30 December 2008

New Year

I don't do New Year's resolutions, mostly because I don't usually find the end of the year to be a good time for reflective contemplation. Between the holidays and all the birthdays, the end of the year is more of a time for doing all the stuff that needs to be done. This year, we're traveling (fingers crossed) so maybe a few unoccupied hours at the airports will lead to some decisions.

I'm still struggling with the decision on where to go to school, the two programs I'm stuck between are quite opposite. Rural vs urban, two years of straight science vs starting patient care right away, $57k vs $41k/year, 340 vs 140 students, and yet I'm drawn to each of the programs for the unique features they offer. I believe I could get a good education at either program and that I will make myself into a good physician regardless, but this is still an important decision to me. I want to be at the right place, the place where I'm learning and growing, not fighting the system or the aspects that are holding me back.

25 December 2008

Not exactly what I had in mind

Hope everyone is having a merry Xmas! K and I ended up being home instead of in Seattle and Grand Coulee, but we're still trying to make it to Vegas for part of the trip. After being delayed multiple hours and being told we were going to miss our connecting flight, have to stay the night in Chicago and that there were ZERO available seats the next day, we decided to stay home. Between weather in the midwest and weather in Seattle, it just wasn't happening. So today wasn't too much like a holiday here, no decorations, no presents, just K and I hanging out. He's working tomorrow and I'm working Saturday since we're here, but at least we're safe and sleeping in our bed instead of airport chairs. Take care and appreciate the ones you love.

22 December 2008


I used to want you to want me, now I'm not so sure. I have been admitted to three medical programs, 1 MD and 2 DO. The MD program required a $50 deposit (non-refundable) within 21 days, which I happily paid. The 2 DO programs require a $500 deposit (non-refundable) within 30 days and a $1500 deposit within 60 days. Big money to hold a spot while I make up my mind - thus, not money I am going to spend until I make up my mind. Therefore, I must make up my mind within 26 days and counting...

Factors weighing heavily on my mind:
  1. The MD program is at least $15,000 a year more than any of the others because I am an out-of-state student, with little hope of changing that.
  2. I want to provide the best possible medical care for my patients, using all appropriate therapies.
  3. I do not want to spend extra studying energy on practices I am not going to use.
  4. I want to kick ass on all further required standardized tests so I can have more choices and better success in finding a residency and in my practice.
  5. I am nervous about buying a house in a severely economically depressed area which I feel is unlikely to maintain it's value over 4 years of school.
  6. K wants to move west.
So, lots of soul-searching for the next month. If you see me staring off into the middle distance, try not to startle me.

15 December 2008


Still no power at the homestead. The wood stove is heating us nicely, with downstairs reaching 70 degrees a couple of times and upstairs now in the mid-sixties. The weather gave us a break today with outside temps reaching mid-fifties. Watson was not convinced about the wood stove at first, but he's now made friends with being toasty warm on half his body and rolling over as needed. He still sleeps upstairs, but then he's always preferred it a bit cooler for sleeping, we've trained him well.

I've never been quite so happy to see power trucks cruising the neighborhood, we've even got international representation with HydroQuebec here to help us see the light. Power came back to the library last night, hence the ability to post, and it was actually all the way to the edge of the neighborhood that we spend a lot of time walking the dog through, but not all the way to our house. I don't know why it grates on me that people who do have power have all their Xmas lights on - it isn't any more wasteful now than it was before the storm, just seems rude when the folks across the street are still shivering by candlelight.

Makes me laugh at myself that the time I post the most is when I have the least convenient means to do so, but I guess sitting in the dark squinting to read with no aural distractions has given me time to think and to write.

13 December 2008

Home again

I finally made it home Friday afternoon, to return to the house being cold and dark. Power was out everywhere, couldn't even pick up Watson because the kennel was closed. K and I finally got motivated enough to hook the wood stove up to the chimney so we could have some heat. We're lucky enough to reach 60 degrees down stairs by the stove and 54 upstairs. Better than lots of folks who are without power and worried about bursting their pipes because the indoor temperature is getting down to the low thirties. I'm supposed to hear decisions from the last two interviews some time at the end of next week, so fingers crossed!

11 December 2008


Sadly, I am not home tonight sleeping in my own bed like I was supposed to be. Upon arriving in Chicago, I was informed that ALL flights home were cancelled and here's the number of a place to help you find a hotel (on my own dime of course). It could be worse, I could be sleeping in the airport. Right now, don't know whether I'm going to make it home tomorrow - fingers crossed that the ice really turns to rain somewhere before noon, my plane is supposed to land at 12:45.

10 December 2008

Apply, Apply, Apply again

I’ve moved away from writing here too much about my application process for medical school, even taking it off the sidebar so I don’t have to see it regularly. Not to imply that it doesn’t continue to saturate every day of my life, but at least it isn’t quite so visible to everyone else. This year is the third year I’ve applied to medical schools and I decided at the outset that it would be the last. Applying is an expensive, time-consuming and emotionally exhausting process, followed by the expensive and stressful process of interviewing, the outright painful waiting for a decision, and for me, ultimately the disappointment of wait-list placement (or death row, as I think of it) with no last minute stay of execution for my dreams of practicing as a physician.

I changed a small number of strategic things this year and have had increased success. The primary change was to include osteopathic medical schools in my applications. These programs do not result in an M.D. degree, but a D.O. degree. At the end, you still are referred to as “Doctor”, you have the same prescribing rights, the same ability to perform procedures, the same state and national licensing, the same liability. It took some serious investigation to convince myself this was a reasonable pathway because I had some reservations about the image of D.O.s falling into the “holistic”, “homeopathic”, “naturopathic” and to be honest, all around crunchy-granola end of the medical spectrum. But ultimately, it was an image and not a requirement of training nor practice of osteopathic physicians.

And finally, some success. I have four interviews in Nov/Dec and have already received an offer of admission to one program with others suggesting decisions will be forthcoming prior to the holiday break. Hallelujah, Amen!

01 December 2008

This is only a test

I was recently guilt-tripped into participating in a haz-mat mass casualty training drill with a multitude of agencies spanning state borders. If you've been paying attention, you'll remember that I only work out of the North station, not the South station that would actually be involved in this incident, so I'm pretty much fish-out-of-water to begin with, then we're going to add the complexity of having no idea what is going on, trying to work on communication channels we never use and being told I may be asked to take patients to two hospitals further south which I've never been to and don't know how to get to. The longer I stood at the briefing, the more convinced I was that this was a terrible idea and likely to result in a lost ambulance circling the city. But what the heck, grin and bear it, right? Nothing like 5 members of the "management team", known as white-shirts for their uniforms, participating in an activity to make sure it goes all kinds of crazy.

After hanging around a fire station for more than an hour while some of our "patients" were made up to look horrible, buses took them away and we commenced "normal daily activities". In this case, we all stood around outside the fire station waiting to hop into the ambulances and head out - just like every day, right ambulance folks? Off we go in a convoy lead by several trucks of white shirts (including 2 in a wheelchair van - clearly a first response vehicle!), no lights and sirens, trucking down the highway to the mall. We check in and resume standing around doing nothing. Move the ambulance 400 feet closer to the mall, resume doing nothing.

Then, a "patient" I recognize from earlier is walked over to the ambulance area with quite some commotion. She's soaking wet (from the decontamination shower), shivering and more than a little freaked out. The half of a story we hear is that when she was being extricated from the scene, she was backboarded, then dropped. A white shirt is busy yapping at her after sitting her on the bumper of my truck, discussing how this is "a little too real now" and basically not accomplishing anything. I finally get around him far enough to get the poor girl a blanket, then suggest that it would make more sense to put her inside the ambulance where it is light and warm. Then we find out that she has chest pain and a congenital heart condition making chest pain a real symptom and not a panic attack.

I'm sure you can guess what happens next, a giant clusterfuck. My paramedic and I are talking with the patient, then his ex-girlfriend who just happens to be in a BLS truck from another company at the same drill hops in to help. What?!? Whatever. I finally have to get out of the ambulance and try and protect the damn doors because every 3 seconds some other white shirt or random person is opening the doors. Very difficult to provide good patient care, including a 12-lead EKG, and keep it warm in the ambulance with all this going on. Next comes the fun of explaining to each white shirt, individually, why it is not appropriate to send this patient with the BLS crew and why it is stupid to wait for a transfer truck that hasn't even been dispatched yet to get here before we leave. Finally, everyone's close to agreement, so honestly, I just went.

After a thankfully uneventful transfer, we arrive at a hospital which is expecting "patients" from this drill, not an actual patient from the drill and there is several moments of confusion trying to get everyone to understand that although we brought her from the drill and she has the stage makeup on, this one is for real. We finish up and head back to the mall, relieve the transfer truck and resume doing nothing. Eventually, we get a "patient" just before they decide to stop dousing volunteers with cold water in 40 degree weather and cancel the rest of the drill.

I have to say that the only part of the drill that in any way resembled what I believe would happen at a real incident was the hysteria and confusion over our real patient. The ambulances, wheel chair vans, city buses, and haz-mat trailers all arriving immediately with appropriate staff is pretty much a joke.

03 November 2008

Cue Theme music

I finished the Manchester Half Marathon. With a 10:14 pace even! I actually had a much better time at this race because I got to run with K for the first time in a very, very long time. We have mostly stopped running together because the disparity in our paces makes both of us grumpy when we try. But yesterday, he needed to slow down for the first half and I needed to keep on pace and somehow those two numbers came together close enough that we ran together for over 9 miles, only splitting then due to a pit stop. K was able to finish his first 26.2 with a 10:48 pace, right on target for him. So a successful day all around!

Manchester Half-Marathon (http://www.cityofmanchestermarathon.com)
Interval @ 9:17, Tempo @ 9:47, Long @ 10:32
Week 10: 4 x 400, 3 mi (29:20), 6 mi (62:39)
Week 9: 4 x 800, 4 mi (40:50), 8 mi (88:42)
Week 8: 3 x 1600, 5 mi (47:41), 10 mi (DNR)
Week 7: 6 x 400, 6 mi (55:31), 6 mi (59:36)
Week 6: 3 x1600, 4 mi (36:00), 10 mi (DNF)
Week 5: 4 x 800, 8 mi (79:09), 8 mi (DNR, 40 min run)
Week 4: 6 X 400, 6 mi (58:24), 10 mi (104:10)
Week 3: 4 x 1600, 8 mi (DNR), 12 mi (130:14)
Week 2: 3x 800, 3 mi, 6 mi

27 October 2008


It isn't even 11a and it is already a bad day.

The background: K is out of town at a class for two weeks, coming home on Friday; we have paid a deposit on having the house insulated, the guys came about 5 or 6 weeks ago and said they couldn't do the walls, but would still do the garage at a later date. Supposedly, that later date is today, which means I have to move everything out of the garage before the insulation guys arrive. Including the ladder, lawn mower, power washer, wheel barrow full of crap (sorry "scraps"), shop vac, table saw, and two motorcycles.

The Honda Shadow which I ride is not a problem, I can reach the ground well and I can handle the weight. The Yamaha K rides is a problem. It is a big, heavy bike. I can't reach the ground as well as I would like, so backing it out of the garage onto our hilly driveway is an issue because there is a point where you have to be able to push with your legs to get it around enough to head down the hill. K tipped it once trying to get it out and thankfully there wasn't much damage, but it took two of us to get it upright again.

Today was a different story. I'm alone and when I hit the hill, down I go. Unfortunately, I didn't have the strength to slow it down the way K did so it now has a beautiful assortment of scratches. I did manage to get myself out from underneath it so I'm not hurt. It quickly becomes apparent that I'm unlikely to get it upright by myself. A quick look around the neighbors reveals that everyone I actually have met is not home right now, being a work day and all. A couple of failed attempts by myself and I realize that something is leaking out of the bike. More than one something actually. Antifreeze out one side and gasoline out the other. After removing my pride and placing it on a shelf, I call the FD where K works. Even better for my wounded ego, it is HIS shift that is working today.

Don't worry, they sent me help and we got the bike up. But not before some photos were taken to "share". I don't know why he insisted on this, it isn't like they can mock K for it, he didn't have anything to do with it. So now, I feel foolish and I'm sure he's going to have to hear about it. Bad, bad, bad. There's more issues going on that add up to not a good day, but this is by far the worst because now I have to figure out how to get it fixed, especially the antifreeze hose because I can't figure out where it used to attach. Good thing I'm working overtime this week, I'm going to need the cash.

EDITED 20:37: Good news, the antifreeze leak wasn't really a leak but rather "flow" through an overflow tube. I've never heard of such a thing, but K swears it's true...

25 October 2008

Patience with patients

My last shift tested my patience. I'm still struggling a bit with how I feel when I walk into a station that used to feel like a haven from the difficult situations I encounter on the truck. So I'm not always feeling my best when I leave for calls and I recognize that and try to keep it from interfering. I worry because I'm one of those people who wears their emotions in a clearly visible way and I really don't want my baggage affecting my patients.

Dispatched for a psychiatric problem, arrived to find a middle aged gent sitting on the outside steps of an apartment building. He really wanted to talk and not about his psychiatric issue beyond "I'm a professional drunk. Not an alcoholic, I don't go to meetings." (To which The Asian replied, "AA is for quitters.") Around the time I thought we were finally making progress toward getting him in the ambulance, he lights up a cigarette. We let him finish. Finally arrive at the hospital and I find out The Asian has made a deal with him that we will wait, AGAIN, while he smokes a cigarette before we go in. I'm not nicotine addicted, I don't know how you feel, but I do know that I'm standing around in the cold while you are trying to give yourself cancer. Apparently, I managed okay because the patient only commented on how great we were and how he appreciated everything we did and when he froze up a bit on actually getting into the ED room, we were able to talk him through it.

Dispatched for difficulty breathing, arrive to find FD applying an oxygen mask to 70-ish gentleman with history of recently (3-4 days) diagnosed lung cancer. On talking to the patient, he says he is not having any problem breathing and confusion reigns until we finally figure out the problem is with his portable oxygen tank and it's "broken hose." I find the slice in the nasal cannula, pull a new one out of our bag and I'm ready to make a break for the door. Then I hear The Asian sit down. WTF? He proceeds to spend another 15 minutes with this guy trying to make sure he knows how to use the tank, the concentrator and all the assorted pieces because guy seems a bit confused. I'm trying not to thump my head against the wall as the guy continues to insist that the tank isn't ready, or he's going to wear it now, or whatever all he's trying to convey with great difficulty. I'm convinced he's never going to get it. Finally a breakthrough comes when we understand that he wants to wear it now because he wants to go down and see his friends. I make sure he knows that he can call us or the FD if there is a problem with his oxygen and he's just happy to know we can fix it because he wasn't getting much help from the supply company.

In the end, happy patients. But I know that it wasn't because of my ability to stop and care about things beyond the medical-transport stuff and reminds me to make sure I'm looking for the cues that the patient needs more. It is an on-going challenge because I get stuck in the cycle of asking what they need and having them list things I can't affect and then not asking any more, even when it is a whole new patient with a different set of circumstances.

20 October 2008

Trauma update

For those who will know him, the medic in question was a slightly older gentleman with a foreign accent who rides constantly. The accident occurred when a driver turned left in front of him, leaving no time for any sort of reaction, no chance to slow or lay the bike down. Reported combined vehicle speed was in excess of 90 mph.

There was a trauma team activation at the local hospital, followed by 90 minutes of "care", followed by a 40 minute additional wait while the doc decided to order blood and wait for it while the pt's pressure dropped below the level where he could receive additional pain meds for transport. When we arrived at the next hospital, there was another trauma team activation, this time with orthopedic surgeons in the room in less than 5 minutes assessing and evaluating. Surgical fix thus far is an external pelvic halo to hold the pieces together while they wait for the last source of internal bleeding they couldn't locate to heal up. Estimated hospital time right now is 6-9 months, then an extended rehab.

16 October 2008


About the worst transfer I can imagine happened today. One of our paramedics was hit by a car while riding his motorcycle, shattering his pelvis with major internal and external bleeding. The Asian and I took him down to a real hospital in the Big City, but I will never forget the sound of someone I know screaming in pain at every bump the ambulance hit and feeling like I somehow should've done a better job of driving, of caring, of just simply being.

12 October 2008

I don't have the power

So, noticeable lack of posting lately is due to complete lack of energy and inability to write about things that are suitable for public consumption. I'm struggling with a renewed sense that I need to watch my back 24-7, be entirely politically correct in all forums and at all times and generally not enjoy life quite so much any more. Can I have fun and not offend people? Maybe, but not lately. I'm undecided on continuing to post here at all but I promise to let you know if I quit entirely.

02 October 2008

Temporal ateritis

The upside to job shadowing in the ER isn't just face time with a physician, it is also the chance to see patients through to diagnosis and a better idea what is actually wrong with them. I had a chance to see an unusual case resulting in a diagnosis of temporal arteritis, something I had never heard of because you can't really diagnose it in the field, but it is interesting anyway. The doc I was with said this is only the second time in his career he has ever actually found it, despite the hundreds or thousand of times he's looked for it.

Patient presented with a throbbing headache on his L temporal region, painful to palpation, some nausea and double vision, negative on stroke scale (weakness to one side), alert and oriented, complaining about being utterly unable to sleep due to the pain. Recent ultrasound to carotid arteries showed no evidence of blockage. On exam, it wasn't the usual side-to-side double vision, but rather an up and down double vision. Typical presentation would describe more of a "blurred" vision, but not everyone is typical. Laboratory blood work showed an elevated, but not extremely so, sedimentation rate indicating increased inflammation. Consultation with neurology confirmed the suspected diagnosis and treatment plan of the ER doc. Patient was given a steroid dose to go and a follow up for temporal artery biopsy.

Temporal arteritis: http://www.nlm.nih.gov/medlineplus/ency/article/000448.htm
SED rate: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm

01 October 2008

Quick updates

  • Fainting while job shadowing definitely makes an impression on physicians. I've done it twice now, to two separate docs, thankfully not in front of patients. This last one left a lump on my head and had me sent home an hour or so early, thankfully the ME was very nice about it and the dead guy didn't seem to mind a bit.

  • Someone needs to investigate the roving gravitational vortex that seems to cause people to fall down all at once. We will go half a day without a fall dispatch and then suddenly get 5 or 6 in a row. My latest involved a drunk who fell through an open floor in some new construction (I managed not to laugh until after we dropped him at the hospital) and two old people who couldn't get up from the floor.

  • Apps are complete at most of the medical schools, so now I'm just waiting on decisions for interviews. In the words of one admissions officer, "Any time between now and March."

  • The Asian and his wife have a beautiful new baby daughter who I got to hold at the hospital. Healthy and happy, some shoulder dystocia which led to a broken clavicle, supposed to heal on its own in the next 6 weeks, no permanent damage. Based on the number of lawyer sites I found while looking for that link, I guess people sue a lot for it.

  • On a related note, this means that I spent all week working with new guys. All of them with the company less than 3 weeks, two of the three have been paramedics for less than a year and the other one is an Ohio State fan (which is relevant to me as a Michigan grad). Looking forward to having my partner back on Saturday so I don't have to navigate from the patient area of the ambulance.

  • Heard today that I'm the newest education addition at the ambulance company, which is good, I think. It will mean more new people, but in a different role where they are the third person in the ambulance and not the second.

  • Running is kicking my behind lately and I'm having trouble to stay motivated for this last month. Training in the late winter/early spring vs late summer/early fall definitely shows some changes. It was great to be able to run in the warm afternoons and not have to worry about snow, but now it is getting dark and making finding time and motivation harder and harder.

21 September 2008


The weather is running circles around me. Today, no forecasted rain, just "possible drizzle" in the afternoon. Just as I'm getting ready to run, I have to double check the time of day because it is now VERY black outside, followed by thunder and a downpour. WTF? I check the local radar and the only storm anywhere on the doppler 8 million in the entire state is immediately over my house. Well, I can take a hint, but I still have to run today. I'm leaving to give it a try, wish I had a lightning deflector of some sort.

16 September 2008

Main event

Ladies and gentlemen, guys and dolls, welcome to tonight's main event. Sponsored by the ambulance co., the police department and a lovely drinking establishment that refuses to say when if there is more beer to be sold.

In this corner, we have The Asian, wearing the blue uniform and hailing from the southern U.S. A record of 5-3-1 and a reputation for being brutally honest.

In the other corner, we have Drunky, wearing the latest in trashy bar fashion and hailing from our great city. A record of 0-0-0 and a reputation for flapping her gums at every passerby.

Let's get ready to r-r-r-r-r-u-u-u-u-u-umble!

The Asian is out of his corner quickly with a sneaky patient steal maneuver, getting the assault victim into the ambulance with no regard for Drunky. He sways a little to avoid her hand on his arm and closes the door. Well folks, this one might be over in the first round as he settles in to treat his patient.

Wait! Wait! Drunky isn't going to take this lying down - she's on her feet and heading for the door. Oooh, that is a triple door slam followed by a shout to the open slider window ("Hey! I'm covered in her blood and need something to clean up with!") and another triple slam for good measure. He can't ignore this auditory onslaught.

Sure enough, here it comes! A quick verbal tap to the forehead followed by the cold shoulder, he should patent this one and charge admission. She's still full of bluster but has to turn back to the crowd to find her courage, this medic isn't going to fold as easily as she thought. Where's the respect and adoration? Where's the gratitude for helping that victim? She stopped that girl's nosebleed all by herself. She's gotten herself back into full rage mode and refuses to be ignored.

Back with the old standby, two triple door slams in quick succession. But hold on to your hats, now the patient jumps up and starts defending the Asian. Nobody agreed to a tag team match, one at a time, save the rest for the pay-per-view rematch! There it is folks, the knockout punch directly to her pride. The killer dismissal ("Whatever, princess.") and this match is over! The Asian has the last word, a happy patient and leaves the scene with no regard for Drunky who is set on slow boil.

Stay tuned folks. See who steps up to take on the medics next week.

15 September 2008

I think she missed the point

Dispatched for an assault, person choked by their neighbor.

On scene, find three little girls running around the sidewalk, one of them flagging us down, and a trashy-looking woman coming out of the door at the address. I walk to the woman, the medic to the girls. "What's going on today?" "That little brat was fighting with the neighbors." "Who are you to her?" "Her mother. Not that she listens." "And she got choked?" This is followed by a string of profanity about her daughter and fighting all the time with the neighbor kids and a whole lot of nothing useful.

"Do you want us to take her to the hospital to get checked out?" "Hell no. There's nothing wrong with her. (At least we agree about that!!) She called 911, ask her what she wants." "Ma'am, you're her legal guardian, so if you don't want us to take her to the hospital, I need some information from you and your signature." "You know, someone should teach these kids that 911 is serious business." "Yes ma'am, somebody should."

Amen sister, somebody should teach this kid a whole lotta things she doesn't seem to know before she gets any older and a not-so-gentle man teaches her some of the other things she should've learned at home.

11 September 2008

I remember

I remember sitting in a conference room watching smoke pour from the buildings, seeing one fall and asking out loud "Did that building just fall down?" because the TV person hadn't acknowledged it. I remember being horrified at the thought of the fire and police at the base of the building. I remember getting the scariest phone call of my married life from K, telling me the volunteer department he was with was sending people and equipment and he was going. I don't know how it is appropriate to "memorialize", but I remember.

10 September 2008

Paperwork in a paperless system

We finally transitioned to electronic patient reports earlier this year, the so-called "paperless" system. The old system involved a single, legal-sized sheet, with 3 carbon copies attached. Patients and facility staff signed the back of the top sheet for all the legal and billing junk. We left a carbon in the patient chart, a carbon in a mysterious box that was supposed to go to the state, and one carbon and the original back to the station for billing and whatnot. Transitioning to the computers was not a challenge though dislike the software because I think it is a disorganized muddle of patient information. Somehow the printed version of it which is faxed to the hospital seems reasonable, but trying to figure out which window had which aspect of patient information was an annoying hurdle when it could have been an intuitive breeze.

The Asian and I have a system that makes us very efficient in turning over emergency calls. The person in the passenger seat starts the computer form with the dispatch information like address, dispatched complaint, which fire engine is responding, etc. while we are rolling to the call. (This takes second seat to helping the driver navigate, if needed, but usually the driver is fine until we're pretty close to the call and the computer work is done by then.) On arrival, one of us starts entering info like patient medications, medical history, date of birth, vital signs from the firefighters, basically as much as we can get and still deliver efficient patient care. Anything that doesn't get entered on scene usually gets entered on the way to the hospital, leaving only the billing information, signatures and narrative to write at the hospital.

Transfers are a slightly different beast. We use the same software, but not everything can go into the computer. There is a separate form for EVERY transfer that involves somebody from the hospital certifying that it is medically necessary for this patient to transfer by ambulance. This form has been the source of a massive number of headaches since just before the transition to the computers. Now we are being told that the crews have to make sure everything is accurate on the form, which we are not allowed to write on and not allowed to make changes to. Rarely, this form is filled out by the MD which saw the patient and is never available for questions/changes at the time of transfer. More often, this form is filled out by a "discharge planner" who may or may not be an RN and may or may not actually read the form prior to randomly checking boxes and signing the bottom and is rarely available for questions/changes at the time of transfer.

First, the crews were the ones taking the brunt of staff resentment at having to fill out this stupid, unclear form and having to tell them either they fill it out or we're not taking the patient. Finally, enough issues were addressed that staff just accepted our form as another hurdle to getting the patient out the door. Crews were told that we just needed to accurately document the patient's condition in our narrative and billing would address the inconsistencies. Now, the crews are the ones who are going to have to point out that to the staff any inaccuracies in documenting the condition of the patient. "So the patient is bed confined?" "Yes." "Then why is he sitting in a chair having lunch?" "!*@#$%, I didn't fill out the form and I'm not going to fix it."

Good to know everything poo-related still rolls downhill to the crews. It isn't enough to be polite to facility staff, kind and caring to your patients, take appropriate medical care of them, and document observations and treatments accurately. Now, we have to find the political savvy to point out that their paperwork is wrong without causing any offense. This will certainly be easier for some crews and with some staff than others.

09 September 2008

Bath day

Apparently, I didn't need to travel too far to enjoy the benefits of mother nature. On Saturday, New Hampshire experienced the remnants of Hannah. During the day shift, we had some seriously sick people, air quality was bad for several days prior and difficulty breathing was the call of the day. After a shift change nap, I spent all night picking up soaking wet crazy and or homeless people. We started with an elderly man who ignored the "don't drive through water" maxim and found out half way through that his little sedan wasn't going to get through 4 feet of water, the FD actually broke out the boat to get him and evacuated several houses near by that were flooded. Amazingly, by 3 or 4 am the vast majority of the standing water was gone and all we were left with were soaking wet patients.

05 September 2008


At the ambulance co, the inmates are running the asylum. The morale at the north station has gotten so bad that there are days I don't even want to go to work. From the rumor mill, apparently the south station is fine because there are more "established" employees there who just don't give two figs for anyone other than themselves. But here, we are agitated. We are tired of seeing good people leave, tired of seeing people get screwed, tired of having no leadership, tired of bitchy phone calls trying to fill shifts.

I've tried to be a reasonable influence, complain when things are beyond unreasonable, let some things roll off, talk calmly and logically to folks about the issues. I don't know that it has had much effect, but I've tried to keep a positive attitude when I'm at work (at home I let some of the negativity out). So I took a big step, a training position came open and I applied for it. Given the state of things, I don't have high expectations of being hired for it, but that isn't the point. The position allows me to keep working my shift with my partner, but adds the responsibility of helping orient new employees to the company and work with anyone they send for "extra" education. I'm hoping that if I get the spot, maybe, just maybe, I can make a dent on the attitude of new hires. I've given up on the old hacks, but if new people understand that there are folks here who care about the standards we're supposed to be held to and that it is reasonable to try and live to them, maybe that will help.

Or maybe you can just sign me up for the neat white coat and padded room right now.

01 September 2008


I read a fair number of other blogs, some regularly, some when a comment catches my eye, some just because I'm avoiding real work (like now). There is a dichotomy between people who write about their spouse/relationship and people who do not. I have mostly been in the do not crowd, you see mentions of K from time to time, but not too often. He knows I write, he's decided that he doesn't need to read it because it is all "old news" anyway. I suppose he's right because I tend to tell him stories from my day after I've had some time to think and frame the story more like how I would write about it than how it actually happened, you know, HIPPA and all. Anyway, after that brief journey into left field...

A few years back we had come to a point where neither of us was happy and there was much time spent arguing, yelling, crying, stomping, door slamming, the works. We pushed through for a while and eventually decided maybe a third party opinion was needed. After some discussion with the professional, we came to "I" statements. When we argue, we're supposed to stop accusing one another with "you do X" or "you need to stop doing Y" and instead frame the problem differently, "I feel attacked and belittled when you do Y". Very difficult advice, especially when you're mad enough to be yelling as we don't have a lot of arguments that involve calm, rational thought. The problem is, we both heard this advice and we both know that what I'm really saying is "Stop that" not some sort of squishy, namby-pamby, you need to respect my feelings statement, and vice versa. The one big benefit has been to realize we don't have to resolve a fight at that moment. Sure, we have to stop fighting, back off to neutral corners and take a little time, but nobody has to be declared the winner.

Recently, I've been working on negotiation tactics, give a little, get a little, find a compromise. I like to do this out loud, as a conversation between us. K has apparently been doing this on his own, behind the scenes. No, I don't know why, just his deal I guess. The problem with this disconnect is that I don't necessarily know what the heck he's up to. The current scenario involves him constantly being up in my grill. "Where you going?" "What are you doing?" and on and on. When I can answer these questions politely, they are usually followed by some sort of "advice". Which annoys me as I wear big girl panties and can manage for myself, and I know where to find him if I want his opinion. During the discussion/negotiation phase, I've learned that many of these questions are not actually the ones he wants to ask. Instead of "Where are you going?", he really wants to know "Are you hanging around long enough that we can watch that movie we rented?". Instead of "Do you know where you're running?", he really wants to know "Can you tell me where you're going so I know where to look for you if you're not home soon?". Very different questions. For the record, there have been elements of compromise on both sides, but we're still stuck.

So here's the part I'm struggling with...is it unreasonable to expect him to ask the questions he really wants answered instead of the annoying ones? He says that it isn't the questions which are annoying, just my perception of his intention. I need to stop attributing "ridiculous" motives to his questions and just answer him so he can expand on what it is he wants. I think that if I was asking something that was being misinterpreted, it would be my responsibility to clarify, not the listener's responsibility to change their thinking. And around and around we go.

28 August 2008

Hurricane preparedness

Today the ambulance co. asked for volunteers to potentially deploy to the southern US if FEMA should request them for areas affected by the hurricane. I actually had to go search around for which hurricane we were referring to, the last one I heard about was Faye. But this readiness is related to Gustav, which is still at least 4-5 days from the landfall in the US.

I'm not sure how I feel about all this agitation over a storm that is difficult to predict. My family tried to evacuate per government orders for an oncoming hurricane (Rita) that missed their area but left them stranded on the highway, out of gas with a small child. After watching the limited and difficult disaster response to other natural disasters, I'm torn between get people out of the way and just get them as much help as quickly as possible. The US highway system is not designed for the amount of traffic it handles daily, much less when you try to evacuate a large metropolitan area.

I did volunteer to go, but the means of selection within the company are kept in a locked box in a mysterious smoke-filled room, so even if we get tapped to send people and/or trucks, who knows whether I'll go. I feel like I would want people ready and willing to come help my family so I should be willing to help others. Just thought you'd want to know, I'll try to post either way.

EDITED 8/29: Definitely not going, the selection process didn't go my way.

20 August 2008

Only in the movies, or maybe TV

In response to this post on things patients expect to happen because they see them in the movies. I had a recent interaction with a patient where I thought pretty much the same thing.

On scene of a two car accident, one car pretty smashed up, spun 180 degrees, cool skid marks on the pavement, the whole deal. Driver was fine but a bit unsettled by the whole thing. I was talking with her about how it happened when she suddenly stands up and looks at the rear of her car, "Oh my god! Look, he almost hit the gas tank. Oh that would be horrible. What would've happened then?" I promise, I tried not to laugh. "Ma'am, it wouldn't have exploded or anything. That only happens in the movies." "But, but...the gas tank!?" "Yes, I see it. It would've made a puddle and been kind of inconvenient, but no explosions or anything."

She still didn't believe me.

19 August 2008


In this lovely ambulance co, we have Road Safety. Essentially, a data recorder keeping track of everything that goes on in the trucks. How fast you drive, whether you're wearing a seat belt, how quickly you corner, how aggressively you accelerate, how often you stop abruptly, whether or not you have a "spotter" for backing up, whether your emergency lights are on, whether your headlights are on, I swear the list is nearly endless. As if it isn't aggravating enough to feel like you're being constantly watched, most of these criteria are also attached to an audible alarm in the truck so you know exactly when you are exceeding the recommended levels.

Some years, the six month summary is made available on each employee's driving record so you have time to "improve". The records are supposed to be anonymous so you can't find anybody's record but your own. The company sets acceptable levels of how many "naughty" noises you can receive and still be employed. That level amounts to one mistake every 8 miles, not a terribly stringent standard. And yet, somehow the standard is not the standard.

A supervisor, not the one who does my reviews, pulled me into the office to discuss my driving. Not based on complaints from anyone but based on the six month summary. I am meeting the standard, but not meeting his expectations. "You really need to do better. Just because you drive so many transfer miles shouldn't excuse this." Hmm, here I thought that was exactly the point of tracking miles per error because the more you drive, the more likely it is that errors could happen which don't entirely reflect your ability.

I suppose as a paramedic and a supervisor, it might be easy to forget a couple of key facts. 1. Many times when he is driving, the patient is not critical - I know this because he is driving. Many times when I am driving, the patient is critical and time is a factor so I am working to drive both safely and quickly. Lights and sirens on 911 calls where we run all the time is not too bad. The same through a large city with narrow roads, limited room to adjust, and the potential for getting lost is a challenging driving environment. 2. If the company sets a standard and an employee meets it, that should be the end of the official story. A constructive suggestion, maybe. Angry words and "disappointment", no.

18 August 2008

Swap, drop and schedule

In general, I like the freedom of working on the ambulance. Freedom in the sense that I work: Tuesday night, Thursday day, Friday day, and Saturday night. 48 hours a week. That means that all the days and nights NOT on that list are mine to spend like my last quarters into the snack machine of life, mmmm Reese's. I don't actually succeed in having quite as much entertainment as all that considering I work at the office job and studying my ever-growing behind off, but it is nice to think I have so many days to myself.

There's always a downside. In the case of this ambulance company, it is the current shortage of actual working per diem employees and an extreme shortage of overtime approval. These two things together equal a whole lot of "vacation denied" messages when you want even a single shift off. Unlike the office job, if I stay home sick, someone has to fill my seat. Instead, you find yourself wheeling and dealing for trades. I'll work X day if you'll work X+2 day. People monkey with the schedule to build themselves 24 hour shifts and cut down commutes. People switch around for semesters at a time to get the M-W-F or T-Th time they need to take a class. Some just dislike certain partners or supervisors.

This company has an on-line scheduling program, leading to multiple daily emails on currently available shifts, and multiple telephone calls from people looking to fill shifts. You need a strong disposition to say no but enough flexibility to help people out for an exchange at a later date both individuals and supervisors. Very political, very annoying.

17 August 2008

Things I probably shouldn't have said

Patient had just wrecked BMX bike on a large curb.

Pt: "What happened? I don't even know what happened."

Me: "Apparently, you aren't very good at riding your bike."

Shouldn't have said it because the paramedic burst out laughing in the middle of his assessment. Oops. Patient not very hurt and will never remember.

05 August 2008

Whatchya gonna do when they come for you?

Saturday nights are unparalleled for their entertainment value. Many folks go out, drink, carouse, and then cause trouble for themselves or others. Not all of these calls are entertaining, but some of them make up for the idiot 22 year old drunks vomiting all over themselves.

Dispatched for a "man down" outside a residential address. The FD arrives just behind us and everybody hops out. No man down, no men at all. Local resident pops out, "He was just layin' there, wouldn't wake up. Then these two guys, they picked him up and carried him off that way. I was afraid they was gonna mug him or something." We do the best we can to get a specific direction from him and head off in search of this sleepy drunk who has likely been located by his friends and taken into an apartment unknown. We receive an update from dispatch that they have received a report of shots fired at an address less than a block up the street. A fair amount of searching leads to a whole lot of nothing and we prepare to clear.

As we're walking back to the trucks, a young woman and a boy come running up screaming and crying about a baby being hit and where are the police and ohmigodohmigodohmigod. She wants us to follow her and check out the kids she states are being abused and immediately heads up the street, directly to the address with the reported shots being fired. Internal monologue, "Well, crap. I don't want to go to this address when there are no cops and somebody shooting. The damn firefighters are all charged up and heading off, and damn it, you don't need your tools for protection. If you think you need protection we shouldn't be going. At least there haven't been any shots since we've been on the block because nobody's interested in the fact that going up here is completely ridiculous." I try to stay in the middle of the group on the general principle that it might be the safest area, blending into the pack like zebras and lions and whatnot on the nature channel.

As we walk up, several more people come piling out of the house yelling about a gigantic black man who was beating his pregnant wife and throwing a 2 year old and a 10 year old against the wall and they called the police 40 minutes ago and nobody comes, nobody cares, oh that poor baby, ohmigodohmigodohmigod. One man gets particularly aggressive and comes charging at the fire officer and manages to be restrained by family just before something really bad starts to happen. As the family is pulling him away, I get the Lt.'s attention and point to the parade of cops coming around from the back of the house. No less than eight police officers file around the house looking pissed and ready for a fight.

This is when the first resident makes a mistake. The police ask about who reported the gunshots and the guy states, "I did but that was a lie. Nobody cares about that little kid." I miss most of the rest of what he says as the senior police officer comes unglued and the whole thing turns into an episode of COPS. It was one of those scenes where you didn't want to watch but you just couldn't turn away. In the end, two people arrested, one for the false call and one for getting a bit too aggressive with the PD. As they are sitting on the curb waiting for their ride to the station, the aggressive man continues screaming about how long ago they called and still nobody checking on the baby, just arresting people who are trying to do the right thing. Then, more screaming from inside the house, mama just found out her son is getting arrested. Police all pile back into the house, more scuffling and someone finally gets her under control. Paddy wagon arrives and hauls the two off. The neighborhood crowd is getting a little restless about the whole thing, and I'm not sure which side they are on, so I'm glad to see the loudmouth leave.

Finally, there are enough officers free to go investigate the original complaint. They stop by to make sure we're okay to hang out in case some one really is hurt, which was the whole point of us coming up the street in the first place. I don't know the story of what the PD found in the second house, but they were inside less than five minutes when they waved us off that everyone was fine. Forty-five minutes on a scene with no patient found, better than an hour of television.

29 July 2008


If you've ever thought waiting to get into a doctor's office has tried your patience, waiting in an ER, waiting anywhere that medical professionals treat people, I think I've discovered the secret. After being tortured with unending waiting during the medical school application process, they are just trying to even the score with the universe. At the rate I'm going, you can expect to wait approximately three years if your appointment is at 10a today. Next week's appointment, well I guess maybe your kids can inherit it like Packers tickets.

17 July 2008

Safety reminder

I think the universe might have been trying to tell me something. This week, I took the Motorcycle Safety Foundation's Basic Rider Course. I managed to successfully complete both the written and riding skills portion, including completing the U-turn maneuver completely within the prescribed area for the first time during the test. Anyway, I knew this course was coming up because I had to register for it in March, so I've been waiting all summer to get my license. A note for those who don't know, New Hampshire does not have a helmet law for anyone over 18.

Saturday night we were dispatched for motorcycle accident on the highway. Updated en route for CPR in progress, an EMT-Basic student riding with us getting a bit agitated to do compressions for real. On scene, find a LOT of blood running down the highway, three or four bystanders, someone doing chest compressions. As we're working, the FD finds more information for us, including the location of the rider's helmet. Securely attached to the back seat of the motorcycle. Ultimately, the patient died. We were still at the hospital when the ME arrived and was kind enough to talk with us while he performed the exam. I swear he looked nearly uninjured except for the massive head injuries.

Just a safety reminder to wear your helmets and for me to ride as safely as possible.

25 June 2008

Personal record

I think I actually had a call hit a personal low last night, which is definitely more difficult after 2 1/2 years. Patient called 911 stating he was outside the emergency room with a seizure problem and they wouldn't see him because he didn't have any insurance. Ahem, can I get a BullShit from the congregation?! See, we know you're full of it before we get there because hospitals will get in BIG regulatory doo-doo for refusing to see a patient.

Anyway, patient stated he was outside, but when we get there, no patient. No patient in the triage/waiting area. Marco? Marco? No Polo. We find him, IN A ROOM in the ER. I sit down with his nurse before I go see him because I'm sure there's a story here that I'm not going to get from the patient. Frequent flyer who usually leaves against medical advice or prior to being evaluated. Here for a "medication problem". Pissed because lab results would not be released to him without being seen by the doctor and he didn't want to waste his valuable time waiting; doctor was in talking with him when we got there.

Coming out of patient's room, doc sees us and states he is not releasing him for transport, we can't take him. Hey doc, guess what?! He's already at the closest appropriate facility, we don't need to take him and definitely don't want to reward this ridiculous behavior. Calling 911 to reduce your wait time at the ER, a new low point for inappropriate wasting of my time.

18 June 2008


DNR. Do Not Resuscitate. Let Me Die. To me, these statements seem pretty clear. I would assume they are even more so when you are being cared for in a "skilled nursing" facility. Nurses, LNAs, PCTs, whatever, should understand the technical terminology, and I truly believe that anyone spending weeks and months with terminal patients can understand the logical choice being made to avoid additional hopeless interventions. So, why, oh why do nursing homes call 911 for DNR patients who are dead or dying?

I just don't understand. 1. Patient is terminally ill, does not want any drastic interventions. 2. You have legal paperwork attesting to that request. 3. You are able to assess a patient and understand his condition, as in either circling the drain or already deceased. 4. You call 911 anyway and then yip at us for wanting to hook up the cardiac monitor to have an objective confirmation of death.

Okay, yes, we brought in all the goods to run a full resuscitation because the dispatch was for a seizure, updated en route to cardiac arrest. We'd be doing a piss-poor job if we weren't ready to do everything in our power to save our patient when we get there. But when you hand us the DNR paperwork, explain the patient's condition and the series of events that find a dead guy sitting in a wheelchair next to his bed, we are capable of switching gears. We understand DNR. Neither of us wants to feel like we're assaulting a corpse and disrespecting a patient's memory by performing interventions he wouldn't want. But there are a series of steps required of us before we can leave, just as there are steps required of you. We may not have known this man, but we can perform our duties with respect and until you see us behave otherwise, save your yipping for a more deserving target.

09 June 2008


A couple of years ago I had gills and a penchant for jumping out onto the shore, feeling the sun stroke my scales. I think I might've made it to amphibian now. I can't quite leave the water behind, but at least I can sit in the air and eat bugs.

Surprisingly, readjusting to office work took less time than I expected. The first day of sitting in front of the computer, trying to remember what commands I needed for the results I wanted was a little scary. By the end of the day, my fingers were flowing across the keys again, dredging up memories banished to the recesses of my mind. Cool water flowing against my skin as I swim upstream and down, no gills, no scales, but still calming. I'm staying near the surface, avoiding the dangers of the depths, the places where my legs will atrophy from disuse.

Back on land, stretching those legs, I can make it to the low hanging trees. Protected, I can assess and assist but the medic is still the one exposed. Airway, IVs, drive, think, question, learn. Keep jumping. I'm slowly being left behind by others who are growing feathers and fur, paramedics, nurses, doctors. I'm just a fatter frog.

No teeth to eat the big stuff. No claws to climb higher. No feathers to get me off the ground. Application after application, how do I explain? They see a frog. Maybe some potential, but not enough. Another dozen years could see something else entirely, but no evolution occurs alone.

14 May 2008

Call of the day

Dispatched for a seizure, have EMT-I student with us, updated to possible stroke. On arrival, patient standing outside dirt-bag apartment area saying he woke up from a nap and his arm is numb and he can't feel his face but his legs are fine. I use all my mystical evaluation skills and walk with him the 2-3 feet to the ambulance and have him flop on the stretcher. I start in with history questions, which basically amount to no relevant history and he might have type 2 diabetes. The stu gets vitals, does a stroke scale, finds nothing except a patient who shouted mighty loudly when he was poked with a sharp object in his "numb" arm, startling the stu. I ask the patient what he thinks is happening, "I might be getting the flu. Everyone else here has it." I muffle my laughter, pointed away from the stu so he doesn't get any hints what is going on with our patient. Patient flops again onto hospital bed. I'm working on the write-up and the stu asks what I think was going on because he's a bit confused. I try to be nice about it but the simple answer, "He slept on his arm," makes the stu laugh until he realizes I'm serious.

Winner, winner, chicken dinner

At what point does it change from being helpful to have people in your life supporting your desire for change to being discouraging and take on the feeling of fake optimism to hear them want you to succeed?

"Oh, by the way, I was chatting with the head of the admission committee and you could still get in. You just have to be 'special' enough so he picks you off the wait list. Make sure to send something 'special' soon." Crap. Can you get him to define "special" for me? I look good in sequins? I can talk trash with the best of them?

"Maybe you could just send a billion more applications next year, somebody will take you eventually. You're smart or something, right?" Clearly not, I'm still doing this.

"Hey, guess what? I met a totally retarded doctor today and I think you'd be waaay better than that. I'm not sure he or she could tie their own shoelaces." Yeah, I know, I met them too.

"Jeez, I can't believe they won't let you in. What hope do the rest of us have?" None. Hold still while I put you out of my misery.

Thanks people. You know I love you all, and I know you're trying to help, but sometimes you're just adding to that loud voice of self-doubt in the back of my head. I knew this wasn't going to be an easy road, but now it feels like if I succeed it would be less like pulling a rabbit out of a hat and more like standing naked in the street and levitating 20 feet in the air just before I get crushed by a speeding semi. Maybe that is what I should add to my applications?

12 May 2008


Calls for unresponsive patients first thing in the morning are usually cardiac arrests that have just been discovered by friends/family. Frequently, these patients have been dead for quite some time, so there's nothing much for us to do but stand by and wait for the police. I didn't realize how adjusted I have become to such scenes until this week.

We found the patient seated, pants down, on the toilet. He had fallen forward into the door jamb when he died, so his head was about 6" off the floor and his naked rear was waving in the breeze. The firefighters arrived shortly before us, but weren't sure whether or not to start trying to resuscitate the patient because he looked pretty dead, but parts of him were still warm. The Asian and I rolled him over. He rolled as one piece, the expected lividity was in his face and arms, nothing more to be done. The firefighters wanted to clear the scene because an actual fire had been dispatched just after our call, but they didn't want to go downstairs to the family alone. The Asian and all the firefighters went downstairs. I stayed to get the patient's medication list into the laptop and to upload the asystole from the LifePack.

After I was finished, I realized that I had been contentedly working in a room less than 5 feet from a dead guy. Weird. Dead people used to creep me out. Freshly dead people are still patients, so they aren't bad, but if you'd told me two years ago that I wouldn't be on edge being left alone in a room with a corpse, I certainly wouldn't have believed you. I suppose this is a good thing if I ever actually get in to medical school because anatomy lab otherwise might've been a bit difficult.

01 May 2008

Caring for the aged

Suddenly feeling my age this week. I showed up as usual at work on Tuesday, first call was for chest pain. This gentleman was having a MAJOR cardiac event, third degree block with a rate less than 40. We zipped him down the road to the closest hospital even though he really needed the cardiac specialist facility across town. At the closest hospital, he coded less than 5 minutes after we moved him to the bed. In their not-so-state-of-the-art cardiac cath lab, he coded twice more. One of our transfer trucks moved him across town with a balloon pump in place. This all went by me with an, "eh."

Later, we transported a different patient to the other hospital and were admiring the newest cath lab photos of a patient brought in by our company. One of the hospital staff was chitchatting and it turns out that patient was a coworker of mine. A 33 year old coworker. Complete blockage of an artery and doc warned him of substantial buildup in several others they checked. Finally got upstairs to visit him on Wednesday and found him in reasonable spirits but looking 5 years older in the week since I'd seen him last. I think I lost a year or two just hearing the news. Bad enough to think I'm invincible and be facing my age through the marriage and children and divorces of my friends of a similar age - but health problems? No way! I'm too young!

24 April 2008


I'm a bit lacking in focus right now. Again, I'm questioning my path, mostly by trying to answer the questions everyone else has for me. To medical school? To a foreign country? Maybe D.O? What would make me happy?

Right now, just studying for my class (see fun photo from lab with my new camera), working on the ambulance, and being crazy enough to take on a small amount of work at the office job again. So, maybe people could ask me questions I'm ready to answer. Like the enzymes of glycolysis or energy production from the citric acid cycle.

19 April 2008


The ambulance company has been having morale problems for quite some time now and the peon grumbling was finally loud enough for management to notice. Constantly changing paperwork requirements leading to crews being threatened for incomplete paperwork, government fines, being promised and trained for new equipment that never arrives on the trucks, and generic job dissatisfaction all pop up.

So what is management to do? Well, if you're a fan of Dilbert, observant of management in general, or just pessimistic, you're probably guessing that they implemented something which does not actually address any of the problems. I'll just call it the "Superstar!" program (envision SNL's Molly Shannon in classic cheerleader lunge wiggling fingers at you). We are to nominate employees who go above and beyond the call of duty; said employees are entered into a monthly drawing to win a prize to be named later, usually a gift certificate or something reasonable at least. My issue isn't with the desire to recognize good employees - the point is that it doesn't actually address the problem and, at least at the north station, has become an object of ridicule.

Yesterday was another ambulance day where we mostly drove around helping people rather than transporting them or providing much medical assistance. We spent an hour with a diabetic, went for a medical alarm activation, a couple of accidents, someone with pancreatitis. On several of these calls, The Asian did things that were truly above and beyond, including cooking lunch and calling a utility company. These are not things he does for recognition, but things he considers part of his duty as a patient advocate. But that doesn't mean that I don't get to spend most of the afternoon telling him he was a "Superstar!" and I was going to send my nomination immediately and others in the station coming up with all sorts of things he's done which could potentially nominate him. He actually already got nominated one month, but I didn't have anything to do with that one. I guess it helps morale because it gives us a common object of ridicule, but really, we don't need help with that.

What would actually help?
  • Employees being held to the recognized job standards. If you're not doing something you're supposed to do, or doing a shitty job of it, something should happen. Not necessarily being immediately fired, but some sort of discipline where you understand that this is not acceptable.
  • Understanding that sending paperwork back to crews for errors made by discharging staff is ridiculous, without having to listen to 4 weeks of crew complaints before they figure it out.
  • Hold off on training about equipment to come until said equipment actually arrives. Many of us have already lost our passwords for the new electronic patient care reports and nobody even knows when the computers will officially go live.
  • Pay equity.
  • Supervisors responding to problems in the station sometime before they become critical, quick examples: a toilet that leaks so long that the hallway 8 feet away smells like pee, a water leak inside that covers two beds in mold.
These are concrete things that could've been done instead of the token popularity contest, but they are also things which would cost time or money. I will at least give credit that things are improving slowly (the two problems above are being addressed) and I'm not sure where the motivation finally came from, but I'll take what I can get.

10 April 2008


I'm struggling to keep my chin up right now. Affirmations all around, "I'm good enough. I'm smart enough." But how do I convince people who sit in judgment without even knowing me?

Dear Applicant,
We're sure that you're very wonderful and everything you claim to be, but you're not going to be that here at our school. We've found dozens of more interesting and more qualified people to fill our class. Good luck in your career! (you're going to need it!)
The School You Wanted to Attend

Okay, the last letter I received over the weekend was actually a wait list letter and not a rejection letter, but after my experience on this very same wait list last year, I'm not getting my hopes up. I'm damn tired of waiting.

Two suggestions that are starting to sound more and more realistic, go to school in the Caribbean and hope I can score a residency, or target the schools in the least desirable locations with the worst reputations. Another more plausible suggestion was looking into D.O. programs instead of M.D. programs, but I'm not sure that I'm open-minded enough for the other students (it isn't the general philosophy/teaching that worries me). The thing that keeps running through my mind, maybe they're right and I don't belong as a doctor at all.

03 April 2008

Incident command

At every level of EMT training, you learn about incident command. Specifically, the fire department senior officer is in charge. Emphasis on period, regardless of the type of "incident". Most departments use the National Incident Management System because the government has decided that is the training required to get a hold of the all important $$$. This system is really intended for large incidents where you need a staging area, different operational groups and levels of command. But, working with fire departments I encounter officers with varying interpretations of their responsibility.

The vast majority of the fire officers are EMT-Basics and are happy to be involved in coordinating their firefighters with the ambulance folk, telling us where to park, how we're going to extricate the patient and helping carry them, performing the complicated and technical extrications that can be required, breaking whatever necessary to get us to the patient's side, even providing patient condition updates en route since they arrive before us, and generally being reasonably helpful and not too obtrusive. As far as actual medical care, most defer to the paramedic on scene, recognizing that the additional education and training usually allow them to make good patient care decisions. All is happy smiles in the world of intra-agency cooperation.

Then there are the other officers, and sometimes firefighters, who want to be in "command" of everything on scene. One particular officer in the city has been an on-going problem for me. Now, he is a paramedic himself, with a number of years of patient care experience prior to the FD becoming a non-transport agency and no longer working elsewhere as a transporting medic, so the issue is not one of education and training. He is in charge when he is on scene unless there is a captain or chief of some rank there, which is rare for EMS calls. He likes to directly "command" every aspect of a scene, including all decisions on patient care, to the point of actively interfering when something is not being done per his assumed course (even if he hasn't told anybody what that is). Where the difficulty lies is that he is not the medic whose ass gets chewed by the doctors if something is not to their satisfaction.

Just one quick example: The Asian and I arrive on scene for an overdose patient, unresponsive in a parking lot at night, maybe 40-45 degrees outside. When we get to the patient, the firefighters are searching the man's pockets for ID to give the police, the officer is talking to PD with the friend who found the patient trying to get noticed. I don't know what to make of this at first, is he dead? is he fine? why isn't anybody treating the patient?

I start assessing the patient, who has a pulse, is breathing adequately and protecting his airway, but is distinctly unresponsive. He is laying next to a car which is blocking all ambient light. I've got baseline vitals and tell The Asian I'm heading for the stretcher so we can move the patient into the truck where it is 1. warm, 2. safe, 3. light. As we get the patient onto the stretcher, the officer decides that we are not allowed to move the patient until we drop an OPA (oropharyngeal airway) to protect his airway. The Asian and I both pretty much ignore him and continue to the ambulance because, since we actually assessed the patient, we're not that immediately worried. When we are nearly ready to leave, The Asian asks if I can go find the pt's friend to try and get some additional information on the overdosed drug. The officer blocks my path and refuses to help locate the friend, instead demanding repeatedly, "What do you want to know?" He never offers any information, and I'm not sure what exactly the question was. Finally, I find the friend the question gets answered and off we go.

This officer follows us to the hospital and demands all sorts of attention and action, eventually keeping his crew out of service at the hospital for over an hour waiting for our supervisor to come address the issue. Which boiled down to respect. He felt we did not respect his command of the scene. Well, I couldn't really argue with that point. The problem is that you lost your opportunity for respect when the crew that you really should be in command of was not caring for the patient and you did NOTHING.

I followed up with some of the management folks on this and was told that I am to do whatever this officer says, when he says it, regardless of what I think about it. He is in charge of the scene and paramedic, or basic, or first-grade nosepicker is irrelevant because the officer on scene will always be the first one on the legal hook. I find this both ridiculous and unbelievable and struggle with it every time we encounter said officer. I don't even want to go on calls with that engine because I always wonder if he's going to be there.

26 March 2008

Impending doom

Not that I won't try of course, but I'm not sure any description will quite do. I have this feeling right now, one of these "if I were psychic I'd be having a vision" kind of feelings. Very strong, very sure of itself. Something is coming to an end. Disturbing. Especially the complete lack of specificity. What is ending? Why? When? Do I care? Am I supposed to do something?

I don't believe in psychic powers, the ability to tell the future, mysterious forces guiding the universe. I don't have any reason to be concerned with this except that it won't go away. I was at work last night and had an awful dream about going to ManchMedic's funeral (please take good care of yourself!!). It was horrible and sad, made all the more so by reaching that state of semi-wakefulness where you know you're having a dream and I still couldn't make it stop. I woke up fully, stumbled out to the restroom, came back and went right back to that damn funeral. It wasn't just the loss of a friend, it was the sadness of all the other people there. People I know and care about and strangers too. Normally, I don't sleep enough at work to dream, last night I woke up crying.

The Asian and I went on a call that took us to the apartments where we worked our pediatric code. All I could think about as we pulled in was that call. I even commented out loud that every time we come here, I always remember. He understood completely.

I heard Monday night about the sudden death of a co-worker from my time in Virginia. A day after we stopped there to visit friends.

My ambulance calls lately have been fairly mellow, no string of deaths or traumas or anything really. I've tried to keep my spirits up, hoping that a good day can keep this feeling at bay. I feel like just writing about it makes it more real...creepy.

16 March 2008

34 hours

Is all it took to get from this (0700 3/15 in NH at 34 degrees):

To this (1700 3/16 in FL at 84 degrees):

And now I have a week without work, without class, and fairly much without care! Now if K could just get over the GI bug and the flu he managed to pick up somewhere just before we left...

01 March 2008

Happy dance - Kitchen update

If you haven't been watching all the way to the end of the kitchen picture series, please do so. Happy dance is for having water in the kitchen for the first time in two and a half months. Reasons this is wonderful: No more dishes in my bathtub. Watson can have a bath (because we didn't want to wash the dog the same place we wash the dishes). I can get water from a faucet while holding my glass straight. The sink cabinet has doors. And more reasons I just can't think of right now.

Items remaining to do: Finish the vent. Trim around cabinets at ceiling. Toe kick on cabinets at floor. Paint. Trim windows, door, and everywhere there aren't cabinets. Under-cabinet lights. Touch up ceiling paint. Decide what (or whether) to do for curtains/blinds.

27 February 2008

Check out the counters

It took three guys three hours, but we have something that actually looks like a kitchen. K is planning on hooking up the sink tomorrow and then I believe the house will probably be struck by lightening or something because we will finally be back to a usable kitchen.

19 February 2008


Yesterday, despite being on a transfer truck, I ended up helping on a cardiac arrest. Our company has a bariatric stretcher with a hydraulic lift system (aka "fatty stretcher"), but in order to use it on an emergency call, you have to call back and have a transfer truck bring it to you. In this case, the call was for elbow pain due to a fall. So no great hurry, but the crew was going to need help to move the >500lb patient.

Patient heads out to us and we get him into the ambulance. My partner and I are heading back to our ambulance when the crew calls us back. Patient is having difficulty breathing. Then patient is not breathing and pulseless. The bariatric stretcher takes up nearly all available floor space when loaded into the ambulance and now there are 2 911 crew members, their student, and 2 transfer truck crew members trying to perform CPR and ACLS on this patient. Not an easy task.

Unfortunately, the patient didn't make it. This is the first call I've done where I met the patient while he was walking and talking and actually watched him die. I have to say it is a lot easier to work on a patient who was dead when you got there than a patient who dies in front of you.

Edited 21Feb: Thanks to Ellie for pointing out ManchMedic's post on this call. It was informative for me to read more of what happened before we got there. I was wondering why some things went down the way they did, and I tend to assume that medics make informed decisions and try not to "back-seat" "hind-sight" "monday-morning quarterback" on calls, so I don't always ask questions even though ManchMedic would be happy to answer them.

07 February 2008

Tired of being sick

Why does every cold have to turn into something miserable? I was feeling pretty darn good about not being sick lately, which was obviously the cue for the local virus to hop on board and change that. Lately, colds have been dropping down into respiratory infections for me, with a lovely hacking cough that won't quit. This one likes sinuses better. I spend all day feeling like someone is standing on my head. No matter how much snot I push out, the pressure doesn't stop. Decongestant won't touch it, somehow it is beyond the reach of mere pills. Stupid virus.

02 February 2008

Follow up

One of the frustrations in EMS is that you frequently don't know the end of the story. You drop your patients at the ER and that is the last you know about them. Since our city only has two hospitals, sometimes you can follow up on your patients a little more, and being the main transfer service means that sometimes you hear more from your colleagues.

So here's some updates on a few patients I've written about recently:
  • Patient our student revived was still alive in ICU 2 weeks later. Hospital did eventually find some family members so hopefully they were able to make good decisions for him.

  • The Asian and I were mulling whether a Catholic nun could disconnect her sister from life support without committing a mortal sin when we saw the patient's obituary in the paper. She died within 24 hours of arriving at the hospital. My best guess would be that nobody had to make a decision like that, the patient probably went into cardiac arrest again and this time they were able to honor her wishes for DNR.

  • Car accident patient who got us on the news had his legs put back together by orthopedics. Still some danger he might lose the worst one if infection sets in but a pretty darn good outcome for being crushed in a box truck.
I'm hoping that my string of bad luck has finally run out. I've had two 911 shifts in a row without a dead person or someone seriously circling the drain. My run of luck has been so bad that The Asian has more IOs with the new EZ-IO than anyone else in the company. He has seven and the next nearest medic has three. This streak started in September with a string of pediatric patients and has been all over the map since and I would not be sorry to work a bunch of drunks and psychiatric patients for a while.

28 January 2008


So how do I, as an ambulance worker, end up on the evening news? The two most recent cases were a car accident where one patient was severely injured and trapped in the vehicle for an extended period of time (giving the news crews time to get there) and a fire that sounded bigger than it was where the news crew happened to be in the right (or wrong) place at the appropriate time. For whatever reason, our local news LOVES to have footage of EMS or fire departments in action. Maybe it is the sense of importance and tragedy, but I tend to think it is because they don't show the patients and they want to have something interesting which makes the whole event seem exciting. Mostly, we avoid the cameras by being as quick to get the patients off scene as possible. No faster than is appropriate for the patient, but hopefully faster than the cameras show up.

The crews at my station hate being on the news. Firstly, it makes everybody harass you because they never fail to use that 3 seconds of footage where you scratched your butt or stood there looking stunned and ridiculous. Secondly, it gives your supervisors and higher management the chance to see you on scene in a way you may not have been expecting. Not a big deal for me as I wear my ugly neon green reflective coat and non-latex gloves all the time and I try to abide by safety regulations, but there are always folks who assume that nobody is going to see them on scene and that they will get away with doing something they shouldn't be doing. Seeing yourself on the nightly news quickly cures you of that illusion. Heck, in a state as small as NH, just talking to people should cure you of that illusion because there is always somebody around who saw you at XYZ place or with Mrs. So-and-so on your stretcher and wants to know all the dirty details.

21 January 2008


After running two pregnancy calls in two days where it looked very likely that The Asian was going to be cleaning and warming newborns, I was prepared for our truck to be ushering new life into the world. I was not prepared for what we got instead.

Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."

At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.

I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.

After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.

12 January 2008


EMS routinely puts patients on long spinal immobilization boards to prevent further spinal injury. And when we do, the goal is complete immobilization, no movement at all. Which is great, until they need to vomit.

Standard protocol for people vomiting when immobilized is to roll them on their side. But once you've secured the backboard to the stretcher, there isn't enough slack in the seat belts to easily roll the patient. If you're in the ambulance, you can reach over and open the belts and roll the board. But if you're walking the stretcher into the hospital room and then the patient starts to vomit, you aren't really in a good position to loosen everything. And if you're at the head of the stretcher, you are in the wrong spot.

Speaking from experience, this results in a vomit-covered EMT. The only entertaining part was that this guy had such force to his vomit that it was everywhere. I guess in the end it was good that I was the one covered in the vomit because I was the only one not dry-heaving or actually vomiting at the sight/smell. Glad I could be of service.

p.s. my camera just came back, good as new, so the pics of the kitchen are better now.

06 January 2008

Non-writing holiday

Okay, so I haven't been posting. Honestly, we've been working on the kitchen and I've been rocking out to Guitar Hero. I got kinda bummed about my camera, so I haven't been keeping up with photos of all the kitchen work either. K and I put together some camera phone pictures so we could post something at least, check out the recent work on the right.

Today we worked 6 hours on the kitchen and got a bunch of the backerboard for the ceramic tile done, should have the rest finished tomorrow. Tile itself will probably have to wait until Wednesday when we're both around because I don't know how to run the wet saw and it is on loan from someone.

Work has been going okay, there's been a lot of little annoying stuff going on with management, but nothing I feel reasonable writing about. The Asian and I made the evening news twice in three days (damn, two station lunches!), once for a doozy of a MVA and once when we hauled off the only smoke inhalation patient from a fire.

Living in NH during a campaign season is extremely annoying. Large mobs of political supporters on many corners, freezing, shouting, and swinging signs. Thankfully, no ambulance calls for political-related assaults or injuries yet.

I'll try to be better about posting. Biochemistry class starts on 1/23 and yes, the plan is to be done with the kitchen by then so I have time to study. Later!