31 March 2006

TGIF

Hooray for Friday! Sleeping late, lounging on the couch with the laptop, performing medical research to change the world. Also, lounging out on the porch in the sun since it was about 75 degrees while studying for the MCAT. Chemistry and sunshine are a good mix - it makes the chemistry less painful.

Today was also a success in that I went shopping and I was actually able to find a pair of shorts that I like and bought! And Eddie Bauer replaced my sunglasses that recently lost a nosepiece - a straight across swap, with no argument required. A most excellent day all the way across the board.

29 March 2006

Why are we here?

The last week has been incredibly slow on the ambulance. Partly because the company added another truck with a schedule that directly overlaps mine, and partly because there just isn't anything going on in the town I'm posted at. Yesterday, we did 2 calls all day, and in between we were posted at one of the hospitals with one of the other trucks, where we lounged in the sun (D got burned), listened to music and hung out. All we were missing was a hibachi and a cooler and we would've had quite the tailgate party. One of the trucks in the company posted in a city to the south did 9 calls yesterday, so it all depends on where you're at.

I'm at the point where I'm battling constant fatigue and feeling fairly certain that I'm never going to do well enough on the MCAT to make all this studying worth while, so it is hard to stay motivated to make it through this last month of torture. If I don't do well enough, I could re-take the exam in August, but the prospect of that many more months of complete insanity isn't settling well. Maybe I should just be a stay-at-home wife?

27 March 2006

Saving the day - South Park style

Would you feel comforted to see me step off the ambulance?

Make your own!

26 March 2006

Children everywhere

Another slow Sunday leaves me some time for an update on my weekend. This weekend I got to be an observer during a Pediatrics clinic, as well as time in the Nursery and on the Pediatrics floor of a hospital. It is all part of the plan of a physician I've been working with to convince me that I want to be a physician and not something like a PA, or just giving up entirely.

I had a good time seeing all the kids in the clinic - lots of simple sniffles and ear infections. I even got to talk with one young woman who had injured her knee, so I got to do the patient history since I have lots of experience with knee injuries at this point. Saturday morning in the nursery was also fun as I got to see a pair of fraternal twins and a five-hour old baby. Not good for K as it reminds me that I think I want to have kids, but fun for me.

I also provided the clinic nurses with some excitement on Friday when I fainted in their hallway. I still don't know exactly why it happened (leading guess is currently too little food), but I was suddenly feeling very flushed and unwell, took one step backwards into the hallway and dropped into a dead faint. I managed to give myself a good headache, because of course the floor was cement covered by 1/8" industrial carpeting, but I was fine after some juice and crackers. I'm grateful that I was able to take that step backwards into the hallway, that way I didn't faint on the patient, who quite honestly had his own problems that day.

23 March 2006

Punk be-yotch

Today was a different sort of day; D and I spent all day with just one patient. Ferrying him from home to a MRI, to a doctor appointment and back home again. It was weird spending that long with one person, and reminds me of why I don't want to be a nurse. Because people are annoying if you have to put up with them all day. So here's the shout-out to all the good nurses with the patience to deal with patients for long shifts.

This patient was also very different from our usual "raisin gathering" of geriatric patients. He was 20, partially paralyzed, seemed to think he was tough and/or a gansta, and very vocal. When we first walked in, he thought we were the police (in his defense, we do wear shiny badges), but once he figured out that we were with the ambulance, he opened right up and started telling us all sorts of things we didn't really need to know. He showed us many of his tattoos and harassed his friend about the one he overpaid for. He told us about being hit by the drunk driver and eventually getting the guy's vehicle and smashing it with a 5lb sledgehammer because that was as much as he could lift. About being on steroids. About all the "hot" nurses at the hospital we were taking him to and how he'd love to see a "Nurses Gone Wild" video. I'm fairly certain he and D had some sort of male bonding experience in the back of the ambulance while I was driving - and the only disappointment to me was that they didn't get to spend more time together. He actually apologized for offending me with his foul mouth at one point, and despite the fact that I hadn't been offended, he said he felt bad because he knew he shouldn't act that way.

One of the nice things was that D and I actually had time for lunch today. In a sit-down restaurant - which is truly unheard of at our company. But we'd been dispatched to stay with the guy and the MRI took nearly 2 hours, so off to lunch we went. We also found the antenna for the XM radio that D had been looking for so that we can actually have some decent music in the ambulance. So despite being the weirdest day yet on this job, I'm going to have to call it a success.

21 March 2006

Hospice-tality

Some of the patients we pick up are going to die. Soon. Most of them know this, especially if they are coherent enough to have any idea what is going on. Today was a different type of experience. Instead of picking up the patient from the hospital or nursing home, we picked him up from a personal residence and he had no idea what was going on.

He was lying on a bed, with his rear on the pillows, his head pointed toward the foot, and his feet propped up on the portable commode. The tension in the house was nearly visible, with three men looking quite upset and one woman fussing around. The woman was really the only one who wanted to talk, and she just kept stressing "We just can't take care of him anymore", as though we were going to take one look at her and leave the patient there. She had a reason for everything, even though nobody asked.

When the patient saw us, he looked confused and spoke in French to the woman who told him something in return. She looked at us and confided that he doesn't know he's going with us. We told him he was going for a ride in the ambulance, his answer was "why?" D explained that his family needed help taking care of him, he responded "am I going to die?" We immediately looked to the family - who had all fled the room. We followed them out and it turns out that the patient was aware he had cancer, but apparently nobody told him that he was going to die soon, and one of them pointedly looked at D and said "you tell him."

We tried to argue that this was more appropriate to come from them, but no luck. With the collective guilt in the room, you might've thought they were sacrificing small children in the basement instead of asking for help caring for a very ill family member. Very weird all the way around. But quite frankly, with those folks, I think he's better off at the extremely nice hospice house we took him too.

19 March 2006

Illin' in the hizz-ouse

Okay, so I haven't been sick all week, but there wasn't a lot that inspired me to write this week. Friday, K and I were supposed to be out snowboarding with FREE tickets (and yes, if you know me, FREE really is that important). It was just over 2h drive to get there, and over halfway there I started feeling unwell. As in, pull the car over somewhere so I can hurl on the side of the road unwell. And then, find me a bathroom, any bathroom right this minute unwell.

When we got to the hill, I stayed in the car, curled in the fetal position while K went out and enjoyed the nice weather and reasonable March snow. Finally, around 2p, I called him and told him that I had to go home. My vomiting was scaring small children in the bathroom and the toilets there were none too clean for the amount of camping out I had to do. I finally kept down some chicken broth that evening, but it was a challenge. K jokingly suggested maybe we should go out drinking and kill whatever bug I had, but the idea of throwing up expensive bar liquor wasn't really all that appealing after throwing up a dozen times that day. I was hoping maybe something I ate had disagreed with me, so that it would just be a one-day deal. No luck.

Saturday wasn't much better, only I got to be curled up in the fetal position on the couch and use my own toilet. Also, the good news is that there is FREE HBO and Cinemax this weekend, so I've seen a lot of so-so movies that I wouldn't normally spend $ on to see. Two doses of pepto didn't really slow things down, but I managed to keep down some applesauce and some more chicken soup. I called in sick this morning because I don't think it would be good to stop the ambulance halfway to the nursing home so I could go use some nasty gas station bathroom. Things are finally clearing up a little, at least I had an appetite this morning, although finding something I thought would stay down wasn't easy. With any luck, I'll be back to saving the world tomorrow - and if anyone vomits on me, I'll probably vomit right back.

13 March 2006

Rainy Sunday

Sundays are almost always slow, but yesterday was a little ridiculous. Very very boring. We did one wheelchair van call in the morning and then NOTHING all day until an hour-drive transfer at 5p which of course made us late getting off work. Unfortunately, it was also a day where I didn't feel particularly well as I've recently started "exercising" again. I think it is more like slow torture for the masochistic because not only is it hard work while you're doing it, but it pains you with sore, knotted muscles for several days.

I can handle most of the sore muscles. It is the upper back and neck muscles that do me in. They knot up and give me a killer headache and nausea and even sometimes the vomiting just for kicks. It has been a life-long pattern and while some ibuprofen and heat can usually take the edge off, the only thing that really helps is sleep, I'm guessing because it allows my body to convince the muscles to relax a bit. So yesterday, just before the long trip, the headache sets in. This is bad. I have two options in the ambulance, I can drive or I can work with the patients. Neither holds appeal with a pounding headache.

This patient was only 6m old so she wasn't going to be a conversational problem, but mom was riding along and very chatty. Also, I actually knew where we were going, and D did not, so I drove. By the time we got to the admitting hospital, I was in active nausea-suppression mode, trying to convince myself I did not actually need to throw up. The bright headlights don't help anything, so D drove us home. Since we are in an ambulance, I at least had access to some disposable heat packs, which helped a little, and I got home after 8p so I only had to be awake a little while before crashing entirely.

Off-topic here...there is nothing more attractive in a man than compassionate care for others. It is one of the reasons that I liked being on the ambulance/fast squad calls with K, it gives that nice reinforcement of happy good feelings about how wonderful, sensitive and caring he is with people. I have to give both D and K gentlemen's gold stars for yesterday though. D was adorable in cooing at the baby and was insistent that we stop the ambulance so I could get the hot packs out of the back if there was any chance it was going to make me feel better. He even offered to wash the truck by himself so I could go home early. K made tasty pizza (by request) even though he went in for some overtime hours yesterday, and rubbed my sore neck and shoulders for a delightfully long time when I got home. Thanks guys!

10 March 2006

Quick update

Just thought you'd like to know that nobody tried to throw up in my general direction yesterday and actually the only patient I had was a crazy lady who went from telling me I was going to be in big trouble if I didn't give her back the rest of her yellow paper to telling me that I had won $150,000. We also had a trip to Boston and back during which the only place we found without a "scenic detour" was the hospital room at the hospital we normally transport to.

Weather is warm and beautiful for spring skiing today, but I have neither the time nor the money to go today with K or tomorrow with D . I'm getting a fair amount of other work done, though. Can't study right now though because I forgot my book in the ambulance yesterday. I'm going to see if I can catch up with it sometime this evening when things usually slow down, but I'm not holding my breath - it will probably have to wait until tomorrow when there isn't supposed to be anybody in that truck. Happy weekend to all and to all a good night!

09 March 2006

Marked

Apparently I'm a marked woman now. Another patient vomited in my general direction yesterday. Thankfully, neither of them hit me, but this is NOT a trend I like. The nurse at the nursing home was laughing at me..."oh, do we have someone who doesn't enjoy a little vomit?" because I was searching frantically for something for her to vomit into. He seemed to have a little more sympathy when I explained it wasn't the vomit so much as being vomited on that bothers me, and that it was the second patient in two days to give me the great joy of hurling noises.

The other EMTs also enjoyed my discomfort when we were posted at the hospital, as D was quick to tell them I am a vomit magnet. I quickly responded that it was obviously his cruddy driving that was causing everyone to throw up. But if anyone vomits at me today, I'm going to have to reconsider this job...

08 March 2006

More fun with nurses

We picked up an elderly patient yesterday from a Cardiac unit in one of the local hospitals who was going to my "favorite" county nursing home. The nurse on the unit told us that the patient had been in for congestive heart failure, was feeling better, and nothing of note to report. When we get her on the stretcher, she begins complaining of nausea.

In the back of the ambulance, she goes from nausea to "I'm going to vomit" and complaining of abdominal pain. She and I are both frantically looking for something for her to throw up into. Yes, the ambulance carries basins for this, but they are in the cabinet that is partially blocked by the stretcher, so I couldn't see them and feeling blindly was not working. I got her a towel to buy myself some more time to find the basin, which I found shortly thereafter. When I look up at her, she's vomiting blood. Not good. I'm looking through the patient's discharge papers and find a history of a relatively recent upper GI bleed (i.e. bleeding in the esophagus or stomach). She says that she vomited blood with her breakfast and didn't keep down dinner last night either. She is noticeably dehydrated, which is consistent with her reported intake. Since we're almost at the nursing home, we decide to talk with the staff there and see what they would like done with the patient.

They seem to be as entirely surprised by her presentation and history as we were, and request that we take her immediately back to the ED. So back we go, lights and sirens this time. She doesn't vomit any more on the way back, but is still complaining of nausea and now dizziness/lightheaded on top of it. Her blood pressure was around 95/55, which isn't terrible, but isn't great for someone you think might be bleeding internally. When we get her into the ED, the nurse asks which unit just discharged her and calls up. Surprise! The patient is headed for hospice care and they aren't going to do anything for her. That might have been a good piece of information for the Cardiac nurse, or the nursing home people (if they knew) to have conveyed to us. She has an abnormal heart rhythm on the monitor which is probably due to her dehydration, but nobody gives her anything for that either. After spending the afternoon in the ED, she gets another ride with us back to the nursing home. This time still complaining of nausea, but not vomiting. Her afternoon nurse in the ED was very rude when we came for her, meeting us at the door, shoving paperwork at me with "she's in room 2 in the corner" and disappearing.

The discharge papers from the ED got under my skin a little though. They diagnosed her with "coughing up blood". I'm no doctor but I do know the difference between coughing and vomiting. If they wanted to claim it was something in her throat somewhere, fine, but she certainly did not cough it up. D was in the front of the ambulance and he knew the vomit sound before I even said anything. But we're just stupid EMT-Bs over-reacting to someone who is dying anyway, thinking we can get some excitement out of the deal.

Thankfully, D was doing the patient care for our next fun with nurses because I might've blown a gasket. We transferred a patient from the same hospital to a different nursing home. She was okay when we left the hospital, but by the time we got to the nursing home she had noticeably slurred and slowed speech and some right-sided weakness. D looks through her paperwork and finds that she is an insulin-dependent diabetic and nobody had given her any insulin today, she didn't get lunch (this is 4:00p), and the last time they took her blood sugar the night before it was 40. Bad times. Basically, the nurse at the hospital had noted on the patient's chart that she was being discharged that day, and everyone stopped taking care of her. At least the nurse at the nursing home was upset and started ordering people around to take care of her patient, good to see one nurse that day who knows how to do more than talk nicely to patients.

07 March 2006

Hot or Cold?

D and I actually got to go on an almost real call yesterday (on top of the other 5 transfers we ran). Someone needed to go to the ED, but the nursing home didn't want the whole world to show up lights and sirens, so they called us. Possible dehydration leading to altered mental status (i.e. he hadn't eaten/drank anything for nearly 24h and was only responsive to pain). When we arrived, it was my tech and D's turn to drive, but it had been so long since I'd been on a real call that it was hard to get back into the swing of things.

The nurse met us at the desk and offered her "current" set of vitals and her opinion that the patient's vitals were stable. Nurses are so weird - I don't know how anyone considers vital signs current when they were taken at 10:30 that morning and it is now 3:30 in the afternoon, nor how they can assume stability when they only took them once...but that is a story for another day. As you can tell, if the patient had been in this condition for more than 5 hours, it wasn't a real emergency and we didn't get to use the fancy lights and siren to go over to the nursing home. When we got the patient in the truck, D actually asked me if I wanted to go hot (lights/siren) or cold (usual driving mode). Since I'm responsible for the patient, it is my decision, but it is a question I've never been asked. The answer here was obvious, but it definitely points out that there are more issues I need to make myself aware of so I can make a good decision on future patients.

To top the whole thing off, this patient is a full code - if he crashes, I have to do CPR and the AED and the whole deal, which I've never done and which is reasonably rare in long-term nursing home patients - and we're 20 minutes from the hospital. The point when he appeared to go from rapid regular breathing to shallow and/or non-existent breathing was enough for a moment of panic - so he got some painful stimuli and some encouragement to keep working on some nice, deep breaths. Once he settled in again, I started talking to him again and suddenly he starts responding. He wasn't all the way there, but he was responding with short appropriate phrases so maybe today wasn't his day to die, nor my day to learn what breaking someone's ribs with the first compressions of CPR feels like.

I had another moment of major panic when D tells me I have to patch in to the ED - another thing I've never done. I punted. D knew everything that was going on and has plenty of experience doing this, so he patched for us. For those who don't know, patching is when you alert the ED that you are coming with a patient and give them information on the patient's current condition. I've listened to way too many conversations about how everyone thinks people who give bad patches are complete idiots, so now I'm paranoid about sounding like an idiot when I do it. Of course, I'm not going to get any better by not doing it, but I was freaked enough yesterday without that too.

Patient was still alive when we left the ED and I expect that some IV fluids probably got him a lot closer to the mental status he usually has so that he could help the doctors figure out what the rest of the situation is.

05 March 2006

Back to saving the world

Two days away from the station almost made me forget what it is like to be crammed into a tiny room with a loud television and ten other people. Almost. But today I'm back, and so far we've rescued the citizens of this fair town from the hazards of a cinderblock in the road. Awww yeah baby.

Weekend update:
I was sick again last week, so Friday was work at home and sleep, oh the precious sleep. After sleeping 24 of the first 36 hours I was off for the weekend, I actually feel like a slightly sick but normal human being again, as opposed to the gunk off the bottom of someone's shoes. Saturday was the first day of the season-end bball tourney in which our team performed approximately as well as we did all season. I.e. our 2-12 team lost two games and was immediately eliminated from the tournament. I didn't mind terribly because if we had won the first game, they would've been playing today without me. But it really stunk to lose the second game because it was against a team we could've beaten and hate to lose to. We lost several important players just before or during the second game because the high school team that all their kids are part of was in the state tournament on the same afternoon. I certainly don't blame them for their priorities, it just made it very hard for the remainder of us to play a second bame in the same afternoon with few substitutions. And now...back to saving the world...

We've made off with someone else's truck for the day because ours was stuck way in the back of the garage. And WTF?! Theirs actually has real equipment! A blood glucose monitor! A pulse-ox! An AED that fits in their first-in bag! A dispatch computer that works. I'm experiencing truck envy. Theoretically, they could actually help someone if they came across an accident or something. Unlike our usual truck, which contains the bare minimum of equipment required to be legally an ambulance. D and I agreed we should behave like a "real" ambulance today and make everyone else wonder.

03 March 2006

Freedom

After the full 40 hours in the ambulance this week, it is very nice to be home today where I can stretch my legs, pee when I want, and eat when I'm hungry. I did still do work for my part-time gig, but I can do that from a comfy spot on the couch, so 8 hours of typing doesn't seem too bad. Sunday will find me back on BLS-24, saving old and/or crazy people from staying in the hospital.

I took the written test this week to volunteer as an EMT for the dept that K works with (and that covers our house). Many of the other ffs in the dept said that if Mr. Union couldn't come up with a good reason for me not to volunteer, then they didn't see any problem with it. A number of their ex-wives have done it over the years, and nobody complained. Next step is the interview. They really wanted me to come in Thursday afternoon as they were getting a panel together for others, but that wasn't really going to happen when I'm supposed to be at work because I can't take time off on short notice. Another interesting twist is that one of the day-time paid positions may be coming open soon, so if I can get trained as a volunteer, I should have an inside track on that position which would pay more and be 911 instead of just transfers.

Speaking of ex-wives, I'm beginning to feel a little paranoid. Most of the ffs are divorced and many of the ambulance people I work with are divorced or just plain cheating. Before we moved here, people at the old ambulance co. said that if K liked me, he shouldn't encourage me to work at the new place because there was a lot of cheating and such going on. He and I both laughed it off, but between the ffs and the emts, I'm beginning to wonder if it is even possible to have a normal relationship in this field. Everyone has the excuse of the long, odd hours, but I think that is mostly a cop-out for not putting the time and energy into a relationship and not having the trust in your spouse that you should. Besides, if you decide you really want to be with someone else, isn't it just common courtesy to break off your existing relationship first?

The strangest comment I've heard lately is that there are two types of women in EMS, "wide-asses" and "girls who put out". I find this strange because it isn't really two mutually exclusive groups and it doesn't really cover everyone. It was said to K and he decided not to put the guy on the spot and ask whether that meant that his wife was a wide-ass, but it is a little weird all the way around. It also comes pretty close to what a woman I rode with recently said about girls who work on their feet and those that work on their backs in EMS. I fail to understand how anyone would put up with someone who doesn't do their share of the work just because they put out, but maybe I'm missing something ...like a penis.

01 March 2006

Howdy pardner

Today I finally met my long-term partner. It was something I was a little nervous about, so it is probably better that I didn't realize today was the day. He was actually there before I was this morning, a good first impression as almost everyone else I've ridden with has been late. And he emptied the trash, woohoo!

It seemed like we had a fair distribution of the work today and, at least to start with, personalities seemed to match up okay. We'll see how things go when I'm trapped in an ambulance for 40 hours a week with him, and maybe I can get him to slow down a little when I'm the one banging around in the back, but I'm feeling optimistic. He doesn't listen to country music, knows what the heck he's doing (so that makes 1 of us), and seems to work well with patients. He also used to work in dispatch, so he got us out of what could've been a very late call tonight as he would've been late for class.