I think the universe might have been trying to tell me something. This week, I took the Motorcycle Safety Foundation's Basic Rider Course. I managed to successfully complete both the written and riding skills portion, including completing the U-turn maneuver completely within the prescribed area for the first time during the test. Anyway, I knew this course was coming up because I had to register for it in March, so I've been waiting all summer to get my license. A note for those who don't know, New Hampshire does not have a helmet law for anyone over 18.
Saturday night we were dispatched for motorcycle accident on the highway. Updated en route for CPR in progress, an EMT-Basic student riding with us getting a bit agitated to do compressions for real. On scene, find a LOT of blood running down the highway, three or four bystanders, someone doing chest compressions. As we're working, the FD finds more information for us, including the location of the rider's helmet. Securely attached to the back seat of the motorcycle. Ultimately, the patient died. We were still at the hospital when the ME arrived and was kind enough to talk with us while he performed the exam. I swear he looked nearly uninjured except for the massive head injuries.
Just a safety reminder to wear your helmets and for me to ride as safely as possible.
17 July 2008
25 June 2008
Personal record
I think I actually had a call hit a personal low last night, which is definitely more difficult after 2 1/2 years. Patient called 911 stating he was outside the emergency room with a seizure problem and they wouldn't see him because he didn't have any insurance. Ahem, can I get a BullShit from the congregation?! See, we know you're full of it before we get there because hospitals will get in BIG regulatory doo-doo for refusing to see a patient.
Anyway, patient stated he was outside, but when we get there, no patient. No patient in the triage/waiting area. Marco? Marco? No Polo. We find him, IN A ROOM in the ER. I sit down with his nurse before I go see him because I'm sure there's a story here that I'm not going to get from the patient. Frequent flyer who usually leaves against medical advice or prior to being evaluated. Here for a "medication problem". Pissed because lab results would not be released to him without being seen by the doctor and he didn't want to waste his valuable time waiting; doctor was in talking with him when we got there.
Coming out of patient's room, doc sees us and states he is not releasing him for transport, we can't take him. Hey doc, guess what?! He's already at the closest appropriate facility, we don't need to take him and definitely don't want to reward this ridiculous behavior. Calling 911 to reduce your wait time at the ER, a new low point for inappropriate wasting of my time.
Anyway, patient stated he was outside, but when we get there, no patient. No patient in the triage/waiting area. Marco? Marco? No Polo. We find him, IN A ROOM in the ER. I sit down with his nurse before I go see him because I'm sure there's a story here that I'm not going to get from the patient. Frequent flyer who usually leaves against medical advice or prior to being evaluated. Here for a "medication problem". Pissed because lab results would not be released to him without being seen by the doctor and he didn't want to waste his valuable time waiting; doctor was in talking with him when we got there.
Coming out of patient's room, doc sees us and states he is not releasing him for transport, we can't take him. Hey doc, guess what?! He's already at the closest appropriate facility, we don't need to take him and definitely don't want to reward this ridiculous behavior. Calling 911 to reduce your wait time at the ER, a new low point for inappropriate wasting of my time.
18 June 2008
Frustration
DNR. Do Not Resuscitate. Let Me Die. To me, these statements seem pretty clear. I would assume they are even more so when you are being cared for in a "skilled nursing" facility. Nurses, LNAs, PCTs, whatever, should understand the technical terminology, and I truly believe that anyone spending weeks and months with terminal patients can understand the logical choice being made to avoid additional hopeless interventions. So, why, oh why do nursing homes call 911 for DNR patients who are dead or dying?
I just don't understand. 1. Patient is terminally ill, does not want any drastic interventions. 2. You have legal paperwork attesting to that request. 3. You are able to assess a patient and understand his condition, as in either circling the drain or already deceased. 4. You call 911 anyway and then yip at us for wanting to hook up the cardiac monitor to have an objective confirmation of death.
Okay, yes, we brought in all the goods to run a full resuscitation because the dispatch was for a seizure, updated en route to cardiac arrest. We'd be doing a piss-poor job if we weren't ready to do everything in our power to save our patient when we get there. But when you hand us the DNR paperwork, explain the patient's condition and the series of events that find a dead guy sitting in a wheelchair next to his bed, we are capable of switching gears. We understand DNR. Neither of us wants to feel like we're assaulting a corpse and disrespecting a patient's memory by performing interventions he wouldn't want. But there are a series of steps required of us before we can leave, just as there are steps required of you. We may not have known this man, but we can perform our duties with respect and until you see us behave otherwise, save your yipping for a more deserving target.
I just don't understand. 1. Patient is terminally ill, does not want any drastic interventions. 2. You have legal paperwork attesting to that request. 3. You are able to assess a patient and understand his condition, as in either circling the drain or already deceased. 4. You call 911 anyway and then yip at us for wanting to hook up the cardiac monitor to have an objective confirmation of death.
Okay, yes, we brought in all the goods to run a full resuscitation because the dispatch was for a seizure, updated en route to cardiac arrest. We'd be doing a piss-poor job if we weren't ready to do everything in our power to save our patient when we get there. But when you hand us the DNR paperwork, explain the patient's condition and the series of events that find a dead guy sitting in a wheelchair next to his bed, we are capable of switching gears. We understand DNR. Neither of us wants to feel like we're assaulting a corpse and disrespecting a patient's memory by performing interventions he wouldn't want. But there are a series of steps required of us before we can leave, just as there are steps required of you. We may not have known this man, but we can perform our duties with respect and until you see us behave otherwise, save your yipping for a more deserving target.
09 June 2008
Evolution
A couple of years ago I had gills and a penchant for jumping out onto the shore, feeling the sun stroke my scales. I think I might've made it to amphibian now. I can't quite leave the water behind, but at least I can sit in the air and eat bugs.
Surprisingly, readjusting to office work took less time than I expected. The first day of sitting in front of the computer, trying to remember what commands I needed for the results I wanted was a little scary. By the end of the day, my fingers were flowing across the keys again, dredging up memories banished to the recesses of my mind. Cool water flowing against my skin as I swim upstream and down, no gills, no scales, but still calming. I'm staying near the surface, avoiding the dangers of the depths, the places where my legs will atrophy from disuse.
Back on land, stretching those legs, I can make it to the low hanging trees. Protected, I can assess and assist but the medic is still the one exposed. Airway, IVs, drive, think, question, learn. Keep jumping. I'm slowly being left behind by others who are growing feathers and fur, paramedics, nurses, doctors. I'm just a fatter frog.
No teeth to eat the big stuff. No claws to climb higher. No feathers to get me off the ground. Application after application, how do I explain? They see a frog. Maybe some potential, but not enough. Another dozen years could see something else entirely, but no evolution occurs alone.
Surprisingly, readjusting to office work took less time than I expected. The first day of sitting in front of the computer, trying to remember what commands I needed for the results I wanted was a little scary. By the end of the day, my fingers were flowing across the keys again, dredging up memories banished to the recesses of my mind. Cool water flowing against my skin as I swim upstream and down, no gills, no scales, but still calming. I'm staying near the surface, avoiding the dangers of the depths, the places where my legs will atrophy from disuse.
Back on land, stretching those legs, I can make it to the low hanging trees. Protected, I can assess and assist but the medic is still the one exposed. Airway, IVs, drive, think, question, learn. Keep jumping. I'm slowly being left behind by others who are growing feathers and fur, paramedics, nurses, doctors. I'm just a fatter frog.
No teeth to eat the big stuff. No claws to climb higher. No feathers to get me off the ground. Application after application, how do I explain? They see a frog. Maybe some potential, but not enough. Another dozen years could see something else entirely, but no evolution occurs alone.
14 May 2008
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?
"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?
12 May 2008
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.
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.
01 May 2008
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!
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!