Getting Back To It

While I still think about the events I blogged about last, I am back in action and coming to terms with what happened.


There is light at the end of the medic class tunnel.

The requirements for the program I am in include clinical hours in various hospital departments and ride time on an ambulance that isn’t your home agencies’. The clinical hours, perhaps obviously, are time-based, and I only have 12 hours of those left (8 with a pediatrician and 4 at our 911 center). Ride time, on the other hand, is considerably more amorphous in terms of how it is measured. There are four phases of the ride time component (orientation, BLS skills, ALS assist and ALS from start-to-finish), and completion of each stage is solely determined by a “preceptor”. In theory, it could take a few hours or hundreds. This has made me nervous as there is no “I’m half way” or “almost there”. Until now, that is.

My preceptor told me last night that he feels he can sign me off after two more outings (I had thought we’d need MANY more). His confidence in me is greater than my own, but it helps to know he thinks I’m ready. He’s a professional paramedic, but also the chief of his hometown fire/rescue/ambulance, so he knows what I’ll be up against when I’m turned loose. Most of the medics in my class will ride with a paid agency and won’t be asked to handle a call on their own until quite a while after they’ve gotten their card. I, on the other hand, will be the sole ALS provider on MANY calls starting from the day I get my card. My preceptor knows all of this so his willingness to sign me off makes me proud and scared at the same time.

The end is in sight, which, oddly enough, means a new beginning is right around the corner.

DJ

Sad News

I just found out that the young man with sepsis died later that night in the hospital. I just was not mentally prepared for a younger medical patient to die within hours of my helping him and talking to him. I don't know why this is hitting me so hard, but here I sit in my office with the door closed unable to stop crying.

Super Dog Update

The first few days after Travis' surgery I was wondering if we had done the right thing. He looked zonked, and could not move his hind legs AT ALL. We spent many days going outside with him and holding up is hind quarters so he could do his "business". Humbling...

My how things have changed. He is still crated most of the time to let him rest and heal, but he can WALK! An ugly walk, but a walk all the same. He looks like his old self, which makes me very happy. In the last year or so we've gone from three dogs to one, and I just wasn't ready to lose a third.

DJ

24 y/o male – difficulty breathing, dehydration

Inside the well kept home is a young man supine on the couch. He looks like I did when I was his age. Tall, lanky, and his hair just a tad too long for his mother's taste, but just right for his age. One look at him shows things are not right. He is moaning, and not the fake moaning of a drug seeker. His skin is very pale and he has goose bumps all over. He is VERY dry (skin, lips, tongue) and hot. My preceptor starts to get a history from the pt’s mother as I grab a set of vitals. Pulse 120, BP 72/48. Time to get moving.

Short version of his recent medical history: Our pt, usually a happy, healthy and active young man, had out-patient surgery five days before our being called. Day one after the surgery he started feeling worse instead of better. Over the next few days he spiked a fever, lost his appetite and could not keep down solids or liquids. His mother tried to get him to go to the hospital several times, but he kept telling her he was OK and didn’t want to go.

I knew the kid was particularly sick when my preceptor did not have me try and start a line. On the third attempt he got IV access with an 18 gauge. We got as much fluid in him as we could on our way to the hospital. When we left he was clearly in discomfort.

We stopped back a few hours later. The ER staff could not get another peripheral line in him, and had two failed attempts at a central line (they had called out for an anesthesiologist to try). They had pumped FIVE liters of fluids into him and his systolic BP didn’t get over 110.

Still later in the day he was being moved to ICU and they were considering dialysis as his kidneys (as well as other organs) were failing. Likely problem: sepsis.

As of now I don’t know how he is doing, but I can’t stop thinking about him and his family and fear the worst. We did everything we could and I worry it wasn't enough.

DJ

Spring Breaking It

I’m on spring break and should be grading tests and relaxing. I’m doing neither. Monday I rode with my preceptor for 8 hours and had 3.5 hours of medic class. Yesterday I spend 8 hours following respiratory therapists around listening to lung sounds. Today is 8 more hours with my preceptor plus a night being on call for my home agency (with the students out of town the board is fairly empty). Thursday I spend in a bigger emergency department and Friday will be in the ICU. I guess I grade midterms this weekend.

Worked a serious difficulty breathing on Monday. We could her the patient breathing from 40 feet away. Patient was hypertensive, had pedal edema and altered mental status. When she saw us she looked at us with that “you’ve got to save me” look. Two doses of nitro and 80 mg of Lasix later we had (if only temporarily) done just that. Her O2 sats went from the low 80’s to 96 and she looked like a different person. Amazing feeling.

DJ

Others in EMS know the following, and I am slowing learning them too...

You can ask the same history question five times and get the same answer, only to have the receiving nurse ask it a sixth time and get a totally different answer.

Some people can be dieing, literally, before they will reluctantly agree to have an ambulance called.

Others will call with a toothache when they are within walking distance of their dentist’s office. My favorite, though, is the non-emergency patient who can ambulate and whose family calls for an ambulance only to follow said ambulance at an unsafe distance in the family car.

You can tell a lot about how sick someone is by looking at them.

How sick someone thinks they are is not correlated with how sick they really are, with one exception: If someone states that they are going to die, you best start driving.

If someone is going to have a “smelly” problem, they will be in an enclosed space with no ventilation.

For some patients, their expression if being in severe pain suddenly diminishes when you tell them you are not carrying narcotics. Their pain can then get immediately worse upon arrival at the hospital. Hard to figure, eh?

Some children live in shitty circumstances. Everyone knows this abstractly. It sucks to see it concretely as it is not just a number or idea, but faces. Faces are hard to get out of your mind or ignore as “not my problem”.

Riding with the "Big Boys"

Ride time with my preceptor has been very useful. When I have more time I’ll fill in more details, but calls I remember include:

Major house fire. My first chance to see second degree burns in the field.

Mutual aid for a call in the boonies. Pt complaining of severe abdominal pain in a house set back from the road. Driveway unplowed. Took the county plow to make it so we could get the pt out (I don't know how the local fire chief got his 4-wheel drive Ford F-250 unstuck, but it was in up to the axles when we left...).

Person younger than me having severe sub-sternal chest pain that was non-reproducible and began on exertion. This guy had NO previous cardiac history. He does now – AMI confirmed via 12-lead. They used thrombolytics and took him to the cath lab. This made me wonder what the insides of my arteries look like…

Saw my first obviously fractured nose. Very obvious. Nurse fought a wheel chair and the wheelchair won. I also got to splint her wrist and apply ice to her patella. Tough job, nursing.

Call came in as full arrest. Long-term EtOH abuser out cold on bathroom floor. His heart and lungs, however, were doing their best to keep him perfused which is good for him, but means I have yet to work a code.

In general: I am starting to like medical calls more than trauma calls. Don’t get me wrong, I LIKE trauma, but for me, at least, the medical calls challenge me more as they are (in general) more of a puzzle.

I have more thoughts that I can’t get down due to limited time right now, but I’ll be back…

DJ

With age comes better judgement...

I had medic class last night (allergic reactions and anaphylaxis) and had a harrowing drive home due to the blowing snow and variable road surface. Upon reaching our house I looked at the driveway to see a considerable amount of drifting. I wonder how deep that is? This is what a scientist calls an “empirical question”. You can answer it by getting your ass out of the car and taking a 50 foot walk.

At minimum, you'd think the "how deep is it?" thought would give me pause. The problem, which all of you who have been stuck in a good snow car know, is that if you pile enough snow under your vehicle it doesn’t matter if you have all-wheel drive and/or snow tires. Your car “floats” up on the snow and you have little to no contact with the ground. Usually there is considerable compaction when this happens, as the car, perhaps obviously, weighs a fair amount. This means that the snow under the car is not easy to remove, but your only options are to get the snow out from under the car or to tow it off the drift (or, I suppose, wait until spring).

(Way-Back machine mode on)
I’m no greenhorn to this phenomenon. In 1981, when I was 16 and was looking at a closed parking lot full of drifts, I too had the thought I wonder how deep that is?. Being young and foolish, I decided to take a running start at the drift to give myself a fighting chance. This, of course, meant I was STUCK-stuck (that’s a special kind of stuck). The events that followed involved hours of cursing and shoveling to free my beloved Dodge Omni 024 (in "nightwatch blue", with AM and FM radio, don’t cha know). I have, of course, done the same thing multiple times since. I am now 39 and much older and wiser
(Way-Back machine mode off)

Back to last night at 10pm, as I sat in my car pondering the drifting, tired and eager to get inside. It was cold out. And, this part is important; I have the cognitive powers of a stroked-out water buffalo. Since I am a &&#^$ story teller, you saw this coming two paragraphs ago, and sadly last night I sort of saw it coming too, but I tried so hard to deny the possibility. I bulled ahead, knowing that speed would either save the night or cause grief (the faster you go, the more likely you’ll get through the drift, but if you don’t, you’ve packed that much more snow under your car and have drifting in front of you and behind you). STUCK-stuck.

I was STUCK-stuck last night. I tried for over an hour to get the car out, digging and digging, rocking and rocking. Despite trying to run myself over, it turned out I was not able to push my car and drive it at the same time (or, I should write, effectively push, as I did give it a good attempt).

So, into the house. Wake up the sleeping wife who has to teach at 8:30 in the morning, had to deal with two kids during the evening while I was off at medic class (this is the WORSE time at our house), and generally deserves better. Another 20 minutes or so and we get it out.

If you have any land in North Carolina, Arizona or Florida you are selling, please let me know.

DJ

Weekend At Home

Had a great weekend just hanging out with my family. Felt strange to not have to be anywhere or have anything that HAD to be done.

Medic class last night was “Acute Abdomen”. People seem more relaxed now that cardiology is over.

I have a busy weekend planned – 8 hours of clinical time and 12 hours of ride time.

My ambulance corps is taking delivery of a new rig this week (one of our old ones had an electrical fire). I can't wait to see it painted up (I've only seen it when it was all white).

Travis the Super Dog is gaining a little more function every day, though he still needs us to support his hind end for any locomotion. Not fun for him or us.

DJ