A moment he wishes he could have back

For once the person doing something just stupid enough to get noticed wasn't me. Unfortunately for the fellow in question, I witnessed the moment and shared my amusement with a number of folks.

Many of you know that there are helicopters staffed with people of spectacular skill and experience (paramedics, nurses, respiratory care folks, sometimes even MDs) ready to fly out and assist patients in dire need. They can be called by even the lowliest EMT-Basic if you have the information to justify the need. What you may not realize unless you're in this field, is that these helicopters not only respond directly to scenes, but also to hospitals where critical patients need to be transported to a higher-level facility. Any interaction I've ever had with flight crews has shown them to be highly professional and strong patient advocates - even to the point of deciding that the patient would be best served not to fly.

The one oft-repeated piece of training to work with them involves landing zone safety. How big it needs to be, what types of obstructions to look for, how far back to clear everything, and how dangerous loose objects can be during takeoff and landing. At one of the hospitals I transport to, the helicopter landing pad is immediately adjacent to the ambulance parking. When the hospital knows the helicopter is coming in, they close off the ambulance parking area to make sure there is enough clearance in all directions. Very inconvenient for ground-based EMTs and their patients, but very safe for the helicopter and staff so the occassional inconvenience is well-tolerated in exchange for the small hype of watching the 'copter come and go. The EMS room has a lovely set of one-way glass with a view of the parking lot and the landing pad, so we have a great view.

Protocol at this particular hospital involves having security meet the helicopter and escort the staff and their myriad of equipment inside the building. I'm not really sure why because I would think the giant "EMERGENCY DEPARTMENT - AMBULANCE ENTRANCE" sign would tell them where to go, but whatever. There is a stretcher in the entryway between the three sets of glass doors which is used to help move the stokes-type basket and all the equipment. This particular day, someone had been useful and covered this stretcher with a sheet. Neatly tucked on all sides, clean, sparkly and ready to go.

Security rolls the stretcher outside just prior to the helicopter coming around the building. He's not really watching the stretcher, which is slowly rolling away from him, but rather fixated on the helicopter. Then, the rotor wash gets serious and that neatly tucked sheet lifts up off the stretcher and heads straight for the sky. Bad, bad, bad - everything should be secured in the area so nothing gets sucked up into the rotors. Security doesn't even see it until the 'copter is all the way down. He turns around to grab the stretcher and notices there is something different here. He spends a few confused seconds looking around and quickly gives up on the mystery of the missing sheet.

After I'm done laughing at his bewildered expression, I head inside the ED to find my medic at the nurses station, which requires a re-telling of why I'm so amused. The nursing staff all lay wagers as to which security guy it was and nobody gets it right, suggesting this was one of a relative few miscues for this fellow. He comes in pulling the sheetless stretcher full of equipment to the patient's room and then disappears. A few minutes later, he comes back, with the sheet. He's laughing because it is a sheet from the hospital across town and he claims it was trying to fly home.

Uninspired

The quiet here is a result of my complete lack of inspiration to write. I'm waiting out the days until vacation - enjoying them and living fully in them, but not really holding anything in my mind except the vision of me sunning myself near a pool and maybe K splashing around somewhere since he doesn't like to be still.

My interview for med school is between now and vacation, but I'm not sure what I'm supposed to be doing about it. I've done some brainstorming on things I want to highlight when I talk to people, and I had a couple of questions I wanted to ask - but then the school sent me a DVD that answered some of them. I haven't been able to generate much anxiety about the issue since I bought my new suit and new shoes. Apparently my issue was mostly fashion-related. For those who want to know, navy blue with white pin-stripes, a lavender shell, and some 2" navy heels. K encouraged me out of the house to get it done and sat patiently through all the try-ons and debating over color, style, cut and even gave an immediate positive reaction to the final selection. He even went shoe shopping on a search for the "gunmetal gray" shoes the saleslady recommended. I love that man and I rewarded him with steak dinner at a real sit-down restaurant.

I'm sick. I rode with a partner on Friday who was stuffy, sniffling, and so on, and sure enough, come Sunday I felt that little twinge in the back of my throat and by today I'm stuffed and miserable. I almost always get colds that start in my sinuses and drop to my lungs, so by vacation, I'll probably be hacking up a lung every couple of hours.

The office job drags on...nothing new to report.

911 at the ambulance co has been busy lately, but that hasn't involved me much. Saturday morning I missed the truck leaving for a call at 0640 as I was walking in the door for a 0700 start. I wasn't too worried, but I did feel bad after the guy who was supposed to be leaving in the morning didn't get off shift until 0900 because they just kept getting calls before they could make it back to the station. In the end, I hitched a ride with a wheelchair driver and met them at one of the hospitals so he could go home. Also, a fair proportion of my emergency calls lately have been no transport sign-offs where we evaluate people and they decide not to go to the hospital. None of them have been people I worried about after I left the scene, so I think they were all appropriate, but it doesn't give me much to write about.

FD has been slow for night call volume, so nothing to report on the volunteer side either. Town meeting on the budget is coming up right after vacation, so I suppose we'll probably have to go be involved in that lest the tax-cutting enthusiasts decide that we can run the town on even less money than last year.

Anyway, I think you can see the problem. I'll keep trying to find something more interesting, but I don't want to do a lot of posts on what is not going on.

Decisions

New Hampshire doesn't really do things half-assed. Today, I do not have a "snow day", I have a "blizzard day". The office job actually closed (first time in the 5 years I've been there) because of the snow. Granted, that location was forecasted for 3" last night, 12-18" during the day today, and another 4-6" tonight. Here at Casa de Jen, we're not supposed to get quite that quantity but our afternoon precip is forecasted as freezing rain and/or sleet before changing back to snow, so we'll have that helpful layer of ice in the middle of the snow.

Here's the decision...I work from home, people who work on-site don't have to work today, so do I work or not? Would I like the day off? Sure. I'm ambulancing it 10h tomorrow, 10 on Friday and 24 on Saturday, so a little leisure today would be nice. Would I feel guilty kicking my feet up on the couch while my computer sits idle in the office? Yup. But I'm thinking getting some work done this morning might just be able to counter that guilt for the afternoon - especially when I'm out shoveling the driveway.

EDITED 20:10: I can conclusively say that I no longer feel guilty for taking the afternoon off, clearly a day with no new email means a day when nobody was workign. 2 40-minute shovelings of the driveway also mean that I have no guilt for not exercising today either!

Pain scale

I was reading this post today and it got me thinking about my own experiences with the pain scale. When an EMT or hospital person finds that you are complaining of pain in some body area, they will usually ask you "On a scale of 1 to 10, how do you rate your pain?" We all have our own slight variations of how we describe the two ends of the scale (not to mention those non-conformists who like to start the scale at zero). I usually use "with 1 being no pain and 10 being the worst pain you could ever imagine". Usually works for me and if there isn't much I'm doing to treat the patient, it gives me a conversation starter about what people are thinking might be a 10. Morbid maybe, but I haven't encountered anyone who flinched at describing what they thought might be a 10 and it usually segues right into another topic.

We all know that pain is subjective. What seems like a 4 to me might be an 8 to you and that could be a very real difference. Part of the reason we ask though, is to assess whether we need to treat for pain and to get some understanding of severity. I've seen a patient who had lost the tips of two fingers, holding his hand up in the air to help control bleeding, looking pale and pained but otherwise not complaining, rate his pain 8/10 and turn down pain medication. He just thought it wasn't that important and everyone should quit making such a fuss over him. I've seen patients looking completely comfortable tell me their pain is 11/10 and then promptly forget that they're supposed to be in pain if I do a physical exam.

My favorite recently though, was a patient from motor vehicle accident. I got refusal of care forms signed for two people while my partner was assessing and working on extrication with the FD for the other three. I return to the vehicle just in time to get handed a backboarded patient and a FF to assist with loading him in the ambulance. I hop in with him and discover that I've got a very polite, scared, 8 year old boy. He was very attentive and intersted in everything I described to him as I walked him through a set of vitals and describing to me how he was feeling. When I got to the head and neck pain he was having (hence the long board), he'd clearly never been asked before to do this numeric rating. He thought carefully about it and told me 1/10. A little further through the assessment, he mentions chest pain where his shoulder harness on the seatbelt crossed his chest and again tells me 1/10. We got rolling to the hospital and I talked with him and his mother about what happened, who was hurt, the baby in the carseat that was going with us and so on. I kept checking back in with my 8 year old about his pain and he always said it was about the same.

Just before we get to the hospital, I point out that we're almost there and this beautiful boy smiles at me and tells me this was the coolest ride ever. He says it felt just like a roller coaster and he couldn't believe that we got to use the sirens for him. I was extremely happy to check in with them 15-20 minutes after we got to the hospital and see that they'd already cleared his spine so he was off the board and having a great time.

Mail call

Yesterday was an unusually busy day on a BLS transfer truck, ending with a messed up call that will be a story for another day. I was forty minutes late getting out of work, had a crushing headache, and was thankful that being late at least meant no traffic to deal with. I came in the front door to a smiling K and an excited Watson full of puppy kisses, both happy to see me. I could smell dinner cooking and it was one of those "all is right with the world" moments where I can actually relax and let all my troubles go for a time.

I headed upstairs in full preparation for relaxation mode. Mail is usually on the dining table at our house, so I glanced over to see if there was anything interesting. And there it was. All alone, perfectly straight and neat. Oh crap. From relaxation to full anxiety in 2.2 milliseconds. To me from ABC Medical School, just a letter, one page from the looks of it. In the ordinary college admissions process, letters are bad news, big fat packets of information are good news. Knowing that and the response I got from the last medical school, I'm thinking rejection and steeling myself for the sharp stabbing pain that comes from being told I'm not good enough.

I look at K, "Great day to be rejected, huh?"

"I don't think so. There's a lot of writing on it. It wouldn't take them that long to tell you no." And he confesses to holding it up to the light and trying to see what it said so he knows whether to get into consolation or celebration mode. He couldn't tell, but it makes me smile just to know he tried. I would do the same if the roles were reversed.

"Nah. They wouldn't bother sending just a single page letter for anything good."

"So open it already!"

And under his intense gaze, I did. My face gave something away even as my brain demanded a second reading to be sure. There it was, an invitation to interview. Holy smokes, somebody might want me, somebody thinks I might be good enough to make life and death decisions about the medical care of healthy and sick people.

K is grinning, "Told you so. I told you all along. Have some faith, of course they want you."

The rest of the night was disbelief and anxiety. A couple calls to the family so they could hear it before they read it here. So there it is, an actual interview - I made the initial cut.

Venting in progress (teakettle whistling here)

Augh!!! I don't wanna do it any more!!! Screw you guys, I'm going home!! Oh yeah, I'm already home, but still... I'm sick and tired of dealing with people who continue to send annoying emails complaining about work I've done and things that are yet to do and for whom nothing is ever good enough. I'm not allowed to make any independent decisions, do work that actually reflects my training and interests, and am generally being treated like a slow or special 12 year old with a history of goofing off. Which, quite frankly, makes me want to behave like a slow or special 12 year old and goof off. K and I went out for greasy cheeseburgers for lunch so I could calm down a bit and actually accomplish something in the afternoon. Yoga tonight helped too, so now I'm more angry than furious and I just need to figure out what to do.

I'm wavering on the fence for quitting the office job entirely. Part-time there pays more than full-time on the ambulance, but at some point I'm just not going to put myself through this anymore. It was why I wanted to make a change in the first place - but how do I justify cutting my finances like that when I'm not even in school yet? I think the idea of leaving is probably better than the reality, but the possibility is tempting...

Station life

I worked a reverse 24h shift this weekend and there are times I think everyone in the station needs some serious time on a therapy couch. There are other times when it is just too much fun to be concerned about anyone's mental health. I've heard many fire departments where people say they are "like family" and they spend many shifts together, year after year, so maybe that is true. In the ambulance station, I think we're more like the delinquents in detention after school than any sort of family. Full-time ALS partners work together at least 3 of their 4 shifts and most are together all 4. But the combination of partnerships that is on-duty any given day in the week changes, as does the entire atmosphere of the station. The staff turnover and vacation/shift swapping makes for a fair amount of variety in staffing. Each supervisor also influences the type of acceptable behavior, much like your favorite teacher in school who used to let you get away with goofing off in the back row sometimes.

Saturday was busy early on, my truck did four calls in 3 1/2 hours and when we finally got a break it took my medic over an hour to get caught up on paperwork. We only saw the other crews in passing at the hospital or as we passed each other on the streets. When we finally flopped back at the station, the weekly card game was well-established (not poker), some edited-for-TV movie was playing and the usual insults were flying. The supervisor was out roaming around giving everyone a hard time about non-work related stuff and in a decent mood because February scheduling was already finished. On Saturdays I'm nearly always the first to bed and this week was no different, the exception being that the city population decided they didn't need too many ambulances overnight so I only had to get up once to run a call that ended up being a no transport anyway.

Sunday brings in a new supervisor, three out of four new crews, two transfer trucks and a whole different personality. Station chores were in progress immediately following truck checks and the whole place was spic and span practically before I stopped staggering around with my eyes closed. Since call volumes are usually much lower on Sundays, people seem to take the effort to be slightly nicer to each other. Don't get me wrong, there is still a large amount of harrassment that goes on and this week was my turn early in the day because I had parked the ambulance slightly askew in the garage. For the next couple hours, it was more like a car wash than an ambulance station as five ambulances and at least five personal vehicles were cleaned and shined.

Eventually, someone suggested a movie and we watched The Descent. I didn't see the middle 30 minutes or so, but I didn't miss much. I came back in just in time for the creepy-crawlies to start jumping out from every nook and cranny and for the day's entertainment...one of the transfer crew was jumping and screaming every time something even halfway scary came on the movie. At one scene, she actually screamed a second time before the first scream was all the way out. The rest of us, including her partner, spent the rest of the movie and the day scaring her and laughing. Some folks were highly creative about it, others just took advantage of the fact that her back was toward two of the crew bedrooms. Of course, with the turnover in calls, everyone missed some part of the movie, so I actually saw the last 30 minutes or so three times and I think I could've been in the cave at that point and not been scared.

End of shift was fairly calm, my truck was next out and we managed to make it all the way to 1700 without getting sent out last minute. New crews started trickling in and there was another palpable change in atmosphere as one started complaining about the fuel in the truck with the supervisor playing his imaginary violin and it was a good time to be clocking out and heading for home.

Diff breathers and a lesson on drinking

Saturday's shift was a day of difficulty breathing. We ran three calls in a row for difficulty breathing, one of them dispatched as a fall. Good day for the students that were riding though because they got to see some seriously sick people.

The last guy (who had supposedly fallen) was sitting in his chair doing the puckered lip, accessory muscle breathing when we arrived. Poor guy couldn't even get a word out he was working so hard to breathe. I'm not sure what, if anything, he told 911 but he hadn't fallen, just couldn't breathe. We got his O2 up to 92% after the duo-neb and solumedrol, but every time he took the mask off his face for even a couple of seconds, he was back down in the low 80s. I don't have any follow-up about him, but I'm hoping maybe they got him a bit more squared away so he could go home instead of to a skilled nursing facility.

The medic I was working with has been around for quite a while and has his stuff together so we were hustling around working more like a real team than the usual tripping over each other that happens with people who've never worked together. It made for a good day and I think we taught the students a few things while simultaneously shocking them about the pace that patient care can move when people know what needs to be done.

We were also on together for the overnight transfer shift which went smoothly, but held us over three hours in the morning while we transported from tiny community hospital to an academic medical center. 19 year old out drinking with friends (BAC more than twice the driving limit) and fell over from a standing position. Patient managed to achieve a basilar skull fracture and epidural hematoma, but still walked into the hospital with friends because someone was sober enough to realize that bleeding from the ears is probably not a good thing. Patient posed no major problems during transport, but it was 50 minutes to the little hospital, 90 minutes from there to the next hospital, and over 90 minutes back, so when you get dispatched at 0500, you aren't going off shift at 0700 as planned. Still, I found it fairly impressive to have a skull fracture from a fall at standing height - makes me glad all I've been doing is bruising my hips when I fall.