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!