!#$&*%(!!

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...

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.

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.

Trauma

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.

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.

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

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.