9/11/11

Crazy homesick today. ♥ to all my girls and boys back in the city. Be safe.

Giving Up

The first time I met him, he was sitting in his boxers on the edge of his bathtub, blood spilling down his arm into the shallow water, his skin still damp from the shower. I knelt on the bathroom floor while I washed his arm off and dressed the wounds, and coaxed him into the fresh pair of jeans waiting on the edge of the sink. We draped his button-down shirt over his shoulders as he hid his arm from the other people in the apartment building, not speaking a word during the entire process.

In the quiet of the truck, he told me that he'd been trying to kick a heroin habit for the last year, that he'd just started methadone treatment and then the social worker took his daughter away. That life had finally given up on him.

I told him that he didn't have to believe me, but it'd been nearly a decade since the scars on my own arms were made, and things had gotten better. He just had to be stubborn.

*

The second time I met him, he was having an anxiety attack because he'd taken the wrong medication. The unknown pills belonged to a friend of a friend, and there were none left to bring to the ER to show the doctors. He wouldn't say it straight out, but we both knew they were illegal drugs rather than prescribed medicine. He'd gotten the two confused because the unlabeled pill bottle had been left on the kitchen counter where his pills normally were. He recognized me, but I didn't want to remind him of his rock-bottom, so we talked about how he was thinking of going to school again.

*

The third time I met him, he was lying supine on the floor of his bedroom, surrounded by empty pill bottles. He was still warm, but not warm enough. His pinpoint pupils stared empty at the ceiling as we manhandled him on to a backboard, attempting to keep compressions going as we carried him down 4 flights of narrow stairs. The monitor told us what we already knew, that electricity was useless, but we kept fighting until the hospital staff took over. We were stubborn. Life wasn't ready to give up on him, even though he believed that it already had.

But he had given up on life.

And he had given up on a little girl, who would have done anything to walk down the aisle one day arm in arm with him, no matter how many scars he carried beneath his black tuxedo sleeves.

*

Good Aim

I like the challenge that gunshot wounds present. I like that they keep me on my toes as a provider. I like the load and go mentality of trauma.

I like the reassurance that people around here generally have bad aim.


I don't like single shots that create an injury incompatible to life.

I don't like recognizing someone we've fixed before, as my partner and I grant them one last measure of dignity, shielding them from the gathering crowd.

I don't like when the only person we transport from the scene is the family member who fainted at the sight of a simple white sheet spread over black asphalt, destroying life as they knew it.


I can't fix anything for anyone in this.

I'm BAAAACK

And mucking up your blogrolls by changing my name. ;)

The Skin Gun

This may just be the most awesome thing I've ever seen.





Check out the National Geographic episode Monday February 7 at 10pm.

Name

For the reader whom I have the misfortune of living down the hall from (and occasionally working with),

You creeper. When I said go read some work-related blogs, I didn't mean mine.

I named this blog when I thought my EMS career would be heading towards paramedicine, rather than back to working on a Bachelor's degree. After that, I kept the name to help keep an illusion of anonymity. Keeping you all confused as to what I actually was totally worked, right? Not. And it just sounded nice. :)

But I'm all growed up now and your reasoning makes sense. I like being an EMT-B.

So fine. You win. Name downgrade in the immediate future. Or as soon as I figure out all the logistics. Or on my 1-year blog anniversary next month. Or I'll just change the title/my name and not the URL, cause I'm awesome like that.

♥

PS: Now I definitely have to upgrade my license at some point. Just to mess with you.

...and you'll get your blackmailing extortionist cookies when I get home tomorrow.

You Know You've Been Working Too Much Overtime When...

You have dreams about cardiac rhythms and EKG strips.

You forget the number of the truck you're driving while talking on the radio. Repeatedly.

You spend an entire shift convincing an elderly patient to go to the hospital.

You fall asleep in the back of the truck while your partner is in the ER writing their report, and they spend 15 minutes looking for you.

You start believing that the weather knows when you pick up overtime shifts, because that's the only time it snows.

2/3 of your Christmas presents were EMS related.

You clean your ambulance every shift change. You haven't cleaned your own car since you bought it.

You 'borrowed' a shirt from the spares box so you could put off doing laundry for another two days.

If someone recorded clips of your partners' snoring, you could name each one of them and what stage of the sleep cycle they were in.

First Snowmageddon of the Year

Dear inventors of sandbags, 4 wheel drive, all terrain tires, and snow windshield wipers - my pickup truck and I would like to take a moment to thank you for getting us home last night in that blizzard. Also, thanks to all those folks with the flashing yellow lights and big ol' plows who like to slow us down on the highway. (I really do appreciate you guys... It's just a lingering jealousy that I don't have a plow and am stuck shoveling myself out...)

Seriously, though. If I'd been trapped at work, they would've had me on the road all night.

For all you crazy kids out there in this mess, be careful. Our big box truck stood the test today because nearly all of the roads we needed were plowed. Traction control can only do so much, if you even have it. The amount of ice that built up in our windshield wipers, and on our windshield as a result, made both my partner and I get completely turned around on two separate calls. And the wind... don't get me started on the wind.

I know you want to speed to that cardiac arrest. We did, too. Even after that sedan fishtailed partway into our lane while trying to pull to the right and scared the shit out of us.

But you know what? We got there in one piece, and the patient got to the hospital in one piece. No police officers, firefighters, medics, EMTs, family members or innocent bystanders were injured in the process.

Remember: Slow acceleration, slow deceleration, 3x the space you'd normally leave between yourself and the car in front of you. Drive like everyone else on the road is about to do something incredibly stupid. If you're responding to an MVA, chances are you'll be driving over the slippery sections that your patient lost control on. When you're out on scene, expect other cars on the road to be losing control on those same spots and stage appropriately. (This includes other first responders! That firetruck may not actually be able to stop. Get word to them via dispatch if possible.) Block the entire road if necessary until DOT trucks get there to clean things up. Level Zero is also known as: don't be stupid, because you of all people know that there is no one to save your sorry butt.

Snow can be very fun when you're off-duty:




BUT THIS IS WHAT IT LOOKS LIKE AT WORK:




Be safe. And bring your own shovel if your truck doesn't have one. <3

Texts From Last Night

It's almost finals. I'm sitting on a few real posts, but here's what I've mostly been doing with my (not) free time. For those of you who don't know, this website is an epically distracting collection of drunk text messages. And proof that we will always have job security. :)

As it pertains to us:

EMT / Paramedic /Ambulance

Hospital / Nurse / Doctor

Firefighter / Firetruck / Fire

Police / Cop


*Note: May not be suitable for work.

So You Thought Your Job Was Dangerous...

We all have some type of cellphone tower within our areas. This video was shot in the USA, and yes, he is free climbing for most of this, against OSHA regulations (ignore what the video says). And it's called a Guyed Tower, not a "Gided Tower".

But how would you respond if he had a medical emergency while properly secured at 1,768 feet? Or got hit by lightning at 1,768 feet? Or had a partial fall from 1,768 feet while secured, which resulted in a spinal injury? What if he hit his partner on the way down and you now have 2 patients?

Tower workers go through training for how to rescue one another at those heights. That guy holding the red tool bag is going to be your point man if anything were to happen to his partner. From what you can see, they travel light, so they won't have much medical equipment readily available. Does anyone do interdepartmental training with their local tower workers? Do your departments have protocols for how to handle these scenarios?

Personally, that's when I call the boys with the big red trucks. They have ladders bigger than the Empire State Building, right?




There's a good discussion about the technicalities of these towers HERE.

Paramedic-Assist

I am now licensed to stab you.

In the name of medicine, of course.


[Credits]

In New York State, EMT-Bs are allowed to play with glucometers if their agency has approval and provides training. Unfortunately, New York City has their own protocols, which don't allow glucometers to be used by BLS providers.

Up here in Massachusetts, glucometers are included in a separate Paramedic-Assist Certification. Which my job made me get. :) So I not only get to stab you to check your glucose levels, I also get to stick on EKG electrodes, secure ET tubes and do basic IV prep (spiking the bag, taping down the catheter). It also covers albuterol nebulizers, which are a regular EMT-B skill in New York.

The upside? More challenging calls. The downside? More cleanup.


For more reading:

How to Use a Glucometer - About.com

New York State Glucometer Protocol

Massachusetts Protocols

E4

My brand new Specialist is alive and well, and still has all her limbs attached in their proper places. She's flying back to the 'Stan tonight for another few months. We've got a last date to send care packages and everything. Cross your fingers that the brass actually sticks to their word this time.

While I was off having epic adventures, I was also contemplating the fact that I now work in a large town in a smallish state, where every department knows every other department's business. So when I go to statcounter and find that local folks have been visiting my blog, I can't really go gushing about how freaking awesome my new training is. (It's pretty awesome.)

Yes, ladies and gentlemen, I am stalking you, too.

And I have one question...


(Click to supah-size)

...Kuwait? Really?


PS: Props to Medic 999 for the linkage. :)

Getting Me Some Of This

...for 2 whole weeks of R&R. In New York City until further notice. <3

Esophageal Varices

Hey, remember this guy? That was my first real emergency, the first time I called in a note to the ER, and the first time I left a hospital knowing my patient's chances for survival were next to nil.

Well, I just learned all about what was wrong with him.

Upper GI Bleed is the vague overarching chief complaint for our paperwork. Or, as I put it at the time, Severe Bleeding from Nose and Mouth. Upper gastrointestinal bleeds usually present as coffee-ground emesis and a seriously unforgettable stench. To me, it smells like heavy metals. Like iron and something worse are so thick in the air that you can taste them.

The gentleman in question had a profuse amount of bright red blood gushing from his mouth and nose. He was so far gone in his dementia that he refused to unclench his teeth. We suctioned what we could, but anything more would've involved breaking his jaw. We couldn't drop an NPA with the amount of blood coming out of his face. For all we knew, he could've been hemorrhaging from his sinuses. We transported him left lateral recumbent with a layer of extra towels to catch the blood flow, and I held the NRB a centimeter away from his face enroute, to give me room to suction and him room to spit. The sheer terror in his eyes scared me more than anything, because he had no way of comprehending what was happening, why he couldn't talk, or where we were taking him. Trying to hold someone's hand, an NRB and a suction catheter all at the same time is not an easy accomplishment.

But back to the actual physiology, and not just Rookie Birdie peeing her pants.

Chronic liver disease (often cirrhosis caused by alcohol abuse), can obstruct normal blood flow through the liver. This makes the blood flow in your body backup, distending your finer blood vessels. In my patient's case, the ones in his esophagus. The technical name for these is Esophageal Varices. Being distended vessels, they're prone to rupture.

Ta-da! Upper GI Bleed.


For more reading:

Esophageal Varices - Mayo Clinic

Bleeding Esophageal Varices - National Institutes of Health

Bleeding Esophageal Varices - New England Journal of Medicine
*Note: REALLY COOL ENDOSCOPY VIDEO

Employment Win

Guess who has a job? Meeeeeeeeeeeeeeeeeeeee.

And I get one of these:


[Credits]

And one of these:


[Credits]

And some of these:


[Credits]

Thank you, Commonwealth of Massachusetts. That 3-week withdrawal from emergency medicine was BRUTAL.

Please Don't Text And Drive

To the idiot in the Jeep in front of me on the highway this afternoon:

1. We were in the middle of a monsoon.

2. We were doing more than 40 mph.

3. One of your headlights was out.

4. You were texting and driving. I could see your phone.

5. You were swerving into the other north bound lane AND the oncoming south bound lane.

6. I was playing this really fun game called preemptive triage via possible mechanism of injury.

7. I realized I only have one oxygen tank in my truck. Somebody (or -bodies) would've been SOL.

8. The game got even more fun when I started keeping my foot over my brake and looking at ideal places for you to crash based on room for staging areas.

9. During that really awesome drift/swerve where you were almost entirely in the south bound lane, I concluded that I didn't want to get out of my truck in the rain.

10. Thank you very much for getting back in your lane and putting away your phone after I leaned on my horn and flashed my brights.

By the way, I really liked the 'oh shit' expression on your face when you realized you were on the wrong side of the road. And the followup expression when you looked in your rearview and saw that I was wearing a blue uniform jacket and aviators.

Because if you hadn't put away your phone, your license plate number and vehicle description were 2 seconds away from being broadcast over 9-1-1 dispatch.


PS: I hope you got home and hugged your family.

Emesis

I missed college. I missed classes. I missed my friends. I missed college parties.

I missed volunteering to be vomited on at least once a week with our campus EMS squad. I missed my friends calling my cellphone instead of the Public Safety department and our official dispatchers, in a drunkenly sensible attempt to avoid being "reported" for drinking. Particularly if the soon-to-be patient is underage.

If I'm on duty, I have to radio my partner for backup because we're usually on opposite sides of the campus, and our radio system involves everyone on our frequency hearing everything. Nevermind that I have to call Public Safety anyways to let them know where and what I'm doing.

We are not the FBI. This is not going on your permanent record. You are not going to get expelled. No one is calling your parents. And hopefully no one is using the video recorder on their iPhone.

If you are sick enough to require more medical attention than we can provide, the fire station across the street will be glad to take you to the local ER. It's only 5 minutes away, and we can go with you if you want someone familiar holding back your hair enroute. The firefighters even stock these, just for us college kids. And they order extras right before our big annual parties.



Now that is what I call a good mutual aid relationship. :)

...Just don't puke on the new ambulance.

The Love of My Life

This is an ode to my baby, the love of my life, and the reason I haven't been around. Between the check engine light, stalling when I turn the wheel too sharply, the crack in the windshield, and putting on the spare tire last week cause I had a leak, she needs some serious tender loving care. Positive thoughts appreciated for my job interviews this week, cause this lovely lady will be getting dropped off for some rest and relaxation time as soon as I've signed papers that promise a paycheck within the next month. I don't want to clean out my emergency fund unless I know I've got more on the way. Nevermind that I need her to get to interviews, and hopefully a place of employment after that.



Ain't she purdy? And yes, it's that back passenger wheel that I switched out after this photo. You can see the chunk missing from the rim at the bottom, which had a sharp pointy edge that got bent in and wore through the tire. Switching to the spare means I won't be doing more than 50mph or using my 4x4 until I get new tires. (FYI: the previous owner cracked the rim, not me.)

But you know what?

That's my baby.

9/11 and The 'Stan

Everyone's got a 9/11 post. I was twelve years old and living in New York City.

End of story.

So here's to my best friend from childhood, currently deployed to the middle of nowhere, Afghanistan. You'd better kick some military ass and get your E4. Your monthly care package is a little belated but definitely enroute. I'm so proud of you for doing your EMT training while you're over there. You're going to be an awesome tech. I wish I was there to watch your back. I'll be waiting to completely embarrass you at the gate when you come home for leave next month.

I love you. Stay safe.



Photo compliments of NATO's AfghanistanMatters.

The Great Commonwealth

Finally mostly settled in up here and already doing shifts with the campus volunteer squad. If it's not a scheduled party night, you can almost safely plan on having six hours of study time while dragging around a jump kit and listening to Public Safety chatter on the radio. No, we do not have an ambulance. I looked in to getting one, but we don't even have $10,000 for a used one, let alone stocking and maintenance. Fortunately, the local fire station is across the street.

And they like to have barbecues. :)