On Rope.

I am now a Level I Rope Technician. Hells Yeah!. So Below are a few photos from our Technical rescue class we had this weekend. A Three day intense as hell class which ended with the building of not one but two massive Highlines over the harbour. we made Anchor points out of nothing in mid air. We did change-overs and pick-offs. We made all kinds of cool shit that my brain can't even wrap itself around right now. But it is the coolest thing I have ever done is to ride a high lie 100 feet in the air. If any of you fire, medical people ever have a chance to take the OnRope courses (www.onrope.com) Fucking do it. It is AMAZING. and you will leave knowing things you never though you would ever understand. I had my AhHa! moments in this class.

Thumbs Up!

Thumbs Up!
Originally uploaded by artist in the ambulance 190.

The Whole Shebang

The Whole Shebang
Originally uploaded by artist in the ambulance 190.

Building the Anchor

Building the Anchor
Originally uploaded by artist in the ambulance 190.

I made a city Yall

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Kinda Cool. Not quite sure what to do now...

Holy Crap, I actually saved one.

The Angel of Death saved a life. Yep. I know hard to believe but I did. Converted them right outta SVT (SupraVentricular Tachycardia AKA really fucking fast heart rate) with a little prayin' and a little drug I like to call "this is gonna make you feel reeeeeal funny" or Adenosine. Now Adenosine basicly is a drug that stops the heart, causing it to reset and start back up at a normal rate, the patient can have anywhere from a few slow ectopic beats to a period of asystole (flatline). It causes the paramedic to have a breif period of "Oh shit don't stay in Asystole". which they normaly don't, but given my track record, I wasn't taking any chances, I had the difib pads ready, the intubation kit out and fire department on the way. None of which I needed, but like I said, wasn;t taking any chances. So this is how it started. Got called to Chest pain on a young patient. now young CPs are normally bullshit...or crack induced, so when we go the address my partner and I were taking bets on whether it was anxeity or crack. Pull up to this trailer, go inside young pt sitting on sofa, CAOx3, looks fine, complaing of chest tightness. I grab the pt wrist to get a quick pulse, but it was a kind of half-assed gesture so I didn't think much when I didn't feel anything. They was about four other people in the room and I didn;t know if [the pt] knew any of them closly so I didn;t want to go over [pt's] whold medical HX in the house. Pt looks fine so we ambulate to the truck. I sit pt on the stretcher and start with the questions as I put the monitor on [pt] and get the 12 lead cables out. Still haven't looked up at the screen yet. The blood pressure beeps that its done cooking and I then look up. and Holy fuckballs [Pt's] heart is just tachying along at 212. Pretty little narrow complexes. Well I know why your chest hurt darling and why I couldn't feel a radial you got a pressue of 80. Lets just lay back and put so oxygen on you. My Partner god love him got a line for me, the only one he could, a 22 gauge IV in the right wrist. Not the best but it was gonna have to work. Which is where the prayin came into play. So I hit her with the 6mg. Which everyone knows 6mgs of Adenosine never works. Then I hit her with the 12mgs. Which worked goddamnit. Even through a 22g in the wrist. I had never given Adenosine before. I have been there to see it work. Be never been the one to push it. And it worked. I fixed her. I saved her. I'm a pretty good medic.

Okay People...Here's a Medical Lesson

A few days ago a local news crew did a story on a local County EMS system on bad response times and high employment turnover. The story, while had some vaild points, was for the most part, and for lack of a better term, Bullshit. And while I have lots to say about all of that today I'm gonna talk about something that one woman they interveiwed said that made me want to shoot my own television. Her daughter had dislocated her shoulder, which , from what I understand, she has done many times before. While I understand this injury is very painful. It is not life threating. It blows the big one. And I am very generous with pain medication for my patients show that dislocated or broken a bone. But will you die, not likely, unless you have massive multi-system trauma like bliteral femur fractures and a broken pelvis. Then we start to worry. Anyways, Im getting off track...So Mom's being interveiwed...blah...blah...we waited three days for an ambulance to show up...blah...Then she said it...a statement all Paramedics cringe at..."She could have gone into SHOCK!" What the fuck!...Come again...So here it is a lesson on what is and isn't SHOCK.

Shock is defined in most if not all medical textbooks as: A state of inadequate tissue perfusion. Now there are several types of shock.

Hypovolemic: a reduction in cardiovasular volume AKA bleeding to death or Plasma loss such as the case with Severe burns or Fluid and electrolye loss from massive vomiting/diarrhea.

Distributive: Shock that results from mechinisms that prevent the distribution of nurtients and removal of waste products. The blood and other fluids can't get were they are going due to either poor vascular tone or other reasons such as infection
Anaphylactic: A severe...SEVERE alleric reaction that results in the bloodvessels dilating and movement of fluid in to the interstial space AKA the vessels a too big and fluids are going where they don't need to be.
Septic: Massive Infection were toxins crompromise the vascular's systems' abilty to control blood vessels and distribute blood. AKA the blood vessals are to sick to work right so blood can't get were it needs to be

Obstructive: shock resulted from interference with the blood flowing through the cardiovasular system. AKA...Something plugging up the pipes and/or the pump

Cardiogenic: shock resulting from failure to maintain blodd pressure due to inadequate cardiac output AKA they be having the BIG ONE causing the heart to fail therefore it's not able to pump blood through the body

Neurogenic: shock resulting from an interuption in the communication pathway between the central nervous system and the rest of the body resulting in decrease peripheral vascular resistance. AKA spinal cord injury...brain can't talk to the rest of the body so it can't control the blood vessels below the injury. so they dialte resulting in shock.

Okay thats the types of shock...and they are all bad. If you are in shock you are DYING. Let me repeat that IF YOU ARE IN SHOCK YOU ARE DYING. Shock does NOT happen in the following circumstances: Dislocated shoulder alone, minor MVA in the drive thru of micky d's, during a posticatal state of a ETOH induced seizure, a fall from standing height with no injury, being placed under arrest for DUI/ public drunkeness/ or beating your wife with a chair leg, being filled with the holy spirit, being assaulted by another drunk asshole and the only injury you have is a busted lip. I could go on, but I think you get the picture.

These are examples of shock...Auto-pededestrian with massive facial trauma, large avulsion across left side of chest and amputated arm with a blood pressue of shit over squat. Man with tombstoming ST elevations in fucking every lead with a blood pressure of shit over squat. Female with 8 GSWs to the chest, legs, and Abdomen who is remarkably still alive when police clear the scene for us to come in with a blood pressure of shit over squat. Old guy with a temp of 105, Respiratory rate of 40, heart rate of 140 and pnemonia with blood pressure of shit over squat. These are all shock. So for fuck sake people quit using this word to descibe...well I'm not quite sure what you are trying to descibe. But unless the person is in an ACTUAL state of shock as explained above, just fine some other word to use. And it ain't shock.

People Suck.

Wow, the Delta Bravos were out in full force last night. But god bless the City Cops, for they kept me sane. One Delta in particular I wanted to assault myself. He gave me the Hold On a Minute Finger...then said "You...Can JUST WAIT a DAMN minute." Uh...No, I can't, you my friend can walk your happy ass to my truck so I can get a better look at the laceration above your eye. I looked at the cop that was standing there who told the guy "Um I would go with her...so she can check you out, plus she alot nicer than us" The guy then proceeded to not give us any of his personal information like medical history or allergies or home address because "he didn't think we needed that" So I kicked him out of the back of my ambulance told his sister that he needed stitches and then stormed over to one of the cops I knew who immediatlly went "B...B...breath..."

"Fuck breathing, J...I'm gonna kick that kid's ass myself. You know you come to assaults going Man I feel sorry for him he just got his ass kicked, then you talk to em and go...I would have kicked his ass too. Fucking Delta. He can bite my ass. His sister's taking him, he's not going in the back of my rig"

And thats the kind of patients we had all night. Fucking assholes. All night, just wanted to be assholes to the paramedics. And I'm a Kind person. Even the cops were like, what the hell? You were nice at the beginning of the shift. I was but you get beat down and by the end you are like all you people suck.

Are you !@#$ing kidding me!

I sometime wish my internal censor button was just a little less sensitive. I had a a patient last night I just wanted to go "Are you fucking kidding me!?, FUCKING SERIOUSLY!, You are calling me at 0430 for this! REALLY? You do understand you are putting an ambulance out of service for 30 minutes for your fucking superficial laceration...no...wait...abrasion... on the side of you leg that you got...what... three days ago from falling up the stairs thats not even bleeding... What do you want me an EMERGENCY MEDICAL TECHNICIAN to fucking do about it...tonight...right bloody now!? FUCK!... I am not...I repeat...NOT...louder please...NOT! taking you to the Emergency Room. At all...not tonight...or ever. Quit smoking crack. Have a nice night and thanking for choosing us for your health care needs.

And people wonder why our response times are extended sometime. It's because we are dealing with bullshit like this. And when a real emergency drops like YOUR grandmother is having Shortness or your father is having a heart attack the next nearest truck is 20- 30 minutes away.

Also, think about this people who aren't EMS, Police and Fire...When you see an Emergency vehicle driving down the road, with lights flashing and sirens blaring... slow down and MOVE TO THE RIGHT. Don't get pissed. Don't flip us off. Don't honk at us. Don't think we are getting in your way, you are getting in ours. You are just slowing us down and we could be going to YOUR family member. Don't be that Asshole. Really. Just don't.

Didn't Break Nothing this Year

Regular Readers of my blog may recall this time last year I was layed up in a hospital with my left foot propped up secondary to an unfortunate run in with a flight of stairs after several bottles of wine and all while wear fishnets and 3 inch heels. Well, this years birthday had no such run ins, infact no bottles of wine and no fishnets. For I was working. I spent the night picking up drunk assaults and psych patients from my fair coastal city. The doc that was working the night of my "accident" was working tonight also. She was happy to see my sober and using both of my feet. All night I was asked "Why didn't you take the night off?" Well, my friends there are two answers to that question. One of them is the paragraph above. I didn't want a repeat of last year's hospitals stay. I can find much less painful ways of scoring Dilaudid. And answer number two is this is my weekend off so I got the next three days off, which I'm spending in Asheville, NC. So really, whats another day, honestly? So I worked. I picked up drunks. I saved the sick and the stupid, because thats what I do. I even was there when Lil' Kim was having her 3rd child. She wanted me to call her cousin Beyonce, but her baby daddy didn't like Beyonce, so we thought it better we wait until the baby was born. So that was my birthday night. No broken bones, no hospitals stays by yours truly, no killer staircases. Just a bunch of crazies, drunks, and respiratorys to show for it.

I signed up on Halloween for drunken debauchery in costumes. What I got was blues hairs falling in the middle of the night and arm tingling. ARE you KIDDING!. Damn it. Oh well there's always next year.

an EMT made me look good

Ok, we all know the saying Paramedics save lives, EMTs save Paramedics. Well, I always tell my EMT, you job is to make Me, your Parmedic, Look Good. Ok, well my EMT, who I had been having problems with for 4 months, did both on our last shift together. We aren't gonna go into why I had problems with them, thats not the story. The story involves a patient that presented with totally random symptoms that turned out to be a big ol' bad CAT 2. So he we go...

Get called to a "sick party" Now this could be anything, this anything turned out to be inconsolable crying. Really. Pt in a mentally handicapped pt, non verbal, who's family calls this the pt's "pain cry". Pt not eating. HX of bowel obstruction. Fever. Ear infection. Tachy at 130. Hypotensive at 90/60s, but pt is also 80lbs soaking wet. BGL at 200. But Pt is compleatly stable. skin is warm/ dry. Pt will focus on you when you speak. I felt perfectly fine putting this pt in the back with an EMT who is also a paramedic student. But then the family wanted the pt trasported to a hospital who is notorious for asking for an IV for even the most mundane of symptoms and this was a borderline BLS/ALS pt. so I said to my EMT partner "I'll ride this in, but I want you to continue to assess as if this was your pt, do a BGL, put pt on monitor, everything but the IV, oh an get a manual BP the monitor been fucking up" SO he does what I say. and as he put pt on monitor I glance up for my seat as I type my report and I see little Normal sinis complexes marching across the screen. little funning looking, but I'mm get up in a minute when we get going and really look at it when i go the start the IV. from where I'm sitting there's a P wave and an upright QRS so we are golden. I go back to typing. Just then my EMT shoves a strip in my face..."Hey!!B!! is that ST elevation?!?"

"Noooo..Thats just a funny lookin...Well fuck me...
I get up and start flipping through the leads on the monitor and get to Lead I and goddamnit if there ain't huge ST Elevation. Well...get em on the 12 lead...we have elveation in leads I, II, aVL, V2, V3,V4. And BIG elevation. And pt had pressure of 90 and can't swallow, so no Nitro, or aspirin so I just placed em on high flow O2 and high flow disel and off we went. Pt didn't like me neither I had to stick em like 6 time for an IV because {the pt} kept trying to bite me.

That just goes to show you paramedics sometimes need them lowly basics.

So I yelled again.

People never stop amazing me. I know it's human nature to gawk at an accident scene. To stare at it from the car window as you dive past and imagine the carnage that may or may not be unfolding. To be mezmerized my the flashing lights of the emergency vehicles. To watch as the Paramedics, Firefighers and Police Officers run around on scene in seemingly aimless patterns, with equiptment and notepads and oxygen tanks and stretchers. To even watch as a helicopter lands in the middle of the highway blocking traffic. I can only imagine what this looks like from the outside looking in. As opposed to being right smack in the middle of it.

So as we pull up to the scene there is a small truck, roof caved in. Looked to have rolled several times. Firefighters at the side two criticals laying in the grass. Another across the highway at the side of a family of three sitting up in the grass, not bleeding. They will be care for in a few minutes. I need to see the two laying supine bleeding all over the place first. Just as we were about to pull up a man with a Nikon around his neck leaps in front of the ambulance and snaps off a few shots. I look up and see where he came from. A goddamn fucking tour bus had stopped in the middle of my fucking accident scene. So not only did I have 5 patients (two of which who were critical) but I had a bus full of fucking tourists snapping pictures. Oh and ONE COP. Who sends ONE COP to a multi car MVA? So ever the professional, I get out of the truck and begin my triage. I go to the first patient. Severe SOB and pain on inspiration, bilat, yet dimin breath sounds, several head Lacs, crushed hand. Place him on High Flow O2, Got a trauma RN on scene to hold Manual CSpine while I go see my next patient. CAT 2, trauma center criteria. Run into some tourist who goes, "You just gonna leave him with that fireman?"
I give the stank eye and go "You gonna tell me how to do my job? Or you gonna move so I can triage all my patients? MOVE!"
Next patient...Partner's got him...Altered Mental, repeating questions, weird looking pupils, neck/back/chest pain. Also CAT 2. CSpine. High Flow 02. Trauma Center Critera. Move him to unit.
GO across highway to triage family...All CAT3 facial pain 2nd to airbag deploy. Can wait on 2nd unit. Firefighter stays with family until 2nd unit arrives.

Thats the run down. Now I walk back over to where my criticals are. Where now ALL the tourists from the bus are now off the bus and all have their cameras out and snapping pictures. I have now had it. This is not a show. This is real life. This is not entertianment. There are two people laying in the grass actually bleeding, actual blood from a actual car accident and these people are treating as if it's an episode of "Grey's Anatomy" So as I walk up, I start yelling. "ANYONE WHO IS NOT PART OF MY ACCIDENT, BACK THE HELL UP AND GET THE HELL OFF MY ACCIDENT SCENE." I then think to myself I'm gonna have to call a supervisor later. I'm gonna get complaints. But right now I don't give a damn. And I got back to my original patient. He looks up at me and says "You tell 'em girl" Then the man with the nikon that jumped in front of the ambulance as we pulled up tried to get up close to me and my patient. "If you don't get that camera out of here...you see that cop over there...I will have him cofiscate that lovely little memory card from you lovely camera because you breaking all kinds of HIPPA laws right now, BACK OFF!" I was pissed. This guy felt he had the right to barge in on the lives of my injured and bleeding patients... and on mine for that matter. But I could fight him off. My patients could not. They lay there exposed to the world, both physically and emotionally. So I was angry and I expressed it and not just at this one man, but at the whole bus load of people who treated the whole thing as entertainment. So what if I end up with several tourist complaints in my file. They acted more inapproriatly than I did.
And so we load both our critcals in the back of our unit and too off.

Our patients made it to the trauma center alive and in one peice. And I only pissed off a bus load of tourists. Welcome to our fair city.

phew glads thats over

Holy mother of god I'm tired. 48 hours on an ambulance will do that to a person. 48 hours and 22 calls later and suprisingly an Angel of Death, such as myself didn't kill any one. (Refer back to a an earlier post for how I earned that nickname) In fact, I might have very well saved one. Woman having the tingling of an Inferior MI. Just the beginings, ever so slight ST elevations in the right Leads (which are ??? my Paramedic students out there) Bradycardic and slightly hypotensive. II did have to laugh at myslef for just a second as I go "I gonna give you a spray of...wait no I'm NOT going to give you nitro, I'm going to turn you fluids up a bit more my hypotensive friend" Its so ingrained, so banged into our heads that EVERY CHEST PAIN GETS NITRO that sometimes we forget that not ALL chest pain pts should get a spray of Nitro.

I do also forget how much fun it is working when you work with someone you get along with and work well together. My partner last night, we have very diffrent styles. Very diffrent. Both of us are laid back type of medics, but I tend to be, well... very sweetly southern. He's from a whole diffrent side of the country and well isn't. He's a no bullshit do you want to do the fucking hospital get in the truck now lets go quit bleeding on my fucking boots type A, but in a way that you like. He lets me be sweet, all while pushing them out to the truck. So it works. Its gets the job done. I get to be sweet and he well...covers me when the shit hits the fan. Plus, he's a good medic with strong medicine. And doesn't look at me funny when I yell at the crackheads who complain of chest pain at 4am (QUIT FUCKING SMOKING CRACK AND YOUR CHEST WILL QUIT HURTING DUMBASS!)

But now I'm going to bed. Sleep is good. And then The Shins concert. I love The Shins. The make me happy.

Keeper of Keys

Back to nights I go. Its time for our 6 month switch, and I get my nights back. Thank god. I'm getting frustrated on these 24 hour shifts. I'm getting downright mean. Not to my patients, but to my partners. I did have a difficult partner this time around, which is why I haven't been writing as much as I used to. I am afraid of what I might type and to be quite honset I haven't been enjoying the job enough to really write. The frustration had taken over and made it difficult to find the interest to sit in front of my laptop and tap out a post. I hate the managing part of my new position. Sometimes on my 12 mile bike rides I think of ways to get demoted back down to crew member. The best solution I came up with was to look up porn while on duty. It's not hurting anyone, nobody dies and after a while everybody forgets about it. As long as you don't do it again. and you let you friends in on the secret (I'm not really a dirty girl, I'm just tired of being bitched at at 0130 because I put the patient on 12LPM as opposed to 15LPM via NRB masK, does 3 LPM really make that big a fucking diffrerance really?) Or maybe making out with that cute City officer in the back of the unit while on duty. Again...not hurting anyone, not killing anyone. But still against policy. I just want to come to work, pratice medicine and go home. I don't want to have to worry if my EMT partner is going to try and push Narcan on MY patient if I wasn;t there to stop them or writing evals or having to sit my paramedic crew member down and tell them that this is not how we write our reports here when they have been doing EMS since before I was born. But here I am in charge. Keeper of the keys, overseerer of medic units.

Put my Penis in my Pocket

I yelled at a fireman yesterday. I went all bitch mode on his ass. But it was for a good reason. I was fighing for my patient. I had a bad call. An MVA on a back road. Car wrapped around a tree the only access I had to my patient... the only part I could even see was a wrist. A wrist with no radial pulse. Now the way the car was crushed, mangled around the tree I knew in the pit of my stomach that the person was no longer of this earth. But there was no way I was going to call someone based on just a pulseless wrist. So I wanted the car off the tree. I wanted access to my patient. And I wanted it ten minutes ago. So when the fireman came up to me and goes "She's dead...you got no pulse in the arm. you calling it now? I need to know now before we start pulling on that car and tree" I went off..."I most certianly am not calling based on a pulseless wrist...GET THAT GODDAMN CAR OFF THAT GODDAMN TREE...I need access to my patient, then we can talk about calling...not sooner" I paced a three foot radius around that car for 25 mins while they cut and pulled and yanked the vehicle off the tree. I do not do well with being inactive, with not helping. I'm a paramedic. I am trained to help. I don't watch very well. So I paced, waiting my turn, every so often going "Capt! You got Any activity from the patient?"
"No Baby, Nothing. But I'm still cutting"
"Thats good Capt, keep cutting!"
Then they got it off the tree. A mangled peice of metal. I got access. I was able to pronounce properly. To put my hands on the patient. To see that there was nothing I could do for her.

I broke down later. I couldn't get to her for almost 30 mins. Then I didn't want to leave her.

My supervisor came by after the call to chat. I needed it. I felt bad for getting all bitchy with the fireman. My supervisor told me that being a female paramedic in charge sometime you have to. You have to "Put your Penis in your pocket and fight like hell for the best of your patient, which you did...now you can go away knowing that you did everything you could for her...even if there is nothing you could do for her"

Lessons learned today
You can't save them all.
sometimes you have to put you penis in you pocket...and be a bitch...if it's best for your patient.

I'm being a very slack medic recently

So I have been productive in some aspects of my job and so slacking in others. To be quite honest, my day to day responsibilities, like washing the truck and making sure that we have all six tires I'm slacking. Because who really care how many transfer needles there are in the IV tray. All I really care about is if there is plenty of oxygen tanks to get my through a shift and if the narcotics and RSI drugs are safely under lock and key and tucked away in the fridge. Is the CPAP machine sitting on the actionary and the laptop plugged in in the back...then I'm going to go take a nap. Those 15 reports sitting in my EMSpro box can sit for a few more hours. I haven't worn civilan clothes in a month and a half. I haven't put on lipstick and masacara for two. I Pay rent for an aparentment I haven't slept at since I moved in three months ago. So forgive me if I don't count the 4x4s(If I you are grabbing more than say 6 4x4 for one wound, you need something other than a 4x4 I might add) nor I'm I going to polish my boots...so there.

But what I have been productive in is reasearching Versed as an alternative for Ativan for contolling Seizures. I recently got an order of IM versed for a 3 year old Status Seizure. This is an order I cannot follow becausse per our state I cannot giver Versed to Pediatric patients. After the call I spoke to the doc, some RNs and other medics and most will agree that Versed is becoming the drug of choice for seizures management. Works faster, higher serum levels for longer (meaning it's longer lasting) and ICU admissions post arrival to hospital are shorter. So if it works better, lets change it. I wouldn't mind hearing from fellow medics who use Versed as first line...what are your thoughts...are the studies true? or are they just blowing smoke up my ass.

Doh!

In the immortal words of Homer Simpson, all I have to say for myself is DOH!. Yep that was the statement of the night. we were called to an assault, ended up with a non transport which was good because as we were trying to manuver the ambualnce through the maze of police cars that lined the narrow winding street we made contact. Actually, let me back up a bit. To when I hopped out of the truck and started toward one of the officers to go "Hey lets move either this car or this car a bit either this way or that way so we have room to get by" Now keep in mind there are like 9 crusiers on this street all with the blue lights flashing and a large group of people all around...and no street lights. So our mirrors are useless...we can't see shit. While I'm talking to one officer another is guiding my partner from the front of the unit through the maze. He forgets that we are much bigger than a Crown Vic. Wider. With a very large box. So I turn around just in time to see the back corner of the box crack the headlight of a police car. What's even better is that the cop that was spotting us, that was HIS cruiser. My partner didn't find the humor in it. I, however, thought it was hilarious. I mean if you can't laugh at something like this, what can you laugh at. he guided an ambulance into his own police car. Comeon! That's funny. EMS comedy.

So there we sat for about two hours waiting on the sheriff's office to come to do the traffic report. No big deal. Kept us from running sick and stupid calls for a while. I could use the down time.

What have I told you people about lying to the medics?

I've been getting these weird calls in the middle of the night. Last shift was the assault that we thought was bullshit drunk guy that turned out to be bleeding internally going into shock guy. This shift was it was running from the cops got tased refused to sit up and talk to us guy, but not because he was that beligerant, but because he had a blood pressure of 70/squat and was tachy at 120. What the hell? He was intermitently responsive. The type of resposive that you had to fuck with all the way to the hospital to keep awake, but as long as you kept fucking with him, giving him a good sternal rub or hollar at him when his O2 sats dropped he came right back up to 100%. I did feel kinda bad when I first got him in the truck and kept yelling at him to talk to me "If you can run from the cops, you can sit up and talk to me, quit fucking around" then his pressure was 70. SON OF A BITCH! "What the fuck did you take?"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"No really, what the fuck did you take!"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"How much you been drinking?"
"I ain't been drinking man?"
"yes you have I can smell it, what esle you been doing"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
well knock me over I got a fucking angel in my possesion. So he bought himself a ride to the hospital with bilateral 16 gauge IVs a liter of fluid, some Narcan, and was going to get to meet a bunch of very nice nurses with a very large foley catheter at the ER. I also found out that I am getting very good at sliding in 16 gauges into handcuffed patients. Its a strange angle but it can be done.

With it being so hot here are some tips from your friendly paramedic. Because I don't want to pick your ass up.
1.Stay in the AC
2.Stay in the AC
3.Stay in the AC
There's plenty of Law and Order reruns on to enjoy, there is no reason to go outside in this heat, to run, play tennis, mow the grass or really do a damn thing
4. if you must go outside, you crazy bastards. Drink water. not Budweizer, not PBR, not vodka, WATER. or gatorade is fine too or my personal favorite, Revive VitaminWater.
5. Wear light cothing, both in weight and color. This does inclued the lowcountry favorite of searsucker. I didn't say it had to be flattering.

If you becaome unresponsive, stop sweating and your temp gets above 103 you are offically in need of my assistance. And I will be glad to come and get you but I do reserve the right to fuss at you if you do not follow the simple steps listed above. Because it's your own damn fault.

Balmy nights makes for miserable Medics

Hot, humid nights brings out two things here in the south. CHF and assaults. It was 93 degrees last night with 110% humidity. The air was also very still, nights like this are more bearable with a sea breeze, but last night there was none. So the sweat just sat on your skin. It made all who worked last night move a little bit slower, almost as if the air was so thick held us back. It also make people more mean I think. We got called to a stabbing. No when we got there, it was not a stabbing, well...it was, but it wasn't. He got cut with a knife and had an avulsion on his finger. Now it didn't raise flags when we saw him and he was all sweaty, we were all sweaty. It didn't raise a flag when he was slightly altered, he reeked of ETOH, it didn't raise flags when he kept saying he was thirsty, it was hot, he reeked of ETOH, and to be honest I was wicked thirsty myself. It even didn't raise flags when the blood pressure on the monitor said his blood pressure was 60/30. That damn thing had read a correct blood pressure all night. But when niether me nor my partner could find a radial pulse nor ausultate a blood pressure for ourselves was when we both looked at each other and then at the cops that were standing outside of the back of the truck and say at the same time "Fucker's actually sick!" I put in a 16 ga IV and threw him on a high flow oxygen my partner gets an 18 ga IV and gets him on the EKG (tachy as hell at 130) and We haul ass to the trauma center. He kept saying he was beat with a board in the abdomen (again no flags raised because ADB was soft, flat, non distended) But sure enough, according to the FAST scan at the Trauma Center he had a large amount of blood in his abdomen. I don't know how it works in some systems, but in mine we can, if they don't meet transport criteria, choose not to transport. The finger injury alone does not meet transport criteria. But the altered sensorium 2nd to what We initally thought was ETOH (which did in fact turn out to be shock) did. So you can say, being drunk saved his life.

The other thing we look fotward to on these balmy nights is CHF. This weather really exacerbates it. We gave over the night, 200 mg of Lasix, CPAPed just about everyone who got into the back of our ambulance, and gave more Nitro that even we of that bitter/ sweet orange nitro smell that all medics should be very familar with. I also went through the supply reqs for the night when I restocked after my last CHFer, and every single sheet listed the same thing Lasix and CPAP circuits. Every single one. Thats was all we did last night. But at least it is easy one you get it under control. It's just CPAP, NTG, and Lasix...CPAP, NTG, and Lasix...lather rinse repeat...

I'm afriad of horses

I'm afraid of horses. Really afraid of them. I never thought this would be a problem until last night when we had a potentially violent psych patient who was being taken care of by two mounted police officers. As we pull up my partner says to me, "Hey, look B, the horse cops are here. I didn't know they came this far up into the ghetto" Neither did I. I just looked at him and said what I thought to myself was "Okay, you can do this, just get out of the truck." Apparently, it wasn't to myself. "You are afriad of horses?!?"
"Uh..No...Yes...well..."
"Jesus, sit here, I got this"
"No..No. I'm not gonna leave you hanging, I'll be alright. I'm just gonna stand over here behind these other police officers across the street from the big scary animals. I got your back if you need it."

Then my partner and the other officers started cracking up. Glad I could be more entertaining than the crazy person who thought he was God.

Promotion

Well it's offical now. I am no longer an "acting" crew cheif. I have offically earned my Sargent stripe, whicch means I have gottan a pay raise, my own truck and the ability to say to pateints that don't meet our transport criteria that they can get the hellout of the back of my ambulance because there is no way I'm taken their dumb ass to the hospital for a broken toe. It also means that I have to keep up with the keys to the controled meds (I can barely keep up with my car keys what the hell are they thinking giving my the keys to the narcs), make sure my very sweet, but very green partner doen't get himself killed because he keeps getting out of the truck on the interstate without a traffic vest, and figure out how the hell I am supposed to get the 400lb inablilty to ambulate down from the third floorto my awaiting truck in the driveway. (How did you get up here, you're on the third floor?!? Why didn't you stay on the sofa in the huge open living room right by the front door?) Actually, it's not a bad gig. I learning to like being in charge. As a crew member, you can't really say much. You just take it. But as a crew cheif, if your CM gets out of line, you can take thier radio from them. Only letting them speak on the radio when you tell them they can. And when working with ParaGods, you can put them in their place if need be. Teach them they don;t know everything and when to ask for help is not a sign of weakness or stupidity. It's just smart sometimes.

HAHAHHAAHA!

This is...well listen...
http://gprime.net/flash.php/llamasong

had to share, welcome to earworm hell

Angel of Death

Angel of Death. Dr. Death. Double Oh Seven. These are just a few of the names I have earned because of yesterday. You know when you are on your third uniform, you have had a bad shift. When you come home wearing you bunker boots because your work boots are soaked through with blood you have had a bad shift. When the Fire Dept keeps a tally on how many full arrests you have worked you have a had a bad shift. Two full Arrests, One traumatic Arrest (GSW who bleed 2 units of blood all over my boots), and six DOAs (one Nursing home and 5 from a massive 4 vehicle MVA that burned up) is the offical death count. Tweleve calls in 24 hours. The AutoPulse batteries didn't even have a chance to charge back up. The Monitor batteries also didn't have a chance to charge. And of course the AC goes out in the box and of course its 122 degrees in the shade and OF COURSE it was 100% humitiy. Oh and the memory card from the monitor was lost along with my cell phone. Its been a bad day. Fucking Friday the 13th.

But I'm home now, with three days off. I have a big glass of wine. And I'm going to bed.

Babies and Social Work

So our EMS family got an addition last night. A Baby Girl. Pretty Little thing, (5lbs 9oz) with a pretty name of a southern belle, Grace. Now most day old newborns, I must say are pretty funny looking, all wrinkled and weird shaped heads. But Grace..Little Grace is beautiful. She had a whole paparazzi waiting on her. Kid's gonna have to get used to flash bulbs, being that this paramedic "aunt" is a photographer in her other life.

Today was Social Worker day. I was more of that than a Medic today. No life saving, just getting the gears in motion so that my patients today could get the help they so desperatly need. Terminal Cancer patients shouldn't have to spend the last few months on earth in dirty squalor. Geriatric couples should live out the rest of thier days not having to worry about what to do when they fall down and can't help each other get up because they live alone. So I played Social Worker today. It's time consuming, spending all shift on the phone with the people who help us take care of these particular type of problems.

But, I'm laerning my place in my new role. And these types of calls are some of the most difficult. I can fix Congestive Heart Failure, I can take pain away using Morphine, but these people need more than a paramedic. But we are the ones that start the ball rolling.

Learning Curve

So this Crew Cheif thing is tough. The whole decision making process is tough. The being in charge part is tough. The working with brand new EMTs is tough. Not that I mind any of the things I have listed, just two weeks without a day off makes for very long shifts. I had a few calls that tested me, like the syncope I went to who done fell out in the middle of the street. When we got her in the back of the unit and hooked up to the monitor, she was in an accelerated Junctional, then her heart just stopped for like 3 seconds, then one complex, the another 3 second pause then converted to just a regular junctional. Mind you she was CAOx3, vitals better than mine, and compleatly pain free. Her only complaint "I'm just dizzy" So we took a ride down to the ER where she never had an episode like that again. I did nothing for the woman other than IV and O2. She was more stable than I, so why fuck with something if it's fine, right? Thats how I justified it. Plus we were litterlly 3 mins from the ER. Had we been further I might have put the TCP pads ON her, you know, just in case Then there was the status seizure who I tried IV lorazapam, line infiltrated and I sat for the rest of the transport trying to figure out how to get the drug out of the vile to give it IM. It was one of those things that you don;t think about until you are sitting there going "I know there is a way to get this out, why didn't I ask my FTO. Damnit" Well, the pt still breathing, and thats what matters, a breathing, circulating patient is just fine. Its when the air quits going in and out and blood stops going round and round do I really worry. From what I understand this man spends most of his life in one long continuous Seizure.

So it's all a learning experience, every call prepares you for the next. We work unsavable full arrests so that when that one savable one comes along we are confident in our treatments. Everyday we learn something new, even if it is something as simple as figuring out how to draw out the lorazapam into a syringe, or something as complex as figuring out a dopamine drip or RSI algorhythm. We practice so that with the next one we can go without pause. Everyday I figure out something else that makes my job easier, makes me even treat with thinking, just doing, and doing it correctly and quickly. Makes it easier to save that one. To be able to go, he's alive because of what I did.

Moving on and moving forward

It has been a rough week. Well two weeks for me, this was day 14 of a 14 day stretch. But this past week especially bad. Driving past all the Fire Stations, seeing the bouquets, the signs, the letters. It make my choke up every time. I even feel bad calling for Fire for man power, or for a driver. I just want to leave them be to grieve. But alas, life must go on. It must move forward. Their will still be fires, paramedics that need help, and patients and citizens that need them. So we grieve this week and start to move on slowly the next week. We can't be sad forever, we must think, they lived and died doing what they love, what was in thier blood to do. You don;t become a firefighter because the money is good or because you like how you look in the bunker gear. You do it because you are made to do it you bleed fire.

Alright enough about that. I was promoted this week also. They handed me the narc keys and told me to go forth and pretend I know what I'm doing. 80 percent of this job is making educated guesses and making it look good. You could have NO idea what is wrong with you patient, but if you make it look good and keep your cool ( and know when to ask for, or call for, help) nobody will ever know, right? I learned how to deal with a difficult partner on a multi patient, multi trauma, very bad MVA (and patients that don;t speak any english on top of it all). Apparently, you threaten to take away said partner's walkie, as they continuiosly kept screaming on the radio before you (as Crew Cheif) could even get a bairing on how many patients, what Category the are and how many more units you need. (The answer is 3 patients, 2 CAT2, 1 CAT3, and two more units.) The following two day were better, as yesterday I had a very green, but very competent EMT, who is so set on doing the right thing, asks permission to do everything. A nice change from the day before. Not that Im on a power trip or anything, I just need to keep control. It's my scene, it anything happens, it's my fault. I'm the grown up.

Moment of Silence

Please take a moment today in remeberance of the nine City of Charleston firefighters who lost their lives in the line of duty tonight. Thank you.

Okay...not a Failure

Okay Okay Okay...I'm not a failure. I passed. I actully passed. They are now putting me in charge of an ambualnce for a shift. And I passed with an 80 freaking 7.5. Who knew? Damnit. I happy I guess, scared outta my mind. What the hell am I supposed to do now? Someones life could very well be in my hands. Oh and I'm moving to 12 hour DAYS. Sunlight makes me melt, I say! My brain can't work when it's light outside. Son of a bitch!. Oh well, I'll take a good partner on a bad truck over a bad partner on a good truck anyday. So this is quick a sweet, but I have to go. I have a 48 hour shift ahead of me.

I'm a Failure

Well, I did it. I finally took my Acting Crew Cheif test today. And to be quite honest, I probally failed. Not because I'm an idiot, but because the questions were off the wall policies and procedures that I don;t know off the top of my head. I know where to find them if I ever need them, like the 10 contraindications for thrombolic therapy in a acute Myocardial Infarction patient. I personally don't need to know what they are. We don't give tPA in the field here. But I would have to know them by the time I encode the hospital, which gives me plenty of time to look them up in my field guide. Same goes for the pediatric dose for an epinepherine drip in a bradycardic pedi or if and when we are supposed to ever transport a DOA (they ain't getting any deader, so again I would look it up in our field guide, or just call a supervisor and go "Can we transport this DOA?) I know the doses for all the drugs in our RSI protocol (1.5mg/kg for Lidocaine and the Succs. .3mg/kg for the etomidate) I know that we need online med control for Dopamine and our controls. Athough, Ativan we can give up to 4mgs on standing order if the patient is activly Seizing. I know that any patient complaining of Chest pain, regardless what the 12 lead EKG shows, gets Oxygen, Nitro, and Asprin. And possibly Morphine if the Doc will let you. I know that CPAP has to stay on the patient so you don't cause flash edema. I know that D50 in administered in a patent IV line as to not cause necrosis. I do get slightly confused mixing D12.5, but help is just a radio click away really.

I also know the proceduere if we break or lose a vial of Morphine...or if we wreck the truck...or what to do if a monitor, drug/ airway combo bag, 4 nasal canulas, a laryngoscope handle (why just the handle?) and 3 D-tanks of oxygen gets stolen from the back of a unit while on a respiratory call in the ghetto. The answer to all three of those questions is "Call a Supervisor"

But, still as ready as I think I am to be putin charge of a truck, I still have to pass the test. Which I don;t think I did this go 'round. Damnit.

Oyst P R

Oyst P R
Originally uploaded by artist in the ambulance 190.

Ark Drive In

Ark Drive In
Originally uploaded by artist in the ambulance 190.

It's too damn hot for me to care

I didn't relize how long it had been since my last post...So here goes. Alright, so I've been moved YET AGAIN. This time to the opposite end of the county. To a fucking hell hole of a truck. I hate this truck. Its busy, the station's too small for the FD and EMS that live there, it's way to busy in the summer, loud, the people in the area are pretentious snobs, oh and it's fucking busy. We ran call after call after call. And because I'm on the truck for my Acting Crew Cheif training it means that little ol me gets to run all the ALS calls. Which is 90% of the call volume. We had 12 calls yesterday, 10 of which I ran. 9 of which were because it was 112 degrees outside and people think drinking several cans of PBR is a perfectly good and healthy way to stay hydrated while mowing the lawn at noon. Everyone was passing out and had a systolic of 70. Oh and apperently it was also moving day for the whole goddamn county, which people also kept hydrated with Budwiezer. I felt like I was working on the surface of the goddamn sun. I lost 10 lbs just sweating. I was a pretty sight when I got off an hour ago. And the smell, oh my, ripe. But I have since had a shower and am about to go to bed. Fucking people.

Then there was the crazy ass woman who passed out, who hit my partner, who grabbed my ass while yelling at me to "Don't you fuck up my wig! This is my good wig!" The mid sentance passess out only to wake up again and finish her thought. She told me about riding along with the narc team with the local PD. "We busted up some college kids selling dope" Jesus help me.

Well thats all I got, going to sleep. night.

Okay, now I'm just rambling...

Well, I slayed the monster. The headache/ migraine from the devil himself ended yesterday. No more laying in the dark, moaning. I would like to thank the ER, my primary care MD and dilaudid for the help. I was beginning to think I was never gonna go away. I have had migraines for about 8 years now and that was by far the worst. Mostly because the damn thing would not go away. But anyways on to better news.

I move in two weeks! Yippie! My new home is this awesome old house in downtown. Walking distance from everything. Bars, restaurants, little shops, even the medic station. Which is great now that gas is up to 3 bucks a gallon. It is on the Historic Registry, build around 1801. I'm wondering if it is haunted. My new roommates seem great, laid-back people. And the room is freaking HUGE. Its got 12ft ceilings, windows that go almost floor to ceiling, and a fireplace in the bedroom. Non working mind you, but still a great little design feature. The one and only bad thing I can find is there is no real closet, just a bar in a little indentation in the corner. But that is a small price to pay for an otherwise wicked cool place. I have my boys and their trucks lined up for moving day. I am counting down the days.

Work is pretty slow these days. I'm out on the island. Spend my day sleeping and my nights watching Futurama. I have a chill partner, who is funny as hell. Doesn't get worked up over anything. Which I find makes all the differance when you're out in the middle of nowhere. I worked out on the east end of the county once, also in the middle of nowhere, with a partner who I had absoulutly nothing in common with. And it was in a one room station, with no internet, no where to escape. Now that was a hard six months. But this time, I like the guy I'm working with. We listen to the same music, we will chat about photography (he shoots too), sometimes we drive around our district , stopping at old churches or farms so I can snap off some photographs. He will sit and watch cartoons with me in the morning while we eat our oatmeal...or grits. He tells me about his wife and kids, who from the stories seem to be as much of a trip as he is. So, yeah, I like working out there with him. Plus I can work an ass of overtime, then go out there and sleep off the night in the city.

They are still pushing me to get my Acting Crew Cheif. I'm fighting as much as I can, but it seem to be a losing battle. It's not that I don;t think I can handle the medicine. I can, I am a good medic. It's just I don't want to be in charge. I don't have good managing skills. I find it difficult to sit someone down and tell then why they suck. I also don't deligate very well. I just feel I can do it better myself, than to have to explain something to someone. Or tell someone what to do. I know thats how people learn and all, but I feel I'm just as capable to re-stock the truck as my basic partner can. I hate telling people what to do. I'm just not that kind of bossy. I mean I can tell my friends and family what to do all day long, but a co-worker, a partner, it's just diffrent somehow. Plus, I don't want to have to write evals. I know I'm not perfect, so I don't want to have to point out someone elses flaws. I'm just too nice when it comes to things like that. Even in photography school, when we would do group critiques, I was the Paula Abdul of critiques. Even it the photograph sucked balls, I never could say that. I always said things like "Well, the lighting in nice" So, Im fighting the powers that be. I'm quietly refusing to take my acting test. I will continue to fight it until they either pushed the test into my hands or they threaten me.

The Monster in my Head

I think I'm dying. Well, maybe not dying. But, close. Since Friday afternoon I have been fighting a migraine. I get them occasionally. I take my Maxalt or my Imitrex, lay down with a cold compress for a few hours and they normally go away. On rare occasions, this doen't work and I make a trip to the local ER where I get a small dose of Dilaudid, that normally knocks them out quickly, never to return. This time however something is painfully wrong. I have taken the Max dose fo my Triptans (300mgs every 24 hours) for three days, Alernating Advil Migraine and Excedrine Migraine every four hours. I have made two trips to the ER, one trip to my Primary Care MD, got two doses of IV Diluadid in the ED and a script for 4mg PO Dilaudid from my Primary and the monster is still raging. The whole right side of my head is ripping open. So here I lay, in the dark, stoned on painkillers wishing for either my head to crack open to relieve the pressure or for the narcs to kick in fully so I can just sleep. Sleep would be good.

Status migrainosus is what it's called. A drug- resistant mirgraine lasting longer than 72 hours. I googled it. A rare species of Migraine who is a particularlly nasty, mean little bastard. The little fucker has caused all kinds of trouble this weekend work-wise, money-wise, health-wise. I had to leave work, forcing somebody in. Which I HATE doing, because it sucks being on the receiving end of that phone call with a Supervisor going, "You have to come back in, someone's called out sick" and it really sucks when that sick person works on an outlying truck, an hour from anywhere, and it's 4 o'clock in the afternoon. Thus, making you drive out there only to be relieved in two and a half hours later. This has also caused all kinds of finacial issues because each ER visit is $150, then $25 for my doctor visit, another $8 for the RX, then $50 more on Thursday when I go see my Neurologist, who will probally give me new abortive and prophylaxtic meds. So even more money because most Migraine abortives are band name only, there is no generic form of Imitrex. And of course, being that I work in the medical field and that I watch way too much "House" I have all these thoughts of "Maybe it's a brain tumor" or "Maybe its a AVM" or "Maybe the kid I took care of a week ago with a fever had bacterial Menigitus" or "Maybe it's a rare African parasite that crawled into my head through my nose while I was sleeping and it is now snacking on my brain" or Maybe it's just a fucking Migraine. But whatever it is, It's not going away. So here I lay, possibly dying from a rare African parasite, who I have now dubbed "Bang Bang" after the way he makes my head feel, missing a TRMT knot-tying class that I need to get into all the rest of my Confined Space and High Angle Rescue Classes from the Fire Academy.

!@#$% You Drug Companies

Been working my fingers to the bone recently. My normal shift is 36 hours right now. Sounds alot worse than it is though. It ususally goes I work the first 12 on a busy urban truck, run 9-12 calls then I travel almost 40 miles out to the islands run maybe 2 calls in the last 24 hours. So sleep is easy out there. In fact yesterday I ran one call then we made it back to the station where I then slept until almost 2030. So no case of the poor mes. You alsmost feel bad taking the systems money, getting pain to sleep and all. Almost. Then you remember what EMS stands for. Earn Money Sleeping.

Quick change of subject...this is something tah really chaps my ass...

I have Asthma. I take Albuterol. I get two MDIs for 6 bucks. Well... I used to get two MDIs for 6 bucks. I went to get my refill the other day and apparently they changed the canister that the inhalers come in. Changed the propellant or something. My new inhaler was 52 bucks and some change. "52 Dollars?!?" I said the the pharmacist. "52 DOLLARS for ALBUTEROL!?! Are you high? Have you guys been snorting the Vicoden back there or something?" My brand name Migraine meds are even that much. This is for just plain ol Albuterol. I refused to pay it. I still have a puffer thats about half full. I'll suck that thing dry before I pay that much for what should noramlly be a very cheap drug. It's cheap like asprin's cheap. What the hell is this world coming too that I, a hard working American, who works in healthcare, who has great health insureance otherwise, has to pay 52 dollars for what any Medicaid recipiant can get for less than $4. But I digress... Just because Warrick Pharamaceuticals is "going green" with some new fancy propellant, they think they can rape the American people and charge this obscene amount for what is a life-saving drug. This is no Viagra. People who use Albuterol use it because without it their airways tighten up and they could die. It's not like the asthmatics of the world can go "Fuck You Drug Companies, Shove it up your assess HMOs, I just not gonna take it, see how you like them apples!" Because they would be doing it while on a ventilator. And as dramatic as that would be, it's nearly impossible to talk with a tube shoved down your throat. So we can only do one thing and pay 52 dollars for a MDI, or 85 dollars for Verapamil (a cheap Calcuim Channel Blocker used to treat hypertension, among other things, like my migraines) or 120 dollars for 8 pills of Imitrex a month. (yes, That is what they wanted to charge me for my Migraine RX before I paid my annual $100 deductable, which is also insane, but again I digress) It's not fair. I already pay almost 90 dollars a month for health insureance. I pay my deductables and co-pays. Why is it now I being made to dig deeping in my pocket for my medications that I need to survive. Are these drug companies not getting enough of my money.

Girl...what you call your Husband?

We were busy little things. Running all over the city, picking up people from all walks of life. Okay I lie, it was only one kind of walk, the downtown ghetto pimp walk. We had psychs, we had diabetics, we had diabetic psychs, we had people just making shit up for a ride. And I got hit on twice and one marriage proposal that went a little something like this...
"Girl. What you call your husband?"
"I call him Officer.
"For RRRREAL!"
"Yeah, for real."
"Girl, you tripping. Where's yo ring?"
"Man. It's diamonds and platinum. You think I be wearing it to work? You crazy."

I was actully suprised the man took a gander at my ring finger and the fact he knew which finger to look at. I wear a silver ring on my right hand, he knew to check the left. Even though the drunken haze he was fairly observant. Too bad he couldn't tell me what happened to his wrist. "Man I broke or sumpin." Genuis. Then there was a schizo diabetic who would hollar gibberish at the top of his lungs unless I I spoke to him. Then it was "Yeah darling whatever you want, you gots a purtty smile" The cops loved that. We saw one of the officers later and he kept saying "You gots a purrty smile, what you call your husband?" I call him "Doctor" officer. I told my mom who was working at the ER tonight about my sorted adventures with the city crowd and my marriage proposal she asked what kind of fantasy world did I live in? All in a days work I guess. Man. I love the city trucks, you get to meet all kinds of people. Tonight will be my last scheduled night on a city truck though. I get shipped off the the islands for a break, even though I just got back on the truck and don't need a break. But whatever I go where I'm told.

Sleepy...

Brutal, fucking brutal. I forgot how bad a 24 hour shift is on 12 hour trucks. (just for those who don't read regularly we have 12 hour shifts in the busier parts of the system, and the norm 24/48 hour shifts in the slower parts) We are so short-handed that we sometime work up to but not exceding 36 hours on the busier 12 hour trucks. (Yes, we do get shipped off to slower outlying trucks to try a get some rest if you are on a 36.) Most of us are used to the long hours of runing and running, but I, my friends, am a bit out of practice. this was my first long shift since comming back to the streets. My body aches, my foot hurts and I am getting ready for bed. One more 12 hour shift tonight, then a long three day weekend that is well deserving. Lckly I have a paramedic partner who can help pick up my slack (We run a ALS on every truck, SInce I am still a crew member I will always have a Paramedic Crew Cheif) Also Luckly, even though it was busy, it was busy with alot od crap calls. Nobody dying, nobody in dire need, Nobody really in need of an ambulance. Just some sick party calls, some ETOH over indulgence, and some non cardiac chest pain. I started IVs because the hospital like them, not because the people were truly dying. I did 12 leads because I was told to, not because anyone was having an active MI, I gave O2, not because anyone was Short, but because it comforted and calmed my patients. I gave Morphine to ease the pain of a very angulated ankle, but it was more out of kindness and comfort, than nesessity. But now, I am going to bed only to get back up in 9 more hours to go and do it all again tonight. But fear not citizens, we are used to it.

Eh...

Run...Run...Run. Thats what we did all night. We went from assault to assault. To CHF then to Asthma. The more assaults. Man I don't know what was going on but people just felt like beating the crap outts each other last night. Nothing serious, mostly Lacerations that might have needed a few stitches... but still. Alot of ass kicking going on for a Monday night. Everybody seemed to have a case of the Mondays too, I got cussed at twice, swung at once and restrained one guy who tried to eat my fingers off. Crack is seriously wack. Oh and we went to this one house because her Imagianary friend was having shortness of breath. (Yes the same one who's other imagianary friend was stabbed a last week, he must have notof made it) But this time, knowing better, we didn't go hunting for 45 mins like we did last week.

I'm gonna end today by saying my heart goes out to all of the students, faculity and families of VT. I don't know you, but you are in my thoughts today... And to the first responders...You did good work yesterday. Medicine in the streets is hard enough when you don't know the people you are helping. I can only imagine what it must be like to work on fellow classmates, friends.

Blegh! OKAY I get it.

Learned two very important lessons last night. One of which that should be taught is every paramedic school everwhere. Narcan causes, no matter how slooowww you push it, Exorcist type vomiting. I knew it could cause vomiting because that is listed under side effects in the formulary, but what it should say is May cause vomiting that will put your unit out of service for 45 mins and need a mop and a hose to clean up thats what it should say. I have never seen anything like it. It was one the ceiling. Dripping like some brown alein goo you see in horror space flicks. And the second lesson is if you sit on the ambulance bay for long enough outside of the Level One Trauma Center, bloody stabbing victims pull up in POVs causing you to get yet another clean uniform bloody. I had just taken off the vomit shirt. Damnit. Luckly, it was just a little bit of blood and peroxcide got it out, but still. I also have a deep seeded aversion to feet. It goes back to when I was a brand new ER tech, and not knowing better pulled the socks off a homeless person c/o feet pain. With the sock came off three necrotic toes. Since then I don;t do feet. I'm not gonna touch yours and you're not gonna touch mine. I don't get pedicures and my orthopod thought this was hilarous. (He said I was the only patient's he's ever had that he couldn't do a compleate physical exam on because he thought I would freak out. I told him I wouldn't freak out, but make the exam quick) But We had not one but three patients with necrotic diabetic feet. I made my partner ride them in. I couldn't handle it. I said I would take the next five intoxicated assaulted college kids and/or smelly homeless if he would ride in the feet. Thats how bad my Feet Aversion is. Seriously.

Well lessons learned. Add that to my growing list of "Things Every Paramedic should Remember" Right above, push Lorazapam slow and keep a BVM near by, just in case your patient goes apenic. (Yep, learned that one the hard way too)

First Night

First night back after 5 months of recovery. Foot held up nicely. Only needed one dose of Aleve to calm the screaming bones, and only limped a couple of times, mostly when we stayed still for longer than 30 min. Took about 10 min to work all the kinks out. Which was well, twice in 12 hours. Had 8 calls and one wild goose chase though an apartment complex looking for what turned out to be an imaganary friend of one of the residents. The voices in her head told her that someone had been stabbed. It took 45 mins of looking for this person before us and PD figured it out that she was basicly talking to herself. Ah the joys of urban EMS. I slowly caught on the the new ways the radios worked (we went to digital 3-4 months ago) and working the AVLs. I figured out very quickly that I need to build my muscles back up when I tried to put the stretcher back into the truck fully loaded with a 300 lb patient. And I also need to clean up my now rusty IV skills so I don't turn my poor patients into a human pin cushion. (I did get one, and he was a tough stick) But everyone was right, it's like driving a car (or riding a bicycle) you don't really forget. You just are out of practice. But... I still felt like a new EMT. I drove a bit, running code once or twice, trying really hard not to throw my partner around the back. All and All an pretty tame night back. Now I'm off to bed so that I can do it all again tonight.

I get to go back I get to go back

Well thank god. I walked into the doctors office today will all the hope of a kindergardener on the first day of school. Hope that I can go back to the ambulance. So I waited quietly of over an hour in the waiting room. Then was brought back and the nurse said "he's a bit backed up" Really, no way, I thought I was just sitting in that room with all the other patients for no apparent reason. But I kept that thought to myself, because I am a sweet, nice person damnit. SO I waited a bit more in the room and the Doc walked in and before he had even shut the door I go "It's-nice-to-see-you-can-I-go-back-to-the-streets-now? My crackheads need me."
"You want to go back to being a street walking crackhead?"
"Yes Please."
"well you can add that statement to the Words I never thought Id hear my patients say list. Yes, you can go back to being a street walking crackhead"
"Thank You...so this is last time I have to see you ever?"
"yep, unless...when is your next big birthday?
"Well, 30 is in about three years"
I actully will miss the doc, he was one of my favorites. He was kind and had a great sense of humor. And most important right after the whole being a good surgeon, has a wonderful bedside manner. Throughout my whole injury and recovery he spoke TO me never AT me. He explained everything and didn't rely on his residents to carry the workload. When I was in the hospital, he would actully come into the room and explain and answer questions, even if the residents had already come in. It's like he takes the time to get to know who he's cutting on. I think he even came down into the ER before I was addmited and spoke to me, which for an attending to do, is well, unheard of. SO I thank him for being so kind to no only me, but my family. So I will miss my doc. But I hope never to see him again, at least not as a patient.

So Thursday night I go back. Back to the streets I call home. I'll be working the City truck. I think I have even found a new apartment. Downtown apartment, in a huge house. I will have mmy hardwood floors and huge windows and 10 ft ceilings. Just what I asked for. And the people in the house seem cool as hell. So everyone, pray to whatever god your pray to that they find me worthy.

New news

Okay, it was pointed out to me that it has been too long since I last posted, so here is some news. I go back to the ortho-pod on Tuesday. Who told me at the last appointment "Unless you seriously fuck up your foot between now and then, I will absolutly let you go back to the streets..." er...or something along those lines, he might have not dropped the F-bomb, so I was paraphrasing, whatever. So we are looking at the soon-est Tuesday night going back to work, unless I decide to get plastered again and fall down some more stairs. But I think the key to the whole thing was the heels, and since I won't be wearing them anytime soon, I think I'm safe. I survived the past Irish Holiday without an ER visit, so we can rule out the alcohol right? Anyways, I am looking forward to going back to my nights of reaking havoc upon the streets of my fair southern city. HQ is getting a bit...ah...tedious. My job right now is finding lost PCRs (patient care reports, for those who aren't medical) We went to electronic PCRs about three years ago. And medics are a fast thinking, but dyslexic group of people, so they like to transpose call numbers, addresses, times, dates and anything else. So in turn the programs we use loses reports. So I take a list of "Lost" reports which is about 100 calls (You do it by month) and find all the mixed up numbers and street names and fix them so the system can find them. It's like a giant game of Where's Waldo...and it blows. Except when you find one you have spent most of the day looking for. Which you then have 30 seconds of "I found it! I found it!" and then you just go to the next one on the list.

When I go back, I will also have to be Third Person for a couple of shifts. "Not because I'm a retard" as one of my supervisors put it. But because we have installed new AVLs, have a totally new radio set-up (we went to all digital radios about two months ago) and these new Stryker Stretchers that are electronic. Yes, you hit a button and it raises and lowers all on it's own. And the legs raise when you go to put the thing in the truck. And it works up to 700lbs (or 317 kgs). And they changed a few of the standing orders. So It's kinda llike easing me back into EMS. Then I will be on probation for and extra month or so and then I will be able to get my acting crew cheif.

So thats all my news for now.

Rules of a Night Shifter

So while I was sitting cubicle hell today, trying to fight off sleep and my ADD by reading the newest issue of JEMS (Journal of Emergency Medical Services) I can across an article by Steve Berry. For those who aren't familar with the man. He is the man behind the I am NOT and ambulance driver cartoons. (www.iamnotanambulancedriver.com) He also writes a column of JEMS. A humor column dealing with some of the lighter things in EMS...and they include the wonderfully twisted humor. This month's column actully caught my eye because he writes about the diffrence between Night shift medics and how we can be a little bit more...ah...rough around the edges. Mostly because we are sleep deprived weirdos who deal with more drunks, more psyhos, more violence than our daylight counterparts. EMS can be a difficult job, and even more when the sun goes down. We, as Steve puts it, "replace [our] pen- lights with the foot long MagLite, donning bullet-proof apparel, and matching garlic necklace, carrying Taser guns with silver-tipped prongs, recharging [our] iPods, and carrying a coffee mug so dee that it warrants a lifeguard when left unattended" He also explains how the attitude of the average EMS worker changes after about midnight. We may not be as sharp looking, sometimes fairly ragged, espaically if you catch us at the tail end of a 36 hour shift. As we know from my other post, I prefer the night. I am the only one in my circle of "medic friends" All the rest prefer working when the sun is out. I tried to explain it to them once, but it was futile. I think it has something to do with my mom being a night RN when she was pregnant with me, and when I was growing up, and when I started this job. It was the time I got the hang with my mom. Even now, if I work the city truck, we sometime go to the ER she works in and chill with them. The other people that work in the ED don;t mind because as long as we are with them, we aren;t out reeking havok and bringing them patients. And sometimes we even bring them donuts or bus-cuits from the 24 hour Hardee's down the skreet. So like like the night.
Steve Berry also mentions that everyone seems a little more laid back post midnight. oh...and he also has a list of rules that he states should be "posted on the ceiling of the ambulance, above the stretcher" They cracked me up, but are so true. Just ask any night medic so here...I will share...These are his words not mine...although I agree with every single one of them. (esp. rule number 2 and rule numbers 8, 9 and 10)
1. It's past midnight and I am not the same kindly medic I was at 8am, so be nice. I have big needles
2. I may need to examine you, but you..."no touchy" the medic
3. Alcohol may turn you into an idiot, but try not to be stupid
4.You are not Immortal. Beware: Ambulances used to be hearses
5.Don't force us to use retraints. We used to work in the rodeo
6. If you drank enough to require my services, it's not beneath your dignity to have me hand you a wastebasket to throw up
7.By law, you are not allowed to smoke in most public places. So what makes you think I am going to let you light up in an oxygen-enclosed closet on wheels
8. Arriving by ambulance to the ED won't necessarily get you faster service. Welcome to Managed Health Care.
9. If you think I'm tough, wait until you meat the ED triage nurse and hospital security guards
10. Maybe I wouldn't have to cut your clothes off if you had worn your seatbelt
11. Life's not fair. Get used to if. If it were there would not be 2 million lawyers in this town
12. Coming in by ambulance is not a "get out of jail free" card
13. To repeat: I am sorry, life is not fair. If it was, I wouldn't have to be here with you at this time and at this place. So, take responsiblity: Will this be cash or charge?
Taken from: "The Lighter Side: What They Don't Tell You in Medic School; When Darkness Falls by Steve Berry (JEMS, March 2007)

So To my fellow vampires...enjoy the night. Because everything looks to bright in the daylight.

Computers suck

Okay people, So My hard drive crapped out on me. Fuck. So it will be a while until I can post again. Just wanted to let yall know.
****EDIT****

I have been borrowing my sister's laptop. So maybe I spoke to soon. Anyways, the closest place I can get my computer worked on in Savannah, Georgia. You would think a city with an art school, and a libral arts college would have an Authorized Apple Dealer. But...noooo...I have to drive 2 hours away to get my computer looked at everytime it hiccups. Or makes a terrible, horrible, very bad screeching noise that I deduced came from the Hard Drive. So I called AIS computers in Savannah, who I have used before and they are wonderful people, and was told that "Yeah, your Hard Drive is about to kick it, and not in a good way, but run Disk Utility, you know, just in case" So after running the Disk Utility, it told me in big bold red letters "The volume Macintosh HD needs to be repaired" So I guess that means my computer is fucked. But at least it is just the hard drive and it will cost me approx. 220 bones to buy and install a new one. thats 120 for the drive and 100 for labor. I would do it myself, but the only downfall to being a card carrying menber of the Cult of Mac, is that Macs are incredibly hard to fix or upgrade hardware. They aren't quite as customizable after the fact as a PC. Still, not a big enough reason for me to switch. I've seen Vista, I watched it as it gave Mr. Gates the Blue Screen of Death during a keynote speech. So went Mac and never looked back (ha! I made a rhyme...I'm an idiot *sigh*) Now I must go and mourn the death of Mac. I'm wearing all black tomorrow.

EMS! Someone call for us?

So last night I went out with friends for drinks (no broken bones this time). Some EMSers and a couple not. One of the ones who wasn't in public service is acually trying to get on with a local Police department. It will be a good change for him, I think. But he is coming from a 9-5 desk job into a whole new world. So we (the EMSers) were telling him of stories. Some of the more strange things we run into. Now when I say what I'm about to say, It's not in a bad way, but I don't think he has any ideawhat it's like to do a job like EMS or Police work. Being a cop is more than running after people and shooting things. It, like EMS, has mnay diffrent layers for lack of a better word. As they were telling stories and telling him "you think that's twisted listen to this..." I was brought back to my first day as an EMT-B. Small things bothered me Like it really bothered me to just walk into someone's house without knocking. I was rasied in a very southern household where it was just polite to knock. That seemed very strange to me. I got over it very quickly, but I still feel kinda weird opening a door without first knocking. I have learned that it's okay to open the door slightly and yell "EMS! Someone call for us?" And then very quicklt get over what are you gonna see on the other side of the door. Are you gonna see a 80 year old with shortness...or are you gonna find a 400 lbs woman sitting on her sofa buck naked smoking a cigarrette yelling about the Queen of England living in her closet. You just never know.

And as always when one speaks of strange EMS calls the conversation always goes to one place. Things in Orfaces. Eggplants, tabasco sauce bottles, lightbulbs, straight pins, cotton balls, bic pens, you name it, somebody has shoved it up in a deep dark place for various reasons. And you never get a straight story. "I slipped and fell on it". But like any other job, you have to maintain some sort of composure and professionalism. I alway have the same running thought during calls like that ...It embarassing for them....Its embarrassing for them. And I think of something like naming all the Beatles albums in order or mundane things like the recipe for my bean salsa, as to keep me from losing it.

Then there are the heinous scenes, the MVAs with deaths or missing body parts, the homocides, the suicides, the dead baby calls. Too many of those, and one could lose thier mind if they don't know how to approach them. You just go to that happy place in your mind and do your job. You just have to think of it that way. It's my job. It's not easy, but this is what I have choosen to do with my life. You take the good and the funny with the awful and the twisted.
We all have way of dealing with the things that we see. Some go to the shooting range, some run or bike. Some turn to the bottle, whether it be alcohol or pills. I, myslef, shoot photographs or I paint. I go behind the camera and with every click of the shutter I let a little bit of all those fucked up emotions go away. But one thing should be the same for everyone. You need an escape from it. This job can kill a person if you let it. You have to grow a thick skin and an even thicker psyche.

Gerber Daisy Sepia I

Gerber Daisy Sepia I
Originally uploaded by artist in the ambulance 190.

Gerber Daisy VI

Gerber Daisy VI
Originally uploaded by artist in the ambulance 190.

Gerber Daisy sepia III

Gerber Daisy sepia III
Originally uploaded by artist in the ambulance 190.

My very good friend K. sent my flowers the other day. Gerber Daisies, which are my favorites. I was having a cruddy day. But she helped make it so much better. It was kinda funny, I had this big bunch of flowers on my desk all day. And everyone who asked who sent them my reply was "A friend" and why they would ask next " Just because"

They really should have naptime

I'm reverting back to my old habits a little bit too soon. I was doing really well going to be at a resonable hour back in January, but now...now my bedtime is getting later and later. I think my body's trying to tell me something. Like maybe I just can't operate in a 9-5 world. We all know by now, I am a night shifter. I prefer the dark as opposed to the sun. I have very fair irish skin, what can I say, the sun burns. It was something ingrained in me as a zygote. My mother worked nights when she was pregnant with me, so I think it totally screwed up my circadian rhythm for the rest of my existance. I'm going to blame her. But I don't mind except at 0830 when I have to try and function and not fall asleep at my desk. And I am working on the always exciting bill codes. Isf they would let me I would totlly work 2030 - 0500. My mind works better at those hours, plus there is less distraction in the middle of the night. And if there is something I don't need its any more distraction. The shiny things on the supervisor's desk I sit at provides me with enough of that. Anyways, I am reverting back to the staying up all night...I try and get into bed by 2200, but I tend to lay there staring at the ceiling until I get bored with that and open my laptop back up and internet for the next couple of hours until about 3 when I finally doze off only to be awoken at 7 to get ready for another exciting day in cubicle hell. All the while I'm at work I keep thinking "I wonder if anyone would notice if I crawled uder the desk and took a nap?"

I need...

I had a friend of mine today say "You're one of the only girls I know that actually misses the work" And I said to myself...I says "Self...Only six more weeks. And then I thought...You spend 8 hours a day 5 days a week in a sunless cubicle, staring at the walls and a computer screen typing in DXs and ICD9s, who wouldn't miss the street?" Right? I need the streets. They are my life. They are a part of me. I feel the need for drips and drugs boluses. I feel the need for blood and guts and Chest Pain and Shortness...I need gunshots and MVAs. I need retarded drunks argueing with me about taking them to the hospital. I need to be able to yell at the stupid DUI kid who just slammed his car into a pole and who has the audacity to call me a bitch. I need precordial thumps, cardioversions, Radid Sequence intubations and needle decompressions. I need to look death in the face and go...HA HA not today you sick bastard! Your not taking him today! I need my old life back. I'm sick of looking at ICD9s and choosing between ALS1 rides and ALS2 rides.

I dream of the day I go back. I miss it. I feel kinda useless. But I am healing. The healer is healing. so I will continue to heal until the day the orthopod says to me "B- you are ready, go forth...save the crackheads; save the sick...save the stupid."

Six

...Six is the number of the day. I went to my wonderful orthopod today for me post-op exam. The good news is I'm healing quite well despite my best efforts. I'm wearing two mathcing shoes. I do have a slight limp, which is slowing becoming less and less. I have alot of pain at night after being on my feet all day, all of which is normal after... lets count... 5 fractures of my foot. The bad news is he wants me to heal for another Six Weeks!. Six. So April is when I'm looking to hit the streets again. I completly understand his line of thought though. I would rather go back a few weeks late, than go back to early and reinjure my foot. I had a very impresive injury. ( a lisfranc fracture, three metatarsal neck fractures, and a Jones, or Dancers Fracture) But six weeks more in cubicle hell is a long time. I miss my crackheads, my gunshots, my CHFers. But healing is what I'm doing now. He told me if I didn't do what I do, I would be back to work in a week, but because my job intails being on my feet for 12 hours, lifting up to 80 lbs of gear up and down stairs and possibly running for my life when the crackheads start shooting at us, he would rather be safe than sorry. So here I am, six more weeks doing ambulance billing. Which I am happy to do, they didn't have to give me that job. I could just be on LWOP. But still...it kinda sucks. But I'm healing, slowing but steadily.

New post.

Well, first I'm going to apologize to all of my faithful readers. I am sorry I haven't posted in a while. Been busy, I'm moving this weekend, so between that I being sick, and having my foot cut open to remove the hardware I haven't really been up to posting. But tonight I shall post. Even if it is a completly pointless post.

Well The pin pulling was a success, I am healing quite nicely. It was kinda funny, the anesetheologist who put me under for my first surgery, was also the one who put me under for this procedure. He was going through his shpeal before, "We are going to give you some medicine that will put you to sleep and then we are going to put a breathing tube...blah...blah", when I stoped him and said "I'm a Medic, you can use the big words on me I understand then...so what size tube to you think you will use?..and weren't you the doc that did my nerve block before?" (I'm a 6.5 ETT, just FYI). He then looked at me really hard and then cracked up..."You were the Medic who got tanked on her birthday and shattered your foot weren't you? We still get a kick out of your story. Your fractures were impressive... Yes, that whould be me, I am that girl.

But taody was a big day for me I wore two matching shoes. This is a big deal because for the past three months I have had to wear a big ugly AirCast on the broken foot...but today...TODAY, I wore Both of my Adidas Shelltop Gazelles. Granted one's a little bit more beat up than the other, but nontheless I was still thrilled.

I also pissed off a snarly High School student when I told him that his reason for not wearing a seatbelt was idiotic it is uncomfortable and his brother's, best friend's cousin's life was saved because he WASN'T wearing a seat belt (Thats a really stupid thing to tell a Paramedic who in five years has never cut a dead body from a seatbelt, but has on more than a few occasions scraped dead ejections from the asphalt, because they were not wearing one...it was like when I was told by a HS student from the same HS that drunk drivers are more careful drivers because they are intoxicated, someone explain that logic to me)

Okay, well thats enough for me tonight, I must sleep, tomorrow I have to help test 20 or so EMT's for the 4 open EMT slots for my system. A...A is for Airway...right?

Pin pulling party

Tomorrow is the day. The day that I have been waiting for for almost three and a half months. Since that fateful fall from grance. No thanks to a bartender and two bottles of a really good spanish wine. I get my screw and last pin removed from my foot. The pin by the way that has almost made it's way to the outside of my skin. gross. But yeah, they come out and I will be able to wear real shoes again. Maybe not black patent leather three inch Steve Maddens, but shoes. I should write a letter the the Madden company though and tell them that even after a fall from three flights of stairs with three shattered metatarsals, a Lisfranc, and a Jones fracture, the shoes remained unscathed. He makes a damn sturdy shoe. Beautiful and tough little things those heels are.

Fallen.

We had a police funeral today. Not a line of duty death, thank god, but he was a well known and well liked officer, not just by his fellow officers, by other public servants. He was good to us, and he will be missed. I only knew him through work. Would talk on scenes, joke, you know normal stuff. I don't have a whole lot of stories like some of the people who knew him very well. But still...he was one of us.

So I don't know how many of you have even been part of a Police funeral, by it is a sight to behold. The city really does shut down. They closed down the main street in front of the church. All the officers lined up at attention in thier dress blues. We also had about 20 medics lines up behind the officers. Then came the rumble of the motorcycles (the officer was a member of the moto team), officers from every juristiction. The drove in front before the casket, with the officer's police crusier behind them. Then we all filed into the church. After it was over there was a motorcaid that stretched across the Connector in to the Island. Just a line of blue lights that strtched on for ever. We had five units at the end and there was two fire trucks. We wound our way to the grave site. There we fell into line, again behind the officers in the dress blues. They had a bugler that playyed Taps, and bag piper that played Amazing Grace, the 21 gun salute. That even had me choked up. Especially when they handed the folded flag to the Parents. Then came the 10-42 salute. It was impressive and beautiful. You never want to have to see this, but it is a wonderful salute to the type of officer he was.

Stupid people

Okay well even when I'm not at work I am still witness to the stupidity of humans. SO I was driving home from k's house tonight after Grey's Anatomy... Well actully let me just say this first, It's pouring down very cold rain and it 35 degrees outside...Okay, so...I was driving, sitting at a light on the Crosstown ( a main street that goes from Downtown to the interstate) when I look over to see some totally fratastic dude running down the street in nothing but a show me your vagina Paris Hilton mini skirt. Thats it. Seriously. Thats really all I have tonight. I'm tired and I have to go to cubicle hell in the am.

Sometimes my readers make my day.

I was looking through some old posts today, reading some comments I never saw because the post are so old and I found this gem of a comment. I love it for last two lines.

Anonymous said...

It's 2 in the morning. I am looking for information on croup. My 3 year old has it bad. Trying to decide if we should go to the hospital. Stuck his head in the ice-box. Kinda helped. He's in bed now calmer but kind of wheezy. Scary, don't like it. His name is Joe. He likes ambulances too.

Those last two lines just made me smile. Kids are wonderful little creatures. I don't know how old this comment is, but I hope Joe feels better. Croup sounds alot worse than it is and smart thinking putting his head in the icebox. A steamy bathroom also works.

so yeah...

So everyone has their weakness. Even God-like paramedics, like myself (ha!), have something that they just aren't that great at. We are not perfect creatures, especially after a grueling 36 hour shift. I am not on my A game. At about hour 27 I lose all capacity to form real sentances, it mostly becomes a series of grunts and sighs. But thats neither here nor there. My real weakness, Is math. I just can't ever grasp a hold of it, which in my line of work can mean giving a patient Four mgs of Epi instead of point four mg of epi which can result in the patients heart actually exploding. Now, with that said, I do drug calc after drug calc, I carry a calulator in my pocket at all times, along with a whole notepad of doses. I have a chart for all my RSI drugs, I have a chart for all of the drips we carry on the truck, I even have a chart that has all of my pediatric drugs and doses. I have no problem looking things up in my feild guide, my standing orders or whatever esle I have handy. Even if it makes me look a little bit rookie-ish. Because I'd rather look like a rookie to a live patient than a dead one.

The reason I'm telling my secret is that this is why I totally scared to get my Acting Crew Cheif. It's really, really scares me that the powers that be want me...the math retard...to be in charge of a truck. It's not like I can turn to the compleatly green part-time basic and say...So how many drops make 5mcgs per min per kg? Not that I wouldn't trust my Basic, because they can save a paramedics ass. But it's something they don't need to know. It would be like asking the stock boy at the grocery store...so...what should I do about my 401K? The Basic's job is to turn to the overzealous medic who is getting all distracted by all those advanced things like IVs and various tubes and say..."Shouldn't we expose the patient all the way because the cop said the dude heard 4 shots, but I'm only seeing 2 bullet holes? It' might explain why the dudes crashing but the holes we see wouldn't cause that" Yes, we medics have been known to over look the basic stuff because we are so into all that really cool blinky, beeping advanced stuff. But thats another post, so back to me...and my drug problems. You wouldn't think a little thing like a few math problems would have me all worked up like this, but it does. I may be able to read a 12 lead quickly, yet efficently. I may be able to restrain a violent psych in les than 2 minutes. I know that help is only a radio key-up away. But when it's just you and your partner out there, and they have put you in charge of not only you partner, but also some other person's life. And I have to know that you give .5mg every 5 mins up to a dose of .04mg/kg of atropine to the dying bradycardic and also how much fluid goes into that syringe to make .5mgs of atropine. That just scares the hell outta me.

But practice makes perfect. So I will continue to do drug calc after drug calc...drip after drip. Just so when the narc keys are tossed to me on that first shift as an Acting I will be able to quit hyperventalating and be able to help the sick and stupid of my county.

untitled

So I have now a date. The date that the pins and screw get taken out of my foot. Feb. 9th I will no longer have a bionic foot. Then about two more weeks to make sure I don't have an orthopeadic collapse. I'm not quite sure what that is but it's doesn't sound good. Actully, it sounds like something we go any given nursing home at 0200 to pick up. Medic 5... 76, delta response... to the old folks home for an 81 year old complaining of orthopaedic collaspe. Patient will be in the dinning room.

Seriously.

Then after that I will leave cubicle hell and head back to the streets, where instead of dealing with the HQ crowd I get my freaks and tweeks back. I'm still debating which can cause me more pain. At least at the office I'm not getting spit on. But then again, I go back to what I love. Having the freedom to drive where ever I want and having my free time during the week to do things like doctors appointments and going to the bank. I really am having trouble figuring out how people stuck behind a desk 9-5 get anything done. Like when do they go to the grocery store? Or to the bank? An hour for lunch just isn't enough time to really do much of anything. I can barely eat, let alone be productive. I guess I have spent to much of my working life with such a screwed up schedule that normal hours no longer apply anymore. Going grocery shopping at 3am just doesn't seem all that strange to me. There sure isn't a whole hell of alot of people getting in the way. and the drunk college kids in the Harris Teeter at 3 in the morning are always good for entertainment. Speaking of drunk college kids, I just have to say I was witness to the most spectaular conversation between two fantasticly drunk girls in the bathroom of a downtown bar. There just isn't words for what I heard. It took all the control I had ever needed to muster to keep myself from laughing so hard that I would have to actually sit down to keep from falling over. It was pure drunkinese and a little bit of word salad, but the parts that made sense went a little something like "So...I like totally respect you and our friendship and like all that sisterhood shit...And it's doen;t matter that you ...like...fucked him and all...I'm soooo over that...because you mean more to me than him...because were like...sisters!" Then somethings that I couldn't understand then watching them teeter on 5 inch manolo knock offs and try and fix what was left of what was once perfect make-up. I actully felt better about myself. In my crappy jeans and tee shirt and barely there make-up. Because it made me relize that deep down, we all are just a mess.