30 January 2007

Venting in progress (teakettle whistling here)

Augh!!! I don't wanna do it any more!!! Screw you guys, I'm going home!! Oh yeah, I'm already home, but still... I'm sick and tired of dealing with people who continue to send annoying emails complaining about work I've done and things that are yet to do and for whom nothing is ever good enough. I'm not allowed to make any independent decisions, do work that actually reflects my training and interests, and am generally being treated like a slow or special 12 year old with a history of goofing off. Which, quite frankly, makes me want to behave like a slow or special 12 year old and goof off. K and I went out for greasy cheeseburgers for lunch so I could calm down a bit and actually accomplish something in the afternoon. Yoga tonight helped too, so now I'm more angry than furious and I just need to figure out what to do.

I'm wavering on the fence for quitting the office job entirely. Part-time there pays more than full-time on the ambulance, but at some point I'm just not going to put myself through this anymore. It was why I wanted to make a change in the first place - but how do I justify cutting my finances like that when I'm not even in school yet? I think the idea of leaving is probably better than the reality, but the possibility is tempting...

29 January 2007

Station life

I worked a reverse 24h shift this weekend and there are times I think everyone in the station needs some serious time on a therapy couch. There are other times when it is just too much fun to be concerned about anyone's mental health. I've heard many fire departments where people say they are "like family" and they spend many shifts together, year after year, so maybe that is true. In the ambulance station, I think we're more like the delinquents in detention after school than any sort of family. Full-time ALS partners work together at least 3 of their 4 shifts and most are together all 4. But the combination of partnerships that is on-duty any given day in the week changes, as does the entire atmosphere of the station. The staff turnover and vacation/shift swapping makes for a fair amount of variety in staffing. Each supervisor also influences the type of acceptable behavior, much like your favorite teacher in school who used to let you get away with goofing off in the back row sometimes.

Saturday was busy early on, my truck did four calls in 3 1/2 hours and when we finally got a break it took my medic over an hour to get caught up on paperwork. We only saw the other crews in passing at the hospital or as we passed each other on the streets. When we finally flopped back at the station, the weekly card game was well-established (not poker), some edited-for-TV movie was playing and the usual insults were flying. The supervisor was out roaming around giving everyone a hard time about non-work related stuff and in a decent mood because February scheduling was already finished. On Saturdays I'm nearly always the first to bed and this week was no different, the exception being that the city population decided they didn't need too many ambulances overnight so I only had to get up once to run a call that ended up being a no transport anyway.

Sunday brings in a new supervisor, three out of four new crews, two transfer trucks and a whole different personality. Station chores were in progress immediately following truck checks and the whole place was spic and span practically before I stopped staggering around with my eyes closed. Since call volumes are usually much lower on Sundays, people seem to take the effort to be slightly nicer to each other. Don't get me wrong, there is still a large amount of harrassment that goes on and this week was my turn early in the day because I had parked the ambulance slightly askew in the garage. For the next couple hours, it was more like a car wash than an ambulance station as five ambulances and at least five personal vehicles were cleaned and shined.

Eventually, someone suggested a movie and we watched The Descent. I didn't see the middle 30 minutes or so, but I didn't miss much. I came back in just in time for the creepy-crawlies to start jumping out from every nook and cranny and for the day's entertainment...one of the transfer crew was jumping and screaming every time something even halfway scary came on the movie. At one scene, she actually screamed a second time before the first scream was all the way out. The rest of us, including her partner, spent the rest of the movie and the day scaring her and laughing. Some folks were highly creative about it, others just took advantage of the fact that her back was toward two of the crew bedrooms. Of course, with the turnover in calls, everyone missed some part of the movie, so I actually saw the last 30 minutes or so three times and I think I could've been in the cave at that point and not been scared.

End of shift was fairly calm, my truck was next out and we managed to make it all the way to 1700 without getting sent out last minute. New crews started trickling in and there was another palpable change in atmosphere as one started complaining about the fuel in the truck with the supervisor playing his imaginary violin and it was a good time to be clocking out and heading for home.

23 January 2007

Diff breathers and a lesson on drinking

Saturday's shift was a day of difficulty breathing. We ran three calls in a row for difficulty breathing, one of them dispatched as a fall. Good day for the students that were riding though because they got to see some seriously sick people.

The last guy (who had supposedly fallen) was sitting in his chair doing the puckered lip, accessory muscle breathing when we arrived. Poor guy couldn't even get a word out he was working so hard to breathe. I'm not sure what, if anything, he told 911 but he hadn't fallen, just couldn't breathe. We got his O2 up to 92% after the duo-neb and solumedrol, but every time he took the mask off his face for even a couple of seconds, he was back down in the low 80s. I don't have any follow-up about him, but I'm hoping maybe they got him a bit more squared away so he could go home instead of to a skilled nursing facility.

The medic I was working with has been around for quite a while and has his stuff together so we were hustling around working more like a real team than the usual tripping over each other that happens with people who've never worked together. It made for a good day and I think we taught the students a few things while simultaneously shocking them about the pace that patient care can move when people know what needs to be done.

We were also on together for the overnight transfer shift which went smoothly, but held us over three hours in the morning while we transported from tiny community hospital to an academic medical center. 19 year old out drinking with friends (BAC more than twice the driving limit) and fell over from a standing position. Patient managed to achieve a basilar skull fracture and epidural hematoma, but still walked into the hospital with friends because someone was sober enough to realize that bleeding from the ears is probably not a good thing. Patient posed no major problems during transport, but it was 50 minutes to the little hospital, 90 minutes from there to the next hospital, and over 90 minutes back, so when you get dispatched at 0500, you aren't going off shift at 0700 as planned. Still, I found it fairly impressive to have a skull fracture from a fall at standing height - makes me glad all I've been doing is bruising my hips when I fall.

18 January 2007

So very wrong

Dispatch of the day, so far: "50-something year old man found down on his lawn (this could be serious). A tree branch fell on him." (ha!ha! snort!) I hear them coming down the street now...


Not the sound of my biological clock, although contact with 3 women in various states of pregnancy yesterday could certainly tend to bring that on. It is the sound of the ticking seconds, minutes and hours of anxiety about medical school. Every time someone asks how things are going, they look completely crestfallen at the news that I haven't heard anything. It is enough to depress any optimist and I've never claimed to be an optimist.

One of the MDs asked yesterday how many schools I applied to and when I told him four he shook his head and said the average was twenty. Now, those of you following along at home heard a little about the price of this whole process and could do the math that 20 schools would mean at least $2500 in application fees alone. No wonder they want to know in the app if anyone in your family is a doctor, otherwise you're probably out knocking off 7-11s to get the cash to apply.

I have a reasonable reason for 4: I'm not spending the cash to apply to a school I'm not willing to attend and right now I'm not ready to move across the country to go to school. I'm no longer a carefree undergrad willing to let the winds of the application process blow me across the country. But I live in a state with no public medical school, which means no preferential admission just for living here. The one school in NH reports that 94% of their students came from out of state.

One of the schools even still shows my application as incomplete because they claim not to have received the two reference letters that were sent in OCTOBER!! I've emailed, called, and still gotten no response from them as to whether that could possibly be true. I'm beginning to wonder why I even bothered to try. I felt like it was a long shot and was somewhat swayed by the enthusiasm of those around me to try anyway. The crushing thing is that I'm not sure I would have a better opportunity at PA (physician assistant) programs I was considering before I started the AMCAS process because I'd have to be able to explain why I want to be a PA and not a MD and they explicitly tell you that not being good enough to get into medical school is NOT a reasonable answer.

So, tick tock...every day that goes by without an opportunity for interview is one day closer to knowing that I'm not going to med school this year and to having no idea what I'm going to do in the next 8 months to make my application better for next year.

15 January 2007

Best & worst

Reverse 24h shift this weekend (1700 Saturday to 1700 Sunday) and here's the best and the worst...

Worst: Dispatched to police booking area for "facial injuries". 21 year old male slumped in the corner, cuffed to the bench, clearly involved in a fight. His also arrested "friend" yapping very loudly a mile a minute, interfering with care, threatening police and other prisoners, and generally being very annoying. Patient wakes up to talk to me and decides to go to the hospital. Injuries include a probably broken nose, which he claims is not new today, and some abrasions and lacerations on the right side of his face, a good guess would be a little road rash from hitting the pavement either during the fight or while he was resisting arrest. One of the cops asks if he really needs to go, and unfortunately, no he doesn't really need to go but the cop and I would both be liable for not taking him since he asked to go.

Pretty much the kid was suffering from "incarceritis" and his friend kept telling him if he went to the hospital he wouldn't spend the night in jail, which is actually a lie because if there isn't anything the hospital needs to keep him for they'll turn him right back to the police. We get him on the stretcher and go, with police in the ambulance rather than just in tow. In a less than 2 mile transport, the kid managed to vomit on the floor over and over - including just about hitting the cop, get blood on the bench seat and generally make me want to just open the doors and push him out when we got to the hospital. I do believe it was possible to become intoxicated just from the alcohol fumes wafting up from the vomit river.

Once in the hospital, staff is trying to decide where to stash him and he decides to lean over and spit on their floor. Not vomit, spit. A completely voluntary gesture he could've controlled. Not a good way to make friends your first 10 seconds in the door. We're finally rid of him and then we get to decon the ambulance. I'm just going to tell you now that no amount of cleaning solution will remove the smell of vomit. I was working that ambulance for 17 hours after that kid was in it and it still smelled enough of vomit that when we'd open the doors, the FFs would ask what the hell happened to our truck. Four separate applications of Febreeze, two complete moppings of the floor, and still the smell gagged people who hadn't been sitting in it for several hours. So, worst call of the shift strictly on the lingering smell.

Best call: Dispatched alpha response (no lights and siren) for injuries from a fall. 70's female sitting in her rocking chair with her right leg elevated. Pt explains she injured her leg when she tripped on her nebulizer, sitting on the floor, and ran into something. She has just started prednisone, a steroid which can cause major swelling, so her ankles are quite swollen. After removing the band-aid her daughter had applied, we find a 2" wide by 3" long area where the skin is really more peeled back than cut. She isn't really bleeding, but oozing fluid. She's very nice and doesn't want to be any trouble so she wants us to decide whether she needs to go to the hospital. Common agreement between us and her daughter is yes, she should go. Tight quarters in the house mean we have to take her out in the stair chair and then onto the stretcher outside, where it is raining and icy. Everything goes smoothly and we get her into the ambulance and warmed up. I ride with her to the hospital and have a wonderful time chatting with her.

At the hospital, they are just opening up the rooms on the back side of the ER where they usually put the less critical patients like this and she's going to have the attention of a nurse all to herself for a little while since there isn't anybody else back there. She repeatedly thanks us for being so nice to her and helping out and apologizes for taking up our time. I try to make sure she knows that we were happy to help and glad she called. Great call for me because it leaves the good feelings about helping someone, but also because contrary to the too common scenario, I got to see a situation where an ailing family member was able to live at home with caring relatives looking out for her, where everything seemed as safe as they could make it, and where I was able to make a difference for the patient just by doing my job.

11 January 2007

One hit wonders

Worst nursing home afternoon activity (actually seen): "Who am I?"

Proof that I'm not yet completely corrupted (I had to see this sign twice to understand why my partner thought it was funny): "Man servicing scrub machine"

Best thing supposed to happen this week: New boots, with zippers! So I don't have to think so hard about laces for middle of the night calls

Second biggest annoyance at ambulance co.: Being sent a list of dispatch times and asked to "Send PCR immediately" when the call happened over a month ago and I turned in the paperwork at the time.

Biggest annoyance at ambulance co: Whatever they're putting in the water at dispatch to make everyone so damn grumpy

Good news from FD: New operating plan means that for now, K still has a job. He has to sometimes work out of the south station, which has actual mice and other vermin infesting it, but at least he gets to work.

Good news from FD part 2: I have to take ICS (incident command) training and was supposed to go take it with the FF class I took Haz-mat with, but I got approval to take it on-line instead!

Worst quality in a partner: inability to lift. My body aches today from working yesterday with someone who admits she can't lift.

This is de-lurking week, so say hi sometime so I don't think I'm just talking to myself. Not that there's anything wrong with talking to myself....

EDITED TO ADD: Biggest waste of an hour this week: Armed and Famous, these people aren't even celebrities and yes, I was coerced into watching this when nothing else was on.

06 January 2007

Alone time

So this isn't a post about ambulance stuff, medical school stuff, or any of the usual topics here. I wanted to write about something else on my mind right now. To those who know me personally, no, this isn't specifically about something going on in my household right now so please no panicked phone calls...

Why is everyone ending long-term relationships right now? Or just plain giving up on dating? The holidays stress everyone out, but this seems like something else. I know one couple that ended an 8 month relationship, one that broke off an engagement, two marriages on the outs, and three separate singles who've "given up" on dating for the forseeable future. I've never really done the "dating" scene so maybe it is just my inexperience which makes this situation confusing. Some days I feel like the only happily married person around. Other days I feel like the most miserable married person around. These changes remind me that probably everyone else feels the same at one time or another and that you really can't know a relationship from the outside.

Different people are willing to share different parts of their lives with me, depending on how well I know them and whether I'm just in the right place at the right time when they need to talk. I've gotten much better at being non-judgemental when hearing all sorts of completely crazy things about relationships. Obviously not about things like abuse, but about situations where I would've previously shaken my head and wondered how and why these people stay together. Everyone gets something out of every relationship or they wouldn't be in it. I don't claim to understand what that is in many cases, but if you listen carefully to people when they're talking about their problems they often give you hints as to what they enjoy as well.

Noticing this in others has made me pay more attention to the way I talk about my husband, my friends and people I care about. I want to make it clear when I'm just griping about someone I care about and when I'm really having a problem and I need help. But the thing I've never really understood is, how do people draw the line? When is enough finally enough? I know there are some things that are just intolerable, but when it is creeping unhappiness? Or that little voice that says "I don't want to go home to that anymore"? When are you just quitting on something worthwhile and when are you watching out for what is best for you?

04 January 2007

Hey, stranger!

I'm at the office today. A real, honest-to-goodness, sitting at a desk, typing on the computer and meeting with people in conference rooms office. It is a shared "homeless" office, but still, an office. I haven't been here in quite some time. Usually when I have to come up, I stay long enough for a meeting or two and then zip back home. Today, I've been here all day. Almost like when I used to work here, except I'm wearing jeans and laughing and having fun.

It has been a good day to catch up with people I haven't talked to in a long time, and with the new year, a good time for everyone to reassess their projects and come up with a three-page to-do list for me. I don't mind though, it is better than trying to psychically determine what people want me to be doing on "their" time. Some folks here are still a bit freaked out at what might happen to their projects if I get in to medical school, some are just doing the finger-in-the-ear-la-la-la-I-can't-hear you routine. Both are fine because I don't have any answers.

With the recent rejection, I got thinking again about what I'm going to do with myself if plan A (go to med school in fall '07) doesn't work out. I don't currently have a plan B. I could stay on the ambulance and work from home. I could quit the work at home stuff and pull more ambulance hours and try and volunteer or get "leadership" experience for my med school apps for '08. I could figure out what I need to do to go to PA school instead which would probably involve re-taking a bunch of undergrad science pre-requisites. I could go back to just volunteering on the ambulance and try to find another office job closer to home. I don't think that last one is a good idea because I really am enjoying patient care and think it has contributed greatly to my day-to-day happiness.

I try not to think on it too hard because I don't want to make a difficult decision and then get in to med school after all and have wasted all that time and energy. This feeling is totally new to me though. Let it ride. Cross that bridge when you come to it. Don't worry about what you can't change. Hmmm, maybe getting older is good for something at least...