Call of the day

Dispatched for a seizure, have EMT-I student with us, updated to possible stroke. On arrival, patient standing outside dirt-bag apartment area saying he woke up from a nap and his arm is numb and he can't feel his face but his legs are fine. I use all my mystical evaluation skills and walk with him the 2-3 feet to the ambulance and have him flop on the stretcher. I start in with history questions, which basically amount to no relevant history and he might have type 2 diabetes. The stu gets vitals, does a stroke scale, finds nothing except a patient who shouted mighty loudly when he was poked with a sharp object in his "numb" arm, startling the stu. I ask the patient what he thinks is happening, "I might be getting the flu. Everyone else here has it." I muffle my laughter, pointed away from the stu so he doesn't get any hints what is going on with our patient. Patient flops again onto hospital bed. I'm working on the write-up and the stu asks what I think was going on because he's a bit confused. I try to be nice about it but the simple answer, "He slept on his arm," makes the stu laugh until he realizes I'm serious.

Winner, winner, chicken dinner

At what point does it change from being helpful to have people in your life supporting your desire for change to being discouraging and take on the feeling of fake optimism to hear them want you to succeed?

"Oh, by the way, I was chatting with the head of the admission committee and you could still get in. You just have to be 'special' enough so he picks you off the wait list. Make sure to send something 'special' soon." Crap. Can you get him to define "special" for me? I look good in sequins? I can talk trash with the best of them?

"Maybe you could just send a billion more applications next year, somebody will take you eventually. You're smart or something, right?" Clearly not, I'm still doing this.

"Hey, guess what? I met a totally retarded doctor today and I think you'd be waaay better than that. I'm not sure he or she could tie their own shoelaces." Yeah, I know, I met them too.

"Jeez, I can't believe they won't let you in. What hope do the rest of us have?" None. Hold still while I put you out of my misery.

Thanks people. You know I love you all, and I know you're trying to help, but sometimes you're just adding to that loud voice of self-doubt in the back of my head. I knew this wasn't going to be an easy road, but now it feels like if I succeed it would be less like pulling a rabbit out of a hat and more like standing naked in the street and levitating 20 feet in the air just before I get crushed by a speeding semi. Maybe that is what I should add to my applications?

Death

Calls for unresponsive patients first thing in the morning are usually cardiac arrests that have just been discovered by friends/family. Frequently, these patients have been dead for quite some time, so there's nothing much for us to do but stand by and wait for the police. I didn't realize how adjusted I have become to such scenes until this week.

We found the patient seated, pants down, on the toilet. He had fallen forward into the door jamb when he died, so his head was about 6" off the floor and his naked rear was waving in the breeze. The firefighters arrived shortly before us, but weren't sure whether or not to start trying to resuscitate the patient because he looked pretty dead, but parts of him were still warm. The Asian and I rolled him over. He rolled as one piece, the expected lividity was in his face and arms, nothing more to be done. The firefighters wanted to clear the scene because an actual fire had been dispatched just after our call, but they didn't want to go downstairs to the family alone. The Asian and all the firefighters went downstairs. I stayed to get the patient's medication list into the laptop and to upload the asystole from the LifePack.

After I was finished, I realized that I had been contentedly working in a room less than 5 feet from a dead guy. Weird. Dead people used to creep me out. Freshly dead people are still patients, so they aren't bad, but if you'd told me two years ago that I wouldn't be on edge being left alone in a room with a corpse, I certainly wouldn't have believed you. I suppose this is a good thing if I ever actually get in to medical school because anatomy lab otherwise might've been a bit difficult.

Caring for the aged

Suddenly feeling my age this week. I showed up as usual at work on Tuesday, first call was for chest pain. This gentleman was having a MAJOR cardiac event, third degree block with a rate less than 40. We zipped him down the road to the closest hospital even though he really needed the cardiac specialist facility across town. At the closest hospital, he coded less than 5 minutes after we moved him to the bed. In their not-so-state-of-the-art cardiac cath lab, he coded twice more. One of our transfer trucks moved him across town with a balloon pump in place. This all went by me with an, "eh."

Later, we transported a different patient to the other hospital and were admiring the newest cath lab photos of a patient brought in by our company. One of the hospital staff was chitchatting and it turns out that patient was a coworker of mine. A 33 year old coworker. Complete blockage of an artery and doc warned him of substantial buildup in several others they checked. Finally got upstairs to visit him on Wednesday and found him in reasonable spirits but looking 5 years older in the week since I'd seen him last. I think I lost a year or two just hearing the news. Bad enough to think I'm invincible and be facing my age through the marriage and children and divorces of my friends of a similar age - but health problems? No way! I'm too young!