A Work in Progress

Graduation went as expected. In the morning we had our departmental precommencement which was nice, as it was a little more intimate than actual commencement with 1300 other people we don’t know. As for graduation, thankfully, we got a parking place downtown, and Mom and Dad found the perfect seats. Other than that the afternoon was filled with mixed emotions and classic activities: crossing the stage in a haze, shaking hands of people I don’t know, adding “BS” to the end of my name, and moving the tassel from right to left. Afterwards, we had a great dinner in little Italy, and moved the first of the boxes out of my room. In the evening, a few people came over to enjoy refreshment and each others’ company. Today has been a leisurely day of packing and stripping the walls. I have a feeling this moving thing will get harder before it gets easier. Now that it’s come to an end, I made a list of ‘UMBC in review’. It grew as I gave it more thought, remembering all of the things ...

I am overjoyed to report that I am one huge step closer to being a paramedic. Today was the practical exam, and I can hardly believe that it’s over. I was so stressed this morning, I don’t remember ever being that freaked out. But all was fine. I never have to face the bane of my existence, Trauma Assessment, ever again, and in fact, I never have to do any of it ever again. Now, only the results of my written stand between me and the disco patch. Let the merriment begin, and maybe the consumption of a particular class of drink (who am I kidding?) Bring on the blender and the pina colada mix!

Night Work 2: We started the second night in with a febrile seizure that was fixed with clothes off and some ice packs. Then we had a cool motorcycle accident where the patient had apparently performed spectacular acrobatics after losing control and accidentally hitting the throttle. He jumped away from the bike right before it became bike parts and just in time to miss the explosion. When we got there, the sad, burnt out shell of a motorcycle was on the ground with the handlebars and front tire about 20 feet away from the rest of it. It was soundly destroyed. The patient walked away with only minor cuts, amazing. Later I got to experience the consummate Baltimore call. An absolute classic. The call came out as an unconscious person. What I didn’t know at the time was it was at an inner city Baltimore church. As we walked in, the singing, praying, and organ music continued. All of the women had on beautiful dresses topped with intricate hats that very few people could pull of...

So, 30+ hours in the city should yield some interesting calls; shootings, stabbings, calls that are generally violent in nature. That is, of course, if you are not a white cloud like I am. I had the formula right: ALS bun, warm weather, the weekend, and I had just sharpened my trauma shears, but I just ended up with a long string of various types of BS calls peppered with the occasional “good one.” I had so many calls, that I literally have to look back in my paperwork to remember what happened. Day work: What did happen? CHF, HTN, unknown unconscious (patent airway), etc. A man with a fractured femur secondary to a car backing into his motorized wheelchair and knocking it over. Then we had a patient who claimed her boyfriend had assaulted her. The cop interviewed her in the ambulance and it soon became clear that the patient was not a very good liar. “What’s your address? Where can I serve a warrant?” “Um… [gives address]” “That’s not your address, that’s a strip club! Don...

Today it appears that my white cloud is back from spring break and hanging over my head once again. 10 hours, 1 call. Woot. I did get to attend a lecture about tasers to break up the day. It was pretty cool, especially when they asked for a volunteer. I thought, they wouldn't...they couldn’t...they did! They shot that guy with a taser! That was pretty awesome! Very useful tools, I especially like the barbed 'probes' that dig into the assailants’ skin. I also ordered a pre graduation, graduation gift, a new (desperately needed) stethoscope from my Godfather. Tomorrow, spring break starts officially for me, I'll be heading up north with the 'rents to check out the place where I’d like to work.

Don't tell, but I actually had patients that required care. The 1st call of the day was a rolled over dump truck with entrapment. No, seriously. Somehow the patient managed to roll the truck onto the drivers’ side, leaving him sitting where the drivers’ window should have been and leaning against the roof. The extrication was pretty sweet to watch. Once we got him out with the obligatory board and collar, it was revealed that he basically had nothing wrong with him, aside from a suspiciously low heart rate for someone his size, and for the fact that he was just pinned in a dump truck. So, we took him to (the obvious nearby hospital of choice) where I caught up with my other patient. After that we had a series of medical patients resulting in a near record three medication administrations. Three! A little lasix for our trouble breathing, some glucagon for our 43 blood glucose diabetic with no access, and a few baby aspirins for our quasi chest pain. Glucose checks, EKGs, 12 ...

I've had a very interesting last few days, pretty much starting with an asystole arrest in a nursing home notorious for killing its residents. As soon as I realized where we were, I said "Ooh, this place." When we got to the room, cpr was in progress, 4 rounds of epi 3 rounds of atropine had already been given, and to top it all off, it was a trach patient, so I didn't get my airway! We tried to pace him, unsuccessfully, both my preceptor and I went for EJs, unsuccessfully, but a few minutes later, we had return of spontaneous pulses. Wow. The patient had been down for 20 minutes, and pupils were fixed and dilated. We transported carefully. Shortly after, we had a patient, that, looking back at my paperwork now, I don't remember at all. I was trying to finish my Fisdap stuff and I couldn't remember a thing about them (do note the use of 'them' as I don't even remember that detail). Apparently, I even started an IV. Freaky. Then we had my f...

I've had a very interesting week, but no time yet to blog it. Sometime in the near future, I'll have stories in full. Here's a preview: quasi cardiac arrest, 2 story fall onto head, cops and belligerent drunks don’t mix, pinned under a dump truck, and some absolute classics: diabetes, trouble breathing, and chest pain. Pt. quote of the week: "Who's driving? It's not the girl, is it?" Partner quote of the week: "Minorities and bigots...I hate them both." (said just fast enough to throw you off)

I’ve had a few days of clinicals, hence the lack of updates, and the length of this one. I started out by hitting a new personal level of ghetto by taping the earpieces onto my stethoscope, classy. We had a very eclectic day, starting with a burn patient, marking the first time I got to give morphine, sweet! Later we basically had an interfacility GI bleed patient, pungent! The patient had a PICC line in and the sending facility had started a 22g; way to put fluids in, not. One call was for neck pain. A quick assessment, (looking at the patient) led to the discovery of a large abscess on her neck. Apparently the patient had shot up there and missed the vein, infiltrating heroin. Of course your neck hurts! Finally we had a, well, technically it’s outside of my scope of practice to diagnose, but we had a seizure faker. Tip to fakers: look up what ‘ails’ you before attempting to portray it. Accuracy helps. For example: seizure patients do not typically stop seizing to say ‘ouch...

Since last I wrote: EMS wise; 23 hours of work and about 13 calls, and 1 clinical yielding 1 call and 4 cancellations. Also, 2 cadavers for an airway class allowing for 2 intubations, 1 surgical crike and 1 needle decompression. School wise; 2 tests back, bizarrely with the same grade, and the score of my last bowling game, 97, marking the end of my phys. ed career. The best number of all: around 75 degrees, the high for the last 4 days. Needless to say, we’ve been kayaking twice. A few miles of flat water so Ewing can be properly acquainted with the new kayak. Flat water is great for honing our skills, edging, bracing, drawing, and my favorite, perfecting my forward stroke. Kayaking wise; smelled 1 skunk, spotted 1 fox, and about 20 geese. 0 impromptu swimming lessons. Today I ordered my cap and gown and the graduation announcements, leading us to the scariest number of all: 72, the number of days until graduation. Which leads us to the next scariest number, or perhaps the mo...

It’s been a while, and I’ve been trying to think of what I did over the last 10 days. I learned that 14 hours at work is about 14 too many. It’s a little scary, because now that I think of it, I can’t remember anything I did during my shift last week. I had a clinical. It started out pretty well with an asthmatic 12 year old whose wheezing I could hear from a cross the room, and an IV on the fly. From there it went to a car v. pole and eventually faded into absolutely nothing. At work recently, I transported 9 day old in withdraw, which was kind of scary. Other than that I had I had some good conversations. One with a spry Greek lady looking forward to Mardi gras, and a minister who had actually interned at my church back in the 70’s. Today I scheduled 183 hours of clinical time between now and the end of April, got the dates for the national registry exam (gasp, shock, horror!), and really made progress on this whole real life thing (don’t look now, but I may have made a decisi...

Today marks 99 days until graduation. To celebrate, I went kayaking in 35ish degree water and high winds. Note to self: water shoes and snowy trails = seriously cold toes. Somehow, putting my feet into a piece of plastic floating in freezing water helped. Other than that it was a nice little paddle. A good reminder for me to invest in nice neoprene gloves and boots, of course. Now we’re off to happy hour (I am happily DDing) to properly celebrate 99 days.

I survived my first day at work as a cleared ALS provider. It was a little weird, but felt great. We had 6 calls in 12 hours, two were BLS. I had my first ‘superstat’ which means that it’s a critical patient that needs to be transferred ASAP. It’s pretty much the only time we get to go lights and sirens in the private ambo service. Our patient was having severe chest pain and was on several drip medications. Once we got her packaged and loaded it only took us 4 min to get to the receiving hospital. In that time the patient gained 1.5 cm of ST elevation in lead 1. We took her straight into a cardiac cath lab where they discovered she had nearly 100% occlusion of the left main, wow! (basically, the patient was having "the big one" (a bad heart attack) and was within minutes of being beyond help.) Everything happened so quickly that the patient wasn’t even registered at the hospital before her cath was underway. When we went back out to the ambulance we were accosted by her dau...

Landing gear down, heat is off, 365 off, door off…wait. Aviation is so fascinating to me, yet I don’t understand it one bit. I feel accomplished just operating my headset and flipping the radio channel switches. Looking in the cockpit, I have no idea what all those gauges, switches, and pedals are for, but I’m glad somebody does. Yesterday I rode the helicopter again. We had two calls, neither of which I would have fathomed calling the helicopter for, but okay. The first was for a guy who fell in the bathroom, and the other was for a kid who had a little too much fun sledding, caught some air, and landed on his back. He was great, totally calm, adorable, and not even complaining that he was uncomfortable. “Can you squeeze my fingers?” “Okay.” (squeezes weakly) “Squeeze them as hard as you can.” (incredulously) “As hard as I can?” (as if to say: “Are you sure, because I don’t want to hurt you with my super-human strength.”) “Yeah” “Well, okay” (squeezes hard) “Ooh, That’s great! You’r...

Being on an ALS chase car is interesting and sometimes frustrating. We’d get a call, and then be cancelled on the way, another one, and be cancelled on scene. Get another call (but don’t get your hopes up) as we’re cancelled again. While we’re en route I’m thinking about treatment plans and drug dosages for the supposed condition, and then…well, nevermind. Chase cars are fun too, we got to meet different BLS crews and ride in some wacky ambulances. We had a patient; 9 months pregnant with contractions 3 minutes apart, and we were in probably the tiniest ambulance I had ever seen. I had to put my feet up on the seat just to switch places with my preceptor. Starting an IV was hard enough, thank God she didn’t start having the baby, I don’t know where we would have put it. We also had a diabetic, dehydration, CHF, and oh yeah, a moped accident involving kids 5, 2, and 20 months. How could three children be on a moped on a blustery winter day? Well, it involves a little neglec...

Yesterday my parents came down and we had a very Baltimorean day. We visited the American Dime Museum which features ‘memorabilia of the exotic and novelty acts of old” such as a mummified giant, shrunken heads, paintings done by monkeys, a two headed cow, a sea monster from the patapsco river and much, much more. (deciding what is real and what's not exactly real is up to you and half the fun!) It's called the 'dime' museum because these novelties were serious entertainment back in the day, and cost a dime to see. Unfortunately, the museum be closing at the end of the month. I suggest you go see this piece of American history while you still can (it’s worth every dime.) Afterwards, I was glad that we stumbled upon the mayor’s Christmas parade going down 36th street or “The Avenue”; it was great. The marching bands were playing Christmas carols, the drum corps were awesome, and Santa was there too! I enjoyed it immensely in spite of myself. We had dinner in Hampden a...

For two nights last week, I was in the city on what I think is the 3rd busiest medic. We were pretty busy and I couldn’t hear the radio at all from the back, so we’d be returning to the station and all of a sudden, we’re going to a mystery location, lights and sirens, like “surprise! we have a call!” Whatever, I like surprises. The calls I went on the first night sounded better as they were dispatched rather than what they actually were. For example, “Shot in the eye with a BB gun.” On the way out of the station, everyone was taunting: “You’ll shoot your eye out!” Little did they know, it wasn’t actually in the eye, but on the eye, therefore making it not so interesting. Also: “Pedestrian struck by vehicle.” True, she was hit by a car, but with no blood, no deformity, no crepitus, strong distal pulses, and no LOC PTA, in other words, very lucky. The second night, I almost missed CHF, forgot charcoal existed, and missed 2 IVs, but, I got to give charcoal (gross!), morphine, and nitro. I...

I started out Monday morning so early that sleeping in until 7 the next day sounded awesome. As I was driving along to this far away clinical, the sun was coming up, the road signs became keystone shaped, and all I could think was “why are there so many people driving at this unholy hour?” It was like a mini road trip except too short to stop and eat, too early or too late to do something impulsive and fun, and I was by myself. The clinical itself was pretty good. The ‘white cloud’ gods didn’t realize I was there until about 10 am, so I got to run a few calls before they stopped coming in completely. I was on an ALS chase car, hospital based system. Upgrading to ALS is nice as the patient is usually already packaged, and histories, allergies, and med lists are already obtained, sweet! We had an asthma attack and a guy who ate a whole bottle of vicodin. The preceptors there are pretty cool as they really do sit back and let you go at it, intervening only if you’re about to kill the pati...

I received my first application for a real job, yikes! This whole real life thing is beginning to freak me out. So far, this is the only company that interests me. To get the job I have to (finish school, get my registry paramedic) apply, take tests etc. Then, if I get it, I have to find a place to live, get reciprocity, probably get a new car, ride 20 shifts before I get cut loose, and oh yeah, this is over 400 miles from home. Don’t tell anyone, but I’m scared. I got cleared at work, yay! (not a fake job per se, but...) Last week, I spent 12 hours of clinical time doing BLS calls, (not that they can’t be useful in some way…wait. what am I saying?) One was a call for a stroke. “Awesome!” says I, anticipating a good ALS call to salvage the day. 5 seconds after we arrived, it became clear that it was not a stroke, heart attack, dismemberment, asthma attack, or fainting; but actually absolutely nothing. Medic: What’s going on that makes you think you’re having a stro...

That (with an open mouthed stare) about sums up my emotions concerning the few patients that I saw during my observation rotation at the premier trauma center in the country. I was told that they often inadvertently have ‘theme nights.’ The night I was there, the theme definitely would have been: Faces. I will spare you from the gory details by using medical terms and other big words. Patient #1: His cerebrum came in contact with a small lead projectile, forcing it to leave the skull permanently. Patient #2: Patient’s frontal lobe was herniating into the orbits. I’ll leave that one to the imagination. Patient #3: Prisoner was stabbed with a bucket handle resulting in a tension pneumothorax. Patient #4: Patient’s face came in contact with a human fist at a high velocity. Patient #5: Defenestrated herself from the second story of a burning building, resulting in the avulsion of the lower 2/3 of her face. If all of these patients had actually only been one ...