October 2003 Archives

The day medic is still here finishing paperwork from the day shift. I am so glad I don't work days. Ouch!

It's been steady since I got here although nothing has been really challenging. One refusal for the choking infant and a cardiac arrest that we worked for a few rounds but called on scene. Add a couple of cover assignments and that has been the extent of the night so far.

I'm hoping that I'll have an hour or two to at least get a start on my tasks for the weekend. Since I am responsible for our durable medical equipment I end up having to complete the annual inventory. Monitors, batteries, suction units, BGM units, etc. all need to be verified against our expected inventory from Clinical Engineering. Not a very exciting task but it has to be done.

I managed to get quite a bit if work done even though I spent a good portion of the night on cover assignments. The paramedic working Medic 2 last night got hit pretty hard with a high call volume. It was his first night solo and although we didn't get a chance to talk from what I could hear over the radio he held up pretty well. That's a really good sign that he will work out well.

Milage for the night: 93 miles

Calls for the night: 9
1 ALS transport
1 BLS downgrade
7 cover assignments

CD for the night: "Mars" by Ben Bova narrated by Harlan Ellison

I got sent to a reported stabbing. When I arrived, the ambulance was right behind me and the PD was on scene already saying the scene was under control. As stabbings go it was pretty much nothing. Stabbed in the bicep with a metal nail file. I figured it to be a quick evaluation and turf it to the ambulance for transport, probably BLS or at best a routine ALS job.

Of course that didn't take the unexpected into account. Now I don't know about anyone else but when the police tell me a stabbing scene is secure I take that to mean that both the stabee and the stabber have been subdued and disarmed.

Unfortunately this ended up not to be the case as the stabber came back to the scene and somehow we found ourselves between 2 cops with shotguns and the really pissed off assailant.

Needless to say I am amazed at just how flat I can make myself on the floor when I find myself somewhere where I shouldn't be. That could have really ruined my night.

Too much excitement is worse for me than too much boredom.

Not at all bad so far. About 60 miles so far but only three calls, 1 barely ALS, and 2 cover assignments. I appreciated the covers quite a bit since I was able to watch the Aurora Borealis for a while. Very impressive. Only the second time I have seen it in my life. This time was totally different than the last time so it was a another new experience. I could have stayed out to watch it all night if work didn't intervene.

I'm doing something a little different tonight. Instead of listening to music I have been listening to a book on my iPod, Mars by the noted science fiction author Ben Bova. Very good, narrated by Harlen Ellison, also a noted science fiction author and a very talented reader as well. If the night keeps going as the first a few hours has I may get into my next book as well. I expect it to be a little slower going than this one as it is entitled "Understanding Islam" and promises to be nowhere near as light as my current book.

The ED was not busy at all and although Medic 2 has done a few ALS calls that needed cover assignments, Medic 3 has been quiet. We'll see how the night goes, but so far it's looking pretty good.

I am torn as to whether I should say my days off are over "finally" or not. For now I lust say I am looking forward to getting back to work.

Management at my other job pulled me into the office to talk about my "inflexibility" in scheduling and was not very receptive to my explaination that I have certain responsibilities for my full time employment that need to be met. I work 3 or 4 12 hour shifts a week, have to deal with mandatory overtime, continuing education, child care, and dovetail everything with my wifes schedule. We worked out some possible solutions that may, or may not help for now and when I left the office they seemed somewhat satisfied. I'd like to see this problem worked out with a solution that satisfies everyone.

Last night I fell alseep sitting in a chair so I got a fair amount of sleep before I took by benadryl this morning and went back to bed. I'm feeling pretty well rested for the night. I also finished my antibiotics this morning and aside for a lingering cough seem to be well on the mend.

Email from the full time boss to the department telling us that they have set up interviews with 6 candidates to fill the 2 open full time positions and some per diem positions. He published a list of candidates and asked for comments. When I looked at the list none of the candidates really jumped off the page at me as being the "perfect" paramedic but then again none of them jumped off the page as being totally unsuitable. All of the candidates have a fair amount of experience and seem to be pretty qualified. Unfortunately none of them have really spent any time in a system where they have such a large service area and so little back up. None of the medics that I thought should be applying seem to have applied for the positions. With the future of our department in question like it is I guess I can't blame them. We'll see what happens. I'll work with whoever they hire and try to give them the insight to deal with the unique aspects of our job. None of them are destined for nights right now so I will not end up doing much field training for any of them in all likelyhood.

The other email from the boss was regarding end of fiscal year finances. I can't quite understand how a hospital that was in dire enough financial straits to lay off 24 people, including the shutting down one department and reducing another by 20% of their full time staff, had a good enough year to send out bonuses to all employees. Not that I am going to turn down a 1 and 1/2% bonus but it does boggle my mind. I sure could use the money and I guess if I got an answer it would keep me up all day trying to figure it out.

Still no news on the funding problem and the last thing we got told was that our boss had decided that he should not approach any of the town governments until after the elections next month. I don't know if waiting is such a good idea or not but then again, I'm not in charge. To be honest, I wouldn't want to be in charge either.

While the hospital pays me very well as a paramedic I need to have a part time job to try and help us get out of the debt that we find ourselves in and to try to give my family some of the things that I want them to have. To that end I have been working part time either for another employer or for myself in the computer field for the past several years.

I have purposefully avoided working a second job as a paramedic for the past several years because I wanted to avoid burning myself out.

I closed my consulting business in June and in August started working at the Apple Store in a nearby mall selling Macintosh computers. I am well familiar with the product and even though I am clearly not cut out for retail as a full time job it has been becoming more enjoyable as I learn more about the "selling" part of the job and the "geek" part of the job has been carrying me.

The problem is twofold. The first problem is money. As with most retail positions you don't get paid much and I find that I am making less than half of what a comparable paramedic hourly rate would be. We also do not get commission on any of our sales. Not that I particularly mind that.

The second problem is scheduling. No matter how I slice it my wife will always make more money than I do and have less flexibility in her scheduling I need to be the one to accomodate the kids needs more often. One of those needs is for someone to be home to get them off the bus in the afternoon when they get home from school at about 1540 every day. I have been accomodating this by only scheduling myself to work at the Apple Store until 1500, which works, sort of. Essentially what this means is that if I get outexactly at 1500 I make it home by about 1538. Usually this has been just in time. However, if I hit any traffic, or get delayed in any way I am late. Since my kids are young the bus driver will not just let them off the bus to wait for me even if they have a key and can get in the house. I have only been late 2 or 3 times this year but that is 2 or 3 times too many. After the last time we called the mother of one of the other students on the bus and made arrangements to have the kids get off the bus at her house for a few minutes in case I was late. This seemed to solve the problem.

Until yesterday, when the assistant manager that does the schedule told me that they would no longer be able to accomodate my working to 1500 since the evening person doesn't come in until 1700 and that leaves them short for the 2 hours in between. I understand that and I appreciate the problem. But I also appreciate that there is no real way for me to easily stay for the additional 2 hours plus the travel time home. See when I said I didn't get paid a lot I'm not kidding. If I am going to have to pay for child care after school I need to get paid enough to pay for care and still make some money. Since I can't use just any neighbourhood babysitter and need to have a sitter that is old enough and responsible enough to get the kids off the bus and keep them safe and occupied until an adult can get home that throws some additional expense into the picture. Which, at best, makes my working the extra 2 hours into a break even at best and a losing proposition probably more likely.

End result? I'll be talking with the manager next week to see if something can be worked out but at this point, the job is not working out and I will be searching for a new part time job shortly. The other end result is that I will probably have to do what I have tried to avoid for the past 9 years. I suspect that I will end up working part time as a paramedic again in addition to my full time schedule.

This brings another problem to the fore. Where would I work? I'm getting kind of old to be hauling people up and down multiple flights of stairs. So I'm thinking that commercial EMS is pretty much out of the question. I really have no desire to stop having a patient care role so a management role is out of the question and since I don't want to work BLS working for any of the municipal services in the area is out of the question as well.

What's left? Well two of the other hospitals in the adjoining counties run paramedic intercept services similar to the one I work for now, they seem like my best bet. Of course this also means that I have to work on my CV again, and I have to go through the dreaded interview process yet again.

My wife is on call and will be at the hospital with a patient in labour for, well, who knows how long, so I am soloing. I love my girls but they do all know how to push my buttons. It doesn't help that I'm a pushover. Tonight was basically a free for all for dinner, each one had something different and I was very accomodating. When dessert time rolled around they asked for candy, of course I said yes, and yes again when they asked for a small second piece after the first one was done. I know, I did things in the wrong order because now I have to get them to buckle down and do their homework but I'll deal with it and hopefully they'll actually try to do the work without having to be "motivated" too much.

I'm actually starting to feel a little better. I still have a hacking cough but I no longer sound like I am going to cough up a lung. Sounds like the Zithromax is kicking in. Hoorah!

Maybe I'll actually get a chance to practice my trombone tonight after the girls go to bed. It would be really nice to have that chance but we'll see. I also need to get a good nights sleep since I have to work a day shift at the Apple Store in the morning as well.

Truthfully I would rather have it rain while I am off than when I am at work but I was hoping that I could take a day during this stretch of days off to clean my gutters, put the storm windows in, and generally get the house ready for winter.

I'm still not feelling 100% with the productive cough and congestion still hanging around. Day #2 of the antibiotic so I hope it will kick in soon and I'll start to recover.

Oh, and why would I rather have it not rain while I'm at work? For some strange reason I tend to get motion sick in the back of the ambulance in the rain. Only in the rain. Weird huh?

He was pretty upset because of the call that he had just done and his inability to determine where the Combitube was placed. He talked a lot about his frustration of being in a situation where there was really nothing that he could do that was actually going to help. We chatted for a while about how that happens to everyone now and then. I told him that sometimes the best you can do is finish a call and say that you did the best you could do with the resources you had available and under the circumstances you found yourself in. You can't always do what you want or have what you do result in the outcome you want.

I have been in this business for 23 years and lately I am finding myself put in a position that I am unused to but I guess somewhat suited for. Today I was a combination of confessor, mentor, teacher, and, I guess, psychoanalyst. It strikes me as odd because I have never viewed myself as the grizzled veteran who has been there and done that.

Of course, now that I think about it, I was already working in EMS for a couple of years when he was born. I guess that I am officially an "Old Goat" now. C'est la vie. I just have to deal with it.

Given the option I would much rather feel like this on a day that I had to work. I mean, if I'm not going to feel well I may as well be getting paid for it. Same thing I have had for the past couple of days, low grade fever, productive cough nothing really bad, just enough to inconvenience me.

Still trying to get back onto a daytime schedule so that I can be a regular person for the next few days. The way my rotation goes I worked like 5 12's in a row and now have 5 days off. I'm still undecided if I like the way that works but it's the what I have for now.

I'll start a course of Zithromax this afternoon and hopefully will start to feel better quickly.

It was not crazy like last night but we were still very busy. 24 hours after release we had about 50 of our original shipment of 500 boxes of "Panther". It was a pretty rough night for me in particular because I have not been feeling well since I got up and am losing my voice. That made conversing with customers very interesting. My fever has also returned and I spent the evening alternating sweating and freezing. Needless to say I was really glad when closing time came so I could go home and drug myself up again with decongestants, tylenol, and some cough medicine.

Lots of cover assignments and just 3 runs, one that ended up being a police matter only, one that was a BLS downgrade and one ALS. The patient load in the ED was steady and pretty non-acute so they didn't need me much at all. I got a lot of paperwork finished and handled some of my routine chores.

What I did conclude from the one ALS call is that some people just should not be allowed to reproduce because they lack the common sense to be parents. What adult in their right mind would give a prescription cough medicine that was prescribed to a full grown man to a 3 year old child and not understand why the kid was now acting strangely? Just boggles my mind sometimes.

Total for the night: 7 runs
1 no medical emergency
1 BLS downgrade
1 ALS transport
4 cover assignments

Mileage for the night: 108

CD of the night: Far Side of the World by Jimmy Buffett

This had to be one of the wildest nights I have seen. They closed the store at 1930 to reset displays and get the product out onto the shelf. By 2000 the line of people waiting to get in stretched quite a way down the mall. Mall security gave the impression that the line was probably between 500 and 600 people. When we opened the store again it was almost frightening to see the mass of people surging to get in. It sort of reminded me of the crowds at an English Football game. The floor was packed so tightly that I was surprised that anyone could move at all. But they did, and they did it in an orderly fashion and people were even relatively pleasant about it even though some product was selling so fast that we couldn't keep it on the shelves.

After my Grandfathers death at the beginning of the year my Grandmother decided that she would move to an assisted live facility. We were all very supportive and encouraged her to make the decision that was best for her. Since that time she has really thrived there returning to her very social ways with lots of friends and activities. The fact that there was a nurse on site to oversee her medical care helped as well in upping our comfort level.

I just got off the phone with my mother who was calling to "keep me in the loop". It seems on her way back from the bathroom at about 0500 this morning my gandmother fell in her apartment. After she crawled to the telephone she called for help and the nurse came and helped her back to bed. The nurse then called my mother to let her know that my grandmother had fallen and was injured and described a bloody nose and a bump on her head and said that it was no big deal and that they should come and take my grandmother to her doctor later in the morning. No, no need for an ambulance, these were very minor injuries.

Or so they thought until my mother and uncle arrived. So here is my 93 year old 90 pound grandmother sitting in a chair looking like she had been boxing. Two hours later her nose is still bleeding heavily and is clearly crooked, she has two black eyes, one eye socket is clearly depressed, a large hematoma on her forehead (describe to me by my mother, a nonmedical person if there ever was one, as the size of a navel orange), a large skin tear on one arm held closed with tape, confusion, and very high blood pressure (240/160). My mother is decribing this to me and I can feel my own blood pressure rising fast.

My uncle asks if they should call an ambulance for take her in since she, to him, was not looking right. Oh, no, these are minor injuries. So they bundle her into the car and head for the doctors office.

At this point I have to mute the phone and scream. What nitwit decided this qualified as a minor injury? Who in their right mind is going to let a 93 year old anemic woman on blood thinners bleed for a couple hours and sit around obviously confused?!?!

The doctors office takes one look at her and calls for an ambulance to take her to the ED. At the ED they run the whole gamut of tests.

So now, as I type this, my grandmother has been admitted to the Intermediate Care Unit with uncontrolled hypertension, uncontrolled afib, orbital fracture, nasal bone fracture, multiple hematomas, confusion and acute falling spell. Oh, I almost forgot, she has been taking too much Coumadin (a blood thinner) for the past several weeks as well.

My frustration level is just off the scale and I know that some of this is because it is my grandmother is involved but I also know that I have felt this frustration so many times before in my career and in 23 years I have never, ever, ever, found an adequate solution to it. I know that there is little if anything I can do to change the situation other than have her move in with me and watch her 24/7 (not practical, if I don't work I can't pay the mortgage). I am thinking of calling the Nursing SUpervisor at the facility and offering to arrange a class on injury assessment and what to do until the ambulance arrives and the like but I fear it will not be well received. I could just drop it and make sure that I am placed on the notification list for those times when she has an injury or medical problem.

I don't know what the answer is and I don't think I ever will. By training my tendency is to overtreat everything and I expect other medical professionals to act just as cautiously as I do. I know that this is probably unreasonable and not practical but what can I do?

My grandmother will recover, I'm sure, they will get her BP and A-Fib under control and get her blood thinners on the right dose. Her wounds and bones will eventually heal.

Why am I so upset by this? I really think that when it comes down to it I miss my grandfather so much that I want to cry some days and I know that she misses him every day and does cry often. She is my last remaining grandparent and the two of them were so important in my life as a child, young adult, and adult, that I am not ready to admit that she too will be gone before too long. They were married for almost 70 years and I had come to never think of one without the other and now that is exactly what I have to do. I feel protective, probably overprotective, and frustrated at my inability to take action to solve her problems. After all, isn't that what paramedics do, take care of people and solve problems? *sigh*

The night started out busy and then, at least for me petered out. Lots of cover assignments as Medic 2 & Medic 3 had fairly busy nights but after my initial burst of runs I didn't have anything but covers until the end of the morning. Of course, right at the end of the shift. Fortunately for me the patient was not critically ill and I was only about an hour late getting out.

Total for the runs for the night: 8
2 ALS transports
6 Cover assignments

Total Milage: 137

CD of the night: Mirrorball by Sarah McLachlan

I like fall weather, crisp, just the hint of a bite in the air. Perfect weather for a sweater but not a heavy coat. Unfortunately we seem to have blown right passed it. Its 2100 and already below freezing. Last night we had snow, tonight we may have it again. I am sitting on a cover assignment thinking that if I get back to the hospital I'll be changing into my long underwear and wool socks.

I don't remember feeling cold this early in the year before. I know I am losing weight and some of my natural insulation is gone but I also think that I might be starting to get older and the cold effects me more. I have to laugh, I got a call from a recuiter a couple of weeks ago looking for paramedics interested in working in Northern Canada. Geez, if I'm cold now I don't even want to think about what the cold is like there. Between the cold and the dark during winter I would probably go crazy. I mean for a night guy I still need to see some sunlight every once in a while.

The day medic is still at the main ED doing paperwork and is likely to be there for a while yet. He got absolutely hammered on days. So far I'm 2 runs and 2 cover assignments in 2 hours so it looks like the trend may continue.

On the bright side I did manage to get one of the per diem paramedics to come in a cover me for a few hours tomorrow night so I can work at the Apple Store for the OS X 10.3 (Panther) release. It promises to be a good time so I'll work there for the evening and come back to Medic 1 at midnight for the midnight to 0700 shift.

So when I answered the phone the first thing the voice says is "I'm sorry to wake you up." which is never a good thing to hear. It's the school nurse, my oldest is in the nurses office complaining of a stomach ache and nausea. Could I please come and pick her up. "Yeah, I'll be there in 20 minutes."

Expecting to find a sick looking kid when I get to the school I am really surprised to find a chipper and happy looking kid all bundled up and ready to go. If this kid is sick, I'll eat my hat.

Someday I'll get her teacher and the school nurse to understand that what its about at the moment is not really what it's about. Frequently my daughter is not easily able to identify the source of her anxiety so she will complain of a physical sympton until, through, careful questioning the true complaint comes out.

Today it came out after a while that she did not want to ride the bus because one of the other kids was teasing her. This I can deal with at least on a practical level. On an emotional level it pains me to know that my oldest is such a tormented soul and has such difficulty comprehending and dealing with the world around her.

One of my favorite EMS authors is Paramedic Thom Dick. Thom has been doing this job for even longer than I have. I have been reading his articles for over 2 decades and have always found them insightful. For a long time Thom always wrote about the tips and tricks of the trade that can make us better at what we do. I have incorporated many of his tips into my day to day practice. For the past few years Thom has branched out into areas that I find equally as important if not more so. Thom has been writing about a lot of the things that we never get taught in school, in our OTJ training, and frequently never get learned even after years of experience.

Thom talks about a lot of the intangible stuff, the stuff that requires you to use your head and your heart rather than your hands. A lot of people hear about some of the stuff that Thom writes and talks about and say that it just simply good customer service techniques or it's just plain old common sense. In some regards they're right. But the realization comes to those of us in this profession that customer service and common sense are not taught in any school or training session.

Today's article struck even closer to home. Thom was talking about something that is very important to me and many of my colleagues. Thom coauthored an article with Dave Snelling, a Police Officer with the Avarda CO PD and a Police Defensive Tactics Instructor. The topic? Making sure you can come home again at the end of your shift.

Thom and Dave make a few points at the beginning of the article that bear repeating:

-Many of our colleagues have died violent deaths supposedly without warning.
-A lot of times these deaths could have been avoided if they had been paying attention and/or not ignored danger signs.
-Some people just do not like or respect what we do.
-Unlike we have been taught as kids, not everyone has a conscience but thankfully these people are a significant minority of the population.
-Being nice doesn't mean you have to be stupid or naive and that you need to already have mechanisms in place to protect yourself from the actions of unusual people.

What Thom and Dave are actively asking us to do is to mentally put ourselves on "Yellow Alert" everytime we leave home to got to work and stay on "Yellow Alert" until the door closes behind us when we return from work.

How do we do this? It's not easy. Our society has developed into a very passive one where we often allow life to happen to us rather than being aware of what is happening around us. We need to become active participants and observers of what is happening around us, always, without fail. We need to practice this and reinforce it in our own behavior and always keep in mind that the most important thing that any emergency worker can do at the end of the shift is go home to their family.

As this skill develops in each of us not only will it enhance our safety but also it will raise our baseline of awareness for what is happening around us. This is something that you never turn off whether working or not, and that's a good thing.

So why do I bring this topic up when I know that many of the people who read this blog are not Paramedics, EMT's, firefighters, or law enforcement officers? Because these techniques can help all of us whether or not we routinely encounter dangerous situations or not to stay safe.

Even just simple day to day things like driving and crossing the street can be made safer with a healthy dose of awareness. Think about what could happen and what you would do if it did happen ahead of time. For example, one of the blogs that I read related the authors experience of almost being struck by a fast moving car while making a turn, and about being hit by debris cast off by a passing truck. Have you planned for situations like that? Do you know what you would do?

Today I know. I am getting sick. Last night I fell asleep by 2200 which is very unusual for me since I am usually just hitting my stride by then on a work day. I slept straight through without waking until 0700, clearly something I needed. Now I'm congested with a sore throat, cough and a low grade fever of 99.7 F/37.6 C. I need this like I need a hole in the head.

I hope the people who were trying to contact me last night understand. The lights were on on the computer but nobody was home. I really did think that I would be there. Sorry for the inconvenience.

I just don't have all that much energy today. I don't know why. Two thoughts came to mind and I don't like either of them. I hope this isn't a preview of what I am in store for once winter arrives and I hope I am not getting sick. I worry about either prospect.

Clearly I don't want to be getting sick. I worry about winter because in the past I have had real trouble with the darkness and dreariness resulting in some truly deep and dark depressions. I know, it's funny that someone who works nights, enjoys working nights, and has worked nights for years would be unbalanced by the lack of sunlight but it happens. I don't need a lot. I'm OK if I get sunlight for an hour or two at the beginning and end of my day. This is not usually a problem until the real heart of the winter when it's frequently dark when I get up and still pretty dark when I get out of work in the morning. It also doesn't help that even on my nights off, when I do my best to revert to a daytime based schedule, there isn't much sunlight.

It looks like the sun might be trying to come out this afternoon so I think I will go out and take a walk and see if that improves my energy level.

Busy to start out with a couple of runs and some cover assignments all coming one on top of the other. Then the night smoothed out quite nicely. I wouldn't mind having more nights like this.

The only strange thing that happened was a rescue mission out to Medic 3's station around 0200 when he locked his keys in the truck accidently. I can't remember the last time something like that happened and I expect he is going to take a lot of teasing about it for a few weeks.

Total for the night: 7 runs
3 ALS Transports
1 Cancelled enroute
3 Cover Assignments

Mileage: 156 miles

CDs for the night: It Just Happens That Way by Mindi Abair
Mirrorball by Sarah McLachlan

For the last few hours there has been extremely heavy fog and every time I have gone out I have felt like I was in a Hitchcock film. What makes it even stranger is the below freezing temperatures and the thin layer of ice on the lightbar of the truck.

When I fire the lights up they look very pretty with the distortion from the ice but they are much less effective. I have had to go out a few times this morning to scrape the ice off. I'm waiting for the commuters to find out that the roads have ice on them, I hope they all wait until after 0700 when I get to go home.

In on time and right out for the first call doing shift change on the fly again with the day medic. She laughed as we did this for the third time in a row that "We have got to stop meeting like this" and she's right. Only 2 runs so far. One cancelled enroute and one a significant call where I was under pressure to provide some lifesaving interventions.

I feel good that I was able to intervene but the patients long term outcome is still somewhat unclear. I feel bad for his family. Even if he survives this he stands a good chance of never being the same afterward and I always worry about the quality of life factor. Time will tell. All I know for sure is that things could have been a lot worse and that that is why I do what I do, to keep things from being worse than they already are.

A lot people think that my job is all about saving lives and in reality that just isn't the case. Mostly my job is about keeping the situation from getting any worse than it already is. It is extremely rare that I actually provide an intervention without which a patient would surely die, but it is very frequently that I am able to provide an intervention that keeps the patient from getting worse. I usually pretty satisfied with that. Fortunately as time goes on the procedures and medications I have available to me becomer better and better giving me a broader range of things that I can do.

A few weeks ago I found a copy of the treatment protocols that I operated under when I first graduated from paramedic training. They were so restrictive and had so few really important things that we could do it's a wonder that we were able to provide any significant interventions at all. Now granted that was almost 18 years ago, and by almost every standard it means I am an old goat but I am so amazed by the progress that my profession has made that I am really looking forward to seeing where we are in another 18 years (and hoping that I'll still be here). When I add the time I worked in EMS before becoming a paramedic and look where things were when I started in 1980 I am amazed. If someone had told me in 1980 the tools and training that I would have at my disposal I would have thought them to be crazy.

23 years is a long time to be doing something and from everything I have seen it is really unusual to be working in the same field that long and still being excited about and looking forward to going to work. I'm only 39 right now and I really hope I can continue to be as excited about my career for the next 23 years as I have been for the last.

Last night was a fairly good night all things considered. I was fairly busy early in the shift but it slowed down later. Nice for a change of pace. Lots of driving though since Medic 2 & Medic 3 were very, very busy and needed lots of coverage. This was actually pretty nice and I had a chance to listen to some great music and reflect on the early part of the shift. OK I also spent some time on a cover assignment in that place where you are neither awake nor asleep. It was quite delightful and somewhat restorative. Gave me a chance to stop kicking myself for the stupid mistake earlier in the shift.

Total calls for the shift: 10
2 ALS transports
2 BLS downgrades
1 Cancelled enroute
5 Cover Assignments

CDs for the night: The Trombone Master by J.J. Johnson
Margaritaville Cafe-New Orleans:Late Night Gumbo
Monk's Greatest Hits by Thelonius Monk

Since that time I have been running pretty much nonstop. Several runs later and about 180 miles so far I have a chance to take a short breather and look at the pile of paperwork that is waiting for me.

Nothing I have done tonight has been particularly bad or challenging which I guess is a good thing, at least for the patients it is. I'm a little upset with myself after the last call because I made a rookie mistake, not the kind of mistake you expect from someone with 17 years as a paramedic and 23 years working in the industry.

It was a simple mistake that I haven't made in so long I can't remember the last time. I was administering Morphine to a patient when he suddenly became violently combative and needed to be physically restrained. This can happen to some people when they receive narcotics.

I had drawn 10 mg of morphine into a 3 ml syringe and administered 3 mg (.3 ml) of it to the patient. When he became physically agressive and needed to be restrained I let go of the syringe. It remained attached to the IV tubing which was probably preferable to dropping to the floor and contaminating the syringe. At least that is what I thought. During the course of restraining the patient I glanced down at the syringe and noticed that instead of having .7ml of liquid in it it was now full, 3 mls of liquid.

Now the question is where did this extra fluid come from. Was it drawn down from the bag in which case I would have 7mg of Morphine in 3ml of saline (a lousy calculation to make if I needed to give more but not impossible to do) or was it drawn from the tubing between the injection port and the patient which would give me an unknown amount of morphine in 3ml of saline. Did more get pushed during the struggle? Did the morphine in the tubing that had been administered get drawn back into the syringe? If so how much? I had no way of knowing how much medication remained in the syringe and how much the patient had received.

Damn, damn, damn. I know this was not likely to have any adverse effect on the patient. I know I got distracted by being concerned for my own, and the safety of the crew but that is the kind of mistake I expect from a student not from a paramedic of my experience.

I reported the whole incident to the attending physician decided that no further action needed to be taken. Fine, I won't get in trouble for it but, jeez, what a dumbass mistake. I guess I can't give my next student or preceptor as hard a time for the same mistake since I made it too.

I really get upset when my job performance is anything less than perfect.

It was fairly busy last night although aside from wrestling with a diabetic with low blood sugar and a crash on the highway that had potential for serious injury but didn't the night was pretty much uneventful. I'm OK with that since I was pretty tired for the beginning and still uneasy from my dream.

Only one call really sticks out from the night. Not because of anything I did or had to do but because I saw a parent make what I think was a difficult decision.

The call came in for Medic 1 to respond with Ambulance 11 to a residential neighbourhood for an unresponsive teenager locked in the bathroom around 0200. As I responded I had no doubt in my mind what I was going to. 2am, Friday night, teenager, locked in a bathroom. No doubt that alcohol was involved somehow, if I were a betting man I would put money on it.

When I arrived the police were coming out of the house and told me that nobody was unresponsive and that the kid was not opening the bathroom door for his father because he was too busy vomiting. Pretty much what I expected.

Going inside I found a young man standing on wobbly legs at the bathroom sink. He told me that he had been out with his buddies and between the three of them they drank a case of cheap beer. As the ambulance crew held him up I went to talk to the father.

The father was clearly upset with his son and as we talked I found out that the family was devout Muslim and that alcohol is not something that is allowed by their faith. When I said we would take his son to the hospital he asked a few more pointed questions. Would they give him anything to make him stop vomiting? I said yes they would. Would they allow his son to sleep? Yes. Would they do anything to lessen the inevitable hangover in the morning? Probably fluid replacement, the sedative effect of the antinausea medication, and sleep would probably reduce the hangover.

The father looks me in the face and says "No, I do not want him to go." When I asked why not he said "My son needs to learn that every action he takes has consequences and that he must be ready to accept those consequences before he takes any action". I actually found that to be a well thought out answer. He went on to say that he felt his son must experience the full brunt of what he had done and that he and his son would be staying up the remainder of the night and studying the Koran until his son understood what he had done wrong and why it was wrong.

Now normally parents are either so concerned about the pain their kids are going through and will go through or are so upset with what their kids have done that I worry about the leaving the child and parent together. I did not get this sense from this man. I sensed that he was very upset, even angry with his son, but also that he beleived that he needed to seize the opportunity to teach his son to accept responsibility for his actions.

Thinking about it afterwards I can see this for the wise decision it truly was. It was clear that the father was upset with what had happened. It was also clear that the father was concerned about the discomfort his son was going to experience. Is was also evident that while he could fix the problem by getting his son medical attention he felt that he felt that his sons ability to learn the lesson that he needed to learn hinged on him suffering through the discomfort that was a result of his actions.

I called the ED doc on the telephone to run it by him and with approval from the doctor left this young man in the care of his father for what was, I am sure, an unpleasant night.

Calls for the night: 9
3 ALS transports
1 Refusal of service
3 cover assignments
2 BLS downgrades

Mileage for the night: 152

CD for the night:

Jagged Little Pill by Alanis Morisette
Mad, Mad World by Tom Cochrane

I came in early to releive the day medic so he could go to an appointment and found that he was out when I got in and I have been going ever since. So far I'm 4 runs and 3 cover assignments into the night. and it's started to rain. That doesn't make me feel confident that the night will get better. We'll see, I can hope.

I fell asleep rather quickly last night at about 0500 and slept for an hour and a half being pummelled the a 3 year old the entire time. After everyone got out the door for school and work I collapsed back into bed and slept very deeply for a couple of hours and then I started waking up every once in a while. I could not figure out why and none of my usual "go to sleep, stay asleep" methods worked for me.

I guess this means that my subconscious is a lot smarter than I am because I awoke this afternoon at about 1445 drenched in sweat with my heart pounding in my chest. Another nightmare. Essentially the same nightmare I had last month. Same scenario, different stretch of road. That pretty much ended any chance I had of getting restful sleep. All I can figure is that part of my mind knew this was coming and wanted me awake to avoid it.

I'm not sure what to make of the fact that I am having another recurrent nightmare. Not enough sleep? Too much stress? Something I ate? Guilty conscience? I just don't know.

No matter the reason I feel less rested now than I did when I went to bed this morning.

I don't know exactly what is making me so unsettled this morning This night is really no different from any other "night before work". I need to spend most of the night awake so I can spend most of the day asleep and be ready for my shift as Medic 1 tonight.

I have been trying hard to keep myself busy for at least another couple of hours so that I don't fall asleep to early but the uneasy feeling has kept me on edge.

I hate it when I feel like this and hope that the only cause is that I am simply overtired.

But I have gotten enough done to keep me fairly satisfied with the morning. I was up much earlier than I had intended, awakened by a child climbing into my bed. I didn't sleep well after that just dozing for the remainder of the night. I finally just got up and started making lunches for the kids and getting their stuff ready for school.

After everyone was out to school/work I sat down on the sofa to answer some email and ended up falling asleep for an hour and a half. I felt better when I woke up and took the time to answer all of my email and practice my trombone for 20 minutes.

It is actually kind of enjoyable to have a quiet morning once in a while. I don't have anywhere near enough of them and wish I could have more. Someday it will happen but I don't see it happening anytime soon.

I'm loving it but after about 20 minutes I was so fatigued that I couldn't go on. Nothing but long tones, whip slurs, and scales tonight. It's paying off. I'm starting to get better tone quaility already and I'm hopeful that in the next couple of weeks I'll be able to expand my practice sessions to much longer time periods. I really need to get to the point where I can play for a couple of hours straight, otherwise I will never get back to performing.

I was in to the Apple Store at 1700 and even though we were short handed everything got done. I didn't have any large sales but I was able to help several people make decisions, most of them to purchase but one to not. Funny how that works sometimes.

Traffic was pretty light. We were figuring that people were holding off to see what the announcement was going to be on Thursday and what was going to happen with the release of Mac OS X 10.3 (Panther) next week.

As strange as it sounds tonight was almost fun.

One of my least favorite things to do in the course of my job is deal with critically ill infants and children. I know I am not alone in this as in my career I have yet to meet another paramedic who says they are comfortable with infants and children that are not just sick but critically sick. A long time ago I learned that kids are not just small adults and I could not treat them the same way. Sick kids compensate longer and when they crash, they crash harder.

Todays class was 8 hours of review, practical scenario based training and testing. I feel fairly well prepared for most aspects of treating kids.

What they haven't ever taught me is how to treat kids without seeing one of my own kids on the stretcher in front of me.

Work at the Apple Store was hard because I was tired and having a tough time concentrating. I was late getting home to get the kids off the bus. There was nowhere near enough time to get the work done that needed to be done and after I collected all three kids they were exquisitely cranky and difficult.

Last night I just couldn't keep my eyes open and fell alseep while trying to get my youngest down. Normally this would not be a problem except that I have not gotten the work done for today that I needed to get done.

Today I spend most of the day recertifying in Pediatric Advanced Life Support (PALS) which is all about the treatment of critically ill children. This is usually an enjoyable educational opportunity but only if I have done my studying ahead of time and since I slept last night instead of studying I am a bit concerned.

After PALS I'm off to the Apple Store for the evening. After that? I haven't thought that far ahead.

Especially when I found out that my trombone instructor had called and changed our appointment to 2100 tonight.

I have been anxiously looking forward for my lessons to start.

When he arrived we sat down and got right down to work. I played scales, I played long tones, we played simple melodies, and some easy duets.

At the end of 35 minutes my lips and face were screaming, my back was sore, and I was happy. This is going to take a lot of work and it is going to be worth every minute of pain that I have to go through to come back.

I slept pretty poorly last night. Fitful and uneasy all night. I don't remember dreaming just waking up frequently and, in the morning, not feeling refreshed. I'm pretty sure it is a combination of vacation being over today and the unusual occurences of yesterday.

I finally convinced myself that it was time to get out of bed around 0800, showered, shaved, and dressed before my wife got up. That was her tip off that something was not altogether right. I never get up before her. We decided that since today was going to be mostly travelling we would eat a big breakfast so we selected the breakfast buffet at one of the hotel restaraunts. The food was very good but the view of the river was spectacular as we watched the Queen Elizabeth 2 dock at the waterfront. This was an amazing procedure thaty I could have watched over and over again.

After breakfast it was back up to the room to pack and check out in order to be at the Quebec airport at 1200. While it is small I was impressed by the airpoirt in Quebec. The staff were friendly, efficient, and seemed very competent. It was without a doubt the fastest security check I had been through in the last few years and also the most thorough. When all was said and done we were done with security well over an hour before our flight was to depart. I was able to make good use of the free WiFi access offered there to catch up my my blog posting and work on some email that was long overdue.

Our flight to Montreal seemed like an "up and down" flight. Almost as soon as we reached our cruising altitude it was time to start descending into Montreal.

The Montreal airport was much larger and offered no WiFi access but the staff there were just as friendly, efficient, and competent as they had been in Quebec. It wasn't until we got to the US Customs checkpoint that things got bad. We were randomly selected to have our baggage searched. This was only made worse by the attitude of the Customs Agent performing the inspection. I know he didn't choose us to be inspected but neither did we. It was clear that he was frustrated when he couldn't open all the compartments of the suitcase without having to search for the zippers and that it took us a while to repack everything after it had been removed. He seemed to be disappointed when he didn't find anything out of order. Kind of makes me wonder a couple of things. First, was this such a random check? If not, what made them suspicious of me?

The flight from Montreal to Hartford was almost empty. It was an 18 seat commuter plane with only 5 passengers. I was able to recline my seat and fell asleep fairly quickly, not waking up until the landing gear came down for our arrival in Hartford.

I clearly needed the sleep.

We started the morning with a short walk down the street to have breakfast. The food and the service were mediocre at best. Then it was back to the hotel to get the car.

Our plan was to do two things. We wanted to go to the Museum of Fine Art and we wanted to go do some serious shopping. What we got was some serious intrusion of reality on our fairy tale vacation. Driving down Grand Allee we ran smack into the middle of a tactical operation by Quebec Police and RCMP. (We later learned it was an escaped murderer holding two people hostage. A drama that lasted over 12 hours.) This shut down the roadway and traffic was detoured several block out of the way to avoid the area.

During the course of the detour we came upon what I initially thought was a traffic accident but very quickley showed itself to be a case of road rage. It seems that on one of the side streets we were detoured down a vegetable delivery truck was double parked in the street making a delivery. A driver who had been caught in the detour traffic became so enraged at the double parked truck that he rammed his car into the back of the truck, crushing the legs of the delivery man in the process. We came upon this about 20 seconds before the ambulance and police arrived and were quickley "move along"ed by the Quebec Police.

Both of these were much to close to everything I was trying to get away from by coming to Quebec. I realize that this kind of thing happens everywhere but that doesn't mean I want to have to deal with it on vacation. For a change I was very glad that I did not have to take action and that I could leave this for my Canadian colleagues to handle, which I am very sure they could do, without my help. Still, two somewaht disturbing incidents that put a damper on my mood.

We had been detoured around the entrance to the art museum so we went on to do the shopping we had wanted to do. The primary goal of the shopping excursion was to look at a ring for my wife as an anniversary gift. After looking at every jeweler in Quebec City (many of them twice) we finally found and purchased the ring she wanted. I woudl love to be able to buy my wife jewelery and surprise her with it but I know that my shopping abilities are so poor that we would just end up having to return whatever it was that I bought. It ends up being much more effective to bring her along and have her choose what she really wants. This took much longer than I expected and true to form, I was totally shopped out well before the shopping was finished.

Dinner was a quiet cafe down by the waterfront and back to the hotel early.

I had made reservations at A La Table De Serge Bruyere which had been the best dinner we had had during our honeymoon. Once again they did not disappoint. The dinner was elegant, formal, and exqusitely prepared and served with the most incredible Creme Brulee for desert.

The only thing that was a bit unusual was my reaction to the wine. Now, to be quite honest, I do not drink alcohol very often, and drank more wine during dinner than I have probably consumed in the past several months. It was wonderful, it complemented dinner wonderfully, and by the end of the meal I was so flushed and sweating profusely the waiter was clearly quite concerned. I was just enjoying the buzz. We took a long, slow walk back to the hotel enjoying some of the shops, listening to the street musicians and just generally acting like newlyweds again.

I should probably mention that my wife also threw me off my stride before we even left for dinner. We have both been dieting intensely and each of us has lost over 40 pounds. I knew she had purchased a new dress for our trip but was floored by it when she put it on. My wife was wearing the sexiest black cocktail dress I have ever seen. I was awestruck and felt very very happy to be waling through Quebec with a woman on my arm who was turning heads. Sorry guys, this is my wife, look but don't touch and, oh yeah, at the end of the night she's going home with me.