The ambulance company I work for also sponsors the ride time required for my class. Meaning that I could ride with only people I know quite well and feel comfortable with if I rode at the station I work out of. Thankfully, I think, most of the people in my class live much closer to the north station than the other one, so I ended up having most of my ride time at the south station. The first day of which was yesterday.
Rise and shine for a 0700 shift start on a day that the north station is doing a mass casualty drill, so every one who is "anyone" is up there practicing for some major incident with pretend patients and so on. The south station didn't even have a supervisor on site, which worked out well for me because then I got to ride on all 3 of the 911 trucks instead of just the supervisor truck, which translated into 7 calls instead of 3 (I missed one with that truck because I was already out), which is a busy day for 8 hours at the south station. I did know one of the medics on shift because he works both stations and at the FD I volunteer with, but the rest of the people were new to me as far as working with them goes.
Everyone treated me well, which was nice because sometimes full-timers are harsh on students, especially if they aren't used to having them along. I did get a little "feedback" from a medic on a call where he put the intermediate and I in the back with the last direction of "start a line", which we did, but we didn't do a full set of baseline vitals first so I got the "do BLS before ALS" lecture. Actually, I thought it was weird at the time that we were starting a line before having vitals, but I'm not really confident enough to question someone I know is an experienced full-timer when I'm still just a student. And for the record, the medic was more annoyed with the intermediate than with me, he just wanted to make sure I heard the message too so I would be confident enough to step up and say something next time.
Not too much excitement altogether, an overdose, a pair of geriatric abdominal pain calls, a teenage seizure patient, a nursing home "diabetic emergency" that wasn't anything to do with blood sugar nor really an emergency, and a pair of difficulty breathing calls, not in that order. I went 2/3 on IV starts, missing one on the overdose which the medic on the call also missed, and the two I got were geriatric patients which are sometimes harder due to their fragile veins.
06 August 2006
03 August 2006
You want me to do what?!
My last Emergency Dept time was on Sunday afternoon. I came in feeling much more confident in my ability to start IVs, and that I could generally handle whatever was going on. As I was walking in the back entrance, I heard the ambulance sirens heading toward the hospital. Excellent, customers right away.
What arrived were four patients from a two car accident. Mom, Dad and 9-month old baby from one car, and teen driver from the other. I immediately missed the stick on Mom, partly because as soon as I stuck her and wasn't in quite the right place she started hollering and cursing, so I gave up and the nurse took the second stick. Baby was screaming because nobody could take him out of the car seat until the MD okayed him, but he turned out to be okay and settled down. Actually, Dad was the only one to even walk out with a cervical collar on, which is pretty good considering their car rolled over. Teen driver was fine and released within an hour.
Later, I was talking with a dog-bite patient, and I got an immediate IV in his right hand without any nurse shoulder-riding. He got a little fluid and a bunch of IV antibiotics. But the good part is that when the animal control cop showed up later, I was the only one who knew when the guy had been bitten, and his helpful description of the animal at large - "I don' know what kinda dog it was. But it was big and brown, bit me and ran off." I laughed at this, because I'd asked him if he knew the dog or who it belonged to, or even what kind it was. Patients make me laugh sometimes, especially ones who are my age and friendly.
Aside from missing several more IVs (as in, I stuck people and didn't get the IV where it needed to be), I declined another procedure that would've given me big bragging rights. There was an actual intubation that happened while I was there. Since it was a patient I hadn't been with, I poked my head in and said that I heard a rumor there was a tube going in. The doc looked up and said, "Yeah. You want it?" My first reaction was holy crap! You can't be serious! And then I realized he was serious, and he would literally let me stick a tube down a real live sedated person (even though my protocols are really only for "dead" people -cardiac arrests).
I've never even seen an intubation on a real person, so I chickened out and declined. When he lifted her jaw to put the tube in, I noticed that she didn't have any teeth and then I was disappointed I didn't try. For those not familiar, you use a laryngoscope
to lift everything out of your way so you can see the vocal cords and pass the tube through them - and as you can imagine from the picture, sticking something metal in someone's mouth runs the risk of hitting, and breaking, their teeth. My biggest fear about the procedure is smashing up someone's teeth. I'm not really worried about the tube placement or anything in the hospital because obviously there is someone right there breathing for the patient and the doc right there to put the tube in if I couldn't. And still, I was so shocked by the offer that I declined before I thought through all the reasons I should've done it.
What arrived were four patients from a two car accident. Mom, Dad and 9-month old baby from one car, and teen driver from the other. I immediately missed the stick on Mom, partly because as soon as I stuck her and wasn't in quite the right place she started hollering and cursing, so I gave up and the nurse took the second stick. Baby was screaming because nobody could take him out of the car seat until the MD okayed him, but he turned out to be okay and settled down. Actually, Dad was the only one to even walk out with a cervical collar on, which is pretty good considering their car rolled over. Teen driver was fine and released within an hour.
Later, I was talking with a dog-bite patient, and I got an immediate IV in his right hand without any nurse shoulder-riding. He got a little fluid and a bunch of IV antibiotics. But the good part is that when the animal control cop showed up later, I was the only one who knew when the guy had been bitten, and his helpful description of the animal at large - "I don' know what kinda dog it was. But it was big and brown, bit me and ran off." I laughed at this, because I'd asked him if he knew the dog or who it belonged to, or even what kind it was. Patients make me laugh sometimes, especially ones who are my age and friendly.
Aside from missing several more IVs (as in, I stuck people and didn't get the IV where it needed to be), I declined another procedure that would've given me big bragging rights. There was an actual intubation that happened while I was there. Since it was a patient I hadn't been with, I poked my head in and said that I heard a rumor there was a tube going in. The doc looked up and said, "Yeah. You want it?" My first reaction was holy crap! You can't be serious! And then I realized he was serious, and he would literally let me stick a tube down a real live sedated person (even though my protocols are really only for "dead" people -cardiac arrests).
I've never even seen an intubation on a real person, so I chickened out and declined. When he lifted her jaw to put the tube in, I noticed that she didn't have any teeth and then I was disappointed I didn't try. For those not familiar, you use a laryngoscope
to lift everything out of your way so you can see the vocal cords and pass the tube through them - and as you can imagine from the picture, sticking something metal in someone's mouth runs the risk of hitting, and breaking, their teeth. My biggest fear about the procedure is smashing up someone's teeth. I'm not really worried about the tube placement or anything in the hospital because obviously there is someone right there breathing for the patient and the doc right there to put the tube in if I couldn't. And still, I was so shocked by the offer that I declined before I thought through all the reasons I should've done it.
29 July 2006
'Cause I'd be good, mmmkay?!
I've been thinking continuously and working sporadically on my "why I want to be a doctor" essay for the medical school application. It is a very hard question to answer honestly in a way that will make admission people want to let me in. Somehow I think that "I just do" is not the 1 page answer they are seeking. "Advice" books/people/websites suggest that this is my opportunity to let them know what kind of person I am, what formed me and shaped me, and why I'm going to be a great doctor. A chance to let them in on the intangible qualities that aren't going to show up elsewhere in the application - even though it is pretty much a cavity search of everything I've ever done.
I have to find other people to submit letters that I am a wonderful person and not going to be a doctor just for the ego trip, or the access to drugs, or the ability to torment people or something. And it might help if they were willing to swear that they would let me treat their children or parents or maybe even themselves.
Worst of all, I have to decide which schools to apply to, and then explain to them why I really want to go to "Quackery School of Medicine" and how it would be such a great fit for me because I'm so wonderful and have feathers and quack and all that, just like everyone else there! And I would make them so proud and donate lots of money when I graduate!
So, I'm feeling a little like it would be more productive to stand in the corner and bump my head against a wall all day - but I shall persevere and I will convince someone to let me in to medical school, even if I have to grow feathers..."I'm good enough. I'm smart enough. And gosh darn it, people like me!!"
I have to find other people to submit letters that I am a wonderful person and not going to be a doctor just for the ego trip, or the access to drugs, or the ability to torment people or something. And it might help if they were willing to swear that they would let me treat their children or parents or maybe even themselves.
Worst of all, I have to decide which schools to apply to, and then explain to them why I really want to go to "Quackery School of Medicine" and how it would be such a great fit for me because I'm so wonderful and have feathers and quack and all that, just like everyone else there! And I would make them so proud and donate lots of money when I graduate!
So, I'm feeling a little like it would be more productive to stand in the corner and bump my head against a wall all day - but I shall persevere and I will convince someone to let me in to medical school, even if I have to grow feathers..."I'm good enough. I'm smart enough. And gosh darn it, people like me!!"
25 July 2006
DOA
What kind of calls you get on an ambulance depends on location, luck and time of day. Now that I'm seeing actual 911 calls with the local FD and doing some observation time with the ambulance company, I'm getting a larger variety of calls including the classic chest pain heart attack, the "someone else panicked but I'm really okay" medical calls, and recently, a call that was dispatched as "unknown medical problem" then updated to "unresponsive, not breathing" as we were pulling into the parking lot of the building (which was not any sort of care facility).
We arrived on scene to find a woman on the floor, a cop using his AED (automatic external defibrillator) which was advising not to shock, and some staff members and family members fluttering around. The cop immediately jumped up to get out of the way when the medic I was with came in the door, but the medic laughed and told the cop he was doing fine and to carry on. The woman's face and hands were a deep purple color, her tongue was out of her mouth and had some dried secretions, and she had no pulse. It looked strange to me that her face was dark purple, because usually blood settles to the lowest point, but all became clear when the staff told us that 911 had them roll her over to start CPR so that she'd actually been laying face down since she died.
The story got a little weirder as it turned out that the husband had found her at 15:30 and the 911 call didn't come in until 18:10, but he'd been trying to find one of his kids to help him because he didn't really know what to do. Weird until you hear that the woman was a DNR (do not resuscitate), and thus he didn't want to call the ambulance because he didn't want anyone trying to revive her against her wishes. So who do you call when someone you love is dead, or nearly so, on the floor and doesn't want to be revived? An interesting question and one that all the hospitals pushing "advanced directives" need to start discussing with their patients because the staff all know what to do if someone dies in the hospital but the family members may not know what to do if their loved one dies elsewhere.
We arrived on scene to find a woman on the floor, a cop using his AED (automatic external defibrillator) which was advising not to shock, and some staff members and family members fluttering around. The cop immediately jumped up to get out of the way when the medic I was with came in the door, but the medic laughed and told the cop he was doing fine and to carry on. The woman's face and hands were a deep purple color, her tongue was out of her mouth and had some dried secretions, and she had no pulse. It looked strange to me that her face was dark purple, because usually blood settles to the lowest point, but all became clear when the staff told us that 911 had them roll her over to start CPR so that she'd actually been laying face down since she died.
The story got a little weirder as it turned out that the husband had found her at 15:30 and the 911 call didn't come in until 18:10, but he'd been trying to find one of his kids to help him because he didn't really know what to do. Weird until you hear that the woman was a DNR (do not resuscitate), and thus he didn't want to call the ambulance because he didn't want anyone trying to revive her against her wishes. So who do you call when someone you love is dead, or nearly so, on the floor and doesn't want to be revived? An interesting question and one that all the hospitals pushing "advanced directives" need to start discussing with their patients because the staff all know what to do if someone dies in the hospital but the family members may not know what to do if their loved one dies elsewhere.
19 July 2006
Melting
No posts in a while because I'm melting away. I actually bought a room A/C, which is a major step for an electricity-conserving tree-hugger. Seriously, I have been spending 15 minutes of every hour standing either directly in front of A/C or inside the refrigerator. That only leaves 45 minutes to scurry around and accomplish things while trying not to stand in the direct sunlight because otherwise I will burst into flames. Yes, NH does not have the sultry summer temperatures of locales further south - but that is one reason why I live in this crazy state, and mid-90s is just too hot. It has been so hot that the ambulance company let us out of our uniform shirts and into company T-shirts for a record number of days in a row.
Yesterday was the hottest this summer and I was in the single most crap-tastic truck the ambulance company owns. Oh yes, a 1993 with 150k miles which finds its way to the mechanic's bay about every third day. A/C was currently on "intermittent" status meaning it works when it feels like it. On max with the fan on high, Giggly* and I enjoyed a temperature of about 92 degrees as opposed to the 97 outside. I'm sure you can guess what comes next. A long transfer up and down hills, which we accomplished. A long drive to get back to the station. After driving 3/4 of the way back, we get another call from an outlying hospital, back the direction we'd come, for a transfer to an even more outlying location. So, back up the hills we go. Until the truck decided it had enough...with the temperature gage on the big red H, the smell of burning anti-freeze, and when we stopped, a giant cloud of steam. Of course, as we're in an ambulance, we have a radio and a cell phone to call for help and dispatch says they're sending us a tow truck.
We're stopped on the side of a major two-lane road waiting, for nearly 2 hours. At least there was an assortment of trees and bushes to choose from to deal with the consumption 200+ oz of fluid to try and stay hydrated in the heat. Exactly 1 private vehicle stopped to ask if we needed help, 1 state trooper, and 1 ambulance from another company. Thankfully, the tow truck guy had his A/C set to deep-freeze so by the time we got back to the station, I felt like a human again and not a sweaty pile of uniform clothing. Then I got to go work a baseball game, but praise the weather gods, the temperature dropped 11 degrees in the first 20 minutes I was there, and by the end of the game was a comfortable 77, and the A/C in the bedroom means I actually slept last night.
*Giggly "Joe" (not his name) is honestly what I call the guy I worked with yesterday to distinguish him from the other 4 "Joe"s that work for the company - there are times when all of them are in the station at once and it is hard to have a conversation when nobody knows who you're talking to or about. I call him this because the first shift I worked with him was one of his first with the company and he was so nervous he just giggled all day. A 21-year old guy, just giggling. Most other people call him by what he has on his license plates, but he's been Giggly to me long before I knew which vehicle was his, so Giggly he remains.
Yesterday was the hottest this summer and I was in the single most crap-tastic truck the ambulance company owns. Oh yes, a 1993 with 150k miles which finds its way to the mechanic's bay about every third day. A/C was currently on "intermittent" status meaning it works when it feels like it. On max with the fan on high, Giggly* and I enjoyed a temperature of about 92 degrees as opposed to the 97 outside. I'm sure you can guess what comes next. A long transfer up and down hills, which we accomplished. A long drive to get back to the station. After driving 3/4 of the way back, we get another call from an outlying hospital, back the direction we'd come, for a transfer to an even more outlying location. So, back up the hills we go. Until the truck decided it had enough...with the temperature gage on the big red H, the smell of burning anti-freeze, and when we stopped, a giant cloud of steam. Of course, as we're in an ambulance, we have a radio and a cell phone to call for help and dispatch says they're sending us a tow truck.
We're stopped on the side of a major two-lane road waiting, for nearly 2 hours. At least there was an assortment of trees and bushes to choose from to deal with the consumption 200+ oz of fluid to try and stay hydrated in the heat. Exactly 1 private vehicle stopped to ask if we needed help, 1 state trooper, and 1 ambulance from another company. Thankfully, the tow truck guy had his A/C set to deep-freeze so by the time we got back to the station, I felt like a human again and not a sweaty pile of uniform clothing. Then I got to go work a baseball game, but praise the weather gods, the temperature dropped 11 degrees in the first 20 minutes I was there, and by the end of the game was a comfortable 77, and the A/C in the bedroom means I actually slept last night.
*Giggly "Joe" (not his name) is honestly what I call the guy I worked with yesterday to distinguish him from the other 4 "Joe"s that work for the company - there are times when all of them are in the station at once and it is hard to have a conversation when nobody knows who you're talking to or about. I call him this because the first shift I worked with him was one of his first with the company and he was so nervous he just giggled all day. A 21-year old guy, just giggling. Most other people call him by what he has on his license plates, but he's been Giggly to me long before I knew which vehicle was his, so Giggly he remains.
13 July 2006
IV
Part of the curriculum for the EMT-Intermediate is learning how to initiate IV therapy and give a limited number of drugs. There are mannequin arms and hands filled with fake blood to practice on, but they are so well used that finding a vein is a matter of following all the other puncture marks and the fake blood oozes out continuously rather than being a more realistic response to a fresh "stick". Even so, the idea is to practice on someone who isn't going to be injured by any stupid mistakes we might make. But eventually, in my group within an hour, you move on to real people, specifically your class mates. The rule is give a stick, get a stick. Here's the results of Monday's practice:
I took 3 sticks that night and this is the only one that looks this nasty (I promise Mom). The flash on the camera doesn't really do it justice, but you get the idea. I knew it was as nasty looking as I thought it was when I walked into the ambulance station and the couple of people who got a glimpse asked what the hell I let someone from class do to me. I have big, big veins that are fairly hard to miss, and the guy who did it sure didn't miss, he just caught the side of it the first time and then straightened out to hit it dead on.
Last night wasn't quite so bad, I was partnered up with the only guy who missed class and live sticks on Monday, so he tried once on each arm, hitting on the second try but at least not leaving any major bruises. Personally, I'm 2 for 3 on my sticks so far. Class only requires 5 successful sticks total, but I'm aiming to have at least 5 on each ER clinical shift.
I took 3 sticks that night and this is the only one that looks this nasty (I promise Mom). The flash on the camera doesn't really do it justice, but you get the idea. I knew it was as nasty looking as I thought it was when I walked into the ambulance station and the couple of people who got a glimpse asked what the hell I let someone from class do to me. I have big, big veins that are fairly hard to miss, and the guy who did it sure didn't miss, he just caught the side of it the first time and then straightened out to hit it dead on.
Last night wasn't quite so bad, I was partnered up with the only guy who missed class and live sticks on Monday, so he tried once on each arm, hitting on the second try but at least not leaving any major bruises. Personally, I'm 2 for 3 on my sticks so far. Class only requires 5 successful sticks total, but I'm aiming to have at least 5 on each ER clinical shift.
08 July 2006
Get back on and ride
Okay, back from family obligations and returning to work of all types. Unfortunately, EMT work is down significantly with the training of one new full-time vanbulance person. I'll still be volunteering with the FD, but July and August could get tight financially so I'm not sure what I'll be doing to make some extra cash on the side, but the extra time to study for the next MCAT in August will be gratefully accepted.
Class is moving along, and in honor of being able to do new things, I've purchased my very own stethoscope in carribean blue, with a hip holster which made K jealous. Not as cool as DTs', but a workable Littman II SE lightweight. Now I don't have to worry about sharing ear cooties with anyone else in the vanbulances. Our clinical time in the hospital starts next week, so I'll be officially sticking people with IVs, checking out heart rhythms, and doing any scut work the nurses pass off to me. Hopefully I'll get some good skills practice in and maybe even see something cool here and there. I know it is too much to hope that I'll actually get to intubate someone, but that would R-O-C-K!!
Today also led to the important discovery that I haven't been taking my meds - which could explain why I feel especially like crap and would prefer not to budge from bed for at least 12-14 hours, which I certainly don't have time for. But, when finally awakened, I now have a clean and sparkly car, notecards for all the drugs I need to learn about before I give them to people, a 2-mile jog followed by some weightlifting for good measure, 4 clean loads of laundry and 1 load of dishes, and a dog who enjoyed his evening walk. And it isn't even bed time yet...
Class is moving along, and in honor of being able to do new things, I've purchased my very own stethoscope in carribean blue, with a hip holster which made K jealous. Not as cool as DTs', but a workable Littman II SE lightweight. Now I don't have to worry about sharing ear cooties with anyone else in the vanbulances. Our clinical time in the hospital starts next week, so I'll be officially sticking people with IVs, checking out heart rhythms, and doing any scut work the nurses pass off to me. Hopefully I'll get some good skills practice in and maybe even see something cool here and there. I know it is too much to hope that I'll actually get to intubate someone, but that would R-O-C-K!!
Today also led to the important discovery that I haven't been taking my meds - which could explain why I feel especially like crap and would prefer not to budge from bed for at least 12-14 hours, which I certainly don't have time for. But, when finally awakened, I now have a clean and sparkly car, notecards for all the drugs I need to learn about before I give them to people, a 2-mile jog followed by some weightlifting for good measure, 4 clean loads of laundry and 1 load of dishes, and a dog who enjoyed his evening walk. And it isn't even bed time yet...
03 July 2006
It's been a while...
...since I could stand on my own two feet again (surely some of you recognize Staind).
This isn't literally or probably even figuratively true, just the overwhelming emotion of late, and my grand excuse for not blogging besides just feeling like I didn't have much to write. Even before the news that has kinda knocked me flat. The news is the recent death of my paternal grandmother. I think this has been a lot harder for me than before I started working as an EMT. I now take people to hospice care or home for palliative care and seeing the grief that wracks their families has taken a toll. It seems to be the opposite problem most people in this field have because it isn't that their grief and pain doesn't touch me, it puts me in mind of all the losses both real and future in my life. Even seeing the people that the nursing staff comment on how quickly they'll be coming back to the hospital is hard because I see the diminshed quality of life and the frustration of sometimes entirely coherent people trying to overcome the limitations of their bodies.
I leave these calls feeling wrung out and sometimes wishing I was more of a touchy-feely-type person so I wouldn't feel so awkward about just walking up and putting my arms around someone who clearly needs it. I've definitely made progress because it is now much easier to at least deliver the "compassionate touch" - the hand on the arm of someone who's upset, holding the hand of a patient who is clearly worried and afraid, and so on, but I feel like I have a ways to go.
This isn't literally or probably even figuratively true, just the overwhelming emotion of late, and my grand excuse for not blogging besides just feeling like I didn't have much to write. Even before the news that has kinda knocked me flat. The news is the recent death of my paternal grandmother. I think this has been a lot harder for me than before I started working as an EMT. I now take people to hospice care or home for palliative care and seeing the grief that wracks their families has taken a toll. It seems to be the opposite problem most people in this field have because it isn't that their grief and pain doesn't touch me, it puts me in mind of all the losses both real and future in my life. Even seeing the people that the nursing staff comment on how quickly they'll be coming back to the hospital is hard because I see the diminshed quality of life and the frustration of sometimes entirely coherent people trying to overcome the limitations of their bodies.
I leave these calls feeling wrung out and sometimes wishing I was more of a touchy-feely-type person so I wouldn't feel so awkward about just walking up and putting my arms around someone who clearly needs it. I've definitely made progress because it is now much easier to at least deliver the "compassionate touch" - the hand on the arm of someone who's upset, holding the hand of a patient who is clearly worried and afraid, and so on, but I feel like I have a ways to go.