31 August 2006

Final exam

Last night was the final in-class exam for Intermediate class. I passed the written test easily and felt good about all the practical stations. At the end of the night, I found out that I failed two practical airway stations (they were both completed at the same time) because I forgot to say that I would wear gloves. Stupid reason to fail because I always put on my gloves before I even get out of the ambulance, but a failure criteria anyway. So I get to go back next week and retake those stations.

I was going to go back next week anyway because our instructor conveniently "forgot" to have our course evaluations ready for us last night and he definitely needs the feedback. He needs it so much that several people have written to the state certification department about what the program needs and whether they should even be certified at all.

I also managed to get suckered in to an 8 hour shift on Saturday and covering half a shift on Sunday, so instead of having the whole weekend off, I really just have Monday off. I'm such a sucker for a sob story...

27 August 2006

Last day of ride time

I finished my last day of ride time last week and now I just have to pass the final cumulative written exam and the practical stations and I am D-O-N-E with this class!!! Ride time was fine, it was my only day at the station I work out of, so it was nice to ride with people I'm more comfortable with. I think I did okay - definitely more performance anxiety because these are people that I need to have respecting my skills and wanting to work with me, or I'm still going to be stuck on a transfer truck regardless of my certification. I went on several calls with one of the supervisors and several with one of the other medics who let me start 2 IVs (successfully!) and push D50. Several people were reasonably impressed that I pushed D50 through a 22 gauge catheter (22 is a pretty small diameter and D50 is 50% dextrose solution which is about the consistency of molasses, not easy to push through a small opening).

Today is my first day completely off of work, of any kind, in quite a while. K is even home today and we've been taking advantage of some dreary weather to relax and take it easy inside. We were supposed to fix the hole in the ceiling today while there were two of us to lift drywall, and to finish the long-postponed shopping, but neither of us really feels like it. No big plans for the holiday weekend, just a softball party on Friday (we lost out of the playoffs this week) and then hopefully some med school apps to work on if they're here by then.

21 August 2006

Cue Imperial March (Darth Vader's Theme)

If you know the song, then you know the feeling. I present you, my lord, with my puny medical school application and beg you not to crush my throat from across the room. (Yes, I'm entirely comfortable with being a nerd.)

I submitted my central application (AMCAS) today, along with the $250 fee for applications to 4 medical schools reasonably near my house and officially ended hours of agonizing debate over what to include, where, and how. I was expecting more of a feeling of relief, but instead it was more like the knot in my chest got a little bigger and tighter. Now I'm official. People know that I want to go to medical school and are going to judge everything I've said and done to decide whether to let me in or crush me like a bug. But first, they have to send secondary applications where I have to write more essays, get letters of reference and send them additional money. Always with the money - I'd think that schools getting in excess of $34k a year in tuition wouldn't need so many application fees, but apparently I'd be wrong.

I don't know how long the rest of the process takes, but most of the schools do interviews from October to January with the earliest admission decisions in January and the wait list decisions running until March or April. Apparently cooking a med school app takes about as long as creating a new life - but I'm really trying to create a whole new life for myself so maybe that's appropriate. At any rate, GULP! I'm good enough, I'm smart enough, and gosh darn it, people like me...I hope.

20 August 2006


I'm going to invoke the word we do not say in EMS in the hopes of getting a few interesting calls today. Things at the FD have been slow. Very, very slow. Thursday we did two calls all night. This is my volunteer weekend and yesterday we had 2 calls (one was a lift assist) and a cancellation, and that was it in 24 hours. We've had one call today so far...slow.

The medic working today got bitten by some sort of bug on Friday and his arm is incredibly swollen today. Yesterday it didn't look nearly that nasty, but today it seems pretty clear he's going to need medical intervention. He showed it to one of the ER docs this morning, asking whether he should get it checked out and the doc's response was "Hell yes!" Kinda sucks 'cause he's one of my favorites and he might not be there if we get a call later. The other medic on this shift I've never really worked with, and from all rumors that sounds like a good thing - so maybe I shouldn't be hoping we get more calls, but I am anyway.

Edited 8/21: So, we did get more calls - all night long. Serves me right for wishing for more work. The medic came back after a dose of IV antibiotics and a prescription for more and he sent the volunteers (specifically me) with one patient of our own and one patient he worked with one of the younger guys taking the lead...exactly the reasons he rocks.

18 August 2006

Time out

Just so you know, I haven't been ignoring you. I mean, it's just that I've been out of town and kinda busy, right? I've been thinking of you even if you didn't know it, that's gotta count for something...okay, maybe it doesn't count for much, but that doesn't make it untrue.

Monday through Wednesday this week I was away at a "conference retreat" with one of the groups I still do statistics for. This yearly gathering is held at a spectacular lake house where they serve gourmet food and give you free run of canoes, kayaks, etc. for enjoying the lake. But the payment is that you have to sit in presentations and meetings and actually accomplish some stuff while you're there. I've had several people comment on how miserable it must've been to go and listen to people all day, but really it isn't that bad. I enjoy listening to smart people talk about interesting things. It is why I like school. And smart people who think that I have something interesting to say - well, even better.

Thursday I turned down an offer to work an extra shift on the ambulance because one of the local hospitals was running a continuing education seminar on heart attacks brought on by illegal drug use. So I sat for another 4 hours listening to smart people talk about interesting stuff. I learned that you should NEVER NEVER NEVER give someone on cocaine and having a heart attack a beta-blocker because it will make everything worse and probably kill your patient, and you should give them some valium or something to settle them down a little. Good to know, but kinda useless personally since I can't administer any of those meds.

Last night was also my volunteer night and my two favorite paramedics were both working even though it wasn't either of their shifts. We only did a couple of calls, but one of them was interesting for me because there were two calls dispatched within a couple of minutes of each other. Meaning the ambulance was heading to the first one, and they were sending the engine from across town to the other and sending in an ambulance from another town. So I pulled a quick U-turn and headed to the second call because I knew the other 2 volunteers were heading to the first (one of them was right behind me). I was with the patient for almost 5 minutes before the engine got there, which would've been great if I'd had any equipment. The patient decided not to go to the hospital, so I ended up doing all the paperwork for the refusal - including the 40 minutes to enter all the info into the computer. The Lt. on the engine definately had some say on-scene as he had to decide whether to cancel the ambulance, which we didn't because we felt like she should probably go to the hospital and were trying to talk her into it. But this was pretty much my patient, all mine, and I'm greedy like that.

09 August 2006

Class ride time, day 2

Somehow I managed to schedule my first two days of ride time very close together, so I got day 2 out of the way yesterday. The first day didn't seem to exciting, but compared to the second day it was a thrill a minute. Yesterday there was not one "real" call. I went on 5 calls between the two trucks I managed to catch, and not one of them was anyone who actually needed an ambulance.

The first one was a "chest pain" dispatch. Cool, because I can get an IV and an EKG and maybe see something unusual. Or it could be that when we arrive on scene, we find a man in no apparent distress at all, complaining of 1/10 chest pain and telling us the last time he felt like this it was gastric (i.e. indigestion), but he makes sure to add "only an EKG can tell me for sure, so I'm going to the hospital." I've seen people having textbook heart attacks - they are gasping for air, are pale and sweaty and generally look awful, have severe pain to the point of being very vocal about it even though they can't breathe. Yes, not everyone has a textbook case, but I'm probably closer to having a heart attack than this guy was.

Hooked up to the monitor, he had a pulse of 54. Normal is 60-100 and heart attacks are usually higher because the heart is struggling to get more oxygen. 54. (insert eye roll here) Some meds can cause an unusually low rate, but he wasn't on any of them. I got an IV anyway and finally an EKG for my skills book, and we dropped him off at the hospital and when I was back with another patient less than an hour later, he had already been discharged. Any time you get out of the emergency department in less than 3 hours, they aren't busy and you aren't having a heart attack.

Other calls were for a police-initiated evaluation of "chest pain" in a prisoner (nothing going on, the patient didn't even want to go to the hospital - and every prisoner wants to go to the hospital just to get away from the police for a little while), an "ETOH problem", a "possible suicidal patient", and a "3 car motor vehicle accident" called in by one of the transfer ambulances as a minor fender bender with many occupants wandering around on the sidewalk.

When we arrived at the accident, the medic asked if everyone was okay and one woman started in with "Well, I think so, but my neck feels funny." She reported that it didn't really hurt, but when asked if she wanted to go to the hospital she said, "Yes, I think that would be good." Congratulations lady, you win a cervical collar, a backboard, and the annoyance of everyone near by who can see that you could've hurt yourself more by stubbing your toe. The accident was pretty much at the front door of the hospital, but we got to drive her around to the emergency department entrance. We hung out for a couple of minutes to see if the doc was going to get her off our board immediately, but she got the full workup and last I saw her was heading upstairs for xray. CYA (cover your ass) goes from good samaritans all the way to MDs because nobody wants to be responsible for somebody's back injury, so instead Medicaid just paid for an ambulance ride, an emergency visit, some xrays, probably some pain meds, and so on.

06 August 2006

Class ride time, day 1

The ambulance company I work for also sponsors the ride time required for my class. Meaning that I could ride with only people I know quite well and feel comfortable with if I rode at the station I work out of. Thankfully, I think, most of the people in my class live much closer to the north station than the other one, so I ended up having most of my ride time at the south station. The first day of which was yesterday.

Rise and shine for a 0700 shift start on a day that the north station is doing a mass casualty drill, so every one who is "anyone" is up there practicing for some major incident with pretend patients and so on. The south station didn't even have a supervisor on site, which worked out well for me because then I got to ride on all 3 of the 911 trucks instead of just the supervisor truck, which translated into 7 calls instead of 3 (I missed one with that truck because I was already out), which is a busy day for 8 hours at the south station. I did know one of the medics on shift because he works both stations and at the FD I volunteer with, but the rest of the people were new to me as far as working with them goes.

Everyone treated me well, which was nice because sometimes full-timers are harsh on students, especially if they aren't used to having them along. I did get a little "feedback" from a medic on a call where he put the intermediate and I in the back with the last direction of "start a line", which we did, but we didn't do a full set of baseline vitals first so I got the "do BLS before ALS" lecture. Actually, I thought it was weird at the time that we were starting a line before having vitals, but I'm not really confident enough to question someone I know is an experienced full-timer when I'm still just a student. And for the record, the medic was more annoyed with the intermediate than with me, he just wanted to make sure I heard the message too so I would be confident enough to step up and say something next time.

Not too much excitement altogether, an overdose, a pair of geriatric abdominal pain calls, a teenage seizure patient, a nursing home "diabetic emergency" that wasn't anything to do with blood sugar nor really an emergency, and a pair of difficulty breathing calls, not in that order. I went 2/3 on IV starts, missing one on the overdose which the medic on the call also missed, and the two I got were geriatric patients which are sometimes harder due to their fragile veins.

03 August 2006

You want me to do what?!

My last Emergency Dept time was on Sunday afternoon. I came in feeling much more confident in my ability to start IVs, and that I could generally handle whatever was going on. As I was walking in the back entrance, I heard the ambulance sirens heading toward the hospital. Excellent, customers right away.

What arrived were four patients from a two car accident. Mom, Dad and 9-month old baby from one car, and teen driver from the other. I immediately missed the stick on Mom, partly because as soon as I stuck her and wasn't in quite the right place she started hollering and cursing, so I gave up and the nurse took the second stick. Baby was screaming because nobody could take him out of the car seat until the MD okayed him, but he turned out to be okay and settled down. Actually, Dad was the only one to even walk out with a cervical collar on, which is pretty good considering their car rolled over. Teen driver was fine and released within an hour.

Later, I was talking with a dog-bite patient, and I got an immediate IV in his right hand without any nurse shoulder-riding. He got a little fluid and a bunch of IV antibiotics. But the good part is that when the animal control cop showed up later, I was the only one who knew when the guy had been bitten, and his helpful description of the animal at large - "I don' know what kinda dog it was. But it was big and brown, bit me and ran off." I laughed at this, because I'd asked him if he knew the dog or who it belonged to, or even what kind it was. Patients make me laugh sometimes, especially ones who are my age and friendly.

Aside from missing several more IVs (as in, I stuck people and didn't get the IV where it needed to be), I declined another procedure that would've given me big bragging rights. There was an actual intubation that happened while I was there. Since it was a patient I hadn't been with, I poked my head in and said that I heard a rumor there was a tube going in. The doc looked up and said, "Yeah. You want it?" My first reaction was holy crap! You can't be serious! And then I realized he was serious, and he would literally let me stick a tube down a real live sedated person (even though my protocols are really only for "dead" people -cardiac arrests).

I've never even seen an intubation on a real person, so I chickened out and declined. When he lifted her jaw to put the tube in, I noticed that she didn't have any teeth and then I was disappointed I didn't try. For those not familiar, you use a laryngoscope
to lift everything out of your way so you can see the vocal cords and pass the tube through them - and as you can imagine from the picture, sticking something metal in someone's mouth runs the risk of hitting, and breaking, their teeth. My biggest fear about the procedure is smashing up someone's teeth. I'm not really worried about the tube placement or anything in the hospital because obviously there is someone right there breathing for the patient and the doc right there to put the tube in if I couldn't. And still, I was so shocked by the offer that I declined before I thought through all the reasons I should've done it.