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.