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.