OD (2)

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 "allow" these patients to refuse. Any patient who is alert and oriented may refuse care and transport to the hospital. The opposite of that is kidnapping and I'm not into that.
These overdoses, while they start out unconscious, rapidly improve and are then often quite fervent in their desire to stay home and be left alone.  This poses a problem for me.  Firstly, I have to allow a drug addled (but oriented) person to stay home. They are not arrested, scared, charged, or even mildly inconvenienced, a fact that annoys me.  They are all but rewarded for their keen overdosing skills. Secondly, the half life of narcotics is much longer than that of the reversal agent. These people could find themselves unconscious again even without taking more drugs.  And I always worry that when they are found dead the next day, that will quite easily fall on me, both emotionally and legally.

One colleague shares my sentiment but takes his tactics to the extreme, and doesn't treat these people until they are already in the ambulance.  This has caused him to have to summon police, get into fights and twice have a patient jump from an all but moving ambulance in the middle of the street. This tactic does not work.
I prefer to gently wake these people up, gather them up and walk them swiftly to the ambulance. As they begin to feel more normal they can be (usually) easily convinced to not jump out of the ambulance and to do everyone (especially themselves) a favor and just come on down to the ER.  So far so good. No messes have been made.
Once they get to the ER, are they suddenly compelled to give up the drugs and reform? No. But do they have the chance?  Yes.  This is pretty idealistic, I know, but I have to feel like I am doing something. Anything to never see another dead 25 year old.

Texas

(way overdue but who cares?!)
Everyone needs a set of friends whom move all over the country to new places and are the picture of kind and generous hosts.  Mine moved to Texas last year, a place I had never been, nor had more than a passing interest in until my favorite family was there.
It took a while to get myself together, but headed to Texas for a week in April.  This was the first time I did anything remotely interesting with a spring break.  I think everyone else in the world is really onto something.
I got a wonderful personal tour of Ft. Hood, Killeen, Waco and the surrounding area.  I went to my first real rodeo, but lasted only 7 seconds.  I really was happy to drive around a chase blue bonnets, the Texas state flower. 


Texas in the spring spoiled me.  It is (allegedly) the only time when the weather is perfect and things are lush and green and flowers are in bloom.  A week or so in any direction on the calendar turns the Texan landscape back into the harsh and dry desert seen in movies.  So, I'd say...go in April.
Sadly, I did not find the basement of the Alamo, nor Pee Wee's bike anywhere despite being set to the task about 20 years ago.  Pedro and Inez, both sadly missing as well.  Possibly on bike.  If you followed all of that, I may want to marry you.
San Antonio was a charming place with a beautiful river, well preserved 18th century Spanish missions.  All with their own characteristics and charm.  I also visited the market square where I was transported to Mexico so convincingly that I kept trying to converse in Spanish as well as convert the prices from pesos.  Accidentally, I found a cool candy store Alamo Candy where I tried some weird and wonderful things and stocked up on souvenirs.

On the drive back from San Antonio, I did spot a real Texas longhorn, stopped a Buckees (the most insane and delightful gas station I've ever seen), and tasted some Texas made bourbon.

Later, in a flying trip to Houston, I learned what this space race thing was all about and saw the room where Houston learned that it had a problem. Also...Space ships!

I found Texas to be surprising and diverse and full of life. I loved all of the decidedly "Everything is bigger in Texas" things and the fierce, what I can only call nationalism shared by Texans.

Call Round Up

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.

The Dog

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 the street.  Glass sparkled along the road as he searched.

Ready to head back to the station, he heard it.  The whimper of a dog.  Crouched under the back bumper, it hopped toward him on three good legs.  Instinctively he reached out to the little thing.  It sniffed- and finding him acceptable, boldly inching closer.
"We're you in here?"  He asked as he scooped it up, clutching it against his chest as it trembled.

He was left standing there, holding the tiny, shivering thing, wondering what to do with it.  His partner returned. "Jesus, where did that come from?"
"I think it fell out of the car."
"Fuck". She shined a flashlight around the dog.
"What do we do?"
"I don't know."  He sighed.

A thin towel protected the small dog from the cold of the steel exam table.  The vet assessed him quickly. Ten, twenty, thirty seconds.  How long to be sure? She looked up and shook her head.

He held the dogs head in his hands, smoothing the fur that caught his tears. 

Calls.

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.

5%

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 dwelling on these truths. I can be on the road to burnout and world-hatred, or, I can accept, move on and try to be the best paramedic I can be. Because one day, in that 5% moment, that’s the paramedic the patient needs.

Negotiations

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 wacked her head. Blood was everywhere, bystanders were concerned, but she was just as happy as a clam. “I’m fine.” She repeated unconvincingly. We got her bandaged up and in the ambulance and all buckled in before she decided that this was not what she wanted to do with her day. Normally, I am okay with people making alternative plans. “Yes, have your wife drive you!” I usually say through the PA of the ambulance as we drive away. But this lady was not making a good decision. For almost an hour, I talked to her. The police came and talked to her. The doctor at the ER talked to her on the radio. She was implacable, and we had no ability to kidnap her for her own good. So, off we left.

Immediately after, we met a guy who “just wasn’t feeling right”. He had had chest pains off and on, felt weak, and then nauseated. Fortunately and unfortunately, everything we could check checked out fine, but I wanted him to go to the hospital. I used anecdotes, scare tactics, and I even pulled out the big guns: “If you were my dad, I would want you to go.” That line almost broke him, but he decided to wait it out until the morning. There are some conditions I can’t fix. Stubbornness is one of them.

Blogging

So, here I am bored at work and I wonder…what ever happened to that blog I used to write? Yeah, there was stuff about EMS or ambulances…something like that. Sometimes stuff about travel. Oh! And a whole month of just pictures. Weird. Then, I think that the job got boring, or sad, or both and the blog sort of stopped. Sure, maybe a few meager posts here and there, but nothing too exciting or deep, but thankfully, no sad poetry either.

Perhaps the world is blessed by having one less blog. One less tangle of self obsessed prose. One less (pre) millennial bitching about how hard real life is. One less quarter life crisis immortalized with questionable grammar in ones and zeros. “Oh, my job is boring. I don’t get paid enough. I’m single. Everything sucks. Oh, I go on trips and rub them in everybody’s face. Oh, I’ve filled the internet with 1000 blog posts, look at me go. Oh, my pets are cute.” No one cares.

 Then I remember. All those calls that I can’t actually remember are here. Some okay poetry. Some travel anecdotes that only I care about. But that’s blogger life for you. My whole life there for the internet to see, yet no one is watching but me. (there’s some more shit poetry). Self indulgent “therapy”.

So, I’m here to stay. I will continue to agonize over wording that no one (very few) will read. I will think about the blog and maybe not say ‘forget it’ right away. I will post pictures of my cats, because I am a single woman over 30 and it’s in my spinster contract. I will make jokes that only I laugh at. I will write down calls that I will forget. My ‘comeback’ will be boring but not as sad as that as some D list actors. I will take my D list blogging to a new level. I will get one new person to read this that isn’t a robot trying to sell things.  One new person whom isn’t a fake Nigerian prince (although, be careful, I am susceptible to romance).  One new person whom I’ve never met. So, c’mon blog. Let’s do this thing.

16 June 16

Temporary insanity in the house while getting a new plaster ceiling.

9 June 16

You're not prepared unless you have a backboard as part of your personal first aid kit.

OD

(This may be the first in a series of posts where I outline how I am trying to love the job again....maybe.)

Suddenly all of the lay people I know are asking me if I am noticing an uptick in overdoses. The truth is that I have.  As the supply purchaser at work, I can barely keep up with buying BVM's (which can be used to breathe for people), nasal atomizers (a handy tool that lets just about anyone squirt narcan up their noses) and narcan itself (the handy drug that reverses heroin overdoses). 

The number of overdoses in America has (temporarily) captured attention.  This is how we are killing our youth.  For EMS, it is all too routine.  Never in my career did I think I'd hear medics (including myself) act so indifferent to patients that are on the brink of death.  I am not being over-dramatic- these people die.  They die often, because you can only not breathe for so long.  But most don't die.  Somehow they chip away at their nine lives and come back from the brink, only to overdose again.

I have been thinking about all of the recent overdoses and and how causally we take them now.  I missed an IV on one of these patients and heard with a chuckle "Oh, he's better at finding his veins than you are." from my colleagues.  Oh. HAHA.  But this is just one example of how we see these patients as not 'real' and as sub-human.  Yes, they lie to us. Yes, they don't believe that they were nearly dead.  Yes, they are unappreciative.  Yes, they are often homeless and unemployed. 

How easy it is to forget how shitty their lives really are, How easy it is to forget that these people are sons and daughters, fathers, and mothers.  Most of us have never truly been addicted. I mean sure...I love candy, chocolate, and playing video games, but those are not actual addictions.

I (do, but) shouldn't judge a person who is so addicted to something that they would do it over and over again to their almost guaranteed demise. I do not understand addiction that ends in ruined lives, children in foster care, and squalid living conditions. But I don't have to understand any of that.  What I have to remember is that these people are human and so am I.  Bad decisions happen.  I could just have easily made the same bad decisions, but somehow I didn't. Addiction is real.

I have to believe that these people want their lives back. They want their kids. They want jobs and to be members of society. I have to believe this because I feel myself falling into the idea that it is okay to joke and judge about addiction.  It is too easy to judge them, write them off, and fantasize about letting them die.

No, we cannot mourn for every ruined life or every dollar wasted, but we as EMS should be trying harder.  I am tired of being the band aid.
So, like John Oliver I want to lay out a rant and then set a challenge.  Mostly for myself.  There is no point in preaching if I can't enact a plan of action.  I have set a personal challenge to start with compassion.  I want to take a moment to remember that addicts are people, people who need help, and we just happen to be in the business of helping people.  I want to learn my local resources for these people.  I want to no longer accept refusals from these patients (but that's probably another post) and get them to the next step.

The last overdose I had woke up and said "I was going to go to rehab tomorrow".
I most sincerely and overly-heroically said "Well, now you have a tomorrow."

Quebec

A few months ago, my sister proposed a trip.  Without thinking too hard, I immediately said yes to a winter trip to Quebec, Canada.  Now, I love trips that require special equipment and apparel, but this was next level for me.  From booking to leaving, my entire winter wardrobe was turned over, bolstered, improved, and tested.  As possible -20 degree temperatures loomed closer, the panic set in.  Are these boots really going to keep my feet from freezing?  Are four layers enough?  Will my mittens fail?  Will all of my digits snap off and I will get them all replaced via socialized medicine?

Happily, on our coldest day (-15 at noon), all of my fears were gone.  If anything I was more likely to have a heat stroke upon entering any establishment, as it is difficult to shed 15 pieces of clothing and still be able to browse.  The cold is a chore there.  There is no running outside to get the mail (well, maybe for locals).  There is no leaving anything in the car overnight.  There is no hitting snooze because getting ready to go outside is really like preparing for space travel (as in it takes a team to dress you). 

The cold there is part of the culture.  It's an ever present element and a source of pride at the end of every winter. (we survived!)  Québécois are a hearty people who know how to have fun in the snow.  They are so good at it that even I felt like I loved it.  We went snowshoeing, glissading, tobogganing, snow tubing, and, best of all, dog sledding.  (Seriously, dog sledding was the most exhilarating and terrifying thing I've done in a while.  It was awesome.) We went to their winter carnival in Quebec city and marveled at a hotel made entirely of ice and snow. 

I learned much, especially that one can get British candies in parts of Canada, roads to not need to be plowed and salted, and we (mid-atlanticers) are really, really bad at winter.

Also, they really take their French seriously there.  Yes, yes, I am the last person on earth to realize that in Quebec people really speak French and many only speak it.  My French consists of a bloody-ear inducing count to 10, so this really was a shock.

It was an awesome and exhausting long weekend and I really can't wait to go back.  But, maybe in summer next time.

PA Update

I know that so many of you are waiting for an update on "Wild ass plan-apply to PA school". Well get ready! Basically, it's boring. I am slogging through my last prerequisite "Intro to organic and biochemistry". Did I save the best for last or what?! Truly, this is the class that I know I will struggle with. How do I know that? Well, it's been two weeks and I already am!
This class is offered at several schools but is accepted for all of the programs in my state. When we had our obligatory introductions on the first class, it became clear that I am not alone in my wild ass plan. Indeed, the competition for these programs was never made more clear. 28 out of 30 students want to be PA's. 28 out of 30 students went home that night and cried themselves to sleep. Those that hadn't already done the math of 1000 PA school applicants for a class of 35 were for the first time feeling the pressure.
It's a mixed bag of backgrounds and ages.  I am probably not the oldest aspiring PA, but the young ones are...so young.  My favorite part of talking to them is when they muse "What is the fastest, easiest way to get patient contact experience?"
As a good paramedic, I take this time to promote volunteer EMS and encourage them to take a 15 week class and get out there and treat some patients.  It's a win, win, win situation for them as far as I can tell.  I can only hope that we can, at the very least get some good EMTs out of these aspiring PAs. (Those who don't think that 15 weeks is too long.)
While exchanging backgrounds, I did worry that everyone would hate me as a pretty well qualified Paramedic, but it turned out that...no one has even asked what I do.  Ah, youth.

UPDATE TO UNPUBLISHED POST.
Now, many more weeks in, I still am terrified of this class.  Not one assignment as solidified an acceptable grade one way or the other, instead, as predicted, I am teetering on the edge of something okay, and something very annoyingly not okay.
But...I will keep plugging away, making attempts to understand the un-understandable.  If at a loss for direction-forward!

Blogiversary 11

I've retrodated this post, as although I was thinking of dear old bloggie on the 15th (our actual anniversary) I was not near a computer. In fact, for the first time in a couple of years had an actual reason for not celebrating the blogiversary. I was lucky enough to be on a long weekend to Quebec with my nieces French class. Don't worry, I sent it a post card. (Bonjour, thinking of you, wish you were here. You know, normal greetings to an intangible object.) I am happy to report that on the trip, I didn't freeze to death or lose any digits as predicted by most (including myself). So, I am now wishing the blog a happy anniversary. I guess I've been 'better' at keeping but still not great. Between work and school and work and television, time for blogging has been limited. The traditional gift for the 11th anniversary is steel. (Hence the I-beam). But now I will be forming at least a couple of posts about how seriously Quebec takes their French and how just plain crazy it is to live in a place that goes to -15 F on a regular basis.

Calls

How about a good old fashioned call round up?

A pleasantly confused old lady with a fever. 'Would you tell me your birthday?' Huge, mischievous smile 'No.' 'Alright, you do what you do.' 'Thank you for a great dinner.' 'Anytime.' 'I'm so glad that's over.' 'Yes. Me too'. (Continues to hospital).

A kid that ate iron supplements. PS. this can be VERY bad for adults but especially children. But in the first stages, all I had to deal with was another kid whom didn't quite like me.

A kid who stabbed themselves with an adult epi pen. PS. I don't really know how bad this can be especially when everything is fine after 45 minutes. Poison control agreed in this instance.

A delightfully bright elderly lady with basically nothing wrong with her. When I stood her up from her chair she was about a head and a half shorter than I am. There was a pregnant pause before she said. "That's as high as I'm going to get!" "Hey, I wasn't going to mention it." I said innocently. "You wanted to. I could tell." I want more patients like her.

A patient with flank pain called at midnight. Within the last week they'd been seen in the ER three times for the same thing. No primary physician.

Someone with a pulse of 35 and a BP of 70/p. Both very not good. But a patient I can treat?! Amazing. Lots of generic chest pains and sick people: aspirin, zofran, yay yay yay!