March 2004 Archives

I know it seems obvious but it was the theme for today. After a morning getting the kids out to school, packing, and getting our stuff into the car we left a little before noon for Boston. The trip started out well with only light rain for the first hour or so. Once we hit the Massachusetts Turnpike the rain got heavier and heavier until it was pouring. Still, the trip wasn't too bad and I was looking forward to getting to the hotel and out into the city.

For someone who doesn't live or work in a large city it was fun to walk around a larger city even in the rain. There are few cities that I would actually want to live in but Boston always makes the short list. Very distinct neighbourhoods, small community feel with big city features. I am realistic, I know that Boston has it's bad sections, crime, poverty and all the things that go along with larger cities but, for the most part, it feels comfortable.

We'll be going to see The Blue Man Group tonight after dinner and my wife starts her conference in the morning. I'll be on my own during the day for the next 2 days.

One of my colleagues was kind enough to point out the MacMedic Tartan and suggested I acquire a kilt and assorted finery to go with it.

While I was amused to find a tartan using my nom de plume (so to speak) I somehow think that I'll pass on the kilt. I have neither the heritage for it nor the legs.

I have been so sick for the past day and a half that the thought of writing anything was just not even entertained. I'm feeling a little better tonight which is a good thing because my wife and I are supposed to go to a birthday dinner for a very close friend at a really wonderful French restaurant. I'm going but I doubt I will be eating much. Too bad too, the chef at this place is incredible.

Oh well, I'll settle for making it through the night without feeling worse than I do right now. If this were any other ocassion I would just skip it.

The night started out well with there being enough time for me to complete all the usual beginning of shift duties. The evenings calls were of no consequence being either routine ALS or BLSdowngrades. It was steady until just before midnight when things stopped. I was able to use the time to get a lot of work done and felt like I had cleaned up almost everything that needed to get done, for work at least, before I left for our few days in Boston later next week.

By 0400 though, I was feeling pretty poorly. I was still pretty happy with what I had gotten done but I had begun to get sweaty, have chills and abdominal cramping. As much as I didn't want to admit it it sure looked like I was coming down with the same thing that my kids had had for the past couple of days. I was looking forward to going home.

As usual, because I was really wanting to go home (at least it felt that way) the last call of the shift came in around 0600. Respond with the ambulance and rescue for a maternity. I thought the bear was getting me at this point. I was wrong, it was going to get much worse. I had only been responding for a couple of minutes when the dispatcher called an update that delivery was "imminent". That made me really unhappy. I have a pretty terrible track record with prehospital OB calls starting with a prolapsed cord 3 days after getting certified as an EMT at age 16 and going downhill from there.

As I pulled up to the scene the patient was being carried down the front stairs to the stretcher. One of the EMT's on the rescue came over as I was getting my gear to give me an initial report. The patient was 36 and a patient of the High Risk OB practice at the large academic hospital about 30 minutes down the coast. She was 38 weeks pregnant, had ruptured her membranes about 4 hours earlier and was contracting every 60 to 90 seconds. That was all I needed to hear, time to go. Total scene time? Less than 3 minutes.

The trip towards the hospital was dreadful. It was raining heavily, I was feeling crappy to begin with, and the patient was getting more and more uncomfortable. She gave us a little more history as to why she was high risk. VBAC, vaginal birth after cesarean section, she had a c-section for her last child and was going to deliver vaginally this time. That was just one last thing to make me really uncomfortable. One of the big problem with VBAC is the possibility that the uterus will rupture during labour. Outside of the hospital there is not much I am going to do about it but if it happens both the child and the mother are in grave danger and all I would be able to do is watch and tell the driver to drive a lot faster.

She was a neonatal nurse at the same academic hospital and had some definite ideas on how things were going to happen. She didn't want me to start an IV for one thing. I'm OK with that for the most part. I agreed to try and follow her plan as best I could and she agreed that if anything happened outside the norm we would be moving on to MY plan.

As we travelled she grew more and more uncomfortable and as we hit the city limits she started to complain of rectal pressure and the urge to push. I felt pretty stupid but all I could say to her was "please don't push" but there wasn't much else I could do besides that and trying the whole breathing thing that I learned when my kids were born.

We rolled into the Labour and Delivery unit and straight into a labour room and all I can say is that it's been a long time since I was this happy to turn a patient over. Her doctor went in to check her and came out again to give the nurses some orders. 10 cm is considered fully dilated and ready for delivery. This patient was "a rim" which the doctor said was like 9.999 cm. The patient had delivered a healthy baby boy before the ambulance crew had even been able to finish stripping the dirty sheets off the stretcher. Can you say close call?

It took forever to get the ambulance crew out the door to head home. I guess I understand it. This is not a call that you do everyday and who wants to pass up the chance to get to see a newborn. I finished my paperwork while they were ohhing and ahhing. Eventually we started to head back.

I felt really awful for the entire trip back and by the time I returned to do shift change (2 hours late) I just needed to leave.

Total calls for the night: 6
1 ALS transport
1 BLS transport
1 BLS downgrade
1 Cancellation
2 Cover assignments

Total milage for the night: 97

CD for the night: "Cracked Rear View" by Hootie and the Blowfish

Clearly I have offended one of the gods somewhere. I don't know who and I don't know what I did but I will be home with a sick daughter again today. I love my kids dearly, but being home with one sick kid or another for the bulk of the last two weeks has really worn me down. My 6 year old again, she felt fine all afternoon yesterday and last night and was sick when she woke up this morning.

What makes today even a little worse is that I have to work tonight at Medic 2 and really need to get some quality sleep. It's going to be a long night otherwise.

Very busy at the beginning of the shift with 3 of 4 calls coming in during the first 2 hours. They were nicely spaced so I always had a chance to clear up from one before the next came in. That was very considerate of people to get sick that way. The last one of the run of three was actually in Medic 3's district. Medic 1 & Medic 3 were both out on calls and I had not even been dispatched to the cover assignment yet when the call for chest pain, 50 y/o female came in. It was quite a way from Medic 2's quarters but I was still the closest paramedic to the scene. I am not at all comfortable with the disposition of the call once we got to the ED but I am very comfortable with my care.

I intercepted with the ambulance about a minute after they left the scene enroute to the hospital. When I got in the back I found that they had the patient on the stretcher looking very uncomfortable and complaining of 9 out of 10 right sided chest pain and numbness radiating to her right arm accompanied by shortness of breath, nausea, and a lot of sweatiness. She was pretty pale as well and I was not comfortable with the way she looked.

Her 12 lead was unremarkable with the only thing out of the ordinary being an incomplete right bundle branch block but I remember quite well that women can have atypical MI presentations. The ambulance had already given her 324mg of Aspirin so I put a line in and gave her sublingual nitro which gave her no relief. She did, however, get some relief from the Morphine and Phenergan she got after that and by the time we arrived at the ED she had less pain, although it was still there. I figured that she stood a good chance to get an overnight visit or at least held in the ED for a few hours to do some serial enzymes. I was pretty surprised when I called a couple of hours later and found that she had been discharged with a diagnosis of arm pain. The doctor that saw her has been doing this for a long time and is on my short list of people that I would let work on me or my family so I doubt he overlooked something. I am waiting to see him next so I can ask if there was something I missed in my exam. I had been going down a completely different path that I thought was reasonable and probable. We'll see.

When I got home this morning I found that I would be home with my middle daughter who was home sick from school with, yup, you guessed it, the return of the GI bug that came through her sister had earlier in the week and all the kids had last week.

Total calls for the night: 6
2 ALS transports
1 BLS downgrade
1 Refusal of care
2 Cover assignments

Milage for the night: 133

CD for the night: "Night Train" by Oscar Peterson

Another good day spent asleep. I can't argue with that one bit. When I got up this afternoon most of my eBay auctions had finished and I was surprised at the number that sold and the price that some of them sold for. It will be good to get this stuff out of the house and nice to have the extra money. Round 2 should get listed over the weekend.

Tonight is Medic 2 and, as usual, I am looking forward to the night. I have some project work to do but for the most part have nothing pressing to do. Some time to think would be really great.

Day 2 with a sick kid at home. This has not been very fun. My daughter has been really off from her normal mood. I don't know if the bug that she has been dealing with has effected her ability to metabolize her meds or if she is just being thrown off by the change in schedule. Either way it has not been a great couple of days as far as her mood is concerned. I have managed to get some work done around the house which is a pleasant surprise. This afternoon she started to feel better so she will be back to school in the morning. I'm not sure who's happier about that, her or me. I actually feel bad for her. Even her difficulties with socialization she does have friends and seeing them and interacting with them has become an important part of her day.

My wife reminded me today that we are going out of town for a couple of days so that she can attend an ultrasound conference next week. I had forgotten that we were doing this and finding myself looking forward to it. Away together with out the kids for the second time in less than a year? Well, that has never happened before.

Although Boston is pretty close to home and far from exotic it will be nice to get a few days to myself and some evenings to go out with my wife to do some things that we'll enjoy. I already bought us tickets to a show by The Blue Man Group. I don't know exactly what I will do during the day yet but whatever it is I need it to be low stress and relaxing.

Things at work are still stressful as we wait for the towns to decide how, or if, they are going to help with our funding shortfalls. What will happen if the funding is not forthcoming? Which towns, will sign on to help fund our operations? Will there be future layoffs? Salary increases, freezes, or decreases? What happens if the contract that we have with one of our border towns to provide them a paramedic is not renewed? There are just way to many questions as to what the future will hold for many of us to feel secure. I know from talking with my coworkers that I am far from alone in investigating other job and educational opportunities. Out of 16 full time paramedics half are investigating other job opportunities or considering returning to school (if they haven't already). The uncertainty is very unsettling and I am not the only one who is feeling the stress from it. I love my job and am excited to go to work just about every day. Up until last March I felt like I was going to finish out my career here and eventually retire from a job that has meant a lot to me. With the future this uncertain I have had to be looking at all the possibilities no matter what they are and trying to be prepared for anything.

Call it what you want, Earn Money Sleeping, Dozing For Dollars, Sleep Working. Whatever you call it I just am not good at it. As much as I wanted to I couldn't sleep. When I finally started to get drowsy around 0200 the only call of the night came in.

The patient was a male in his forties with a pretty severe asthma attack. He looked pretty bad in the beginning with no lung sounds at all and had been sucking on his nebulizers for a couple of hours. I was worried that we would have to intubate him but after we ran pretty quickly to the end of the guidelines he started to open up and his wheezing got worse. I am always leary of giving patients that are, ahem, pushing middle age injections of epinephrine. The last thing I want to do is induce a cardiac event but that was what started opening him up and getting him breathing better. I also hung a magnesium sulfate bolus on him. I don't know if the epinephrine or the magnesium was what turned him around. I know both did something, the epinephrine made him jittery and the mag sulfate made him spectacularly nauseous.

It was well after 0430 when we finally got back in quarters, cleaned up, restocked, fueled, and done with all the paperwork. An hour later I finally started to drift off. I didn't sleep all that well but it was somewhat restful.

I used to be able to sleep anywhere at anytime. Not anymore it seems. I am very glad that I am not working 24 hour shifts any more.

Calls for the night: 1 ALS transport

Milage for the night: 8

No CD for the night but I did listen to an EMS Journal Club tape.

The night started out pretty badly and ended badly for the day medic. His last call was about 20 minutes before shift change and 10 minutes before I got in. When the patient decided they wanted to go to a different hospital about 30 minutes down the coast from us he was pretty much locked in. It must have been really hard for him to be less than 10 minutes from home when he arrived at the hospital knowing that he still had well more than a hour to go before he could be home again. These things happen, but it still sucks.

My night started out shortly after I came in and went online as Medic 4. I was dispatched to respond to the fitness club at a hotel in the area for a man down. A few minutes into my response the local dispatch called me to tell me that the police were on scene, had shocked the patient twice with their defibrillator and CPR was in progress.

When I walked in they were doing good CPR and the BLS crew was putting a Combitube in. I was startled by how young the patient looked. His fiancee said that he had been running on the treadmill and suddenly collapsed. The first responder was on scene within 2 minutes with the defibrillator, the ambulance 5 minutes later and me a minute after that. When I got him onto my monitor he had some very slow, very wide, very irregular, and very ugly ventricular complexes with no pulses.

The BLS crew was getting good ventilations with the combitube so I elected to get an IV and administer some meds. After the second round he went into V-fib again and we shocked him again. The resulting rhythm was still wide and ugly but was faster and accompanied by pulses, for about 30 seconds, and then they just got slower and slower until they stopped altogether and that's how he stayed for the remainder of the transport.

I did intubate him before we began to head to the ambulance. It was very frustrating. His tongue seemed to be really big and floppy and no matter what I did I could not keep it out of the way. After 2 failed attempts I finally grabbed a 4x4 peice of gauze and had one of the EMT's just grab his tongue and hold it in one place so I could finally pass the tube. I never have that kind of trouble intubating and I will admit that this did shake my confidence a little.

We arrived at the ED to find another shock waiting for us. The patient was a good friend of the ED nurse assigned to the cardiac room. This really threw the staff off their stride for a little while. It didn't make much difference though. Since the patient had been asystolic for most of the time I had been with him and I had administered enough medication to get a stone to have a heartbeat the doc called it shortly after we arrived.

It was a little unsettling to have a fairly young man in good shape dead on the stretcher in front of me. Every thing aside from the intubation had gone well from the start, rapid response of the first responder with the defibrillator, quick BLS, quick ALS, short scene time, rapid transport. If it was going to work it should have been this one. But it didn't.

I wish it had gone differently. THis call really set a subdued tone for the rest of my night. The rest of the night was fairly uneventful with only a BLS downgrade on an abdominal pain and a pediatric syncope that I couldn't get an IV on. After midnight there was nothing in my district.

I'll sleep a little while this morning and then get up around noon. I wanted to go have dinner with my parents. Although my wife and kids have been seeing them a lot over the past few weeks, I have not and I just want a chance to catch up.

Total calls for the night: 3
2 ALS transports
1 BLS downgrade

Milage for the night: 58

CD for the night: "The Emminent J.J. Johnson, Volume I", by J.J. Johnson

Reynolds, an EMT from London, who writes over at Random Acts of Reality has experienced one of the things that I fear most on this job. Exposure to the blood of a patient with a communicable disease. He has a great attitude about it, though, and seems to be getting good medical advice. I'm not sure I would be handling it nearly as well, even if I understood how small a chance that he has of coming up positive from the exposure.

Still, he has to look forward to 4 weeks of Post Exposure Prophylaxis which could make his life unpleasant to put it kindly.

It's an uncomfortable situation for him and, to a lesser extent, to all of us who know him in any fashion. There is a certain amount of discomfort that goes along with being acquainted with someone who is put in such a bad situation. What can you say? Right now all I can think of is to say "Reynolds, I'm thinking of you and if there is anything I can do please don't hesitate to ask". Somehow it just doesn't feel adequate and doesn't express the level of my concern.

Interesting conversations with a couple of colleagues this afternoon have left me in need of some time to think. Both called to find out if I would be applying for an EMS Coordinator position in a system that I had worked in for a few years early in my career. I am torn, there are a lot of reasons that I wouldn't mind taking it and lots of reasons why I wouldn't want it.

I really feel like this position is opening up at the wrong time for me. I am in the job I have always wanted, at least in a clinical sense. I have worked in administrative positions in the same system before, albeit quite a few years ago and in operations rather than QA/QI/Education. On the other hand, with the uncertain future of my current department this position is attractive because of the stability it offers. I can't lie, the idea of working Monday through Friday with nights and holidays off is something I am curious about as well. I have always worked nights and have always liked working nights but now that I have a family and kids that are getting older the idea of being able to be home for them more often than I am now is appealing.

Professionaly it really comes down to one question. Am I ready to stop being a street paramedic and become an administrative type with limited clinical time? My immediate reaction is to say "no way". But I can't help wondering if that is just a knee-jerk reaction to keep me in a familiar situation rather than dealing with an unknown situation with new and different challenges.

This whole decision would be easier of I knew what the future held for the system I am in now. Will the hospital continue to employ the paramedics for the county and surrounding areas or will it be contracted out to a commerical provider? Will our funding be such that we can continue to be as progressive as we have been, at least when compared to other services in our state, or will we be forced to sacrifice progressiveness just to stay in operation? Will I be satisfied to work for a less progressive service? Will I be satisfied to work in a system that is not clinically challenging? I can't even believe that I have come up with all the questions that I need to consider yet.

So many questions, so few answers. A mellow and low key night would give me a chance to think about this. I would feel better even if I thought I had found a fair amount of the questions. I can work on the answers later, but just knowing the questions would be helpful.

I am not all that hopeful for a quiet and thoughtful night as Medic 2.

I could have stayed home for all the good I was able to do last night. I just did not have much to do. Neither of the patients I saw were all that complex and definitely not challenging. Aside from racking up some milage the cover assignments were uneventful as well. As I was tired when I got to work this only served to make the night drag on forever. I was pretty happy when my releif got in the morning and I could head home.

I took some time when I got home to talk to my family to find out how their nights had been. My wife's call had been quiet with only a couple of phone calls and no deliveries. This was good because it meant that she got to spend the night at home. My girls were not all that enthusiastic about their dance. My oldest said she had an "OK" time and my middle daughter pretty much dodged the question. I got no real sense of what was the reason for their lack of excitement about something they had been looking forward to for a couple of weeks and I fell alseep in my chair before I could try to sort out more of the story.

Total calls for the night: 4
2 ALS turned over to the ALS ambulance
2 Cover assignments

Total milage for the night: 101

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

Well, the day could have been a lot better, could have been worse too but it could have been a lot better. All three kids were home today which made things very interesting. My sleep was very broken and not nearly long enough even though my mother came earlier than I expected her to and spelled me for a while so that I could get a few hours of uninterrupted sleep. Since my wife is on call and I have to work she will be spending the night to watch the kids until my wife and I both get back from work. I will spend most of the day asleep tomorrow (if I am lucky) and be back to work at night.

Whatever comes tonight will be fine with me as long as it does not involve any more snow.

Not a busy night and I got a lot done. It didn't start snowing heavily until morning and while the roads were a little slick they were not as bad as they could have been. I was able to get quite a bit of work done both on my inventory, some of the PM's for our monitors, and a couple of proposals I have been working on. One was finished completely and the other had a big chunk finished.

It was completely another story when I got home. When I arrived home I found that none of my kids were going to school today. The youngest was sick, yet again, and the older two had a snow day. This threw a pretty giant wrench into the works. Instead of 5 or 6 hours of uninterrupted sleep it was going to be sleep in small bits. Not what I wanted but the best I was going to get. Tonight will be an interesting night, no doubt.

Total calls for the night: 8
1 ALS transport
1 BLS transport
1 Cancelled upon arrival
5 Cover assignments

Milage for the night: 83

CD for the night: "Paramount Brass" by The Paramount Brass

First night back after a few days off. I am glad to be going back and looking forward to the night. I don't know what to expect and really it doesn't matter, whatever comes is OK with me. It is kind of strange, so many people complain about getting cranky if they work too much, I get moody if I don't work enough.

We're back in winter mode. Temperatures are expected to be in the 20's F tonight with snow called for but not much accumulation expected. Even that isn't subduing my mood all that much.

What am I listening to? The Same Love that Made Me Laugh, Made Me Cry from the album: Friday Night Special by Janis Siegel

At least that's the way it feels. I have been cleaning my office off and on for the past few weeks, lots of stuff has been thrown out and lots has been saved. Now that I have thrown out everything that I didn't want it was time to look at what was left and see if there was anything that someone else would want. Oh yeah, lots of stuff. A few hours later I was looking at a pile of stuff numbering about 50 items. By the end of the afternoon half of them had been listed on eBay and I, singlehandedly, made sure that eBay turned a profit today. OK, probably not, but it sure felt that way. More stuff will go up tonight. Some of it will sell and some of it will probably not. Either way it won't be going back into my office.

I have always been amazed by eBay. You can find almost everything for sale there at one time or another, some of the things I look at and say "Why?" and sometimes I look and say "they're paying how much?". Well, one man's trash is another man's treasure. I just hope there are some people looking to buy my trash, I mean, treasures.

What am I listening to? Metsyn Tytto from the album: Karelia Visa by Hedningarna

I finally am getting my head above water again. Getting my list server running again has been a much bigger job than I expected it to be. It took a while to get the server running properly. What surprised me was how long it took to get the whole thing tweaked to where it needed to be. It's been a long time since I have been that intimate with a computer. I am quite happy that it's done.

The day was a little less organized than I had hoped too. About 1030 I got the call to pick up my youngest at her day care. She was having some GI upset and needed to come home. It was cloudy and cold and supposed to snow at any time. I already knew that my older 2 girls would be coming home from school early because of the snow and I knew it was going to make my work a lot more interesting.

Yeah, more snow, just what I wanted to hear. I am so sick of winter that I can't even begin to express it adequately. 9 more inches is just more than I want to deal with and the weatherman says there's another storm coming towards the end of the week.

More scheduling hassles at the end of the week. Friday night my wife is on call again and I am scheduled to work Medic 1. Every once in a while I have a day when none of the other medics can swap with me. This was one of those nights. It got worse when I tried to have one of the per diem medics cover the shift for me and use some vacation or PTO. None of them could take the shift either. Falling back to, oh I don't know, Plan Q, my parents agreed to come and spend the night with the kids. Even though they are saving the day again I am really disappointed. I really wanted the night off so I could go to the Girl Scout Father/Daughter Dance with my 2 oldest. The Girl Scouts are having a 50's dance and they are very excited. Grandpa has agreed to go with them so they don't miss it but it doesn't help me to feel better. It actually made the girls more excited (ouch!, just rub some more salt in) when they found out that Grandpa was actually alive in the 50's and had been to dances then. I'm glad they get to go but really wish I could be there with them.

What am I listening to? The Complex from the album: The Complex by Blue Man Group & Venus Hum

I wish I could say I was having a lazy Sunday afternoon but that I'm not. Instead I have a bunch of different irons in the fire (so to speak) with laundry, entertaining my daughters, making some telephone calls, and fixing my listserver topping the list.

For a number of years I have used ListSTAR as the server for all of the mailing lists I hosted both for my business and for personal use. It provides a great deal of flexibility and has feature set that will do almost anything I need it to do. Of course it's not perfect. Since my office is entirely Macintosh based except for a couple of Linux boxes that I use for experimentation and general hacking ListSTAR is a Mac based application. As such it has great stability and security. That's the good part. The bad part is now that I have migrated all of my Macs of OS X I am stuck with only one application that is not available in an OS X version. You guessed it, ListSTAR. Running in Classic mode works for weeks at a time but every several weeks I need to bring the list server down and run some routine diagnostic tests and make some repairs. Sometimes they are easy repairs and sometimes they are complex repairs. Today they're complex and I am struggling to get through without pulling what is left of my hair out. This has convinced me of one thing, if ListSTAR doesn't come in an OS X native version soon I will have to try something else that will run on my server down in New York. This is the biggest pain in the rump I have run into for quite a while. In the end it will get worked out but it won't be fun while it happens.

I am hoping that I can finish most of my work up so I can spend some time this evening deciding what I want for my 40th birthday coming up this summer. I have been looking at a few different things but am really being tempted by satellite radio. I love to listen to jazz, both early jazz and newer stuff. Where I live is a veritable wasteland for jazz fans and not much better for people like me with widely varied tastes that are not well satisfied by commercial radio. I have been looking at the two major satellite radio companies serving the U.S., Sirius and XM. Both seem to have superior offerings in the jazz categories and quite a selection of other genres. Which to choose, which to choose? If anybody has experience with either of these and wants to drop me a note with what they know I'd appreciate it. I have gotten the "go ahead" from my wife to sign a contract with one or the other before we start taking our summer trips.

Do I really need satellite radio? No, not really, but I am going to be 40 (an age I never thought I would reach for a variety of reasons). It's a landmark and, lets face it, I have waited a long time to find radio with good jazz on it.

Right now I am listening to Devil May Care from the album: Live in Paris by Diana Krall

Pretty busy today after a lazy morning. Some of the housework got done before we sent our oldest off to the birthday party she was attending and then it was out to get cat food, insulin syringes for the cat, and some other stuff. By the time we were done it was time to go and pick up our daughter and ger friend and return the friend to her home.

While we had been out and about we had made plans to meet up with some friends of ours and their kids. They had wanted to go for a walk and we didn't have to try very hard to talk them into going on a search for a geocache this afternoon. My wife and I looked at a couple of different caches and finally decided on one in one of the nearby state parks. The description looked like it would be fairly easy and a nice walk. The cache ended up being on a hilltop overlooking the Connecticut River and the view was spectacular. If it hadn't been so cold I would have loved to have sat there and just looked for a longer while. The GPSr had been very accurate and one of our friends found the cache after only a few minutes of looking. The kids really enjoyed trading tchotchkes that were in the cache (Take one out, put a different one in) while the adults just enjoyed the view.

The sun was going down by the time we started back and it was getting colder so rather than taking the scenic route by the riverside we took the more direct route down the man park road. Even so, we got a good 2 or 3 mile walk in. It was really great to get out and stretch my legs and do something physical after a long winter. We even managed to find a way to make our walk uphill in both directions. Go figure. I am looking forward to warmer weather and some time off so I can go searching for some of the more difficult and complex caches in the area either by myself or in a "grown-ups only" group.

When we got home finally the kids were all worn out and the usual bedtime resistance was only a shadow of its usual level and the kids were in bed and asleep pretty quickly followed by my wife. I had dozed for a little while earlier and spent some time reading and blogging. Almost time for me to go to bed. Tomorrow is another day and I will be home with the three girls by myself while my wife is on call. Religious school for them in the morning and, with luck, we'll keep them occupied for the afternoon and evening.

Life is as it usually is for me. Go until you can't go anymore and then fall over. Last night was my turn to fall over. After a week of sick kids and limited sleep I sat down to read a magazine last night and woke up a few hours later. I was awake enough to stumble down the hall and go to bed and slept for another 9 hours. It's amazing how much better life looks when you have had enough sleep.

It's still going to be a busy day with all sorts of errands to get done, laundry and housework to do, and a million other things that need to get done before my wife goes on call again tomorrow morning for the remainder of the weekend.

Really busy for the first 8 hours of the shift and then I played catch up to finish the paperwork in time to go home. Almost patient I saw was ALS which was an interesting change compared to the day medic who saw very few ALS patients, well actually he saw few patients at all, lots of calls, just not a lot of patients.

More trauma last night which really reduced my sense of uneasiness. Some people may think that it's strange and sick that someone being involved in a serious medical emergency or trauma can make me feel good but it does and I won't apologize for it.

Last night was a near head on crash on one of the main streets, 2 lanes each way, crossing under a railroad trestle, Even though it is a city street the speeds can get quite high. We used to have serious crashes at the same place on a regular basis until about 12 years ago when they replaced the previous railroad trestle which had less than one lane in each direction with 2 lanes each way. In general it was a good thing, although it did make a dent in our trauma volume.

This time it was a SUV vs compact car at pretty high speed. The car crossed from the far lane on one side to the far lane on the other side, the entire width of the road to slam into the SUV almost head on. The SUV was stopped dead in it's tracks with the impact being strong enough to break the frame and separate the rear axle and both front wheels from the vehicle. The car managed to slide for about another 100 yards and end up striking a building back across the street on the side he originally came from.

When I pulled up there were already 2 ambulances on the scene in addition to 2 engine companies and what seemed like every police cruiser in the city. One of the engine companies was working on disentangling the driver of the car while the other company was up the street working on the other vehicle. I could not tell what kind of car it was. The front end had been crushed down to less about 2 feet from the front bumper to the edge of the shattered windshield. I was very surprised to find that while every other window in the car had been damaged the windows on the drivers side doors were still intact. Go figure. I should say they were intact until the FD went to work to try and get the doors off. They put big sheets of contact paper like you would line a drawer with on each window and then put a window punch into a corner on each one. Cool trick, the windows shattered but most of the glass stayed stuck to the contact paper and they were able to lift each window out with very little of the glass getting inside the car.

The patient was wedged quite tightly with his knees slammed into the dashboard and his left arm pinned between the dashboard and the lower edge of the windshield with some moderate bleeding from a wound on his left bicep. I could see the blood oozing through his jacket but couldn't get a look at it yet. The odor of alcohol was unmistakable as was an odor that, to me, smelled like marijuana. The patient was very confused and had multiple lacerations visible on his face, scalp and hands.

It took about 15 minutes for the engine company to cut him out of the car and he came out quickly and was moved right into the ambulance. I had spiked a couple of IV's during the extrication process and was ready to go.In he came and we started heading for the trauma center. I was transporting on a BLS unit since i had sent the paramedic ambulance to take care of the other vehicle and the EMT in the back with me was very experienced and we made short work of cutting his clothes off. As I cut his pants off a noted a rather large bulge in his crotch. I admit it, the first thought that crossed my mind was "nobody is that well endowed". OK, before anyone's mind heads for the gutter there is a condition know as priapism which is essentially an erection as a result of a neurologic injury, usually traumatic. As I cut down the legs of his pants I realized that this bulge was NOT living tissue of any kind but instead a rolled up sock. No matter it doesn't belong there and I went to toss it onto the remains of his clothes when several little baggies of what appeared to be marijuana flew out of the sock onto the floor.

Well, that's interesting but not really all that relevant at the moment. Just as I finished securing the second IV down we made the final turn to get on the highway. As we proceeded through a newly green light I could hear the very loud screeching of tires outside and could only ask "what the hell was that?" just as the cloud of smoke rolled past the back windows of the ambulance. I took a peek out the window and found that there was a car less than 6 inches from the back bumper of the ambulance. That was interesting too. Glad I didn't see it as it was happening.

Aside from a few more lacerations on his legs and arms the only injury that the patient had that was visibly remarkable was a rather large avulsion on his bicep which went very deep and looked really nasty. We were able to control the bleeding with some pressure.

The rest of the transport was uneventful and we made good time to the trauma center. The patient remained pretty confused, only improving slightly. Drunk, stoned, head injury, some combination of all three, hard to tell yet.

As we rolled into the triage area one of the two nurses started to take the story from me and decide where we should be going. As usual the question of why we came to their facility came up. Before I could get my answer to the question out the other triage nurse looked over and simply said "Trauma, trauma center." and our nurse stop grousing and sent us back to the trauma bay. As we went down the hall I realized that I knew the other triage nurse, he had been a long time paramedic in one of the other cities that I had worked in a number of years ago. That explained a lot.

The trauma team took over and for the most part were unimpressed except for 2 of the patients injuries. The first was the patients lower jaw and its 7 fractures. The second was the laceration on the left bicep which ended up being a complete through and through laceration of his bicep muscle which had caused it to retract into the wound. Nasty.

A few hours later, after I had returned to my ED and done a few more calls the police came looking for me. They had been given the packages of what they identified as marijuana by the hospital staff and were looking for a statement from me as to where and how they were located. Great, yet more paperwork.

All in all it was still a pretty good night and I was able to be finished with my paperwork at 0655 as my relief walked in. Perfect timing.

Total calls for the night: 8
1 BLS downgrade
2 ALS transports
2 ALS calls turned over to the ALS ambulance
1 Unable to intercept
2 Cover assignments

Total milage for the night: 135

CD for the night: "Cracked Rear View" by Hootie and the Blowfish

Well, the last few days have not been the greatest. First with one daughter sick, then me, and now another. I seem to have recovered for the most part and will be working tonight (yea!) at Medic 1. I am really looking forward to getting back to work. Normally I would be working tomorrow night as well but for some reason I took it off as a vacation day. Weird thing is I don't remember why. By the time I realized it the shift was already filled so I'm stuck with it. However, since I will be home with a sick kid again it may not be such a bad thing.

When I left the house to go get daughter #2 at school after the school nurse called I met the UPS truck who was (finally) delivering my new uniform pants. I know, it's something small, but it made my day. Finally I get to wear trousers that have the right number of pockets AND fit properly.

I'd love to have to buy new trousers again by the end of the summer in even a smaller size. I have got to get back on track with my weight loss. The weather is looking like we are finally heading into spring and aside from the dieting I want to get into a regular walking program and do more of the hiking I tried to do last year but never was able to. Last year I had discovered Geocaching which combined my geeky side and my desire and need to get outside and get some excercise. I found that I could combine outside excercise with high tech gear and my computer and have a great time in the process. In an ideal world I would be able to search for 3 or 4 geocaches a week both on foot and on my bike and continue to drop more weight. Well, see, things rarely work out the way we intend but I am going to try.

My powerbook came back from repair yesterday. I have been using an older laptop running YellowDog Linux for the weekend while it was out to have a problem with the CD/DVD drive fixed. Linux is a great OS but it lacks the wonderful simplicity of MacOS X so I'm glad my primary is back.

When the DHL guy dropped it off I opened the box and read the report from the tech. Huh, I've never heard of that causing a CD-RW/DVD-RW drive to fail to recognize media and eject it a few seconds after being inserted. I have been a hard core geek for a long time even being a Mac consultant for over 10 years and had never, ever seen this one. You learn something new everyday.

What did I learn? Even if the computer is running fine in every other respect it pays to pull the RAM out one chip at a time. Had I done that I would have found the bad 512MB RAM chip that was causing the whole problem. I have seen lots of bad RAM but never with a presentation like that.

Yesterday when I got back from work instead of going to sleep, which was what I wanted to do, I found that I had a cranky, feverish, vomiting, 3 year old who wanted nothing less than my undivided attention.What did she get? Exactly what she wanted, for as long as she wanted it. It was not a very pleasant day and by the time I finally got to go to sleep I had been up for about 30 hours and was closing on the end of my energy and patience. My youngest was starting to feel better but would still be home with me for another day so sleep seemed to be the order of the night. I skipped the other work I had to do and was sleeping much quicker than even I expected.

This morning everybody is well rested cheerful with no sign of fever or any other complaint. I'll be spending a lot of time working around the house trying to catch up on the chores I didn't get to yesterday.

I'm hoping that this afternoon will be lower stress than yesterday was. My other 2 daughters have a half day due to a "Professional Development Day" so all three will be home for the afternoon and my wife will be on call at the hospital for the day and at least part fo the evening.

If things go well this afternoon I can get some work done on some of the writing that I have been working on. I am hoping to take some of my writing to lunch with an acquantaince sometime on the next couple of weeks. He is a retired magazine editor and author and I would really like his opinion on some of my work.

The snow didn't start until almost the end of the shift, that was a good thing. However, the 50 degree temperature we had seen for the past couple of nights was gone and the temperatures were at or below freezing all night.

Only two calls, one at the beginning of the shift and one at the end. Nothing spectaular, nothing difficult. That was OK I guess as I started to feel a bit run down towards 0300 or so. Right before my wife called me to tell me that my youngest was sick and that I would have company for the day.

It's going to be a rough day but I'll try to get through it as best I can.

Total calls for the night: 2 ALS transports

Total milage for the night: 67

CD for the night: "It Just Happens That Way" by Mindi Abair

I am very glad that the night is over and I was able to go home. It took quite a while to resolve the bomb threat at the ED and nobody is really satisfied with the way things happened. The procedure that was in place was followed as best as it could be on the part of the employees but as soon as administrators got involved things went down hill. It wasn't until after 0400 that the situation was mostly resolved when it was confirmed that the person who called the threat in was now a patient at a psychiatric facility in Vermont. Of course there is nothing to say that he didn't leave us a "gift" before he left for Vermont but, well, when I pointed this out it was received less than favorably.

Fortunately it was not a busy night both in the ED and in the field so the disruption was not as much as it could have been.

Total calls for the night: 2
1 Cancelled enroute
1 Cover assignment

Total milage for the night: 47

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

I am pretty much ready to scream. We have been operating under a bomb threat for over four hours and still have no idea what's going on. One of the local psych patients, the one that the police won't even approach with less than two officers present, the one who threatened the judge the last time he was in court, made a friendly call to the ED to say that he was going to "blow you up with my bomb". A nice friendly message.

Since then the policy has gone straight to hell as hospital security is short staffed so they have nobody to send down. Aside from me the entire staff tonight is female, the police can't find the person who made the threat, he may be in a hospital several hours away.....or not. So the building has been searched by nurses and a paramedic who have no training in this kind of thing, we've gone into lockdown mode and are allowing nobody to enter the building without being identified first, and waiting nervously for the police to give us the all clear.

None of this is making me feel very comfortable with the situation and I would much rather just punch out and go home.

Down to Medic 2 tonight. I am kind of looking forward to it, since the nights are starting to warm up again (we hit 50 degrees F last night!) I am looking forward to going back to my favorite spot to finish paperwork down by the shore.

I slept like a rock today. Crashed a little before 9 and didn't get up until I was attacked by my Lilliputians around 1645. I could have slept longer but, well, I did need to be getting up.

Tonights tasks? Reconfigure the event markers on our LifePak 12 monitor/defibrillators to reflect our updated protocols and inventory some of our supplies. Pretty much the same old thing for me.

The rain appears to be stopping and the sky is clearing. Good news for me, it'll make my night more comfortable.

The night was "Medium Busy" with the calls spaced throughout the night pretty evenly. Two of the calls were reasonably significant and truly needed ALS intervention. Both of these calls came after midnight.

The first one was a single car MVC on one of the Interstates that runs through our service area. I was out covering Medic 3 and quite a ways out of position for this call which extended my response time longer than I would have liked. When I arrived I found a compact car (I couldn't tell what kind) with significant damage to 2 sides off the road and into a stand of trees. The trees were fairly large and some had been uprooted so I took that to mean that this was a high energy crash. The ambulance and rescue were already on scene and extrication with heavy tools was already underway. It was foggy and a light drizzle so I already knew it would be a ground transport to the trauma center.

The patient was a young man, probably in his early 20's , who was the unrestrained driver. As near as the troopers could figure he spun out at high speed on the wet roads and went back end first into the trees on the side of the road. The patient was alternating with agitation and combativeness and posturing. Not a good sign, even though he had very few obvious external injuries this really made me suspicious of a head injury. After 10 minutesof work the patient was extricated onto a long board and brought to the ambulance. Gaze deviated upward and to the left, blood from mouth and nose. Very noisy respriations with irregular depth and rate. Not a very good sign.

I told the EMT driving to "get busy" and we started to transport. On a good day it would be a 15-17 minute transport but with the roads slick that could be longer. I kept suctioning huge amounts of secretions from the patients mouth while he wasn't fighting with us and set up to intubate him while the ambulance started 2 IV's. Lidocaine to reduce intracranial pressure and 20mg of Etomidate (used as a sedative) later the patient was no longer fighting with us but still posturing. His jaw was clenching and unclenching and I couldn't get the laryngescope through his teeth. It got much easier after I administered Succinylcholine, a paralytic, and I was able to intubate him with some difficulty due to the large amount of blood and secretions in his mouth. The tube was secured, lung sounds were present and equal, no belly sounds, good waveform on the capnography, I was comfortable that the tube was in place properly.

As we came off the interstate the paralytic started to wear off and the patient started to clench and uncleanch his jaw again. Last time I came to this trauma center I got myself reamed out quite hard for using a longer lasting paralytic on the patient and decided that I would just resedate him which worked well for about 5 minutes. As we rolled down the hall to the trauma bay he was again clenching and unclenching his jaw and chewing on the tube even though he had a bite block in place.

We turned him over to the trauma team and gave a thorough report. After I put my gear back in the ambulance I went back in to see what was going on. Not good, the patient was frothing at the mouth quite heavily. It was fairly obvious what was happening, everytime they squeezed the bag to ventilate him the froth got worse. My money was on a with the the endotracheal tube cuff. The senior resident pulled out the tube changer and, being the first time he had ever used it, struggled to change the tube. When the original tube was pulled out I could see that I was correct, the patient had bitten through the pilot balloon where the tube is inflated. With the airway secure again they wisked him off to Cat Scan to see just how bad he scrambled his brain.

With his presentation I just don't get a warm fuzzy feeling when I think about the patients long term outcome.

I finished the night with a COPD patient within sight of the hospital. So close that I was first on scene and the patient met me at his apartment door with a nebulizer in one hand and a cigarette in the other. That set the tone for the remainder of the call. AFter I sat him down and started to assess him it didn't take me long to see that he was also intoxicated and very obnoxious. I started continuous nebulaizer treatments with Albuterol and threw an Atrovent into the first one with some releif of his shortness of breath. The ALS ambulance arrived and after we got him down from the third floor I turned over care to them for the 30 second transport.

Matbe the whole thing would have made more sense to me if I were a smoker. I just had a hard time wrapping my mind around the patients story. He wakes up short of breath a little after 0300. Takes a couple of sprays from his inhalor which doesn't help so he smoke half a pack of cigarettes and guzzles some cheap scotch. At 0530 when he uses his nebulizer and calls 911 he lights up another cigarette. It made no sense to me and after a while I tried to stop even trying to figure it out, I really need to sleep today and if I think of this much more I won't be able to.

By the time I was finished with the paperwork from the night I was getting out half an hour late and just headed home.

Total calls for the night: 7
2 ALS transports
1 Turned over to the ALS ambulance
2 BLS downgrades
1 Refusal
1 Cover assignment

Total Milage for the night: 87 miles

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

Back again, tonight is almost exactly the same staffing for both EMS and the ED as last night. We're hoping for a good night. Busy or slow won't matter much to me. If it's busy, I'll enjoy it. If it's slow I'll get some project work done and start revising my research proposal. The new EMS Coordinator starts in a few days and I would like to have a workable draft proposal ready for my first meeting with him week after next.

I found the one drawback to Ambien this morning. Ambien works really well to get you to sleep and to sleep through the first few hours. I got woke up after about 4 hours and had a very difficult time getting back to sleep and staying a sleep. From what I have read this is fairly common. I need to remember to turn off the phone before I go to bed and this won't happen as often. Even taking that into consideration I slept well and felt rested when I finally woke up.

No excitment last night, none at all. As a matter of fact I couldn't even give ALS away. Everything was either already resolved or something that required no ALS. *sigh* I know, it's really a good thing that nobody was very sick or injured.

We did get some good news over the past few days even though the future of our department in uncertain. We received emergency authorization for the purchase of 6 new portable radios and new mobile radios for the new vehicles that were just ordered. This is really good news since the mobile radios we have been using are all about 18 years old and the radio guy has been reduced to hunting for replacement parts on eBay. The portable radios will replace the 7 year old units we have been using and the ancient pagers that we have had since the program started in 1988. Not everybody is happy with the idea of having to carry the portable radio all the time but it seems like the best way to spend our money, replacing 2 peices of equipment for the price of one.

The new vehicles were ordered from one of the local Chevy dealers and rather than being drop shipped to a modifier in New Jersey they will be delivered to us directly. Installation of the lights and radios will be done by Whelen who manufactures the emergency warning systems. They usually put some kind prototype lights on our units, have us beat on them, and come back to the factory when they break.

We're still waiting on the delivery of our CPAP units so that we can implement the new protocol but that should be fairly soon.

As unclear as our future is it's nice to see that we are at least getting the funding for new equipment that we have asked for.

Total calls for the night: 4
1 Cancelled enroute
3 BLS downgrades

Total milage for the night: 74

CD for the night: "Night Train" by Oscar Peterson

I am looking forward to getting back to work so much that I can't wait. I know that is a strange thing and that not a lot of people feel that way but I do, for the moment. I have been off for almost a week, because of my swap and my normal rotation.

I'm hoping for a moderately busy night. I want to be kept active but horribly so. Actually, I think I want to be active because then I won;t miss not having my laptop with me and not feel bad for sitting on cover assignments without working on my projects.

Today was the first day that I tried using Ambien when I slept. Because I had never taken it before I only took a half dose and after struggling to get to sleep for 20 minutes went to sleep quickly and slept well until I was awakened by my wife calling on my cell phone to remind me to get up and get the kids off the bus since she was not going to make it home in time. All in all I would call the first trial a success and we'll see if we can be successful in future trials as well. I would really like to be able to sleep well again when I need to.

Yet more working around the house today. I'm getting to the point where I am looking forward to getting back to work so I can get some rest and some quiet. All the kids are pretty cranky tonight and I am very happy it is time for them to go to bed. Perhaps some sleep will improve their moods. Maybe some sleep will improve our moods, although since I start back at work tomorrow night I need to stay up a while longer than I have been so I will be in a position to sleep for a good portion fo the day tomorrow. Even so, the sleep will do me good too.

I have plenty of tasks to do tonight anyway. I have been thrown a little off my stride by the unexpected malfunction of the CD-ROM on my PowerBook which requires it to go back to Apple for repair. They have always be extremely quick getting stuff back from repair but the idea of having to do without my primary computer for any period of time is unsettling. I am way too technology dependant, I'll be in withdrawl until I get my computer back.

24 hours post my daughter injury and she is acting like nothing happened. Her eyelid is a little swollen but no sign of infection yet and she is having no discomfort. We got a note from her teacher telling us how glad everyone is that she was not hurt badly and how upset the rest of the other kids were. It seems that the other kids were either so upset or so grossed out that they had to remove the class from the room.

We got calls from several of her classmates asking if she was doing OK and wishing her well. Somewhat surprising for second grade kids.

Today has been taken up by cleaning and assorted errands. I've been trying to get a hold of one of the State Troopers assigned to the local barracks so that we can meet and he can get my statement regarding one of the calls I was on over the past few weeks. I don't know which one yet and wish I did.

Today was supposed to be a day to get stuff done around the house. We did get some done but not as much as we had intended. After doing some work in one of our bathrooms removing a toilet so my wife could start her project of putting new tile on the floor and finally getting my PC back to the point where it would boot again in both Linux and Win 2000 I ran out for an appointment that took me about an hour. My wife stayed home and started preparing the floor for the application of the substrate and had made good progress by the time I returned.

I hadn't been home for more than a couple minutes when the phone rang. It was the school nurse, not the usual nurse but rather a substitute. My first thought was that my oldest was manipulating the substitute nurse to get out of something that she didn't want to be doing. The nurse went on to explain that my daughter was OK but she had an injury that was going to require me to either come to the school right away or meet her at the ED. OK, I'm listening now! She explained that my daughter had apparently tried to remove the necklace she was wearing, one that she had made by stringing beads on a stiff piece of wire, and somehow it had become stuck in her eye.

Of course I am visualizing the worst, punctured to the globe, avulsed eye, you get the idea. The nurse went on to tell me that the wire was still stuck and that my daughter was getting frantic. I said I'd be right down, gave my wife the story as I had it and left. She would meet me at the school after she had a chance to change clothes.

The school is about 10 minutes away from our house. I made it there in about 5 and was met at the door by the nurse who tried to guide me to my daughters classroom. Since I knew the way fairly well she had to run to keep up with me. I wasn't running but I wasn't exactly taking my time. At the door to the room I found my oldest daughter sitting in her chair with her back to me and her paraprofessional holding her head still. As I came around to the front of her and got a look at what was actually happening I was able to relax somewhat. My daughter had indeed hooked herself on her necklace but it was pushed through her lower eyelid like a fishhook. No visual field problems, no obvious damage to the eye itself just a 2 mm puncture on the outer surface of the lid (the exit wound) and a 1 cm lac on the inside of her lid where the wire had punctured it. Minimal bleeding, no decrease in her ability to move her eye through a full range of motion, no visual disturbance, much better than I had been expecting from the nurses description.

I made one quick attempt to straighten the hooked end of the wire and was not able to do it without causing a lot of movement and fear on my daughters part. I sent the nurse on a search for a pair of wife cutters and treated the remains of the necklace just like it were a fishhook. Removed with little discomfort and no difficulty.

The nurse insisted on putting an eye patch on her eye and an ice pack and I saw no reason to stop her. Right about that time my wife came in and did the whole exam I had done over again. Rather than take the trip to the ED we called the pediatrician and asked what they wanted us to do. The reply was to see an eye doctor ASAP. It worked out well that my wife was friends with one of the eye docs at the hospital and she said to come right in.

After she examined the eye she said that there was not even a scratch to the globe, the laceration would heal on its own without sutures and the puncture would do the same. No structures had been damaged and, after showing her the remains of the necklace, that this was one of the freakiest things she had encountered in her career. Mom and I were relieved. My daughter? She was disappointed that she didn't need glasses. Go figure.