, but I actually had in my bag including cell phone and camera. I walked in anyway to the most sterile room I had seen. Even more sterile than the MVA, at least they have some plants! There were only a couple of non employees there and I went to what looked like the main desk.
The, um, receptionist was as warm and inviting as a snake that you're not sure is poisonous. She made sure I had the appropriate documents and sent me to the other side of the room to sit in one of the chairs in several rows. There were no tables, no magazines; just a big red number on the wall to tell who was next. Luckily, that was me. A guy beckoned me over to his station and had me sit down while he entered numbers into his computer.
My cell phone rang and I almost fell off of my chair in an attempt to mute it. I looked around nervously, ready to justify myself. "Uh, I make that noise sometimes. It's totally normal and not a cell phone at all. I'm practicing for sound effect school, Brrrrring!"
Happily, I didn't have to go into an insane tirade and the scary guy just gave me a quick glance while I smiled at him dumbly.
Without exchanging a word between us, he had me stand beside him while he wiped my fingers with water and carefully, almost obsessively, scanned my fingerprints into his fancy computer.
It only took a few minutes and then he took my picture.
"Is it serious?" I asked him.
"You can smile, but no teeth."
"Ok. Mug shot it is."
He took the picture and showed it to me.
"Ooh, that is serious, isn't it?" I asked.
Then, he actually laughed.
He stamped my paper and sent me on my way.

I practically skipped out of the office in relief and on my way back to the garage spotted a FedEx store on the street. I dropped everything into the envelope, licked it, clasped it, and covered it with tape. I took a deep breath and dropped it into the box, putting it out of my hands.
By some miracle, I found the car and exited 36 minutes after I had arrived. Of course, the price went up after the first half hour.
I spent the rest of the day at a pub drinking beers with a couple of friends and watching the Man U. vs. Aresnal game in HD. It was awesome.

Predict the unpredictable

Yesterday I had the most predictable conversation ever with my beloved visa expediting service. I called them to confirm that by the time I went to mail it on Tuesday, I would have all of the necessary documents. I carefully went over the many documents I have collected-

Me:"...and an official transcript from my undergrad degree. And, well, that's everything I have."
VES: "Yeah, that all sounds great, I think you have it all." -short pause- "Except one thing."
Me: "I am completely unsurprised that you said that."

From there we shared a laugh as she pointed out that this process was actually a lot easier last year. I was also unsurprised about that.
It turns out that I needed the mysterious "Appendix 8" a document that until then I had no idea existed and would have absolutely never found without them sending the link to me.
Tomorrow at work I will busy myself with filling that out and then using their laser printer to print out the shipping labels from FedEx. Apparently one can't just go to the freestanding FedEx store and get them to print out shipping labels. I don't even know why the freestanding store exists, really.

May 2nd


May 1st

My bosses' plan for giving nebs to possible swine flu infected patients. Here's a link to help you figure out "Do I have Pig Flu?"
Or, if you're feeling a little more pessimistic, here's another link to help in the diagnosis. Do I have Swine Flu?
(thanks to Dr. Andy for the links)