A Work in Progress

Wow, work is weird after a six month absence  My first patient back was really sick and I was panicked,-"Somebody do something!"  I shouted in my head, but it's me- it's me, just like old times.  And I have be be the interview, provider, and advocate for this patient.  My assessment is twice as long as it used to bed (and half a useful in the prehospital arena).  I actively think that I should have more to offer patients by now. I'm a PA student now. I know some things.  But all they need was what I always had to give to them.  An IV, an EKG, and a recognition of sick or not sick.  That I can do.  That I sill have an instinct for.  Thank God.

EMS is... cold dinners missed sleep split seconds golden hours chest pains back aches filthy houses narrow stairs dead on toilets dead behind doors woah, look at that! talking off the ledge boredom adrenaline knowing too much knowing too little making cots squeezed hands repetition bitching held pressure held breath all eyes on you public scrutiny high expectations bull shit feeling cool looking dumb driving too fast   getting there too late panicked parents happy babies hidden sorrow unbridled joy

"Hurry up, hurry up!"  she shouted. Why were they getting out of the truck so slowly? "He can't breathe, he can't breathe!"  she shouted. They are still taking forever. "He needs oxygen, he needs oxygen!"  she shouted Finally they are at the door. "Where is he?"  they ask.  Isn't it obvious? "In there, in there!"  she shouted.  "What happened?"  they ask. Isn't it obvious? "He needs oxygen, he needs oxygen!" she shouted. They are standing on his oxygen tubing. "Don't stand there, don't stand there!"  she shouted.  They opened their bags. "No breathing tube, no breathing tube!"  she shouted.  "What do you mean?"  they ask.  Isn't it obvious? She waved a paper in their faces.  "It says it right here, right here!"  she shouted "He doesn't want any of this?" they ask.  Isn't it obvious? "He just...

"Hurry up, hurry up!" she shouted. They're going as fast as they can "He can't breathe, he can't breathe!" she shouted. Get the bag, the oxygen, the monitor, the board "He needs oxygen, he needs oxygen!" she shouted. Crossing the threshold. "Where is he?" they ask.  How would they know? "In there, in there!" she shouted. "What happened?" How would they know? "He needs oxygen, he needs oxygen!" she shouted. They enter the room, evaluate the situation. "Don't stand there, don't stand there!" she shouted. CPR started, oxygen delivered, heart monitor on. "No breathing tube, no breathing tube!" she shouted. "What do you mean?" they ask. How would they know? She waved a paper in their faces. "It says it right here, right here!" she shouted "He doesn't want any of this." they say.  How would they know? "He just needs...

Growing up, our outdoor cat would often leave us 'presents' after a successful hunt.  She sought praise, but often got indignance as we mourned a cute little mouse or baby rabbit.  Even now, my indoor cats will stare at a mouse- trapped behind something- for hours before eating what they want and leaving the rest for me to find (usually by stepping on it).  Oh, what good cats they are! My favorite doctor in the ER used to be a paramedic.  So he knows it for a fact: paramedics are like cats. I proved this just the other day.  We started with a cardiac arrest. But not just any arrest:  one where I actually got to do stuff! To feel like I could do something or make a decision that would improve the outcome of the call.  It felt really good, (despite the ultimate patient outcome) to actually have to think and remember stuff that I haven't practiced in a while. (I'm not sure if that sounds good or bad to you, dear reader).  When got to the ER, ...

Midnight: Flank pain. Been seen in the ER three times already. "It just hurts." 0330: Woman thinks temp is 108 due to using a 50 year old unreadable mercury thermometer. Midnight: 30 year old with pain. Was in the ER this afternoon, left against medical advice with a diagnosed problem. Didn't fill prescription, didn't make follow up appointment, pain worsens. 0520: Shortness of breath that "just started" according to facility staff, been going all night according to patient. Midnight: 20 year old throwing up for 1 hour. Doesn't know what to do. 0400: 40 year old with weakness for two days. Why now? It just didn't get better. Midnight: 22 year old male with a fever. 2310: 29 year old with anxiety. 0230: 24 year old. Supposed leg infection. Just left er waiting room against medical advice. Walked to payphone, Called 911 0100: Short of breath. Just needed a chat 0245: 55 year old with blood in urine since noon. 0445: 26 year ...

Everyone wants to talk about overdoses these days.  My job is now not known for daring rescues and fiery crashes, but our menial contribution to a disease that has finally caught public attention.  I am baited upon meeting new people and I fall for it.  "What's your most common type of call?"  "Have you ever been on a heroin overdose?"  "Do you carry narcan?" Ah, damn!  Next thing I know I am in a conversation about the good old days, how kids are spoiled, or 'why don't they all just quit?'. One of my first calls as a student was for an overdose.  My first.  My preceptors 5000th. "Pump the brakes"  I am told. No, you won't get to intubate this patient. At best you will finish this call and not have been punched or yelled at. So, no, giving narcan is not news to me. Giving it on the regular in a town of 6000 residents, that is noteworthy.  That is something we've all noticed.  One thing I resolved to do was not "...

A lovely old man who fell down. We had to break into his house. Twice. A patient with sepsis. Nursing home claims she was 'just fine an hour ago'. A patient fell down the steps and died. On thanksgiving. Lady whom needed us to fetch and pack the entire contents of her closet and living room before she was ready to go. Dear oldie who gets picked up off the floor at least once a week by EMS. When you know the names of your patients' pets, it should be a red flag. Nursing home patient who had the worlds smallest laceration. “Everything must go!” Same nursing home gives patient three nitros within 10 minutes. Blood pressure changes seem to be a surprise. Woman noticed a problem. Called 911 eight hours later. WHY? So much why.

She was dead.  He knew it from the moment he saw the car, but he had to check for sure.  The worst part of the job.  Glass crunched under his boots as he approached the car, now barely discernible from the tree it hit.  Two fingers found their way through the broken window and onto the side of her neck and lingered.  Ten, twenty, thirty seconds.  How long to be sure?   He could have stood there all night waiting to feel a pulse, but he knew better.  He shook his head at his partner. The backboard in her hands made a soft rumble as she retreated, dragging it along the road back to the ambulance. He wanted to be sure that she was the only one in the car.  He shined his bright flashlight through the car and along its final path. Snippets of her life were now strewn along the road.  Cell phone, spilled purse, her favorite gum, a snapshot of friends.  He turned his flashlight to the woods, to the field across t...

I forget most calls by the next day.  Looking back on the old blog, I remember more from years ago because I actually wrote them down.  So, here's a few. A guy with bleeding ulcers that had been leaking for about a week or so.  Yeah, you have no blood left. A man whose dialysis shunt sprung a leak.  Yeah, you have no blood left. A house fire where I gave a cat oxygen.  EMS bucket list check. (Damn, no media coverage of that!) A benzodiazepine overdose. Ooh, drugs and unconsciousness. An unconscious stroke displaying Cushings triad. Let's intubate you and atropine you, and get you right down to the ER real quick like.

Someone recently asked how many of my calls were true "emergencies". I said 5%. 5% may even be an over-estimation Something I’ve come to realize and have to accept that we are not in the business of saving lives. We are in the business of solving problems. Boiled down, our job is to be the clear head in the situation where no one else can seem to get their shit together. Yes this is a great illusion. It is not why I got into this business or why anyone got into this business. Work has become like air travel, long periods of boredom punctuated by tiny moments of excitement. Like, when a meal arrives. But maybe this is a natural part of any job. Any job becomes routine. Maybe anyone with 10 years in any field would feel the same way. Maybe anyone would say that their job is at its zenith 5% of the time. Maybe I am lucky that I can. That, or we’ve convinced ourselves that public service is easy and rewarding which often it is not. There is no sense in dwellin...

As a paramedic, have to be a pretty good negotiator. Maybe you are surprised that negotiation is an important aspect of the job. Sometimes people call, and then when we get there and bring some calm, they get cold feet. I have to convince people to stay home as well. “You have the flu, please don’t come to the ER.” I usually say through a window using a bull horn. When hospitals get busy, I have to sell alternatives. When I want to start an IV, but the patient doesn’t trust me yet, I get that done. I have to coax kids into not crying, coax parents into not crying. I have to squeeze information from human turnips that just about drive me crazy. At the same time, I have to figure out if these people are drug addled, drunk, or just plain lying to me. All this talking to people, as an introverted extrovert, is exhausting, but sometimes a rewarding part of the job. The other night, I couldn’t make anyone do anything. We started with a lady who had a seizure and then fell and...

I have been working for the past few months on a genuine ambulance, as opposed to being the ALS chase car.  I had not realized how much nonsense I'd been shielded from over the last eight years.  So many silly calls that I was canceled on before I even got there.  But now all of those calls are mine.  The good and the bad and everything in between.  So, I must thank all of those BLS crews for keeping my standards high, prolonging my faith in humanity, and staving off my own insanity. The general public would really not believe what people call 911 for.  Growing up, my career goals were fed by Rescue 911 and ER. Fed by the genuine, 'I'm stuck in a laundry chute', or 'I am inches from death' type emergencies. I still remember learning how to call 911 in kindergarten (or somewhere around there) and from then until I became an EMT, I believed that, like me, people only called 911 in an actual (universally agreed upon) emergency.  When I started really r...

Looking back in the blog, I see that I used to at least mention calls I'd been on that week/day/month.  Over time, I realized that all of this documentation could have gotten me in trouble. That, plus the novelty does wear off, even in a business like EMS. So, the call logs tapered off.  But, I also realize how many calls I've forgotten in recent years.  In fact, I've even forgotten the calls I've written about! So, here are a few that I remember.  Closed broken ankle- single step won.  Open broken ankle, driveway won (but it was for a a good cause).  Great old crack on the head that looked like a murder scene...he was fine! (More or less).  A guy had a seizure and fell onto something that busted a huge gash in his face.  Insult to injury (or the other way around).  A lady with restless leg syndrome.  Yes, this is totally a medical emergency (did you get the sarcasm?)  A guy who 'bumped' his head and felt like going to the hospit...

Last week, I got to go to the EMS World conference in Nashville, TN.  More on Tennessee later.  But, like every time I have been to an EMS conference, I was left wishing I had my own ambulance service as well as absolutely unlimited funds.  I liked a lot of the things.  I wanted almost all of the things...except those that were totally absurd.  I am sure that my employer will hate that I went because I will only make safety oriented and expensive suggestions at budget time.  Some ideas I saw there filled me with a sense of urgency and the desire to completely change every ambulance I encounter.  I'll give you the top 5, not including the fake blood that actually clots. 1.  Lifts This thing may look really silly.  But, I believe that it fills a huge void in our care.  We've all been on those calls when an old or overweight or frail person has fallen out of or off of or just fell and can't get up.  Classic, right?  Here's my ...

There's been some of discussion lately around work about wearing shorts on scenes in the summer.  Some providers argue that 'if they are truly sick, patients won't care what I look like when I show up.'  But let's be honest, how many patients are truly sick?  Sick enough to not look at you with even a slightly critical eye.  Let's not forget that our patients are rarely alone, accompanied by friends, family members, or staff of a medical facility.  They can see us to. Our immediate appearance must build trust with them as well.  When you walk into the home of someone whom called for your help, everything matters.  They are the ones about to put their lives ino the hands of strangers.  Appearing professional can come down to having your boots tied and your shirt tucked in.  No, these things do not directly affect patient care.  But, they do affect how your patients respond to you.  Trust must be built from the first moment you walk...

When I was a kid, I wanted to be a paramedic.  Almost every year in my school books I said I wanted to be a firefighter, EMT, or paramedic. The evolution was easy.  Once I realized that I was afraid of things that were on fire, paramedic was it.  There is little I am more passionate about than a good education.  "Think education is expensive? Try ignorance."  As those elitist say. I went to college, followed the path I was 'supposed to', and no one ever talked about money.  How much money will you make in your career of choice?  Everyone knows the careers that would technically make a lot of money, and it's all but guaranteed that without a college education you will have no hope (so the guidance counselors would have you believe).  Equally passionate about education, my parents saved and scrimped to send me to college.  Other paramedic students have long term loans, crippling debt, or second mortgages.  No matter how they arri...

It was a necklace.  A necklace of tiny plastic purple beads. Yes, those are definitely tiny plastic purple beads, or maybe not.  Is that a sex toy?  No, that is more ridiculous than a necklace.  Well, then I guess it's an alien.  I've entered the twilight zone and I am about to witness an alien birth.  I'm not sure. I mean it's late and my first time but there was definitely something weird there, something weird coming out of this woman's vagina. I composed my 3 am brain, willing out to figure out just what was happening.  She was in labor, at her due date, and assured me that everything was normal.  This may have been my first time, but it was not hers.  They just waited a little too long, that was all. And I was stoked, so excited to get a classic delivery.  A delivery that should go fast and smooth.  I am one of the few paramedics who want to deliver a baby.  We're 15 minutes out and she's ready to push.  This is goi...

I spent much of last week in a refresher class.  This year, I've transitioned from a Nationally Registered EMT Paramedic to the new title to Nationally Registered Paramedic (NRP)  I know.  That's a lof words.  But it is kind of important as the NREMT's is trying to make sure every paramedic in the country (more or less) is on the same page.  They've added some new things to the national standard curriculum such as end tidal C02 (I know you do that already) and the potential use of ultrasound and bed side lab work in the prehospital arena.  This is all very exciting, I guess, especially as I have survived the class.  I do love to see services expanding their horizons, questioning the norm, and demanding excellence. Medicine is an evolve or die kind of business and EMS should be the innovators, not the followers.  Okay, I'm done.  This is the second time I've taken the week long refresher and it is always odd.  It's the only time for one...

Once I was asked what kinds of things I had learned from this line of work.  I was asked in a very philosophical way by someone who doesn't understand this job at all.  Maybe he was being nice, but I found him trying.  The first things that came to mind did not include a deeper understanding of my fellow man, a closer relationship with God, or insights into the meaning of life.  What came to me were the practical things.  For example, don't climb a ladder with a saw in your hand.  Don't climb a ladder without someone holding the bottom.  Don't climb ladders.  Life is better when you don't do drugs., but do take your medication.  Don't drive motorcycles while drunk.  Don't drive motorcycles without a helmet. Don't drive motorcycles.  Knowing full well these were not the answers this person was looking for made them all the more satisfying to me.  He returned this sound advice with a blank stare.  You're welcome. ...