First Standing Ovation

Well, the ovation wasn’t for ME, but it felt like it!

Friday we had a call to the college soccer field where there was a contest going on. Seems our goalie was kicked in the head by an opposing player who was (hopefully) trying to kick the ball. Turns out those college soccer players can generate some force when they go about trying to score a goal. Who knew?

We drove onto the lighted field to see the trainers and team physician trying to keep the now conscious but confused goalie from getting up. Head stabilization, quick assessment (can you pronouce anterograde amnesia? - sure, I knew ya could!), collar and board, and into the rig he goes. As we are loading him the crowd stands up and applauds. At that moment, and only then, I realize a BUNCH of people were watching me work. I was so focused on our patient that it seemed like I was alone with him and the other first responders. Weird feeling to know that so many eyes were following what we were doing.

What the &#!! have I been doing with my time?

Don’t have a story to tell but I have been very busy.

Home

We are still grieving the loss of my father-in-law. It is slow process and the function is non-linear, particularly for my wife who will be doing fine and then all of a sudden remember her father.

Everyone has been sick over the last few weeks. The Petri dish that some call “school” triply infects our house (I pick it up at the college, my son the grade school and my daughter the pre-school).


EMS Wise

Medic class – We are moving out of A&P and into Pharmacology

Taking a minimum of two six-hour shifts a week as an EMT with my volunteer corps (though I usually pick up an extra shift or two). I went on an assault call shook me for a bit but don’t feel I can blog much about it for a variety of reasons.


Academia Wise

Teaching statistics to 30 students who, for the most part, are excellent.

Advising 7 independent studies / senior research projects (2 hoping for honors)

Working on a study abroad proposal to take a group of 18 students to Australia from 2/06 to 7/06.

Formulating a job ad and description for a program I have worked with (NOTE: for some tasks, eight people are NOT better than two)

Working on “course projections” for the Spring of ’05 for the program I chair.

Getting institutional review board approval for some of the studies I am running.

Analyzing some data for an alcohol and drug treatment program for teens. My institution basically does some pro bono work for local groups and non-profit agencies and I managed to get sucked into this endeavor because I know SPSS to some (minor) extent.

Meetings for this, that and the other thing. Yech.



We are due for a major trauma or “interesting” call so keep watching this space (yes, I know, someone who teaches statistics knows better than to describe a random process as having something “due” to happen, but you EMS folks know the feeling!).

Anatomy and Physiology in six hours of lecture

We had approximately 150 pages of reading due this week for my AEMT class and all of it in anatomy and physiology. We are talking reading where you could spend 10-15 minutes on per page to really understand and retain the material. The book we are using has all of this information IN ONE CHAPTER. Topics ranged from atoms and molecules to multi-system response to insults to homeostasis. It is odd reading about acid-base balance and then, fifty pages later but in the same chapter, reading about how the nervous, endocrine and circulatory system work in concert to maintain blood pressure. I was mega-stressed going into last night’s class as despite my best efforts I did not know everything in this section like the back of my hand (I get a hair bit compulsive and assumed that if the reading was assigned they want us to KNOW it). After 10 hours of reading and finding myself about a third of the way through the material I had to change my strategy towards the material.

Based on class last night, I am getting the feeling that the reading was meant to be read (vs studied) as background to class and that much of the details will be saved for when we get to a particular body system. I also get the feeling some of the details are just not to be worried about EVER. For example, the instructor said, and I quote, “What I want you to know about blood clotting at this point is that it involves platelets and that fibrin is the main player”. Hmmm, that is a hell of a lot easier than the three pages which go into the many enzymes, steps and factors that underlie the very complex issue of blood clotting.

Obviously I want to know a lot about A&P. Practically speaking, five days of reading and two classes is not enough to really UNDERSTAND A&P to the level the book gives it. I assume an endocrinologist knows different details about A&P than an orthopedic surgeon does. Certainly they were both exposed to a lot of the same material, but some information is more relevant to their chosen profession. Choosing which details are important to spend time on as a pre-hospital care provider is difficult for me to do right now but obviously important. I expect MY students to be able to read a text and selectively learn based on the guidance I give them in the syllabus and lecture, so I just need to suck it up and start being selective about where I focus my energies. It is just hard knowing there are things I could know better if we had more time to read and have more lectures (yes, yes, yes, - I won’t ever know even close to everything, it isn’t rational to want to try, and in fact it is a sign of psychopathology – Go ahead and commit me).

Lung Sounds

I had a patient yesterday who had just finished seizing as we arrived. The crew was a driver and myself, making us a BLS unit on a call that is ideally handled ALS (any change in mental status should be ALS'd by our protocols). I wasn't too worried as the patient is a frequent flyer and the hospital was within spitting distance (and our nearest ALS).

What I was worried about was the patient’s lung sounds. The patient had a sound upon exhalation that was very distinct and I was horrified that I was not prepared to label this sound. Ronchi? Rales? Shit. I realized then I had never actually heard these things, just read about them. I felt like a moron going into the ED and saying during my patient hand-off that the patient has a "crackling sound" upon exhalation, bilaterally. I wish the EMT class had a patient simulator with digitized sounds inside it that could be programed to simulate different respiratory symtoms.

My clinical time for the medic class involves a few rotations with respiratory therapy. I will make SURE I get to listen to these things so I won't be stuck trying to match what my ears are receiving to descriptions by eyes have read.

HEY! HO! LET'S GO!

"Johnny Ramone" died yesterday.

I want to be sedated.

http://www.nytimes.com/2004/09/17/arts/music/17ramone.html

What do you want and have you found the candidate who will give it to you?

My blog is not political that often. Probably for the best. Forgive me for going astray.

I am in favor of conservative GOVERNMENT (not conservative politics). To me, this is in line with what the founders of the US constitution had in mind. That is, government is fundamentally evil, though very necessary. The goal of the people should be to have the minimum amount of government as possible to have a safe and functioning society. Anything that doesn’t NEED government intervention should not have it.

Monopolies and oligopolies are problems, as are child molesters and people who tell you that paying $10k for peach pit infusions will cure your cancer. They need government control. Interstate trade and travel? Industries that can hide the “true cost” of their product by dumping pollution or other costs onto others besides their customers (e.g., society as a whole) to be paid later? Clearly we need government. Do we need a government to tell us what we can and can’t do in the privacy of our bedrooms? To tell us that extra large fries or rear engine cars shouldn’t be sold? I think not. Clearly there are lines to be drawn. I guess the tough part is that we all disagree on where those lines are. My current problem is that I don’t think there is a candidate for US president who has a chance in hell to win that is truly “small governement”. Who can I vote for? Are they not both whores to the sources of money who put them in position to win their respective positions? Is it not the case that both of them will end up sucking my money from me to pay back the sources that bought them? Is it reasonable to vote for “the least evil option”?

Some days I think my father is right: We are going to hell in a hand basket and there isn’t much an individual can do about it. This is one of those days.

This Really Happened (but not to me)

You know those stories that happen to "a friend" but you KNOW it really happened to the person with which you are talking? This one REALLY did not happen to me. I'll even leave it vague as to which corps (now that I've started my medic class I hear stories from a variety of agencies, some volunteer, some paid). That said, I really trust the source, as the story does not make him or her look good. Here is the story...

Relatively new EMT arrives on the scene with a driver only (driver has no certs). Call came in as intoxicated individual. When ambulance arrives, police leave, leaving the EMT with a patient and two bystanders. Patient "fell" while intoxicated. New EMT is about to board and collar the patient when bystander #1 says "I'm an EMT and was with the patient all the time. I can help and go to the hospital with you)". Bystander #1 begins to walk patient into the back of the rig, is a member of new EMT's agency, and new EMT is short handed. The reply is seemingly obvious: "Sure".

The short ending is that bystander #1 was also intoxicated. This person was an EMT, but in no position to provide patient care. In addition, bystander did NOT witness patient's fall, and our protocol would be to collar and board this patient. New EMT figured if a more experienced EMT on the scene cleared c-spine, then all is well. Doc in ED wonders aloud why patient was not immobilized. EMT explains experience. Doc chews out bystander #1. EMT feels like (s)he should have taken control of the scene and made a mistake.

Complicated. In small agencies, where having people arrive on scene (not with the rig) is common, isn't it reasonable to expect that anyone who you know, and is a member of your agency, and states they are an EMT, is taking the responsibilities of an EMT? On the other hand, ultimate responsibility rides with the EMT that takes the rig out. Ouch.

Anyway, patient was fine. EMT is still worried. I don't know what happened to the bystander EMT.

Back in Town

I am back from services for my father-in-law. We had as "good" a time as one could hope for given the circumstances.

Currently in the process of:

* Teaching

* Attending meetings up the ()*&$&*

* Studying for my medic class.

* Working up course projections for Spring of '04

* Working on my application to take a study group abroad (oy! oy! oy!).

etc. etc. etc.

I am afraid of the lawn. VERY VERY afraid.

Will blog more when I catch up from being away.

Goodbye Steve

My father-in-law passed yesterday. He went at home and relatively peacefully, for which we are very thankful. I did not spend a lot of time with the man, but given how wonderful my wife and her sisters are, I always knew he must have had greatness in him.

090404

Two calls this weekend so far.

Sat at 0130 – “Report from campus safety of an intoxicated 18 year old female who has taken other drugs”.

Points of interest to me:
• As I walk into the student apartment containing our patient a male smiles at me and says very sheepishly “Hi Dr. J”. No, this will not go on your permanent record.
• 18 y/o intoxicated female in an apartment with 6 upperclassmen? Maybe I am over-reacting, but I would NOT want my 18 y/o in a similar situation.
• When the doc tells you not to mix ethanol with your anti-depressant, anti-anxiety and anti-seizure drugs, the doc ain’t kidding. Sheesh.
• Their TV. I swear the TV in this apartment was at least 72”. I don’t know where it came from, but maybe the kid driving the Hummer around campus (a REAL Hummer, not the pretend one) can help them haul it home.

Sat at 1200, just as I am sitting down to lunch with my wife – “Injuries from a fall from a horse at [location]”. “Location” is NOT anywhere in civilization and is not on the map. Turns out it is a “truck trail” on state land in the middle of a state forest with miles of horse trails. I am again reminded that there are people with WAY higher pain tolerances than I. This guy was reporting pain as a “4” and I am fairly certain he has broken ribs. He screamed each time we went over a bump. It took us almost 30 minutes to get to the hospital and our rig was covered in mud and horse [stuff]. I tracked so much crap into the ED that within two minutes of my entering the place I heard a request for house keeping over the PA. Sorry folks, I wiped my feet.

Keep thinking about...

(note: In order to protect people's privacy I am leaving a lot of things out of this post, including when the call happened)

I was on a call at some point this year that brought us into a house with four kids in it. The house was a mess, and the kids were clearly being neglected (the police were there with us). Two of the kids looked just like my daughter and were just as sweet. All they wanted was to be held and they did not want us to leave. I just can't stop thinking about these kids. Through no fault of their own their daily life is just so different from how my kids live, including but not limited to attention paid to them, nutrition and cognitive enrichment. For reasons I can't explain this call has weighed more heavily than any of the traumas I've seen. I really hope those kids end up getting enough love and I know there is nothing I can do about it (yeah, yeah - social services knows about the situation).

F'n Taxes

I know I have it good. Really. And, I understand that it is expensive running schools, roads, etc. But...

We just got our "School Tax" bill. $6,500. In addition to this, we pay county property tax, state income tax, sales tax, registration and inspection fees for our cars, gas tax, alcohol tax, and, of course FEDERAL INCOME TAX. I know I'm leaving many taxes out of this.

The following piss me off:

1) Can't we just have ONE tax bill? That is, don't I, as a citizen, have the right to know how much I am paying to the government? The curent system makes it nearly impossible to do this math.

2) Over 1/3 of my son's school mates recieve reduced or free lunches. You want to guess what percentage of those parents smoke, drink or feed their kids fast food? You want to do that crap on your dime, help yourself. My dime? We need to talk about nicotine and alcohol free living and eating rice and beans. In addition, half of the EMS calls I go on have people on public assistance who have satilite TV, VCRs and snowmobiles. I PAY for these things. YOU pay for these things. This is WRONG.

3) The tax code. I have a Ph.D. My wife has a law degree AND a Ph.D. We pay someone else to do our taxes, because they are complicated enough that it would cost us more (in terms of time given our billable rate/hr) to do it ourselves. This is BAD. The tax code should be understandable to anyone with an IQ of 95 who can read. The current system just has to be simplified.

You too poor for your kids to get medical care? I'll help. You trying hard to get a job and can't? I'll help. You drinking a case a day, smoking a pack and a half, and feeding your kids twinkies and froot loops? I'd rather not, thanks.

Sorry, BAD DAY and then I come home to a 6.5K bill that I'm not in the mood for.