More dissection

It isn't surprising to me that the most interesting thing I'm doing in medical school right now is dissection. It also isn't terribly surprising that the memorize/regurgitate portion of anatomy takes some of the fun out of it. I try not to let that interfere with my enthusiasm for discovery and recent weeks have been quite interesting.

My dissection table learned a small amount of patient history at the outset of the course. As we progressed through the dissection, I learned she had several surgeries including some procedure which required her chest to be wired back together and that surgeons are not very careful about making sure free ends of wires are flat under the skin. Every time we begin dissection on a new area, we search for clues about what her body experienced and how it recovered or compensated. Although the first year of medical school is focused on normal anatomy/physiology/etc., we've encountered a fair amount of pathology from examining cadavers with 70-80 years of life experience.

The current section is chest and abdomen, but we've only just begun the chest. I held her lungs in my hands and marveled at the size, the structure and complexity of a lung and what it accomplishes. I wondered how hard it was for her to breathe in her last months with a tumor filling much of her right lung. We tried to guess where the tumor near her trachea had grown from and to before we were permitted to dissect that section. I held her heart in my hands and wondered if the tumor pressing down on it caused her pain, if she could feel the weight of her heart failing.

Interestingly, in conversation with some of the other students, they are questioning themselves because they felt nothing.  One woman said she held the heart in her hand and thought, "Okay, what am I taking out next?"  She is experiencing some self-doubt and questioning, but I think that is an entirely reasonable response.  We've done so much dissection of these bodies that sometimes there really isn't any wonder left in a student by the end of lab.  I don't think my reaction is any better or worse than others and I'm glad some folks are honest enough to share.

Demotivational tool

Sometimes, feedback is not really what I need.  Today I performed a physical exam (history, review of systems and the hands-on examination) of a "simulated patient".  Simulated patients are people who are trained and paid by the university, come in and pretend to be patients all afternoon, complete with story lines and complaints, for the medical students to practice on.  It is great to try being a doctor with the few skills I've actually gained and to try and shift my perception of myself from student to physician.  It is nice to hear from my simulated patient what she thought of my performance and what I can improve upon.

The part that is not nice is, today, I sucked.  I couldn't keep my mind straight on all the things I was supposed to ask, so there were some long awkward pauses.  I have some expectations for myself given that I have patient care experience, but today I wouldn't have believed that I have ever been in the same room with another human, much less a patient.  Even worse than just being bad is that it is recorded to DVD.  I have to watch it and comment.  I have to bring it to one of our small group sessions for everyone to watch and comment.  I do not want to do that.  I know my performance was not good.  I know there was no sort of rhythm or flow and that I seemed nervous and awkward.  I felt it at the time and my patient reinforced it, I don't need to have 11 other medical students tell me that too and I don't need to watch it.  Just another wonderful thing to look forward to, I guess.

Reciprocal education

One of the courses I'm currently taking involves a VERY non-traditional process for in-class activities and learning structure. This class is traditionally one of the more difficult, even when taught in a traditional manner. The educational method for this class involves two phases. Phase 1 is assigned readings to be completed before class, an in-class quiz, group discussion and a group quiz over the same questions without access to course materials to discern the correct responses, and a brief instructor-led review of topics which frequently consists of diagrams from the text with little additional explanation. Phase 2 consists of readings or brief case descriptions involving a patient presentation of the related concepts from phase 1 (graded), a group activity to connect concepts and case presentation, a group quiz with questions from the case presentation, an entire class response time where we use "clickers" to record our group decision and receive group grades and sometimes a brief instructor-led discussion. Inherent in the grading is also peer-evaluation where the group members rate performance and contribution. There is also a contribution of the traditional written exam grades which is about equal to everything else listed above.

This course has caused much wailing and gnashing of teeth among students who feel that the instructors have completely abdicated teaching and evaluation duties and are not enhancing student understanding of this traditionally difficult material. I can honestly tell you that I retained zero information from the first several rounds of this process and spent a disproportionate amount of time trying to be prepared then separately trying to learn the information required for the written exam. A group of concerned students met with the faculty to attempt to understand how we were being graded, what the goals of the process were, how we could enhance our learning and what type of help they were willing to provide. This has been interesting because it resulted in additional information on what the intended goals were as well as persuading the instructors to provide us with additional information in the form of on-line lectures and the topics we need to connect between the case presentations and related concepts.

Today was the first time I felt like I've learned anything from this process. I read material before the quizzes last week, I listened to the online lectures and worked through my incorrect quiz responses from phase 1. I read the case presentation, found and worked through the concept connections and feel like I might actually understand how the material relates to the case. We'll see if that holds up tomorrow during phase 2 but I feel more optimistic about the process than at any point during the first 13 weeks of class.

Pause for a moment of dissection

I had my first "Wow" moment of anatomy dissection this week. Not to say that other things haven't been interesting or informative, but what I saw this week was really amazing. Part of lab is the expectation that you will complete dissection on the cadaver at your table and learn from the variation present in other cadavers throughout the lab to make the most of the unique experience afforded by our generous donors and to give students a chance to learn about natural variation.

Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.

Hermit crab lifestyle

Carrying your home on your back can be hard work. Students of many levels experience this phenomenon, but I think grad students living off campus take it to an extreme. In the age of electronic everything, a number of my textbooks are available on-line which allows me to live out of a backpack and lunchbox. I generally refuse to stay on campus for dinner and try not to return to campus in the evening since I study well at home. Others in my class travel with multiple bags for exercise clothing, other books, breakfast and lunch and dinner, and the variety of other junk people carry around when they don't know when it might be feasible to leave the building. If we really could invent some sort of portable shell which would allow us to curl up and nap securely on campus, I don't think some of my class would even bother to rent an apartment.

Exam results

Results were returned to us on Wednesday and I passed everything and medical school moves on. Grades are returned as percentages, even though they are officially recorded as Fail, Pass, High Pass and Honors. How that differs from an A/B/C/F system, I'm not really clear. You are not "high pass" compared to everyone else, you're just reaching the high pass standard for grades. With this set of exams I am now halfway through my first courses. Most courses are not cumulative for the next exam, but there were two courses that did not participate which are cumulative. (Of course everything is cumulative in the larger sense because board exams cover everything you were supposed to learn!)

In the grand scheme of things, official "terms" have little meaning because EVERY course I'm in continues into the next term. There is a big turnover after the second term because anatomy (including histology and embryo), physiology and biochem end. I'm not sure what comes after that because all the calendars I've been given only go until February, but I'll deal with those when they show up. Studying carries on, hopefully at a reasonable pace so I can continue my grades.

Wake up call

All the little details of fixing things around the house and remodeling can sometimes add up to unexpected fun. The house at school is from 1915 and needs a little work, so K's dad was working here last week while I was studying for exams. We've installed nifty smoke/CO detectors which communicate wirelessly so an alarm in the basement causes the detector on the second floor to activate. Pretty handy when your furnace is in the basement, less so when your chimney is under repair. K and dad had unhooked the chimney on Friday to insert a liner, found out the company shorted them 5 feet of liner and left it unhooked awaiting delivery of the missing 5 feet. Liner still hadn't showed up on Wednesday as the weather cooled with a night time low near 40 degrees. Everyone thought someone else had turned the furnace off and nobody had. 0430 rolls around with an ear-piercing "FIRE! FIRE! FIRE! Evacuate!" (did I mention the detectors talk?) followed by the same message in Spanish, at something like 90 decibels. My exam wasn't until 10a, but I was pretty well awake after that. I guess that's one way to avoid the dreaded oversleeping an exam.

Exams

My first set of exams is this week, one where I have to demonstrate skills on a patient, a cadaver lab exam, an histology lab exam and then the giant written exam. The written exam will cover didactic material from all the courses (see earlier post for list). This exam is six hours long, two fifteen minute breaks and a half-hour lunch break. I'm currently occupied cramming information into my head to attempt more than 70% recall since that is the pass level.

The amazing thing is the collective level of stress in the class. When I'm home, I feel as though I have a lot to study and not enough hours in the day but that somehow I will get enough to do okay. When I'm in the classroom with 124 other people, most of whom need to be peeled off the ceiling, my anxiety jumps from barely noticeable to overwhelming and I can't hardly get my thoughts in order. I've always been receptive to a collective mood and right now my best survival mechanism is to stay away from anybody who appears stressed or overly anxious. These are also the folks who appear to be getting the least done as they run around the building and consult with everyone else in sight.

Hours fly by when I barely even take note of the time and before I know it, another day is gone and I'm closer to the proving ground for classroom material. My biggest interest lies beyond the classroom though, I'd rather be heading for the proving ground of patient care.

Things I miss from before med school

1. My husband.
2. Reading things that entertained me and made me laugh in a good way (not in the current "you've GOT to be kidding me" kind of way).
3. Going to the grocery store or Wallyworld or the mall without trying to decide whether I'm going to stay up late or skip on some required reading. Food, underwear and an occasional pair of shoes are necessities.
4. Time to bake cookies.

I'm sure there's lots more, but these are the ones that occur to me at lunch time on my least busy day of the week.

First weeks: Survival

The information load during the beginning of medical school is massive, my science topics right now include gross anatomy, histology, embryology, physiology, biochemistry. These courses require massive amounts of reading and understanding of relationships, connections and general synthesis of information. The biggest problem is how to acquire all the information AND make those connections in the couple hours a day I'm not in class. One method would be to layout a coherent strategy of rotating through the topics for new reading, review and discussion, but my current strategy is more along the lines of reading and learning as much as I can for the next topic on the schedule then freaking out when I'm asked a question on an old topic that I "should know by now" and trying to emphasize that for a spare five minutes. Rather dizzying to be sure.

Then I've got three other, softer side classes, including one appropriately described as "how to be a doctor". I suppose it is good they require this class because some of the questions asked by fellow students seem to imply they believe they are training to be a life coach, a counselor, a law enforcement officer or something other than a physician. Community physicians come in and work with us in small groups on how to physically perform exams, how to get collect information from patients and then answer all our random questions on the social, business and lifestyle issues of being a practicing doctor.

The program I'm in also includes a large amount of "clinical correlation" which means that every time we talk about a scientific idea, we also get a patient presentation or diagnostic test result or something that would relate that idea to actually being someone's doctor. I can't decide whether I like the amount of it we get. I mean, sure it is great to go through some examples, but when every second or third paragraph in the text is interrupted by "this is why people get tennis elbow" or "clavicular fractures usually occur in this area" or "testicular swelling can cause discomfort", it makes for difficult reading. I know the program is responding to the complaints of prior students about making the information real and this is a nationwide trend, but I'm not convinced yet.

Welcome to campus

So, this was the first week of Medical School, two days of orientation and three days of classes. Orientation was pretty much the only preparation I had for how many hours I was going to have to sit still in a classroom. I can't speak for everyone, but my undergraduate and even graduate education included a number of different classes, scheduled specific days of the week at somewhat random times which allowed for a long lunch some days or an early afternoon or less often, a late morning. The transition from having an active, moving job to sitting still has not been easy. Count me as fully unprepared for what 8 hours of lecture might do to my rear end, my brain and everything in between. Today is the first day I left the building before 5p and I haven't even been studying on site!

We have already started dissecting our cadavers and the good news for me is that apparently I've already killed any negative olfactory response with some of the other odors I've encountered on the ambulance for the past 3 years. The dissection promises to be an interesting experience and I hope I can feel confident enough in locating the structures not to be completely annoyed by the process. We've also been dumped into the deep end for physiology and histology, hopefully I'll be able to get on top of some of the material soon so I feel less than completely lost.

It has been a long time (if ever) since I have felt so out of place and overwhelmed in an academic environment. The only saving grace is that most folks seem to feel pretty much the same way which means I'm not way behind, but ultimately the assessment is based on competence not on a comparison to the other students. I guess the only theory right now is just to keep plugging along and do the best I can.

Moving day, part 1

I can never decide if short distance moves are a curse or a blessing. There is less pressure to actually be organized and get everything done in one trip, but this also makes it drag on and on. Today K and I got a trailer, filled it full of stuff, tossed a couple more things in the back of the pickup and drove to the new house.

Before we left, I knew the power wasn't on in the new house, but it is mid-summer after all, so there was enough light to see by as we hauled everything inside. We resolved the power issue with a phone call I was expecting to be pleasant but was actually quite annoying and required me taking a certain "tone" with the company rep. Sorry to you company rep, but the lady the day before had quite clearly stated same day hookup was not a problem and made NO mention of an "extra convenience charge". Good news, just before we left this afternoon, the guy showed up and performed the magical 1.5 minutes of work required to "install" the power and we returned to life in the 21st century.

Problem #2 was discovered shortly after arrival, the water was off. K searched the basement and was unable to find a valve, so I got on the phone with the water company to make sure it was an issue with us and not with them. This rep was able to confirm that the account was square on their end, and eventually we found the valve. Which had been shut off because it was leaking. It had not been leaking at the time of the house inspection. The limited assortment of tools we took with us did not include a wrench large enough to tighten the valve and return water to the house. A visit to the locally owned hardware provided us a quick tour of the new town I'll be living in and a wrench, a pair of pliers and copies of the new house key.

Problem #3 was discovered fairly early on, but unfortunately this one has not happy ending yet. Apparently the stairs in the new house are so low ceilinged and so narrow that the box springs for the bed do not fit. We tried, twisted, moved, squished, wriggled and did everything we could think of and got the box springs half way up the stairs and entirely wedged. We were able to get it down again, but as of right now, I might be sleeping in the living room.

Last shift

Tomorrow is my last full time shift on the ambulance, the last time I will be certain to work with The Asian. I've been gradually saying my goodbyes to folks as I don't know who I'm going to see again. Plus, turnover at the ambulance company is high enough that I'm not sure who will even still be working there by the time I work a few shifts again. It is weird to be saying goodbye to a place I never intended to stay. Three years of applying and waiting for school have made for some interesting times with a fun, caring group of people. There are a lot of things I've learned while working on the ambulance and it has been great experience.

Crawlies

I have been to this house before, but I don't recognize it until I reach the porch steps. We are assaulted with a wave of stench and the resident banging on the screen door to push it open. Gagging and choking on the overwhelming ammonia smell of stale urine triggers the heavily repressed memory in my brain of what else I'm going to encounter in this apartment. We have a EMT-B student with us tonight who is carrying our supplies and has no idea what is about to happen, he didn't know what to think when asking about "public assist" calls and I told him it could be literally anything at all. I'm crossing my fingers that this call will be as fast as humanly possible, whatever public assistance this person requires will be a quick fix and get us back on the road.

As the resident cracks open the screen door, we find out the assistance required is to "put my parrot's cage back together". I know we are entering into the kitchen but all the lights are out and what my small flashlight shows is a large metal cage, two pieces assembled, three pieces on the floor and a small bird hanging out in the middle. Resident is in a wheelchair and can't reach high enough to put the pieces of the cage together. Every step I take across the room results in a crunching sensation beneath my boots. The floor is a mass of moving insect life and I'm struggling not to be a "girl" about this and just keep going. The stu puts our bag on the floor and I'm immediately in his face to pick it up and do not set another piece of equipment down while he is here. Resident points me to a light switch, but more light just means more bugs I can see, none of the roaches are the least bit disturbed. There are probably undiscovered species of bugs evolving in this apartment as we stand there.

Rather than argue with the resident about the necessity of calling 911 for a parrot cage, we try to put it together as quickly as possible, but nobody knows which piece goes where and it takes time. I give in to my inner paranoia and try to keep my feet moving at all times to discourage the bugs. Each piece of the cage has bugs crawling on it and I am more thankful than usual for my gloves. I do NOT look up, the thought of what is crawling on the ceiling and could decide to drop on me at any second is just too much. Assembly completed, we stampede out of the apartment.

For the record, we called social services the last time we were in this apartment, this resident has a social worker. I did not call again last night. I can not imagine being the folks who live upstairs from this hell-hole, I hope they pay almost nothing and have invested some money in an extermination company to visit daily. I've never been past the kitchen. If I had to see the bedroom in a similar state and imagine this person sleeping with all those bugs night after night, I'm not sure I would sleep again. Stu will never regard public assistance calls quite the same way, nor probably ambulance calls in general.

A different slice of life

Some folks live places where they know their neighbors by just saying hi in the hallway and moving on about their days. Some live places where they've known people forever and are related to most of them. And then, there are the folks who live in New Hampshire. K and I have made a number of trips to or through the airport in the last couple of years and I have NEVER been through there without seeing someone we know, sometimes, even on our flight. It is extremely weird to me that we live somewhere a thousand miles from family, generally at least hundreds of miles from long-term friends or people from childhood, and we still manage to run into people at the airport. I don't think this happens other places. Other places have enough flights that odds of seeing someone are fairly low. Not here. There is no sneaking out of this state by air, and most of the time, someone you know will even see you on the highway and comment about where you were headed. Just plain odd if you've ever lived somewhere this sort of thing doesn't happen.

Undecided

I can't decide whether some of the situations I encounter on the ambulance make me more sad or angry. First of all, even if your child is "developmentally delayed", calling the ambulance for an "out of control 3 year old" is kinda pathetic. I think maybe you should call your social worker for some parenting classes instead because keeping the 3 year old out until midnight is not a secret for success. And honestly, if your older child is also "challenged" or "special", maybe it isn't such a great idea to allow the next pregnancy to happen, especially when you're already using it as an excuse not to parent the children you already have and there is no partner involved anywhere.

Housing

I've written before that I enjoy looking at houses. The sneak peek into someone else's life, the images of what you could do with a space, changes you could make. Just as interesting is the home inspection process. If you've never done it, or somehow missed out on walking around with your inspector, you're missing out on a LOT of information about a place.

We went to the house by school for inspection yesterday. Interesting stuff. Biggest finding was that the boiler is cracked, something we never would've found unassisted. The good news is that the heating system is still working right now, meaning there isn't a worry on frozen pipes from last winter when the house was unoccupied, but a pretty big concern for this winter. This is a negotiable finding from the inspection, meaning we can ask the sellers to fix it or compensate for fixing it in the price. Other findings included a little bit of water leakage at the basement windows and some outdated electrical wiring.

This housing experience is like none other for me. It isn't my money on the line, but it will be my daily activity influencing the remodeling and updating. I've never been involved in a home sale from a trust instead of actual residents. I don't know whether the trust was formed because someone is no longer capable of making financial decisions or because someone died. Looking at the stuff in the house, it could go either way. Now I'm just waiting on the negotiations to find out if this is the place.

Sale?

Anybody know where I can buy a bottle of Give-A-Damn? I seem to be out with no refills pending.

I don't give a damn about your complete inability to manage your employees, no I will not fill your empty shift for you. I don't give a damn about your stupid toe pain for 3 days, just get your sorry ass on the stretcher so I can get away from you.

Where there's one, there's two.

After the call with the drunk lady and broken ankle, we had a second call involving a suspected broken ankle. Arriving on scene, we find a dude trying to crawl across the pavement away from us (picture every Hollywood scene involving a robot/android which has lost its legs and is still coming to get you). Dude had jumped an 8' fence and not seen the 20' drop on the other side of the fence. His story was that "Some Mexi-cans were chasing me! I di'n't do nothing to them! I just wanna go home." I think maybe they were relatives or maybe a Mexican outreach program for Sumdood ?

I don't know the end of the story, but my bet was actually more on heels and hips being his injuries based on the yelling and squirming he did during our exam. Dude also had an amazing recollection of his alcohol intake, including 9 16 oz beers and 3 or 4 shots of tequila. Young, stupid and fearless, is there any combination that makes for better ambulance calls?

Entertainment

Sometimes I wonder whether the ambulance job has changed me, or just let my natural inclinations shine through. We went on a call for a fall with possible broken ankle, usually calls like this are just sprains and an over-reaction from whomever was being helpful enough to call. This time I walked around the corner of the ambulance just in time to see The Asian lift the woman's leg a little and see a bone end poking up under the skin. Ouch.

The patient was convinced she was fine, arguing it wasn't broken and this was all just silly. Of course, the day-long alcohol binge might have a little something to do with that. She even offered to get up and walk back in the bar. I voted that we should let her, just for the entertainment value. No point in arguing with a drunk since they're immune to logic, just let her prove to herself that she should go with us. Unfortunately, it is a bit against protocols to let her fall down again. Still, it would've been entertaining.

Countdown

The clock is ticking for the start of school, two months and counting down. During that two months I have to: find a place to live, find enough stuff to live separate from K without depleting the house or the bank account, move, figure out my work schedule and when my last day will be relative to the previous item, set up utilities at the new place, and all the other tiny details that come with moving while not moving. The office job is officially over now and my computing needs for school are taken care of, at least there are a few less things to worry about.

Posting

It is frustrating when I take the time to write an entire post only to have the network disconnect and effectively delete it. I'll try to get motivated enough to write it again.

Premature posting

Apparently I worried too soon about bad-luck ambulance calls. In the last three overnight shifts, in four days, I have seen exactly 0 patients who needed to go to the hospital, much less by ambulance.

I took a frequent flier who "we" have begun telling children's stories to, recently, "The Little Engine That Could" and "The Boy Who Cried Wolf". I think most folks are operating on the assumption that she never had the kind of caring family environment to learn these stories and morals and clearly needs some intervention, or they're just trying to entertain themselves on yet another B.S. call. I can't even bring myself to care that much.

Ambulance.....OF DOOM!!

Edited 5/21: I try and de-identify calls as much as possible, but I'm not sure I did a good enough job the first time, so I've trimmed this one down a bit...

I've come to believe that bad calls don't just stick to individual EMTs, but to trucks too. Lately, my truck has become the ambulance OF DOOM. If this truck shows up, you are in deep trouble. Rollover accident ends up with C-spine fracture. Gunshot to the head ends up as not quite dead yet with EMTs trying to save your life. Chest pain ends up being something serious, heart attack, broken ribs with lung laceration. Difficulty breathing ends up with an intubated patient (or two). Thankfully, not all of these are my calls, but enough that I'm probably on a downhill slide for crappy calls too.

The latest fun was an overdose dispatch which actually said multiple patients were involved, and they still only dispatched 1 ambulance and 1 engine. We brought the stretcher, O2 and first-in bag up with us to the fourth floor, FD brought their oxygen. A cardiac arrest and an unresponsive patient in a tiny bedroom where most available area is taken up by the bed and dresser. Everyone in sight denying drug use, everyone having mysterious matching puncture wounds in their arms. Nobody brought up a defibrillator or cardiac monitor and no first-line cardiac arrest drugs were available upstairs either, pretty much a worst case scenario for patient care.

After the giant hassle of getting the unresponsive patient out of the room, I head out with the paramedic from the second ambulance (because the unresponsive patient was mine) and leave the second EMT with my partner. Stretcher doesn't fit in the elevator, so we have to stand the backboard up and I take a second elevator with the stretcher and meet up downstairs. We head to the more distant hospital, my partner heads to the closer hospital in town.

Cardiac arrest patient died. Unresponsive patient woke up with some Narcan. Nobody was willing to discuss what had caused the mysterious wounds and PD is following up.

Letter

Dear Brain,

I would like to place a request for improved coordination between the eyes and the hands. Softball is not an especially dangerous sport, but when the hands and eyes don't work well together, other body parts suffer. Obviously, the feet and legs are listening well as they moved directly into the path of the oncoming ball, but somehow the glove just didn't get there. I don't appreciate this large painful bruise, despite all the lovely colors it adds to the normally pasty white area.

Sincerely,
Left Thigh

More boring waiting

Even now that I'm finally admitted to school, I am still waiting. August can't come soon enough. I'm just trying to grit my teeth through May and June because I think there will be plenty to do throughout July to get ready/moved/relaxed. There are still some open-ended questions about how my housing situation will work out, thankfully it is a situation with a couple of workable options instead of one with no solution.

I'm also in the market for a laptop and I know just enough about computers to know that I don't really need a high-end machine but I don't want one that will be completely outdated for new software before I'm done with school. Financial aid includes a "computer allowance", but I'm not really planning to wait until the money from the guv'ment comes in to buy a new machine. I've never run any version of Vista, anybody got suggestions/short cuts/useful tips?

I'll try and think of something interesting to write about soon...

Redeeming night

So many ambulance shifts consist of nonsense after idiocy after dumb-assery, every now and then one comes along which make me feel a little better about the job. Not that the individuals involved are any different than the usual suspects, just that they actually needed an ambulance.

This particular night started with a lift assist for an older gentleman who was stuck between his rocking chair and dining table. His family had been unable to help him up, but we were able to get him situated and on with his evening. Next call was for an unresponsive person on the sidewalk, turned out to be someone we've picked up before, alcohol and unknown medication overdose. He woke up a little on the way and we liberated two fifths of vodka from him. Always good fun when the crowd is catcalling both us and the patient as we're trying to get him off the street. Next call was pure stupidity, the eventual solution was that the woman needed more instruction with her crutches and a more explicit explanation that a "fractured" foot meant it was probably going to develop bruises in a couple of days.

Then the fun starts, dispatch for a roll-over accident on the highway. Car is on it's driver's side, patient halfway out the window with her neck and shoulder supporting her weight and screaming loudly about her neck pain. After more than 25 minutes of playing with their toys, the fire department was able to get her out of the car and onto a backboard. (All I'm going to say is that to a man with a hammer, everything looks like a nail!) She had some periods of unconsciousness and when she was awake she was screaming and complaining. At the hospital, she got a quick dose of "be quiet" involving Haldol, Morphine and Ativan. She turned out to have a cervical spine fracture, a skull fracture and a lung contusion and got shipped out to a higher level facility pretty quickly.

Next dispatch is for a car in the median on the highway. The car was found by another group driving by, no information on how fast it was going, or even which way it had been going on the highway. When we get there, the patient is laying outside the car on the ground, unresponsive, each eye twitching a different direction. A quick transport to the hospital and she earns a helicopter trip to a trauma center in the big city. All in all, a night where 80% of the calls were legitimate and I feel like did something useful.

Remembrance

Suicide brings up a lot of emotions in me, many I can't even name or describe through the general turmoil of my thoughts. Ultimately, the person who dies leaves everyone else to sort through the wreckage for meaning and the strength to go on. The recent suicide of a co-worker has brought on memories and questions.

TP started at the north station as an EMT-Basic, working on a transfer truck with a woman who was full of laughter and emotion. He often appeared shocked by the openness many of us brought to the station, sharing details of lives, loves, disappointments and desires. I attributed this to his younger age and general inexperience, never thinking about the type of broader experiences that might make a man reluctant to share, hesitant to open his heart. Over time, he became accustomed to the rest of us and began to join in our laughter and the general teasing that goes on in the station, if not our sharing.

He shared only a very small portion of his outside life with us, frequently deflecting questions about his family, his life or goals. He would often answer something non-committal, "Whatever you say," or just "Sure." It took me a very long time to learn that he lived a couple towns over in an apartment, no family or roommates. When he moved into a new place, it was months until I figured it out based on the few clues which came up in conversation. The one thing everyone knew was his dedication to EMS. He completed his EMT-Intermediate and was excited to do more for his patients and the services he worked for. He worked for pretty much every company or municipality in the area at one point or another, frequently for a hundred hours or more a week. If you needed a shift off, TP was always available for more work.

We noticed a change in him when he was dating more seriously. Instead of 90 hours a week, he'd cut back to 70. He took a fair amount of ribbing and pointed questioning about which woman was equal to all the fine company he had at the station. A girlfriend, or maybe two, came and went, the only noticeable change being the number of hours you could find him at the station. He began training for the 2008 EMS Memorial Bike Ride, riding to work, losing weight and generally living a healthy lifestyle. He asked for, and received, donations from his co-workers, some of us learning for the first time about this organized effort to recognize line of duty deaths for EMS workers as distinct from the Fire service. He returned a changed man. I didn't realize the extent of the change at first, but he was more focused on his profession and improving his skills. Station gossip went from substantial issues to petty complaints, a sure sign of improvement. Eventually, we found out that he also returned with a new woman in his life and he seemed quite happy for at least 8 or 9 months.

Two weeks ago, he seemed to shut down. With his history of withholding personal details, I didn't directly ask what was going on but tried to show concern. Every "How are you doing?" was met with a "Fine," or some other answer to turn us away. The station environment being what it is, we eventually got around to teasing him about his girlfriend, with someone piping in "What's wrong, did your woman dump you?" He got up and left the room. Several of us followed up with him that night and in the following couple of days to express our concern for him. He still turned us away. The next week, he seemed to be feeling better. Not quite back to his normal self, but able to smile a little and willing to interact again at the station and back to working a ridiculous number of hours. And then, he was gone.

His sudden death leaves a hole in our station. We all feel it, friends or not, and we grieve his loss. I'm working through my own emotions about the scenario, to order and organize my thoughts and feelings, to place this shocking event in a larger context, but it is not easy work. Services are being held Friday, I'm hoping a larger gathering of colleagues and friends will help me recover.

Drat!

Okay, that isn't the four-letter word I used upon opening my email this afternoon, but you get the drift. The school I've been waiting to hear from sent me the wait list letter again, for the third year in a row. I've been hoping for an end to the uncertainty, but apparently that is not going to happen. I don't really understand their wait list process but I can tell you that it hasn't favored me in the last two years, so I'm pretty disappointed in that outcome.

Maybe the new mattress will help me sleep away some of my sadness, sure wish I had it today instead of in two weeks...

Things I never expected to say

To a woman who had just left a snot trail on my shoulder while sobbing, "Don't worry about it. If that's the worst thing on my shirt by the end of shift, it will be a good day."

History taking

Sometimes, the things that happen just before the ambulance gets on scene are important. I've been on calls where the patient was moved and it takes 10 minutes to get the story straight because a patient laying in the middle of a big bed should not have a softball-size lump on his head from falling "right there", or "I took that pill the doctor gave me" turns into a 20 minute search for pill bottles and a game of 20 questions which never get me to the mystery pill (remind me to tell you that story sometime).

This call was memorable because as the first ambulance on scene, I got some of the information that the second ambulance didn't have and didn't think to ask for. Responding for a "sick person" call, arrive to find a middle-age woman very upset and pointing us to the living room where there is not 1 but 2 elderly folks in a state of disarray. The female pt had clothes on, sitting on the floor propped up against the couch; the male pt was laying on his back on the floor with a shirt and no other clothes. The room looked like a tornado had hit with model cars and trucks scattered about, the coffee table in pieces on the couch, a recliner on its side, and various other items strewn about. After the Asian and I split up and each assessed a patient, it was clear they both needed transport to the hospital and we called for a second ambulance.

While waiting for the second ambulance to arrive, the FD helped us do a spinal assessment and get both patients dressed enough to head out of the house. On arrival of the second crew, I try to give them a brief idea of what we know, including the male patient's medical history, vital signs and medication list. What they didn't ask, and I didn't think to tell, was the little detail of what we had done for the patient - getting him dressed and seated back in the recliner. We took both patients to the same hospital and made sure social services got involved with possibly placing them in assisted care because their needs were outpacing their family's ability to care for them.

Later in the day, I checked in with the other crew to find out how their patient was. "You'll never believe this! When the hospital stripped him down to put on a gown, they found a model truck in his ass!" Followed by the second crew member, "I don't even want to think about what those old people were doing!" I could have let this stand, after all where the truck was or why doesn't really make any difference, but I felt bad to have the patient get a reputation for something he wasn't doing, "Well, he could have fallen on it, there were a lot of models on the floor." Other crew, "No way! He was wearing pants." "Well, not when we got there he wasn't. We figured he'd probably want pants for the trip." The other crew appeared disappointed, but they'll probably still tell the story of the elderly gent with a truck up his butt and maybe we'll all remember to seek more details.

What is that smell?

That, my friends, is the tangy, bitter smell of rejection. 'Tis the season for med school rejection letters again, and even though I'm accepted elsewhere, the rejection letters never feel good.

What they said: "You can be confident that the decision on your application was made with careful attention to your academic record, MCAT performance, extracurricular activities, and letters of recommendation. Rest assured that your application received a thorough, sensitive, and judicious review."

Translation: Don't call us and complain that you didn't get in. We read your stuff and we still didn't want you. And as for sensitive, well, we didn't laugh directly in your face and that's pretty darn sensitive.

What they said: "Although this does not end what we are sure is an unpleasant waiting period for you, your desire to become a physician, your understanding of the requirements, and your perseverance are commendable."

Translation: We're not even taking you all the way off the list just so we can string you along for a few more weeks. You appear to enjoy bashing your head into a brick wall so why don't you just go right ahead and keep on doing it because we're enjoying the entertainment.

What they said: "The Committee on Admissions wishes that the admissions process were such that it could accommodate you and all the fine candidates who apply for admission."

Translation: We seriously wish we could get more money out of you somehow, but unfortunately, there are rules against charging you fees for waiting on our list for months. If only there was a way to let you pay course fees without actually admitting you...hmm, we'll be sure to let you know when we figure it out.

A day away

I spent yesterday enjoying some fresh snow, riding down the mountain at ridiculous speeds and working my body to a state of exhaustion. Today, I have the sore muscles to remember it by. Sadly, yesterday was the first day I have been snowboarding all winter and reminds me that I need to make the time to do winter activities so I don't start hating all six months of it.

And now, my heroic secret identity is ready for action....

Follow up

Some folks have asked about the post earlier this week (or the related facebook update) and I'm sorry, but I don't want to get into the details of the incident in question. There are just times when something happens in your life that makes you take a hard look at yourself and question what you see. What type of person do I want to be? How should I be treating people? How would I prefer to be perceived?

I have never been one of those "sweet" girls. You know, the ones with a nice bit of encouragement or support for everyone, wants to be everyone's friend. I work to take care of my friends and people I care about. When you are my patient, I consider you an important responsibility and I will bust my ass for you. When you are a student or new employee riding with me, I pride myself on giving you everything I can to help you succeed. If you are preventing me from accomplishing these things, I will do whatever I can think of to get you out of my way - even when it isn't very nice.

I don't actively want to hurt people's feelings, but I do have a unique sense of humor which sometimes finds the one thing you wish nobody would notice. I don't enjoy having to rely on people who have proven themselves to be incompetent or plain stupid and I don't always have the patience to coddle their feelings. But the recent incident reminds me that I have to avoid slipping into a "scorched earth" policy with these folks as well.

I am feeling a bit better overall, which helps me find a little more patience, and I've been lucky enough to have a couple new employees who were good at their jobs this week, which helps me find a little more joy in my days. So, thanks for the concern.

Today's insight

I am a raving bitch. Irrational and angry. Working on it.

*and I don't mean raving in an "oh, isn't that cute, she's all worked up about something." I mean spouting off in a "holy crap, back slowly away from the crazy person and call the dudes with the straight jackets." Seriously.

Worry

Funny how syncope for myself just gets me irritated, but my dog being in pain worries me enough to keep me up at night. Watson came home from his walk last night and wouldn't come up the stairs. I went over to see where he was and he had stopped in the middle of the flight of stairs and refused to come up or go down. K carried him up the stairs as I'm giving him the third degree, "What did you do to the dog?" "Why won't he come up the stairs?" "Did he hurt himself?" and probably at least half a dozen others in the time it took him to walk up five stairs cradling my aging baby.

As a good EMT, I immediately assessed the patient. He wasn't bearing full weight on his right rear foot. He cried in pain when I touched his right hip. When laying down, I could take his leg through a full range of motion without apparent distress, but he still cried when I touched his hip. I strongly considered checking the internet to see whether I could give him any over the counter medication for pain, but ultimately decided to have him sleep the night and see how he felt in the morning.

This morning, he was not improved. When he got up to eat, he cried when putting weight on his leg. When he went outside, he walked tenderly, using his right leg as little as he could. I walked around the house with him so he could get downstairs without using the stairs and he curled up next to my chair, not even willing to go the extra 2 feet to lay on his pillow. I was worried he might have a soft tissue injury from a dislocation that he had been able to get back in place, or some loose ligaments in his joint that was allowing his hip to slip out of joint in some fashion. We had a vet appointment at noon.

Some of the early questioning by the tech involved ticks and I never really made the connection until the vet said she felt comfortable that this wasn't Lyme disease. Watson was very patient and easy-going during the exam, definitely reacting with pain when she got to his right hip and enjoying the gentle massage on the rest of his legs. After the exam, she decided it seemed like a soft tissue injury, possibly a bruise. Watson is crazy at times and will run around the corner from the yard onto the porch and lose his footing in the snow/ice, so this is entirely possible. He's now on a course of anti-inflammatory and pain reliever, with no walks, no outdoors (except leashed bathroom trips) and no stairs for 10 days. My hope is that this will be enough healing time for him because after this it is sedation, x-rays and the options get less pleasant.

February blues

For some reason, February and I do not get along. I would like to think it is the cold or the dark, but December and January are darker and usually colder. I just find it very hard to deal with every day annoyances during this month, motivation is at a nadir, and pretty much I just don't wanna anything. This month was not improved by a visit to the PCP which reinforced the need to "lose weight" because the "trend" on her graph of my weight has been upwards the last three visits in a row, despite being an actual change of less than 5 lbs, and where she suggested cutting out all sweets and doing a better job of eating small meals throughout the day to manage my blood sugar. Nor by the cardiologist who assured me I was fine, 3 syncopal episodes in a year is nothing to worry about because there are people with "15 in a couple months" and I just have to cut way back on caffeine and drink lots more water.

(Side note: He actually suggested I drink 15 OUNCES of water when I have to get up in the middle of the night to do an ambulance call. I usually drink about 15 oz all day. If I implemented this suggestion literally, all I would do is pee at patient's houses. I'm not sure he was impressed when I laughed at his suggestion, said "Are you serious?" and laughed some more when he assured me he was serious.)

So, I get to hear how I suck at life at a point when I don't feel up to anything. For the record, all the medical suggestions are reasonable ones, just not ones I can handle very well right now.

Tiles are done!!

K still has to finish caulk and the spout, but at least the grout is done.

Yearly poke and prod

(No, I'm not talking about "relations" with K, smart ass...)

For someone who wants to be a physician, I find it odd at times how much I dislike going for a yearly physical. I love my PCP. I hate having a breast exam and pap smear. But, I do take advantage of some slightly less scheduled time with her to bring up issues I want addressed.

I had seen her following an ED trip for a syncopal episode at work in the past year and after some blood work and whatnot, it was more or less dismissed. No big deal to me, I wasn't sure what happened but didn't really think it was terribly important medically. Yes, it had happened before but not recently enough to make me concerned about a trend. No, I wasn't satisfied with a "vasovagal stress reaction" explanation, but how do you explain that working an ambulance call for an assault patient isn't really that stressful?

In the time since that episode, I've had two others. One was a full-on, pass out, hit my head on the countertop and the floor, unconscious period. The other was a "jeez, I don't feel too good", everyone in the room staring at me commenting how horrible I look, feeling like if I stood up I would immediately pass out, lay down on the couch, have some OJ and start to feel better after 15 minutes or so episode. Not enough to drive me to the doc for an evaluation of just this issue, but enough for me to bring it up at physical time (especially since the last one was only a few weeks ago).

So, I have a referral to cardiology next week. Possibly a tilt test coming, definitely another EKG. Probably no real answer to the issue. Send syncopal wishes my way next week so maybe they can figure it out...

Slow progress

I haven't updated about the tub/tile situation because it is not finished. I worked on the tile through 20 lbs of mortar yesterday and I'm still not done. There is ONE tile which touches the ceiling now, but I have a bit more work on the walls before I can move to the ceiling and get done. I've had a couple of requests for pictures, but I'd like to wait until the grout is in and you can see the finished result.

School interview last week was the weirdest one yet, I don't even know whether I did well or not. The first guy had a more argumentative style, asking questions and then pushing you on the answers. Somehow we ended up talking about the health care system as a whole, who makes decisions on which treatments are used and available, and how to fix the current system. At one point, he looks at me and just says, "So what is the answer?" I tried to be as polite as I could but my response was "If I had the answer, I wouldn't be applying to be a physician, I'd be running for office and just fix the problem." I did take some time to elaborate on needing more information and feeling like too many people think they can see the answers from outside the system and end up recommending completely impractical things. Later, he told me that the concerns I had about health care were more appropriately fixed by economists and lawyers and maybe I should look into those options. What!?!?

Second guy behaved as though he had already decided, asking lots of questions about my re-application, the timing on when I took and re-took the MCAT, why I haven't been accepted yet and why I still applied the third year. Not angry questioning, just a lot of details. Then he moved on to how K and I are going to manage his job in south-east NH with my schooling in central-west NH and the 1 1/2 drive in between. Sounding very much like he intended to let me in, but I'm not sure that was the case.

School states there is a minimum of 6 weeks until they will decide anything and probably not even then. I have 53 days and counting until I need to give the DO program the next $1500. I need to file my taxes, my FAFSA and additional financial aid paperwork at all the schools in the next week. Busy, busy, busy.

Pile on

You know how things seem to come in groups? Three cardiac arrest calls, a week of bad news, nothing seems to happen in isolation. I used to feel like a big part of that was perception, once you're down everything just seems worse. Last week cured me of that feeling. No matter how hard I tried to keep a positive attitude, a fix it and move on mentality, the hits kept coming. The following began last Tuesday...

Bathtub liner was feeling "squishy" for a week or two, decides to "pop" off the floor of the tub a night when it was below zero outside, breaking the caulk along the walls, leaving the tub not water-tight. Having only one bathroom, we continue using it, trying to minimize the amount of water behind the liner, while trying to determine the best solution. K leans toward the whole tub/shower remodel, I lean towards gluing the damn thing back down (fingers in my ears, "lalalalalalala - I can't hear you, so there is no problem"). I call the company that installed the liner in the hopes it is still under warranty, of course it is not - they know exactly how long their glue lasts.

Bathtub decides on it's own that it would like to be replaced. Water between the liner and the old tub builds up and begins leaking into the basement. Prior mold and rot to the wood in this area of the house (presumably from when the tub leaked leading to the liner installation) make this require an immediate fix.

K reports desktop computer not working right, nothing shows up on the monitor when you turn it on. "Lalalalalala - you're just doing something wrong, computer is fine." As we have other machines in the house, this one is temporarily ignorable. K has projects due for class which are started on the broken machine, but has enough time to finish elsewhere.

A search of local home improvement stores leads to the finding that they only carry white bathtubs in-stock and we don't really find tile we're happy with. Any sort of off-white tub (which would match or at least not clash with the toilet and sink) is "special order", requires a couple hundred extra bucks and a 7-10 day wait. A search of specialty bath places locates a "Linen"-colored tub, available the next day, for about the same "special order" price. We locate a tile place which claims to have everything in-stock in project quantities and are able to select tile and leave with backerboard, mortar, grout. Credit card heating up.

Removal of old liner, tub and tile commences. Liner is well-secured in many places with a rubbery epoxy which simply stretches as you pull it away from the wall, anyone doing this would be well advised to have a Rotozip or something similar with a plastic cutting bit, as that seemed to work well to get manageable pieces which could be pried off the walls. Old tub turns out to be robin egg blue, blech, and cast iron. If you don't know, cast iron is VERY, VERY heavy. This tub is upstairs in our split-level. The Internet recommends smashing a cast iron tub into smaller, easier to carry pieces for removal. 8 smashes with a heavy maul have lead to chipping the porcelain coating, but no breakage. K is not going to give in to a tub and continues smashing, finally we get a chunk to break and then the demolition takes off.

Demolition debris is loaded into the back of our pickup for recycling/disposal the next morning. We get down to the last piece of cast iron tub, it is about 1/4 of the tub and is the piece with the drain and overflow, weighs at least 100 lbs and is very awkward to carry, even with two of us. Up and over the side rail of the pickup, rounded side down. As soon as we let go, the unmistakable sound of glass breaking. Tub went through the back window of the pickup. Only broke one part of the three-part sliding rear window, but whole thing has to be replaced. NH is very cold this time of year, open windows are not workable. Credit card placed in snow bank to prevent melting plastic.

Carpentry repair goes reasonably well, new plumbing install goes reasonably well and it is time to set the new tub. Tub does not fit. Remove and/or break holes in drywall. Tub does not fit. Opening is 60", tub is 60". Can't slide it in from the side because of forced hot water heating pipe. Can't tip it in, gets stuck on studs. Begin shaving studs on interior wall. This old house has 2"x3" interior stud walls, so not too much available here to shave, other option is to remove that wall entirely and re-build after tub install. Wall is in MY closet and would require removing nearly every piece of clothing I own. Eventually get enough gap to tip in tub from shaving studs. Tub is level the direction of the support stringer. Tub is not level from side to side. Remove tub. Install some additional plywood on outside edge. Reinstall tub. Hear chorus of angelic singing as tub fits and is level. Check head for bumps or concussions, find none, clean eyes, tub still appears to be in place and level.

So here we sit, tub in, backerboard up for tile, waiting for mortar to dry. Tonight's adventure is rolling on the waterproofing membrane, then waiting again for dry time. Tomorrow is to lay out the tile pattern and all the necessary level reference lines and start to tile. K works tomorrow and I work tomorrow night, so limited work will be finished. Fingers crossed to finish tile Wednesday, wait for drying. K might be able to grout on Thursday, I'm out for a school interview. Maybe by Saturday, I can shower at home again.

Repeat business

Walking into the hair salon this weekend, my stylist commented to another, "Look, I am so good she doesn't even look like she needs a haircut!" She was joking of course, but that brought us to a conversation about never actually wanting to be that good because it would kill the bread-and-butter of repeat business. If hair didn't grow, there wouldn't be a steady line of customers every 4-8 weeks looking to have her make their hair look exactly the same as last time.

In itself, repeat business on the ambulance is not notable. Some folks are seriously ill and we see them often enough to know a bit about them. Others have a variety of reasons for calling that have little or nothing to do with their medical conditions. We have a large set of "frequent flyers" who should earn free trips for the amount of business they give us, if only they paid for trips in the first place. I was recently on-duty for 3 calls to the same address in less than 48 hours.

The original call was in the late morning for an overdose/unconscious person. We arrived to find a sobbing woman who pointed us to a bedroom. On the bed was a man laying on his back, snoring loudly. Not "snoring respirations" (a somewhat bad sign where a person is not keeping his airway open and possibly not getting enough air). Just snores. I walked in and shouted his name, to which he immediately awoke. After a long series of questions to both the patient and the woman, it turns out he "overdosed" on his sleeping medication and "passed out" the night before and her mom told her to call the ambulance. Stupidity discovered, we leave the happy couple with the police and move on.

Second call to the same address the following evening for overdose/unconscious person. Again, on his back, in bed, snoring. Again, wakes to verbal stimulus, but this time is substantially sluggish. We check his prescription bottles and one of them is a couple dozen pills lighter than yesterday. Off to the hospital where the fine doctors and nurses monitor him as he snoozes the medications away.

Next day, another call to the same address, same problem. Unusual for me to be working this many days in a row, but a shift swap leaves me in the station for too many days. This time, the call isn't for my truck, but I update the responding crew on the prior days events. Catching up with them at the hospital, I discover that this time there was a disagreement in the house with no overdose involved and the patient is now at the other hospital in town being evaluated for some other random complaint unrelated to any recent or potential overdose.

If we were ever good enough in medicine to prevent this sort of repeat business, the ambulances might have very little business at all.

Buying time

Time is money and not just in an abstract way. During the medical school admission process, if you want more time to think and decide, it costs you money. Holding my spot in the MD program until the end of the admission season cost me a $50 deposit. Holding a spot in the DO program for 30 more days cost me a $500 deposit. If I want more time after that, it will be another $1500 (this part is refundable until June).

Why am I interested in buying time instead of just making up my mind? Well, right around the time I was hitting the decision point, I got an invitation to interview at my top choice school. I know that doesn't eliminate the possibility of ending up at another institution and needing to make the choice, especially since it is likely I won't hear back from the top choice by the time the next deposit is due, but it took a lot of the pressure off and my preference between the two has actually swung back the other direction.

Funny enough, purchasing this education is approximately as expensive as buying a house but is way more stressful to me. I don't actually mind ending up in a house that isn't perfect, good enough is usually the only thing in our price range and we have some skills to help make a place more suitable for our needs. This flexibility is assisted by knowing that we aren't going to stay for the next 50 years, maybe just 4-6 years. It is also assisted by being able to get at least some of my money back (maybe more) when I leave. If medical school felt more like a short-term investment that I could recoup my costs in 4-6 years, I would probably just make a choice and move on. But realistically, education is a mortgage I'm going to have to pay in full and it is difficult to estimate when I might be able to see a cash return on my investment. When is my bank account going to return to current levels? When is there going to be enough money to support an increased lifestyle? How do I know whether spending extra $$ now will result in a bigger or faster return on my investment? We have a financial planner to help with these kinds of questions for our overall and retirement planning, I guess I just need one for medical school too.

What happens in Vegas

...ends up here. Well, parts of it anyway. K and I have seen Neil Diamond in concert, watched Anthony Cools perform hypnosis and listened to lounge acts. Family gathered to renew connections and catch up with everyone as they gradually cultivate their own lives away from the center. We've gambled at slots, video poker and craps, winning a little, losing a little and watching time go by. We've wandered up and down the strip, through the casinos, marveling at the excess and the sheer volume of money wasted day after day, hour on top of hour. I've remembered how fantastic it is to live in a state with smoke-free bars and restaurants as today my lungs decided every additional breath of smoke was going to result in a wracking cough. All in all, a decent vacation, but I'm looking forward to home, relaxing with no expectations, petting the hound and not smelling like an ashtray.

Security

Heading out to Sin City today, lounging in an airport for multiple wasted hours of my life. Sitting here in view of the geniuses employed by TSA reminds me of a story I haven't told about being stuck in Chicago during the New Hampshire Ice Storm of 2008. (Sorry for the capitalization, I've seen too many year end summary shows where everything is Made Extremely Important By Capital Letters.) After being told I wasn't going to get home that night, I waited on hold for quite a while and finally got re-booked on the first flight out the next morning.

Arriving back at the airport, I found out I could not check myself in because I no longer had an electronic ticket and got lectured by the agent about "When you change your ticket..." Somehow, she was not especially sympathetic to the fact that I did not want to change my ticket, I wanted to be home. Upon arriving at the security check-point, I'm told that I have to go through extra security screening because "You bought a last minute ticket." Again, no sympathy for the fact that I had nothing to do with the ticket change, just a lecture about not having to go through the alien anal probe if I bought my ticket in advance.

I was personally escorted through a maze of walls and doors where my ID and boarding pass were handed to the next agent. I guess they were afraid I might make a break for it and everyone knows that if a wannabe cop is holding your driver's license, you're as good as locked up. After taking all my carry-on baggage away, I get my shoes and coat off when the guy tells me I have to put my shoes back on then step into the booth which resembles a combination of a telephone booth and an MRI machine and looks about that comfortable. "Stand on the foot prints. Do not move until the doors open." This is when I learn that I should've probably gone to a spray tan booth before traveling because I'd probably be a lot less startled when I'm suddenly hit from 360 degrees by sharp puffs of air. Yes, I got sniffed for explosives because I'm a danger due to my late ticket and I probably convinced them I wasn't a terrorist just by jumping about 3 feet when the air hit me. Finally, the doors open and I'm led off to an individual screening area where I have to take off my shoes, all my bags are individually swabbed for explosives, and I'm checked with the wand. Fun, fun, fun.

After all that, I have to think that it seemed like a relatively silly display of inconvenience more than making me feel secure. If I wanted to do something to a flight, I wouldn't buy a last minute ticket. I would be the world's most OCD terrorist, they could probably find me just by looking to see who checked on the flight 657 times in the 12 hours before take-off and look for the woman checking all her pockets for anything she forgot to pack to head to Heaven, Nirvana, or wherever terrorists think they're going.