01 April 2009
Things I never expected to say
To a woman who had just left a snot trail on my shoulder while sobbing, "Don't worry about it. If that's the worst thing on my shirt by the end of shift, it will be a good day."
23 March 2009
History taking
Sometimes, the things that happen just before the ambulance gets on scene are important. I've been on calls where the patient was moved and it takes 10 minutes to get the story straight because a patient laying in the middle of a big bed should not have a softball-size lump on his head from falling "right there", or "I took that pill the doctor gave me" turns into a 20 minute search for pill bottles and a game of 20 questions which never get me to the mystery pill (remind me to tell you that story sometime).
This call was memorable because as the first ambulance on scene, I got some of the information that the second ambulance didn't have and didn't think to ask for. Responding for a "sick person" call, arrive to find a middle-age woman very upset and pointing us to the living room where there is not 1 but 2 elderly folks in a state of disarray. The female pt had clothes on, sitting on the floor propped up against the couch; the male pt was laying on his back on the floor with a shirt and no other clothes. The room looked like a tornado had hit with model cars and trucks scattered about, the coffee table in pieces on the couch, a recliner on its side, and various other items strewn about. After the Asian and I split up and each assessed a patient, it was clear they both needed transport to the hospital and we called for a second ambulance.
While waiting for the second ambulance to arrive, the FD helped us do a spinal assessment and get both patients dressed enough to head out of the house. On arrival of the second crew, I try to give them a brief idea of what we know, including the male patient's medical history, vital signs and medication list. What they didn't ask, and I didn't think to tell, was the little detail of what we had done for the patient - getting him dressed and seated back in the recliner. We took both patients to the same hospital and made sure social services got involved with possibly placing them in assisted care because their needs were outpacing their family's ability to care for them.
Later in the day, I checked in with the other crew to find out how their patient was. "You'll never believe this! When the hospital stripped him down to put on a gown, they found a model truck in his ass!" Followed by the second crew member, "I don't even want to think about what those old people were doing!" I could have let this stand, after all where the truck was or why doesn't really make any difference, but I felt bad to have the patient get a reputation for something he wasn't doing, "Well, he could have fallen on it, there were a lot of models on the floor." Other crew, "No way! He was wearing pants." "Well, not when we got there he wasn't. We figured he'd probably want pants for the trip." The other crew appeared disappointed, but they'll probably still tell the story of the elderly gent with a truck up his butt and maybe we'll all remember to seek more details.
This call was memorable because as the first ambulance on scene, I got some of the information that the second ambulance didn't have and didn't think to ask for. Responding for a "sick person" call, arrive to find a middle-age woman very upset and pointing us to the living room where there is not 1 but 2 elderly folks in a state of disarray. The female pt had clothes on, sitting on the floor propped up against the couch; the male pt was laying on his back on the floor with a shirt and no other clothes. The room looked like a tornado had hit with model cars and trucks scattered about, the coffee table in pieces on the couch, a recliner on its side, and various other items strewn about. After the Asian and I split up and each assessed a patient, it was clear they both needed transport to the hospital and we called for a second ambulance.
While waiting for the second ambulance to arrive, the FD helped us do a spinal assessment and get both patients dressed enough to head out of the house. On arrival of the second crew, I try to give them a brief idea of what we know, including the male patient's medical history, vital signs and medication list. What they didn't ask, and I didn't think to tell, was the little detail of what we had done for the patient - getting him dressed and seated back in the recliner. We took both patients to the same hospital and made sure social services got involved with possibly placing them in assisted care because their needs were outpacing their family's ability to care for them.
Later in the day, I checked in with the other crew to find out how their patient was. "You'll never believe this! When the hospital stripped him down to put on a gown, they found a model truck in his ass!" Followed by the second crew member, "I don't even want to think about what those old people were doing!" I could have let this stand, after all where the truck was or why doesn't really make any difference, but I felt bad to have the patient get a reputation for something he wasn't doing, "Well, he could have fallen on it, there were a lot of models on the floor." Other crew, "No way! He was wearing pants." "Well, not when we got there he wasn't. We figured he'd probably want pants for the trip." The other crew appeared disappointed, but they'll probably still tell the story of the elderly gent with a truck up his butt and maybe we'll all remember to seek more details.
11 March 2009
What is that smell?
That, my friends, is the tangy, bitter smell of rejection. 'Tis the season for med school rejection letters again, and even though I'm accepted elsewhere, the rejection letters never feel good.
What they said: "You can be confident that the decision on your application was made with careful attention to your academic record, MCAT performance, extracurricular activities, and letters of recommendation. Rest assured that your application received a thorough, sensitive, and judicious review."
Translation: Don't call us and complain that you didn't get in. We read your stuff and we still didn't want you. And as for sensitive, well, we didn't laugh directly in your face and that's pretty darn sensitive.
What they said: "Although this does not end what we are sure is an unpleasant waiting period for you, your desire to become a physician, your understanding of the requirements, and your perseverance are commendable."
Translation: We're not even taking you all the way off the list just so we can string you along for a few more weeks. You appear to enjoy bashing your head into a brick wall so why don't you just go right ahead and keep on doing it because we're enjoying the entertainment.
What they said: "The Committee on Admissions wishes that the admissions process were such that it could accommodate you and all the fine candidates who apply for admission."
Translation: We seriously wish we could get more money out of you somehow, but unfortunately, there are rules against charging you fees for waiting on our list for months. If only there was a way to let you pay course fees without actually admitting you...hmm, we'll be sure to let you know when we figure it out.
What they said: "You can be confident that the decision on your application was made with careful attention to your academic record, MCAT performance, extracurricular activities, and letters of recommendation. Rest assured that your application received a thorough, sensitive, and judicious review."
Translation: Don't call us and complain that you didn't get in. We read your stuff and we still didn't want you. And as for sensitive, well, we didn't laugh directly in your face and that's pretty darn sensitive.
What they said: "Although this does not end what we are sure is an unpleasant waiting period for you, your desire to become a physician, your understanding of the requirements, and your perseverance are commendable."
Translation: We're not even taking you all the way off the list just so we can string you along for a few more weeks. You appear to enjoy bashing your head into a brick wall so why don't you just go right ahead and keep on doing it because we're enjoying the entertainment.
What they said: "The Committee on Admissions wishes that the admissions process were such that it could accommodate you and all the fine candidates who apply for admission."
Translation: We seriously wish we could get more money out of you somehow, but unfortunately, there are rules against charging you fees for waiting on our list for months. If only there was a way to let you pay course fees without actually admitting you...hmm, we'll be sure to let you know when we figure it out.
24 February 2009
A day away
I spent yesterday enjoying some fresh snow, riding down the mountain at ridiculous speeds and working my body to a state of exhaustion. Today, I have the sore muscles to remember it by. Sadly, yesterday was the first day I have been snowboarding all winter and reminds me that I need to make the time to do winter activities so I don't start hating all six months of it.
And now, my heroic secret identity is ready for action....
And now, my heroic secret identity is ready for action....
22 February 2009
Follow up
Some folks have asked about the post earlier this week (or the related facebook update) and I'm sorry, but I don't want to get into the details of the incident in question. There are just times when something happens in your life that makes you take a hard look at yourself and question what you see. What type of person do I want to be? How should I be treating people? How would I prefer to be perceived?
I have never been one of those "sweet" girls. You know, the ones with a nice bit of encouragement or support for everyone, wants to be everyone's friend. I work to take care of my friends and people I care about. When you are my patient, I consider you an important responsibility and I will bust my ass for you. When you are a student or new employee riding with me, I pride myself on giving you everything I can to help you succeed. If you are preventing me from accomplishing these things, I will do whatever I can think of to get you out of my way - even when it isn't very nice.
I don't actively want to hurt people's feelings, but I do have a unique sense of humor which sometimes finds the one thing you wish nobody would notice. I don't enjoy having to rely on people who have proven themselves to be incompetent or plain stupid and I don't always have the patience to coddle their feelings. But the recent incident reminds me that I have to avoid slipping into a "scorched earth" policy with these folks as well.
I am feeling a bit better overall, which helps me find a little more patience, and I've been lucky enough to have a couple new employees who were good at their jobs this week, which helps me find a little more joy in my days. So, thanks for the concern.
I have never been one of those "sweet" girls. You know, the ones with a nice bit of encouragement or support for everyone, wants to be everyone's friend. I work to take care of my friends and people I care about. When you are my patient, I consider you an important responsibility and I will bust my ass for you. When you are a student or new employee riding with me, I pride myself on giving you everything I can to help you succeed. If you are preventing me from accomplishing these things, I will do whatever I can think of to get you out of my way - even when it isn't very nice.
I don't actively want to hurt people's feelings, but I do have a unique sense of humor which sometimes finds the one thing you wish nobody would notice. I don't enjoy having to rely on people who have proven themselves to be incompetent or plain stupid and I don't always have the patience to coddle their feelings. But the recent incident reminds me that I have to avoid slipping into a "scorched earth" policy with these folks as well.
I am feeling a bit better overall, which helps me find a little more patience, and I've been lucky enough to have a couple new employees who were good at their jobs this week, which helps me find a little more joy in my days. So, thanks for the concern.
18 February 2009
Today's insight
I am a raving bitch. Irrational and angry. Working on it.
*and I don't mean raving in an "oh, isn't that cute, she's all worked up about something." I mean spouting off in a "holy crap, back slowly away from the crazy person and call the dudes with the straight jackets." Seriously.
*and I don't mean raving in an "oh, isn't that cute, she's all worked up about something." I mean spouting off in a "holy crap, back slowly away from the crazy person and call the dudes with the straight jackets." Seriously.
16 February 2009
Worry
Funny how syncope for myself just gets me irritated, but my dog being in pain worries me enough to keep me up at night. Watson came home from his walk last night and wouldn't come up the stairs. I went over to see where he was and he had stopped in the middle of the flight of stairs and refused to come up or go down. K carried him up the stairs as I'm giving him the third degree, "What did you do to the dog?" "Why won't he come up the stairs?" "Did he hurt himself?" and probably at least half a dozen others in the time it took him to walk up five stairs cradling my aging baby.
As a good EMT, I immediately assessed the patient. He wasn't bearing full weight on his right rear foot. He cried in pain when I touched his right hip. When laying down, I could take his leg through a full range of motion without apparent distress, but he still cried when I touched his hip. I strongly considered checking the internet to see whether I could give him any over the counter medication for pain, but ultimately decided to have him sleep the night and see how he felt in the morning.
This morning, he was not improved. When he got up to eat, he cried when putting weight on his leg. When he went outside, he walked tenderly, using his right leg as little as he could. I walked around the house with him so he could get downstairs without using the stairs and he curled up next to my chair, not even willing to go the extra 2 feet to lay on his pillow. I was worried he might have a soft tissue injury from a dislocation that he had been able to get back in place, or some loose ligaments in his joint that was allowing his hip to slip out of joint in some fashion. We had a vet appointment at noon.
Some of the early questioning by the tech involved ticks and I never really made the connection until the vet said she felt comfortable that this wasn't Lyme disease. Watson was very patient and easy-going during the exam, definitely reacting with pain when she got to his right hip and enjoying the gentle massage on the rest of his legs. After the exam, she decided it seemed like a soft tissue injury, possibly a bruise. Watson is crazy at times and will run around the corner from the yard onto the porch and lose his footing in the snow/ice, so this is entirely possible. He's now on a course of anti-inflammatory and pain reliever, with no walks, no outdoors (except leashed bathroom trips) and no stairs for 10 days. My hope is that this will be enough healing time for him because after this it is sedation, x-rays and the options get less pleasant.
As a good EMT, I immediately assessed the patient. He wasn't bearing full weight on his right rear foot. He cried in pain when I touched his right hip. When laying down, I could take his leg through a full range of motion without apparent distress, but he still cried when I touched his hip. I strongly considered checking the internet to see whether I could give him any over the counter medication for pain, but ultimately decided to have him sleep the night and see how he felt in the morning.
This morning, he was not improved. When he got up to eat, he cried when putting weight on his leg. When he went outside, he walked tenderly, using his right leg as little as he could. I walked around the house with him so he could get downstairs without using the stairs and he curled up next to my chair, not even willing to go the extra 2 feet to lay on his pillow. I was worried he might have a soft tissue injury from a dislocation that he had been able to get back in place, or some loose ligaments in his joint that was allowing his hip to slip out of joint in some fashion. We had a vet appointment at noon.
Some of the early questioning by the tech involved ticks and I never really made the connection until the vet said she felt comfortable that this wasn't Lyme disease. Watson was very patient and easy-going during the exam, definitely reacting with pain when she got to his right hip and enjoying the gentle massage on the rest of his legs. After the exam, she decided it seemed like a soft tissue injury, possibly a bruise. Watson is crazy at times and will run around the corner from the yard onto the porch and lose his footing in the snow/ice, so this is entirely possible. He's now on a course of anti-inflammatory and pain reliever, with no walks, no outdoors (except leashed bathroom trips) and no stairs for 10 days. My hope is that this will be enough healing time for him because after this it is sedation, x-rays and the options get less pleasant.
13 February 2009
February blues
For some reason, February and I do not get along. I would like to think it is the cold or the dark, but December and January are darker and usually colder. I just find it very hard to deal with every day annoyances during this month, motivation is at a nadir, and pretty much I just don't wanna anything. This month was not improved by a visit to the PCP which reinforced the need to "lose weight" because the "trend" on her graph of my weight has been upwards the last three visits in a row, despite being an actual change of less than 5 lbs, and where she suggested cutting out all sweets and doing a better job of eating small meals throughout the day to manage my blood sugar. Nor by the cardiologist who assured me I was fine, 3 syncopal episodes in a year is nothing to worry about because there are people with "15 in a couple months" and I just have to cut way back on caffeine and drink lots more water.
(Side note: He actually suggested I drink 15 OUNCES of water when I have to get up in the middle of the night to do an ambulance call. I usually drink about 15 oz all day. If I implemented this suggestion literally, all I would do is pee at patient's houses. I'm not sure he was impressed when I laughed at his suggestion, said "Are you serious?" and laughed some more when he assured me he was serious.)
So, I get to hear how I suck at life at a point when I don't feel up to anything. For the record, all the medical suggestions are reasonable ones, just not ones I can handle very well right now.
(Side note: He actually suggested I drink 15 OUNCES of water when I have to get up in the middle of the night to do an ambulance call. I usually drink about 15 oz all day. If I implemented this suggestion literally, all I would do is pee at patient's houses. I'm not sure he was impressed when I laughed at his suggestion, said "Are you serious?" and laughed some more when he assured me he was serious.)
So, I get to hear how I suck at life at a point when I don't feel up to anything. For the record, all the medical suggestions are reasonable ones, just not ones I can handle very well right now.