I couldn't sleep, I woke up when I normally wake up for work.

I'm having issues with the boy.  I found out that he has been lying to us about some pretty important things.  I'm not sure what to do about it.  We have seized all electronics and have yet to discuss how much time he will get to spend outside the house. The girl was sure easier. 

So I'm up, have had a cuppa coffee, have an omelet made for breakfast and have the windows open enjoying the fall morning breeze.  I wish I had a deck to sit outside on.  Maybe someday.  

Not only am I stressing about the boy, and where I went wrong as a mother, but I am (like always) thinking about my patients. I ran some interesting (to me) calls recently.  I hate never knowing what the definitive diagnosis was.  These are my favorite calls, because I love to try to reach a diagnosis (in my head of course, because I wouldn't want to offend anyone), but am also so terribly frustrated when I can't figure it out, and have to way to find out. I know sometimes it is simply that the patient is having multisystems failure. But I always play this chicken or egg scenario in my mind. Did they have respiratory failure due to a cardiac problem or did the respiratory problem cause the cardiac problem? Or is it drugs? No evidence of narcotics, no pinpoint pupils, no evidence of tricyclic antidepressants.  Or is the liver failure resulting an a hepatic encephalapathy which is causing the alt loc and in turn everything else?  I wish we could get a bedside cbc and blood gases in the ambulance.  Normally if it is any one of these things, I can figure it out.  But when there are symptoms from multi systems, it becomes a frustrating mystery.  I guess it's my own fault for not going further in my medical career.  But on the other hand, I like the position that I'm in, where I am the pts first step entering the healthcare system.  The care that I initiate sets the tone for the way the patient will be treated.   (Depending on the relationship that I have with the physician and whether I got it right). 

Some days I feel like I can handle anything.  I am looking forward to the next mystery after each code green patient.  And then I will get my mystery. And I wind up running the call like it was my first day.  Everytime I decide on a treatment, the patient's condition changes.  I will get a drug drawn up and mixed, and then the cardiac rhythm changes.  The heart rate is irregular and I'm not sure which way to go with treatment.  I can't intubate to address the airway.  I can either throw on high flow oxygen and if the patient has a patent airway, that is all I need to do.  Otherwise, I will use a bag valve mask and assist the patient with their respirations, or I can apply cpap (if they are alert, oriented and not hypotensive, and will tolerate it).  

And then there are times when I feel like I have done everything right.  The patient is fairly stable (for their condition). They have a good bp, 02 sats are above 94.  And we move them over to the ER bed and suddenly they are guppie breathing with a bp of 67/42.  Wth just happened?  They are getting intubated as I am leaving.  I get busy on other calls and the next thing I know it's an hour and a half after my shift is supposed to have ended and I find myself really wondering about this patient.  Did he die? Is he up in the expensive care unit? There's no way for me to find out.  None of the nurses or techs doing patient care are people I know well enough that they would tell me anything if I asked.  The Dr isn't one who I would feel comfortable approaching.  And even if they were, by the time I get back to the hospital will I luck into being there when they are on shift?  I feel like as medics we could grow by leaps and bounds if we could somehow take a peek into our patients charts.  I'm not suggesting that we need to follow each and every patient, but maybe just the mysterious ones.  

I guess I should get the boy some breakfast.  He is up and ready.  I'm so mad at him though.  I am so disappointed.  I really thought that I could trust him.  I believed what his teachers and random people tell me about him being a very nice, respectful boy.  He will be if I have to put him in military or home school! 

Be back later...wish I knew if anyone reads these.   

No I haven't given up on this

My laptop bit the dust.  I just got a new one though, so now I can begin sharing my thoughts again.  I could have blogged from my phone...but it's a pain in the ass....I know...lazy.  Lots of stuff has happened.  I've lost a few friends...to terrible illnesses which were fast thankfully.  Lots of things going on with the homefront.  Parenting has become way more challenging in the last few months.  I've learned that I need to keep a much tighter leash on the boy.  I've started reading again.  For pleasure.  I've been reading Atul Gawande.  The first book I read of his is called Being Mortal-Medicine And What Matters In the End.  I think that this book should be required reading for all healthcare professionals.  It seems that we have become far to driven with attempting to cure rather than attempting to maintain quality of life as health care professionals.  This book has made me realize just how lacking our culture is in palliative health care.  I started a 2nd book of his called Complications.  I so wish that I could go further in healthcare.  I love being a paramedic, but reading these books and certain calls make me wish that I could do more for people.  I ran a call recently.  58 y/o woman who's family called us out because they thought that she had a seizure.  They thought that she was postictal.  They noticed her behavior in the morning and called us about 6 hours after they noticed that something was wrong.  She had a hx of alcoholism and hadn't had anything to drink that day, so understandably the family thought she was having withdrawal symptoms.  She was also a methadone patient (for pain) so enters the possibility of narcotic overdose.  She couldn't remember the last time she had eaten, and was very emaciated, which brings up the possibility of hypoglycemia.  We quickly ruled out seizure and fixed her hypoglycemia with no change in her condition.  Her symptoms didn't fit narcotic overdose.  She passed our stroke screen which just meant that she most likely wasn't having a stroke right now. Her vital signs were mostly ok, except for her ETC02.  It was very low.  So she's acidotic.  I so wish that I could have gotten a set of labs on her.  She also began to get bradycardic with frequent pvcs throughout transport.  She would stay in this rhythm for a minute or two, then convert back to sinus tach.  She did this several times while in my care.  There were so many possibilities  I just hate not being able to have all the tools that I need to diagnose.  But alas, that's not my job.  I got her to the hospital alive.  And gave the Dr all of the information that I had.  That is my job.  I wasn't familiar with any of her nurses and it was a new Dr. So I will probably never figure out what all was wrong with her. I love patients like her though.  I love trying to solve their mysteries.  I just wish I could go further. 

Ok, well I need to get myself in gear and get my day off chores done.  I will be back as soon as I can though!
 

A bowl of dicks

So there's this one person that I have to come into contact with on a regular basis who makes me angry just by existing.  Idk why I let this person get me so mad. They are never pleasant, always rude, nasty, not helpful at all.  I don't even know what their function really is. It doesn't matter what I do though, this person always gets pissy and rude.  I'm trying to let it go.  But I'd really like to send them a bowl of dicks.  Not the good candy gummy kind, but nasty insect infested, pubic hair coated, stinking, rotten dicks.  

So the hubby's birthday is this weekend. I thought we may have a party and go out for drinks with some friends, but guess we aren't. Think we are just gonna go out to dinner.  That will be nice too.  I'm glad he'd rather be alone with me.  It will be nice to have a weekend to ourselves.  I ordered his presents and they haven't all come in the mail yet.  I hope they will be here in time. 

So things have been pretty calm on the jobfront lately.  I probably shouldn't have said that, I will jinx things. 

My friend passed away a few days ago.  I can't believe how fast he went.  Dx with cancer on July 15th and gone before August.  I feel so sorry for his wife.  It sounds like he went pretty peacefully though.  Which is the only good thing about the whole effed up situation. I'm so glad that his wife has lots friends and doesn't have to be alone for awhile.

I really need to play the lottery more.  I love my job, but just wish...well, I can't be too specific.  I just wish. Lol 

WebMd is the DEVIL

So I have been down lately.  I had a run of bad calls.  Then I found out that a close friend of mine was diagnosed with stage 4 esophageal cancer on July 15th.  He got sick, got sepsis, multiple organ failure and today his wife and family will turn off all of the machines that are keeping him alive.  He just turned 48 this week. From what I know of him, he has not lived a high risk lifestyle.  Not that it would matter if he did, nobody deserves this.  This couple spent their entire marriage taking care of others.  Foster parenting, taking care of their parents.  They had just gotten to the point in life where they were going to have time for them.  And this happened.  It's just horribly sad. 

It seems like whenever something like this happens, a person starts noticing every lump, bump and ache.  Well I went to the dentist last week, and found out that I have to have a crown.  I asked the dentist to look at a lump that I have noticed on my soft palate for the last few months. It's a clear little blister.  I will pop it, but it always comes back.  Its annoying.  The dentist looked at the bump, and couldn't see much, but recommended that I see an oral surgeon for a possible biopsy.  The dentist also noticed my tonsils (which have always been huge). She said that they are awful red.  So I will have the oral surgeon look at my tonsils too.  So now I've decided that I probably have oral cancer.  Or tonsil cancer.  Or head and neck cancer.  I got really scared and panicked for a few days.  A lot of crying.  And then I did some reading.  And have been back and forth for the past week.  I think I'm ok now though.  I know that whatever it is, I will fight it.  My appointment isn't until the 25th with the oral surgeon.  Thats the soonest they could get me in.  And my crown will be on the 11th.  Or 12th.  I can't remember.  I'm terrified about that too.  I wish they could just knock me out.

I've been working with different people for the last few days.  Thank God I'm back with my partner today.  I can just relax more when I know what to expect.  I have been dealing a lot with an over utilizer.  Also known as a frequent flyer.  This person was seen at one hospital at least 4 times yesterday.  He is narc seeking.  I don't know what to do about this person.  I guess there really is nothing I can do.  I have tried everything that I can think of to help him. I will keep brainstorming though.

My patients are on my mind a lot. I feel like there is so much more that we could be doing for them.  To provide them with a more permanent solution.  A lot of these people don't need the ER.  They are going to the ER because they don't have the money to pay for what they need, and they know that the ER has to provide it for them.  Tylenol for a fever, etc.  I wish I would have kept track of how many ER scripts I have seen unfilled lying around patients's homes.  Some of these people legitimately don't have the $5 to fill their prescription.  But the majority of them could fill them.  They just choose to spend their money on cigarettes or booze.  There are many people that I wouldn't mind buying their prescriptions. But I can't do it for everybody. And I don't want people to expect this of other medics.  Not everyone could afford to do this. 

Things are starting to pick up, the radio is getting noisier.  So I feel like I should pee.  I will be back later! Hope everyone is having a great and safe weekend!

Fear, life

I woke up today and my stomach is a mess. I'm not surprised though, because it was when I went to bed last night too. Cramping, pain, bloating. I spose I need to get into the Dr and get it checked out, but I just can't seem to find time.  We are going away this weekend to see some friends which means that I won't be able to spend any time with the boy.  So I feel like I should spend my days off next week with him instead of in the Drs office.  I bought some OTC ibs medicine that I've been taking.  I thought it was helping. I didn't have time to take it regularly yesterday though, so hopefully if I get back on it today it will clear me up.  I took the max dose this morning.  

I had a pretty stressful day at work yesterday.  I think there must be a bad batch of drugs out there because I have been running a TON of patients who are out of their minds, angry and violent. Twice in the last 2 weeks I have been afraid.  I don't remember ever being this afraid for my personal safety.  We got called out yesterday for a guy who had been missing from his job for the last few days but decided to show up yesterday. His employers called police out because he would not leave their lobby and was not making any sense, talking like he was out of his mind were their exact words.  Of course I'm up.  It's always my turn to do patient care when we get the difficult patients.  So we walk in, and it takes me about 5 seconds to figure out who the patient is. There are 3 pd officers in the office and 3 lay people.  So I make eye contact, walk towards the patient and ask him what is going on.  He looks into my eyes, but doesn't say a word.  He starts balling up his fists and his face and eyes are just full of rage.  Minutes passed before he finally spoke. He said very few words, but it was apparent that he wasn't a part of our reality.  He thought that my uniform was fake and didn't trust me.  He got more and more aggressive, so I backed away and pd moved in closer.  A few more words were spoken and he tried to dart into an office.  Pd followed him, took him down and put him in handcuffs.  And then pd tells me "will you transport him, because if we do he will just kick our windows out".  I agreed as long as they will help secure him to the cot.  There really is no "securing" a sweaty, stimulant strength person to the cot.  They may appear secure, but in my mind, they are always just a quick second away from slipping out.  It didn't take long before this gentleman figured out how to pull the velcro on our four point restraints.  I was terrified.  I decided that it was time for some chemical assistance.  Our protocols allow us to give haloperidol and midazolam.  The drs and my partner get upset when I sedate with midazolam.  It is the most effective, and has more of a rapid onset than haldol.  But I knew that haldol would be the path of least resistance.  So I pulled it up and injected it into his bicep.  Which just pissed him off more and added to his paranoia.  Meanwhile, he is picking at the velcro on the restraint on his right hand.  I just knew that he was going to find a way out.  And the look on his face and the things he was yelling left no doubt in my mind that if he got free, I would be lucky if all he did was hurt me.  So I grabbed some coban and wrapped it around the velcro so he couldn't get to it.  It took some doing and some time.  I had to lean over him to do it, because there was no way that I was letting him get between me and a door.  So leaning in that awkward position, trying not to get bit, trying to weave a roll of coban in and out of a 1 inch space while my partner was throwing me all over the truck with his driving was the best I could manage. Thank God we finally got to the hospital.  Security and pd were waiting for us when we arrived.  The patient continued to thrash and be nasty and scary.  I have never been so glad to turn over patient care.  I later found out that it was meth that the patient was on.  I had been guessing k2.  I also found out that he became "nice" and cooperative later.  So I'm sure this patient was cut loose from the hospital.  I decided that I am never going to do this again.  My words can in no way describe what it was like.  I am going to use the damned midazolam in the future.  Drs and partner can kiss my ass.  My personal safety is #1 priority.  Not to mention the future of the patient.  I'm not going to try and "tough it out" anymore.  This behavior emergency protocol is in place for a reason.  Situations like this are going to get people hurt, if not killed. 

This meth stuff is nasty.  My first call of the day was meth related too.  My first call was a person who I have run multiple times.  This person always eats meth.  I think he was smoking it this time too.  Add that to paranoid schizophrenia and you get a helluva good time.  (Note the sarcasm).  This patient is probably the most paranoid person I have ever seen.  He spent the entire ambulance ride looking out the window, turning around looking behind him, trying to get off the cot.  Pd was on scene before us. They actually patted him down, but during transport he pulled his keys out of his pocket, put them in his hand and put one key between each finger and balled up his fists.  I saw him do this, said NO, and took them away from him.  He was easy because he didn't resist.  He just let me take them.  But this is just another example of how I'm gonna wind up dead.  Lol.

So my last call of the day, like all of the others, couldn't be easy or simple either.  It was in a decent neighborhood.  I'd just woke up from a short nap.  I had stuff that I should have been doing between calls, but I felt like shit.  My stomach hurt and I was so weak.  So I'm kind of still waking up.  The call came out as chest pain.  We get there and I see a little chihuahua behind their fence just barking like crazy.  It makes me giggle, because of my chihuahua.  I love those little dogs.  We get inside and fd is there too.  I walk in with my monitor and approach the patient, and fd says, "it's not a chest pain!".  The patient says I am having cramps.  He is grabbing his leg and is extremely restless. The patients wife is also there and says that he was hospitalized several years ago for heat exhaustion and heat cramps.  This is a 50 y/o male, tall, in extremely good shape.  He is muscular.  A black man, with some gold teeth.  He is very impatient.  We are trying to take vital signs and get the whole story.  Turns out he had been working out in the heat, and has drank a ton of water....8-9 glasses he says.  So I think that his electrolytes are probably all messed up.  So I try to get an ekg.  He won't sit still thought.  He stands up but keeps pulling the leads off.  Fd was acting irritated, so I let them go.  I ask the patient what hospital he wants to go to, and he says that he doesn't want to go if he doesn't have to.  He says that he took an aspirin (like dispatch instructed because of the chest pain).  He blames the cramps getting worse on the aspirin.  I told him that I needed to check his vital signs but that there's nothing that I can do immediately for his cramps without assessing him.  He decides that he wants to go to the hospital now but won't let me do an ekg.  He starts walking towards the door, so I have my partner break down our cot as quick as he can.  (Unfasten seatbelts, lower it, etc). We get the patient on the cot, and he is sweating profusely.  Which concerns me.  He is in great shape, so I am thinking that this may be more than just cramps.  The patient is extremely agitated and keeps yelling at us to get him out of this heat.  I told him that we were moving as fast as we could.  We get him in the truck and he yells at me to get going.  I explained to him that my partner was getting the rest of our equipment put back into the truck, that we were moving as fast as we could.  I get the ac going and pointing at him and get the bp cuff on and the monitor put on.  I am finally able to get an ekg...and guess what?  Acute MI suspected.  Stemi.  Yep.  So I holler at my partner to call a stemi alert (alerting the hospital that they need to reserve the cath lab, expedite everything), I get aspirin down him (because he isn't sure if he had a baby or adult aspirin prior to our arrival), get the fast patches on him (because people like to go into scary rhythms who are having a stemi) and get an IV started, bag of fluid, nitro and fentanyl for his pain.  I explain to him what is going on, and he says "well the cramp on the left side of my chest is the worst".  I'm not sure if he is really having a stemi or if his electrolytes are just off, or if maybe the heat caused an mi.  It's not my job to determine this, so I just treat for the worst and hope for the best.  He remained stable throughout his time with me...thank God.  We got him to the hospital and the Dr decided to not send him up for a heart cath until he got a few more ekgs.  We had to leave before I found out what happened with him. 

So we are trying to get back to post, as it's 15 minutes before our shift is supposed to end.  The city is blowing up.  There are calls coming out on all sides of our area.  We got stuck at a stoplight.  Sitting ducks.  A call came out that was kind of on the line.  It could easily be ours or the truck in the area next to us.  My partner is driving and hears this, and turns west quickly...lol.  We take the side streets back to post.  Which avoided lots of traffic, but also put is further away from the questionable call. Lol.  I'm furiously working on patient care reports while he is driving.  I'm getting carsick from not watching the road.  I am hot as hell, dripping sweat and hoping that we get back to post before we get tagged on another call.  We have gotten caught on late calls for the last 3 shifts.  Just once I would like to get off after 12 hours.  Luck is with us, as we made it.  Our relief was there, so we didn't have to go on a late call, but wound up staying a little late to finish paperwork.  

Now I'm home trying to prepare for our weekend out of town.  Hubby is playing video games with the boy.  I'm enjoying one cup of coffee before I get started cleaning up the kitchen from the last two days of the dishes piling up from when I was at work.  Laundry, etc.  I don't mind though.  Nobody is trying to kill me while I'm doing dishes or laundry.  It may sound like I'm complaining about it all.  And I am.  But I wouldn't have it any other way.  No other job in the world would allow me to see and learn so much about so many different areas of medicine.  My only regret is the time this life takes me away from my family.  I also wish that I would have started this when I was younger.  A medical career really isn't conducive to family life.  Well, let me rephrase that....an exciting medical career really isn't conducive to family life.  I could go to nursing school.  Be a school nurse.  Or work in a Drs office.  Yawn.  

My anxiety has been thriving lately.  I think it's because of some bad things that are happening to a good friend.  My friend's husband was recently diagnosed with esophageal cancer.  Stage IV.  He is in his 40s, she is in her 30s.  A few weeks before that, an acquaintance's husband was diagnosed with a stage IV brain tumor.  He was given 6 mos. to live.  His wife had just had reconstructive surgery due to breast cancer.  I know that the nitrates in our water are off the charts.  It's not safe to drink.  But it seems that the rate of people getting cancer in our little town are way out of proportion with the population here.  There aren't that many people who live here.  Everyone is getting sick.  I get anxious about being away with my son.  If I find out that my stomach issues are some horrible terminal cancer, am I going to feel guilty about all the time I spend away from him and he is alone? I miss him as it is.  Hubby has been having a lot of belly pain lately.  What if it's his tumor coming back? My new Dr is a dick.  I find myself avoiding seeing her because of this.  Putting off concerns like this won't do any good I know.  Anyway, just more stuff to worry about. 

Work, family, health, money, unfinished things.  That's life right?  And that's just the stuff that I can mention here.  

Boob sweat of epic proportions

It has been hot as fried hell.  Makes me wonder why I live here.  Why we didn't get away years ago.  Also makes me want go back to night shift.  Less busy and cooler.  On Tuesday I didn't get home until 9 pm.  Yep 14 1/2 hours.  Doesn't sound like much, but when you're running back to back calls, don't get time to eat or drink or even wipe the sweat off, it is a terribly long day.  Our cot battery was dead for 5 hours and we were about to run out of monitor batteries.  By the time we got back to our station, we were down more patient care reports that I have ever been down.  It's hard to remember what happened with a patient you saw 6 hours ago when you have seen 4 more since then.  I don't think I have ever been so hungry or thirsty in my life.  My undershirt was completely soaked with sweat.  It was so gross.  Nobody cares either.  They just wonder why you don't work more overtime. Or take more classes (on your own time without pay).  This is what I signed up for though.  Don't get me wrong, I love running calls and taking care of people.  It just breaks you down physically (and mentally) to be that busy when it's so hot out.  Looking back on the day from hell now, I am thankful.  I am thankful for the experience. Every patient I take care of makes me a little bit better for the next patient I take care of.  I heard a rumor that our new medical director doesn't like older medics.  I'm not one of the dinosaurs, but I am older than the average medic.  I hope this is just a rumor. 

So one night this week I got home after a busy day at work, got showered and fixed myself something to eat when my pager went off.  I wasn't on call, but it was a code blue, so I knew that I needed to dress myself and go on this call (as I'm the only medic around on work nights).  So I got dressed and left...and heard another one of our crew members just screaming on the radio.  She commanded the ambulance to stop and wait for her.  So, she felt like it was appropriate to delay care for this person who is in cardiac arrest.  It didn't occur to her that it would be better for the patient if she let the ambulance go on without her.  Granted, her help would be needed, but it would be much better to let the ambulance get there, get an aed on and get chest compressions started.  Throughout this debacle, she was on the wrong radio channel.  So she is screaming on the dispatch channel for the whole county to hear.  Someone radio'd up and told her that she was on the wrong channel, and she just screamed at them.  It was ridiculous.  I am betting that she has no idea how she sounds.  I followed behind in my personal vehicle.  I saw her get out of a vehicle, stomp over to the fire suburban and slam the door.  I wanted to mute everything and play some circus music.  I don't understand why she gets so worked up.  She has been an emt for years.  After all of this, we didn't even make the scene.  Another agency was closer and triaged code black.  Meaning the person was too dead to attempt to resuscitate. 

So the super busy day....I got home...and was asked "what's for supper?".  So I get home at 9 pm, and the other people living in my house were incapable of getting themselves dinner.  I ordered a pizza when I finally got back to post.  I hadn't eaten since breakfast, so to say I was hangry would be a drastic understatement.  The boy had been home all day, and was sleeping when I got home.  Hubby got home from work before 5pm.  The kitchen was a disaster.  No effing way I am cooking! It would sure be nice to know that they would consider that I may be exhausted.  Maybe I would be hungry.  It would be nice to have dinner prepared for me without me having to direct it.  I guess there will be plenty of that when I get to the nursing home though.  Guess what though? The kitchen is still a mess.  Know why? Because I haven't cleaned it yet.  I will most likely do that today though.  I have company coming over in a few minutes, so I won't get to it soon.  

Yesterday was kind of fun.  Kind of.  I took my boy and met my daughter, her bf and his nephew and niece at the zoo.  It was ridiculously hot again.  I was a puddle of sweat within 20 minutes of going in, but sweat seems to be my look lately.  The boy loved it.  He wasn't ready to go when everyone else was....lol.  It was fun hanging out with the little kids.  They were adorable.  Makes me wish that I could have had more kids.  I can't wait to be a grandma.  After the zoo we went to a new donut shop in town that just opened.  Idk if it was the extreme heat or the fact that we had taco bell for lunch earlier, but the bite of donut that I had just didn't sit well in my tummy at all.  They make all kinds of donuts.  Weird stuff.  Orange tang, grape, smores, etc.  I'm anxious to go back when I'm actually hungry and not in the midst of heat exhaustion.  

I guess I have to sign off for now.  My company will be here in a few minutes.  And I should put a bra on.  and maybe get dressed.  I hope to be back later.  I have so much more to say. 

Another crazy day

Dammit! I keep touching the screen of my home laptop thinking that it's a touch screen like the one at work! Annoying! I am home now! Sheesh.  

My last day at work was....interesting.  I ran the complete insane person that I had gotten called out to one other time.  This time she barricading herself in her motel room and busted out a window.  PD asked me to keep an eye on her through the window. I'm glad that I had the sense to stay back far enough that I just got a little shower of glass instead of a face full when she busted the window.  Of course shes naked again.  Covered in sweat or water.  I'm not sure.  And now blood because of her arm going through the window.  I tried to bandage it so she wouldn't fling blood on me, but she wouldn't let me.  So I spent the entire transport just keeping my distance and not making eye contact.  My instincts told me to dart her with some haldol and versed.  But the hospitals don't like it when we snow their pts.  Even though thats what they wind up doing.  So I got her to the hospital, and of course she wound up in 4 point restraints and chemically restrained as well.  All of this due to being bi polar and non compliant with meds.  

We also had a code blue. He had a pulse when we got him to the hospital, but it was just a cpr/epi pulse.  The only reason we transported him was because he had high end tidal numbers.  I should have called for an order to cease resuscitation, but one of my superiors said "you will never get an order to cease with numbers that high". So we took a corpse to the ER.  Giving the family false hope, and several thousand dollars of bills.  I spoke to the Dr who said that he most certainly would have given a cease order.  I should have spoken up and been a better advocate for this patient and his family.  

At the end of this horribly long, sweaty, muggy, 2 uniform day, I realized that its Sunday.  I still hadn't gotten groceries this weekend.  I like to get them on the weekends because Dillons offers double fuel points if you shop on weekends.  I HATE shopping in uniform.  It always guarantees something will happen.  I will find a patient, someone will drop and require medical attention, someone will recognize me or someone will try to fight with me.  This can usually be prevented if I go outside my coverage area to shop.  But, it's late, I'm tired and just want to hurry up and get it done, get my fuel and get home.  So I brave the closest Dillons in the DS.  A friend calls me on my way there. I'm pretty relieved.  If people see me talking on my headset, maybe they will leave me alone.  So I park and go inside and try to get to it.  This isn't my normal store, so I'm not real sure where everything is.  I didn't need much though, so no big deal.  Right? Murphy's law ALWAYS applies to me.  At least one of them.  So I'm toodling around the store, just trying to get my shit and get out.  I get almost done and go to the deli counter.  There are 4 people in line ahead of me.  I had a coupon for some salami that I really like, but decide that it's not worth waiting around.  So I have to figure out something else to have for that meal that I had planned.  My boy always wants fish sticks, so I head to the frozen foods aisle.  So I'm trying to make my way down there with my cart, and theres a woman on the right side of the aisle with the freezer door open standing inside it.  Her cart is on the left side and her kid is kind of by her cart.  So I wait for a bit....and nobody is moving.  So I decide to squeeze through.  There was plenty of room.  While I was squeezing through she decided to back up, running right into me and dropping her red bull on the ground.  I picked it up for her and apologized.  She wouldn't take the red bull, so I sat it in her cart.  She looks me in the eye and says "bitch".  Then her husband, baby daddy, pimp, brother...hell...idk...comes walking up.  I am instantly pissed, but remember that I'm in uniform, so I just walk away.  I'm fuming though! Bitch takes up the whole aisle, oblivious that there is anyone else in the store other than her and then gets pissed and acts like an ass in front of her kid.  Thank God I'm in uniform.  So now I have to wait for them to leave the aisle before I can get my damn fish sticks.  So I mess around in the appliance aisle and find a teapot that I've been wanting.  Finally I get my fish sticks and head to a self check out, so I won't have to talk to anyone else and can hopefully get the hell outta there faster.  So I am getting my stuff moved and checked out, and smash my finger somehow. (The klutz gene is alive and well in my bloodline).  So I'm standing there bleeding, fishing a bandaid out of my pocket, trying not to bleed on my white uniform shirt, when the woman in the line behind me comes over and grabs my coupons.  She looks me in the eye and says "you sure do have a lot of coupons".  She's trying to steal my coupons! So I grab them back from her, mumble something at her, swipe my damn card and get out.  Her and her shady friend followed me out to the parking lot.  I'm thinking that my balls are sure bigger when I am wearing my radio with the orange panic button.  I reached down into my pocket to check that I have my knife, because I'm anticipating them starting something with me.  I notice the security guard at the door, who looks like he should probably be on disability.  I catch them staring at me the entire time.  I got my groceries loaded and got to the gas station without anyone getting stabbed though.  Finally....headed home.  I can't decide if the extra 20 cents off a gallon was worth it.  I also decide that I'm NEVER shopping in the DS again.  I will take the extra hour or so that it takes to get to civilization.  So it's like 8 pm, I walk in the door....and my son asks me "whats for dinner?".  I think that someone should give me a medal.  I didn't hurt him. 

 

May the 4th be with you

Well it's day two of the holiday weekend. 4th of July.  I'm feeling very guilty for working while my family is home. My son may be 14, but he still wants to show his mom when he's shooting fireworks.  I wish I could be there to make the potato salad and homemade ice cream. I feel like I am depriving my family of a normal family life. Mom is rarely there on the holidays. I know that they understand, but I know that if I still feel the sting, so do they.  I hope they realize that I do this for them. Not just for the income, but as an example that life needs to be about what you do for others. I hope that is what they take from this.  And I will try to make my days off a little more special for them this week. I'm planning a family suck day Monday night.  The original movie Jaws is playing at the Orpheum theatre downtown.  It's such a cool old theatre.  I don't think that my son has ever been there.  I hope he will enjoy it.  I'm also hoping for a zoo day. Or a water park day. A water park day sounds better actually.  Eff this heat.

Yesterday was a busy busy day.  Our first call came out before our night crew even left.  It was pretty much hopping like that all day.  It was a syncope/fall/on the ground kinda day.  All of my patients were on the floor/ground.  Except for one.  And she would have been had we not held her up.  One of my calls was very interesting. Well, kind of rare.  I had a dystonic reaction patient.  We don't see those super often.  She looked like she walked off the pages of a text book.  Tardive dyskinesia was so so obvious. I gave benadryl and it helped calm the symptoms and the patient was actually able to talk to me.  I'm not sure what caused it. I am suspicious of a few of her medications and the way she was managing them.  The rest of my calls were syncopes.  I like syncopes.  They are typically pretty easy to figure out, but once in awhile you get an oddball that you're not 100% sure on.

I spent the day kind of walking on eggshells.  I was anticipating some type of aftermath from my previous shift.  But no nastygrams and nothing was said.  I tried to get the heck away from the hospitals yesterday as fast as I could so I didn't run into anyone who may chew me out.  So maybe I escaped? I will feel better after the weekend is over.  My stomach was so messed up all day yesterday. All day. I tried some pepto and think it may have helped a little bit, but it's still hurting a bit today.  I think that's why I'm so tired. I'm hungry, but afraid to eat anything besides yogurt.  And coffee.  Can't function without coffee.  

Evidentally I was so tired that I missed a few things that happened around the little city. I hope my ems family will forgive me.  I heard nothing after I fell asleep last night.  I woke up for work this morning and hubby told me that it was a weird night.  He seemed pretty bothered by what he had seen.  He needs to stick to fires...lol.

The radio is starting to make lots of noise.  People are waking up.  And falling.  And waking up with low blood sugars.  Today is either going to be busy as hell, or it will be the calm before the storm tonight. I hope I have a little more time.  I need to make some decisions about next weekend sometime soon.

I'm still trying to erase the image of one of my recent calls from my mind.  On the way to the call in the call text it was mentioned multiple times that the patient had no clothes.  Trying to be optimistic, I told my partner that maybe it just meant that the patient hadn't put them on yet.  Maybe they wouldn't be naked an aggressive.  We both knew better though.  Why are they always naked? Of all of the bad things that have happened to me and my family and friends, we have never been naked.  It's like they get naked, go upstairs and sit on the toilet before they call EMS.  Anyway, this patient made many references to nakedness.  Pointing at their crotch and saying that they get a vacation every month.  Asking us if we liked what we saw because the person they were with didn't.  It took a little bit, but it finally occurred to me that this person really does get a vacation once a month.  Their employment is foiled by mother nature monthly.  This patient took a wrong medication, that they are supposedly allergic to.  When asked what kind of reaction they have had to it in the past, the patient said "It makes me piss all over, break out in hives and pisses me off".  Yep, thats been my day so far.  

I hope any of you reading has a happy and safe 4th. And that I don't have to see you at work today.  And for God's sake, if I do...make sure you get naked and sit on the toilet before you call...upstairs!

Bullshittery

The last few days at work have been typical I guess. Except I got madder than I think I've ever been.  I love working with different medics, seeing different ways of doing things. But...things don't run normally and I got called out for it publicly.  One of my bosses got super mad at us. Just reinforces the leadership qualities that I admire in my other bosses.  Working with other medics makes me think that maybe I have an anger problem. My regular partner is super patient. I have never seen him get angry. There was one patient in particular that I got super angry with during one of my last shifts.  He was intoxicated, broke several major laws and did some things that hurt and could potentially hurt a lot of people. I was ready to do what was best for the taxpayers, public and us. My partner of the day was a true advocate for him. Kept her cool, was super kind to him, and took enough time with him that we got into trouble with the brass.  It didn't bother her. She was ultimately looking out for his best interests.  That is what we are trained and supposed to do.  Despite all these other challenges.  This lady isn't a brand new gung ho medic either.  She has a lot of time on our department.  She should be crusty and angry, but she's not.  She is who I want to be when I get to her age/rank.  I'm not sure it pays off career wise, but she is a very happy lady.  I hope this all doesn't come off as negativity. While I was super angry about the whole afternoon, I have to say that I won't make those same mistakes again. I will be more conscientious about the things that made my boss so mad while at the same time trying to be an advocate for the patient despite the situation surrounding things.  

I wish that I wouldn't have gotten so angry and spent so much of my time off simmering down.  It really affects me when I get that mad.  My digestive system has been all jacked up.  Horrible heartburn.  I should probably buy some stock in omeprazole and chewable antacids. It even effects my dreams.  And why wouldn't it? Last night I dreamt that I had a good friend of mine's son as a patient.  He was doing fine when I had him.  I don't remember what the chief complaint was.  When I got him to the hospital, he started going downhill and eventually died.  I remember trying to comfort my friend and being there for a very long time. I guess I turned my radio off.  I got into big trouble with my bosses when I finally realized it.  I remember going over and over in my brain what I could have possibly missed during my assessments with him.  That dream woke me up.  I also dreamt that I was running calls with someone else I work with and admire.  It was very odd.  I wouldn't normally be working one on one with this person.  I did things in this dream that I would never do in real practice.  I remember having a trauma with lots of bleeding and bandaging to do where I wasn't wearing gloves.  This person that I worked with took his gloves off and gave them to me.  When we got out to the truck with the trauma patient, the tires were all almost flat.  Idk what my subconscious brain is trying to tell me here...lol. 

I spent part of my day yesterday with my mom and kids.  It was a great day.  I love hanging out with my family.  I always feel better when I've spent time with them.  Especially my daughter.  She is such a bright soul.  She is always cheerful and exudes positivity.  Even when she's in a bad mood, she's funny.  We went to Tanya's Soup Kitchen for lunch.  I had never been there.  The owner (Tanya) was killed a few weeks ago.  It felt weird in there.  There were pictures of her sprinkled around the restaurant with cards and a book that people had written their thoughts in.  I wish I would have met her.  Just looking at all the pictures, she looked like someone who really enjoyed her life.  I loved the style of her restaurant. The food was super yummy, but I overate and paid for it all day and night.  It was so delicious.  And seemed healthy.  Lots of nutrient rich foods.  We went and walked around at the spice merchant after that.  I love the smell in there.  I love the smell of their coffee.  I was in hog heaven between the coffee and all the kitchen gadgets.  I didn't buy anything.  But I wanted to.  They have these coffee mugs that have animal heads in the bottom.  So they slowly start to emerge as you finish your drink.  My Aunt Sue had one of those that I loved as a kid.  I think it had a little frog in the bottom.  The mugs were on clearance.  But I didn't buy one.  After that we went to the new Costco store.  My daughter wanted me to go in half on a membership with her.  Idk if I will get out there that often, but I went ahead and got a membership with her.  It is a neat store.  Idk if their prices are that super on everything.  I was impressed with their yogurt prices.  And their produce looked good.  I bought a ton of fruit.  I'm anxious to try it all.   

I have tons more to say, but looking at my dirty house is making me feel guilty for sitting here writing and drinking my coffee in leisure.  I will be back to spew more bullshittery if I get time.    

Back to work

I'm back to work today after being on vacation for the last week.  I'm glad to be back. Only here can I forget about problems and heartaches and just engulf myself in the lives of other people's medical lives.  My regular partner is on an extended vacation to work on harvest so I've been getting random partners every day.  This will be a good week.  I am working with 2 people that I really like today and the medic whom I most want to be like tomorrow.  It's been a pretty nice day.  Got to run a diabetic call.  I think those calls are fun. You get to see the patient improve almost immediately. 

I couldn't seem to eat until just a few minutes ago.  My worries were getting the best of me.  I am feeling much better now that I've gotten back into the groove. I also got to see my daughter, which helps.  I like days that we are both working and I get to run into her at work.  Just heard the first heat exposure call of the day come out.  I bet we will see a lot of that this week.  I made sure we were stocked up on iv fluids and ice packs. 

I thought of something odd the other day.  There are certain things that I say to patients that make it almost impossible not to break out in song.  When I'm assessing their level of consciousness, I commonly ask "you know where you are?" In my head, I always hear "you're in the jungle baby....you're gonna dieee...". 

There was more...but it's going to have to wait for another day.  I can't concentrate on this right now.  I will be back though!

Smalltown medicing

I don't know if all small town medics have these thoughts.  I'm sure they do.  I don't really think that I'm anything special or extraordinary.  But for those who don't live this kind of a life, I will share some of the things that enter my head on a regular basis.  

My husband is on the volunteer fire dept here in town.  I adore all of our ff.  I don't know what we would do without their help.  They started going on all of our medical calls a few years ago.  There's only a couple of them that are medically trained. That doesn't matter to me though.  These guys will do anything we ask them to.  They have done chest compressions on people they know and love.  They go and retrieve equipment.  They crawl into places that my big a$$ won't fit.  They have worked tirelessly in mangled messes of what was one time a car, squished next to bodies, trying to free them from wreckage.  They block traffic on busy roadways.  They are the eyes in the back of my head.  When I'm focusing on a patient, they have my back, keeping me safe and anticipating my needs.  They are there to help lift when my partner can't lift.  Our relationship is so that we can make eye contact and they know what I need or what I'm saying.  They recently lost one of their brothers.  I was on that call.  That call was our worst nightmare that came true.  Those are the days that I fear the most.  All responders dread that call.  The only silver lining on calls like that is knowing that I did everything I could and more.  I know that if survival was meant to be that day, it would have happened, because I did everything I could.  That soul received the best possible care. Calls like that make you so thankful for the people you see everyday on calls, that have your back.  It makes you love your brothers and sisters that much more.  

Now for the down side...lol.  Our volunteer fire dept is not bound by hippa like we are.  I am not speaking towards any of them other than my husband.  My husband cannot keep a secret.  He has a chronic case of diarrhea of the mouth.  His words leave his face before his brain has time to catch up.  I am terrified that he is going to send me to prison.  I never discuss details of calls with him.  Because I know, he just cannot keep a secret.  I can't control what he sees on calls with the fire dept though.  But it terrifies me.  Especially in our small town.  What do small towns love besides fried chicken, Jesus and football?  Gossip.  Especially the juicy kind involving emergency lights and sirens.  I have told and told him, please please don't gossip about calls.  Even if I'm not there on the call.  People are going to assume that I have given him the details.  It could end badly for us.  The chronic diarrhea of the mouth always seems to prevail though. 

Another down side is when I'm out and about in town I always run into someone who's wife, husband, son, daughter, sister, brother, mother or father I have had as a patient.  I don't know most of these people very well.  But it feels like I have to speak to them to be friendly, but it's awkward.  The ones who's family member died feel the most awkward for me.  Since I don't know them that well, I feel like I am a reminder of one of the worst days of their life.  I awkwardly say hello to be polite, but seem to always catch them looking at me.  It makes me feel bad.  That I remind them of that day.  The ones that I know a little better are not quite as awkward, but still make me feel weird.  They thank me over and over again.  I don't want those people to feel like they have to thank me.  I'm not special.  This is what I have studied to be and do.  If this was the area in which they had chosen to specialize, they would have done the exact same things that I did to take care of their loved one. I know it is awkward for them too.  And I'm not complaining, just trying to give a glimpse into what it's like.  I go out to walk my miles around the walking path and it's very rarely that I can go and get home without running into a former patient or their family.  I think the worst ones for me are the ones who are angry.  They feel like I or our crew should have done something different. These people don't understand that we do the things that we do under a Drs orders.  Drs orders change with scientific research throughout the years.  What we did back when they were on the department is very different now.  I wish I could produce a positive outcome on every call.  Death or disability is beyond my power though.  Bad things happen.  I wish they didn't.  But they do.  I just wish that everyone understood that bad outcomes affect us too.  Next to them, nobody is more sorry than me when their loved one dies. Even though I know deep down that it's beyond my control, I feel responsible.  I spend days, weeks, years sometimes going over that call in my mind.  Trying to find something that could have made a better outcome.  Anyway, I don't know if the others on my department think about everything like this or if its just my hamster wheel of a brain.

It's the positives that keep me getting out of bed every morning though. The little girl who lived and kept her leg because of me.  The little boy with the worst brain injury I have ever seen in a patient who is just fine, with no ill effects.  The heart attack that would have died if I wouldn't have treated it.  The cardiac arrest patient who died, but his family knows that I did everything in my power to save him.  The mentally ill patient, who's daughter knew that I would be kind to him, and make him feel calm and reassured on his way to seek treatment.  My friends and neighbors, who know that they can come to me with their fears and concerns.  Those are the reasons that I keep doing this.  

Every call makes me a little better.  A little smarter.    

   

Last weekend

So last weekend sucked.  With a capital S.  I was paying back a shift trade which meant that my regular 12-14 hour shift would turn into at least 18 hours.  This leaves me with about 3 hours to sleep between shifts.  This wouldn't be a big deal if it wasn't such a busy rotation.  I'm not even sure how many calls we ran.  It was hot as fried hell outside friday, and I forgot my hygiene bag.  So my clothes wound up soaked with sweat before noon.  Those of you who do outside work will know exactly what I'm talking about.  My clothes never dried out.  It was the type of day where I didn't have time to sit down and eat all day.  Between calls I peeled a couple of hard boiled eggs and ate them in the truck, but didn't have time to get the shells out of the sink. 


I don't mind being this busy at all.  I like running calls.  It would be nice to have a few minutes to sit and eat, but it happens sometimes.  As I so often do, I got a late call.  My partner of the day's relief and his student showed up on scene to relieve my partner of the day.  Which was great, because they took the call, which meant one less report for me to write.  

The late call made me late for the shift trade that I was paying back at another post.  Which meant one of the day crew had to hold over and wait for me.  Evidentially the night shift person that I was working with clashes with the person who held over for me.  Thankfully the night captain let us go 10-6 (out of service) until we were able to get back to post, so we wouldn't get anymore calls until everyone got where they were supposed to be.  Well I was driving back to post, and got off the bypass.  The night medic looked at me and says "what are you doing?" I told him that this was the way that I take back to post to avoid traffic.  He goes off and says "that is way farther than the way I take. It's at least a mile on this road, and a mile on another road".  This is complete horseshit.  But this control freak goes on and on so I finally just told him that if he really thinks it's that much further that I would get back on the bypass and get off on his road.  He said it is much further, so I went his way.  I told him that the traffic was lighter the way I go.  He says "you don't like traffic do you? The way he said it was incredibly condescending.  All the while he is texting and sending messages on the ambulance computer.  He then says "you small town people".  Then I told him that I just didn't like to wait when I could save time. And he says "clearly, thats why you got a ticket a few months ago".  I just tuned him out from that point on.  Then we get back to post and I was hurrying around getting my things gathered up, and I stopped to rinse my egg shells down the sink (because he has complained to my partner before about our lack of cleaning, etc). He sees me doing this and says "get out of here now Dawn.  I'm serious".  So needless to say, I'm a little irritated.  

I finally make it to post #2 and we get a call shortly after I walk in.  The guy I was working with now has maybe a year of experience as a medic.  He took the first call. It didn't go well.  There were bugs everywhere.  I took our equipment outside, was picking bugs off him, and kept my feet moving (they won't crawl up your legs as easy if you keep moving).  After the call, I mentioned the bugs and he went completely code orange.  Told me that I needed to tell him the next time I saw bugs.  You would have to be blind not to have seen them.  

So he makes me take the next 2 calls, which made me late getting off.  His driving was so bad that it threw me into a cabinet.  So my ass knocks the cabinet door off.  It was just a horrible night.  I had no help making up the cot after I dropped the pt off, which is a normal common courtesy.  You remake the cot while your partner is giving bedside report.  So instead, I had to remake it in the back on the way back to post.  Nevermind the reports that I have to do.  It was just a horrible night.  

For me, the actual patient care isn't the stressful part of ems.  It's the politics and people.  A lot of the people in EMS are very power hungry insecure little people.  I don't understand why they have to be a$$holes.  If I'm working with someone who is doing an 18 hour shift, I go out of my way to help them and take the late calls.  I always try to be mindful of the patient and my partner in the back when it comes to driving.  And I would never be condescending towards someone as far as their choice of routes.  The route I was going to take back to post was 0.23 of a mile more than the way I was dictated to take.  It is much shorter with traffic.  But that's one of those things that just isn't worth arguing about.  To me anyway. 

Days like that make me very thankful for my regular partner and the other reasonable adults that I have worked with.  Thanks to the EMS Gods that I got decent partners for the rest of the weekend.  

I'm sure none of my irritability had to do with sleep deprivation or hanger...lol.  Yea, hanger IS a thing.       

Happy Vacation To Me

I decided to reward myself for a long last week of work before vacation by finally starting a real blog.  I bought a domain, which makes it real.  

I guess I will start by introducing myself, which will be boring for the people who know me.  

I'm a 41 y/o married mom of 2.  My oldest is a beautiful, sweet 25 y/o woman.  I have to say that she is the best thing that I have ever done with my life.  She is the kindest most tender hearted soul that I know.  She is absolutely beautiful.  She is everything that I wish I would have been at age 25.  My youngest is a 14 y/o basketball loving, video game playing bundle of hormones who is reluctantly at times growing into a gentleman.  He is getting to an age where he doesn't need his mama quite as much and it is breaking my heart.  But I suppose that's part of a boy becoming a man.  I have been married to his dad for 17 years this August.  We have our ups and downs, but there is nobody that I would rather have these ups and downs with.  

I am also a paramedic.  I wasn't sure which part of me to start with.  Being a paramedic is just as big a part of my soul as being a wife and mother.  That probably sounds wrong, but it is what it is.  My family knows this and accepts it.  My husband is a volunteer firefighter, so he gets it.  My daughter works in the busiest ER in Wichita, so she understands also.  I have a feeling that my son will also join this calling someday in some capacity.  

I work for the largest EMS service in Kansas.  I absolutely love it.  The politics are a bit much at times, and I doubt that I will ever be much more to them on the career ladder than a paramedic, but I'm ok with that.  I want to spend my life running calls and taking care of people.  I feel like there are way more opportunities to learn in this capacity.  I didn't mean for that to sound snotty or spiteful.  I guess I mean that there are more opportunities to learn about the stuff that interests me the most in this capacity. 

I also volunteer as a paramedic in the small town where I live.  They paid for my tuition to paramedic school.  So I volunteer.  I would have volunteered here even if they hadn't have paid my tuition though.  I feel like it is something that I need to do as long as I'm able.  It's challenging as hell at times, but nothing fun is easy. I'm not so great at the administrative duties that I have been given.  I need to be better at that.  Someone has to do some of the boring stuff too though.  

I try to spend my time off doing completely un-medic like things, but it's hard to put out of my mind.  I spend time with my parents.  Mainly my mom.  My parents live here in the same town. I go out to lunch at least once a week with my mom.  I don't know what I would do without them.  They pick up a lot of my slack.  My boy would be lost without my mom.  

I spend my weekends off with my best friends in the universe.  I can live the life that I do because I know that these people will always have my back, no matter what, no matter when.  My husband and I plan to retire with this couple.  Move in together.  We have it all planned out.  We will split all of our bills and share all of our income.  We have all kinds of retirement plans, that will be more easily attained with the four of us.  I know it sounds weird, but you will soon learn that weird should have been included in my introduction way before now.  

You will also learn that I am kind of a basket case at times.  I think you have to be to have a successful life in emergency medicine though.