Thursday, July 27, 2006

the ghost

Everywhere in my city is haunted. This city is one of the oldest in the nation. Established because of the great harbour and large port. Pirates, sea men, boats, ships. The whole downtown is build facing the ocean so that in the days before god gave us the joy of AC the winds off the coast would cool the homes. There are streets made out of the cobble stones that were used to weigh the ships down in thier home ports before they sailed here. This is were American History starts. I know its not like Europe, where history is measured in 1000s of years. But It is the history of my country. So that brings us back to the ghosts. They are in every home on the Battery. They come in shapes of children, civil war soldiers, and ruined women. Some are frightning, some not so much. I know many of them, because as a child, my father would read the ghost stories to me. My girl scout troop leaders would tell them to me. So call me niave, call me lame, but okay...I believe them.

So flash to me starting at EMS...and my first shift at Medic 10. My crew cheif thought it would be funny to tell me, the little green EMT, about "The Ghost" Yes, there is an Indian Ghost that resides in the Medic 10 station. Apparently in full headdress, and he like to scare the new EMTs and Medics. So for the months I worked that station I slept with the lights on. I never saw the indian, but everyone knows about it. At recent count... of current employees I know of only one who has actully see him. And I don't want to be the second. I am still scared of the Indian. I told my best friend about the ghost and how I can't sleep at the station, at least not in the bunk room. I sleep in the living room in the recliner, with a lamp and the TV on. Just in case the ghost happens to like CSI:. When I told LB about this, she laughed so hard she fell out of her chair. She started hyperventilating. She said in between breaths "You, my big, strong, best friend, that sees dead bodies, can save lives that can drive an ambulance like she stole it in on coming traffic, and is scared of nothing, is frightened by a ghost she doesn't even know exsits". Yes, and you can qiut laughing at me now. I might not know much, but I do know better than to fuck with the afterlife.

Scar Tissue


Scar Tissue
Originally uploaded by strange little girl 190.
This is the scar left over from the knife that fixed me. My surgeon cut to the left of my tattoo because he couldn't cut through the medical symbol. I got the caduas several years ago for protection after I started having some pain. It is part of a drawing I did in High School. Now I am beginning a new career path, taking a few steps back, back into the ER were I got my medical start. The ambulance still feels like home. But now I am going to make a new home in the hospital. Still caring for the sick and the stupid. Just not at 60MPH.

Sunday, July 23, 2006

Can I still call myself "Paramedic"?

Well it official...I am leaving the ambualnce full time and going into the controlled chaos of the Emergency Room. I wrote about this several posts ago, while I was still out in injury. This is not a choice I made because I wanted to, it was because I had to. I am a 26 year old paramedic that at my young age had back surgery. Back in March, I started having pain. Pain I had been familar with since I was 15, but at 15 I was not carting 80lbs of gear and lifting gurneys up flights of stairs. So I made the trip to my spine doc I had been dreading since the day I put on the uniform. Surgery, he said, could fix me, but if I wanted to keep walking like a normal person, EMS is not where I needed to be. So after four months, during the recovery period of my spine post surgery, thinking about what to do now, I came up with it. I would quit the job I have grown to love, go back into the ER, and start respiratory therapy school.

EMS is not what I wanted to do when I began college. I was a fine art major in college, learning all the finer points of photography. It was, however, photography that got me into EMS. When I was studying, my mother worked in the Trauma Center. For my final, our assignment was a photo essay. I did my essay in the ER. After having all the papers signed and the rules laid down (really only one...No patients). I spent the next 13 weeks shooting in the ER, getting to know the night shift and becoming like a little sister to all the staff. My mom moved to the Pediatric ER during the shoot, but I would still come around get a couple rolls of film off and go home. I was there every weekend shooting. I learned that they cut all the clothes off of trauma patients and was told by the staff if I ever came in as a drunk MVA they would cut my clothes off no matter how bad I was injured. I watched as the cracked chests, fixed broken limbs, and intubabted asthma patients. And I fell in love with it. The mess, the chaos, the blood. Yes, I was hooked. So that summer, I started in the ER as a EDT. After a few years, the medics pushed my into the streets. S here I am, a busted up and broken medic, having to go a few steps backwards to go forwards.

I will still be on the ambulance part time. I worked to hard to get through the hell that is paramedic school ( I lost 30lbs and never got more than 3-4 hours of sleep a night during the almost two years of school) to just give it up compleatly. I do love it. I love the patients, working with the other public servants (police fire my co-workers), driving the three ton truck compleate with lights and sirens, like I stole it. Where else can you drive on the wrong side of the road, and get away with it? I will continue to play paramedic as much as possible. And I will continue to blog about my experiences.

Friday, July 21, 2006

The post is dedicated to a a reader of my blog who doesn't have anything to do in EMS and wants to know what all the accronyms and abrivations mean. So here are some we use, some official medical terms, some not so much...

LSB: long spine board
CSpine: the whole package with the Collar, board, straps,tape used for neck and back injuries. It's kinda like a whole body splint.
CAOx3: conscious alert and oriented to place date and name
PMSx4 pulse motor and sensation in all 4 limbs
SOB: Shortness of breath
CP: chest pain
SZ: Seizure
HTN: hypertension
IDDM/ NIDDM: diebeties (insulin and non insulin dependent)
PERL: pupils equal reactive to light
ALS; ain't liftin' shit or advanced life support
BLS: Be liftin shit or basic life support
CPR: cardio-pulmonary rescu
FUBAR: fucked up beyond all reconition
CATS: cut all to shit
CTD: circling the drain
WUD: woke up dead
TSTL/D: to stupid to live/die
FDGB: Fall down go boom
DFO/IC: Done fall out /in church
ART: assuming room temperature
DRT: Dead right thar
HIBGIA: Had it before, got it again
TBC: total body crunch
CHF: congestive Heart failure
MI: Myocardial infarction
CVA: cerebral vascular accident
MVA: motor vehicle accident
HA: headache
NGAH: no groceries at home
FOW: fish outta water (Seizure)

Now those are just some...comment if you got new ones. I always need a chuckle.

Thursday, July 20, 2006

You know the old phrase...

...you can't bullshit a bullshitter. Well, you can. I have proof. We got played. Truly and utterly played. And it totally pisses me off. Hindsight is always 20/20.

So we get called to an "unconscious trauma". We were about 20 minutes away standing by in another district so we go taking off down this oak tree lined two-lane highway, lights, sirens blaring. FD calls and tells us, Yeah she is totally out, responsive to nothing. Not pain, not voice...nothing. When we get there we are met outside by the FD and staff of the place. They tell us that she was moving tables from a stack and the stack toppled over on top of her striking her in the head and pinning her head between the floor and the table. We walk in and damnit all if she isn't seizing. Not tonic clonic flailing like a fish, but a quiet focal SZ, but apparently she had been doing it about 10-15 mins PTA. So I start a line and give the Ativan...and she stops. We package her in C-Spine and get her out to the truck. Where we discover that her pupils are unequal. Like ones is dialated and the other is constricted. They are sluggish to react. And she is OUT, responsive to only really deep pain. She is breathing and her spO2 is 100% on a Non-rebreather. I call into the trauma center and get orders for another MG of Ativan and one more is the SZs start again. I get a second line put in and my partner notices another SZ. So one more MG of Ativan. Her eyes are becoming less reactive. The sternal rubs aren't doing anything, the big ol' IVs I put in aren't doing anything. So she has had recent head trauma, is unresponsive, has unequal and sluggish pupils and is activly seizing...or so we thought. We had a fire guy drive us in, code 7, risking life and limb driving down the two lane highway with all the trees. Not just risking our lives, but the other motorists on the road because getting over for the blaring ambualnce means risking hitting a huge tree...and we all know that people can freak out with an ambulance screaming down the street. We get to the ER after working our assess off trying to one...figure out why she is seizing and two...trying to make them stop. If she hadn't been holding her own on the airway front, she would have been RSIed and bought herself a tube and an ICU bed. The ER doc actually got into it with a trauma resident over the CT scanner. Feeling that she needed the scan first because of the head trauma and all of the other symptoms, not the stable trauma. Now after the scan is when Mom shows up...and proceeds to tell the ER doc SHE IS FAKING IT. ALL OF IT. She has been seen by several neurologists and they all say the same thing...PSEUDOSEIZURES, faking it. And she has been doing it for years. and has it down to an artform, this girl had us fooled, the FD fooled, the ER fooled. But what about the pupils you ask? She has history of head injury when she was very young, they are always unequal, it happens I guess.

Now the more I thought about this the more pissed off I get. This is EMS abuse at its worst. This pisses me off more that going to an ABD pain x 2 weeks in the middle of the night. For the sole reason that we thought this girl was truly hurt. We worked our asses off trying to help her. We put numerous people at risk just getting her to the hospital, driving down the road CAT 2, we put our lives at risk for the same reason. We fought the good fight for her. Then looked like a moron when finding out is was all an act. It hurts your pride and it makes you think that everyone is faking it. It makes you jaded and mistrusting. We trusted our guts and it turns out that your guts, the ones you use to treat potentially sick people, was so totaly wrong that you don't know if you can rely on them.

As I thought more about the call, I remember her possibly "helping" me move her arm, the seizure might not have looked right. But I could be all wrong.

Monday, July 17, 2006

We do what?!?

Frank Pierce: "I realised that my training was useful in less than ten percent of the calls, and saving lives was rarer than that. After a while, I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply turned up."

This is one of my favorite lines from a movie. Every paramedic, firefighter, police officer, ER doc, ER nurse, EDT, and rescue worker understands this line. Because that is what we do, we bear witness to the atrocities of human behavior, we soak it in, and it becomes part of our being. If you stay in this job long enough, you see the ghosts. I drove past the spot where a cyclist was hit yesterday. I haven't been back to that area since the call three years ago...and I started shaking. Now, he is not a ghost, in fact he is alive and doing quite well, but that call shook my entire being up. He was my one call, in which everything came together, my partner, my mentor and I worked to actually save this man's life. He changed everything I ever thought of EMS. Before him, I had never "saved" anyone. I thought our job was to just get the patient to the hospital in one peice, alive, but we don't actually save anybody. We postpone the eniveitable... And for the majority of calls, thats it. We give a little of this drug and little of that drug, maybe shock 'em back to life, but save them? No. We stablize and transport to definitive care, so that the MDs at the hospitals can figure out what has gone so teribbly wrong as to summound us and thats what saves them. But once in a blue while, and this is so rare that there are even some seasoned medics that can't say this. We actually "save" them. It was our hands, our skill, our years of training that are the reason that they are still walking around. Not the doctors, not the ER, but us, the Paramedics, EMTs and Rescue Workers. I have been lucky on that front, I got that realization early in my EMS career.

We get called, we show up, sometimes on the worst day of somebody's life. We take their pain and make it our pain as to lessen the blow, maybe. I have seen total and utter fear in some of my patient's eyes. Sometimes, I can do nothing but show up and the fear goes away. Sometimes, I can do everything in my control and the fear stays. On any given day, I can see life, death, sickness, sheer happiness, or total defeat. But I will always be there, even if all they need is somebody to listen to them. To convince them that they are not alone, that somebody, even a stranger, as I am, will let them tell their story. And so I might tell it for them when they are no longer able to.

Wow, this was a rambling post. But whatever, EMS isn't this deep all the time. Most of the time it's just a ride to the hospital. A really bumpy, uncomfortable ride to the hospital. So just advise and transport.

Friday, July 14, 2006

One More thing...

I was introduced to this puzzle by the Utata Group on Flickr. You have to change the URL to get to the next screen. It goes in numeric order. See if y'all can figure it out.
n.nfshost.com/1.html

Good Luck.

We are not a giant taxi

Oh good lord, people... an ambulance is not a taxi service. Wow, I feel better. I forgot how much people abuse us poor paramedics. Please, I ask all of you, the public, to think before you pick up the phone and dial 911. Think about the abdominal pain you have had for 6 WEEKS, then think about how you make car payments every month to have a working vehicle in the driveway, and maybe you have several working vehicles. Do you know where the keys are? Now, pick up the keys and drive yourself to your doctor. There is really nothing the ER is going to do for ABD pain you've had for 6 weeks. They will give you a GI cocktail, do some blood work, and tell you to go to your regular doctor. This is not a hard concept, the same thing is held for "chest pain" times several months (I said Months, not Minutes...see the diffrence) arm pain since January, and neck pain after falling asleep in the recliner. Why , oh why, must you wait until 3am to call an ambulance for something like this.

Acute cases are diffrent, the onset of Chest Pain 15 minutes before can be critical, you just might need us. And if you suddenly can't speak, or lost use of your arm or have a massive Headache all at the same time, that too can be critical...and that too may need an ambulance. If you internal difib is going off, like a recent patient we had, you need emergency care. So, do we all see the diffrence between the above cases. Acute onset, meaning is just came on=Emergency, which=911. We don't mind the truly sick or hurt, or even the not so sick, but the scared, thats our job, thats what we train for hours for. What we don't like are the ones that treat us like a taxi service, who abuse us. Who call us in the middle of the night for say toe pain (yes, this really happens) or because you want rehab, at the three in the morning on a Tuesday, after you have been drinking since last Tuesday, you aren't going to get it, you are going to sit in a lock-down room for many, many, several hours, until you sober up and Palmetto opens its doors again to accept you. And this isn;t just the public, it can also come from theother public servents we work with. Police can be bad about this. Now, before you start bitching at me, I know you guys have policies too. And I know it all comes from above. But come on guys, use that common sense I know you all have. A small laceration on the arm or a driver from a MVA with no complaints does not need EMS. Think about your fellow officers. When you call us for that MVA to "check out" a party that has no complaint to begin with, you are putting an ambulance and the crew basicly out of service. That is one less ambulance not covering their area. So what happens when one of your co workers gets attacked or worse yet, shot, and the closest ambulance is 20 minutes away? I'm not telling you we don't want to help you out, that's not it. And we really do apprciate the help and protection that you provide. There has been a few of you that have saved my ass on calls, kept me from being killed, quite literally, on one call several years ago. I am just asking you to use your brain and think "Would I call an ambulance for this if it was me?"

Tuesday, July 11, 2006

We fixed him.

Busy Busy Busy...the islands have kept me up all day and all night. Not too many calls, but alot of standbys. Lots of driving around the county. I did however have the cutest kid in the whole damn county in the back of my ambulance. Mom called us at like 0200 for shortness. Her three year old woke up with a pretty nasty sounding cough. Kid had croup, nothing life threating, but that loud, seal bark cough can freak out the most level-headed of parents. It even jarred me for a second before I relized what it was. The kid wasn't very playful in the house, but once out in the truck and post humitified oxygen he was a chatty little thing. We talked about "Cars" and "Madagascar" naming all the characters, we talked about his sisters and brothers. He told me all 6 of thier names, ages and birthdays. Oh and most of his immediate family. He told me all about the trip on the carriages with the horses downtown and his new bicycle. Yeah... its amazing what a little oxygen can do. It really is the best drug we carry on the ambulance. It can turn a three year old into a little chatty-kathy. It fixes most cardiac problems, like PVCs. It can turn a CHFer or asthmatic around in a matter of seconds. It can postpone the effects of shock and even lessen the pain from Migranes. Yep oxygen is ia great little thing, but I do like watching Adenocard work the best.

Saturday, July 08, 2006

untitled

Well, another day another shift come and gone...and for some reason the islands have been busy. We ran 5 calls and just as many standbys. Nothing too critical, just run of the mill weak and dizzy all over and allergic reactions. We also had a girl who called because of a migraine. Now, I have migraines. I get them about once a month. I know the pain associated with them. I know about the photophobia, the nausea, the thundering pain. You just want to lay in the dark and make it all go away. I have even gone to the ER because of them. But call an ambulance? Especally when they have a history of them, its really not like they don't know what's going on. It was also one of those overdramatic bitches that just make your job, which is to be compasionate and sympathetic, that much harder. It's when they don't help you out by answering your questions, that you need to ask, like how long have you had the headache and have to taken anything for it do you just get frustrated. And then when they fake "passing out" is when I really want to lean down a whisper "Get your ass up and quit acting like a kindergardener" Oh and the screaming, she just kept screaming. I tried to tell her to quit the hollaring and it just might help, but what do I know?

Wednesday, July 05, 2006

Jose Cuervo is not your friend

Happy Fucking 4th. You know, when I choose to go out to the islands to "ease back into EMS" i really wanted to ease back into it. Run a call or two a day, nap some, do a standby or six, but 10 calls in a shift, that's not what I signed up for. If I wanted to run like that I would have requested The City truck. Too be quite honest though, not one call yesterday was related to the 4th and the rednecks that celebrate it by getting drunk and blowing shit up. Nausea and vomiting was the cheif complaint of the day. Of the 10 calls 8 were n/v the other two were kids less than the age of 3 who fell off the bed. (parents, a 3 year old that falls off the bed, a head injury not makes, I fell 20 ft fron the top of a flight of stairs onto the gravel driveway below at the age of 2 1/2 and I'm fine. well fine as a paramedic can be) Kids that age bounce, really they do, it's proven. Actually I lied, one call was related to the fourth. A young man barely in his teens, learned that Jose Cuervo and JD are not his friends. Even I don't drink those together and I'm a dingbat. I guess we all need to learn only once. So by the time he reaches college, he will know, do not mix your liquors. Anyways, he made a mess of my truck by yaking corn and ETOH all over the back of my ambulance. I cleaned up up while fighting my own nausea associated with the migraine I have been fighting since Sunday. And to top it all off, I missed the fireworks I was so looking forward to.