It figures

K and I are currently a bank check away from starting a kitchen remodel. And by "starting" I mean actually ordering the cabinets and such and waiting the 4-6 weeks for them to arrive so we can start my personal hell of home remodeling. So of course, yesterday the counter top microwave decided to shoot blue sparks and try to burn down the house. Being the good firefighter he is, K decided to shut it down and unplug it so there wasn't actually a fire. After reconsidering, he kinda wishes he'd let it go a bit and burn some of the ugly cabinets so that the insurance would cover some of the remodel, but I'm not a big fan of insurance fraud nor potentially out of control fires so I think he did the right thing.

The new kitchen layout includes an over the range microwave to save some counter space. The current cabinet over our range is too big to install a microwave there. No other cabinet in the kitchen is actually 30" wide and NOT over the only available counter space in the kitchen. As far as I can find on the internet, it is verboten to set an over the range microwave directly on to the counter top.

I'm the type of girl that really can't go 8-10 weeks with no microwave, my favorite food is anything K already cooked that I can just zap quickly. So I guess I'm going to have to take the Asian up on his offer of one of their spares at a reduced cost. Just figures that it would break now though.

Irritant

It is like a medium sized splinter under your skin on your index finger, just in that spot where you hit it every time you use your hands. It is too deep to pull out, you have to wait for your body to react enough to push it out where you can reach it OR you have to dig, poke and prod with a needle until you make a big enough hole in your skin to get it out. Red, inflamed, irritating. Yeah, just like that.

My current splinter? Salary. Specifically, what I'm being paid relative to other individuals in the company with similar levels of experience and seniority with the company. If I'm being paid $x/hr, there is a guy with approximately 2 months more experience who is being paid $x+2/hr. I've talked with a number of EMT-Is in the company, who have all been open and sharing with me, and the salary inequities are startling and upsetting. There is a woman who has 3 years of experience who is making $x+.50. Only 50 cents more than I got as a new EMT-I out of school.

In talking with a supervisor and some senior employees, everyone suggests that I should go to HR and ask them to evaluate what I'm being paid. And that if I'm not happy with what they suggest, I should go to the director of the ambulance co. So here's where I have the two painful options, my yearly evaluation is in November and they usually try to address salary issues at that point, so I could wait and see what they come up with. But evaluations are frequently not completed on time, and my official "evaluator" is out after just having a baby. Or I can dig and poke and try to get money from the company now so that any pay increase I get next month (which are usually percentages) will be based on a new salary, or they'll stiff me entirely because I just got more money.

I don't know what I'm going to decide, but I do know that it is annoying and I'm bumping into that sore spot every time I go to work.

¿Habla íngles?

At least 3 years of high school Spanish and one year in college aren't going to waste. I've had a string of patients lately that only speak Spanish, or little enough English to be unable to communicate. I'm able to remember enough to impress my ambulance partners and thoroughly confuse my patients. I knew a fair amount of conversational Spanish, and as I need phrases I've tried to learn them. But really, I don't think my high school teacher ever expected me to ask, "Does the pain move anywhere around your body or stay in one place?" K is also taking an introductory Spanish class because he's encountering patients he just can't communicate with and it is hard to help people when you don't know what is wrong with them. We do have access to language line, a telephone translation service, but it really is easier if you can just talk with the patient yourself.

Also inconvenient is the need for trying to ask questions in multiple ways. For English-speaking patients, I'll frequently ask a question, get an answer, move on with some other questions or information and then come back to ask the question with a different phrasing to make sure I'm getting consistent answers. When I come up with only one half-baked translation for a question, I'm unlikely to try it again unless I think of a better way to ask it, so I'm never sure I've gotten quite all the information.

The last patient like this had been working on his car when it fell off the jack and crushed his arm underneath the wheel (not the tire, the metal wheel). Nobody on scene spoke English. Myself and one firefighter spoke some Spanish. I was able to get enough information out of him to give a decent radio patch to the hospital and a reasonable report to the triage nurse. Unfortunately, they didn't have a translator available in triage, so I was trying to ask some of her questions too, "Have you ever smoked?", "Do you drink alcohol every day?", "Who is your primary care physician?" with about as much success as I had in the ambulance. What really made me laugh though - when I returned to registration to try and get his demographic information, there was a fluent Spanish speaker working with him on that and nobody thought to ask her to help us out in the back.

Quick points

I have so many things rattling around in my noggin to write about that I don't want to forget, so here's a quick update on the things I may write about later.

• Is there something wrong with you when the most jaded and detached people find you strangely unmoved by a difficult ambulance call? Call was for an unconscious infant, updated en route to CPR in progress, ultimately a death from unknown causes. I was on an overtime shift and we had a paramedic student with us who had never seen a code before, much less a pediatric one. Medic later told stu, "Don't worry, these are hard calls. Not everyone is as unemotional as she is." Thankfully, I'd already had a conversation with stu about the call, so I think he knew that wasn't really the case. I do seem to be attracting bad calls lately though.
  

• I don't normally give you much information about my reading choices, nor endorse or pan books I've read but "Isolation Ward" was great. I find that I enjoy novels, shows or movies that have characters I can relate to or ones I could imagine myself as and this book really hit the spot. I also enjoyed "Iron Ties" which is the second book in the series - as usual I read them out of order, so I just finished "Silver Lies" and I'm glad I started with the second one because it was much better.

• The fire station had open house on Friday and K was dangling from a rope as part of the big show to impress the kids. I'll try and post a pic later.

• We've got company in from out of town for a couple of days from MI, so we're hitting up some of the local highlights. Every time people visit, we come up with more things to see so eventually we'll actually be able to have suggestions for folks.
  

Arrests

Personal experience with ambulance staff on either cardiac arrests or trauma calls are one of the biggest reasons people give for deciding to pursue EMT training of their own. But once you start working more than a couple of cardiac arrest calls, they really aren't that great. Here's the run-down of the past month's trifecta of arrests.

The first one was the bystander witnessed, clutch your chest and teeter over type of arrest. ZM and I arrive to FD doing CPR after using the AED, and when we got the patient on the monitor there was nothing but asystole. We went through the whole arrest protocol, even getting to use the IO when IV access wasn't readily available. Nothing resembling life ever made it back to the patient and the hospital worked him for less than 20 minutes before pronouncing him dead. So, a whole lot of sweat and work summed up into the same outcome as if we'd never shown up.

The second one was with the Asian and the medic student riding with us. Called for mutual aid to a neighboring town for a cardiac arrest at a nursing home. We're debating on the quick ride over (this part of their town is closer to our station than many parts of our town) whether the patient will be "workable", i.e. will the medic student be able to do any of the skills he needs to accumulate? On arrival, we load up for a presumed arrest, backboard, monitor, drugs, first-in, 02, and I think someone may have grabbed the stretcher at some point. We and the FD stampede into the room and are brought up short by the vision of our patient lying peacefully, eyes closed, on the PT bed with a nasal cannula and the staff standing around looking at him (nursing home version of Folded Arm Observation technique). What the ?!? Since nobody was doing CPR, I asked if the patient had a pulse, and yes, he did. Not so much a cardiac arrest. In the end, the story was an initial complaint of chest pain, 2 NTG followed by a fainting. He did come around a little in the ambulance and I'm still not entirely sure why he was not able to respond to commands initially, but I believe he ended up okay.

Third one was again with ZM (who now thinks I'm bad luck because we've had one each shift). He's grumbling at me about the amount of work this is going to be, patient is on the fourth floor, it is again unseasonably hot, etc. etc. We arrive to find a FF walking back out to get his SCBA so at least one of them can enter the place against the smell; one other was gagging in the hallway. Apartment manager went to post the eviction notice after non-payment and complaints of the smell, and for whatever reason, opened the door. This patient was long past saving. When people rot, like any other meat, they acquire maggots, and then flies. The description here was "condominiums of flies". We don't know how old the patient was, or even the name, nor how long he'd been dead.

Application process

Tomorrow's the day for my first medical school interview of the season. I'm slightly less nervous this year than last, just because I've been through the process at this particular school before and it is the one I'm most familiar with anyway. I'm still a bit twitchy to make a good impression and actually get in this year, but that usually works to my benefit.

The more frustrating part of the process are the schools which either STILL show my application as incomplete, or have given me no information on where I stand. It drives me nuts not knowing whether they are even looking at my application yet. Admissions offices do not answer their phones, shunning the applicants directly to voice mail which they never reply to. One of the programs I applied to last year confided that they do record "contacts" like those in your application file for consideration.

Someone outside the process confided that another applicant she knew was engaged in a "postcard campaign" of trying to get off the waiting list into the admitted class by sending some form of correspondence every couple of weeks. I would find that incredibly annoying if I were on the admissions staff, but apparently it is a process with reasonable success. I'm trying to decide whether I have the fortitude to begin such a process now when I don't know whether they've even gotten to my application.

In many cases, it is nice to not be a student during this process because I have more freedom with my schedule and more energy for following up on loose ends. But right now, it sure would be nice to have some distraction from the fact that I'm back to waiting, checking email again and again, heading to the mailbox as soon as I hear the mail truck, checking for voicemails, and just generally acting like a lovestruck idiot.

Officer down

For pure sphincter pucker, this call probably runs neck and neck with the infant cardiac arrest. Of course, because I've suddenly developed into a black cloud, I wake up to this dispatch at 0300. I'm on a long-term swap for one shift a week working with ZM, so no Asian with me tonight. I'd already been up for a minute or two and walk back into the bunk room to get my vest and make sure my partner is moving just as the dispatcher gets to the "officer down" part. "That's not good." "Did she just say 'officer down'?" "Yup." "Shit." "Yup."

As we come around the corner and head the last couple blocks to the dispatched intersection, all I can see are cops. I had no idea there were this many cops on duty in the city at 0300 on a weekday. Cops at every corner waving their flashlights down the street. Bicycle cops, patrol cars, unmarked cars, I think the only thing we were missing was the horses. I hope they left someone at the jail with the prisoners. Update from the FD as we're pulling on scene was for a shoulder injury. One FF pulled opened the passenger door to the ambulance to get me outside and begins rattling off information. Before he can even finish, I turn around with the first in bag and get nearly run over by the push of people herding the injured officer into the truck.

Just seeing the officer in question walking, talking, and joking was a massive anxiety-reducer. It turned out that there was a foot pursuit of a suspect and when the officer tackled him, he strained his shoulder. I rode with him up to the hospital and was able to sing the stripper song for him when he got in the hospital room and started removing more uniform pieces. He laughed and played along. Not too bad for a guy who has been on the force about half his life.

ADDED: Yes, I know this is the sixth anniversary of a relatively huge event in American life which directly involves fields that K and I work in, but I struggle with the inappropriateness of a lot of the memorials and I'm not going to add to that clutter. Maybe sometime I'll write about where I was and how I experience that event, but not today.

COD unknown

Our company allows ride-alongs of several types on the 911 trucks. From new employees to EMT students to athletic trainers to interested observers, you never know who is going to be riding. This particular day, we had an ER nurse who is considering applying to a flight program and wanted to know more about "street" medicine. Also in-house was our chaplain, but we don't ever take two riders on one truck.

One of the most terrifying types of calls gets dispatched to our truck "4-month old, cardiac arrest". Everybody hops in (after the nurse and chaplain fight it out for the backseat, we get the nurse), I'm driving because The Asian wants the short ride to straighten his thoughts and mentally review pediatric doses for the ACLS drugs. We're hauling ass across town even though these kinds of calls go two ways. We arrive, everyone is fine and there was some sort of overreaction, maybe we transport, maybe not. Or, we arrive, there are lots of panicked people, many screaming or shouting and a rapid transport.

This call is one of the latter. The nurse grabs our pediatric bag out of the back and takes off towards the building, only stopping when she reaches the door and realizes we aren't behind her. The Asian grabs the cardiac monitor and oxygen, shouts for me to grab the med box and the first-in bag and we all head to the building like a stampeding herd. Before we get to the first floor apartment, a firefighter appears carrying the baby and running toward us while trying to perform CPR.

A blue baby being run directly to you by a man who looks relieved to see that help has arrived is one of the most terrifying things I can imagine on the ambulance. "The baby's still warm!" Two more breaths in, then he tries to hand the baby over to The Asian, who immediately calls for a rapid retreat to the ambulance and tells the FF to keep doing CPR on the way because we're going to need his help. The next few minutes are still a blur to me. I know an incredible amount of stuff got done, a decision was made about transport, another about who we were taking, then I'm back in the driver's seat heading back across town as fast as I can convince people to move to the right or at least out of the way.

I catch pieces of conversation from the back, hear the IO go in, drugs being administered, the confirmation of asystole on the monitor. Somewhere along the trip, despite their advantage of an opticom to change the stoplights for them, I lose the engine which was tailing us - in their defense, I don't have to haul a couple hundred gallons of water up the hill to the hospital. En route, I have to patch to the hospital while trying to drive, not an easy task but accomplished well enough I suppose.

We pile out at the hospital and walk in to a strange sight. Normally when you call in a cardiac arrest, security is waiting for you at the door, the first trauma room is open and there is an accumulated crowd in the room. The trauma room is closed, we continue down the hall and find a nurse and patient family standing in the hall and everyone looking as though there is nothing special about us getting here. The Asian hollers at me, "Did you even call THIS hospital?" Yes, I certainly did and finally when we get to the nursing station, someone points us to the second trauma room and there is the crowd we were expecting. I'm pretty much just in the way at this point, so I take as much of our equipment as possible out of the room to make space.

I wish I had a happy ending to this, but the baby was dead before we arrived on scene and we didn't change that fact. The hospital we transported to was the one our riding nurse works at, and we hear later that the baby had a 105 degree temperature at the hospital which is fantastically high considering that was a minimum of half an hour after death. We find out this was the first time the nurse had ever done CPR on a real patient, and we were lucky to have her with us because she was helpful and not panicked. We're trying to follow up with the medical examiner to find out autopsy results, but the EMS system isn't really designed for this, and the PD are usually pretty quiet about the results of their investigations, so I don't know if I'll ever know what happened.