22 June 2006

Something less depressing

I feel like I've been focusing on a lot of negative things lately, so here's something positive. The fireflies are out. I saw them last night. Since I grew up in an area without them, they always require a double-take, a "Did I just really see a flashing light in the bushes?" stare. They also make me feel happy, almost giddy with the memory of catching them and feeding them to my frog and watching him flash all evening as he digested them. Yes, I'm weird, but fireflies make me happy. Other recent happy nature occurrences include the wonderful sound of frogs after the massive rain. I enjoy listening to them rather than just the regular creaking crickets.

Happy warm fuzzies to you all today!

20 June 2006

Fence sitting

MCAT (medical college admissions test) scores were available on-line today. I had heard a rumor they would be, so of course I checked. Kinda wish I hadn't but at least now I have no fear of the envelope in the mailbox. Scores on the multiple choice portions of the test were exactly where my prep work suggested they would be and I think they are in a reasonable range for admission to the schools I was looking at. Not so high as a guaranteed slot, but workable with a well-rounded application. Score on the writing section was in the toilet. As in, second lowest score type of low.

I'm on the fence because I don't know what this means for my chances of admission. Don't know whether to re-take the test in the hopes of getting a better writing score because the other sections could go up or down. Schools see all the scores from every time you take the test and each one does something different with multiple results. Waffling because the prep course I took the first time will let me re-take it for free if I'm going to re-test, but the writing was exactly the part I felt the least prepared for because there was no mechanism for feedback on the practice.

Also gets me back to waffling on the whole ordeal. Am I really willing to sell my soul to get in? Can I even make it through a hyper-competitive degree program with people nearly a decade younger than me? Can I convince an admissions committee that I have something to offer them when I'm not even sure what that something is? Can I go through another two months of studying and prep work where I don't interact with my husband? And am I really asking for four years of probably living apart from him or at best seeing him occassionally?

19 June 2006

99% perspiration

The other 1% is probably frustration, because it certainly isn't inspiration at this point. The last couple of days have been extremely toasty which hasn't been helping my complete lack of motivation to accomplish anything. Yesterday was my first shift on the vanbulance since Tuesday, and I'm not going back until Thursday and working straight through next Sunday. This part-time thing is weird because I work in big clumps rather than evenly spaced.

Sunday brought a slightly unusual patient for us, as he had a tracheostomy and needed suctioning. In the 4 months I've been rolling in the same truck, I've never used the wall suction nor the portable unit. The suction machine already had a Yankauer tip attached to it, so I never really paid it any attention during the morning truck check beyond "yep, it's there." This patient was well experienced at suctioning himself, so the nurse advised us simply to give him the suction and let him do it. He starts with it, then looks at me, clearly trying to communicate something (he can't talk at all because the trach is below his vocal cords), then pulls the tip off the tubing, flips it over, and connects it back together. When he's finished, I gave him my paper and pen so I could understand what he wanted me to know. Basically, he wanted me to know that it was on backwards. D'oh! I felt bad because that made us look pretty stupid. Guess I shouldn't have assumed that whomever hooked it up had done it right. Looking at the new one we got from supply to set up the equipment again, I'm not entirely sure how it even fit on there backwards anyway.

This week also brought my first shift as a volunteer with the local FD. It was even a day that K's shift was working which is good because I see those guys all the time and I'm reasonably comfortable with them, even though K had the day off. The guys were harrassing me about how happy they were that they didn't have to deal with both of us at the same time. I now have a big "probie" notebook full of things I'm supposed to accomplish in the first six months I'm there. It includes things like knowing the streets in town, knowing and learning to operate all the equipment on the ambulance and the appropriate way to drive, and a couple of other weird skills like the raising and lowering system they use, the cold water rescue suit, and dressing a hydrant. Not nearly as comprehensive as all the stuff K has to prove he knows to be off of probation 7/1, but still quite a bit of stuff. The night was quite slow, with the only call happening while I was already at the station so there was no chance I was going to get lost.

15 June 2006

Blue canaries

EMT-I class last night was interesting. A guest speaker provided a whole different type of lecture, compared to Monday's anatomy and physiology, about violent situations, personal safety, abuse, and crime scene awareness. He was a state trooper for 20+ years before becoming a paramedic for the last 10+ and also works as a SWAT medic, so he's got a lot of experience with dangerous situations.

First rule, always send the cops in first if you suspect any unsafe situation. They get paid and trained to handle violent, dangerous people, EMTs do not. And if you're not the person with direct patient care, your job is to watch the bigger picture, including the "bad guy". I'm going to struggle with this assignment on the street because I want to help with whatever is happening with the patient and not just stand there and try and pay attention to everything else. Conceivably I could delegate this task to one of the firefighters who are frequently on scene, but I think this would take some discussion with whomever I was partnered with to figure out how it is going to work and would have to be FD people that you would trust to remember that they are supposed to be watching your back.

Anyway, lots of food for thought with everything from where and how to stand on a call, to how to read body language of potentially aggressive people, to choices for body armour. Also he had some good insights into communicating with the local PD to find out ahead of time what they use for guns, non-lethal weapons, body armour, etc. so you know what kind of injuries they are likely to cause and receive. He gave a couple of good reasons for ambulances to carry a single set of old-style chain handcuffs (it has NOTHING to do with restraining patients - we have restraints for that specific purpose) and at least 1 handcuff key even if you don't have the cuffs themselves, both of which are supplies I would never have remotely thought of on an ambulance.

The abuse section is always hard because it gets you thinking about all the bad things that happen to people. Since I've been involved with a lot of elderly patients lately, seeing and talking about the elder abuse was much more difficult than it has been previously. EMTs are mandatory reporters, so if we see something questionable, it requires a phone call to the appropriate agency or a report to the doc at the ER or both. It is always good to be reminded of that and to remember that I have to stand my ground if something doesn't feel right.

Crime scene awareness always starts off feeling kinda cheesy with repeated entreaties of "don't touch anything", but he was able to give us a couple new things to think about - like at car accidents to be paying attention to any marks left on the road so you don't park the ambulance on them or drive through them, noticing what gear the transmission was in, and making sure not to do things like turning off the headlights or at least remembering to tell the police that you did it.

Any class or lecture is always more enjoyable when it makes you think and gives you immediate practical information, so even though I didn't really want to be there the full 4 hours last night, it was a great lecture to have and well delivered.

10 June 2006

Way #7,698 to make me annoyed

Good nurses are worth their weight in precious metals. Bad nurses would serve patients better by just not showing up. While picking up a patient today, "her" nurse was out at lunch so one of the other nurses on the unit was covering. When we arrived, I asked for a signature on the paperwork I have to write (the patient care report or PCR) and a brief report. I really don't need to know everything there is to know about the patient, but it is good to be treated like a fellow medical professional and advised of important information on the patient I'm about to be in sole care of. The covering nurse laughed at me and told me that she would sign but she didn't know anything about the patient.

For any patient admitted with a pain complaint, I've learned to ask when the last dose of pain medication was given, whether the patient is due for more, whether the pain is adequately controlled, and then all the other usual questions about major medical history, vital signs, etc. All relevant questions if you're going to bounce someone down the pot-holed local roads in the back of an ambulance on a barely padded stretcher. Again, I get the laugh and then an annoyed sigh when she realizes I'm serious despite having just been joking with another staff member on the unit about patient's complaining when they are in pain. She gives me the eye roll as she digs out the patient's chart and tells me her last dose was at midnight (it is 1300). Another sigh when I ask for the last set of vital signs. When I ask whether the pain is under control she replies with, "Not my patient, not my problem." Pretty crappy attitude to have about someone you're caring for, even if only for an hour. I'm only caring for the patient for usually 15-20 minutes and I care, how hard is it to have empathy for another human being in pain? In defense of the good nurses out there, I've had them see the stretcher rolling on to the unit and immediately head toward the patient, pain meds in hand, to make sure they're dosed with enough time for maximum efficacy before transport.

Apparently, this patient's pain had been controlled because she had been sitting upright and still for the last four or so hours. Once we got her moving, she was distinctly in distress. At the nursing home, she was in enough pain that she was gasping for breath. All because some stupid beyotch nurse couldn't be bothered to giver her some pain meds, that there were already orders written for, before the ride.

08 June 2006

The Line

I found the line in the sand, the place I will not cross. I will take senile, smelly, vomiting, crazy, or dirty-joke telling patients. I will NOT take a 420 lb patient on a ordinary stretcher, especially not with a female partner 5'5" and 110 lbs. I don't care that the stretcher is rated to 500 lbs. I don't care that you are sending me another truck for a "lift assist", which is only helpful on the hospital end because when we get to the facility we're going to have to get him out of the truck on our own. I don't care who told who how big he was and who's pissed that he has to wait. I will not load a patient on my stretcher when I can not raise the side rails and I can not get the seatbelts around his waist nor over his shoulders. If the company has transported him previously on the bariatric stretcher , then I'd say the odds are pretty good that is the way we should transport him again. I don't care how busy all the ambulances are, I'm not injuring myself for $10/hr so a non-emergency patient doesn't have to wait an extra hour.

06 June 2006


Today's van-bulance story is courtesy of a 90 year old man who recently had his right leg amputated. P and I were transporting him to a nursing home (the scary one I don't like) for rehab/therapy so he could eventually go home. He was quite able to get around, on and off the stretcher, seemed fairly alert and very friendly. I learned later that he had some mild dementia and was a little disoriented as to when he was, but pretty clear on everything else. When we arrived at the nursing home, we were met by a social services/admissions-type person who rode upstairs in the elevator with us.

No sooner did the elevator doors close than the patient curled his finger in a come-closer gesture and asked "Do you girls have time for a joke?" Being the smile and nod, humor the patient type, I told him "Sure," as we were stuck in the elevator either way. He grinned and began, "So there was this businessman, a hard-working guy, who decides one day that he wants to go home and have a hot lunch with his wife. He calls her on the phone and tells her he's on his way, looking forward to a nice hot meal, and will be there in 10 or 15 minutes. The businessman then hops in his car and drives home. When he gets home, he opens the door only to see his wife sliding down the bannister. He asks her, 'What the hell are you doing?' To which she replies, 'Warming up your lunch.'" Our patient then just about laughs himself silly because P and I were chuckling but the other lady had turned bright red and completely embarassed. He then leans towards me and says, "I like to save that one for the ladies."

05 June 2006

Wheels down

I made it back from the wilds of Michigan where I attended 2 separate family events for the in-laws, one on the maternal side and one on the paternal side. K and I drove over 12 hours there, departing at 4:30a Thursday and driving all night last night to return at 7:15a this morning. K is still crashed out because he drove from 11:30 until 5:30, swearing the whole time that he wasn't too tired and doing fine, until we had breakfast after which I drove and he immediately fell deeply asleep.

The trip went fairly well, although I can never complain when I get TimBits, the most wonderful junk food to ever grace the face of the earth. I would drive to Canada daily for those if I could do it without weighing 700 lbs. Yes, there are some in the U.S., but not nearly enough and it is one of my traditions when visiting Canada. I'm not quite an honorary Canadian because I'm not addicted to their coffee as well (I don't do hot beverages), but I've got to be close.

It was good to see the families, but I'm not sure they've forgiven us for moving away yet. One baby shower and one high school graduation and 500+ questions about what I'm doing with the rest of my life of course get me thinking about everything going on lately, but I'm no closer to figuring it out since I STILL do NOT have my test scores back yet.