Friday, May 29, 2009

Heros and Villains

I met both a hero and a villain yesterday. First, the hero, because he deserves higher billing...

We took a patient to Military Hospital yesterday from his home, for some wound care. He is a WWII combat vet, and a holder of the Purple Heart. As he tells it, his unit was searching for some downed pilots in the jungles of some Pacific island when he was shot in the leg. His leg essentially had a hole in it, with all kinds of fun stuff hanging out of it. He says he got shot around noon, and his unit helped him splint the leg, and fashion a crutch out of bamboo, and they continued on. They were held up by a Japanese ambush patrol, but were saved by another unit who ambushed the ambush. He finally made it to the field hospital around 6pm, where doctors argued over whether or not they could save the leg. They decided to try, and just cleaned it out, put sulfur powder in it, and put a cast on it. Two months later, he developed an infection and they found that maggots had gotten into the cast, which is pretty gross till you think that the maggots cleaned out all the old, dead flesh, and left the new growing flesh. This soldier spent a year in and out of various hospitals until he was given a medical discharge.

This is even more impressive when you consider that this man had already served his time in the military before the war, and then decided to sign up again to fight in the war. Not only that, but he had to go to Maryland to sign up, because DC did not allow any of it's residents to be deployed (something about retaining a protective force around the nation's capitol).

Think about all that for a second. You are searching for some downed pilots, get part of you leg shot out, and walk for 6 hours in the jungle on that leg, avoiding enemy patrols, and ambushes. You finally make it out, and the doctors want to take you leg. They decide to let you try to keep it, but wait another 6 hours. That's 12 hours with a giant bullet hole in your leg, folks.

There are so few WWII heros left. I was lucky that this guy was completely coherent and able to tell me his story. So many of the other WWII vets we transport aren't that lucky.

Now for the villain...

We were in Big Government Hospital, waiting by the elevator to go upstairs to pick up a patient. We were waiting patiently, and had already been waiting about 5 minutes. One elevator was down, and it was a busy time, and with all the wheelchair-bound patients, the elevators were filling up quickly. A woman in a wheelchair came up to us, and said 'You're blocking the elevators,' (you know, because we were standing there for no other reason than to block the elevators) to which my partner replied, quite nicely, 'Well, we're waiting for the elevator.' The woman then went on to loudly complain about the elevators here at BGH, how they never worked right, etc etc.

Then she proceeded to make comments about us. I'm pretty sure she wasn't speaking to anyone in particular, but said 'These people think they're more important than the patients, but they're not.' Then she said 'If they think they're getting on before me, they better watch out.'

We didn't reply, because there wasn't much point in it, and because there was a huge crowd there, but it really irritated me. We had been letting patients and people go on before us for about 10 minutes, making us late for our pick-up, because we well know that a stretcher takes up a lot of space, and the area was very busy. The fact that she came up after we'd been standing there for 5 minutes and started making those comments was totally uncalled for and I really was tempted to say something, but couldn't think of anything sarcastic and nice enough to say that wouldn't leave us as the 'jerks verbally attacking a patient in a wheelchair.' But I just really don't understand the point in making those comments, and then continuing to make those comments. Which I think is what makes me the most pissed. Why be so mean and bitchy to random strangers who are trying to do their job and help your fellow patients? Do you feel that insecure in your position as a patient that you have to run down other people? Or did you just need that elevator THAT much?

Of course, this is the same person who would complain and bitch at us for being late to pick her up if she had needed transport, I'm sure.

Wednesday, May 27, 2009


I like my partner. Truly I do. He's a nice guy, despite his insistence that we listen to R&B all fucking day! We get along fairly well, and while I don't see us getting to the stage that Epi did with her partner, it's not a bad deal.

However, my one beef with him is about driving. He generally does all the driving, because, quite honestly, I have a hard time seeing over the dashboard in the driver's seat (it goes up a bit, which obscures my view of the front of the truck, which makes me uncomfortable). He brakes a little hard for my liking, and takes corners a bit hard as well, but that may also be the difference between an ambulance and a van-bulance.

But where I really get annoyed with him is his following directions. Or rather, not following directions.

To be fair, he does know his way around DC and some parts of MD much better than I do. And we do have a GPS for most things. But he consistently misses the directions the GPS gives, and we end up turning around because we passed the nursing home or whatever (usually with the patient on board). Today, we had to find our way out of a neighborhood. I set the GPS to head to the local hospital, telling him to just use it to get out of the neighborhood so we could get back to the highway. He called me to the window because he got turned around twice, taking my directions for getting on the highway, but then listening to the GPS because it was telling him to turn around. No biggy, as I knew where we were and easily got us back on track.

Then we were getting close to the destination hospital, and I knew exactly where we were going, so I told him what exit to get off at and so on. We ended up on a different road, totally lost, because he saw the hospital off to the side and thought that's where he needed to go. Fifteen minutes later, we finally made it to where we needed to go.

I really wouldn't have minded so much, except that the patient was having some respiratory issues, and we really needed to get where we were supposed to be.

All that said, I really do like the guy. He just really needs to listen to my directions when I say I know where I'm going.

All else is on the GPS.

By the way, I have joined the darkside and moved to smugmug for my photo needs. Picasa was nice, but I'm at 99% of my alloted space, and smugmug is unlimited. It also has some nifty features I liked, and it's relatively inexpensive, especially with a promo code from a friend.

Tuesday, May 26, 2009

Some of the people I meet

First some house-keeping....I finally saw that I got comments! w00t!!! Unfortunately, I can't seem to find the button that sends me a message when I get comments. Help, anyone? (I am so illiterate at some internet stuffs)

Anyway, a good deal of my patients come in vegetable form, but I do occasionally get those that are alert and oriented x 3. The other day I had a gentleman who had worked as a technician for the FAA, and had traveled all over the state testifying in various state courts for an organization against rape crimes. Not because he personally knew someone who had been raped and murdered, but because he heard about the crime against a bright, beautiful young woman, and felt so strongly that he just HAD to do something. He was bed-bound due to a previous stroke, and yet his mind was as sharp as any I have ever encountered. I truly believe what I told him...That he had experienced and forgotten more history than I had learned thus far. He laughed.

Then I had another gentleman with whom I had a very interesting conversation about politics. It started about 2A rights, and extended into politics in general. I gave him some websites to peruse, which he said he would when his wife wasn't home, since she didn't like him reading political stuff, as it made him angry all the time. (heh)

I had an elderly woman who had grandchildren and great-grandchildren in abundance, who were coming to visit her for Mother's Day. We talked about her children and them visiting her in the hospital. When we left her, she wished me a Happy Mother's Day. When I told her I wasn't a mother (aside to my dogs), she said that she wished it to me anyway, since she wouldn't be able to wish it to me when I did have children.

I had a patient who lectured me on my 'adventurous ways.' He countered my complaint that C doesn't want to come rafting with me because it's too dangerous with evidence from his friend (who fell out of a raft and hit his spine on a rock, becoming an instant paraplegic). It doesn't make me want to go rafting any less, and I felt horrible leaving him in the absolute HOLE of a nursing home he was stuck in.

The patient's family is also very fun. When I was still 'training,' a patient's wife and I had a long conversation about anything and everything while we were stuck in traffic and then taking a detour to her house.

On the other hand, dealing with people all day, everyday, is taxing my poor, introvert brain. I had thought originally that C was the one who had a bit of a stabilizing effect on my temper (and the judicious application of the hormones from the birth control I started taking about the same time). Now I'm wondering if it was the lack of 'people' in my day. In the lab, I could escape people fairly easily, and most of my co-workers knew that I didn't like people much, and left me alone.

Now that I'm back in an ambulance, I'm finding that my road rage is back, although it is still somewhat less than it used to be. Perhaps I'm finding balance.

Do the Shuffle!

Though I may bitch and moan about doing the interfacility shuffle, I'm still thinking it's better than the lab job. I do like the patients. However, my tolerance for stupidity is getting less and less, especially in regards to dispatch.

See, our 'area of operations' is DC and Baltimore (more DC than Baltimore, truthfully, but we do venture up there about once a week). Evidently, years ago, we had our own dispatch, in DC, which makes sense, since movement in a vehicle around DC is only understood once you've experienced it. However, because it made sense, management decided that it must go, and dispatch was moved to Philly. None of the dispatchers in Philly have been to DC, let alone driven around here.

Are you seeing where this is going?

Now, I have to say, I totally understand the difficulty dispatch has. They have to send a truck, and while they try to be nice if we are coming to the end of our shift, sometimes they just don't have a crew to send to cover a call, and the board is full up for the next shift. And most of the time, I don't mind...Overtime is overtime, after all.

However, calling us at 1700, when we are well off the beaten path (meaning the Beltway) in VA, and telling us that we have a pick-up at 1800 up in MD, halfway to Baltimore, is not an efficient use of crew resources. In normal traffic, that trip would take about 45 minutes. However, in beltway rush hour traffic, that is a 2-3 hour trip. When dispatch then calls the crew at 1810 asking for an ETA, and the crew says 'We're sitting in pretty heavy traffic, and we haven't made it to MD yet, so probably another hour and a half to 2 hours,' it is not conducive to have a crappy attitude over the radio. The crew was not being snotty, and the sound of the dispatcher (who is 2-3 hours away, sitting in A/C, NOT in a hot truck in miles of traffic) sighing heavily into the radio and saying 'Well, just do your best,' is not in the best interest of crew morale. In fact, perhaps checking the internet for traffic in the DC area (which is easily found via several websites) would be a better use of time.

Or perhaps, when the crew says it will take another hour and a half or more to get to the destination, and it is close to the end of their shift, finding another crew who could get the job done in that same amount of time would be a better use of crew resources.

Or, as I've said before, perhaps having dispatchers spend some time in the field with crews, driving around in the traffic here, would give them an understanding of why it sometimes takes 2 hours to go 15 miles.

Or perhaps not...

Sunday, May 17, 2009

The new puppy

So, we adopted a puppy because I wanted to try working her in SAR. She is a 6 month old black lab and border collie mix. I'm not sure how well she'll work out though. She loves kids, and loves men, but she's very submissive to women, which concerns me a bit. She listens to both me and C equally, so that's not really an issue, but she just seems to be on guard all the time around women.

So far, she mostly knows 'sit' and is working on 'down' which is coming along. She's pretty good about her recall, although, like any puppy, she isn't really good about it when she's distracted by something (which is true of any of the commands...something we're working on). She is a bit of a jumper, and C and I really have to stop allowing her to jump on us, except when she's given the command 'up.' She's mostly house-trained, but if we don't notice her at the door to go out, she'll pee on the carpet. But she doesn't have a good tell, so it's hard. And annoying.

I go to my first SAR training next Sunday. Well, not first, but first in several years. I'm looking forward to seeing many of the people again. I had gotten out of it when I went to nursing school, because I just didn't have the money to drive all over creation. Plus, they didn't have any provisions for someone who didn't have a dog. Now I have a dog, so we'll just have to see if she passes their evaluations. If not, I'll just have to work as a walker until we move to a bigger house and I can get a dog that will work out.

Of course, we haven't payed for the new puppy yet (her name is Kaylee). I keep trying to get the woman in the rescue organization to email me her address, but she keeps forgetting. I need to call her again.

She and Kobe get along well, except when there is human food involved. But she is getting a bit better about that as well, and there is much less snarling when an event occurs.

Any way, here is a picture of Kaylee, and the bottom one is Kobe.

Thursday, May 14, 2009

It's raining again...

It's raining again. At least we had 2 or 3 days of spring, right?

Today was a rare day, and made the earlier (more horrible) part of the week seem like a distant memory. I made it a late start, but got there in time. MB, the supervisor, gave us his favorite truck, which was clean on the outside (OMG!!!) and mostly clean on the inside (double OMG!!!!) No crumbs on the floor, not a whole lot of trash inside. Wonderful.

Dispatch posted us to the VA. Of course, the day I bring my lunch. But we were able to go to my favorite deli in the city, and get lunch, which we then ate in our new favorite spot when posted to the VA.

I love the National Shrine. Easier to access than the National Cathedral, and they have a free parking lot across the street.

So, we got to eat lunch. Aside from a brief attempt from dispatch to give us a call (it was out of Virginia, and we are not yet certified as EMT's there), we were undisturbed for almost 2 hours. We got a call for the VA, but when we got there, the patient decided he didn't want to go (evidently, you can do that in the VA). So we left, and told the nurses to call dispatch back when they had convinced the patient that, yes, he really did want to go home.

So, back to our spot at the Shrine. We watched a collection of older middle school (perhaps young high school) students from Wisconsin get off their coach bus and head towards the Shrine. Which was interesting, considering there is a road between the lot and the Shrine. Not an overly busy road, mind, but not one I would like to cross with a butt-load of teenagers. Not to mention that buses usually drop off their charges in front of the shrine and then come over to park.

We got another call at a nearby hospital, for a patient to go to a place down in Virginia. At 1600. In DC. Needless to say, traffic was a bit of an issue, and, though we got off the floor in record time (all the paperwork was done and the patient was ready!), it still took us till nearly 1800 to get to the rehab place.

Dispatch decided to be kind to us, and let us head back to base. Considering the traffic, we made decent time, and got back to base EXACTLY at off-time.

My dogs are crazy. The puppy still occassionally attacks Kobe for sniffing at areas where she has eaten people food. She hasn't done it in weeks, yet she did it tonight. I have no idea why. Perhaps I could ask the vet when I take her in next week. Still, they have been playing and such for the better part of the last 30 minutes, so I can't complain. They do get along fairly well.

Company comes tomorrow. I have to finish cleaning. Unsure of what we'll do this weekend, but if the weather is as bad as they say (all rain, all the time) I'm leaning towards something inside. Perhaps climbing?

Wednesday, May 13, 2009

Insurance stupidity

I really wish I was better able to put my rants into eloquent words. I just always feel like I'm ranting aimlessly, not doing much to effectively put my thoughts into words. But whatever....I'm still doing it.

SO the other day we got a call to take a patient from the hospital to his house. I wasn't sure about this one as soon as I walked on the unit, and checked on the patient's room. I could hear him breathing from where I was in the doorway. Even the nurse's were saying that the man needed to stay in the hospital. No home health care, no home O2, no home suction....and only his equally elderly wife to care for him. The patient was bed-bound, and pretty much awake, but un-responsive. The nurse had taken off the O2, and the patient had developed what I call the 'fish-eye stare;' the stare of someone who doesn't have enough O2, and whose brain is shutting down due to lack of oxygen.

So why was this man, who so obviously needed to still be in the hospital, being sent home, especially to a home that was not equipped to care for him? Because his insurance had decided that they were no longer going to pay for his hospitalization, and had cut off payment at noon that day. Therefore, the hospital was sending him home. Our company would take him home, and charge the insurance company for it.

We managed to finally get him home (see previous post rant on nurse's not having the patient ready to go when we get there), to a house that was supremely unfit for a person who is constantly ill. His wife, a tiny woman who 'had a cold' apologized for the state of the house and how it had been built years ago, before anyone thought of disabilities. I had put the man on O2 on the way over, just to give him a chance at staying home a little longer, but I would bet my next paycheck, his wife called 911 not an hour after we left.

So, let's add things up. Insurance company pays for X number of days in hospital, and won't pay any more. Patient requires more hospitalization, but is sent home because insurance won't pay for more hospital time. Private ambulance company take patient home, and charges insurance company. Patient needs more time in hospital, so 911 is called, who comes to take patient to hospital and (most likely) charges insurance company again. Patient is taken to ER, who charges insurance more money to see the patient, and treat him, and bed him until another bed opens up on the floor. Patient goes up on the floor, and stays until insurance stops payment again. Or until the patient is healthy.

Or until the patient dies.

Rinse and repeat, ad nauseum.

So you can see my irritation here. I've ranted about insurance companies before, though not here, and their ridiculous policies that have no relation to reality. One example is my old insurance company's policy that physical therapy is limited to 30 visits, regardless of medical need. So, you know, don't have a stroke, or any other serious medical issue that may require extensive therapy to recover from.

It is my firm belief that anyone who works in the policy making department of an insurance company should be made to spend time with EMS crews (both public and private), and on the floors in hospitals and in ER's, so they can see what happens in the real world, as opposed to some mythical virtual world where everyone is magically healed after X days, and there are never complications.

Monday, May 11, 2009

After several days in the new job....

And I'm still pretty sure it was better than the old lab job.

My shift gets more OT than pretty much any other shift. For some reason, dispatch can't ever find any other ambulances for those 1830 transfers, so we get snagged for it. Which of course, puts us late. Usually, really really late. Like 2 hours late.

Still, we got off early tonight, so it's not so bad. And only 2 calls today.

Ok, so a new pet peeve of mine, based on the things I'm learning on this new job. If you, as the nursing staff, or discharge planner or whatever, call my dispatcher and tell them that you want an ambo for a transfer at a certain time, it behooves you to have ALL the paperwork ready by that time. Don't wait till zero time, and then panic when you see us and run around like a chicken with no head and try to get the paperwork together. I WILL stand at the nurses station and stare at you. I WILL tell anyone who asks me if I've been helped that I'm waiting for YOU to get the paperwork together. My patience is rapidly beginning to run out, and I WILL start calling dispatch and telling them that you are NOT ready. This may cause dispatch to start tendering our call times to give you that extra time you so obviously need to get that paperwork together. Since, clearly, it is hard for you to get the paperwork organized in the 6 hours between the time you learn that the patient is leaving and the time that I show up.

My company is starting to track times. It seems that my partner and I consistently get the calls where we show up and the nurse for X patient is at lunch, and no one knows what is going on. Or the ones where the nurse doesn't have the paperwork together, or the patient has to finish dinner, or the medicine hasn't come up from the pharmacy yet, or it's shift change and no one will talk to me because they are either giving or getting report. This will screw with our times. We also, working the 11-7 shift, consistently get the longest transports that take us through the worst traffic.

Still, it is better than being a lab rat.

Another rant to come tomorrow on the idiocy of insurance companies, and how it is stupid to allow people with a BA in business to determine medical policy.

But now...

GO CAPS!!!!!!!!

Sunday, May 3, 2009

New Job, different from the old job...

Well, I started the new job on Friday. Thirteen hours in the back of a small ambulance without A/C on a muggy, rainy day. Lovely. I'm pretty sure it's still better than the desk job. We actually only ran 4 calls in those 13 hours. Transport only is a bit boring, and I wasn't too sure about some things that the guy I was riding with was doing, but since the appropriate equipment was in absence, I have to figure that it's how most of them do it. A little sketchy to my taste, but I suppose I can do things 'the right way' when I get cut loose. My new schedule will be Mon-Fri, 11a-7p, which isn't horrible, but I had been hoping for a fewer day, longer shift schedule. Still there's time to change, and the only other shifts available involved weekends, which I just really can't do.

On the other hand, in August, I'll be starting paramedic school. I applied and was accepted. Getting laid off is scary and unfun, but I took it as a chance to do what I've been wanting to do, and talking about doing for years. The fact that I went on several interviews for science jobs, and never got a one (even the one I was sure to get, due to lack of grant money) makes me think that this was one of those 'meant to be' things. Sure, the pay is significantly less than what I was making, or what I could be making if I had stayed in science, but money isn't everything, and I'd much rather be shuttling patients back and forth from hospital to nursing home and back again than sitting at a lab bench, shuttling chemicals from beaker to beaker.

In other news, we got a new puppy. I have to call the woman to get her address for sending her the check (it's been a 2 week trial thing to make sure she'd work in our household, and with our other dog). Things are still a bit sketchy at times with her and the older dog, since she is a total puppy, but she's a quick study, and most of the issues we had were more related to her lack of socialization with other dogs than actual aggression. I'm hoping she'll work out for SAR.

Why do they air commercials for Sonic, when there isn't a Sonic around here for miles and miles (and hours)? Why do they taunt me so????