Sunday, September 27, 2009


Nothing like chilling at home all day Sunday, working on homework and other stuff.

The house is relatively clean, including the dogs, which is good, since C leaves tomorrow for NJ for the next 6 months. Oh, he'll be home on weekends, but that doesn't count much when he'll be sleeping all day Saturday, and half of Sunday, and then have to either go to bed super early, or leave Sunday evening. One day, I swear, I will be able to spend a full calendar year with my love. By this, I mean that neither one of us is away for a significant period of time over the course of a year. Consider, we started dating in January of 2007, I left for Antarctica in October 2007-February 2008. In October 2008, C was sent to North Carolina for what was supposed to be 4 weeks, and ended up being 5 months. He came back in February 2009 when I got laid off. No he's being sent to NJ for 6 months. So yeah, one year we'll spend the whole year together.

In other news, I tanked a cardio quiz. Very disappointing and led to a brief crisis of faith where I doubted if this was the right move for me. I'm especially worried about the test from Thursday now. There is another quiz in cardio tomorrow though, so think good thoughts for me.

Add to all this money woes in regard to whether or not we'll be able to pay for everything for the wedding, and you have one lovely weekend. Granted, some friend's of mine have had a much worse week than I have, with people dying and finding out that others have serious cancer, so I should really count my blessings.

Which reminds me...appointment with the surgeon on Tuesday to see if I have to have the gallbladder out ASAP or if it can wait a bit.

Wednesday, September 16, 2009

Neat stuff

So last night I dragged my sorry butt to the firehouse, which I haven't seen in about a week (which I must rectify) for drill night. I've never actually been to a 'drill night' as every time I'm there on a Tuesday, I've either gotten the night wrong, and we don't have drill because we have a business meeting the next night, or I am on the ambulance and get sent out on a call that doesn't get me back to the station until drill is done.

This week was special. There is a gentleman living in our first due who has a Ventricular Assist Device (VAD). This is a little magnetic pump that is inserted into the left ventricle that, via centrifigul force, pulls blood from the ventricle and sends it through a shunt to the aorta. The atria are unsupported, but they do still beat. You will still get an EKG reading. It usually is associated with an internal pacemaker. And you will not get normal heart sounds. At all. Essentially, the heart is no longer really beating (though, if the pump fails, it can beat effectively enough to maintain life for a short period of time). The blood is being moved through the heart by this pump.

Here's the kicker...he has no pulse! Read that again. NO....PULSE. Also, no blood pressure, unless he is really super hydrated. This makes treatment slightly difficult, to say the least.

The interesting thing I found was that there are several hundred, if not thousand of people across the country who have different varieties of these things. Before last night, I wouldn't have known what to do if I had a patient present to me with no pulse or blood pressure, yet he was upright and talking.

The most important thing about the whole lesson was that he CANNOT be separated from his bag. The wire that controls the pump is connected to a computer in that bag. I shudder to think what could happen should an emergency happen (say, a car accident) and responders attempted to move the bag too far.

Anyway, these VAD's are mainly for people who have serious heart failure and are either waiting for a new heart, or aren't going to get one, and this allows them to have a much higher quality of life than they would otherwise have. I'm sure the nuisance of carrying around a mini-computer in a bag and having a wire come out of your side is much more tolerable than the nuisance of getting winded walking from your bedroom to the bathroom.

It's an interesting thing, and once more shows what technology can do. If you don't already know about these things, look them up. These people can be travelling through anyone's area at any time, and could have a problem.

Besides sounds wild!!! Like your standing near high tension lines or something. Seriously, if you don't care about anything else about this nifty bit of techology, look it up just to hear what it sounds like!

Thursday, September 10, 2009

The man is keepin' us down!!! it were...

Today I had a revelation of sorts. Our instructor climbed up on his soapbox about MAST trousers (a soapbox I share, given my hard science background and the overall lack of research that goes into most EMS decisions). Having come to the Promised Land of EMS (as the People's Republic of Maryland would have you believe) from a state that didn't believe in killing thousands of trees every year just to change 3 words in the protocols, I have viewed much of EMS here quite skeptically. From the insistence of people (who should damned-well know better) on flying patients based on their MOI to the hospital that is within visual distance of the accident scene,to new regulations every time the governing body gets bored, to in refusal of the state medical board to allow medics to use medications that are used every day in other parts of the country, I have become heartily tired of the stupidity that runs rampant in the EMS systems around here. Rogue Medic's recent posts have only provided food for thought.

I digress. At any rate, during the discussion of MAST trousers and why we are suddenly prevented from using them, he began railing against a certain segment of the medical community and why paramedics are the only licensed professionals in the entire country (that I'm aware of, please correct me if I'm wrong) that have a group of other professionals over-seeing, passing judgement and making rules for us. I think I've been slowly approaching this particular revelation, but today I got smacked in the head with it, and it makes sense.

To use the examples used in class today, sitting on the next computer over when we take our licensing test is a plummer, and next to the plummer is an electrician. Both of those professionals require a license, with the appropriate test, just as paramedics do. But neither one of those professionals has another person, say an electrical engineer, or a fluid mechanics physicist, sitting over top of them to give them codes and tell them what they can and cannot do, and what pipes or wiring they can and cannot use.

So why is it, that as a paramedic, I will have to defer to some guy sitting behind a desk somewhere, who hasn't touched a patient in decades, tell me that what I do for my patient is the correct thing to do? Why don't paramedics write protocols for paramedics? Why is it that doctors, who many times haven't the foggiest notion about what EMS is all about in the 'real world,' are the ones who say what we can do, what meds to give, and so on? (I admit that there are several exceptions to this, and I'm painting with a wide brush, but let's face the time many docs get to the point in which they are writing protocols, they are generally more politician and businessman than doctor). One person in the class answered that it was because paramedics usually only have a high school diploma, and because you are dealing with 'life and death' situations, which require the higher education of a doctor. He was challenged with the facts that electricians generally have high school diplomas and 2 or so years of education (same as most paramedics in this country), yet they are given control over their own domain. The argument of 'life and death' is a strong one, yet, if the electrician does a shoddy job, and the client's house burns down with the client inside it, is it also a life and death situation? Yes, there are shoddy medics, who do it only for the extra money or quicker promotion potential (in a FD run EMS system) and there are crappy programs out there that do nothing but teach to the test and just churn out as many medics as they can. Quantity, rather than quality, is often the idea.

I had an ER doc (granted, he wasn't a medical director, but in all honesty, what would stop him from becoming one if he wanted to?) once complain that paramedics only gave lidocaine for V-tach, when amiodirone was a much more effective drug. Here was someone who was giving paramedics drug orders via radio, who didn't understand that the state of Maryland does not allow amiodirone to be given under their protocols (not that I can blame them, given it's hideous expense).

So why is it that paramedics are forced to subjugate themselves under doctors? Because the AMA refuses to allow any profession that may challenge the all-knowing doctors. They don't allow nurses to diagnose..instead, nurses are relegated to 'nursing diagnoses' which say nothing important when they say 'the patient is having ineffective breathing' rather than stating the obvious 'the patient is having an asthma attack.' I've had doctors pitch a fit on me for 'diagnosing a patient,' which, given the lack of proper letters after my name, I am prohibited from doing. I have seen, over the past 10+ years, the progressive 'dumbing down' of EMT and yes, paramedics, due to the reluctance to do such revolutionary ideas as 'diagnose.' EMT's are now taught to pass the test, and not question the information they are given. No thinking...just treat.

And yet, what is the solution? Surely the 'dumb paramedic' issue could be solved with more programs that offer a bachelor degree in Emergency Medical Services. It leads (in my not-so-humble opinion) to better providers, as a provider who has been taught to think can better treat the patient. Even now, we are moving in that direction with the influx of Associate degree paramedic programs. I think that, much as nursing has, gradually we will move away from simple 'certification' programs, then away from the Associate degree programs and into the realm of bachelor degrees. Nursing, physical therapy, and several other medical related jobs have traveled the same route. But the problem is how to break free from the over-seeing doctors? They won't ever let EMS go willingly.

I know there are several arguments, but I have to go and will deal with them later...

Friday, September 4, 2009

Week 1 down!

Well, week 1 is in the books. I am sitting in the Commons, a kind of 'town square' thing that houses several eating places (ala carte, really), the bookstore, and several other things. Had this been King's, my former place of higher education, I would call it the Student Center. This place, being much bigger, has this, and another student center type place.

I've forgotten how much fun it could be on campus. Seeing other students walking to their dorms and apartments, seeing people playing frisbee (and croquette, even) in the quad, and in general relaxing after a week of classes brought back a strong nostalgia of what-has-been. I miss being able to just walk down the hall, or up a set of stairs, or even just across campus to see my friends. Getting together on a Friday night to role-play, or watch a movie. Getting up late on Saturday and going to the park to play Ultimate. Watching football on Sunday with the whole group of friends.

I find myself wondering what might-have-been had I had this radical idea of medic school (rather than medicAL school) and had come here 13 years ago. Would I have met the same people eventually? Would I have met C? If I hadn't met C, and decided to come here now, would I opt to lie on campus rather than at the Crofton house?

These things go through my mind, but I know I wouldn't trade those years for anything. There are things I would do differently, but I can't complain about the track my life has taken overall. I have friends who have been with me through thick and thin for 13 years. Not many people can say that they've remained friends with people from college for this long after college, at least not with as large a group as we have maintained. And now, S will be having a baby in a few months. 13 years ago last week, S and I met for the first time, along with R, who has 2 children now. I am continually amazed that, even though some of us have moved away, we have remained friends enough to keep in contact with each other through more personal means than facebook.

In other news, I'm sitting here because C is picking me up. The Gnome-Mobile is safely stashed in a parking garage on campus, and we will be heading north to the Poconos for a visit with parts of my family. This weekend will be full of good food, family, and lots of catch-up reading for school.

This flexi-keyboard is working ok, although the harder keystrokes make it harder, as does the necessity of hitting the keys perfectly square. Still, I'm getting better at it.

Speaking of things I'm getting better at, actually going to the gym is getting easier. I'm getting back into the swing of things, and I'm learning more about form vs weight. And today I can actually move. The diet is a harder thing for me, but even if I eat 'bad stuff' I'm learning to eat less of it, and I hope that eventually I'll just phase that nonsense out of my diet. It's a process.

Thursday, September 3, 2009

More on school

While I'm thinking about it, and have some time to breath, another few notes on school.

Our main instructor is rather kick-ass, and reminds me of Rogue Medic, in that Why is nothing in EMS based on research??? sort of way. Can't say I blame him (either him, that is), given my hard science background and the fact that if any of the sciences I've ever dealt with did things that way, nothing would have ever been done. Pharmacology is a beast, in the evenings in the middle of the week after 2 other classes, but at least it's taught by a guy who has a good sense of humor and can make as light as possible from a heavy and dry subject.

Other than that, the netbook is working well, though I find I can't type notes on it like I had planned. But it is good for pulling up the slide presentations we use and following along. I am one notebook short, which will have to be rectified this weekend. I have more reading to do than I did for my first degree, and, given my inability to read for long periods of time (at least, when it's dry and boring material), this is rather nerve-racking. The other problem I'm running into is the battle of over-confidence. Much of this I have done before...not so much in undergrad the first time, but rather in the 11 years I've been doing this, in nursing school, and then the EMT-I class I took. I find myself reading sections and saying I know this stuff, and I am tempting to skim past that bit, or not pay attention. But I have to, lest I miss some important tidbit of info that will pull the whole kit-and-kaboodle together. It's a new sensation, and I'm not much for it, really. But I'm terrified of missing something that will come back to haunt me on a test somewhere down the line. I find myself being completely anal-retentive and hyper-vigilant. I can only hope it lasts.

On the good side, in one of the hardest classes we have, we had the first of our daily quizzes, and I (am pretty sure) got 100%. Yes, it's only a quiz, and no, they will not always be this easy. But it's a start.

In other news, I am heartily tired of being called by work. I told them time and again that I can't work during the week, due to my schedule, the work load, and the commute. Yet I get a call asking if I can come in on Tuesday, or Wednesday, or Friday. I finally emailed my schedule to my supervisor, since he wasn't there the day I brought it in. Hopefully I won't get asked to work wonky shifts like 2p-midnight. Once C heads out of town, I'll have to get home to let the dogs out and feed them. I really am beginning to wish I had a different part-time job.

Tuesday, September 1, 2009

First day of school

Today was the first day of paramedic school. An easy day, as they go, with only 2 classes, running from 0800 till about 1200. Which is good, since my lazy ass took itself to the gym yesterday for the first time in about 4 months, which, in turn, led to some fairly incredible muscle soreness today, mainly from squats, but a little bit from the push-ups.

The good news is that my 0800 Tues/Thurs class is now mostly only on Thursdays. The bad news is that Wednesdays are my late nights, with class running till 8pm. I'm wishing he had opted to have classes on Tuesday, but I'll take what I can get. The other bad news is that I find myself behind the 8-ball as far as reading goes, thanks to a company that shipped the wrong book, and then forgot to ship the correct one after I called them to fix things. Good thing I read fast, eh?

The other good news, however, is that all loan issues have been straightened out, and while I still need to electronically sign things, once I do, the money will be in the system for the school, and all I need to do is contact the FA director, who said she would request the withdrawl of the late fee from my account. I'm not sure how good a 'request' from her is, but it's something.

In the meantime, today, I need to run some errands out, and then come home and read. Lots of reading. Lots and lots of reading.