January 2004 Archives

The day started out at top speed and held it for quite a while. I started the day much earlier than I had wanted having to be out of the house by 0800 to go teach a group of EMT's how to use theCombitube. The class was for a volunteer fire department based ambulance and was the second of two classes I was giving for them (the first was a couple of months ago). I was a little disappointed with the turnout, only 12 students came for a class that could accomodate 24 and out of a membership of about 60 EMT's. I suppose when I add these 12 to the 18 that were trained at the last class the numbers don't look as bad but, still, I was hoping for more.

The class went well and everyone picked up the skill very quickly and by the end of the practical session nobody was having any difficulty. I wish I could say that it was my superior teaching style but in reality it is such a simple device to use that even my 9 year old daughter could use it with minimal exposure. No matter, everyone was happy with the way the course turned out and they learned the skills that they needed. That is what's most important.

I seem to be constantly tinkering with the program, the Keynote presentation, the lesson plan, the testing materials always trying to shorten the lecture, lengthen the hands on time, and make the testing more skill related rather than rote memorization of facts. To me so much of what EMT's and paramedics do is better taught with the hands that it just makes more sense. For most non-paramedics is is more important that they understand why and how they are doing something and what effect it has on the patient rather than the actual physics and theory of it. I would love to teach this course in really small groups of no more than 6 and have no lecture portion and do all the training hands on. I would still need to discuss the how and the why but it could be done during the practical teaching so that it could be related directly and immediately to the device that is being taught.

That finished up around 1230. I had return the projector and airway trainers to the station and had some time to kill so I took the long way home driving down along the shore and enjoying how different the sea, the shore, and even the lighthouse looked in daylight. It was still cold enough that I didn't stop at the seawall though. As I drove down the main street and by the local outdoor outfitter I made the spur of the moment decision to drop in and see if I could find some warmer socks to wear to work. Since I started losing weight I have been much colder than ever before and while this is uncomfortable it's how cold my feet have been getting that has been unbearable. I explained what I needed to the "backpacking specialist" who was very sympathetic and understood exactly what I wanted. 10 minutes later I was walking out with 2 different pairs of socks one made of a wool/silk blend and one made of wool with a polypropylene inner lining. I really hope one of them works.

I got home around 1400 and finsihed the project I had started on my laptop the night before. I had been running out of space on the hard drive and was in the process of changing the hard drive out to an 80GB model but got too tired last night to finish the job. I mean I probably could have finished it but the inside of my Powerbook is so tightly packed with parts that I really wanted to be in top form to do the work. The last thing I wanted to do would be muck up something else while installing the hard drive. With some sleep it was a short job to finish the data transfer and install the new drive. One of the hidden benefits I have found since closing my consulting business down is that I still have a number of parts left that never got used or sold so I have been either using them myself, giving them away, or sending them out on extended loan. This hard drive was pretty much the end of my inventory and I was glad that I had it and glad that I have been able to reclaim the shelf space in my closet.

Now it's time to get ready to go out for dinner and a concert. I am looking forward to this more tha I can express. It should be a great evening.

A little surprise was waiting for me when I arrived home. It seems that my youngest daughter had been sick during the night and would not be going to preschool. This meant that she would be staying home with me so my day of sleep was out the window, or so I thought. She seemed fine but I knew she wasn't feeling well when, around 1000, she climbed up into my lap, pulled the quilt over us both and proceeded to fall asleep.

Not being one to miss an opportunity to sleep I dozed off as well. I was very pleased to wake up 5 hours later in the same position with the same child, now awake, resting quietly on my lap. We are both pretty well rested and feeling pretty good.

That's a good thing since I need to spend some time this evening preparing for the class I am teaching in the morning and adjusting things to deal with the fact that I was unable to get the projector to hook up to my laptop to give my presentation. It's not that there isn't one available, the problem is nobody seems to have the key to the cabinet it is stored in.

Fortunately for me this is not a course that requires a lot of lecture and does require a lot of hands on practice.

Not a bad night, the ED was really busy when I got in and aside from a quick and minimal shift change I was in the ED helping out. It took a few hours to get things back to just a mildly crazy state and by then I had already been out on my first call and transported a patient to a tertiary care center about 25 miles north of us.

After this the calls came slowly and I had a chance to get the paperwork done in between calls as well as finish up the reports from yesterday mornings incident.

Some of the talk last night was about the defib incident I mentioned earlier. The Medical Examiner concluded that the patient was deceased before the defibrillator caused the fire. The why is still up in the air although the whole thing is still being investigated by the Department of Health, Office of EMS, FDA, State Police Major Crime Squad, as well as Philips (the manufacturer of the Codemaster 100). I don't expect this to be over by a long shot but a lot of people are feeling pretty anxious about using the Codemaster and an answer or at least a plausible theory has to be found. Fortunately we don't use the Codemaster, prefering the Medtronic Physio-Control LifePak 12. Still in the back of everyones mind is the question of this happening with other models of defibrillator.

The bad thing for the night? On my way home I realized that I forgot to QC a peice of equipment last night that I was supposed to. With the ED cranking when I got in I figured I woudl go back and do it later when things slowed down. When that happened it slipped my mind. I really hate it when I do things like that.

Total calls for the night: 5
2 ALS transports
1 Cancelled enroute
2 Cover assignments

Total Milage for the night: 94

CD for the night: "Buffett Live: Tuesdays, Thursdays, and Saturdays" by Jimmy Buffett

It sounds like it will be another cold night and I hope to stay out of most of it if I can. I have a huge amount of paperwork resulting from the "incident" with my unit last night. I love it, I wasn't in the vehicle, I didn't see the collision before, during, or after. But I still have to fill out lots of paperwork with lots of questions that, without being a witness, I can't answer. On the other hand I'd rather do the paperwork than deal with a more serious collision and possible injury.

Tonight is my last night before I have about 4 days off. I am of two minds about having this much time off because I know that I have a lot of stuff that needs to get done around the house but also because I know that after a couple days I will start getting stir crazy and want to go back to work.

I'll have to keep my eye on the pager for some overtime, although I also need some time to do one of my least favourite things, shopping. My wife's birthday is next week and with Valentine's day the week after I need to get some gifts. Without a doubt I am the world's worst shopper and if there were a way for me to afford to hire a personal shopper to guide me through the process of choosing and obtaining a gift I would do it in a heartbeat. I lack the imagination to select truly great gifts and figure out where to get them.

One of the things that I always seem to be griping about is that I really have very little time to do enjoyable things with my wife and friends without having the kids tagging along. Usually it is one schedule or another that conspires against any of the happening but the planets aligned and my wife and I along with another couple found ourselves all with the same night off, Saturday 31 January. We decided that we should do something that gets us all out of the house and something that we don't get to do much of, go out and enjoy ourselves.

There was a lot of debate, should we go to the indian casinos nearby and see what all the fuss is about? Should we just do dinner and a movie? Should we find something else, something different?

Different won by a landslide and my wife and I searched the web to find something really interesting to do. We were successful, or rather my wife was. While I was trying to sleep she found and purchased tickets to a jazz show at the Jorgensen Center for the Performing Arts on the campus of the University of Connecticut. What will we be seeing? The Newport Jazz Festival 50th Anniversary Tour. This should be a welcome diversion and a chance to go out with another set of adults and do "grown-up" things.

I am really pumped to be going, I am such a fan of jazz and have always wanted to go to the Newport Jazz Festival but never been able to arrange it. I still haven't gone but this will be the next best thing. My only regret? My trombone playing is not anywhere near ready for public performance. The only thing better than lsitening to good jazz is playing good jazz.

A fairly relaxing night, I managed to get a bit of work done and a bit of reading as well. None of the calls were particularly challenging or even interesting and the only thing that was different about the night is the volume of paperwork I now have to fill out after an "occurance" on a call.

I had responded to a call for a child with severe back pain and when I arrived park my unit at the bottom of a fairly steep and slippery driveway. Took my gear inside and found a 10 year old with right flank pain. A few minutes later, while I was checking the childs blood pressure I thought I heard a metal on metal chrunching sound very faintly but I had my stethescope in my ears and that can make ordinary sounds sound different. One of the ambulance crew walked in and as a way of greeting said that she had just slid into the back end of my unit.

Great. OK, well, not much I can do about it now so I stayed with the patient and when the ambulance finally arrived followed the stretcher back outside. Fortunately I had relayed to the ambulance to park at the top of the driveway and walk down with the stretcher. On the way out I looked at my unit and was surprised to see that, aside from plastic and glass littering the bumper that there was no new damage. There was a dent in the bumper from an incident that someone else had a while ago but there appeared to be no new damage, heck, the layer of dirt and slush from the bad road condition didn't even appear to be distrubed. The front of the responders personal car faired much worse than that with lots of damage to the grill, headlight, and bumper.

Of course this started a big chain 'o paperwork for me starting with getting the State Police to come out and file a report. After the call we met the trooper on the scene and handled all the paperwork the he needed, then it was back to station to handle the beginning of the rest of it. I fired off a quick email to by boss and then faxed a copy of the information from the police and wrote a note to myself outlining the incident as I remember it happening. Tonight I'll fill out the official hospital accident report and occurence report and hopefully that will be the end of it.

As things go it could have been much worse. I'm not all that upset that it happened, things like that do happen in this weather and line of work. I just don't like doing more paperwork.

Total calls for the night: 3
1 ALS transport
1 BLS transport
1 Cover assignment

Total milage for the night: 81

CD for the night: "It just happens that way" by Mindi Abair

You know something is wrong with you when you are thinking how warm it is now that the temperatures are into the mid 20's. After so long in the single digits at night the 20's are absolutely balmy, break out the suntan lotion and a beach chair! (Well, OK, not quite, but you get the idea.)

I slept fairly well for the afternoon and am ready for the night. I'm not hearing too much activity from the day medics and am not sure if that means that there is nothing to hear or that I am just not hearing it. No matter, it won;t change anything I do tonight.

Listening to the news on NPR I heard a story which is disturbing. The story is not detailed in the particulars but it seems that the paramedic service in the neighbouring county had an incident recently that involved a flash fire in a patients clothes and hair during a defibrillation attempt. In almost 24 years in the field I have never had anything like this happen. Yes, I have had some burn marks, yes I have singed some chest hair but I have never had the patients clothing and hair combust. Clearly there is more to the story than we have been told.

I can think of a couple of possible scenarios, neither of them very nice but both having to do with skin prep and paddle/pad placement. The only thing I know for sure is that I will be much more careful making sure that the patient has no moisture or other substances (i.e. Vicks rub or oils) on their chest and that hair, if any, gets at least a quick shave to assure that the pads make good contact. Oh, and definitely make sure that the pads are applied smoothly with no gaps or folds between the conductive medium and the skin surface.

Bizarre no matter how you look at it.

School was officially cancelled this morning at about 0500. I really didn't expect the schools to open with the amount of snow that was forcasted but you never know. I woke up enough to check the school website, shut my alarm clock off, and roll over to go back to sleep. If the kids aren't going to school there's no need for me to wake up at 0630.

The kids were pretty happy when I woke up, each of them had already foraged for their breakfast (I know, bad Daddy) and had each made some surprisingly good choices so I let it be. Looking outside we had about 10 inches of fresh powdery snow with more falling. The kids were excited with the prospect of going out side to play until they saw how much snow was getting whipped around by the strong wind. I said they didn't have to go out right away but they were going out to play (meaning tire themselves out so that they would be tired later on when it was time for me to go back to bed).

My wife got home a little after noon after being on call for the day yesterday and spending the night at the hospital. Now that she's home I can headback to bed to grab some sleep before I head in to Medic 2 tonight.

I have been reading some of my past entries and some of the writing I have done that I have not included here. Putting them all together I have come to a few conclusions.

First, I'm glad I don't make my living as a typist. I would be flat broke if I did.

Second, some of the stuff I have written is quite good while other stuff has been quite dreadful.

Third, I have gained considerable clarity of thought writing about some of the things that are happening to me and that are making my mind churn and I should keep it up.

It does beg the question, should I actually actively learn how to write better or should I just go ahead and use what skills I have and not worry about it? It's really strange for me to be even thinking about this since for as long as I can remember I always considered the "liberal arts" types to be much too cool for me. I was not an author, a poet, or an artist by any stretch of the imagination and never, ever, thought I would have the mind to do such things. Now I find myself trying to write, searching for my muse, and doing some of the artistic things that I never thought I had an aptitude for. Of course I am finding that these skills are so atrophied in me that some of it is actually quite difficult and that my thought processes don't always flow in a way that is conducive to writing things that are not technical in nature.

For the last 9 years one or more of my daughters have gone to day care at a center on the campus of a local liberal arts university. I find my self interacting daily with people who specialize in art, history, philosophy, writing, poetry, film, and religion. Even my synagogue is full of authors, editors, journalists, painters, composers, and others. I wish some of it had rubbed off because now I find myself finally with something that helps me vent my stress and clear my thoughts and I lack the basic skill set to do it consistently

Clearly it is so frustrating to know what you want and need to say but not to be able to say it coherently.

I have been thinking a lot about necks lately. Actually I should clarify, I have been thinking about cervical immobilization. Our department is in the process of implementing a Prehospital C-Spine Clearance Protocol. In essence what it will mean is that someone who falls or is involved in some type of trauma does not necessarily need to have their cervical spine immobilized as a matter of standard practice. Patients who meet specific criteria can be, at the paramedics discretion, allowed to go without the application of a cervical collar for transport.

The funny thing is, and the thing that is making me think so much about it is this. I have been a big proponant of a protocol such as this for many years. Now that it is almost a reality I am struggling to reverse almost 24 years of tradition where everyone who has any kind of fall or possible trauma, no matter how minor is supposed to get full spinal immobilization. Old habits die hard I guess.

Well some rocket scientist at the school district offices decided it would be a good idea to close school at the half day mark because it's going to snow TONIGHT. I enjoy having my kids around but things are certainly not calm.

The weather reports are calling for an inch of snow by evening and about 12 more inches tonight with about 14 inches total accumulation by Weds. afternoon. This is a good news bad news thing. My wife is on call today so with the weather predictions being for so much snow she's not even going to try to come home tonight. That's the bad news. The good news? I'm not working tonight in what promises to be pretty ugly weather. I will still have to work tomorrow in the continuing frigid nightime weather but, well, I'm coming to expect that.

Yeah, it doesn't take much to make me happy some days. After a fibre optic cable cut somewhere in New York City left my server unreachable for almost 24 hours it's connected once again.

I haven't stopped making entries and they will be added in the proper chronological sequence over the next several hours as time permits.

I am a perfect example. I have been arguing with a sore throat for the past 3 weeks. I figured it was just post nasal drip from the cold weather messing up my sinuses. Well this morning I found that it was so sore that I was having difficulty swallowing and none of my sinus meds were doing anything. Since all my kids were at school and I was out to get my hair cut anyway this morning I called my doctors office to see if I could have someone just take a quick look in my throat.

They had an appointment open with the Nurse Practitioner about 20 minutes later and I could have it as long as I could get there in time. That would be perfect I told them.

The Nurse Practitioner used to work in one of the ED's before she graduated from her APRN program. It was really good to see her again and we talked about all the things that were happening in my department and what my future was looking like. She said a few things that made some sense that I haven't wanted to think about lately. The possibility that my department will be disbanded by the hospital is a possibility that I need to be prepared for and that after being employed in a capacity that offered me so much autonomy and responsibility it would be highly unlikely that I would be happy going back to work in the commercial EMS arena. She's right, of course, and when she dcommented that I will be 40 in a few months and that going back to a transport job would be pretty hard as well. I really hate it when people point out things to me that I don't really want to think about but whe was right.

After we talked for a little while she left the room to check on the results of my throat swab and came back in with the delightful news that I had a strep infection in my throat and that was why it was sore. Great. Hello to a 10 day course of antibiotics.

She also asked me to think about a couple of career possibilities that would be great for someone with my experience. The first was a PA program. I've thought of this before when I was really frustrated with my job and while the PA program sounded appealling and challenging I have always been unable to come up with an idea of what kind of work i woudl like to get into. The second thing she mentioned was a combined BSN/MSN program that would graduate me as an Nurse Anesthetist in three years. That holds some appeal but the fact remains that I am still doing what I want to be doing and have no interest in changing right now. We'll see what happens with my department in the future. It will be a hard decision and one that I am not anxious to make.

The night itself wasn't too bad although I only slept for about 90 minutes which was not really enough. I don't know what it is but I just do not sleep well when I am at work. It's something that I used to be able to do very early in my career but haven't done well for a very long time.

It didn't help that just before 2000 my server connection dropped. I don't know why and I don't know what to do with it. I can do a traceroute from where I am but the trace hangs in New York City at a Cable and Wireless, Inc. router. I figure either the router is misconfigured or there is a cable break somewhere. Not much I am going to do either way. Still ticks me off.

The night was slow with only one call for a 60ish woman who was woken up by chest discomfort and arm numbness. From the moment we got in the house she was apologizing profusely and continued all the way to the ED to apologize every few minutes. Considering her age and presentation I thought it was perfectly reasonable to call for an ambulance, even at 0300 in the morning. It never ceases to amaze me how the people who really need to be calling 911 for help apologize so much and those who more or less abuse 911 never do. Call me cynical but I almost want to say that the more a patient apologizes the greater the possibility that they are truly sick. I was kind of surprised to find out that she was a retired CCU nurse. When she wasn't apologizing she was trying to convince herself that this was nothing serious and that she was not really needing to be evaluated.

Denial at full power captain. When we arrived at the ED the EM resident told her flat our that she would be admited to the hospital for at least 24 hours to make sure that she was not having a heart attack.

Ny the time we got back to quarters it was almost 0530 and as tired as I was it didn't make much sense to try and go to sleep. I was pretty thankful when 0700 came and my relief walked through the door.

Total calls for the night: 1 ALS transport

Total Milage for the night: 4

No CD for the night, the damn minivan doesn't have a CD player

A very cold night but one that was not too busy. Two calls early on in the night and then one more just before midnight. Every once in a while patients amaze me. One of tonights patients is definitely in that group. This patient was feeling very stressed and anxious and decided that the best way to solve that problem was to drink about 18 oz, about 533 cc, of Robitussin DM. I don't know about anyone else but I have a hard enough time getting that down by the teaspoon, the idea of drinking a bottle and a half is totally mindboggling. It didn;t help her calm down any either only making her more anxious and gave her hallucinations. She was tearful most of the way to the ED. I felt very sympathetic telling her about what was going to happen in the ED, the security guards securing her clothes and valuable, the charcoal (orally, to absorb whatever was still in her stomach), the psych evaluation that would be done, the monitored room and describing in as friendly a way as possible what was going to happen to her. In between hallucinations she was very grateful that I was sharing this information with her because she was very scared. It actually worked as I intended, when we arrived at the ED she was able to get through the admission process and into the charcoal phase before she started to get extremely anxious. Even so she did not need to be restrained or tranquilized as some patients do at that point. I am hoping that she will do well and really hope that her psychiatrist will do a better job of monitoring her. After hearing her story I really think that her problems could have been predicted. This patient had a past depressive history and had suffered the recent death of a parent and had returned to work after a three year absence and was under considerable stress. Her stress level changed but her medications and therapy didn't. Somebody should have seen this coming and headed it off.

Nothing else was all that memorable and the other two calls only generated paperwork and not much else. One patient was admitted with the flu but it was not a very challenging case.

After about 0130 I spent the night just trying to stay alert and out of the cold.

Total calls for the night: 5
2 ALS transport
1 Cancelled enroute
2 Cover assignments

Total milage for the night: 67

CD for the night: "Mirrorball" by Sarah MacLachlan

Man it was difficult to get up this afternoon. After the late call this morning I didn't manage to get to bed until almost 1030 and when the alarm clock started going off at 1630 I was not in much of a mood to do anything except whack the snooze button (I really hope the inventor of the snooze alarm suffered a painful lingering death). I finally dragged myself out of bed around 1650 and staggered to the shower turning on the radio to listen to what the day shift was doing. Days was getting hammered quite hard and I was not all that happy to hear that. The weather report was for even colder weather than last night.

I'm on my way out the door in a couple minutes and will be hoping to stay as much of the night inside as I can.

The night was pretty busy but most of the activity was Medic 3 or at least it seemed that way with all the cover assignments I did. We were fortunate that the medic that came in to cover part of the open Medic 2 shift was one of those that really cares about the quality of care that our department provides. He was supposed to stay until 0100 but since nobody was coming in he ended up staying for the entire shift. I'm really thankful that there are still some of us that are that dedicated, who really care about the overall performance of our department and not just their own performance.

We got slammed for most of the night system wide. None of it was cold related but the cold figured into how uncomfortable we were. Temperatures were in the single digits all night with a stiff wind that drove the wind chill well below zero F which made for a very tough time staying warm.

Lots of responses, lots of cover assignment but only one call that was of any interest at all. A little after 0600 I got dispatched from a cover assignment for Medic 2 to cover a call on the far eastern edge of that district for a seizure. As I was responding from quite a way away I asked the comms center to check and see if a paramedic from the next county were available to take the call since, even coming from their base, they would be several minutes closer than I was. No such luck, that county was out of paramedics completely and looking for additional coverage for their own calls. They had a four alarm fire working that was tying up 4 medic units plus a couple of other calls operating simultaneously. They had already pulled paramedics from the next county north of them and from the indian casino to try and cover the calls that they had.

It took me about 25 minutes to get to the scene and when I did the ambulance was in the process of bringing the patient down from the second floor. A male in his early thirties who was a couple of days post bone marrow transplant who was now febrile and had a 10 minutes seizure. His mental status was still altered and he was very slowly getting more oriented. He had no history of seizures, just cancer. As I talked with the family they related the story and what they were expecting. The story was pretty much what I expected it to be, classic grand mal seizure but what they were expecting was not what I had been expecting.

It seems that the patient had his transplant at Brigham and Womens Hospital in Boston and that was where they were expecting to be taken. I don't have a problem with transporting a patient to a distant hospital, within reason, but The Brigham is about 3 hours away and aside from the fact that it was already 0630 (and shift change is 0700) that is just too far for me to be comfortable transporting. I called the Medical Direction Physician and his recommendation was to transport to the nearest hospital with a transplant team, either 60 minutes north or 60 minutes west of where I was. The family was adamant that that was an unexceptable solution since either hospital was further away from Boston. Eventually we struck a deal where we would transport to the nearest hospital between our current location and Boston provided they were willing to accept the patient. I called theED that would be our receiving facility and they agreed to accept the patient after a little debate. It was weird having a patient that none of the reasonable receiving hospitals would accept or the family would find acceptable. Before the ED agreed I was worried that I might end up going all the way to Boston, not something I wanted to do for a whole host of reasons both patient care related and personal.

The patient did quite well during the transport with no further seizure activity and no other problems. He slowly became more oriented and by the time we arrived he was pretty much back to his normal mental status, although he had no memory of what had happened and had no idea why he was being brought to the hospital.

I finally got back to my base location at 0830 and still had to complete some paperwork.

Calls for the night: 13
2 ALS transports
2 ALS turned over to the ALS ambulance
1 Cancelled upon arrival
1 No medical emergency
7 Cover assignments

Milage for the night: 187

CD for the night: "Live in Paris" by Diana Krall

The pager has been going off every few minutes since about 1630. The medic working Medic 2 tonight has called in sick and nobody seems to want to come in. If I were not already working I would be more than happy to take the shift for a few different reasons. First, I could use the overtime, second, I don't mind working Medic 2 at all which is something that not all of us can say, and finally because the last thing I want to see is the unit just taken off line and Medic 1 and Medic 3 covering the entire county by themselves. There are a few of us that really get upset when this kind of thing happens and will, if we can, bend over backwards to see that it doesn't but 2 of us are already working tonight.

I fail to comprehend how management can justify taking a unit offline considering how large the service area we have, but nobody asked me. When we go down to 2 units both of the remain units go to their cover assignment posts and cover all 600+ square miles from locations that really are less than ideal. From those locations we pretty much have areas, especially in Medic 1's territory that are just not reachable in a timely fashion. It makes me upset because I always want to provide the best possible care and if I can't get there I can't provide any care. My frustration levels are through the roof.

Another sad day for those of us who are older than we care to admit. Bob Keeshan, who played Captain Kangaroo for 36 years and was a morning television staple for many of us while growing up, died in Quechee VT USA died today at age 76. Keeshan had been ill with heart problems for a long time accdording to news reports.

Captain Kangaroo played by Keeshan (Right) and Mr. Green Jeans played by the late Lumpy Brannum 1910-1987 (left)

To me Captain Kangaroo was a grandfatherly character who is one of my earliest memories of television I loved Captain Kangaroo because of his gentle and loving ways as well as his quiet nature. Oh, and the fact that the morning shout of "Good Morning, Captain!" was probably the only time my mother let me shout in the house. I secretly missed him when he went off the air in the '80's even though I was a "grown up" and read his insightful books as an adult.

I am left with just one thing that seems appropriate to say. Good Night, Captain. We'll miss you.

Wrong, wrong, wrong. I was so wrong. The night was depressingly slow. It wasn't that I did nothing all night, it's just that nothing I did was worthwhile. Two cover assignments early in the shift for Medic 2 and I didn;t see my first patient until almost 0200.

The first patient was an patient at a rehab facilitiy who had a mucous plug in his trach tube. The staff had been unable to clear it completly and was sending him to the ED. Just before EMS arrived they cleared the plug and the patient was no breathing normally with good vital signs. Since he had these plugs frequently the staff was not concerned anymore. Of course they were going to send him to the ED anyway even though the problem had been corrected. Not much for me to do here.

0400, responding with the engine company to a house about a half mile from the hospital for a 24 year old young man with chest pain. When I arrived the engine cancelled me and I could see the "patient" being led away in handcuffs by the police. It seems that around midnight he had been involved in a domestic dispute with his girlfriend and stormed out of the house. After getting seriously drunk he returned home at 0400 and found out that his girlfriend was still angry at him and, in an effort to get some sympathy, complained of chest pain and called 911. I guess it might have been working until the police and the engine arrived and the patient was dodgy and evasice abotu answering questions and eventually admitted that he was not REALLY having chest pain. Some people are just not too bright.

Last call was at 0600 back to the same SNF I had been to earlier. This patient had apparantly pulled her trach tube out 2 days ago and had had ocassional minor bleeding from the site since. The ambulance arrived at the same time and we went upstairs to the unit and found the patient to be asleep in no distress. After waking her up and evaluating her we found no active bleeding or evidence of recent bleeding. Staff was still insistant on the patient being transported so the BLS crew loaded her up and we started down to the ambulance. It all made sense when one of the aides on the first floor (who was an volunteer EMT for a local service told us they had a couple of sick calls on that unit for the day shift). I cleared the patient for BLS transport and headed back to the ED. When the ambulance arrived they didn't even let the crew take the patient off the stretcher. The ED doc evaluated the patient, changed the dressing on her trach and sent her back to the SNF in under 10 minutes.

Such was the night for all of us. Medic 6 slept all night of course while 1, 2, and 3 struggled to remain alert.

Some days you get the bear and some days the bear gets you.

Total calls for the night: 5
2 BLS downgrades
1 Cancelled upon arrival
2 Cover assignments

Total milage for the night: 97 miles

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

Par for the course. I got my other sweater back from the cleaners after having the insignia put on that one. Not only is the department insignia not straight, they put them on the wrong sleeves. *sigh* I really wish this stuff didn't matter to me as much but I find it very disturbing. I mean, it's not rocket science, why would I put the patches on the opposite sleeves as the 4 shirts I had also dropped off for the same thing. Someday I'm just going to leanr how to do it myself and then I'll know it will be done right.

The day medic is sounding pretty busy and I am hoping that we can keep the pace up for a good portion of the night. I'm well rested and ready for a steady night.

I am shocked that I got another good day of sleep. Tonight I start a run of 6 out of 7 nights and for a change feel really rested and ready to go. I'm not ready for the cold but, well, I never am.

It get's more and more interesting at home though. My oldest is surfing the internet like a pro which I think is a pretty good thing. She's restricted as to where she can go but there are still lots of things she doesn't understand. The other day a box arrived in the mail with a Terra Haute IN return address. I don't really know anyone in Terra Haute and thought this was strange. When I opened the box it had 10 brand new DVD's in it. Most of them pretty awful titles but some of them also very, very familiar kids titles, a bill, and a letter welcoming me to "the club". Uh oh, I did these clubs when I was a teenager and eventually figured out that it was no bargain. So where did this come from? I called the company and asked. "Oh" they tell me, "you signed up from a link on the Power Rangers website." Oh really? They hem and haw about taking the package back and voiding the bill saying, "it was probably one of your kids." No kidding, doesn't change the fact that the package was addressed to my name, some of the movies were rated R, the bill was in my name, and the website they say that the signup originated from was a kid oriented one. I am NOT going to pay for these DVD's and I am NOT going to send them back at my own expense. The drone on the other end of the phone escalates me to a supervisor and I explain the whole thing again. "Well, sir, you did click the "I accept" button on the website which states that you accept the terms. This is a binding agreement and I cannot void it." I am starting to get really, really ticked off and decide to play my trump card. So I tell the supervisor that his subordinate accused one of my kids of signing up for "the club" and asked how that was enforcable. "Well" says he "your kid is acting as your agent." Oh, buddy, don't go there. So I tell him "My oldest kid is 9 years old. How can you make an enforcable contract with a 9 year old?" Long pause, followed by an even longer pause. "UPS will be there in the morning to pick up the package, please seal it up and leave it at your front door. Thank you for calling." click.

I wish this had been the first time this had happened. Several months ago my wife had been checking on the status of an order at Amazon.com and walked away from the computer without logging out. A couple of days later a box arrived at our doorstep that contained a doll. I know I didn't order it but maybe my wife did. When she got home she denied ordering a doll and we asked our duaghter if she ordered something online. To which she quite politely answered "Yes". We didn't fight this one and made her pay for it out of her allowance and birthday money and figured this had taught her a lesson. No such luck.

The computer the kids use has just finished moving from the kids playroom to the living room where we can keep a better eye on it. I'll be configuring the Mac OS X firewall on their computer to deny access to a lot of sites as a stopgap measure until the software arrives to limit the kids access to only an approved list of sites. Sorry kids, the internet is not always safe for the niave and we need to lockdown access and keep an eye out to what you are doing. Before you ask the question, the answer is "because I'm the daddy" that's why.

When I got home this morning my wife was getting ready to leave herself to go to a meeting that would probably last all morning. I would be home with my youngest until then. I was pretty tired and thought that the morning would be pretty dreadful. As it turned out it worked out quite nicely. I changed out of my uniform and sat down on the sofa and my little girl climbed up in my lap, snuggled in, and promptly fell asleep. Cool. Not one to look a gift horse in the mouth I covered us both with a quilt and fell quickly asleep and we both slept for a couple of hours. Not all the sleep that I needed but certainly a good start.

After my wife got home I crashed in bed and slept for the remainder of the afternoon. I slept quite well and deeply and although I dreamed it was a pleasant and relatively relaxing dream of which I remember very little else.

I'm awake, feeling good, and looking forward to sleeping the day tomorrow in preparation of the Medic 1 night shift. Tonight I hope to get quite a bit of routine work around the house done as well as some reading and writing in the early hours of the morning.

The ED at this station closes down at 2300 so I was kind of surprised when I arrived at just before midnight and found the ED staff still there. They only had one patient left but were haviong a hard time getting everything done so they could discharge the patient home. The medic that worked the first part fo the night shift was there and really ready to go home to his wife and their new baby. I remember those days, I even still feel that way sometimes, although other times I want to be at work where I can have some relative peace and quiet. He only did one call and no cover assignments which is more like the way this station used to be before the layoffs and our new System Status Management plan which has made this from the slow quiet station to the station that always moves to cover no matter who does a call. He was out the door on time and headed home as I checked through the gear. Perfect as usual, there are some people where you just know that the gear will be exactly the way it's supposed to be.

I didn't have to wait long for the first call. Motor vehicle crash on the highway, multiple calls, responding with Ambulance 17 and Rescue 17. I get on the highway one exit east of where I need to be and headed in the other direction but I have a pretty good view if the eastbound lanes and I see nothing all the way up to the exit where I am supposed to turn around. I'm already into the next town and someone elses coverage area but I head up to the next exit to turn around and see if the caller got the exit number wrong. Nothing here, heading east again I find one of the fire officers parked on the side of the road near a break in the guard rail. There are tire tracks in the snow that look fresh but no vehicles. We both think that this is what the call was, someone strucl the guard rail but was abel to drive away. He returns the assignment and I continue a couple exits east just to make sure and head back to quarters. We get things like this so often that it has just become a standard practice, one exit beyond in each direction and then send everyone home. When I'm in a more cynical mode I want to say that they should just send out the trooper and call us if they find anything but I really know that that's not the way things need to be done.

On the other hand then there was the other call where I was dispatched with the same ambulance and rescue to a one car crash on a two lane country highway to meet the State Police already on scene. I'm coming from a cover assignment so a normally 3 minute response is goung to be closer to 10 or 12 minutes and I arrive after the rescue and the ambulance. The officer tells me I can stand down as soon as I walk up so I put myself available and hang around to see if they need a hand. The car has moderate damage on the outside with deployment of side airbags from glancing against the guard rail. The patient is quite intoxicated (or course) but uninjured and is in the processof being cuffed and searched by the trooper so he can be taken to the barracks for processing. What I really want to know is why, if the trooper was the one who found the crash, why he requested and allowed a full assignment from EMS to arrive if he had already determined that the patient was uninjured and going to become a guest of the State Police. Sure it would be nice to have a medical evaluation of the driver but he the trooper was not allowing EMS to do anything. So why request the assignment and especially why request the assignment late? How do I know it was requested late? The tow truck was already there when we all arrived.

I probably don't want to know the answer to that question, it might keep me up all day trying to figure it out.

That was it for the night, nice and slow, and boring.

Total calls for the night: 3
1 unfounded
1 cancelled upon arrival
1 cover assignment

Total milage: 57 miles

CD for the night" "Volcano" by Jimmy Buffett

Riddle me this Batman, am I really so obsessive-compulsive that I would let a small imperfection in my uniform bug me? You bet. The sweater I had left at the cleaners to have the insignia sewn on has come back and there is no doubt that I'll need it tonight. The paramedic insignia is dead on where it needs to be and because of the shape is easy to see that it is straight on the right sleeve. My department insignia is round and located in the exact spot on the left sleeve where it is supposed to be and everything looks good until I put it on. Until I put it on and realize that the department insignia is rotated about 10 degrees from true. In all honesty I doubt anyone beside me would notice without looking at it critically to see if it is perfectly straight but it bugs me anyway. Eventually I will have it corrected but tonight I need to stay warm. Yes, indeed, I am way to anal about my uniforms.

So, wearing my imperfect sweater I am off to Medic 3 for the midnight ot 0700 portion of the night shift. I'm expecting to spend most of the night on the road so I've brought a good book and a spare laptop battery.

One of the problems that I run onto when I have long stretches of days off is that it really decreases my contact with other adults and I find myself getting pretty down. This is especially true when the weather is such that doing anything other than staying inside is uncomfortable and when my friends are all busy with other things and not around or able to talk/chat/email. I find this very surprising since for a long time I really considered myself a loner who really didn't need much contact with the outside world. Now I find myself needing to be in contact somehow with friends and family.

What makes this even funnier is that my dream job is still that of being a lighthouse keeper at any of my favorite lighthouses (with a really fast internet connection too):

Highland Light, Truro, Massachusetts

Minot Ledge Lighthouse, off Scituate, Massachusetts

or New London Ledge Light, New London Harbor, New London, Connecticut

I'm glad it's done. My daughter enjoyed the day but for me it was a tough day to get through. I just was not in the mood to do what we were doing. I was tired and not feeling well and the movie was dreadful, at least I thought so. We did get a chance to do many of the errands that needed to be done. *sigh*

I need to sleep and tomorrow needs to be better. I hope that I can get some alone time to decompress and start to feel better.

I slept a good portion of the day yesterday and after some difficulty falling asleep last night slept long and deep until midmorning. About time that I got some good, uninterrupted sleep. My wife was fantastic keeping the kids from bothering me as long as she could. It was hard, though, since when they woke up there was another 6 inches of snow on the ground and they were anxious to go out and play. I'm well rested enough and far enough away from having to go to work that the snow isn't bothering me as much as it usually would. I still feel like past New Year's the snow should stay at the ski areas but, well, who asked me.

It has been a pretty lazy day so far and we are finally getting motivated to go and do what we need to do. The snow is tapering off and the roads don't look too bad. We are going to go and do some shopping, I need new belts, all of mine are now too big. As long as my parents can make it through the snow we'll meet them for dinner at the mall.

Tonight's big task, in addition to the usual laundry and such, is figuring out what to do with my oldest daughter all day tomorrow. My youngest will go to preschool just like any other day (It was her choice) and my middle daughter will be at the dance studio all day for Dance Camp. That leaves me with just one. I want to do something special but don't know exactly what. We'll come up with something, maybe a train ride, or a museum trip, I'm not sure.

Another busy and cold night. Not as cold as my last shift and in comparison this was balmy, with temperatures about 20 degrees higher. The day shift had been extremely busy and I came in to releive the day medic 45 minutes early. After I repacked him from his calls I started getting my own almost right away.

The first one certainly was THE call of the night for me. I was dispatched for a "man down, unknown" in a condo complex in the northernmost part of my district. The ambulance was on scene well before I was and I heard nothing from them and had no real idea what I was responding to. When I pulled up I met the ambulance crew as they wheeled the stretcher around the condo building with a patient boarded and collarded on it. I could tell riight away that something strange was going on because the patient was almost completely naked and shivering quite violently. The story I got was that he had been found face down actually frozen to the ground. The first arriving police officers had to actually break him out of the ice to roll him over and see if he was alive. This was a first for me, I have seen several people frozen to the ground in one way or another but they were usually dead, this man was definitely not dead, yet, at least.

We quickly got him into the ambulance and cut away what remained of his clothes. He had large patches of skin missing on his legs pelvis, and chest, I can only assume that the skin remained frozen to whatever surface he had been lying on. His extremities were cold with no peripheral pulses and he was very pale and barely responsive but holding his own airway. Vital signs were relatively stable except, I assumed, for his core body temperature.

I needed more of the story to try and make a decision as to where we would transport him to. Do we go back to the local hospital or do we go to the trauma center which was only about 10 minutes further away. When I asked about the scene I found out that the patient had been found I was told he had been found below the balcony to his apartment, a fall of 8-12 feet. Even though the trauma criteria specify a 10 foot fall as the cutoff I felt that this was close enough and with the altered mental status, lack or pulses in his arms and legs, and obvious injuries we would be better off heading for the trauma center.

During transport the patient seemed to start warming up and his mental status became better, he was still shivering uncontrolably but was able to answer simple questions and sometimes even give answers that made sense. The story of what led him to be outside didn't always make sense but we were able to piece together bits and pieces that seemed to make sense.

As near as we could tell the patient had been drinking a large quantity of alcohol while in his apartment and left to get somethign out of his car. When he returned to the building he found that he had locked himself out. When sober he had ocassionally climbed up to his balcony and let himself in that way. Tonight he got most of the way up and realized that he was much too intoxicated to be climbing that high when he fell and landed on the snow and ice covered ground and was eiother unconscious or unable to move to an area where he would be easily discovered to get help. It made some sense, it fit with what the police found when they entered his apartment and eventually interviewed the neighbours.

When we got to the trauma center they were less than pleased with me. The patient was still not always lucid, thinking it was 1973 and that the President of the US was Eisenhower. Even so he was telling the trauma staff that he slipped on his front stairs about 10 minutes before the ambulance arrived. Why take the word of the sober EMSproviders when you can take the word of a drunk, head injured, hypothermic patient? No matter, I think I made the right decision and stand by it. He ended up with a core temperature of just under 90 degrees F and was being slowly rewarmed when we left to head back.

That was the only real significant call of the night. Most of the rest of the night was spent rushing from one call to another, all of which sounded bad, and usually getting cancelled as I pulled up.

By morning I was pretty happy to be done and ready to go home.

Total calls for the night: 13
2 ALS transports
1 turned over to ALS ambulance
1 BLS downgrade
4 Cancelled
5 Cover assignments

Total milage: 218 miles

CD for the night: "Beach House on the Moon" by Jimmy Buffett

When I arrived home I found that my kids were all awake, my wife was ready to leave for work and drop my youngest off at day care, my oldest was unhappy to be stuck home with me until the bus came, and that my middle daughter was going to be home sick, and that sometime during the day I would really need to get some sleep.

Within an hour it would get even further from dull as school ended up being cancelled due to the cold (something they never did when I was a kid) and I would be home with my 2 of my daughters instead of just one. My middle daughter is pretty low maintenance. It is well within the realm of possibility to make her lunch, put it in the fridge and crash on the couch and get a fairly good days sleep. My oldest is the exact opposite, she's pretty high maintenance and if I were to try this I would stand a good chance of finding the house destroyed in short order.

We're going to try a compromise, I sleep in short naps of an horu or two and then get up and spend a little time keeping the kids in good shape and then go back to sleep. I won't get a huge amount of sleep but I will get some. We'll see how this works.

To say the night was cold would be an understatement. During the course of the night the temperature I saw got as low as -9F and stayed well below 0F for the enitire night. I know, I'm whining again. I started the night meeting the day medic in the parking lot to take a call and was pretty much going from that point on. While I was busy I will say that I was luckier than Medic 3 who was dispatched to a Motor Vehicle Crash in the middle of the night that was reported as a rollover with extrication. Sorry, way too cold for that kind of call. Aside from the cold there was nothing really remarkable about the night.

I have decided that in this kind of weather I should try listening to "warmer" music to see if I can convince myself that I am not as cold as I feel. I dragged out my Jimmy Buffett CD's. His music seems to fit the bill and listening to it made me thing things were not as bad as they could have been. After all, I could have been in Maine where the temperatures, according to a medic there, were -20F and below before the wind chill was factored in.

Calls for the night: 11
3 ALS transports
1 BLS downgrade
2 Cancelled
1 No medical emergency
1 Presumption
1 Unable to Intercept
2 Cover assignments

Total Milage: 111 miles

CD for the night: "Banana Wind" by Jimmy Buffett

I'm ready for the shift to start. I'm dressed in so many layers that I can barely move, or at least that's the way it feels. Now I know how my kids feel when I dress them to go out in the snow. From the sound of things it's going to be busy, the day shift units are just getting hammered.

My kids came home from school with a notice that school would have a 2 hour delay tomorrow. *sigh* That is going to really take a bite out of my sleep time. They will get on the bus around 9:45 and get home at the usual time. That gives me 5 hours at best, enough to keep me going but not as much as I really need to be at peak performance.

You know, this morning I said I was not a winter person and now that I have seen the weather report for tonight I'll say that that is an understatement. The weather report for tonight is calling for temperatures from -6/-21.1C to a balmy -1F/-18.3C with wind chill as low as -14F/-25.5C.

What is really depressing is that the weather forcast for Reykjavik Iceland is warmer than here, 12F/-11C.

I am just so not happy with that forcast. Anybody got some cheese to go with my whine?

Can you guess that I am not a winter person? This morning I awoke to the squeels of joy that can only come when children wake up and find a blanket of fresh snow everywhere outside. Dragging myself to the window I saw 4-6 inches of fresh powder. The kind of snow that would excite me B.K. (Before Kids) when I would want to rush off and go skiing. Now it sent me rushing to the computer to check the school website to find out if school was cancelled or delayed. 2 hour delay, better than cancelled but still taking a bite out of my sleep time for the day. It was hard to get the kids motivated to get out the door for the bus but they are finally on the bus and on their way. I am heading back to bed to grab a few more hours sleep before I have to be up to get them off the bus again and start getting ready for work.

Sometimes I wish I could go back to those days of skiing at a moments notice and taking life as it comes but I suppose this is what happens when you start to grow up.

Today was a pretty busy day. It started out with a trip into town to pick up my wife at the hospital so we could go out and run some errands with my youngest daughter in tow. None of the day was extremely exciting although some of it was downright thought provoking.

Three things really got my mind going today. The first was a stop at the mall to buy my daughter some new shoes. She and my wife went to find shoes and I wandered into the Apple Store to visit, pick up a FireWire cable, and, as it ended up, the new Rainbow Six game (a total splurge). I watched some of my former coworkers dealing with customers I was reminded again just how ill suited I was for retail work. I am glad to be out and respect anyone who can work in retail successfully.

Next stop was the uniform store to order some new uniform shirts. I have been hemming and hawing at this and have, after talkng about it for a couple of months, finally gotten around to getting in, getting fitted, and placing the order. This was a somewhat frustrating expereince since the shirts I wanted were not the shirts that the hospital buys. I don't know what it is but I just cannot wear cheap shirts. The shirts that the hospital buys are nice enough shirts but they have several flaws that make them uncomfortable for me to wear. Not physically uncomfortable but mentally uncomfortable. They are 100% polyester and tend to pill. They look pretty ratty after the first dozen wash cycles. They don't hold starch worth a damn, and they have sewn in military creases. I like miltary creases but the sewn in ones always seem to pucker on the cheaper shirts and after a while just look awful. So instead I ended up ordering a nice heavy weight tropical weave with baked in creases similar to the shirts that the State Police issue (which seem to look good forever). Yes they were more expensive but I will feel more comfortable wearing them and I think I will look better in them. The clerk thought I was nuts. It was also strange buying long sleeved shirts for the first time in almost 11 years.

I also made myself step back and think when I got to the cleaners to drop off my current crop of shirts to be laundered and starched to within an inch of their lives (if I can't stand them up in the corner by themselves they don;t have enough starch). I was also taking the opportunity to drop off a uniform sweater that saw very little use from a previous job to have the insignias changed. I was rocked back on my heels a little when I realized just how anal I was being about the placement of the patches on each sleeve. It's not like the seamstress hasn't done this before. I finally stopped in midsentence and just said "Well, she knows what to do", and left it at that.

Man, I have got to lighten up when it comes to uniforms.

Some of us in Emergency Services have wondered for years if anyone understood what it was like to be working on the roadway and having cars and trucks whizzing by you at ridiculously high rates of speed. SeaDoc brought this story to my attention regarding the new law in Texas regarding how drivers are to act when approaching emergency vehicles operating in the roadway.

For some reason, even though it has been signed into law it is still known as "Senate Bill 193" in Texas. Typical of most new laws anywhere lots of people don't know about them as evidenced by this news report from KXAN in Austin Texas. Is this law perfect? I doubt it but it is a step futher in the right direction than most areas have made.

Marley now understands what drivers of emergency vehicles go through all the time. He almost got hit by a pickup while walking to lunch. I get the same feeling he describes every time I get a close call while driving to an emergency and someone picks a new and inventive way to react to an emergency vehicle.

Read about Marley's experience, and and mine.

I was going through my daily reads and found this little gem that Dori Smith encountered trying to hook up her PDA to her computer via Bluetooth.

Somehow I doubt that real security is that simple.

Our EMS Coordinator left his position. Last Friday was his last day and everyone has been wishing him well, myself included. He's going to nursing school full time and will still work with us as a per diem paramedic. I'm happy that he is going back to school to do what he wants to be doing. My only negative to it is that it seems perpetuate the idea thatEMS is not a career.

I was asked the other day if I was going to apply for the EMS Coordinator position. When I said that I had no interest in it they asked if I was going to go to nursing school or become a PA. When I said that I wasn't this person was very put out. "As a P.A. you would be terrific!" Well that may be the case but for some reason people just don't understand that I am doing what I want to be doing. Right now and for the foreseeable future I really want to be a paramedic. I just have no interest in being a manager, and full time educator, a nurse, a P.A., or even a physician.

It took me 5 years of earning an engineering degree to figure this out and I have no plans of making the same mistake twice. I really do like what I am doing. I mean, sure there are things about my job I don't like but when you look at the big picture I really like being a paramedic and, as near as I can tell, I'm pretty good at it. So why would I want to leave a career like that to go do something else?

To me this just points out why EMS has such a hard time getting recognized as professionals. So many of the people working in EMS are simply using this as a stepping stone to get to somewhere else. Very few people seem to look at this as a career. It's hard to advance a profession when the rate of turnover is so high. The turnover rate won't change until the pay and working conditions improve, the pay and working conditions improve until we gain recognition as professionals, and we won't gain recognition as professionals until the people working in EMS view it as a career position, and, and, and....you see the vicious cycle here?

I get the impression that many (most?) people think of EMS as something that you get into, do for a while, and get out of while moving on to something else. It seems so clear to them.

Why is it so hard for me to understand what others appear to understand so clearly? Why is it so hard for them to understand what I see so clearly? Is it that I am stuck in a rut and am following the path of least resistance? Should I be looking to do what so many others seem to be doing and advance into other fields and leave this all behind? Why am I so adamant that I don't want to change careers? Why am I even worried about this?

Well now, I got what I wanted last night which was a slow night. A single dispatch for the whole night shift and that was for a cover assignment that was cancelled before I even got into position. The ED was slow (for a change) and everyone (except me and the doc) spent the night knitting. The rest of us spent most of the time reading and I did manage to get some project work done as well but my big accomplishment for the night was putting a hguge dent in the novel I'm reading.

Total calls for the night: 1 Cover Assignment

Total milage: 46 miles

CD for the night: "Banana Wind" by Jimmy Buffett

I'm off to Medic 2 in a couple of minutes. I feel relatively well rested and ready for the night. It sounds like it will be not as cold as the past few nights but still pretty chilly. I have been listening for the past hour and have heard absolutely no activity from anyone so I am thinking that my chances are pretty good that it may continue that way.

I hope that is the case, of course I have no way of predicting it reliably. I know that what I really want to be doing tonight is reading some journal articles and when I am done with that reading some more in my novel. I have other work that needs to be done but I am not in the mood to do it right now. Maybe later, we'll see.

It will be a late night tonight. I'm working nights tommorow so I need to reorient my body clock back to a nocturnal schedule. I would love it if I didn;t have to do this but I am not ready to work days both because of the havoc it would raise in our child care and because I am not ready to trade off call acuity with call quantity. Someday, maybe, but not now.

I'll use the time tonight to catch up on some chores that I have to do and talk with a few friends. Once I have done that I may even try to read some. I'd love to finish the book I'm reading and move on to the next one. I'm enjoying the book but it is a slow read.

It has been a pretty long day already. Even though I worked all night last night there was no rest for me when I got home. My wife left for the hospital to begin her 24 hours on call and I was in charge of amusing 3 kids and playing cook, butler, chauffer, and referee. The girls were mostly peaceful for the morning until it was time to take my middle daughter to her dance rehearsal when everyone had a small meltdown. It seems that nobody had the shoes they wanted and there was no making anybody happy. Still I managed to get everyone in the car and we were at the dance studio on time.

At the end they asked the parents to step in and watch the full run through of their routine and I was very impressed by the whole class but especially my daughter. It was clear that she was having so much fun and really seeing this as a chance to express herself and not just a time to follow directions. She is clearly a performer.

After that it was back home to feed everyone lunch and then get my oldest out for her playdate. I was so happy to have her get a phone call from one of the other 2nd graders this morning asking if she wanted to come over and play. It really makes me think that we are making some progress in the social skills area.

My wife got home midafternoon, office hours and rounds done, she had no one in labour and was home to releive me so I could nap for a couple hours. I managed to get about 2 1/2 hours of sleep which has been enough to take the edge off my 26 hour day that started Friday afternoon.

I'm looking forward to a low key evening so I can get some ideas that have been going around in my head down on "paper" and do some chores around the house.

I can't beleive how cold it was last night. I saw temperatures as low as -4F/-20C. Fortunately the night was not tremendously busy and I didn't have to spend too much time in the cold.

Only one really significant call last night and it could have been much worse if the Engine Company and the BLS ambulance hadn't been on the ball. The frustration of many calls altely is that we are frequently out of position to respond on what I consider a timely fashion. In this case I was heading downcounty to cover for Medic 2 and Medic 3 who were both out. About halfway down to the cover location I heard the tones going out for the engine company to respond to a difficulty breathing call. As I turned around at the next exit I didn't think much of it as I was counting on the ALS ambulance to bethere quickly to work the patient up and transport to the hospital, about 7 minutes away. When the ambulance signed on and I realized it was a BLS unit and not ALS I was started to get concerned. The engine company arrived and a couple of minutes later I heard them inquire as to my location and ask that I "put it to the floor" (which I was already doing anyway). The I heard the ambulance arrive and about 4 minutes later I made it to the scene. As I pulled in I saw the patient being brought down on a stair chair and the stretcher being setup at the bottom of the outside steps so I started to set up in the ambulance.

As the patient was loaded in I found myself looking at a fiftyish male who had the barrel chested look of a lifelong smoker. The patient was in pretty sever distress and was not breathing very well. He was severely diaphoretic and with a respiratory rate of 48. When I listened to his lungs they sounded wet to about 2/3 of the way up on both sides with some scattered wheezing. His heart rate was too fast to count when I tried and the ambulance had gotten a blood pressure of 240/180, pretty high.

Once the monitor was attached I was very surprised to find that he had a narrow complex tachycardia on the montir with a rate of almost 200 beats per minute. OK, I had a pretty good view of what I had. What I didn't have agood view of was which of these two problem was the most threatening and which came first. Was the patient having difficulty breathing because his heart was beating so fast that it was not moving blood efficiently enough or was the patients tachycardia due to the fact that he was working so hard to breath. Hard to tell, so I decided to hit them both at once, starting a line and then slapping 2 inches of nitropaste as I setup the Adenocard. The nitropaste is supposed to dialte the peripheral blood vessels and allow blood vessels to dilate and allow the fluid to collect in his arms and legs instead of his lungs. The Adenocard was supposed to slow his heart rate down to the point where we could at least tell what the underlying rythm was. The Adenocard had no appreciable effect after three doses while enroute to the ED. I had time for more nitrates and a diuretic before we pulled into the ED and were ushered into the critical care room.

Once in the ED the patient got one more dose of Adenocard and then, when that failed, they placed him on CPAP which really turned him around as far as his breathing goes. His heart rate was still through the roof and did not start to come down until he had recevied a big does of Cardizem. A few months from now the CPAP and the Cardizem might have been started in the field but for today I felt pretty frustrated that I didn;t have any of the tools that the patient really needed.

Total calls for the night: 6
1 ALS transport
1 ALS turned over to the ALS ambulance
2 BLS transports
2 Cover Assingments

Milage for the night: 92 miles

CD for the night: "Volcano" by Jimmy Buffett

I was pretty tired by the time I got home and was into bed within a matter on minutes. For a change I fell deeply asleep quickly and stayed asleep for the next 4 hours. I don't know why but for the last few weeks I have been waking up between four and five hours asleep, going back to sleep with a little difficulty and then sleeping restlessly for the next couple of hours. It's pretty frustrating but I spent 6 hours in bed which was as good as it was going to get. I'm feeling moderately rested but sure could have used a couple of additional hours of really good sleep.

My two oldest kids came home on the school bus and were happy and calm which was nice for a change. I was able to do some chores around the house without having to deal with the grousing and bickering that seems to make up the usual afternoon. The only grousing I guess was mine when I went out to get the mail and realized just how cold it actually was outside.

When I got to work I found out that I would have a student for the first few hours of the night. The student that was riding during the day needed to make up a few hours that she was short so that she could finish her school and graduate on time. I was happy to have the opportunity to teach again. I really enjoy it and have been disappointed that most of the students have prefered to work days rather than working even a partial night shift.

The night, however, did not start out all that well. The student and I rode back to the unit with the ambulance which is something that happens frequently. What doesn't usually happen is arriving back at the vehicle and having the sick realization that the day medic still had the keys. I didn;t start to get anxious about this until I realized that I had left my breif case with my spare key in my car back at the hospital. No worries, I though, there's still the emergency backup key that we keep in the pack....that we stopped carrying there a while ago. Somedays you just can't win. I called and talked to the day guy who was not happy that we had forgotten to pass the keys. Fortunately for us Medic 2 was just clearing the ED from a call and could take a side trip by the scene where we were and drop off the keys on his way back downcounty. About 15 minutes later Medic 2 pulled up and I was once again in posession of the correct keys. I'll take some ribbing for a week or two but in the long run most of us realize that this kind of mistake can (and either has or will) happen to all of us eventually in our careers. I'll take the ribbing, I deserved it I guess for making such a basic mistake.

We were not very busy but we did get her a couple of ALS calls which was a nice way for her to finish her internship. Neither call was all that difficult or even significant, an elderly woman with a TIA and and young woman with palpitations. Both were discharged before I was done with the paparwork. The student left around 2300 to go home.

After she left the night slowed considerably and I had time for some project work. Not to much time though as midmorning I got sent out on another call and then a cover assignment for Medic 2 which ended up being fairly long.

Temperatures got down to the single digits and we did get a dusting of snow but none of my calls were weather related or even effected by the weather other than my feet and hands always being cold.

My relief was in a few minutes early and we chatted for a few minutes about his new daughter and his full time job and after the usual change over of keys, narcotics, and pagers he was almost immediately sent out on a call. The baton was passed and I was on my way home for some sleep.

Total Calls for the night: 5
2 ALS transports
1 ALS Turned over to the ALS ambulance
2 Cover assignments

Milage for the night: 110 miles

CD for the night: "Riding with the King" Eric Clapton & B.B. King

It is cold already and supposed to get even colder during the night. The last weather report I heard was talking lows in the single digits F with wind chills going down to -20 F. Every once in a while I regret not taking a job in someplace a tad warmer, at least until summer when I regret not taking a job further north where it would not be as hot. As long as I can remember I have never been a big fan of really hot or really cold weather. Nothing has changed yet and I still haven't learned to take the weather I have and stop grousing about it.

I've been listening to the day shift and it hasn't sounded too busy, although he got sent on a call about a mile from my house as I was stepping out of the shower. If I had been ready to go I would have driven over and releived him there. But that isn't going to work so at least I can try to be at the ED to releive him beofre he has to ride back with the ambulance to get his vehicle.

I sit here looking at my cat who seems to have cheated death yet again. For the past few weeks we have been growing more and more concerned as his diabetes began to look very uncontrolled. He was drinking HUGE amounts of water and, well, doing what comes along with that. He was starting to act like he had dementia. When we talked to the vet he was not very hopeful that his outcome would be all that positive. We talked about the options and decided to make a "low impact" attempt to bring his diabetes under control again. We also talked about that at 16 years old it didn't make much sense to hospitalize him for series blood tests and observation.

This is not the first tie that he's been looking like he was on deaths door, when I first got him he came with some pretty extensive history. I read through his chart he had been hospitalized for renal failure, respiratory failure, urinary tract blockages, probable pulmonary embolus. It ready like a real bad ICU patient. He was only three when I got him so to have gone through such extensive by that time I didn't think he would live for the 13 years I have had him.

I got him right after my first marraige collapsed and was living on my own again. I was going crazy coming home to an empty apartment day after day and just needed to have something else alive in there to keep me sane. My sisters vet had mentioned that he had a cat that he had "acquired" that was looking for a home. The cat it turned out had been brought to the vet to be destroyed after the owner decided she couldn't handle a cat with serious medical problems. The vet, after keeping the cat alive through so many major problems, refused to destroy the cat outright and took him in and the cat lived at the vets office until He left to come home with me.

Having a cat made such a big difference in my ability to live alone. I admit, I became very attached, very quickly and that's probably why I was not looking forward to his death. I know that it is inevitable, but, well, I'm in no rush for it to happen.

So here we are. I know the end is only a matter of time but for now, we are just titrating his insulin dosage to his fluid intake and output and enjoying him while he's here. He's been a good friend and I hope to have him around for a while longer. We've been through a lot together.

So, I get sent this email by a former coworker with the subject "Why there are so few blonde paramedics". Attached is this picture:

Now I found it an amusing picture but just could not make the connection to the subject of the message. This is not an uncommon, I frequently don't get some of the jokes that get sent to me. It's byproduct of having "a PBS mind in an MTV world". Usually I just hit delete and move on figuring that I am just to old or stodgy to figure it out. This one just captured my attention and I really wanted to know what the sender was thinking. Of course maybe I don't, it could be one of those answers that will keep me up all day. However, my curiosity is getting the best of me. Anyone care to enlighten me? Please?

Continuing education seems to be a constant in the medical field. I have to complete specific amounts every year to remain credentialed through my employer. Strangely enough the State has no education requirement and as long as I continue to send in my $75 they will continue to renew my lisence. I have always found that to be a strange thing but accept that it is the way things are.

I always have enjoyed the opportunity to learn new things that can help me be a better paramedic and probably the most exciting educational opportunity I have ever participated in is the EMS Today Conference put on by the folks that publish JEMS. I have always been impressed with the quality and calibre of the presentations and presenters at the conference and try to go as often as I can. This year it is in Salt Lake City, Utah and, as usual, I would love to go. It's not going to happen but there's always next year.

My wife has to meet certain continuing education requirements for her Board certification and, as I have found, conferences are a great way to meet these requirements. The big difference is that some of the expenses are picked up by her practice for her conference time. Even though I can't get education credit for the topics covered at her conferences I still enjoy accompanying her and find that it is an easy way to decrease the cost of a short vacation.

She just planned her conference for the year and I have submitted my vacation request for the same time. The kids? Well, grandma and grandpa have agreed to watch the kids for a few days. In the past we have gone to some great places for these conferences and enjoyed ourselves immensly in the process. This year the money just wasn't there for us to go to someplace distant or exotic so she had to find something local.

This year we're going to save some money and go to a conference we can drive to so she found a nice conference in Boston at the end of March. I have always loved Boston not only because of the history and cultural opportunities but because, as cities go, I have always found Boston a very fun city to spend some time in. As a single man I did this fairly frequently and always had a great time even if all I did was nothing more than walk around Newbury Street, exploring some of the neighbourhoods, or just meeting my sister for lunch at Quincy Market.

The fact of the matter is that I'm actually pretty enthusiastic about the chance to spend a long weekend in Boston. I haven't had the chance to explore Boston on my own in over 10 years and while my wife is learning I'll be free to explore for a couple of days.

All things considered last night wasn't all that bad. I hadn't had enough sleep that was for sure but I made sure I was well caffienated and it wasn't too bad. It was a clean sweep with not a single response even when it got icy towards morning which was kind of surprising. I almost feel guilty about taking money for a shift like that, hey, I said almost. I was able to use the time to get some prep work done for the 2 Combitube classes I am teaching at the end of the month and clean up paperwork from the 3 classes I did last month.

I looked at the weather for the next few days and am not at all upset not to be working tonight or tomorrow with the forecast calling for night temperatures in the single digits. I'm hoping that temperatures like that will be done by the end of the week but if they aren't I'll just have to suck it up and deal with it.

I'm looking forward to a little sleep this morning and then finishing the stuff that I didn't get to yesterday.

Sometimes what seems like a good idea by the light of day is a less than good idea when it comes time for it to actually happen. That's what is happening with my shift tonight, it seemed like a good idea at the time but now that I have to get up and actually go to work it seems a little less good. Not that I regret it completely, the shift still needed to be covered and there were not all that many people stepping up to the plate and I certainly don't mind the OT plus emergency call in pay. The shift is filled by me working midnight to 0700 and the medic that worked days working until midnight, putting him on a 17 hour shift. His shift is much worse than mine since he not only has a long shift today but needs to be back in at 0700 in the morning to work the day shift again.

Since I have been up I have been listening and there has not been much activity so I am hoping that he has had a light shift, at least for the evening portion of it. At least the rain has stopped.

After working late yesterday I fell asleep in mid-conversation and had a real hard time getting up this morning. Now that I'm up I'm doing OK and will get better after I get my first bolus of caffiene. Lots of work to do today, bills to pay, laundry to do, dishes to wash, you know, all the domestic stuff. Once that stuff is underway I have a huge number of phone calls that need to be made and, with luck, will manage to get a nap in. Now that I have said this it remains to be seen if any of it happens as I have planned it.

The other thing that I have to get to in the next day or so is clothing. Two major things. First, I need to get rid of all the clothes that no longer fit me. I will mourn the loss of my "fat man clothes" (sure I will). Second, I need to go buy some clothes that fit. During Sundays shift I had the opportunity to stand outside in the wind on a call and with all the excess fabric in my shirt the flapping sound was incredibly loud and I felt like I was wearing a boat sail. It is definitely time. Not that that upsets me much since it means that I have lost weight, about 45 pounds so far, with more to go. Slow and steady seems to be doing it and I hope to be down another 20 pounds by the end of the winter.

Let me say this right up front. Holy cow! I am absolutely astounded with how busy we were today. I can't remember a shift that was busier than this one. The first call came in at 0657 and the running didn't stop until about 1930 and then was followed by about 2 hours of paperwork. Even so, I left the night medic with a fair amount of paperwork to be completed. Dispositions and diagnosis on most of the patients that I saw today, finding demographic information that was not available during a computer outage and whatever paperwork he generates on his own part of the day.

The prevailing themes for the day were unresponsiveness and shortness of breath. I started the day with a cardiac arrest. One of those nightmare patients, obese, with a short bull neck and lousy veins. The first responders, the ambulance, and I all arrived within a minute of each other and when I walked in the firefighters were struggling to get this woman out of bed. It always seems like it should be so easy to get someone out of a bed and onto the floor until you remember just how flacid an unconcious body can be. It ended up taking six firefighters to get the patient out of bed and onto the floor so CPR could be started. Of course, the patient vomited profusely as soon as they got her down on the floor which made things all the more difficult since now whatever got touched by it was slippery like it had been greased and combined with the latex gloves made some equipment almost impossible to hold. In this case I was lucky to have a paramedic ambulance on the scene and while I was trying to secure the airway she was looking for an IV site and finally found one that was usable. The monitor was as flat as you could get. It stayed flat even with good CPR and that didn't bode well. I threw almost every cardiac med I had in the drug kit into this patient and tried using the external pacemaker on her. The pacer got great electrical response but absolutely no mechanical response. In a very simplified way this means that the hearts electrical system was responding but the muscle itself was not responding at all. Under normal circumstances I probably would have called the arrest right at the house but in this case it was pretty clear that this was not a good thing to do. The family was too upset and a fair amount of the responders were also put on edge by certain aspects of the call, most notable the fact that the patient was only in her mid forties, around the same age or slightly older than most of the career responders in the room. We transported to the ED where the code ended about 5 minutes after we got there. We had tried just about everything and there wasn't much left for the ED to try. Not exactly a great way to start the shift.

Things didn't get much better as as soon as I was repacked from this call Medic 3 started to get hit pretty hard and I ended up on cover assignments for him. Lots of driving back and forth from the cover and back to the city. By this time it was raining, coming down in buckets actually, and the roads were slick and in some places covered with several inches of water.

In the middle of the downpour I was given one of the kind of responses that I hate. I was assigned an unresponsive person at one end of Medic 2's district, on the shore, and I was responding from the center of Medic 3's district clear on the other side of the county. This would be a 25 minute response in good weather and I could only imagine how long it would take in the rain. But I was indeed the closest paramedic since Medic 3 was still on another call and Medic 2 had just gone out for chest pain. Halfway across the county Medic 3 cleared up and ended up taking another assignment in the same town less than a mile from the scene I was going to. So with all three of us assigned to calls we were out of units. When the GI bleed came in the closest paramedic was Medic 14 coming from the next county over. Medic 14 made an admirable try to make the intercept with the ambulance but between the heavy rain and the distance involved he just could not make the intercept and the patient ended up going in BLS with no paramedic. Not the end of the world but knowing that no paramedic was able to take the call was very frustrating.

Lots of very sick people and lots of interventions. Some of the interventions were significant and truly made a big difference while some were essentially comfort mesaures and some were totally fruitless. It was not uncommon to have multiple paramedics operating in the same area all afternoon and numerous long responses to make up for the fact that we were always in a bad position to respond to the calls as they came in.

This went on right up until the end of the shift at about 1935. The paperwork seemed to be neverending and it wasn't for another two hours when I could finally swipe out and go home.

Total calls for the night day: 16 
4 ALS transports
4 ALS turned over to the ALS ambulance
1 presumption
1 cancelled enroute
6 cover assignments

Milage: 189

CD for the day: "Etched in Stone" by Off Kilter

I have been listening to the night shift for the past hour and a half since I managed to drag myself out of bed and hit the shower. So far the entire county has been pretty quiet and I'd really love it if it could stay that way for the day. I sounds like it is going to rain and if that is the case it will make me very unhappy.

I have to say, this being the second day shift for me in less than a month, that I am finding this to be less hard to get started than I have in the past. It's kind of scary to think that I could be getting used to it. With luck I'm not getting used to it, I'm only sleeping better and that makes it a little easier to adjust. Last night I fell asleep much earlier than I expected, almost in mid-sentence in an ICQ conversation with a friend. Terribly rude of me but I couldn't help myself.

Well, the emails went out from Human Resources about people who were over maximum allowable vacation time. I'm only 80 something hours over max so it's not too bad, although in my department I am the one with the most excess. They have offered to "buy back" up to one week's vacation and although the money is tempting I have pretty much decided to not go that route.

Instead I am taking a day here and a day there as vacation time to help deal with conflicts between my schedule and my wife's. At first I thought that that would be a waste of the time but then realized that I have been hitting my coworkers up pretty frequently for swaps, sometimes at the last minute. So a little figuring on my part and it seems that by taking 48 hours of vacation time over the next couple of months I can clear all the conflicts that exists as of today and give my coworkers a breather from my seemingly constant swap requests. I sent in that request tonight.

Now I need to head off to bed as I am working overtime tomorrow as Medic 1. My kids found the fact that I was working during the day pretty strange. To be honest, so do I.

This is the time of year when every one seems to make all sorts of resolutions most of which they won't even come close to keeping. I have been thinking pretty hard for the past several days about what I want out of the coming year and what I need.

I know I could have sat down and made the same resolutions that half the population of the world have made every year since what seems like the beginning of time. Like a good portion of the population of the world I would fail to accomplish them either partially or completely. So it seems important that what I feel I need to do for the coming year should be something that is realistically achievable. Even so, it cannot be something that can be acheived without significant effort on my part. I get no benefit by reaching a goal that is set too low and offers me no challenge.

What do I need to do? What will make me feel a year from now that the year 2004 was a significant year for me? A year that will make a difference in the rest of my life?

I have been thinking about this for aome time now and after long thought and careful consideration have come to the conclusion that what I need to do is not a set of individual actions or acheivements but rather a change in the way I look at life. Something that I started to do in 2003 but did not fully achieve because of all the distractions. It is something that if I can acheive will allow me to accomplish everything else that I deem to be important. Accomplishing the intangible will make the tangible possible.

So what is this thing that I need to do? What is it that holds the key to my ability to accomplish whatever I set my mind to?

The answer is so simple that it has seemingly eluded me for years. I need to continue to push the envelope of my existence, and open my mind to new thoughts and new experiences. I need to stop forcing my life to fit the same parameters that I have been using since I became an adult. Only when I let my mind out to excercise will I really be able to accomplish the things that I need and want to.

2003 is over and I have to say that for the most part I am really pretty glad. In general 2003 was a difficult year for me. Deaths, job strife, depression, and financial pressures all combined to put me under a lot of stress for most of the year. A few days ago I left a comment in Julie's blog and as I think about it it seems quite appropriate for me to post it here and expand on it as well. So here it goes:

On 21 December 2003 The MacMedic said:

"Julie,

Many of us have had tremendously challenging years and every once in a while someone has needed to point out to me that without the hard years we would never appreciate the not so hard years.

What remains a constant is our family and friends who are loyal to us and support us through the good and the bad. All they seem to ask is that we are loyal to ourselves. When we fail that they forgive us and continue to support us anyway.

In the past year I have found support from people whom I have never met in person, spoken to on the telephone, or even know what they look like. Their support has been valuable to me none the less and I have learned that a friend does not have to be someone that you can physically touch, hear, or even see, just someone who is there for you.

No matter how dark the night seems count on your friends, of all types, to be there for you.

I'll leave you with two bits of Native American philosphy that I learned in college. "What does not kill us makes us stronger" and "The path to true wisdom is littered with painful experiences".

Years like this one make us strong and wise and remind us who our friends truly are."

As the year has gone on I have been constantly reminded as to the value of friends and family. I have had the pleasure to have found a circle of friends and family that have remained loyal to me even when I was not being loyal to myself and probably deserved being abandoned. I have become a stronger and wiser person and, I hope, have learned how to be a much more loyal person to not only my family and friends but to myself as well.

For all the caring, love, and support I have received I need to express my gratitude, with a special mention to my wife and children for putting up with me no matter how bad I got. Thank you, everyone, for everything you have done.

May 2004 be a better year for all of us.

Lots of miles, not a lot accomplished. Most of my milage last ngiht was for cover assignments for Medic 1 & Medic 3 which were the busy spots for the night. My first call of the night was for the syncopal episode at the movie theatre. The patient was watching "Master and Commander" and during one particularly gruesome scene felt nauseous, diaphoretic and passed out. One of the other patrons did CPR on him for several compressions (even though the patient was reaching up and grabbing at him). After that the patient took 2 nitro even though he did not have any cardiac chest pain. Go figure. If he were a little younger and not had a cardiac history I would have thought twice about working him up but with a history that included an MI 10 years ago I figured he bought an ALS workup anyway.

The only other call I did in my district was a woman who woke with a headache and became rapidly unresponsive. She was very hypertensive and definitely unresponsive. I was called late to the scene so I had little time to do much more than put in a line and draw labs. She ended up getting electively intubated and transfered to a tertiary care facility with a subarachnoid bleed.

I did manage to get a little reading done. For some reason the book I am reading now is a slooooow read. Not because of the content, just because I have had no time to sit down and read it except in really short blocks.

Total calls for the night: 8
3 ALS transports
1 Unable to intercept
4 Cover Assignments

Total milage for the night 202 miles

CD for the night: "All for you" by Diana Krall