A Great Time To Remember

It's cooler outside these days. I walked down the few concrete steps outside of my domicile this morning and was refreshed by a cool earthy fall breeze. It made my early morning journey much better even though I would have much rather been upstairs with my wife who was probably falling back to sleep with our two muts filling my absence with fur.

Each step I took I felt better about the days ahead but I couldn't help but think about days past. It's funny how the weather brings back memories. I reminisced about walking across a long field at daylight to sit in a tree stand and about stepping into a cold river at the beginning of a cathartic day of fishing. I do miss those days when the fall brought expectations of long evenings shooting the breeze with friends after being outside all day swinging a hammer and listening to country music. Not that I would trade them, I am happy now, but nostalgia overcomes me periodically especially this time of year. I've missed the crispness of the air and the crunch of fallen leaves.

It's so been so hot and stifling over the past couple of months I had almost forgotten that fall was around the corner. I've been caught up in the everyday business of living that I haven't taken the time to just stop and absorb what makes life so wonderful.

I finally arrived at my car and set down to start the engine. It whined a little and sputtered but, as it has for a while now, performed without fault as I drove from the parking lot. I rolled down the windows and let the wind fill the cab with yet another opportunity to remember the past.

Powered by ScribeFire.

It's Been A While

My blogging has suffered over the past few weeks. My personal, off-line, journal and my workout running biking whatever journal has also been neglected. I have had some interesting experiences on the front lines of emergency medicine but I haven't been compelled to write about them. I feel as if I am in a slump of some sort. It seems to be like quicksand or a flushing toilet. The longer I remain in the slump the deeper and more consuming it becomes. I am sure every person experiences this from time to time.

I just watched President Bush give his speech on Iraq. It was actually a compelling speech and most of it was probably true. It is a shame we live in a world that settles conflict with guns and bombs. I wonder where this behavior originated. Do you think the Geico cavemen duked it out over who got the biggest bone?

They probably did.

Powered by ScribeFire.

My Experience

I began volunteering at a local rescue squad at the ripe young age of 13 and became proficient in the art of ambulance washing very quickly. As I washed the one ambulance in our squad I listened to the over-inflated stories that became more gory and self gratifying the longer they were told. I was hooked, I wanted to start IV's and intubate and shock a dying heart. I couldn't wait to pull a person out of a burning car or hang from a cliff while dragging a bus load of bleeding hemophiliacs out of the grips of death.

I enrolled in the first EMT night class I could a few months after I turned sixteen. I excelled for two nights a week. My boring high school classes suffered dramatically but I really didn't care about the Cartesian Coordinates or literature.

I progressed through EMT intermediate and then paramedic shortly after graduating high school. High school came and went, much to fast, and I was out in the world. I worked in construction during the day and volunteered at the rescue squad at night. I even began telling some of my own war stories. Many of them growing from a small sprout of truth into a tree of exaggeration. I did learn from some of the best.

My love for pre-hospital care continued to grow and I was lucky enough to be hired by a large urban service in North Carolina. Prior to beginning there I had never met someone who went to school with the intent of becoming a paramedic and nothing more. I assumed everyone volunteered during their free time and was ecstatic to be paid for something they loved. I was wrong, actually I was extremely wrong. Many of the paramedics were unhappy with their job, their life and especially their role in the health care system. My enthusiasm dwindled quickly, sadly much like my naivety. I learned that the stories that were told, out of fun I thought, were really a way to vent frustration and prop up fragile egos. My hobby, my passion, had become a job and my job quickly began to frustrate me.

I quickly experienced burn out, my attitude turned nasty and I was rude to patient's more often than I would like to admit. I formed my own opinion of what an emergency was and unfortunately no one met my criteria.

Looking back at this time in my professional life I realize just how negative I was. It was so easy to feed of off everyone else and mimic their poor attitudes. At least I now have those experiences. The gift of hind sight is priceless.

My passion has returned and I enjoy the medical field once again, thankfully. So much so that I plan to return to school and learn those things that I neglected in high school so that I can progress into a leader in medicine. How knows, I may have the opportunity to improve pre-hospital care for the sick and injured and maybe even those who take care of them.

This post has completely veered away from what I originally intended. Oh well, better luck next time.

Powered by ScribeFire.

More Difficult Than I Thought

I began a series of post a short time ago with the intent of having a completed work of.. uh.. art by now. I have came to realize that the more I research pre-hospital care the more fragmented and disappointing I have found it to be. More to come...

Powered by ScribeFire.

Paramedic Evaluation 2 - Bad

My partners last evaluation.

Compensation

As we all know, one of the most important aspects of any job or career is compensation. On average, in the US, a paramedic makes 36,970 $ Per year according to Salary.com. Some may say that is good money and others may look at it and laugh. More than likely you will begin laughing pretty soon.

The average paramedic also works 24 hour shifts every third day. That equals out to 10 shifts per month. Before you say, "you only work 10 days a month" here me out. It's not all roses, actually there are no roses involved at all. On average that is 52 hours per week. In actuality every third week will be a 48 hour week and the rest are 72. The bread and butter in this profession is overtime, as you can see. The first forty hours are compensated at a very dismal hourly rate that is as low as 9$ per hour and only after the second shift in a week does the pay increase by one half. This makes it imperative to work every shift because any vacation time that is received completely negates the necessary overtime pay and decreases take home pay dramatically. This can quickly lead to milk and bread shortages (and maybe even beer).

Of course they are other ways that paramedics are paid. One of my favorite is something I dub Chinese Overtime. This method is based on a salary type pay scale but has some really nasty consequences. The pay is set at a yearly amount with the thought that the paramedic will work every shift without time off. If there is unscheduled overtime the base rate is divided in half and the paramedic receives comp time. This is basically a nice way of screwing people while they are asleep and unsuspecting. Overall, the more hours that are worked the less the medic makes per hour until they are no longer increasing their take home pay. The other nasty part is the fact that the comp time that is received is compensated at the base rate so you lose the overtime and are basically working 72 hours a week at the dismal base rate mentioned above.

One more pay method and I will stop. This method is used more with firefighters luckily and not paramedics but it sucks nonetheless. In short, the 24 hour shift is broken into a 16 hour block and an 8 hour block. You are paid for the 16 hours of "Awake" time but are not compensated for the 8 hours of "Sleep" time after midnight. Basically, you are asked to sleep in a foreign bed and remain ready to run an emergency call at any time with the expectation that you will be awake and in the ambulance rolling out of the station within one minute WITHOUT being compensates. Ugly, I know.

So that is how and how much a paramedic is paid. Tune in next week to see what they are paid to do.




















Wikipedia's definition of paramedic: a medical professional, usually a member of the emergency medical service, who responds to medical and trauma emergencies in the pre-hospital
environment, provides emergency treatment and, when appropriate,
transports a patient to definitive care, such as a hospital, for
further assessment or follow-up care.

Powered by ScribeFire.

What is a Paramedic?

I have often been asked this question in so many words. Sometimes it's "what do you do?" or "What's the difference between an EMT and a Paramedic?" or "do you just drive fast?" I have even had the occasional "hey, are you an idiot" question threw at me especially after explaining the crazy schedule an average paramedic works.

I would wager that some of you reading this can't even explain the role of a paramedic in todays healthcare system.

Lucky for you. I have decided to begin a series of post on the true nature of a paramedic. This isn't going to be a rambling journey through war stories but a true attempt to explain the profession I am currently in and also some conjecture on where I would like to see this profession progress.

Powered by ScribeFire.

Not Worth a Title

Sigh....

I find it very difficult, most if not all of the time, to control my cravings for food. I am not an obese person but I do eat things that I shouldn't. Not only is this bad for my body but it is bad for our bottom line too. It is nearly impossible to eat out for Supper, or even lunch for that matter, under ten dollars a person. This is a very bad thing when I kind of have the money but kind of don't and a craving for Mu-Shu-Vegetables or a fish sandwich take complete control over my brain. What am I supposed to do? I just can't control the urge.

I don't consider myself a weak person by no means but this is certainly my vice. I guess I will wonder through life forever afraid of my overwhelming cravings.

Powered by ScribeFire.

Just Fucking Stop

Got your attention?

I do not understand what motivates someone to call 911 while driving down a residential street to explain that a person "seems to be having a heat stroke" but doesn't stop and speak to that person. Is it that hard to pull over and say "Hey, what's your problem?" Are you afraid that the person will ask for help or does the simple call to 911 make you feel like a good Samaritan. Because if it does you are badly mistaken! Badly. Mind your own business or actually help. Don't be a half-ass just to stroke your ego.

On another note. The past week or so has been stressful. I have changed partners, not by choice, and we get along well enough but there is still a learning curve. My previous partner and I worked together for a year. When we were taking care of patient's most of the time we didn't have to even speak. During emergencies it is important to bring order to chaos and it's much easier when you can predict the actions of the person that you are working with. I am having a hard time predicting this guy. I know the more we work together the better it will go but this week we have been thrown to the fire.

About an hour before shift change ( I was still asleep) the tones blared and we responded to a possible DOA. We arrived and soon found out that the patient had not died long ago and we made a futile attempt at resuscitation. Unfortunately, the area we working doesn't have very effective first responders especially in the mornings. Basically, we ended up working the entire code by ourselves.

Other than that I have been putting way to many hours in at my part-time job. I am probably averaging 80 hour work weeks. This alone can be very stressful. One year left.

Powered by ScribeFire.

One Year

By the way. Happy one year anniversary to this blog.

Powered by ScribeFire.

Blogsphere Sample

Not much going on today so I thought I would amass some samples from various blogs, so here goes.

• Creating the God Complex answers some questions from his readers on his installment of Questionable Admit.

• The Girl With The Blue Stethoscope relays her thoughts on hard-core textbooks using childish cartoons in Adult textbooks + cartoons...WHY???

• Caprese Salad, just looks good. What else can I say.
  

• The Surgeonsblog, which happens to be one of my favorites, crawls onto a large box of soap and delves into health care reform on More Solutions, Long Post

• If you are inclined to reading blogs with a heavier clinical back bone then head on over to Scapel or Sword and check out "Emergency" Management of Elevated INR's.

• For a little airier read check out Sara in Israel. She's tackling some interesting things from the viewpoint of a helicopter and it does sound like Sometimes, its cool to be me.

• Must read: The Science Behind Beer Goggles.
  

• Panda Bear, MD eloquently and maybe even daintily describes the intern year in a marine's Welcome to Intern Year.
  

• Up for a challenge? Swing by NY EMERGENCY MEDICINE and take a shot at the VizD challenge of the week. Try this one for starters: Answer: VizD Challenge Week of 7/2/2007.

• Midwife With A Knife conjures up some OB wisdom on a regular basis. A New Approach to Call affords a sneak peek into the dreaded delivery room and beyond.
  

• P4P, the new buzz term. You'll just have to read it.
  

Ok, that's enough for now.

Powered by ScribeFire.

Road Bike

I am buying a road bike. A Caloi to be exact. It's the model that was built for the Motorola bike team in the mid 1990's. Some of you may recognize the team probably because Lance Armstrong began his racing career with them during the time this bike was used. triathlons here I come!

Powered by ScribeFire.

Little Old Lady

The computer screen shows an ekg. The phone rings and a woman answers. She sounds frail, old and intimidated. The technology she holds and wears is unfamiliar and the technician who is on the other end of the line is indifferent.

Earlier today she felt a "flutter" in her chest while riding a crowded bus and it scared her. She lives by herself and she couldn't help but wonder what she would do if this happened when she was home.  She finds herself afraid much more often now since her husband of 50 years died.

She called her doctor's office and they made an appointment for her immediately. Everyone on the bus said she should go straight to he ER because they were scared for her but she wanter to see HER doctor not a stranger in an overcrowded ER.

She changed her plans and continued on the bus until she arrived at her doctor's office. As she walked into the non-assuming building she felt much calmer and she even looked forward to seeing someone she new would listen.

The receptionist seen her coming and rolled her eyes as she spoke under her breath "I don't have time for this."

As the glass door opened the lady behind the counter curtly explained that she should sign in and because she was a "call in" it would be a while before anyone could see her.

The frail lady stepped into a crowded waiting room and sat down. An obese lady sitting next to her coughs and looks uncomfortable in the small seat. A small child walks by wiping his nose on his shirt while his mother grabs him by the arm and scolds him for not "acting sick."

The needy continue to file through the door and briefly pass the sliding glass window and continue to their seat, to wait.

"Ms Big Pants" the nurse calls and the obese lady stands, coughs loudly, and slowly makes her way through another door where she expects to feel better.

"I've never waited this long before" the little lady thinks but she still is confident in the fact that her doctor will be there to comfort her and tell her she is going to be ok.

Finally, a nurse steps out and calls her name. She stands, shaky, and walks through the door into a white, quiet hall that has several generic wooden doors. The nurse stops, opens a door, and ask her to have a seat on the table. The nurse takes her blood pressure and pulse then walks out. No one has spoken.

A nurse practitioner opens the door and begins to speak. She takes a history and asks questions while she types on her laptop. Little old lady tells her story and the NP leaves the room while the lady waits for her doctor.

A technician enters the white room with a picture of a beach hanging on the wall. The tech puts one of a thousand heart monitors on the old lady and explains that she should call the number written on the front of the monitor and ask them what to do next.

He turns and shows the lady the way out. "Don't forget to stop and pay your co-pay on the way out" he instructs and opens another generic wooden door disappearing into the white.

Fifty dollars later she steps out into the street with no purpose. Luckily, it is only  July 3rd and she has a few more dollars in her pocket to get her home. She takes the bus because there is no one to call.

The monitor she is wearing begins to beep and she remembered that she was supposed to call the number on the front of it and decides to as soon as she gets home.

"I wonder where my doctor was today" she thought. Disappointed and looking for someone to speak with, she begins to look forward to calling this number in hopes of speaking with someone that will explain why she couldn't see her doctor today.

The bus drops her off and she steps onto her yard and into her home.

she picks up the phone and calls the number and begins to ask the person on the other end why she didn't she HER doctor today. Before she can finish the question the technician explains that they don't work for her doctor and they don't have a clue why?

Powered by ScribeFire.

Rated R

What's your rating? Check out this website and rate your blog.

I got the big R and I am proud of it.

Mingle² - Online Dating

Powered by ScribeFire.

It's Not My Problem

I had the opportunity to shadow an ER physician the other day. Before shadowing him I was always impressed by his ability to quickly identify and prioritize emergencies and care for them appropriately. I even liked him personally. Don't get me wrong I still like and respect him because he is a good person as well as an excellent EM doc. However, I did see something that made me question not only his thought processes but EM in general.

"It's not really my problem, it's not an emergency."

The patient was in his mid-thirties complaining of severe groin pain that hasd smoldered over the past couple of days and peaked earlier today prompting this ED visit. Dr. Cool explained that the emergent condition, the one he could treat, was a testicular torsion, however his gut feeling told him that it was Epididymitis.

In this case, luckily for the patient, it was not a torsion. He would get an antibiotic and be on his way. In and out, that's the goal.

In the mean time Dr. C ordered some blood test and an ultrasound of the guys nuts. We wandered around and seen a couple of other patient's. Finally, after the blood test and the ultra sound returned everything was reviewed and a dx was made. It was in fact epididymitis, the testicle wasn't injured and it also had unimpeded blood flow. However, the patient's creatine was threw the roof. Dr. Cool looked back at the patient's past history and noted that the patient was not having problems urinating and never had.

He then discharged the patient without mentioning the fact that his blood test were not normal.

Is this a big deal?

I personally trust this doctor and believe that he would not do something to harm someone. What bothers me is the fact that we all know that even the best doctors can become indifferent when so much pressure is put on them to move people in  and out like cattle.

From someone looking in from the outside it almost felt like Dr. Cool was ignoring something because it may increase his workload just because it may not have been an emergency.

On one hand I completely understand why this happens and the patient's health beyond a life threatening condition is their problem. However, I do think the test results should have been relayed to the patient with hopes that the patient would follow-up with their primary care provider.

Powered by ScribeFire.

Decompression

It's nothing like an hour of running with my wife and dogs, good vegetarian food and  North Carolina Cabernet to relieve stress.

Powered by ScribeFire.

A White Bowl

"I seem a small table with a white bowl and I was so afraid"

My grandmother told me. I new she was talking about a recent surgery she had to endure for oral cancer but I did not have a clue what she was referring to.

She began to cry as she explained, "I heard something that sounded like a horse trotting toward me and it kept getting louder and louder but I knew if I could just get my hands into the white bowl then I would be safe."

She continued to cry as my aunt explained that during her stay in the ICU granny's "heart went bad and all of the white coats came in."

Granny was very close to death that night and suddenly I realized she was explaining to me what she experienced during that time. How fragile is life and how enduring is death when our mind continues even when our bodies have given up.

Powered by ScribeFire.

Death

I enjoy reading the thoughts of other bloggers, especially others in the medical field. I have been reading one this morning, Surgeons Blog,that was especially good. He has written a series of post that detail a specific surgery that I especially enjoy. He also writes about death earlier in his blog that struck a note in my mind. Although my current training in medicine is limited to a very small set of actions and treatments that are provided in an emergency, I do have the unfortunate job of witnessing death often. The perspective of a physician seems to be in tune with how I attempt to rationalize death. (In the future after I have completed further medical training I hope to return to this is to see if I was right.) I do feel when my patient's die that I somehow failed them especially when a certain set of skills are "supposed" to make a difference when executed correctly and they do not. It is very difficult, nearly impossible, to not blame oneself in these instances. Unfortunately, the very high turnover or "burnout" rate that is seen in the prehospital health profession can be attributed to the guilt felt when a patient's outcome isn't satisfactory. I can't help but think that a physician must feel the same guilt because death is certainly universal.



As for me, each person that I come in contact with in life is unique whether it is a patient or their family member. In the unfortunate situations I sometimes find myself, I always attempt to explain to the patient and the family as clearly as possible what I believe is happening and the possibilities that can occur. Although I don't always have the luxury of time, as my profession hinges on crisis and not prevention. It would be much more difficult for me to get to know a person and watch them deteriorate slowly over a coarse of care that I had planned. Certainly that will be a tremendous change for me in the future. But for now, I must be content in the fact that life, as a great circle, must be completed by death and sometimes there is no cure or quick treatment. I can only become the best at the small set of skills that I am afforded and make sure that when the call comes I can perform as the patient deserves, flawlessly.

Powered by ScribeFire.

Complaints

I am not sure what to write this morning. A couple of interesting things have happened in my life over the past few days. Nothing spectacular just the same old same old really.

I had a complaint filled against me. That's generally an awesome thing to learn about. The other morning I had a whining rich teenager who was riding in a large SUV and crashed into a rock pole. It was a very minor accident and he was one of three people in the vehicle and the ONLY person complaining of neck pain. So, we took all of the necessary precautions; putting a C-collar on him and placing a long spine board to his back and taking him down from a standing position without moving his neck or back. It was just a taxi to the hospital after that.

This scenario happens all of the time. More likely than not when we arrive at the hospital the patient is sent to triage after their C-spine is cleared to wait there turn. But, at 0300 in the morning there obviously was nothing to do in the ed. When we arrived their were several nurses and doctors waiting in their main trauma room. We wheeled our patient in the room and placed him on their cot. I begin telling the story, or giving a report, and the doctor began speaking over me. At that point I gained a signature from one of the nurses and left the room. Yes, I could have stayed and gave a more detailed report after the doctor cut me off but I didn't. I felt that a brief explanation of the incident would suffice because it was very minor.

The next day as I am sitting at my second job when my phone rings. It's the assistant director of the ambulance service. He called me, on my day off, to explain that the doctor contacted him and was upset because I did not give an adequate report.

Looking back I try to take my ego out of the equation because it has no place in patient care. I probably should have stopped and explained over and over again that the accident was minor and the only complaint the patient had was neck pain. No obvious trauma was noted and he was mainly afraid that his mother was going to ground him forever. The neck pain was probably an attempt at sympathy on the patient's part anyway.

I just can't believe something so trivial went as far as it did. I also can't help to think that if this patient was a minority and not from an influential family that he would have been immediately dismissed and the staff would have cared less what I said or did prior to bringing him to the hospital.

What a crock of shit.

By the way the patient was discharged with no injuries.

Powered by ScribeFire.

Yet Another Day

Although I do appreciate that I am healthy and have the ability to be a productive citizen of this great US of A, I am getting a little distraught at the fact that it feels like I am never making headway. Being riddled with debt and in the middle of selling a home just aggravates this fact. I know that my wife and I will make it past this bump in the road in time but how much longer do I have to wait to pursue my interest? I can’t help but ponder that question. It may be the self-centered side of my personality shining through or just a bit of momentary disgust at our current situation.



I am sure it’s only a brief thought because all in all I am a happy person. I just have this nagging drive that continually tells me to drop everything and go back to school now so that I can apply to medical school sooner. I wish I could do that but until our finances are secure I can’t and this depends greatly on my spouse’s graduation date. Unfortunately, this date is elusive.



You see, in the sciences, graduate education is very dynamic. Many factors influence when you earn your three letters instead of the completion of classes or a set amount off training. This is yet another reason for me to pursue medicine instead of a graduate degree in science.



However, I do have a keen interest in History and plan on learning more and more about it as my studies progress. My ideal degree would be a history major, biochemistry minor with graduate work in public health and of course a medical degree. I think that would spring board me into my passion of humanitarian and maybe even academic medicine.



Although idealistic as it sounds, I fully expect to reach these goals and the only way I can reach them is by putting in the grunt work now. -Current pain for future gain- I hate (well not really) it but it is how it is and there is nothing I can do about it. Every one else has put in the time and now it is my turn. I just have to continue to remind myself of this great truth.



Which brings to my reason for this blog entry. As my description explains I do work in other places when hungry… i.e. broke and in debt. Now is one of those times and yes I have returned to one of my prior employers for part time work. I actually managed a portion of the laboratory during my time there. As you can imagine it is a little odd for me to return to find that some of the individuals that I assisted in hiring are now running the show; however, it hasn’t been so bad. I was able to fit in doing a job I am very comfortable with, which is very good for part time work.



So yet another job to add to my duties over the course of this year. Just for an update, this week I will tally 82 hours in the next five days. That’s an average of 16.5 hours per day.



Thank goodness I was able to ride my mountain bike this Sunday.

Powered by ScribeFire.

Mountain Biking

Mountain biking is one the best stress reducing activities I am aware of. Nothing frees my mind like being in the woods and pushing myself to the limit on two wheels.  My wife and I rode for three and half hours yesterday and had a blast. The weather was phenomenal and the trails were perfect. My Haro flew through some pretty technical stuff yesterday, I was really proud. Who needs full suspension anyway? One of the trays dubbed downhill that has a warning at the beginning "Expert Level or Above," which begs the question of what is above an expert, had an excellent technical downhill that screams. We rode down and caught some really long air and didn't break the first bone. I was impressed at how our hard tail bikes stuck to the rock, rooty, washboardy terrain. Although the entire trail wasn't nearly as technically as this section it still was excellent. Here I am at the beginning of a new week and all I can think about is "when can I ride next."



Well, maybe that isn't all I can think about. Right now I am hungry and can't wait for 7PM to roll around so I can truck it home to fix big fat burgers and homemade  sweet potato french fries. Oh, my belly is growling!

Powered by ScribeFire.

The Medical Blog

I've read some interesting articles on medical blogs and their ability to incite fear in the hearts of hospital administrators. I do not blog to embarrass or to brag about other people or patients. I blog because I enjoy writing and the release that it affords me. Yes, I could write in a journal but a blog gives me an opportunity to share my thoughts to others very easily. It also pushes me to improve my written communication and obviously I do need the practice. By the way, any suggestions are appreciated. With that being said, I reserve the right to post anything I want as long as it doesn't harm anyone.

Powered by ScribeFire.

What the patients don't tell us

Why are so many people programmed to lie about their health?

A brief war story is in order to explain what I am talking about. Last shift we picked up a lady who had a nasty roll-over car accident. The whole time we were cutting her out of the car she was hysterical; kicking, screaming, swearing and generally acting like someone who was hit really hard in the head. So we give her the benefit of the doubt and assume she has a bad closed head injury and treat her accordingly. As we were removing her from the car she stopped talking and moving. She failed to respond to anything we asked and didn’t even flinch during a sternal rub. Ok, I am convinced at that point. We drive fast and do all of the necessary things that has to be done for significant trauma patients. All is well except for the fact that she is in and out of consciousness. One minute she is screaming and not responding the next. About five minutes before we arrived at the hospital she becomes completely flaccid. We rolled up to the ER and wheel her in with all of the theatrics that she deserved. I gave the nurse a rushed report indicating that I really didn't want her to die on my stretcher. Of course that went over well. We transfer her to a hospital bed and by this time several spectators had congregated in the room and were helping us. With all of this going on around her she remained unresponsive until we lifted her up and set her onto the hospital bed. Miraculously she wakes up, completely lucid, and begins to explain everything that happened this evening to the doctors? The nurses begin laughing and everyone files out of the room while the patient is calmly dialing a phone to call a family member and tell them what happened. I don't get it?

This is certainly not the normal “I’ve lied to you” situation but it just portrays how inconsistent care can be. Of course once that happened everyone in the ER assumes this patient has nothing wrong with her even though her mental status had changed like Tennessee weather. Not only is this bad for this patient, it is bad for the next patient I bring in because the ER staff is going to assume I am full of shit. Unfortunately, this doesn’t just happen to me or prehospital providers in general. I think to some extent it happens every time another provider comes in contact with the same patient. Just like in grade school when the teacher would whisper a phrase to one person and ask them to pass it on until everyone heard it. The phrase always became distorted. I am not sure if there is a fix to this but in the future if someone’s report doesn’t match what I am seeing I’ll not automatically assume the report is wrong.

The devil in a white shirt

I had an interesting encounter this morning with a patient that really gave me the hee-bee-jeebies. My partner and I, totally different partner since this is an extra shift, were called into another zone because of a woman experiencing hallucinations. It took us several minutes to get there thus giving the first responders ample time to drive this lady completely over the deep end. When we drove up we were met by a fireman who looked kind of scared. I thought he was going to open the door to the ambulance and drag me out he was so upset. He then proceeded to rattle off that they were holding here down and she keeps calling them devils. "Oh this is going to be interesting I thought." I immediately called the appropriate people so that I could restrain the patient before making contact. Just as we were stepping into the home husband walks out dripping in sweat and appearing exhausted. "I just make it worse" He said as he continue down the steps into the yard and not stopping. By this time the yelling was audible and it wasn't difficult to find the patient. As I stepped up and assessed her I was surprised by the fact that the patient appears healthy and neat in appearance. However, she was very agitated and screaming the same things over and over. Interestingly she did not even acknowledge the fact that we had entered the room. I reached out to touch her wrist and asked the fireman to let her go for a moment. I received a very apprehensive stare as you might imagine. When they let go of her she stood up and as I was taking her pulse, which was rapid, she began to walk with me. "This is good" I thought, so we just sauntered together, the devil and the patient, all of the way to the ambulance without any question. As we were walking two police officers stepped out of the front the house carrying large leather restraints and very serious looks. Apparently the first responders were going to restrain this lady a chair or someone I didn't want to ask. We continued to the truck and was able to sit the patient down and apply the normal straps that keep patient's from lying to and fro around inside the ambulance. the patient didn't mind at all but she was beginning to breath very very rapidly. It was obviously self initiated and not secondary to any medical condition we could help without Haldol. She then began screaming about how she had to look away but continued to stare at me. At this point everyone was thinning out and it was just the patient and me in the back of a very small ambulance. This made me rethink my decision to not restrain her. As we were beginning our one hour drive she continued to scream about looking away and also continued to stare at me. By this time I began to get a little weirded out by this and could understand why the first responders wanted to tie this lady up before she really did flip out. I continued to speak to her calmly but it really didn't change the situation. I placed a NRB mask on her in hopes of her not spitting on me. That's another war story altogether. I checked her BGL and it was normal. That nearly became a fight when I pricked her finger. Because of this I did not even begin to start an IV. The cardiac monitor wasn't a problem after the BGL though. As we continued her antics became louder and weirder and I suddenly was the devil and that was why she had to look away. Apparently it isn't prudent to stare the devil in the eyes. How weird can you get. I think her eyes became larger and larger as we drove and the stare was wearing me down. All I could think about was the movie Excorist that gave me nightmares for most of my childhood. We finally made it to the hospital but not until I made the ritualistic call via radio to the ed to let them know we were coming. The entire report was masked by the continually "you are the devil I can't look" scream which did get us a bed at the ER quicker than I have seen in a while.

Crazy.

Bored again

It's not such a bad thing to be bored at work. If I am bored then no one is experiencing an emergency. However, when I am bored I not only eat everything I also think way to much about things like the future and school and mostly debt. I am not sure I have covered my debt situation on this blog and I guess now is a good a time as any. Since my wife and I got married four years ago at the end of this month we have accumulated a huge amount of consumer debt. In case you didn't know my wife is a graduate student. She actually makes pretty good money but we haven't been the best stewards of the money we make and this has gotten us into a situation that many people are all to familiar with. It's like a restraint on everything we try to do. I can't continue my education until we are out of debt. Originally our plan was for me to go on to school after she finished and that is now compromised because of the way we have abused credit cards. It's not all bad because we are going down the write path, albeit late, to get out of debt. Putting our home up for sale is the first very large step in that process. If we can make enough from the sale then our situation will dramatically improve. If not, well lets just say I will be working many more 48 hour shifts over the next few months. As it stands now I will have three days off over for the rest of this month. I think going to school and studying three or our hours a day will be a breeze compared to what I am doing now.

Typical boredom. Here I go pondering over how bad things are and not focusing on the good. Hey, at least I am healthy enough to work three jobs. At least three different employers will allow me to work. We will dig out of this hole I am sure of it and when we do it will be most rewarding.

Ugh

After drinking a little to much last night I finally settled down to sleep about ten or so. I don’t understand alcohol but it is a vice that I have difficulty with at times. My biggest concern today was the fact that this morning I could still taste the wine I drank last night. That’s alarming especially when I am beginning a very long shift this morning. I am certainly going to pay for last night as these days progress. I guess that is my punishment for a lack of self-control. Well, I shouldn’t drink again for a while because it slows me down and I can’t be slowed down. I’ve to many goals and plans to take care of and alcohol doesn’t fit. I have been a social drinker for a while but have never been a big partier. For the most part I haven’t overdone my alcohol consumption but this morning when I could taste wine I couldn’t help to think that I my performance at work may be affected. I only drank two beers and two glasses of wine starting at six in the evening and ending around 8:30. Theoretically I should have metabolized all of the alcohol by at least 11PM and I don’t feel like I am hung over. Maybe it was just the type of wine I drank or the fact that I mixed it. Ugh, that was probably it. Well, in my normal fashion I am over analyzing this. You know, I quit drinking altogether for about 7 months until I went to Baton Rouge for a conference about a month ago and since then I have drank it up. Yea, it’s time to quit again. It’s time for another nap as I wait for the next emergency to occur. (Hopefully it won’t).

Once again I find myself writing a little and thinking about what I have accomplished today. Nothing, well something, money was made. Other than that I didn’t work toward any future goals. With that said, I need to begin either studying or working out more during my shifts. Both would be even better. Study Spanish or Chemistry or any other subject even literature would be OK. So, what will it be? Obviously I have no clue especially tonight. Stream of thought writing may not be easy to read but it does clear the mind some anyway. Stop changing the damn channel. I am sitting here with my partner, the same one that I wrote about the other day, and he has the remote. In the last hour he has probably changed the TV channel one hundred times. I am going to go through the roof. He does drive me insane sometimes.

American Idol

Well, we are moved. It wasn't easy and there were many steps involved but we did it. On the other hand is our house and it is no were near being ready to sell. It is a little odd, I have always joked about having a house in the country and an apartment in the city. I never dreamed that it would happen at 25 even though it is bittersweet. My salary is strained as you may imagine and my wife's student income is spread like butter on really hot bread. However, if we could sell in this slow market really quickly then all will be well? Never mind all of the worries. Right now I am sitting in front of the TV watching American Idol and drinking a glass of chardonnay. This is the first show that I have watched this season and so far I am not very impressed. I am just interested in who will win and whether or not it will be the hometown girl. Pink is singing right now and I think she is stoned. There is no other explanation for someone acting like she is. I don't think I have ever heard of her? She's pretty good though. Maybe I'll check out some of her other work. I just checked out the website and it is extremely over done. Anyway, enough bashing. Work, I dread it. Tomorrow I began a 48 hour shift and it is going to be hell. Wait a minute, the more I dread it the worse it will be. So, it should be really ok. I'll be working at two different stations but they are pretty slow most of the time. Hopefully no one will die or get tore up in a car. It will be fine, if it happens I'll put them back together the best I can and whether or not they life will be up to our maker. Well, nothing exciting to speak about tonight. I guess it is time to check out all of the other blogs on my list and see what they have to say. Peace.

Krystal's

I ate six krystal’s with cheese today and a few French fries, well, one regular order of French fries. I washed that down with some Coke, the real deal, not diet. It was so good but so bad. What’s not good about a dinner role, piece of “meat”, pickle, mustard and a big piece of cheese? I don’t want to think about how unhealthy it was because every once in a while a little bad eating keeps everyone motivated. Anyway, my training is going well. I have added swimming and biking to my 20 or so miles of running a week so that I can complete a triathlon early next year. Interestingly enough I have been much more hungry over this past week. I will need to be more mindful of my caloric intake until my training levels out.



That’s enough about training. Work so far today has been moderately busy. One call in particular sticks out in my mind. This morning just as I was getting out of my car at the Fire hall the tones go off. Apparently someone wrecked in a curve just a quarter mile below the hall. No one likes to get a call at shift change and for this reason I try to get to work about 30 minutes before my shift begins. Luckily, this morning wasn’t any different. I ran in and signed for the narcotics very quickly without counting them, which is against all narcotic protocols that we have. My partner drove up as we were pulling out of the station so we were able to relieve the crew that had been on for 24 hours. As we leave the hall we could see the accident down a small hill in a sharp curve. This is a normal place for accidents when it rains as it did this morning. When we arrived, just as the engine, one woman was sitting in her car that was slid off of the road with no damage. I approached the car and asked if she was ok and she looked at me with a very blank stare and said “no habla English.” I was able to find out that she wasn’t hurt and assisted her out of the ditch into the back of our ambulance. Luckily, one of the PD officers could speak fluid Spanish and helped us out. It turns out that she was driving her sons car and the only ID she had was a voter registration from Mexico. The funny part of the story was when the officer asked her what her address was. She pulled a Chik-fil-a pay stub from her pocket, which had her name on it and someone else’s SSN. After she signed our paperwork the officer took her and more than likely took her to jail and began deportation. Luckily no one was hurt and she did not do any damage to the vehicle. After thinking about this call I wondered how I would feel if I was out of the US with my mother and she had an accident and was hauled off to jail without notifying. That must have been very scary for her.  It only brings the current changes to immigration into my life more than I would like it. Now I really disagree with hauling off someone without any regard to his or her situation. Yes, she was an illegal alien but she is still a person. Unfortunately we as Americans are more concerned with the dollar sign that is expended on this person than why they are in the US or what their life is like at home. If I knew I could double or triple my income by just crossing a border and working so that my family life could improve I would do it in a heartbeat. Can you say visiting worker program?

Powered by ScribeFire.

My Motivation

Once again I sit in front of my computer writing about what I should be doing. I am sure that if I write more and think more then more things will be accomplished? Right? No really, I am the type of person who has to plan each and every thing that I do. My wife and I are moving this weekend and I should be packing things up and cleaning around the house. My schedule is far less restricting so I should be shouldering the majority of the burden of this move. I know this and still I can't get past the lack of motivation. So what do I do? I sit at my desk and create a list of things that I must get done and attach a certain time schedule to it. Usually this is all I need to do because the list becomes my goal and I have something to work toward that is planned. Maybe I am over thinking this issue and should stop typing and get to work. Yea, I think that's it.

Holy shit

Let me tell you about someone I work with. I know, not such a good idea to openly bash coworkers on the internet but who cares? This guy is such an ass for the most part. First of all he constantly has to say something to someone in order to appear in charge. No matter what type of situation we are in he just can't keep his fucking mouth shut even when he has no idea what he is talking about and more often than not he has no clue what is going on. For instance, his level of medical training is mediocre at best- first responder like- but he has been in prehospital care for probably fifteen years or so. That in itself throws up red flags in my mind because who does that for fifteen years? When we arrive onscene of an emergency he continually rushes into the house and begins speaking to the patient and the family as if he has any idea of what is going on. Anyway, this is a bitch post with lots of profanity. He really isn't that bad of guy he just has an enormous chip on his shoulder. It's as if he needs everyone to know that he knows more than he should if that makes sense. Generally, he means well but it almost always pisses my off when he starts running his mouth about rules and treatment and how long he has been in EMS. Who cares big guy? I am glad I am a tolerant individual with a blog to vent. Otherwise, I would probably go completely Ya-Ya on this guy. You know what's funny? Most of the time we get along really well and I regard him as one of my best friends. Crazy how that works?

A Change of Pace

A change of pace for this blog is in order. For starters, writing more than once every few months may be a good idea. If I remember correctly this thing was supposed to chronicle my academic pursuits but has mainly been a mix of rubbish and periodic pic-me-up types of things. That's all well and good, it is my blog, but I think I will mix things up a little and begin using this as a training diary and incorporate my academics as they progress. If you were wondering they have progressed very little in the past few months, anyway. Training on the other hand has been about the same unfortunately. I will be running the Country Music Half-marathon this weekend and it should be a blast. Being a bit under trained worries me though. The last few weeks have been very hectic with moving and traveling taking up most of my available time instead of training and focus. I am coming around though. I've set some ambitious goals for May and expect to complete them and run a couple of 5K's and 10K's toward the end of the month and the beginning of June. I am also contemplating a triathlon in September depending on how my riding and swimming skills improve. A triathlon would be an excellent way to maintain my stamina and weight through the winter and keep my enthusiasm up for the summer running season. Another idea is to train for a warm weather marathon in our winter season. No decisions have been made so more to come on that topic.

Work hasn't changed all that much. Finally returned to the truck after traveling for two weeks to a conference in LA. It was a blast and I learned a lot but it was to long. I missed my wife and dogs and even work to some extent. It did give me a recharge that hopefully will last until I return to school in January. By the way, the next few months will be hell because we are still selling our home and renting at the same time. I also will be working way to many hours at my various jobs but it will be worth it. Melissa and I will be out of debt by January and I will return to school to pursue my real passion. It will not be easy though but nothing in life that is good comes easily.

I have rambled on without any cohesiveness as I normally do. More to come later because I feel a surge of writing and correct living upon me. Good Day.

Training

This Saturday was demanding and one of the best training days I've had this year. My wife and I began our morning running 5 miles and then traveled to an awesome MTB course for 8 miles of two wheeled abuse. After the ride I was exhausted but still wondered when the next opportunity to ride would be. That's what made it such a great day. After working 100 hours last week Saturday was an awesome escape and spending time with my wife really put the icing on a cake like day. Back at work today but I may be able to hit the trails tomorrow hopefully whether running or biking either way it will be fun.

powered by performancing firefox

Ready for the trails

Finally, I purchased an awesome MTB to thrash some rocks and also to make some money as a bike medic. I searched several (6) different specialty shops looking at many different bike manufacturers and finally fell in love with a Haro V4. It's absolutely awesome. Black and gray with Shimano LX dérailleurs and a Rock Shox Judy front fork that has over 3.5 inchs of clearance. I'll be telling much more about this bike in the near future.

powered by performancing firefox

Things I do

It's funny, I feel like I understand the things I must do to remain healthy and have energy. I write down what I eat, how much I run and workout and how I feel after these things. Wait, I don't always write these things down. Usually, when I am slacking or "wobbling" as I heard it said, I am not journaling these things. Journaling is key to my health as I have found out over and over and this leads me back to what I am saying. At what point does these things become automatic? Will I always have to consciously, grudgingly, go and write down what I eat etc...? Why isn't it easier? How can I make it easier? One day I will find the perfect balance but until then I must be disciplined and a hard ass to become a hard ass.

powered by performancing firefox

Medical Blogs

The amount of medical blogs have been increasing exponentially over the past couple of years. That's pretty exciting because with the increase in volume comes the increase in quality. Many of my favorite blogs, ones which I will be posting links to in the near future, speak to the heart of medicine as well as the difficulties that medical personnel face. Especially when faced with things such as the DMV or unruly patient's. Speaking of unruly patient's, I think I will share a war story with my one reader. I used to work in an inner city emergency service where it was routine for gunshots, stabbings, gang related violence as well as all sorts of medical emergencies from the unfortunate individuals who did not seek medical treatment until it was too late to occur. Boy, have I got some stories.. As I was reading through other blogs today an encounter with a giant came to mind.



Late one night during an especially busy shift my partner and I had just finished eating when we were summoned to a gang infested area of our lovely city where we didn't go without at least three metro police officers escorting us. The precession arrived at the house and was promptly met in the front yard by the largest person I think I had ever seen. He was 6' 10'' and appeared to be very muscular. His hair was in a semi-afro parted in the middle with a comb protruding from the left side. I immediately concluded that the comb was impaled in his scull but was afraid to ask, actually I was afraid to step out of the truck to take a closer look until we found out what was going on. As the individual stepper closer it was apparent that he was our patient. He had that really crazy look in his eyes, the one that people have just before they pull the trigger or jump off of a bridge and he was walking in a somewhat bizarre fashion. Finally, my partner and I got out of the truck, with our mag-lights in hand just in case, and approached the gentlemen. As we began to speak he walked past us, opened the side door on the truck and stepped into the ambulance and closed the door. At about that time one of his family members added "He crazy." My partner along with the police officers exchanged looks and opened the ambulance door to find the patient lying face down on the stretcher. I asked what was wrong and he said he was tired and felt like sleeping. He denied any complaints and his family said he called 911 but they didn't have any idea why. During our ride to the hospital the patient didn't say anything else. When we arrived at the hospital the patient, who's name I didn't get, stood up and let himself out of the truck and walked into the ED. We followed and explained what we knew to the nurses and doctors while the patient proceeded to lie on his stomach on a gurney and asked everyone to "just be quiet." Later on that morning we returned to the hospital and inquired about our patient. The charge nurse told us that he evidently just wanted to sleep. All of their test were negative and he didn't complain of anything. They finally kicked him out after three or four hours off good sleep. Maybe it was the family that was crazy and wouldn't let him rest, who knows?



That was weird. Anyway, there's a war story for ya.

powered by performancing firefox

Jobs and the DMV

I am frustrated, really frustrated. I end up at the DMV this morning to renew my already expired license and there are 38 people in front of me. That's not a big deal because I don't mind waiting my turn; however, I sat down in the black seats that are noticeably dirty and begin waiting patiently when two women seated behind me begin talking about kids. Just then a little bastard walks out from behind me and begins hitting my shoe with a drenching wet dog toy looking thing. The mother of the child says "Say you are sorry, maybe he should have moved his foot." She then proceeds to explain to her friend that she just doesn't know how she is going to handle the three more kids that her "boyfriend" wants to have. Unbelievable. So, as I sit there and become more and more educated in the art of poor child care I decide to go to my care and get a book. I also realize that the DMV, in their infinite knowledge, do not accept debit cards. I then leave the child and its mother to get cash from an ATM and grab my book. That was pleasant. I return to another seat far away from my previous neighbors and begin reading. Much to my delight the line has moved from A046 to A053 and luckily I am only A080, so my time is coming. A few odd and pressured conversations later and an hour and a half my number is finally called. I approach the -Examiner- to be graciously informed that the renewal instructions that I received in the mail are not correct and that I will need my birth certificate to prove that I am a citizen of the United States. Brilliant, I really should have seen this coming but I didn't. Luckily, she told me out of pity to find her when I return and I wouldn't have to wait any longer and she would take care of my renewal. "Sweet" I thought, too soon. I left the DMV to return home and pick up my birth certificate and return to the shit hole but I decided to stop and get a quick bite to eat so that my endurance doesn't suffer for round two when much to my dismay I couldn't find my wallet. I get out of my truck, as I sit in the Taco Bell drive thru and begin looking for my missing wallet. I didn't have any luck so I decide to continue home, pick up the birth certificate, return to the DMV, renew my license, find my wallet and run like hell. No problem with the birth certificate. I return to the DMV and the -Examiner- is there and she takes my info, glances at the birth certificate and I hand her twenty two dollars and she tells me that all I need is my photo taken and I will be finished. I wipe my brow and thank the nice -Examiner- and walk over to where the pictures are taken. The picture taker which is also an -Examiner- (instills great confidence in me) instructs me to sit in front of a blue piece of fabric on a black metal chair with a soiled red cushion and stare at the camera in front of me. She then looks at me in a very awkward way, which coincidentally does make me smile and then turns to speak with an elderly women who is concerned that her license picture is more than two years old. I continue to stare at the camera; however, the smile is gone. A few moments later, ten minutes, she returns to the camera and tells me that my name hasn't came up and she is going to restart the computer and "its going to be a few minutes." "Great, I will be looking for my wallet in the parking lot." I tell her. I exited the picture area and began searching the parking lot for my wallet. No wallet. I returned to the picture area to find several angry looking individual waiting just like me for the damn picture. We were then informed that the computers have crashed and they are sorry but no further IDs or license can be processed today. Funny, I thought. I was right where I began 5 hours earlier except now instead of having an expired license I didn't have a license at all. Luckily, after another 45 minutes I am able to procure a "temporary" license so that I can travel to another testing station and complete this entire process all over again.......

powered by performancing firefox

NY Times article

Mr. Negroponte stepped into a pool of crap with to many layers of bureaucracy to begin with and has more than likely been looking for a way out of a potentially career ending stint at a make believe post that was destined for doom at its inception.



NyTimes article.



http://www.nytimes.com/2007/01/05/washington/05intel.html?hp />

powered by performancing firefox

My First Time

So, I am attempting my first techy-like blog from somewhere other than my website. This is supposed to revolutionize how I blog. Lets hope it also improves the topics that I write about.

powered by performancing firefox

It's 2007

Odd, it really doesn't feel different. I have been thinking for several days on the most important changes I can make in my life during this very important year not in order of importance. I would like to get in the best shape of my life, get out of debt, love my wife more and more everyday, read many rich books, learn a different language and continue to improve my guitar playing. That's it only a few things to improve on. I can do it, I know I can. It is really simple, make the correct decisions and don't allow myself to slide. I read on a triathlon web page about how they fight what they call the "wobbles." Once you recognize yourself sliding away from your intended path whether it is nutrition, training or just lack of motivation you should set a three day goal and stick to it. It works, let me tell you. Generally speaking three days of discipline and attachment to a goal can turn around some of the worst wobbles. On another subject. This new blogger is pretty impressive. I am not sure if the spell check is coming from my firefox browser or my computer but I know everyone (one reader/writer) will be very thankful. Until next time.