Visa Process Update

I am living in the hope that by early next week, my completed and fully documented visa application will be making it's way to the visa expediting service. None of the finite goals for this project have come together "on time." I've said, "...and then I'll have it in the mail by Tuesday!" at least three times, referring to three different weeks. Every step is actually hiding an extra step under its coat. The closer I get, the more things I have to do, and now I have to amend my post about the UK student visa process.
The UK apparently changed some of their rules on required documents last month. As a result, I have also had to collect my pay stubs from the last three months and yesterday I had HR at work write me a letter that stated that I did, in fact, work there.
I also had to find my old passport, and an old UMBC transcript that states that I did, in fact, attend that university and did, in fact, graduate. No, UK, I am not taking my 14x12 inch framed diploma to Kinkos and getting a copy made. Well, unless you insist.
At this point, I'm not even sure if I need the fake flight itinerary, or to know how to stand in line, although I am sure I will be queuing like a champ when I go to Baltimore to get my fingerprints done. Ah, an adventure around every corner!
Also, tomorrow, I'll be headed to the FedEx store so that I can prepay an envelope to send with everything so that the expediting service actually, you know, mails everything back to me.

But, today I did finish my application, I successfully paid for it in US dollars (hooray for not having to pay foreign transaction fees on the credit card) printed it out, copied it, and signed it. It is in a lovely, $218 stack on my kitchen table. The salt and pepper shakers and the flowers are in awe of it. I am a little nervous, even though they told me to, about the section that I put a line through and corrected by hand.
So, new plan number (oh, I stopped numbering them!) Go to FedEx, call the expediting service and pray that they agree that everything I have is okay. Then, wait over the weekend, get fingerprints, put absolutely every stitch of paper remotely associated with the visa (whether they want it or not) into what will be a very stuffed envelope. Seal it with a kiss, spray it with my perfume, and mail it with a tracking number, return receipt, and require a signature upon delivery.
So again I say: "...and then I'll have it in the mail by Tuesday!"

That photo a day thing 5.09

I've decided, given the beautiful weather and varied activities in store for May, I would make my "photo a day project" an annual blog event. Last May I posted a photo a day for the whole month, and, though I'm not sure if any of my four readers enjoyed it, I did. Hopefully this year I will make it to the end of the month without cheating as much. Actually, now that I've looked back on it, I never even posted a picture for May 31st last year.
Well, this year, to illustrate that I am confident I can get 31 unique, interesting pictures, I will give a preview picture for today.
This is a page I received about a call while at work. It was 3 am and it says: " has extreme pain in female organs..." I don't know why, but that's funny.

Outside Time

The outdoor season is now in full swing. C and I have been kayaking and biking and are having a contest to see who can kill who first with our favorite hobbies. I think he's winning as on our last bike trip I had my first proper, slow-mo, nearly over the handlebars crash. I survived with bruises, but was thrilled to wreck, as I feel it's a rite of passage to real mountain biking.
We've gone kayaking a few times as well, and yesterday I found a few bottles floating in the lake, and then a recycle bin to put them in! Here are some more pics.

A long 24

0515 Woke up and got dressed. Gave kitty some treats and out the door by,
0535 Listened to the latest podcasts about how Joan of Arc worked and how to launder money on the way to work.
0635 Arrived at work, threw my jacket in the truck, got the keys and pager from off going medic.
0645 call for 2 y/o with shortness of breath.
0713 Kid with specialty problems, and almost had to transport to very far away specialty hospital. Parents were thankfully happy with a little extra oxygen and refused.
0730 -0930 breakfasted and napped.
0930 call for patient with exacerbation of chronic bronchitis. I took the same patient for the same reason last shift. She looked worse and was moving no air. Thank God the nursing home had her on 4lpm via nasal cannula.
0945 Headed to kind of far away hospital per patients request. Forced a neb into her and then straight on the CPAP.
1015 Arrived at hospital with the patient feeling good and a pulse ox of 97%
1020 Caught up with an old friend who works at kind of far away hospital. Hadn't seen her in three years!
1215ish arrive back home and got some "lunch" (for me, carrot sticks and slurpee)
Caught up on paperwork and upload some pics to facebook until,
1500 call for stroke.
1503 Arrive at said stroke call where daughter of patient was a nurse who would have bet her paycheck that her mother was having a stroke.
1505 Glucose check is 26 mg/dl. Did our best to smother amused looks at eachother.
1506 Started IV and gave D50.
1510 Everyone was happy.
1525 Cleared scene, stood around and talked, and restocked until,
1615 call for chest pain.
1618 Arrived to find an older guy who got winded putting his socks on.
1620 Patients heart rate wass 33 and pressure of 100.
1625 Fixed him up with fluids, atropine, and prophylactic pacer pads.
1700 Cleared that call and headed over to local ambulance services' annual banquet.
1700-1830 enjoyed a nice, hot, free meal. Sat around and talked until,
1850 call for stroke.
1855 Arrived to find older guy who is confused due to dimentia, and very likely not having a stroke.
1917 Left for hospital
1917 Arrived at hospital. Yep, we could see it from the house.
1930 Attempt to get back to banquet for dessert, abandoned that at,
1945 for a call for syncope.
1948 Arrived to find patient I've had before who, then, was sleeping in her car (outside of her house) in the middle of the night. Tonight she can't stay awake for some reason. It could be all the oxycodone she took.
2020 Finished with that call.
2025-2230 Headed back to the station to finish four tripsheets and chat with co-workers.
2230-0100 Made my way to the bunkroom. Toyed with the idea of smothering my snoring partner.
0105 Call for shortness of breath.
0108 Arrived to find feverish older guy who definitely had pneumonia.
0210 Finished with that and head back to the station for more paperwork!
0240 Finished paperwork and back to the bunkroom.
0320 Call for abdominal pain
0325 Arrived to find upright, non complaining patient walking around.
0330 "How about we get you on the stretcher and go to the hospital because it's 0330 and that's what we do."
0340 Finally a call for my partner, I drove to the hospital; bed calling my name.
0400 ER asked us if we are available to do a transport. Very reluctantly, yes.
0405 Chugged 20 oz caffeinated beverage.
0445 After waiting for ER to get their crap together, headed out to the hour away hospital.
0500 Patient slept and I scribbled in my notepad.
0600 Arrived at hospital, gave futile report to trauma team, and got mad at the system.
0645 Stopped for coffee on the way home. I must have been tired, I don't even drink coffee.
0720 Arrived at station, restocked, and headed for the inevitable paperwork.
0800 Left work an hour late. Sang along loudly to Coldplay and ignored tiredness.
0915 Arrived home, slept until 1230.

A look into the UK student visa process

So, the final hurdle. The deciding factor that can say whether I study in England or not. How to get a UK student visa. I had no idea how complicated it is to get one.
To help the three people who read this blog to get one someday, I have compiled a list of things to do. It's pretty inclusive as far as I know. Well, inclusive of the things I know for sure, and the things I know in theory.

1. find a school you want to go to with an appropriate major.
2. figure out how much it will cost to go and stay in the UK.
2a. get the money.
3. apply to the school.
3a. collect transcripts, recommendations, and personal statements.
4. wait to be accepted.
5. upon acceptance, send international wire of first tuition payment.
6. wait forever.
6a. in the mean time, get or renew passport.
6b. for that you'll need new passport photos, 75-100 dollars, and the application.
6c. in the mean time put all necessary money (after initial payment) into checking account in your name.
7. once the school gets the payment, wait for them to mail you an official 'Confirmation of Acceptance for Studies' letter.
8. get two more passport photos.
8b. it would be more efficient to get these in step 6b, but now you know.
9. confirm all the money you need to pay for tuition and living costs is still in a checking account and has been for at least a month.
9a. get copies of bank statements that attest to step 9.
9b. alternatively, get the bank to write you a letter that attests to step 9.
10. go to a travel agent and get them to print out a potential flight itinerary for your travels.
10a. write your name on top of that paper. For real.
10b. this doesn't even need to be a flight you will actually take, just proof that you know how to book flights.
11. apply for visa
11a. here's where it gets sketchy for me.
11b. to start, you need to know where you'll be living, and have your passport, and an e-mail address.
11c. oh, and $250.
12. print out completed application.
13. go to local police station and get fingerprints taken, and another passport type photo taken.
13a. this should be fun.
13b. once fingerprints are taken, you have two weeks to submit the visa application.
13c. this is in case your fingerprints change.
14. collect all important documents (application, passport, school letter, bank statements, bank letter, fake flight itinerary, fingerprint receipt (for real it’s a receipt))
14a. get picture of you hugging a beefeater. (something to do with loyalty to the crown, and they're more cuddly than the guys with the big hats.)
14b. ensure your proficiency in standing in lines, making tea, and drinking beer.
14c. know the difference between crisps, chips, crackers, fries, biscuits, and cookies.
14d. incorporate words like 'whilst' 'courgette' 'loo' and 'bollocks' into your everyday vocabulary.
15. mail all important documents and passport to a visa expediting service.
15a. insure it and get them to sign for it.
16. this service will make sure everything is in order for you (allegedly) and then take it to the British consulate for you. Then they will mail it all back to you (hopefully)
16a. all this is for a fee of at least $50.00.
17. wait patiently and nervously for the application to be approved.
18. wait patiently and nervously for the expediting service to mail everything successfully back to you.
19. receive your shiny new visa.
20. actually book the fake flight from step 10.
21. send an international wire for the remainder of the tuition.
22. arrive in UK, learn and enjoy.
22a. never, ever part with any document you collected before arriving in UK (especially the passport with visa attached) even whilst in the bathroom whilst taking a shower.
23. upon arrival, register with the local police.
24. leave when the visa tells you to.

I am only on step 8, and although steps 9-24 are mostly theory at this point, I believe and fervently hope that once it gets started, everything will fall into place and happen very quickly. Except for the leaving part.


May the road rise to meet you.
May the wind be always at your back.
May the sun shine warm upon your face,
and the rain fall softly upon your fields.
And until we meet again,
may God hold you in the palm of His hand.

A former coworker of mine died last weekend. I hope he found what he was looking for.

Happy Easter

A belated happy Easter!

Mini Cov Update 3

Yesterday, figuring "holidays over and it's time for action," I sent a carefully worded e-mail to everyone I had ever been in contact with at Coventry. My problem is that I sent my payment on March 5th and have received no word from them. I don't take kindly to half my savings floating around in some sort of limbo of uncertainty (I was assured by my bank that they would not tie it to the back of a dolphin and hope for the best). Beside that, I still need to apply for a visa and get more official balls rolling.
So, I sent my carefully worded e-mail, (not the first I'd sent inquiring about my payment) yesterday. This morning, I magically had three responses! All confirming my payment and assuring me that my official letter would be on it's way to me more or less immediately.

So, there's that done. I can now shake myself out of my growing "seriously getting doubtful mode" and get nervous again. Oh, and send them more money.

2 minutes after writing this post I received an Unconditional Acceptance letter and a PDF version of the 'confirmation of acceptance' that I use to get my visa.

Lost Dog

After a series of unexciting cancellations, we went for a call for a lady who had gone unresponsive while on the phone with 911. Like so many other calls, this had potential. We arrived on the heels of the ambulance expecting the need to bust down a door or two. (any excuse will do) Luckily (for the door) it was unlocked and we easily gained access. We were greeted by the melodious yap of a smallish dog. The dog was more annoying and friendly than a safety concern for me. I am not a fan of dogs on scene, controlled or otherwise.
Our patient laying in bed and was not unconscious (in the medically problematic sense of the word) but rather asleep. "Hello! What's going on!" I greeted her warmly as my partner pressed his knuckles into her sternum.
"OH, hi!" I said, pleased with her groggy response. The dog stood on her and yapped. She explained that she had a migraine, and now was very tired. I became confused. This prompted a 911 call? "Does this feel different than tiredness you feel when you've had migraines in the past?" I was displeased with her answer of "No." The mood of the call was now far more casual. The BLS crew had readied the cot outside and we squeezed four people into her tiny bedroom to help her get up and outside.
My partner petted her yappy dog, explaining that he just loved dogs. It was kind of cute. I led the patient down her narrow hallway as she was squeezing her eyes shut.
As I held the outside door open for her to pass, I saw the dog race past me and into the yard. It looked back expectantly, ready to play. I sighed.
"Grab him!" my partner yelled futility. I took one step toward it and off it went, circling the house. As the BLS crew got the patient settled on the cot and into the ambulance, my partner and I found ourselves chasing this dog we didn't know around the house, and unsuccessfully into the door. I went back in and found its treats. With that silly sing-song voice people reserve for when talking to babies and puppies I called the dog and shook the bag of treats. It was all I had. After twenty minutes, with the ambulance and patient long gone, we gave up. It was a warm day, and I had a feeling the patient would be home in a matter of hours.
I felt bad leaving it. I put a couple of treats on the porch, hopefully to entice it to wait there for its master. I love my job.

Happens to me all the time.

Today I had a patient who shared my name. She was just a little older (60+ years) than I am, and a tad more forgetful.

On scene:

Pt. "Where are my glasses?"

Me "They're on your face, dear."

On the way to the hospital:

Pt. "Oh! Did we bring my glasses?"

Me "Yep, you're wearing them."

At the hospital:

Pt. "I hope I have my glasses."

Me "You do, there on your face. That's how you can see me so well."

Pt. "Oh, right." she said looking around as if she had just put the glasses on.

New Oven

I got a new oven yesterday. It works, it heats things up, it tells time, it beeps, it is awesome.

1st epic ride

Sunday was the most glorious day! Perfect weather, perfect company, perfect list of things to do. C and I went to a christening and there I met a German paramedic. Talking to her was absolutely fascinating. I hope the feeling was mutual. Apparently in Germany, they cannot do anything to the patient without a doctor physically there. There are no such things as standing orders, or on line medical direction. Anything they do before the doctor gets there is their own liability. She said medics there get sued a lot, mostly because not all paramedic programs are accredited and there's no national standard curriculum. Imagine, an EMS system that is weirder than America! Imagine, a more litigious society than America!
They all (the good ones that is) get a year of training and a year of practical training under and experienced medic. They can do most all of our skills, but mostly assist the doctor, or directly carry out their orders. They do not intubate, but learn how to. She said that she also gets paid three euros an hour. Only a few minutes into our conversation I was counting my blessings.
She was fairly scandalized that we could do all sorts of skills and treatment without even consulting a physician. Their protocols, she went on to say, are one page long and basically say "Get there, get the patient out, wait for the doctor, go to the hospital." Wow. If I spoke German, I might make it my personal goal to improve their EMS.
After the baptism party, we went to one of my favorite local parks. It is good for everything: biking, kayaking, and hiking. We had thought ahead and brought our bikes and related equipment. I thought we might hit the trails for a few miles, but three hours and about 14 miles later we made it back to the cars. The trails were awesome, he took me on one I never knew existed and we went over a ton of rocks, roots, creeks, gravel, stones, dirt, and even a stretch of demoralizing grass. All the love of mountain biking I had came rushing back from the moment my tires hit the dirt. It was a challenge, I was scared of dying more than once and I hadn't had so much fun in a long time. He called it an epic ride. Next time I'll take some pictures. I was too busy this time trying not to break anything.
Needless to say I was overjoyed to see the cars again and we were both utterly spent. We drove back to my house and had a barbecue on the sidewalk. Last week I had gotten a firebowl that goes with my camping grill and I couldn't wait to try it out.
It worked great! We grilled chicken and some veggies and had a really nice evening. Above is a picture of the inaugural lighting of the firebowl. The perfect end to the day.

Head Bleed 2

Last week at part time work we had a patient come in who had apparently fallen and then began having some neurological symptoms that were worrisome. I didn't really notice what was up until she came back from getting a CT and I heard her breathing strangely. Fast, unconscious breathing through clenched teeth. We had a medic student with us that day and we gravitated toward the room because I knew this patient was about to "buy a tube" and it was a good opportunity for the stu to get some experience.
In the room the nurse was getting a couple of IVs started and bloods drawn. The patient was wriggling all over the place and we helped hold her down. After what seemed like ages the doc came in and we all got on the same page that this patient needed an airway. He ordered drugs to RSI the patient (sedate and paralyze a patient to facilitate intubation). The nurse got the drugs together and then my partner for the day got wind of what was going on. He grabbed the intubation kit and headed for the room. He and the doc got into a discussion about God knows what, probably like whether or not dogs can look up. Meanwhile, the student, the nurse, and I were pushing these serious drugs. The doc kept talking.
I tried to interrupt their all important discussion. "Hey, how about we stop talking and intubate this patient?" I gestured with my hands the motions of intubation. They kept talking. I exchanged a significant look with the nurse. She stood between them. "I've pushed the sux, maybe we should do this now." They were both finally snapped back to reality. My partner made to do the intubation, when I stuck up for the stu. "Why don't you let him do it?"
Thankfully he agreed. I quietly coached the student and when he got the tube I was as happy as if I had done it myself.
So many times in clinicals I wished I had had an advocate, and here the tables were turned.
By the time the patient was tubed and sedated the helicopter was there to take her to a facility that could hopefully fix her.

Brain Bleed

Last week at part time work we had a 20 year old student come in. He had been lifting weights and suddenly fell down and had a seizure. His friends called 911 and our local CAD (computer aided dispatch) system made it a low level call. BLS got there, saw that he was actually still pretty bad off and just came to the hospital, as calling the chase paramedic would have wasted more time than it would have been worth. I walked out to the ambulance bay to meet them when they pulled up. Opening their back doors and found the patient to be vomiting everywhere and completely flaccid on his right side. My partner of the day and I took him straight to CT to figure out what was going on with him. In the hallway we started an IV and put him on the monitor. The CT showed a huge brain bleed which caused his seizure and subsequent symptoms.
The doctor supposed that he had a weak vessel in his brain and the strain of lifting made it burst. The patient was taking this news well, and although his symptoms were bad, they were not getting worse and he was mentating perfectly. He was transferred to another facility, where they could try to fix him. I don't know what happened after that, and unfortunate reality of EMS. In my own mind he will make a full recovery. He had age and time on his side. I think in total he was at our community hospital for about 40 minutes which included waiting for the transport ambulance to get there.

I did a little googling and found that acute spontaneous subdural hematoma in young people is not completely unheard of, but probably pretty rare. What other reminder do we need to get us to live our lives to the fullest?

Clothing Removal

Last week I had a patient who fell from her horse while jumping at a show. When I got there the BLS crew had immobilized her and, well, that was about it. She was complaining of neck pain and at that moment couldn't remember what had happened. I used my horsey knowledge to build up a healthy rapport with a scared patient. In general, not a lot was wrong with her. My biggest problem was that she was on the backboard and still had on all of her fancy English riding clothes. I made my best efforts to get off her button up shirt with high collar and black outer riding jacket, but it caused her pain, and then I made it worse. Worse than falling off your horse, worse than the public embarrasment of having an ambulance called for you, worse than defenitly losing your show class, was the stupid paramedic who cut off your expensive riding clothes.
I, too, had never felt worse for cutting someones clothes off. She cried and shrieked and you would have thought I was punching her in the gut. I used to ride and I know how expensive and sacred riding clothes can be. Nothing brought her solace.

"It's a great excuse to get new clothes." I offered, looking to the eagar father.
"I just got these yesterday!" she lamented back.
Oh I felt bad.
Only when cutting leather pants off of a burly motorcycle rider did the process of becoming "trauma naked" yeild such heartache.

Conversely, I recently had a call for a stabbing. If you want to see police, firemen, EMTs, paramedics, old people, kids on bikes, press, marching band leaders, and various other random people come out of the literal woodwork of a smallish town just put the words "stabbing" and the phrase "intestines coming out" over the airwaves and see what happens.
It's hard to supress the rush of adrenaline that shows itself as one skips toward the medic unit while heading to a call like this.

We arrived in a most dramatic fashion along with police and ambulances, to find the guy in his house smoking a cigarette, and we all immedaitely stood down, so to speak. Then as he went to leave he fainted which certainly piqued our interest.

We got him in the ambo, and I immediatly spiked a bag and went to cutting his clothes off. It was already too late when he began complaining about the loss of his best sweatshirt. As opposed to the horse girl, my sympathy waned. Then I felt bad for not feeling bad. What I did cut off revealed a sizely laceration, but the stabbing was more of a cutting that, lucky for him, did not actually expose his intestines.
He had a bit of an attitude for someone in distress and nearly insisted that he not to to the trauma center as he kept touching his laceration. We got him sorted out and sent him to the trauma center anyway.
I got my picture on the local newspapers' website:

A few years ago, my friend got the wise idea to put ambulance patients in gowns. This was a radical idea that was met with much, well I think it was largely ignored, but if it's going to happen anyway, why not get a head start? Maybe one day it will catch on.

The moral of the story is, if you can, take beloved clothing off before I arrive with my trauma shears unsheathed and at the ready like a charging warrior. If you can't get them off, remember that your life is more important than pieces of cotton strategically sewn together.