26 June 2007

Stretcher ballet

Sometimes, you just can't share the humor in moments with the people involved. On a call where so much had gone wrong, we all needed a good laugh, but I think I'm the only one who got one.

Dispatched to the home of a frequent flier for 'cardiac arrest', on arrival he's not in arrest but is unresponsive, breathing inadequately and not protecting his airway. The firefighters on scene are performing the near-miraculous patient care technique known as 'folded arm observation'. Especially powerful tonight because there are four of them instead of the usual three. I give them credit for actually putting the pulse oximeter on the patient to make sure he wasn't in cardiac arrest before resorting to the FAO, but it is never encouraging to walk into a scene like that. They know this patient well, they've run full codes on him more than once and true to Murphy's law, not only does he have a full array of medical problems, he is a NOT small man.

BP was crap, SpO2 was low, no gag reflex. MC is after an intubation, sends me in for IV access. No go on IV. Second try at the tube gets us a fantastic vomit fountain of pink slurry due to esophageal placement. Two more tries for a ET tube leaves us pushing a combitube and making good use of the little plastic elbow attachment known locally as the vomit diverter. We finally decide to get moving, so the firefighters pick up the patient and head towards the stretcher. As they reach the hallway, they realize that the new guy had brought the stretcher in head-first while the patient is heading out head-first, meaning his head will be at the foot of the stretcher. We were loading him onto a backboard anyway in case we needed to do chest compressions, so I suggested that perhaps rather than attempting to deal with the issue in the hallway, they should load the patient as-is and we would move him when we had a little more room.

Out we go into the dark parking lot, throw open the doors to get the rear scene lights on, and now we have room to maneuver. The firefighters had done a good job of getting him out, loaded, and outside, so I decide to stay out of the way and let them reorient the backboard the proper direction on the stretcher and hop in the back to get some other equipment ready. This gives me the best seat in the house for the show. They do remember to unbuckle the stretcher straps and leave the backboard straps attached. The do lift him sufficiently to clear the railings of the stretcher. But somehow, in the large array of protective clothing, big pockets, and the assortment of equipment they each carry, they got hooked. They are pivoting clockwise with the backboard and the stretcher is pivoting gently beneath them. Keeping time with their every movement, defying their best efforts to fix the positioning.

Finally, the officer grabs the stretcher and yanks it 180 degrees releasing it from whatever was keeping them hooked. All of them look into the back of the truck where I quickly busy myself with something other than directly laughing at them. I know they heard me earlier and I know they heard me then. I did share a laugh with them about it at the hospital (MC took 2 with him in the back of the truck), so I know no feelings were hurt.

Oh, and in case you're wondering, patient was awake, tube removed and whining at the docs by the time we cleared the hospital. A little Narcan is good like that.

14 June 2007

Movin' on up

A few new things happening for me...

I somewhere found the strength of character (and the $1000) to torture myself again with applying to medical school. I gave long and serious thought to whether I was willing to be disappointed again, whether I should retake the MCAT, what plan B was going to be if I don't get in this year, and where in the country I should apply since staying local didn't really pan out last year. I looked at a LOT of schools and ended up applying in the east and/or beginnings of the midwest (depending on who you ask). I really tried to apply to some schools out west but everything there is either strongly centered on in-state applicants (>90% of students) or located in California or both. I was advised to submit the application on the first day I could, so I am applying almost two months earlier this year. I'm still a little behind because I didn't realize AMCAS was going to have to re-certify my transcripts until I was all the way finished with the application, but I think that will still be earlier than last year.

Only two weeks left at the office job. The last project leader is having fits of anxiety about the transition because he doesn't like anything he's not in control of. Thankfully that has mostly manifested itself by demanding I drive up to the office all the time. I think the new people are all doing fine and the sun will continue to rise and set without me, so I just have to convince him of that.

Ambulance co. stuff is going well, the rate of changes has slowed down a bit, allowing everyone to be a little more settled. I'm actually learning who some of the new people are so that not everyone has to go by "FNG" anymore. And I managed to score a new full-time shift. No more Saturday and Sunday 12 hour transfers!! My new shift is 3 911s and 1 daytime transfer shift, but doesn't start until the middle of July.

Most shifts are 2 transfers and 2 911s, so there were a lot of internal applicants for the position. The medic on the shift was actually asked who he wanted to work with (highly unusual) and he picked me. The supervisors were actually asked who they thought the shift should go to (slightly unusual) and apparently they even voted and picked me. If I had known there was going to be a popularity contest, I would've been nicer to people (hahaha!), but at least this way I think it might be mostly based on my skills and work instead.

The last hurdle was to talk with EMS1 about the rumors that I was leaving in September because he didn't want to give a prime shift to someone who was only sticking around for a couple more months. I was honest with him about the unlikely outside chance I would be accepted off the wait-list for medical school this year, but that I didn't really expect that to happen and was planning on being around for another year. He decided that would work and gave me the shift. (happy dance!!)

12 June 2007

Motion sickness

One of the most common questions I get from non-ambulance people is "Don't you get carsick?" Generally, no. I don't find that riding, reading, or writing in the ambulance gives me much trouble. I've always been able to read and relax in vehicles without too much trouble. Riding contrary to the direction of travel hasn't really added too many problems. Sometimes if I already have a headache, being stuck in a small space with an annoying and/or smelly patient will about try my patience and make my head thump louder, but carsick isn't really the problem. I've never really had motion sickness on water either, although I think that is partly because I don't generally go boating too much and I definitely don't go in nasty weather.

There have been two notable exceptions though. Both were VERY long transfers (in excess of two hours) on windy Vermont roads through hilly areas. For some reason the combination of winding left and right with the up and down of the hillsides is enough to turn me green. Generally, we've been well over an hour by the time we hit these stretches of road, so I've got nothing much to do for the patient. I've been through their paperwork, done as much of my paperwork as I can, and I'm probably out of small talk. All I notice is being sloshed back and forth, up and down, over and over again.

On both trips, by the time we made it to the hospital, I was ready to run through the hallways, toss the patient in the nearest empty bed, and make a run for the restroom. This, of course, is unacceptable behavior. We must walk through the hospital, find the correct room, find the correct nurse, settle the patient, sort out paperwork, and then politely ask directions to the restroom. All while trying desperately not to vomit all over a hospital I've never been to in order to avoid leaving a bad impression.

Could I just be sick in the ambulance? I could. Aren't there various contraptions there for capturing vomit? Yes, there are. But no matter how much vomit you get into a container, the smell always escapes. And lingers. And lingers. I don't relish being sick in the first place, but having to smell it the entire 2+ hour drive back to the station is more than I can handle.

03 June 2007


I took one for the team a few weeks back. MC and I were doing the long 12 hour transfer days that make up our weekends and 20:00 brought us a transfer down to the Big City, just over an hour away. We get the page, ALS transport with IV for a bowel obstruction. Bowel obstruction being transferred?!?

Checking in with the nurses on the unit gives us some more information about the patient's condition and surgical history (she's being transferred because her surgeon is in Big City). Sounds like she's been through a lot of stuff, but she's not too thrilled with being taken off her PCA pump and not afraid to tell us about it. Her nurse had promised that we would be able to give her pain medication en route, but the doctor (or PA) had neglected to leave written orders for pain medications and MC doesn't give narcotics on transfers without written orders. So, nurse decided that the percocet given as we walked in would be sufficient for the hour long ride down. Since it was my turn to tech and there were no longer any paramedic skills required, I was the lucky winner of the "who gets to piss off the patient" contest.

Nobody brought up the whole pain medication issue right away, the nurse didn't want to make a scene and I was hoping to postpone the complaining as long as possible. As long as possible turned out to be about five minutes into the transfer.

"You're going to give me something for the pain, right?"
"No. The doctor didn't leave orders for pain medicine and the nurse gave you some right before we left."
"WHAT!?!!! She promised me pain control. I'm never going to make it, I'm in pain already. This is unbelievable."

It went downhill from there. Thankfully, it is fairly easy for me to say no because there is absolutely nothing I can do. The pain medications are in a locked cabinet. No amount of explaining was good enough to convince her that I wasn't out to deprive her. No amount of explaining was enough to indicate that it makes no difference whether I thought she was a drug-seeker, I just don't have drugs to give her.

Finally, she demanded to seek her paperwork. I'm a big fan of informed patients, so I happily gave it to her. She wanted to know where it said that she couldn't have morphine. I pointed out where it should say she could, and that it didn't. Then she went through EVERY SINGLE PAGE, reading, questioning and demanding. For those who don't know, reading or writing in the back of a moving ambulance is an acquired skill, especially on the ruts and bumps of some of the roads in this area, so I got to enjoy her complaints about not being able to read easily too.

I've never been so glad to see the end of a transfer. There are only so many ways my tired mind can come up with to say N-O at the tail end of a twelve hour shift.