He has a what?!?

He had a pulse folks. Un-freaking-believable. I was beginning to think that the whole "CPR saves" mantra was solely effective marketing by the AHA. Blah-blah-early CPR-blah-blah. I was finally on a call with a patient who went from asystole back to a perfusing rhythm.

The Asian, the stu' and myself were dispatched for a cardiac arrest. Nothing like that dispatch to put a spring in the step of a stu; he nearly ran to the truck. Workable arrests are highly prized for paramedic students because it gives them the opportunity to practice a number of skills and have procedures checked off their list all in one fell swoop. The usual review of what equipment to take in and our division of responsibilities happened on the ride over. Update enroute with CPR in progress.

On arrival, we find out CPR had been in progress from pretty much the moment the arrest happened because there was an off-duty city FF on scene. The engine crew took over when they got there, no shock advised on the AED and they had a good combitube airway, so this patient was getting everything he should be and mighty fast. Our stu dropped an ETT, I got the IV and the first round of drugs into the patient, patient on to a backboard, onto the stretcher and out to the truck. Transport initiated within 10 minutes. More drugs and an IO enroute and just as we're pulling into the hospital parking lot, he has a pulse.

I get to the back doors to help pull the stretcher out and am surprised to hear the good news. We roll the patient inside and The Asian starts giving report as the rest of us are working on moving the patient into the hospital bed. I look up and see a nurse doing chest compressions and loudly state that our patient has a pulse because clearly she missed that part. Thankfully she only got in 3 or 4 before I stopped her, CPR on a living person is not so good for them. Doc gave us the thumbs up for the good work. Update before the end of shift (6 hours) was that patient was in the ICU and had actually opened his eyes at one point. I haven't been able to check in again to find out whether he had any brain injury from the arrest, but as far as I know, he's still alive.

Open letter

Dear admissions offices,

I recognize that crushing people's hopes and dreams is just part of the daily routine for your office, but I request that you have a little bit more consideration as to when it happens. Applicants all want quick decisions so they know what to plan and prepare for. I would just like to ask that you please not send rejection letters on Christmas Eve.

I'm not a particularly religious person and I don't always get to spend the holidays with my family, but that doesn't mean that I would like my Christmas celebration ruined (two years in a row) by feeling worthless and depressed about not being accepted to your program. Obviously, I think you have a good program that would be worth going hundreds of thousands of dollars in debt to attend. Please just wait to destroy my self-worth until after the holidays. I propose that you not send rejections between December 23 and 27.

Thank you for your consideration.

Jen

Kitchen update

Okay, I was going to post some more pictures, but if you get to the end of the slide show, you see where the camera gave out. Good news is that it is a known problem for Cannon and they are going to fix my camera, no charge! (M&D - if yours is still hanging around, they'd fix it too.) Bad news is that now you have to wait to see pics, although I may try a few with the camera on my phone and see if they look reasonable enough.

Verbal update, all the cabinets are out, sink is out. All drywall will be finished hanging tomorrow (needs two of us to lift some remaining pieces). Plan is for first coat of mud/tape finished Saturday, hopefully second coat on Sunday/Monday. After that, primer + texture + paint ceiling, replace the rotted piece of subfloor which was under the sink, and on to tile! No timeline yet for finishing, too much left to do and too many variables for work that will take two of us vs. work that can be accomplished with only one home and all the conflicting schedules.

Re: feedback on the format not lining up properly in IE - I tried changing some of the widths and nothing seems to make Exploder happy. Try Firefox.

Quotable

Sometimes patients say hilarious things. Sometimes the entertainment comes from somebody else on scene. The Asian had the misfortune to be the source of this story, and I will now tell it to anyone in the station who hasn't heard it - every time he gets on my case for something. Dirt is good.

On scene with PD and an extremely intoxicated "psych problem". Eventually we get the patient heading down the stairs, The Asian in front and me behind. On the way down, The Asian asks how much the patient has had to drink. Patient replies (every one in the field knows this answer!), "Two." "Two what? Beers? Cases?" PD comments that the patient prefers vodka. Patient answers, "Fifths."

Asian decides to be funny, "Two fifths?! Why didn't you just drink the whole thing?"

Upon realizing that he honestly doesn't realize that two fifths means two whole containers of vodka (The Asian doesn't drink), I try to contain my giggling while explaining what the patient meant. PD wasn't quite so polite at containing the guffaws. Later, I find myself additionally amused that my partner really thought the patient could do math in that intoxicated condition.

Sanity, stage left

Wait, is that my left or your left? I don't see it over here, maybe I left it over there? Under that? "Honey! Did you move my stuff!?!" Crap, it's gone. Sob. I know it's here somewhere, but I don't know if I'm ever going to see it again.

One of the fundamental tensions in our house is my stress-related cleaning and K's need to have everything laying out everywhere. The long-term compromise solution has been that he will keep stuff in "piles" and I will try not to move the piles too far. Anything not in a pile is fair game for being put "away" in a place of my choosing. I try to put things away in the same place, but sometimes I forget that last time I put that mystery box in his bedroom closet and the time before I put it in the coat closet.

K believes this rule null and void during construction projects, and if you asked him, it probably just shouldn't apply to tools at all. So, every minute I'm home, I have to step over tools, around broken cabinets with sharp nails and splintered wood and try and keep a running tally of where (across 5 rooms) we put everything that used to be organized in the kitchen. I made a trip to the dump the other day and managed to throw away at least 3 things he "wanted to keep" or "could put back together". I'm not to clean anything. Watson can't even play because there is no room to throw a toy. Cabinets are supposed to come tomorrow and I don't even know where we are going to put them.

K did not appreciate my attempt at humor when he excavated his ski patrol equipment from a hidey-hole and offered "if there's anything you don't need for a while, I made some room" and I suggested that he wouldn't fit in there.

Monday night

With a room full of NE Patriots fans, I was up rather late for MNF anyway and crashed in bed for about an hour before the call went out. One of the ambulances was being dispatched as part of a second alarm on a house fire. Less than 15 minutes later (0240), ZM and I were being dispatched to the same fire.

On scene, we were sent to post near the engines so there would be staff and equipment (but not the truck!!) nearby in case they found the resident still unaccounted for or in case there was a FF injury. Yesterday was also our first big snow, over 6" in the city, with temperatures dropping to the low teens overnight. While we were standing outside. Eventually, we were on 15 minute shifts with the other ambulance staff so nobody would freeze to the sidewalk.



I think the photos tell the story of the FD work better than I could, but not too much left of the house when our relief got to us at 0740. Rumor was that the 15 cords of wood in the basement made the excavator necessary to knock down enough walls so they could reach the basement. Final word on the missing resident was a fatality after he returned to the basement for something he would not leave without. All FFs were coated in a thick layer of ice and seemed to be enjoying themselves. The most helpful we were was ferrying an engine crew back to their station. Otherwise it was 5 hours of freezing boredom, and a free donut and hot chocolate from the Red Cross around 0645.

In the beginning...

...there was a kitchen. An older, dirty, but functional kitchen. Then an alien mind-control device, contagious psychosis, or some other unexplained phenomenon took over our house. Suddenly, making the kitchen less old, less dirty, and more functional seemed like a good idea. Weeks, perhaps months, of being nearly unable to cook or eat in my own house. "A minor inconvenience." An extended period of dust, dirt, debris accompanied by hammering, sawing and all manners of loud noises. "Sufferable."

Now, staring at bare insulation, naked wire, raw wood, and empty cupboards, I'm beginning to feel as though my period of temporary insanity needs to be extended into purposeful amnesia so I don't have to remember any of this. But I will post pics for you all to enjoy, click on the caption box at the bottom to see the dates and descriptions on the photos.

Eeny-meeny-miny-GO!

Dispatching for the FD used to be a relatively simple process for the ambulances. There were four ambulances, numbered 1-4. They were dispatched in order, usually. If ambulance 2 responded to the last call, 3 would be next. Fairly simple system, easy for ambulance staff to keep track of. You could guess whether you might have time to grab some food, perform larger maintenance tasks like changing the main O2 tank, getting fuel, or whether it was even worth trying to catch a few minutes of sleep. Those days are over.

Recently, we've changed to a GPS-based system. Each call is dispatched to the closest ambulance, or if all the ambulances are in quarters, to the ambulance which has been in service the longest. This seems a reasonable theory, reducing response times by sending the nearest ambulance, or the one who finished up the last call quickly. The problem is that this produces two escapes for ambulance crews who would rather not run calls. 1) Go to an out of the way location so you aren't closest to anything. 2) Wait as long as possible to put your truck back in-service. Both of these options shift extra calls onto other crews.

Now, we never know which call is going to be ours. Even if you hear the other calls, you would have to keep in mind where they were, if and where they transported to, and so on. What was an easily trackable system has changed to a big game of tag. You're "safe" while occupied on a call, but as soon as you tell dispatch you are available, you're "it" and trying to get from the hospital back to quarters without getting "tagged" for another call.

I go to work to do ambulance calls, so it would be rare to find me complaining about doing my job. But at 1700 for shift change, this entire dispatch system can make it very difficult to get out of work on time. The Asian and I got stuck the other night, one call at 1650, cleared the hospital at 1720, next call (when we were two blocks from the station) at 1730, cleared the hospital at 1800, next call (when we were 6 blocks from the station) at 1810, cleared at 1820 and made it back to the station at 1830 to get the evening crew on the truck. I can guarantee that our 1810 patient did not get the same caring ambulance crew that patients earlier in the day saw as we're fighting to make it home.

Action hero?

Which Action Hero Would You Be? v. 2.0 created with QuizFarm.com

You scored as Lara Croft A thrill-seeking, slightly unscrupulous, tough-as-nails archaeologist, Lara Croft travels the world in search of ancient relics perhaps better left hidden. She packs two Colt .45s and has no fear of jumping off buildings, exploring creepy tombs, or taking on evil meglomaniacs bent on world domination.

Shopping success

Sometimes, success is a matter of knowing what you want and limiting your expectations. K and I usually go shopping together on "Black Friday", 5 or 6 am will find us waiting in line in the cold for some good deal. We do a fair amount of our gift shopping and at least as much buying for ourselves. Everywhere we went, we were early enough to get the specials. Anybody still wondering for what this year's "it" gift is going to be, I think I can pretty conclusively tell you it will be GPS navigation systems.

Today, I think we topped ourselves. I believe total spending was in excess of $1600. Of course, $999 was for the 46" LCD HD TV we waited in line at 4:30 at Sears for. Temperatures dropped last night and the wind picked up this morning, so the crowd was pretty much huddling for warmth. I didn't see any trampling, but we didn't go to ToysRUs or WalMart, both of which had some vicious crowds.

K also bought a compound miter saw, an 18v cordless drill, and a compressor with nail gun. All for the kitchen project, of course. At least that store didn't have much of a line. I think the manager there is going to know K personally before this entire project is over. So new TV and new tools = happy husband today.

Assault

Apparently, sometimes you can bring a bat to a gun fight and win.

Last night ZM and I went for an assault call. On arrival, we see our patient lying face first in the grass, handcuffed and not moving. This is not good. Normally, even if they've been arrested, patients are still moving their legs or heads and more frequently, they are still hollering and putting up a fuss. Relief washed over me when a few steps out of the ambulance I see the patient move his legs and generally look a little more alive.

When we get over to the patient, PD informs us that he had been attacked with a baseball bat after trying to break into an apartment near by. This was not a couple of timid swings to the body either. Looking over the patient, you could see multiple impacts to his head. He's still conscious and talking, being reasonably cooperative, but not really aware of what happened or what is going on now. As we are getting him secured to the backboard and moved to the truck, we hear a few more details of what the cops think happened.

Patient broke into the apartment carrying a shotgun and a pistol. Pair of brothers are home in the apartment, one downstairs, one upstairs. Brother downstairs gets a hold of the shotgun and is trying to wrestle it from the patient when brother upstairs comes down with the bat and gets a good crack at patient's head while both hands are wrestling for the gun. Patient continues to struggle, more hits with bat, brothers end up with both guns and patient runs for it. PD called in the midst of all this chaos while patient still in the apartment. Patient makes it about 5 feet out the door before collapsing and being met by PD.

Ultimately, patient gets two large IVs, O2 and assessment from us, then a quick trip to the hospital. Less than 3 minutes after arriving, patient has a seizure. Seizures after head trauma are generally a sign of a pretty severe brain injury. Patient gets medicated, intubated, and has his head scanned. Results were a depressed skull fracture, subarachnoid bleed, multiple brain contusions and a broken jaw. Too bad he'll never remember the helicopter flight to a bigger trauma center, it was a nice night for a flight.

p.s. Not relevant to the story, but we've got snow on the ground today...winter finally made it. Kitchen cabinets to be delivered the week of Dec 10th. Electrical panel to be replaced this week. I have way too much shopping to be done on Black Friday.

Day of good deeds

Recent shift consisted of:

• Help a half-naked man (not the socially acceptable half) back to wheelchair after falling on the floor.
• Search for a person slumped over the wheel of a parked care (not found).
• Transport the least injured person from a car accident.
• Carry an elderly woman upstairs after the FD got her out of the broken elevator.
• Bandage a kid with a head laceration, then lead his mom to the hospital so she didn't get lost.

Weird day, only 1 transport and the rest just driving around helping people. Not bad, just odd.

Also, favorite diagnosis from an ED doctor recently "Acute exacerbation of chronic crazy."

Lobotomized lab rats

are smarter than my last two patients today. I'll just tell you that they were passed out in somebody's front yard (at 1500!) and leave you to fill in the rest. These are the days that make me wonder why I decided to do this.

Also, we now have Ativan, Zofran, and Toradol on our trucks and the medic student even got to use one today.

Updates

• I addressed the salary question with HR and they "investigated" and decided to up my salary to $x+0.30/hr retroactive to April, then $x+0.92/hr after my evaluation this month. Because I'm a "valued employee". And I'm now sworn to the confidentiality of my new salary to help support morale...ha!
  

• K and I decided to buy the new microwave now and rig up a temporary set up to use it until we can officially install it. We aren't using the convection oven settings now because I'm not sure how the heat gets vented, but I'm guessing that 3" of space underneath probably isn't enough.

• The home equity loan isn't closing until next Wednesday, so we're trying to figure out whether we're missing out on any good sales if we wait that long.

• I've been sick for the last two days, achy and miserable. Strangely like the flu I'm not supposed to get because of my flu shot. No respiratory symptoms though, and that is usually the first thing I come down with when I get sick.

• I checked in with the school I interviewed with in September and I'm still on the no decision made list.
  

Recipe for confusion

Ingredients:
1 dispatch, "Meet PD for psych problem"
1 caseworker outside building
1 naked patient
2 unhappy cops
3 people on the ambulance (1 student)

Apply dispatch to EMTs, stir gently for 3 minute response time while student verbalizes potential patient scenarios. On scene, add caseworker. Allow complaints of patient medication non-compliance, conditional discharge, and other caseworker jargon to saturate EMTs, eventually requiring them to be rude and ask for entrance to the building to assess patient. At apartment, add 2 cops to a separate dish, laughing at EMTs and being grumpy for getting dispatched to a medical call where they had to request an ambulance. Add sweaty, naked patient, breathing heavily, answering "yes" to all questions. Wait patiently while EMTs stick to floor, seek clothing, dress patient, continue to be mocked by PD, attempt to get non-jargon information out of caseworker, and walk patient down stairs. Place PD aside for potential use in different recipe. Place mixture in ambulance, find out patient is schizophrenic with violent hallucinations, caseworker knows nothing further about medical history, knows nothing about what medications patient takes. Continue assessment, find blood sugar reading "HIGH" on glucometer. Agitate gently for 4 minute transport to hospital. Remove from ambulance and deposit mixture into ER room. Serves 6-8.

Sounds tasty, no? This entire call left me completely confused. The patient was trying her best to do everything we asked of her, so I was fairly irritated with the caseworker complaining about "non-compliance" when there was clearly a bigger problem going on. No known diabetic history, but this patient was in DKA (diabetic ketoacidosis). We missed it initially because there were so many funny smells in the apartment and we had been focused on psychiatric issues. At the hospital, they intubated her immediately. We later found out that she was also in renal failure and had some sort of fungus in her blood.

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.

Weird

0400 call for chest pain, not far from the station. It was a reasonably slow night, so we were actually sleeping, but less than 4 minutes to get there from dispatch. The door was answered by a woman with a tracheostomy who was still on the phone with 911. She leads us down a hallway to a man in bed. She points us to him then wakes him up.

Everybody catch that? We were called for chest pain and she had to wake the patient up. And no, this was not the "shake and shout", patient circling the drain kind of wake up, he was sleeping peacefully.

Upon seeing us, the man begins to get annoyed. "That crazy bitch called you? I'm fine and I don't know what her problem is." When asked why she called she responds, "His pancreas is acting up." What?!? First point, pancreas does not = chest pain. Second, do you have some sort of special diagnostic capabilities in this apartment?

Man adamantly refuses transport or even any sort of evaluation, tells us and her to go away and let him sleep. Woman tries to talk us into taking him with arm gestures and eye contact. We refuse to kidnap him, she apologizes for disturbing us.

1200 call from ambulance co. management about "that call last night." Sorting through calls in my head, I don't even notice this one as a call that might result in a phone call from management. He asks open-ended what happened on the call. I relate the above (minus the commentary, of course). He sounds intensely relieved and I finally ask why he wants to know, did something happen? His answer, "It is a long story, but at the end of it, she's dead and it is a little troubling to have an emergency call for chest pain where we didn't transport followed by a dead body at the same address." She's dead? But the "chest pain" wasn't even hers.

I follow up with the crew that ran the second call and it turns out that there was a friend of the woman's in the apartment when they arrived. The friend was there because the woman had been making suicidal statements the night before. Woman was found surrounded by empty narcotics bottles, vodka and tomato juice. Was the first call a cry for help? I think not since there were several times she was alone with us and could've said something, but still I feel a little bad that there wasn't something more we could've done for her.

Been a long time

Hello again. I know, I missed you too. Yes, I'm a jerk because I never write and I never call. Sorry 'bout that.

I've been writing for quite some time now about EMT stuff with less about where I think I'm heading in life. Transitions take time, patience and an unending supply of optimism. I usually run 1/3 and have been feeling stagnant. I finished all this year's medical school apps, and just today got an invite for my first interview, so I feel like at least I'm moving again. Seven apps takes a lot of motivation to finish when there were some with 3-4 essay questions on them, including such gems as dinner with someone famous, motivation to be a physician, and personal unique contribution to the class. Blech.

I'm still working as an EMT and enjoying it. I have a new partner, "The Asian". Only in NH could you nickname someone like that, implying that they are the only one because here, he is. He's had that nickname for longer than he's been working for our company, so don't gripe at me about it. The 3-and-1 schedule has been quite nice. Company-level b.s. still happens on my transfer days, but at least it is only once a week. I remain pretty much a white cloud, but every now and then we get something interesting.

There is still unrest with family issues and for some reason I always let it affect me more than other people think is rational. Yes, TX is a long distance from here, so I don't have to get involved with the day-to-day difficulties. When it involves the only family I have, I give myself the freedom to be a little irrational at times. I had a period of two days where I was struggling just to keep afloat and the littlest negative comment was leading to overreaction and near- hysterics. Thankfully, I've now got the experience to be able to realize what is happening. It doesn't stop the hysterics but at least I know that it will pass.

Yes, I will try to write more. I'm toying with the idea of joining fantasy football, so that will eat some time, but now that I'm not volunteering with the FD any more, I've got a little more time. I do have another volunteer opportunity in the works, but it hasn't panned out yet...

A small fit

Okay, I admit it, every now and then I just get tired of being insulted, taken for granted, and generally treated as though I contribute little to the given situation. And then, I tend to create a scene. It used to be worse, the scenes were bigger and the injustices smaller - I've mellowed a bit with age. But there are still times when I have had enough.

My new shift started this week and hallelujah is it nice to only have one transfer shift because that is where I really tend to get cranky with the ambulance co policies, dispatchers, nurses, people in other vehicles, etc. This particular shift had been horribly slow and boring. 1600 rolls around and we're only an hour away from that delightful time known as shift change. Naturally, this is frequently the time of day when the 911 trucks get very busy. All four are out on calls, one of the other transfer trucks gets sent on a 911 call, and we get hit up for taking the next 911 call. One of the 911 trucks manages to get turned over and in service at the hospital before we get called out, so all looks good for a 1700 departure barring some sort of emergency transfer.

Then dispatch comes over the radio looking for the night crew on our truck to sign on because they have a call pending. The night paramedic is on one of the 911 trucks that is mid-call and the night intermediate is nowhere to be found at 1700. Another paramedic steps up and offers to take the call so my partner can leave, and we're digging through the schedule trying to find out what is going on when the night supervisor wanders through at 1705 and casually mentions that my relief is going to be at least 20 minutes late and continues past without offering any solutions. When asked to take a late call on a transfer truck, by dispatch, by a supervisor, by another employee with a schedule conflict, I have ALWAYS done it without complaint. Because I'm just that kind of person. I would want people to help me if I was in a bind, so I do what I can to help others.

Unwritten company policy is that if you're on a truck which runs 24 hours a day you can NOT, under any circumstances, leave before you're relieved by someone. Which means I'm now on the hook for this transfer. A BLS transfer taking someone from the hospital back to their home. There are two BLS trucks which are on shift until 1800, another ALS truck on shift until 2200, and the nagging question of what difference could it possibly make to this patient to wait an additional 15-20 minutes before being discharged from the hospital. But I'm not allowed to ask any of those questions under threat of disciplinary action, including termination. Set on a slow boil, I leave to do the call.

Now, just to clarify, I'm not especially mad at the person who is going to be late, she doesn't make a habit of it so there probably was some real situation going on for her. I'm not mad about how late I'm going to get out, it is an in-town transfer which will likely get me out of the station by 1800 or maybe 1830. What I am raging over is the assumption that it is MY problem that the incoming staff is late. That it is MY problem that the supervisors who knew she was going to be late did NOTHING to cover the truck, instead just leaving me on the hook. That my time has no value except when I'm bringing in money for this company.

The late staff took another vehicle over to meet us at the patient's residence so that when we completed the call, she could be officially staffing the truck so I could leave before anything else got assigned to that truck. This is toeing the line of policy that you never do a staff change during a call. But the call was my tech, so I'm not leaving until we're all the way done, so at least we're toeing the right side of the line. It turned out to be very helpful to have the extra set of hands because getting in to the residence was no easy task with the stretcher, the patient refused the stair chair, and it is flat out pouring buckets of rain. The late staff personally apologizes to me and thanks me for taking the call, and as far as I'm concerned she and I are square.

I head back to the station, to the supervisor who decided not to resolve this issue, and I'm none interested in concealing my opinions. So, I made a scene. In front of pretty much everyone who was on duty that night. Of course it didn't get me anywhere because the supervisor comments that his personal opinion is in agreement with me, but company policy is as described above. Now, I did alright at not saying anything that was explicitly going to get me fired. I managed not to dissolve into cursing and tried to maintain a reasonable argument that since I have no power to fire, discipline or otherwise control the on-coming employees, it should not be my responsibility to cover the truck.

Last words

Your Famous Last Words Will Be:

"So, you're a cannibal."

What Will Your Famous Last Words Be?

Okay, this little widget cracked me up to no end, thanks to MonkeyGirl. Three simple questions and I'm fairly sure they got it right. I was thinking about last words because K has had 2 deaths in his last 2 shifts at the FD. If there's any joke to be made about situations like this, you can guarantee they will be made at some point by somebody.

The first death actually seemed to have affected K in a way I haven't seen before. The fact that he's still talking about it kinda clues me in. The second one today was entirely different, but seemed to disturb him on a different level. I'm not sure how far to push him with this beyond just letting him talk about it when he needs to, but honestly I'm still annoyed with his complete lack of response to the last call that stuck with me (post still in progress on that one). He has a completely different reaction to these calls than I would, so I don't know what he needs and he sure isn't going to tell me. But I'm still working at it.

Happenings

I feel like I should always be apologizing for the lack of posting, but I don't think it really helps when I feel guilty about not writing. So just know that I've been hoping people read but I'm not willing to stress over something that mostly functions as an outlet for me.

Weather here has been AWFUL - hot, sticky, nasty. I moved away from VA to get out of exactly this type of weather in the summer but apparently not so much. Although watching the weather channel suggests that it doesn't matter much lately, as it is hot and nasty everywhere. Monday was a large thunderstorm (just in time to cancel softball, grrr) and the lightning hit very near our house, possibly on our property. Close enough anyway to fry the dog's invisible fence and the DSL modem. Many hours of phone calls later brings a new modem which works with my laptop and not the desktop yet. Naturally the provider's answer was to update the desktop - with files from the internet. Foreign accent man on the phone failed to see the irony in that. Tomorrow will probably yield more hours on the phone just to have them tell me that it is something wrong on my end and not their problem, they already transferred me to the computer manufacturer once.

I've been struggling to answer essay questions for medical school applications, hoping to get everything submitted this month. Trying to sound coherent or maybe even intelligent in between 250 and 1500 words about things as varied as "your motivation for becoming a physician", "biggest issue for medicine in the next 40 years", and "how you contribute to the diversity of our student body" is taxing my creative writing abilities. K keeps reminding me that writing nothing is worse than getting something together and sending the damn things in. Some of the questions have so many things I could say and just ramble on endlessly, others I just have no interest in - I don't want to have dinner with someone who made a major contribution to health or the human condition. I hate it when people talk on and on while I'm trying to eat, or spit food while talking, but somehow I doubt that this would be an interesting answer for the admissions committee.

There have also been some family issues going on that I'm not going to address right now, but it has been stressful and I'm not convinced my sister is actually on speaking terms with me right now. Little Z sounded like he had a good birthday, I wish I could've been there.

Oh, just in case you're wondering - the Transformers movie ROCKED!! I was a fan of the toys and cartoon as a kid, but not an obsessive one, and I was mostly looking for the movie to be a good summer movie and it was. There was enough story line to keep it moving. The only thing that would've helped is if we'd been able to sit a little further back in the theater, but that's what we get for deciding fairly last minute to see the sneak preview the day before the official release.

Today's my last 911 shift with MC and so far it's been entertaining. Abdominal pain, help PD pick up hypodermic needles out of the street, alcohol intoxication, and an overdose of unknown medication. The alcohol intoxication was a call from the PD for a woman they found peeing on the sidewalk who then passed out. One of the docs at the hospital had the quote of the night: "If you drop your drawers and pee on the sidewalk, that is a legal issue and you don't need a hospital. If you have uncontrolled urination while walking down the street, that is a medical problem and you should come to the hospital." Words to live by.

Stretcher ballet

Sometimes, you just can't share the humor in moments with the people involved. On a call where so much had gone wrong, we all needed a good laugh, but I think I'm the only one who got one.

Dispatched to the home of a frequent flier for 'cardiac arrest', on arrival he's not in arrest but is unresponsive, breathing inadequately and not protecting his airway. The firefighters on scene are performing the near-miraculous patient care technique known as 'folded arm observation'. Especially powerful tonight because there are four of them instead of the usual three. I give them credit for actually putting the pulse oximeter on the patient to make sure he wasn't in cardiac arrest before resorting to the FAO, but it is never encouraging to walk into a scene like that. They know this patient well, they've run full codes on him more than once and true to Murphy's law, not only does he have a full array of medical problems, he is a NOT small man.

BP was crap, SpO2 was low, no gag reflex. MC is after an intubation, sends me in for IV access. No go on IV. Second try at the tube gets us a fantastic vomit fountain of pink slurry due to esophageal placement. Two more tries for a ET tube leaves us pushing a combitube and making good use of the little plastic elbow attachment known locally as the vomit diverter. We finally decide to get moving, so the firefighters pick up the patient and head towards the stretcher. As they reach the hallway, they realize that the new guy had brought the stretcher in head-first while the patient is heading out head-first, meaning his head will be at the foot of the stretcher. We were loading him onto a backboard anyway in case we needed to do chest compressions, so I suggested that perhaps rather than attempting to deal with the issue in the hallway, they should load the patient as-is and we would move him when we had a little more room.

Out we go into the dark parking lot, throw open the doors to get the rear scene lights on, and now we have room to maneuver. The firefighters had done a good job of getting him out, loaded, and outside, so I decide to stay out of the way and let them reorient the backboard the proper direction on the stretcher and hop in the back to get some other equipment ready. This gives me the best seat in the house for the show. They do remember to unbuckle the stretcher straps and leave the backboard straps attached. The do lift him sufficiently to clear the railings of the stretcher. But somehow, in the large array of protective clothing, big pockets, and the assortment of equipment they each carry, they got hooked. They are pivoting clockwise with the backboard and the stretcher is pivoting gently beneath them. Keeping time with their every movement, defying their best efforts to fix the positioning.

Finally, the officer grabs the stretcher and yanks it 180 degrees releasing it from whatever was keeping them hooked. All of them look into the back of the truck where I quickly busy myself with something other than directly laughing at them. I know they heard me earlier and I know they heard me then. I did share a laugh with them about it at the hospital (MC took 2 with him in the back of the truck), so I know no feelings were hurt.

Oh, and in case you're wondering, patient was awake, tube removed and whining at the docs by the time we cleared the hospital. A little Narcan is good like that.

Movin' on up

A few new things happening for me...

I somewhere found the strength of character (and the $1000) to torture myself again with applying to medical school. I gave long and serious thought to whether I was willing to be disappointed again, whether I should retake the MCAT, what plan B was going to be if I don't get in this year, and where in the country I should apply since staying local didn't really pan out last year. I looked at a LOT of schools and ended up applying in the east and/or beginnings of the midwest (depending on who you ask). I really tried to apply to some schools out west but everything there is either strongly centered on in-state applicants (>90% of students) or located in California or both. I was advised to submit the application on the first day I could, so I am applying almost two months earlier this year. I'm still a little behind because I didn't realize AMCAS was going to have to re-certify my transcripts until I was all the way finished with the application, but I think that will still be earlier than last year.

Only two weeks left at the office job. The last project leader is having fits of anxiety about the transition because he doesn't like anything he's not in control of. Thankfully that has mostly manifested itself by demanding I drive up to the office all the time. I think the new people are all doing fine and the sun will continue to rise and set without me, so I just have to convince him of that.

Ambulance co. stuff is going well, the rate of changes has slowed down a bit, allowing everyone to be a little more settled. I'm actually learning who some of the new people are so that not everyone has to go by "FNG" anymore. And I managed to score a new full-time shift. No more Saturday and Sunday 12 hour transfers!! My new shift is 3 911s and 1 daytime transfer shift, but doesn't start until the middle of July.

Most shifts are 2 transfers and 2 911s, so there were a lot of internal applicants for the position. The medic on the shift was actually asked who he wanted to work with (highly unusual) and he picked me. The supervisors were actually asked who they thought the shift should go to (slightly unusual) and apparently they even voted and picked me. If I had known there was going to be a popularity contest, I would've been nicer to people (hahaha!), but at least this way I think it might be mostly based on my skills and work instead.

The last hurdle was to talk with EMS1 about the rumors that I was leaving in September because he didn't want to give a prime shift to someone who was only sticking around for a couple more months. I was honest with him about the unlikely outside chance I would be accepted off the wait-list for medical school this year, but that I didn't really expect that to happen and was planning on being around for another year. He decided that would work and gave me the shift. (happy dance!!)

Motion sickness

One of the most common questions I get from non-ambulance people is "Don't you get carsick?" Generally, no. I don't find that riding, reading, or writing in the ambulance gives me much trouble. I've always been able to read and relax in vehicles without too much trouble. Riding contrary to the direction of travel hasn't really added too many problems. Sometimes if I already have a headache, being stuck in a small space with an annoying and/or smelly patient will about try my patience and make my head thump louder, but carsick isn't really the problem. I've never really had motion sickness on water either, although I think that is partly because I don't generally go boating too much and I definitely don't go in nasty weather.

There have been two notable exceptions though. Both were VERY long transfers (in excess of two hours) on windy Vermont roads through hilly areas. For some reason the combination of winding left and right with the up and down of the hillsides is enough to turn me green. Generally, we've been well over an hour by the time we hit these stretches of road, so I've got nothing much to do for the patient. I've been through their paperwork, done as much of my paperwork as I can, and I'm probably out of small talk. All I notice is being sloshed back and forth, up and down, over and over again.

On both trips, by the time we made it to the hospital, I was ready to run through the hallways, toss the patient in the nearest empty bed, and make a run for the restroom. This, of course, is unacceptable behavior. We must walk through the hospital, find the correct room, find the correct nurse, settle the patient, sort out paperwork, and then politely ask directions to the restroom. All while trying desperately not to vomit all over a hospital I've never been to in order to avoid leaving a bad impression.

Could I just be sick in the ambulance? I could. Aren't there various contraptions there for capturing vomit? Yes, there are. But no matter how much vomit you get into a container, the smell always escapes. And lingers. And lingers. I don't relish being sick in the first place, but having to smell it the entire 2+ hour drive back to the station is more than I can handle.

N-O.

I took one for the team a few weeks back. MC and I were doing the long 12 hour transfer days that make up our weekends and 20:00 brought us a transfer down to the Big City, just over an hour away. We get the page, ALS transport with IV for a bowel obstruction. Bowel obstruction being transferred?!?

Checking in with the nurses on the unit gives us some more information about the patient's condition and surgical history (she's being transferred because her surgeon is in Big City). Sounds like she's been through a lot of stuff, but she's not too thrilled with being taken off her PCA pump and not afraid to tell us about it. Her nurse had promised that we would be able to give her pain medication en route, but the doctor (or PA) had neglected to leave written orders for pain medications and MC doesn't give narcotics on transfers without written orders. So, nurse decided that the percocet given as we walked in would be sufficient for the hour long ride down. Since it was my turn to tech and there were no longer any paramedic skills required, I was the lucky winner of the "who gets to piss off the patient" contest.

Nobody brought up the whole pain medication issue right away, the nurse didn't want to make a scene and I was hoping to postpone the complaining as long as possible. As long as possible turned out to be about five minutes into the transfer.

"You're going to give me something for the pain, right?"
"No. The doctor didn't leave orders for pain medicine and the nurse gave you some right before we left."
"WHAT!?!!! She promised me pain control. I'm never going to make it, I'm in pain already. This is unbelievable."

It went downhill from there. Thankfully, it is fairly easy for me to say no because there is absolutely nothing I can do. The pain medications are in a locked cabinet. No amount of explaining was good enough to convince her that I wasn't out to deprive her. No amount of explaining was enough to indicate that it makes no difference whether I thought she was a drug-seeker, I just don't have drugs to give her.

Finally, she demanded to seek her paperwork. I'm a big fan of informed patients, so I happily gave it to her. She wanted to know where it said that she couldn't have morphine. I pointed out where it should say she could, and that it didn't. Then she went through EVERY SINGLE PAGE, reading, questioning and demanding. For those who don't know, reading or writing in the back of a moving ambulance is an acquired skill, especially on the ruts and bumps of some of the roads in this area, so I got to enjoy her complaints about not being able to read easily too.

I've never been so glad to see the end of a transfer. There are only so many ways my tired mind can come up with to say N-O at the tail end of a twelve hour shift.

13.1

I finished the half-marathon over Memorial Day weekend in 2:16:57. That was slightly slower than the 2:10 - 2:15 I was hoping for, but not too bad for my first race. K finished around 2:02, and M finished around 3:28 despite the handicap of the organizers having picked up all the directional signs.

* 13.1: Boston's Run to Remember (2:16:57)
* Week 9: 3x800; 3 mi; 6 mi
* Week 8: 4x1600; 8 mi (DNR); 12 mi (1:58:39)
* Week 7: 6x400; 6 mi (55:03); 10 mi (1:39:28)
* Week 6: 4x800 (DNR); 8 mi (1:15:00); 8 mi (DNR)
* Week 5: 3x1600; 4 mi (37:27); 10 mi (DNF)
* Week 4: 6x400 (DNR); 6 mi (57:06); 6 mi (DNR)
* Week 3: 3x1600; 5 mi; 10 mi (1:43:26)
* Week 2: 4x800; 4 mi (38:41), 8 mi (1:20:40)
* Week 1: 4x400 (DNR); 3 mi; 6 mi (59:38)

8 things

Tagged by MonkeyGirl, so playing along (finally).

Here are the rules: Each player starts with eight random facts/habits about themselves. Write a post about your own random things. Post these rules. At the end of your blog, tag 8 people and post their names. Don't forget to leave them a comment and tell them they're tagged.

1. I'm thinking about ditching the medical school idea to stay on the ambulance for little pay and constant verbal abuse by drunk strangers.

2. I have a nickname at the ambulance co. (Space) and it makes me feel quite accepted.

3. I've been 2 for 3 in my last two softball games. This trend will soon break, I'm sure. It is usually fun for the first few games of the season to hit balls over the heads of outfielders who only see a girl and not a hitter.

4. I hate whiny patients. Most especially when they are the last patient of the day and after 2000.

5. I like school, the learning, the hanging out talking about interesting things with smart people. If the student loan program had a retirement option, I'd probably never leave.

6. My entire house is a mess right now and it is driving me insane. K likes to start projects and not finish them and this results in a huge mess because he never puts anything away until he's "done", which never happens.

7. When I get upset about things, I clean. I'd rather clean than cry, but sometimes I do both at the same time.

8. Sometimes I want a loaner kid just to be able to do all the fun kid stuff, but Zac lives too far away.

I don't know 8 people well enough to tag for this, so play along if you like.

Holy Shit!

It was a dark and stormy morning. The kind that makes you want to pull the blankets up, swat the alarm clock across the room and forget the outside world exists. This was not the morning I would have naturally picked to haul my sorry carcass out of bed to run endlessly around town. But this was the morning I had after missing a chance yesterday for an afternoon run. Three hours to get up, get running, get done and get on the road to the next task.

Twelve miles. An intimidating total run larger than what I had been doing weekly before training began eight weeks ago. The training plan calls for 10:22/mile, a pace I've never managed to keep. My long runs tend to start fast, then slow and speed up irregularly, and end walking. Not exactly the measured pace I'm supposed to keep. Today I was aiming for a slow start and a steady finish. And somehow, some way, I did it.

I ran every step of 12 miles. No walking in the middle. No dragging feet at the end. Just running. The sound of jogging feet and deep breathing. The showers at the beginning weren't steady but did keep the pollen down, at 8 miles the rain started for real, but by then I was in the happy place. The place where it wasn't really so much like running as moving from location to location. Noticing the scenery, mind free to wander, just me and the run.

And best of all, I think I could've done 1.1 more today.

p.s. I've been tagged for a meme I'll try and get to tomorrow.

New link

Remember the comment about better written stuff...here's one newly added to the links list:
Musings of a Highly Trained Monkey. Enjoy!

Lost

No blogging for a while, no ideas, no motivation. Just feeling kind of lost and adrift. Seems like there are so many better and more interesting EMS blogs that it isn't worth writing about calls, med school isn't happening and I'm just out of things to say.

I've got a new full-time partner on the ambulance, which always takes a little adjustment. Things at the ambulance company are in a constant state of transition for the last few months, which is unsettling and stressful for me. I can adapt to change, I'm entirely flexible in how things work on calls, but I just don't like not knowing what I'm walking in to every day. There is one supervisor, moved up from the south station, whose personality just grates on me and I've already had a run-in with him in the first 4 weeks. Once I'm in the truck and doing my thing, the rest of it fades away and I really enjoy what I'm doing. Even on the Thursday night that was so busy my truck did back-to-back dispatched calls because we were the only ones even close to available. Normally the city runs in a 4 truck rotation for calls, giving everyone at least a little time to find an ER bed for their patient. The middle of the night call was the drunk assault victim I had told my partner that we were missing for the trifecta, so at least the night was complete.

Running is going. I was feeling pretty good about the whole deal, but a week where I wasn't able to accomplish what I wanted to (including a day where I was dehydrated and it was 85+ degrees and ended up walking home - and then had to work overnight) has left me feeling despondent about the whole idea. I feel like there is no way I'm ever going to make the 12 miles I was supposed to run this week, much less the whole half-marathon in two weeks. K ran his 12 in speedy time yesterday, which just makes me feel like that much more of a failure. I haven't even been able to get in 3 days a week on the training schedule. I finally got my ass up this morning to at least run something because I was starting to feel like I just wasn't going to run any more at all. I'm hoping to make time tomorrow afternoon to get the 12 done and off my mind.

I can't decide what to do about medical school. Do I spend the $2k to get help on the MCAT, submit applications again to more schools all over the country, and silently hope something works out? After submitting the financial aid documents, I found out that my "expected family contribution" for school is over $39,000 a year. K's salary won't even cover that plus the monthly mortgage for a year, so I'm not entirely sure how anyone figures that we're going to live completely in the red. Even though K tells me not to worry, we'll figure something out if I want to go, I'm not sure that I could do a decent job studying if I knew that every minute I was there was costing us the financial security we've worked the last eight years to achieve. So, do I stay on the ambulance, spend the 18 months to be a paramedic and work until I don't want to be on the ambulance any more and then make a new decision? Do I start trying to get my ducks in a row to apply for PA school? Do I just run off and live under a bridge?

I can't wait until the office job is over. They're trying to kill me in these last moments by demanding that I'm on-site (1.5 hr drive each way) instead of working from home two days a week. Those are my only two completely "off" days from the ambulance and kill any available time for running. I'm training the three part-time people who are taking over my job and that is actually better than doing all this myself, but I still don't get why we all have to sit in the same place to look at items on the network drives.

I guess this is the long way of saying that I may not be posting much, but I won't go away entirely without saying goodbye.

Tonight

Friday, end of the work week. Time for a nice dinner out, maybe some dancing or a show in their younger days. Now, they don't get out as much, the children are grown, the grandchildren filling their hearts with pride. Friday might not have been anything special any more. The usual routine, watching the news and the late show then off to bed. They lived in the in-law apartment, upstairs around the back, close to the love and support of family because they weren't getting any younger or healthier.

Today she had seen her doctor because she hadn't been feeling so well. Not that she'd been feeling great too many days lately, cancer will do that to you. He'd given her some new medication for atrial fibrillation, she was going to start tomorrow. Her chemotherapy was on schedule and everyone seemed hopeful for remission.

Her husband was sitting in his favorite recliner waiting for her to finish up in the bathroom when he hears her fall. She didn't even call out, just a thump as she hit the floor and the glimpse of her head in the hallway. He called downstairs for help and then called 911. The woman on the phone asks the usual list of questions and when she gets to "Is she breathing?", her daughter finds out the unfortunate answer is no. The dispatcher gives directions for mouth-to-mouth and that sinking feeling sets in. "Does she have a pulse?" "Please start CPR."

Her daughter gives an audible sigh of relief when the FF walks in and gently asks her to move out of the way. She won't be the one to have to do compressions, to hear her mother's ribs breaking, to wonder if she's doing them right, to wonder if she could possibly be responsible if her mother doesn't survive. Suddenly a scene of quiet desperation has changed to a scene of flurried activity. CPR in progress. Paddles on, monitor showing asystole. First try at an IV, no good. She gets moved to a backboard, strapped down and then she's gone, hustled down the stairs to the waiting ambulance.

Once she's inside, the family thinks the ambulance will be leaving now. But there's order to this chaos and things that are easier done before departure. IV established. ET tube placed and secured. Drugs given and a tiny glimpse of hope on the monitor screen. Finally, someone comes back out of the ambulance to tell them what is going on and the ambulance heads out in a hurry. More chaos as everyone decides who goes and who stays, which car to take, who is able to drive, and the million other decisions that have to be made before everyone can run out of the house.

The drive is the longest twenty-five minutes any of them can remember. By the time they reach the hospital, it is all over. The hospital staff doesn't let them back to the room right away. Nothing left to see or do, her room guarded over by security and a nursing staff which is trying to support them and prepare themselves for an incoming major trauma all at the same time. Dazed and confused, they stand at the room at a loss for words or actions. Loving companion for more than 40 years of marriage, kind mother, gone in the space of a missing heartbeat.

Appearances

I was eating dinner in a local fast food burger joint on Tuesday night and had ended up sitting next to a mother who was eating dinner with her little boy (probably around 4-5 years old). She was having the usual struggle of getting him to eat what she wanted him to eat in a reasonable amount of time. He immediately noticed me as a suitable distraction and spent some careful time evaluating the situation. His conclusion? "Mom, that girl is eating without her kid. Why doesn't her kid get to eat?" His mom tried to smooth things over with, "Maybe she doesn't have any kids. Eat your chicken strips." I tried not to laugh too much because he was clearly watching for my reaction.

Today I ran an 8 mile training run. During mile 6 I was feeling wiped out and just trying to get to the mailboxes at #15 for the next mile marker. I could see them just ahead and generally pay little to no attention to traffic on the other side of the street so I didn't notice the pickup heading my direction. I didn't notice until the 17-18 year old guy driving it felt the need to lean way out the window and whooo-whooo at me. I was too tired to laugh, but still a bit stunned because it has been quite a while since someone made lewd noises at me on the side of the road.

In both cases, K was entirely too amused when he heard about it later. So apparently I look like a mother who has left her child in the car away from fast food AND someone worth whooo-whoooing at.

MD process

• 18Apr07: Wait listed by school from 1Mar interview
• 16Apr07: Wait listed by school from 29Mar interview
• 29Mar07: On-campus interview
• 23Mar07: Third school invitation for interview (apparently app was complete)
• 1Mar07: On-campus interview
• 28Feb07: Rejection without interview to second school, third school application never considered complete due to missing reference letters
• 5Feb07: Invitation for interview at one school received
• 18Jan07: Fielding questions from interested supporters, but no news from the schools themselves
• 25Dec06: Rejection without interview to first preference school
• 14Nov06: All reference letters returned to schools
• 30Oct06: Secondary applications returned to all schools
• 02Oct06: Secondary application information for remaining two schools received
• 28Sep06: AMCAS review completed
• 08Sep06: Secondary application information for second school received
• 06Sep06: Recommendation letters requested
• 30Aug06: Secondary application information for first school received
• 28Aug06: Transcripts received, application in line to be reviewed at AMCAS
• 21Aug06: Application submitted to AMCAS
• Apr06: MCAT taken

Name change

So, maybe I need a name change for my blog. I'm not transitioning anywhere in a hurry. Last decision came back today - wait listed again.

Last day with Ellie on 911 today, the slowest day in the history of ambulances - even when we only had 3 in the rotation instead of 4 for a couple of hours while a couple of overachieving crazies took a patient all the way to Big Big City hospital an hour away instead of to one of the locals and having a transfer truck move them there.

Anyway, I'm out for some yummy sympathy food and to think about buying appliances for the kitchen that are actually from this decade.

Earmuffs

I worked an OT shift on the ambulance last night and I had NO idea that Monday nights were that busy. I got to finish a dinner I started at 2030 at 2330 and slept a little from 0200-0430. Many places here are flooded out, roads washed away, etc. but not in the city, in the city we have the usual suspects.

"BEEP-BEEP-BEEP Ambulance meet the PD for an assault in the alley behind [local scummy bar]."

I had just finished about 10 bites of dinner with K, just enough to make me realize how hungry I was and not enough to actually do anything about it. Calls had been coming in just fast enough that Code 10 (my partner for the night) and I had been next out pretty much all night. We'd finish one call, hop in the ambulance to leave the hospital, maybe get parked at the station and then head right back out. Calls at the local scummy bar are generally not fun. This is a place that opens at 0700 and has customers all day - a steady flow of people with nothing better to do and no better place to do it. Many of the patrons are homeless, alcoholic, psychiatric, in ill health or all of the above.

We missed the turn to the alley, but did get enough of a glimpse to see PD already on scene. Rolling to a stop out front, the flashing lights attract only a limited amount of attention. Folks around here see us come and go so often that we aren't even interesting. Code 10 hops out of the truck and heads towards PD without waiting for me to grab the first-in bag, leaving me hustling to catch up while trying to take a good enough look around to decide if we really should be heading down this dark alley, PD or not.

We find the patient sitting on the ground, hunched over his knees, none too happy about the situation. He's covered in blood and the area below his right eye has seen some better days. When PD shines the flashlight on the patient, I'm surprised at the size of the swelling and the lacerations given that the patient isn't complaining about any of the injuries to his head. He's understandably annoyed with having been assaulted, but he's not showing signs of internal head injury, he's cooperating with the police, stands up when offered a hand and walks to the ambulance where we actually have enough light to see what is going on. As we're walking back, Code 10 asks him about living in the south city our company covers (because he works mostly down there). "Nahw man, I live in this city." "But you told the police south city." "Yeah."

We get him on the stretcher, start in with vital signs, and trauma assessment. NH has a protocol for being able to NOT use a cervical collar and backboard on patients, but it involves the patient being "reliable" and drunk=unreliable. The patient reports 4 beers and despite Code 10 giving him a hard time about it, will not admit to any more. Mid-twenties male, around 5'10", 160-175 lbs, admitting to 4 beers in 4 hours, probably a little borderline on the reliability. Patient denies head, neck, back pain beyond the obvious injuries and is complaining about pain in his ribs where he was kicked. We decide not to do the board/collar, start an IV and get rolling to the ED.

En route, the patient continues to be upset about being assaulted and his associate (who's had way more than 4 beers) in the front seat isn't really helping by turning around and shouting "helpful" advice every couple of minutes. "Yeah man, let them help you." "Dude, don't fight with them, they're just trying to help." I'm not sure what convinced this fellow that his assistance was needed because I wasn't having any problems with the patient at all. No drunken belligerence, no theatrical threats to the life of his attacker, no macho bravado. A rather pleasant change from the usual assault victim who seems to be determined to convince us that this was entirely undeserved, totally shocking and calls for an immediate retaliation.

The patient was having 7/10 pain in his ribs, with a notable contusion and a small amount of crepitus on his right side. He has some diminished lung sounds in the bases of his lungs, but he's also not taking full deep breaths, so I don't think he's really passing air that deeply. The crepitus seems to me more like a broken bone than any air trapped under the skin, so that is a good sign for his lung function. He doesn't want any pain medication and keeps fidgeting to try and find a comfortable spot. I try to reassure him that there is NO comfortable place on a stretcher so that maybe he'll hold still long enough to get a little pain relief. He's groaning about the pain, but actually manages to keep his language decent, although once asking me if I would do earmuffs so he could scream and curse a bit. He laughs a little when I tell him he's not going to top anything I hear around the station, but decides maybe he doesn't need to curse after all.

Neither of us heard what happened to him. Code 10 was convinced he was going to be transferred to a bigger hospital for surgical repair of a broken bone under his eye. I was guessing short observation and discharge from the ED because I don't think it was broken and there isn't much they do for broken ribs if they aren't causing any problems. The doc had him collared and x-rayed for spinal injury after we arrived but didn't really give us a hard time about not having done it on scene. He was gone by the next time we were in that ED long enough to check and nobody in our company transferred him anywhere, so I hope he's home recovering and maybe finding some new associates.

Waiting

I haven't done much posting lately because I feel like I'm in a holding pattern. I'm waiting for the last two medical schools to crush my dreams or give me nightmare debt. I'm riding on the ambulance waiting to find out who my new partner is - I heard a rumor the other day that he's been sighted and the best anybody could tell me is that he looks like so-and-so, but with glasses. That information really didn't help my insecurity because appearance isn't the issue. I'm trying to figure out how to manufacture enough hours in the day for race training and there are only so many times I could write - "ran a lot today. tired now, body hurts." before even my family would quit reading.

Today there has been a small change. The school from the second interview made an admissions decision on my application. Wait list. Why am I not surprised? At least I'm getting better at waiting. Now the question is, do I succumb to the encouragement of the admissions office and be a pest, repeatedly declaring my undying love for their institution in the hopes that they will admit me? Is any medical school better than no medical school, or do I learn from my experiences there that this is not the right fit and let it go?

Quick updates

• I HATE working on my birthday. Working just takes all the fun out of the day, especially when K had to work too.


• My partner was working overtime yesterday and ended up on a call that made the front of the newspaper. She's lucky enough to be out of town the rest of the week though, so she'll probably slide on having to buy everyone lunch.


• K came to the ambulance co. station on Sunday to make Easter dinner for everyone on shift, and I ended up having a 4+ hour transfer which started right around the time he got to the station and pretty much missed the whole thing and the chance to hang out with him.


• I broke down and called the admissions office of one of the medical schools today and they tell me that a decision will be in the mail by the end of the week and here by sometime next week at the latest. This process requires a lot more patience than I possess.
  

Interview #2

I had my second (and last this year) medical school interview last week. The general structure was something like the first interview, presentation by admissions staff, meeting with financial aid, lunch with students, tour of facilities, and finally a single one-on-one interview with someone with the potential to let me in to the school.

But there was one major difference. This is the school that never showed my application as complete. These are the admissions staff who NEVER answered emails and 2 voicemails, and in the course of half a dozen phone calls never once actually answered the phone. This is a place that tells you to show up at the admissions office, without actually giving you the address of the building or the room number; a place that charged me to park in a campus parking lot while I interviewed. So I was feeling a bit abused by their system.

During the admissions presentation, the woman made sure to point out that even though it was a getting to be a little late in the admissions cycle, we were not just interviewing for slots on the wait list, there really were still seats open in the class. Following this declaration, she promptly told us that if we got wait listed we should call regularly to check on our status and to indicate that we were still interested in the program because people who did call regularly could be admitted ahead of higher ranked individuals who did not call regularly. Oh, and be sure to check your status on the online applicant center as we update that frequently. WTF?!?! So my persistence and ability to annoy you counts for more than my application and interview?

I probably should've held my tongue, but I could not let these statements pass. I stated that this was not at all comforting as they do not answer the phone or return messages and their online applicant center never even showed my application was complete. She gave me that insincere "nice" smile and said she would love to have my feedback on the little postcard included in my packet today. Because apparently she was too busy ignoring me right that minute to actually hear what I was saying? Not really selling me on the school with those statements.

The students were fairly informative, as usual, but they were all first year students. They were not really in a position to answer some of the questions about things that happen during the second year, about how the selection process works for third year clerkships, about the relationships (or lack there of) between the classes, et cetera. The tour was a joke, we saw two lecture halls, a small group classroom, a bunch of hallways and an atrium in outpatient area of the hospital. Another applicant in my group asked to see the anatomy lab space, can't do it. I asked if we could see anything in the hospital, even the cafeteria, can't do it. When we returned to the waiting area the admissions lady wandered by to chat, so I asked her what it would take to get a tour of any inpatient area of the hospital. Her response, "Well, we really aren't satisfying you today, are we?" along with that annoying fake smile again. Final answer was that the hospital would not allow it, even as individual applicants instead of a large group. My experience as an EMT leads me to believe that it is extremely likely that I could've walked over there and into just about any adult inpatient area without being stopped or questioned, but I decided that if they wanted me to judge whether I was willing to attend their school based on hallways, then that was what I would do.

The actual interview itself went well. I enjoyed talking with the MD who interviewed me and thought I performed reasonably well. He apologized at asking his first question, but honestly, I think it is probably the most reasonable question anybody has asked me. "What the heck happened on your MCAT?" I don't remember posting my scores here, my subject area scores were fine, but my writing score (on a scale of J to T with J being the low end) was a K. In other words, beyond awful, translated to the lowest 3%. He said he'd never seen a score that low and didn't know they actually gave them. He wanted to know if I'd challenged the results of the exam because that seemed like it should have been a mistake. I think I was able to give him a reasonable explanation and after asking whether I'd written my personal statement essay myself (I did), stated that he wasn't concerned about my writing abilities because it was one of the better statements he'd read this year.

He had some other good questions about my work as an EMT, my experience teaching, and why I wanted to change careers at this point. When I was doing some practice interview questions with investigators I work with, one asked about my most difficult call as an EMT. I was able to come up with a recent call that fit that bill. The interviewer's actual question was slightly different though, he wanted to know about my worst call. I've never met an EMT that enjoys that question. Some people ask it because they are prepared to be grossed out about dismembered, decapitated, bloodied patients. But I define "worst" a little differently. To me, worst is a call I still remember the next week, a call where I wish I had the ability to give the patient something more. So I told him the truth and he was definitely surprised that my personal worst did not involve death or traumatic injury at all.

The interview was the end of the day. Although I've been on this campus before, I asked the admissions lady for a campus map because there wasn't one in the folder (which seemed strange). I got a non-answer answer about how the campus was changing so quickly right now that they didn't have a current map, but eventually got a non-current map out of her. I have no idea how my dissatisfaction with their system or their admissions staff is going to factor in to their decision-making, but I'm not willing to pretend I'm happy-go-lucky satisfied when I'm not. If it comes down to a choice between this school and nowhere, I'll probably go, but I'll have to think about it.

Read this!!

Go, read.

I'd be willing to bet that the manufacturers never expected to have to put a warning against that use on that product! Snort!

Change

Big changes afoot here - again. There's a reason the word transition is in the title, my life seems to change drastically every couple of months. April 1st brings a return to full-time ambulance work, but this time on an ALS shift instead of a BLS shift. Instead of 5 8-hour days, I'll have 1 10-hour day on a 911 truck, 1 14-hour overnight on a 911 truck, and 2 12-hour day transfer shifts. Add that all up, 48 hours - guaranteed overtime every week. Until she leaves, I'll be partnered with Ellie which is disappointing only in the fact that I know she's leaving. I've heard only good things about her personally, her skills as a medic, and working with her in general.

A 48-hour work week on the ambulance, plus the 20-hour work week at the office job equals a shortage of time to volunteer with the FD. My two transfer shifts are on the weekend so I won't be able to volunteer on the rotating every-5th-weekend schedule no matter what. I could probably change to another night for the during-the-week portion, but I sent an email to the chief and I've gotten no response so I'm guessing I might be done with them. There are a lot of political issues swirling around and through the department, many centered on volunteers and call firefighters, and the short story is that the full-timers wouldn't really be sorry to be short another volunteer. It isn't anything personal, more of a negotiating tactic than anything else. Tonight might be one of my last two nights with the FD, so I'll have to hope for at least one call so I can leave feeling useful.

Still no official word from the last medical school yet. At the interview, they suggested everyone assume that no news was really good news because it meant you were still being considered. I'm fairly certain a letter one way or the other is going to show up in the next couple weeks and I'll let you know about it when I get done crying or hyperventilating over the financial burden.

Season of change

Many places have four seasons. Most people refer to them as Winter, Spring, Summer and Fall and those words bring specific idyllic pictures to mind. Happy people frolicking in a couple inches of snow, all bundled up in scarves and sweaters, maybe a cup of cocoa or coffee steaming away. Beautiful flowers just pushing up through dark, rich earth under a beautiful blue sky and 50 degree weather. Swimming suits, beaches, drive-in movies and no responsibilities. Spectacular leaf color and crisp nights crunching through the early fall leaf litter, again maybe that hot cup of coffee near by.

In New Hampshire and Vermont, not so much. We do have four seasons. Winter, Mud, Summer and Fall. Winter lasts from October until mid-March or April. Mud season lasts from the end of winter until late May. Summer, from June until mid-August. Fall, from August to October. Now, for those not from this area, you may be asking what is mud season? Mud season is the delightful time of year when the weather alternates from 60 degrees to -5 and back again, frequently and quickly. When the snow melts and turns everything not paved into a giant sink hole of mud, and then it freezes, snows again, and repeat. When dogs and EMTs track mud everywhere they go, with a special affinity for white carpet.

This, my friends, is why I left for vacation in March. You might think that avoiding the bitter winter cold would be a higher priority - but you can't really avoid something that lasts for six months and I own enough sweaters to outfit a small impoverished nation (if they lived somewhere cold). But mud season - just plain aggravating. The day we returned from vacation, 67 degrees. The next day, 71 degrees. The next day, 25 degrees and 12+ inches of snow. Just makes you want to find Mother Nature and kick her ass for teasing you with the warm weather.

So, if you're dealing with the mud, or just longing for a taste of the tropics...here you go, a little taste of Georgetown, Grand Cayman.