Friday, December 10, 2010

It's the end of the semester as we know it....

Today is my last day of clinicals. I am spending my day in a firehouse in Smaller County (that I hope to possibly get hired in when they open applications this month), attempting to defrost my hands. Who decides it's a good idea to wash the ambo in sub-freezing weather anyway? My sleeve is wet where the water ran down from the hose. I miss the sauna in McMurdo's Station 1.

Anyway, as stated, it's the end of the semester, and I have a chance to breath. Facebooking has been possible, but that's about all I've been able to muster. While this semester hasn't had the intensive class time and tests of last year, it has been a study in time management, of which I am a poor student. Three days of clinicals a week, several papers, and a couple of tests thrown in for good measure have had me hopping around like a headless frog the past few months. I have had some interesting calls, which I will regale you all with once the semester is done for good next week and I have time to take a breath and actually think. Next Monday is ACLS class (finally!), and Tuesday is my final presentation for my research class.

I will say that I find myself endlessly frustrated by the seemingly arbitrary skills and the number of times we have to perform each skill in order to finish our ride-along time. In apparent direct contrast to the new AHA guidelines, we are required to record the number of patients we ventilate, (one patient=one ventilation) and we are required to ventilate 20 patients. However, we are not required to track or have a certain number of patient's we perform compressions on. I don't know about anyone else, but most working codes, where one would be performing ventilations, tend to come in late at night, generally after we are forced to be out of the firehouses. Not to mention that even as a live-in at a relatively busy, non-medic staffed station I didn't have 20 working codes in an 8 month period. So please explain to me how I am supposed to get 20 ventilated patients between September and December (and then again in February to April). I am quite frustrated.

Add to this that I seem to be the ultimate 'white cloud.' Medics breath a sigh of relief when I walk through the door, knowing that the next 8-12 hours will be easy. The most calls I have run on a medic unit in a 12 hour period was 5, and only one of those was an ALS call that required more than a bandaid and a bit of comfort. Not that those things aren't important, but as a student who is required to have a certain number of specific skills (IV starts, ventilations, medication administrations, etc) these type of calls do not really help, aside from the assessments (which, admittedly are also important, as I need assessments for things such as respiratory distress, chest pain, altered mental status, syncope, psych, OB, etc). Most of these I have, but we just don't run that many trauma calls (most of those being of the BLS type). Therefore, I find myself behind in trauma, psych, and AMS assessments. I have a plethora of respiratory calls, but very few chest pain calls. The OB calls will come when we do our L&D rotation next semester, and I find myself hoping that I will be able to get more hospital time next semester to attempt to check the appropriate boxes. However, even the nurses at the hospitals are happy to see my wander in, as my presence guarantees a quiet 8 hours.

All told, I am not unhappy. In fact, I have had several calls that were excellent teaching opportunities, both as far as assessments, skills, and interpersonal relations go. I've learned lots of what not to do, and some of what to do. How to deal with difficult nurses and doctors, when to treat and when to let it ride, and so on. Riding at my home station isn't quite as good, because I can't practice as an ALS provider, but the medics there know I'm in school and let me ride with them to work on my assessments. One of the medics (I seem to be the only one who likes her) is an excellent provider, and quizzes me on what to do next, and basically runs through the call with me, what I would do next, medication dosages and so on. It's very nice to have that extra help.

But I am very glad the semester is nearly over. Just 4 more short months, and I'll have my second BS degree, and be a licensed paramedic. Then it's just a matter of finding a job.

Thursday, November 11, 2010

Faking it...

Honestly, if you're going to insult my intelligence by lying so blatantly to me, the worst you can do with your sob story is gin up some real tears. A two-year old can come up with better crocodile tears than you.

Last night proved a classic example of pain. I read a book once, You're Never the Same Once the Air Hits Your Brain, written by a neurosurgeon (sorry, can't remember the author's name) where the good doctor, as a young medical student/intern, learned the difference between real pain and 'fake' pain. Note: when I say 'fake' pain, I don't necessarily mean that the patient is faking being in pain. They may very well be in pain, and usually are in some discomfort, and therefore, must be treated as such (never tell anyone they aren't in pain. No one feels pain the same, and what may be a 10/10 to one patient could be a 4/10 to another). But 'real' pain vs 'fake' pain patients will differentiate themselves.

Patient one called for abdominal pain, due to gallstones. A previous attack had shown what the pain was, and, though surgery was scheduled, another attack came on. The patient complained of pain at a 10/10, and could not find a comfortable position. The entire 25 ride to the hospital was spent with the patient moving around constantly on the captain's chair (no stretcher by patient's request, as it would restrict movement too much), stretching, breathing, sighing, and doing everything to not cry. The patient couldn't describe the pain very well, only that it 'hurt badly' and was so distracted by the pain that she couldn't even remember her age, could barely walk, and just could not find a comfortable position. When asking the patient questions, we had to frequently remind her of the question we asked, or ask several times, as she was so distracted by the pain that she would forget within seconds of what we asked.

Patient two actually called for chest pain, but arrival on scene showed it was a frequent flyer patient with a history of back problems and general muscle pain and spasms. Frequent flyer-ism is not unusual with chronic pain patients, as they call when something happens to disrupt their homeostasis; they run out of meds, have a particularly bad day (weather can do this), or overstretch themselves, and need more relief than they can get from their home meds. This patient had a history of spinal issues after a recent (within the last year) car accident. This car accident was reported to be the patient's fault but the patient was currently suing everyone involved, from the other driver to the police and EMS departments for poor handling of the case. A laundry list of medical history accompanied her. The entire call consisted of much screaming and yelling, and then crying as she related her story, complete with embellishments I'm not sure are ever possible. Her story was related with a lot of detail, including dates and names of those involved. By asking our own questions, we were easily able to distract the patient from her pain complaints, and when we asked about pain in general, we got an answer of 'It's the same.' However, if we immediately asked about a specific body part ('What about your big toe?), the answer was a scream or wail of how it hurt so badly.

Do I doubt either patient was in pain? No. Again, pain is extremely subjective, and who are we to say that a patient has pain or not? Chronic pain patients often have high pain tolerances, and acute exacerbations of their pain are often accepted with resignation and familiarity, and they tend to not trend towards the dramatic side of the scale. Patient in 'real' pain are often unable to describe the pain unless prompted with suggestions, because all they know is that 'it hurts.' Patients in 'fake' pain often use colorful imagery, such as ' it's sharp, like miniature elves are running up and down my legs, stabbing me with red hot pokers.'

Again, this is all very subjective, and I tend towards the treatment rather than not. Patients in pain are in pain, and whether they are trying to sucker you for drugs or for insurance-itis or they are totally and completely really in pain, they all should be treated the same. Keep a high index of suspicion, but don't discriminate.

Another note: I have minor chronic pain. Severe carpal tunnel in both hands, constant shoulder pain that has only been partially relieved by rotator cuff surgery, and lower back pain are my friends. I am no where near some of these patients level of pain, but I also have a high pain tolerance (my rotator cuff was torn for over a year before it was repaired, and that was a year of push-ups and weight lifting and firefighting). So, I'm just saying I have a very slight view of what some patients go through.

Monday, November 1, 2010

WEEEE!!! It's Stream of Consiousness time!

Why yes, I am still alive. Clinicals are eating my life. And yet, I do so little at them. The past few weeks have been full of medic unit clinicals, with less than 20 calls to show for it. And today, I sit at a station far from home, bored to tears. Only one call all day thus far, and it was a BlS run, which netted me ZERO patient contact credits.

I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.

I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.

I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.

Though I didn't help my case much by having a dozen buffalo wings for lunch today.

I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.

Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.

In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.

By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....

Sunday, October 3, 2010

Eyebrow raiser

Clinicals are still eating my life. I think I'm putting in more hours/week than if I was actually working.

Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.

If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.

So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.

So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.

Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.

So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.

I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).

I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.

I will be better than that in the future.

Monday, September 20, 2010

Really? That's it?

Papers are eating my brain.

In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).

Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."

Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????

You might as well spray that morphine in the air for all the good it's going to do the patient.

OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).

I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).

Friday, September 3, 2010

Right then....

First of all, a huge CONGRATS!!!! to Epi on passing her NREMT-P and becoming a full-fledged medic! So proud of you, girl, and I hope to be able to write the same thing next June.

School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.

This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).

My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.

Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.

I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.

Friday, July 30, 2010

Slow times

Not much has been happening. I am leaving for a 2 week camping trip tonight, and when I get back, I have 2 days before I leave for a 3 day camping bike trip. I'm very excited.

I've been trying to work out more lately. I'm tired of being tired, and I would like to lose weight before my wedding next October. I am short and round, and I'm tired of that shape. My problem is that I often start going to the gym, and in a few weeks, maybe a month or two, I lose my motivation to go. I think the problem is that I have no goal. While it may be sad to say that losing weight and getting in shape and being healthier should be goal enough, it's not.

My fiance loves to run. He ran cross-country in high school and college, and occasionally runs now. He's one of those lucky few that is tall and thin with a high metabolism (though it is starting to slow down). A good friend of ours, who is also working on losing weight, has discovered that he also likes to run, and is training for 5K races. His wife, who hates running, will be entering a body fitness competition next fall (Fall of 2011) at the ripe age of 54.

So I decided I needed a goal. Something to train for. A specific item to work towards, rather than the more nebulous finish line of 'lose 'X' pounds by 'Y' date. I thought back to the activities I like to do. I do like to lift weights, but there is no way I could be ready for any kind of body competition in less than 2 or 3 years. I like to bike ride, and I love to swim (I am a fish). I remembered that in the early days of my pre-teen and teenage years, I would spend the summer in the pool and on my bike, and when I saw my first triathlon on TV. I would swim several laps in the pool, then jump out and hop on my bike and ride around the neighborhood a few times, then drop off my bike and run the same route. So, I decided that next summer I would run a triathlon.

Now, I have no doubt that I will not win. But that really isn't the point. The point is to finish, be in good enough shape that I won't die on the route, and be happy when I finish so that I want to continue. In the future, should I continue, I am sure I will start competing to place, given my competitive nature, but for the first one, I just want to finish.

And before anyone thinks I'm totally off my rocker, triathlons come in various sizes. There is the Ironman, the half-Ironman, Olympic distance, and sprints. The sprints are the shortest ones, consisting of about a half mile swim, a 13 mile or so bike ride, and a 5K run. If I work hard on training, I should be more than ready to do one by next summer.

My one concern is school. This year, I only have classes twice a week, with clinicals the other 3 days. I'm concerned with how the clinicals will affect my training, given that the hospitals do not have workout rooms, nor do some of the fire stations I'm in. Time is another factor, as clinicals don't exactly have time built in to work out. But, it doesn't take long to knock out some push-ups and sit-ups, squats and lunges, and there are always pylometrics to bust your ass some. Nutrition will be a challenge too, but I think that eating properly will almost be easier than working out. I just have to say 'No' when the medics go out to eat.

So that is my plan. I've already started the past 2 weeks, by doing some interval training, circuits, and other fairly intensive workouts. Spinning is now playing a large role, and I am going once a week. I'd like to bump it to twice a week, but my schedule will not allow that once school starts. I have a good beginning cycling program that I will be starting when I am home from all my trips, and I will likely add swimming in the mornings twice a week before classes.

My goal is a sprint triathlon in July next summer. I probably won't be posting too much of my progress here, because I have a workout journal on Livejournal. If you happen to have an account on Livejournal and want to be added, let me know.

Anyway, that's the plan. I have some EMS related posts swirling around in my head, and I will probably work on them during my 3 week of relaxation.

Monday, July 12, 2010


Today's xkcd was LOL funny. I immediately thought of Rogue Medic.

Wednesday, June 30, 2010

At least there's catchy music...

Having been reminded that the state protocol updates take effect tomorrow, I realized that I really should waste 30 minutes of my life and view the 'update rollout videos' before I'm taking off riding status. I suppose I should be grateful that they've put it up online so we don't have to go through classes face to face, wasting a whole day.

New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.

Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.

But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.

And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.

*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.

At least the protocol rollout has catchy music...

Wednesday, May 26, 2010


I am officially an NREMT-I!!!

Now I don't have to worry about it till next year with the NREMT-P test.

By the way, what the heck is with the security for the written test? ID, fingerprint, palm print, photo, signature. Can't take anything into the test area with you, not even chapstick. What the hell? How is my chapstick a security concern? I mean, really? I know that they administer tests for people other than NREMT, but is there really a need for all this? I thought they were going to ask for a DNA sample next!

Tuesday, May 25, 2010


In case anyone was wondering, I passed my practical NREMT-I test on Friday. I only had to retest IO, since I had a minor equipment issue (unknown if it was brought about by operator error or not. I chose not to challenge it, and just retest the station). So yes, I passed. Happy day.

The day before the test I didn't have time for terror, since my laptop gave up the ghost, and I spent much of the day running around on errands, and getting a new computer. Now all I need to do is get a sled so I can move all my files from the old hard drive to the new one. It isn't a huge deal, but it would be nice to have my wedding information instead of having to redo the budget, guest list, etc all over again. I also have to finish moving my music, since iTunes was being sullen and didn't get all my music from the external hard drive, leaving me to transfer everything myself. It's good, in a way, since it will allow me to go through and erase all the duplicates and so on. I am a bit miffed about the loss of all my playlists, though.

So, at 0800 this morning, I took my NREMT-I written test. I was done in just over an hour, and took another 20-30 minutes to review all my work and the flagged questions. There are still a few I am nervous about, and I left feeling that I either knew my shit or didn't know anything at all. I should get results sometime this afternoon.

Since I had to be in the glorious County of Monkeys this morning for my test, I decided to meet my old co-workers for lunch. I've come to realize over the past year and some that getting laid off was probably the best thing that could have happened (something I voiced then, but didn't quite believe). I enjoyed working for that company, mainly due to the people there, but felt trapped. It was a vicious cycle I went through on a fairly constant basis, becoming excited about a new project and working as hard as I could on it for several weeks, only to gradually become disenchanted with it when it dragged on too long. I would slack off, get depressed, and then something would happen, or I would think of something that would take me back to that excited, busy state again. It was like I was manic depressive, but only about my job. During my low periods, I would constantly talk about leaving and going back to school to become a paramedic, just as soon as I'd paid off more bills. Well, you know how that goes...For years I never left, aside from the trip to Antarctica, and one of the main reasons I didn't go back to the Ice was because I felt it would be pushing my luck to leave again less than a year since I'd been back.

Ironically, I was laid off a month short of my year anniversary of being back from the Ice.

So today, the day I took my test and took one more step towards fulfilling my dream (I'll consider it a full step when I find out if I've passed), I am once again meeting with my co-workers, my tie to my former life. It's a strange circle I feel I've come to, honestly. I readily admit that there is a part of me that still misses working there, but I think it's more for the loss of the camaraderie and those other intangibles other than the work itself (in fact, I'm sure of it). I miss the verbal sparring, the joking, and laughter we shared. I miss being surrounded by people mostly my own age, and, truth be told, I miss being 'the kid.'

Don't get me wrong...I'm enjoying where I'm at now, and I enjoy (mostly) my classmates. But being a full generation older than everyone but my instructors (one of my instructors is a year younger than I am) is wearing. At least at my old job, while I was younger than most, I had a good appreciation of things the people older than me enjoyed. My current classmates have very little appreciation of what came before, and I find it discouraging to make jokes and have only the instructor laugh. It's depressing to have to constantly explain things to the children in my class.

All the same, I am happy where I am now.

But I'll be happier when I know I've passed my test.

Wednesday, May 19, 2010


We went to the Joint Services Open House at Andrews AFB this weekend. I am now peeling like a snake. My face got extremely burnt, thanks to some expired sunscreen and a whole day on the flight line. My back got sunburned the day before, gardening in a tank top. See pictures here.

In other news, my NREMT-I practical exam is on Friday. I am terrified. The last time I took it, I failed the medical, trauma, and both cardiology stations. This time, I feel fairly confident in everything except dynamic cardiology. We haven't had much time in class to do actual practice in class; most of our dynamic practice has been more of a 'practice by committee' kind of thing. So today we finally got a chance to actually sit down with our instructor and do a dynamic station. I did it twice. And failed twice. And we don't have practice time tomorrow, because our instructors are setting up the test.

I am in terror. I don't know how I'll handle it if I fail. I feel confident about all the other stations, and feel confident that I will fail dynamic cardiology.

To make matters worse, The Fiance will not be in town this weekend, which means I have to get up at 0330 Friday morning in order to be at the test site at 0800 (it's 1.5 hours away, which means, at rush hour times, I need to budget at least 2 hours, if not 2.5 to get there).

I'm hoping to get to the firehouse tomorrow, in the dream that someone there can run me through some dynamic cardio scenarios.

On the plus side, in happier news, The Fiance got word today that once his exile in NJ is complete, he will be placed on a project here at home, that will last for at least a year and a half. Which means he will be in town for the wedding. And my senior year of this program (assuming, of course, I pass my NR test, and make it to senior year).

Thursday, April 22, 2010

Right-sided MI's

So, I was responding to a post by RevMedic over at EMS Haiku (go there to see the actual strip) who was talking about a right-sided MI he might have caught through careful assessment and so on. I was talking about a tip that I got from a doc during a clinical on the medic unit, and realized Hey! This is one of those things I could put in my blog!

So here it is. Thinking logically, the lead V1 in a 12-lead EKG is the exact reciprocal of the lead placed on the back in a 15 of 18 lead (I don't know which one, since we haven't studied them, only talked about them briefly). Therefore, if you see a depression in V1, you should expect that there is reciprocal elevation in that lead on the back. Thinking further, the lead on the back is pretty much directly over the right ventricle, and therefore it makes sense to see elevation there.

So yeah. While it is not diagnostic by any means, seeing ST depression in V1 lead, when you don't see reciprocal elevation in any of the reciprocal leads, should lead you to suspect a right-sided MI, and move your leads over to double check.

Sunday, April 18, 2010

A small light

I'm beginning to get excited. Only 2 more clinical shifts left for this semester. It's been fun, but I'm heartily tired of waking up at 0500 or earlier every damned morning, including weekends.

This weekends clinicals were relatively boring. A pseudo-busy shift at the hospital (you know the ones, where you are running around all day, but at the end of the day you look at your paperwork and say 'Wow, I hardly did anything today!') and 2 days at the same medic unit (a total of 24 hours) with only 3 calls. Luckily, I don't have to worry quite so much about patient contacts this semester, but it would be nice to get at least a little ahead of the game.

On the plus side, I cranked out the last 4 trauma homework assignments, finished my take-home test, and did almost all of my clinical paperwork yesterday and today. The only school work left is 2 papers, various tests (of course), a presentation, and the NREMT-I test. There are some other issues that I have to work out, which is it's own ranty post, so stay-tuned.

Paper due Thursday, paper due Monday, then a bit of a breather till May 12th. There is a small light at the end of the tunnel, for this semester at least.

Sunday, March 28, 2010

I think my IQ just dropped a few points...

Look, I am all for making mistakes. It's how we learn best. I am all for asking questions so you DON'T make mistakes. But seriously people...use your brain. It's that organ located in the lump 3 feet above your ass. If you occasionally engage that organ, you can save yourself from a lot of mistakes, and make yourself look less like a fool, and more like someone I'd want treating my family.

For my hospital time clinical, I go to a large, well-known university hospital. They also have a peds ER upstairs from the adult ER, but the critical care rooms (trauma rooms) are down in the adult ER. So whenever there is a consult for the peds ER, the adult ER listens in, just in case they end up coming to the adult ER.

As an aside, any paramedic student doing time in a hospital should listen in when a medic unit does a consult. Not only does it let you know if there are any traumas or serious medical cases coming in that you could look in on, but it also shows you the difference between a good consult and a bad one.

Any way, yesterday I heard the box go off, and listened in with the charge nurse. It was a consult for peds, but we listened in. The information was as follows:
12 year old male picked up from school with chest pains and trouble breathing. Unknown medical history per patient and school nurse. All vitals unremarkable (BP something like 120/80, P 80 something, R 18, O2 sat 100% ra). EKG shows NSR, IV with lock.

All sounds ok right? Then the medic consulting dropped the bomb. "Given that the patient is past the age of puberty, we would like to know if we should give NTG and ASA."

WTF?????? Are you serious? With vitals like that, and a kid who's 12, you want to give NTG and ASA? First of all, per MD protocols, a child is considered pediatric until age 15. Secondly, per MD protocols, NTG is no indicated in children. Thirdly, haven't you ever heard of Reye's Syndrome? You know, what possibly happens in children who are given aspirin? (Granted, I don't know the time frame and dosages required to give a child Reye's Syndrome, but still).

But the biggest problem here is this. Regardless of the age and so on, look at the vital signs. There is ZERO sign of any kind of heart problem, and, absent any concrete history, I'd be hesitant to give ANYTHING.

So yeah, I think my IQ dropped a few points listening to that consult.

At any rate, the rest of the clinical on Friday went well. The clinical Sunday went well too. Not as many skill check-offs as I would like, but several good medical patients that were serious head-scratchers and a good experience to sit in on.

Wednesday, March 10, 2010

You CANNOT be serious...

Heard on the county radio tonight at the station: Haz Mat call for the 'smell of chemicals outside' someone's house. Chief gets on scene, sets up command. Engines are on scene, detect chemical. "Yeah, we can smell it, it's a slight smell of skunk."

Command cancels all incoming units, EMS units call in asking if they are canceled too.

Command: "No, keep EMS coming. The woman is on the balcony, complaining of respiratory distress from the smell."

Seriously? You smelled 'chemicals', and called 911. I can actually understand that, having been around a skunk when it initially let go, and it does smell like chemicals at first. But, the skunk is outside. YOU are outside. You are having respiratory distress. From a skunk? How's about you just GO INSIDE?????

Sometimes you just can't make this stuff up, you know?

Monday, March 8, 2010

4 more days

Till spring break. I have managed to get almost all of the projects due this week done; just the take home test and group presentation to finish. Spring break will be spent most likely trying to get ahead of the work load for the last half of the semester. And trying to find a job.

EMS Today was interesting, though it was hard for me to really get into a lot of things when I was there mainly with my fellow students. They all mainly wanted to get the stuff for the assignment done and then get the hell out. I would have liked to stay longer, check out some of the things I missed the first time around (due to long lines at the booths) and see the Chronicles of EMS at the Zoll booth. Maybe next year.

I did end up staying in B-more longer than I planned, since the plans for getting the group project done fell through. Classmate N and I walked down to Inner Harbor and hung out watching the last cannon shot on the Connie. Then we went up to Uno's for another drink and a snack. A friend drove up from home to pick me up, got lost several times, and we finally got home and dinner around 2030. Long day.

I looked for the bloggers I read, TOTWTYTR, AD, and Epi, but never actually recognized anyone. Perhaps next year I'll actually meet people.

Saturday, February 27, 2010

And away we go!

The season of clinicals has begun. Tomorrow will be my last day without a clinical till the end of March (not counting spring break). So far, clinicals have been pretty good. The last few have been relatively slow, but the calls have been good ones, real head-scratchers, as it were. A diabetic with N/V/D who was extremely diaphoretic, whose 12-lead showed an inferior infarct. We gave him NTG, and it bottomed his BP from 170-ish/110-ish to 70-ish/40-ish. WOW! Yesterday I was at a station that was a block from the hospital, so we didn't do a whole lot of interventions, but we had 2 combative patients (one I had to put in an arm lock to keep him from punching me and the other providers), and an unresponsive.

So far the semester has been hectic. More papers, more homework, more quizes, etc have me running in circles. I'm actually kind of glad that the last few clinicals have been slow, since it gave me an opportunity to catch up on homework and get a little bit ahead. I almost feel like a single mother, what with the dogs and all, although I have the ability to leave a 1 year old and an 8 year old alone for 8 hours and the state won't lock me up. I have a whole new-found respect for my mother and Epi who worked, went to school, or both, with children who couldn't be left alone for hours on end. Luckily, I have a very good friend who works and lives not far, who is willing to swing by and let the dogs out and feed them when I am in class or clinical. Next week is EMS Today, which I will be at on Friday, and maybe Saturday morning. We have an assignment associated with the Exhibit Hall, so I won't be able to take any classes, but will be available for dinner and drinks after if anyone is interested.

In other news, the large amounts of snow we got are melting, and my yard has puddles all over it. The wind in the past few days has dried out a lot of it, especially since it came with a little bit of sun. The lilies are coming up, and I have to divide them as soon as they are up a bit more. C is planning a fence around the gardens, since Kaylee has found her way through the wire ones we put up last summer. The veggies that can be started inside are started, and the herbs are going as well. Most things are going in containers because we just don't have the space.

And now, I have to use the last few free hours I have today to go prune my roses and pull up some weeds. It's cold and windy outside, but the sun is a-shinin'.

Sunday, February 14, 2010

And so it begins...

First off, I have survived the epic snows of DC. No crashes, no roof cave-ins, all is well here. See pictures of my dogs and neighborhood here. Look under the Weather gallery, under Snowmageddon 2010. I haven't minded all the snow as much as some people (it kind of reminds me of high school in NEPA, when the snow actually stayed on the ground for more than 2 days), though it's been hell on my schedule. I had just started getting into the swing of classes again after winter break, and then we had a week off. Though I did get in some good hours at the fire house.

Secondly, perhaps in reaction to the large amounts of snow in my yard, I have started my seedlings for the spring. We are trying to have a modified veggie garden, in containers on the porch. We don't have very good soil, and we don't have the money to build raised beds. So, the herbs go in the bed by the house which is the oldest and therefore has the best soil, and the veggies will go in the containers, and we are co-opping with a friend for use of her porch as well.

Thirdly, we have started clinicals. I have to have 200 hours by the end of April, essentially. Thankfully, due to my schedule, I didn't have to make any hours up because of all the snow days we've had this week (haven't been to school since last Thursday).

The most interesting thing I've experienced at clinical so far is the lack of plowed roads in the county I was in on Friday. There were a lot of unplowed roads, and therefore a lot of patients that had to come out by Hum Vee. I've never had to do that before, and it was an experience. It also netted me my first ride in a Hum Vee (the story of that call will be told in a different post). The hospital clinicals have been cool, since I'm at Johns Hopkins. WOW!!! That's all I have to say about that. The doctors let me watch them do all kinds of stuff. The first time I was there I 'assisted' (as in, I helped the patient stay on their side, and handed the doc stuff) while the doctor drained an abscess on someone's side. This week I watched some surgeons drain some seroma from a patient's abdomen. Rather than send the patient upstairs, the surgeons come down to do the minor things. Very cool.

So far my schedule isn't too bad. I'm short one hospital clinical shift, and 4 medic unit shifts, but I do have a few open days I can use. And I can pull a hospital shift during the week (since I'm practically guaranteed to be able to leave on time. So I've got some time.

And now, to print out my clinical journals, and go to bed.

Sunday, January 31, 2010

Back to the Grind

Well, classes have started up again, and this semester looks to be a royal bitch. We have to do 200 clinical hours. The crappy part is that, due to the state furloughing the teachers, we cannot do ANY clinical time during our spring break, which, frankly, I was counting on to be able to make all my hours. So far, I've signed up for most of the shifts I need, though I'm still a few hours short. The fact that C is in NJ for the next 5 or 6 months means that I have to be home to take care of the dogs during the week. This makes it difficult to do clinicals during the week, since I have to be home for the dogs at night (I do have someone to let them out and feed them at night, but I can't leave them alone all night long). I could do clinicals after classes, but then I won't be home till midnight or later, and then to get up at 0500 for classes will be a bitch. This means that I have only Fridays (no class on Friday so we can do clinicals) and weekends to do my hours, which means I won't be able to see C when he is actually home. The original plan when I decided to go back to school was that he would be home to take care of the animals so I could crash at someone's place closer to school if I had to do clinicals or something late. But what are you going to do? At least he has a job. So far I'm only 4 or 5 shifts short, and worse comes to worse, I'll plan for a week of evening/night clinicals and C can take the dogs with him for the week so I can stay at a place up near school.

The snow they called for this weekend hit and we got a fair sight more than they said we would. Shock. It ruined our plans for Saturday, but we made new plans and cleaned the kitchen. The counter and backsplash behind the sink have a large gap between them and I worry about all the water getting up in there and making the drywall and such moldy. So we caulked that space and straightened up, and basically just cleaned up the house and put clutter in it's place.

I've been having sleeping issues recently, and I don't know why. I do have occasional bouts with insomnia, and I suspect it's just the change in my diet and exercise that is screwing up my system. I was doing well over most of the break, going to bed and waking up at a reasonable time, and since my surgery, I have not been doing well. Unable to sleep, staying up late to read and finish books, sleeping really late. I need to get back on a good schedule, and hoped that this weekend would help, since C goes to bed fairly early. Last night struck that one down though, as I was stressed after scheduling out clinical times, and went on a stress-related crying jag. To relax, I grabbed a book, and stayed up reading the whole damned thing.

On the good side, I'm taking a SAR management class this semester. I'm excited about it. In April, we take a 3-day SAREX for training. It should be fun. I'm hoping that after this semester is over, and Kaylee the nervous K-9 has had some obedience training, I can get back to SAR. I'm not sure yet if next semester's schedule will allow it, but I'm hoping.

One more week until I can ride again. I can't wait.

Thursday, January 14, 2010

Twingy, yet alive...

This lack of gallbladder thing isn't so bad. All the steri-strips are gone, and there is minor stinging when the skin stretches a bit much, especially around the belly-button. Muscles aren't bad, aside from stiffness when I stand up from being in a sitting, bent-over position, much as if I had done too many sit-ups a few days ago at the gym.

I am on a 20-lb lifting restriction until Feb 8th, which means no medic clinicals until then (I figure ER rotations are ok, as I am less likely to need to lift people). No fencing or rock climbing for 6 weeks total (5 weeks now) and I'm figuring no heavy lifting at the gym (or sit-ups, for that matter) for the same amount of time. No need to get a hernia now. I can do cardio as soon as I feel I am able, so that'll be my work-outs for a while.

I've been experimenting with new recipes of late. Being at my mother's house (supposedly recuperating for the week) allowed us to try numerous things. We had chicken pesto with broccoli, lemon caper chicken, a very light, brothy asparagus soup, and some corn and crab fritters. Tonight I made a chicken with potatoes and celery, lots of garlic and spices. Tasty indeed.

Next week I have to get my pissed-off face on with financial aid at school. They pitched a fit last semester because I had only set up to pay for the fall semester, and was told to get the loan for both semesters. Then they sent a check for the amount of about half the total (one semesters worth), and now they are charging us for the amount for this semester. Someone is going to feel my wrath.

Now, I normally don't get into politics on my blog, because I don't generally express my opinions in words well enough to not piss someone off (and I have few enough readers as it is). But seriously...Pat Robertson? Dude needs to Go. Away. He's certifiably bat-shit crazy. I've thought so for a long time, but this one takes the cake. I'm pretty sure that God is not at all pleased with his 'prophet.'

And this guy tried to run for president? Sheesh. This is obviously why we just can't have nice things....

Saturday, January 9, 2010


It is now 0630 and I have been up since 0430. Guess Percocet only lasts 6 hours for me. Oh well.

The surgery went well, the gallbladder was removed (there were several stones with evidence of some slight inflammation and infection) and the surgeon could not eyeball the 'atypical' FNH's in my liver. So I will have to eventually see a GI specialist for that, since the radiologist was unwilling to conclusively say that the very slightly atypical nodules were FNH.

At any rate, I seem to have developed a slight sensitivity to latex. I have round itchy rash spots where the heart monitor electrodes were, and the bandaids are driving me to distraction. There is, in fact, very little pain. A bit of cramping, similar to the cramping I had during the gallbladder attack, and some muscular pain at the incision sites, but even that feels more like a few too many sit-ups at the gym than anything else. There is some pain on deep inspiration, but even that isn't too bad, and my fear of atelectatasis is greater than than the pain.

I have a warm dog curled up beside me, who refused to go to bed with C and the puppy. I suppose I should be flattered that he feels the need to protect me, or something.

I am hungry. But I will wait for C to get up. Poor guy. I think he was more worried than I was about the surgery, and didn't sleep well at all the night before. Add that to a bad week at work, and he was wiped out yesterday. Sunday I head to my mom's house for recovery. Mainly it's so that I don't have to get up every five minutes to let the dogs in and out of the house.

Sunday, January 3, 2010

My feet are cold...

It is extremely cold here at the Home of the Gnome (relatively speaking, of course). I haven't experienced such low temps and wind chills since Antarctica. And no, that is not an exaggeration. Living in a townhouse on a concrete slab with 20 year old windows is not conducive to keeping a warm house. I'm reluctant to turn the heat up anymore, given the increase in energy prices, and so I am relegated to cuddling under blankets. Sadly, my other heat source is on his way to NJ for the week, and therefore is not here to help me warm up. I suppose it's all for the good...colder temperatures are supposed to be better for your metabolism...burning calories to stay warm and all. Though I'm not sure that the temps in the house are low enough to suffice for that.

The holidays are over, and for one I am grateful. I love the holidays, but this year just seemed to sneak up on my from out of nowhere, and before I knew it, it was a week before Christmas, I had no presents purchased, and I had to get the house ready because I had to head to St Louis, and Chris was not home (he had to work the weekend before Christmas, and was in NJ). The blizzard didn't help much, but overall didn't crimp my overall plans. The dogs loved it though...

I was supposed to have surgery this coming Friday, to remove my gallbladder (after one attack, and the confirmation of gallstones). Given the craziness of the past few weeks, I forgot to schedule my pre-op appointment, and therefore will likely have to reschedule the surgery. This leaves me with a timing issue, what with classes starting up on January 27th. Given the surgeon's indication that I will require at least 2-4 weeks for recovery, postponing surgery could push into the beginning of classes. Then there is the whole surgery thing overall. I have not had any problems since Labor Day, which was the only attack I have ever had. I have since tried (and mostly succeeded) in decreasing my overall fat intake, and I hope to continue doing so. So I wonder if I should go through with the surgery, when, if I watch my fat intake, I may not have another gallbladder attack for years, if ever again. Getting surgery will set me back at least one month, if not more, in several areas, such as fighting, the gym, and other things. Not to mention that the insurance company has not been making this easy at all. I am quickly reaching the point where I am going to crawl through the phone and confront people face-to-face on this issue, since evidently, sarcasm does not translate well through the phone lines.

At any rate, things are going to be boring for the next few weeks. I have to order books for classes, and determine if I want to add a class to my schedule for this semester. I will be severely lacking in human contact over the next few weeks, given that everyone is working, Chris is in NJ, and if the surgery is done, I'll be stuck in the house, unable to drive. You may get more posts then.